This cohort study describes national trends in nitrous oxide poisoning mortality in the US from 2010 to 2023.

Background: Cardiovascular disease remains a leading cause of preventable mortality in the United States, with rural counties in the Deep South experiencing disproportionately high burdens. Grounded in the Andersen healthcare utilization model, this study examined how enabling resources, predisposing characteristics, and access-related barriers relate to coronary heart disease (CHD) prevalence and mortality. Methods: This ecological analysis included 418 counties across Alabama, Georgia, Louisiana, Mississippi, and South Carolina. Using Local Indicators of Spatial Association (LISA) and multivariable linear regression, we tested three theory-based hypotheses and assessed the spatial clustering of CHD outcomes, while identifying key structural and sociodemographic predictors. Results: Counties with greater rurality and fewer healthcare providers exhibited significantly higher rates of CHD prevalence and mortality. Primary care provider availability and higher household income were protective factors. Digital exclusion, measured by lack of access to computers or mobile devices, was significantly associated with higher CHD prevalence and mortality. Spatial analysis identified the counties with better-than-expected cardiovascular outcomes despite structural disadvantages, suggesting the potential role of localized resilience factors and unmeasured community-level interventions. Conclusions: The findings affirm the relevance of the Andersen model for understanding rural health disparities and highlight the importance of investing in both digital infrastructure and healthcare capacity. Expanding telehealth without addressing provider shortages and social determinants may be insufficient. Local policy innovations and community resilience mechanisms may offer scalable models for improving cardiovascular health in disadvantaged areas.

Suicide is the third-leading cause of death among adolescents, with lesbian, gay, and bisexual (LGB+) youth facing a significantly higher risk of suicidal ideation and behaviors compared to their heterosexual peers. This study aims to explore differences in suicidal ideation and planning among adolescents in the U.S. by sexual identity. A secondary analysis of the 2023 NSDUH was conducted, which assessed suicidal ideation and planning in adolescents ages 12-17, alongside sexual identity. Multivariable logistic regression models were used to examine the associations between sexual identity and suicide-related behaviors, adjusting for covariates including age, sex, race/ethnicity, and county type. The final sample included 8600 adolescents. Findings revealed that 12.2 % of adolescents reported suicidal ideation and 6.1 % made suicide plans in the past year. Bisexual adolescents had the highest odds of both suicidal ideation and planning, followed by those identifying as "other" sexual identities and those unsure of their sexual identity. Moreover, adolescents who identified as bisexual, another sexual identity, or were unsure of their sexual identity were at increased odds of planning suicide in the past year. This study highlights the heightened suicide risk faced by LGB + adolescents, particularly bisexual youth. The increased vulnerability is likely influenced by factors such as discrimination, family rejection, and lack of social support. Supportive environments, including inclusive schools and affirming families, are critical in mitigating these risks.

This study examined the relationship between training load, mileage, and session rating of perceived exertion (s-RPE) as predictors of injury and illness in Division I women’s soccer players. Twenty-four athletes were monitored over a 13-week season including 69 athlete exposures (