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American Journal of Preventive Medicine

The American Journal of Preventive Medicine is the official journal of the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. Of particular emphasis are papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse.

Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. Papers on health services research pertinent to prevention and public health are also published. Additionally, the journal publishes official policy statements from the two co-sponsoring organizations, review articles, media reviews, and editorials. Finally, the journal periodically publishes supplements and special theme issues devoted to areas of current interest to the prevention community. 


Matthew L. Boulton, MD, MPH

Dr. Boulton is Professor of Epidemiology, Health Management & Policy, and Preventive Medicine in the University of Michigan School of Public Health and Professor of Internal Medicine, Infectious Diseases Division, in the University Medical School. He completed his MD at the University of Nevada, his clinical and preventive medicine residency training at the University of Michigan, and his MPH in epidemiology and international health at the University of Michigan School of Public Health. He also currently serves as the Associate Dean for Global Public Health and was Director of the university’s preventive medicine residency for 13 years. Prior to his faculty appointment at the University of Michigan, he was the governor’s Chief Medical Executive and the State Epidemiologist for the Michigan Department of Health which was preceded by several years’ work in local health departments as a Medical Director. Dr. Boulton has received research and training funding from NIH, CDC, HRSA, APTR, RWJF, Kresge Foundation, Trehan Foundation, and the Public Health Foundation. He an active research and has published on infectious disease epidemiology and control, vaccine preventable diseases and immunization coverage, global health especially in China and India, and the public health workforce. 

Current Articles 

Cancer Symptom Recognition and Anticipated Delays in Seeking Care Among U.S. AdultsOpen in a New Window

Early stage diagnosis strongly predicts cancer survival. Recognition of potential symptoms of cancer may improve survival by reducing time to seeking care.


Interactivity in a Decision Aid: Findings From a Decision Aid to Technologically Enhance Shared Decision Making RCTOpen in a New Window

Colorectal cancer screening (CRCS) remains underutilized. Decision aids (DAs) can increase patient knowledge, intent, and CRCS rates compared with “usual care,” but whether interactivity further increases CRCS rate remains unknown.


An Educational Intervention to Improve Statin Use: Cluster RCT at the Primary Care Level in ArgentinaOpen in a New Window

Statins are essential drugs for high cardiovascular disease (CVD) risk management; however, there is still low adherence to good clinical practice guidelines for statin use at the primary care level in low- and middle-income countries. This study aimed to test whether a complex intervention targeting physicians improves treatment and control of hypercholesterolemia among patients with moderate to high CVD risk in Argentina.


An RCT of Dating Matters: Effects on Teen Dating Violence and Relationship BehaviorsOpen in a New Window

Teen dating violence is a serious public health problem with few effective prevention strategies. This study examines whether the Dating Matters comprehensive prevention model, compared with a standard of care intervention, prevented negative relationship behaviors and promoted positive relationship behaviors.


Association of Worksite Food Purchases and Employees’ Overall Dietary Quality and HealthOpen in a New Window

Most Americans spend half their waking hours at work and consume food acquired there. The hypothesis was that the healthfulness of worksite food purchases was associated with employees’ overall diet and health.


Medicaid Coverage of Sexually Transmitted Disease Service VisitsOpen in a New Window

Chlamydia and gonorrhea are the most commonly reported notifiable infections in the U.S., with direct medical costs for the treatment of these infections exceeding $700 million annually. Medicaid currently covers approximately 80 million low-income Americans, including a high percentage of racial and ethnic minorities. Studies have shown that racial and ethnic minority populations, particularly those with low SES, are at an increased risk of acquiring a sexually transmitted disease. Therefore, as Medicaid expands, there will likely be a greater demand for sexually transmitted disease services in community-based physician offices.


Novel Smartphone Game Improves Physical Activity Behavior in Type 2 DiabetesOpen in a New Window

Many type 2 diabetes patients show insufficient levels of physical activity and are often unmotivated to change physical activity behaviors. This study investigated whether a newly developed smartphone game delivering individualized exercise and physical activity promotion through an elaborate storyline can generate sustained improvements in daily physical activity (steps/day).


Changes in Breast and Colorectal Cancer Screening After Medicaid Expansion Under the Affordable Care ActOpen in a New Window

Medicaid expansions following the Affordable Care Act have improved insurance coverage in low-income adults, but little is known about its impact on cancer screening. This study examined associations between Medicaid expansion timing and colorectal cancer (CRC) and breast cancer (BC) screening.


Changing Trends in Opioid Overdose Deaths and Prescription Opioid Receipt Among VeteransOpen in a New Window

To inform overdose prevention, this study assessed both recent trends in opioid overdose mortality across opioid categories and receipt of prescription opioid analgesics among Veterans who died from overdose in the Veterans Health Administration.


Parent eReferral to Tobacco Quitline: A Pragmatic Randomized Trial in Pediatric Primary CareOpen in a New Window

Quitlines are effective in helping smokers quit, but pediatrician quitline referral rates are low, and few parents who smoke use the service. This study compared enrollment of parents who smoke in the quitline using electronic referral with that using manual referral.


Association of Fitness With Racial Differences in Chronic Kidney DiseaseOpen in a New Window

Non-white minorities are at higher risk for chronic kidney disease than non-Hispanic whites. Better cardiorespiratory fitness is associated with slower declines in estimated glomerular filtration rate and a lower incidence of chronic kidney disease. Little is known regarding associations of fitness with racial disparities in chronic kidney disease.


Dietary Guidance and New School Meal Standards: Schoolchildren's Whole Grain Consumption Over 1994–2014Open in a New Window

Since 2005, the federal government's Dietary Guidelines for Americans have recommended at least half of total grain intake be whole grains. Beginning with the 2012–2013 school year, the U.S. Department of Agriculture updated school meal regulations to align with this recommendation.


Neighborhood Food Environment and Physical Activity Among U.S. AdolescentsOpen in a New Window

Few U.S. adolescents meet physical activity guidelines. Although several neighborhood characteristics influence physical activity, the role of food-related features as potential drivers of adolescent physical activity remains understudied. Using representative U.S. data, authors examined the effect of the neighborhood food environment on adolescents’ out-of-school physical activity.


Trends in Energy Drink Consumption Among U.S. Adolescents and Adults, 2003–2016Open in a New Window

Energy drinks refer to non-alcoholic beverages that contain caffeine, amino acids, herbs, and vitamins. Although energy drinks are marketed to reduce fatigue and improve physical/mental performance, frequent consumption of these beverages has been linked to negative health consequences. The purpose of this study is to provide timely, national estimates of the percentage of energy drink consumers in the U.S. and to analyze trends in energy drink intake between 2003 and 2016.


Patterns of Youth Cigarette Experimentation and Onset of Habitual SmokingOpen in a New Window

Although research suggests that youth e-cigarette experimentation is associated with later combustible cigarette experimentation, it is unclear how this relates to habitual smoking. This study assesses how minors’ patterns of combustible cigarette and e-cigarette experimentation relate to habitual smoking at ages 18–21 years.


Smoke-Free Moms: Financial Rewards for Smoking Cessation by Low-Income Rural Pregnant WomenOpen in a New Window

Maternal smoking places the child at risk during pregnancy and postpartum. Most women who quit smoking do so early when they first learn of pregnancy. Few low-income women quit once they enter prenatal care. The purpose of this study is to test in a clinical prenatal care setting the effectiveness of the Smoke-Free Moms intervention, which provides pregnant women a series of financial incentives for smoking cessation.


Sobriety Checkpoints and Alcohol-Involved Motor Vehicle Crashes at Different Temporal ScalesOpen in a New Window

Roadside sobriety checkpoints are an intervention in which law enforcement officers stop passing vehicles to check whether drivers are impaired. There is clear evidence that a program of roadside sobriety checkpoints is an effective approach to reducing alcohol-involved motor vehicle crashes, likely because of general deterrent effects across the entire population of drivers. The aim of this study is to assess the duration of time over which individual roadside sobriety checkpoints are associated with alcohol-involved motor vehicle crashes, within the context of a broader checkpoint program.


Relationship Between Grip Strength and Prediabetes in a Large-Scale Adult PopulationOpen in a New Window

Prediabetes has been a growing health problem in China, and it is a high-risk state for developing diabetes and cardiovascular disease. In previous studies, low grip strength has been associated with diabetes. However, few population-based studies have examined the relationship between grip strength and prediabetes. Thus, the purpose of this study was to investigate whether grip strength is related to prediabetes in a large-scale adult population.


Alignment of Preventive Medicine Physicians’ Residency Training With Professional NeedsOpen in a New Window

Preventive medicine (PM) physicians promote population-based approaches to health care with training that emphasizes public health, epidemiology, and policy. PM physicians use these skills in varied, often nonclinical, practice settings. PM career diversity challenges educators when designing residency curricula. Input from PM physicians about workforce environments is needed to ensure that residency requirements match skills needed post-residency. Graduates of one PM residency were sent a cross-sectional survey in 2016.


Association of State Laws With Influenza Vaccination of Hospital PersonnelOpen in a New Window

Healthcare personnel influenza vaccination can reduce influenza illness and patient mortality. State laws are one tool promoting healthcare personnel influenza vaccination.


Flow Restrictors and Reduction of Accidental Ingestions of Over-the-Counter MedicationsOpen in a New Window

Flow restrictors are child-resistant packaging innovations designed to limit the amount of liquid dispensed from a medication bottle. In 2011, flow restrictors were added to pediatric liquid single-ingredient acetaminophen formulations. The hypothesis of this study is that implementation would be associated with reduced volume and severity of pediatric acetaminophen exposures reported to the U.S. National Poison Data System.


Cervical Cancer Death Rates Among U.S.- and Foreign-Born Women: U.S., 2005–2014Open in a New Window

Historically, foreign-born women in the U.S. are less likely to be screened and are more likely to die from cervical cancer when compared with their U.S.-born counterparts. In order to inform prevention efforts and reduce this health disparity, mortality data were obtained from the National Center for Health Statistics to describe cervical cancer mortality among U.S.- and foreign-born women.


The Supplemental Nutrition Assistance Program and Child Weight Status: A ReviewOpen in a New Window

The Supplemental Nutrition Assistance Program (SNAP) is a food assistance program that helps Americans afford a healthy diet. However, its influence on children's weight status is unclear. This review examined the evidence of the relationship between SNAP participation and child weight.


The Impact of Social Determinants of Health on Hospitalization in the Veterans Health AdministrationOpen in a New Window

This study aims to assess the effect of individual and geographic-level social determinants of health on risk of hospitalization in the Veterans Health Administration primary care clinics known as the Patient Aligned Care Team.


Accuracy of Self-Reported Height, Weight, and BMI Over Time in Emerging AdultsOpen in a New Window

Self-reported height and weight may lead to inaccurate estimates of associations between BMI and health indicators. The purpose of this study is to assess anthropometric misreporting in emerging adults, compare weight classification by self-reported and direct measures, and examine associations of self-reported and direct measures with cardiometabolic biomarkers.


Prevalence and Correlates of Receiving Medical Advice to Increase Physical Activity in U.S. Adults: National Health and Nutrition Examination Survey 2013–2016Open in a New Window

National objectives recommend healthcare professionals provide physical activity advice. This study examined health and demographic characteristics associated with receipt of medical advice to increase physical activity among U.S. health care–utilizing adults and differences in associations by age group.


Mobile Health Applications in Weight Management: A Systematic Literature ReviewOpen in a New Window

Weight management is an effective strategy for controlling chronic disease and maintaining physical health, and research on this topic has risen dramatically over the past four decades. The present systematic literature review aimed to identify existing evidence on the efficacy of mobile health technology in facilitating weight management behaviors, such as healthy food consumption and physical activity.


U.S. National 90-Day Readmissions After Opioid Overdose DischargeOpen in a New Window

U.S. hospital discharges for opioid overdose increased substantially during the past two decades. This brief report describes 90-day readmissions among patients discharged from inpatient stays for opioid overdose.


Dietary Approaches to Stop Hypertension Diet Concordance and Incident Heart Failure: The Multi-Ethnic Study of AtherosclerosisOpen in a New Window

In observational studies, the association between the Dietary Approaches to Stop Hypertension (DASH) diet and incident heart failure has been inconsistent. It was hypothesized that higher DASH diet concordance has a protective effect on heart failure in a multi-ethnic cohort.


Non-clinical Prevention Opportunities and Waste in the U.S. Healthcare SystemOpen in a New Window

The National Academy of Medicine (formerly known as the Institute of Medicine) estimated in 2010 that wasteful healthcare spending cumulatively totaled approximately $765 billion per year, or nearly one third of all healthcare spending.1 Adjusting to 2016 healthcare expenditure totals,2 unnecessary medical spending costs the average American more than $3,400 per year. Yet, the authors argue that even this sizable figure understates the magnitude of healthcare waste as it excludes a large array of missed upstream prevention opportunities.


A Critical Assessment of the Adverse Childhood Experiences Study at 20 YearsOpen in a New Window

This year marks the 20th anniversary of publication in this journal of the first of many articles on the adverse childhood experiences (ACEs) research by Drs. Felitti, Anda, and colleagues.1 As we celebrate the impact of this seminal research, it is also imperative to assess critically its serious limitations: an unrepresentative study population and narrow operationalization of childhood adversity lead to undercounting adverse experiences and misrepresenting their social distribution. Placing ACEs research—and the movement it has generated—in the wider contexts provided by the social determinants of health framework,2 and by the rapidly growing biology and neuroscience of early childhood adversity,3–5 can enrich ACEs research and extend its impact to shaping primary prevention policies that address social and economic conditions producing adversity.


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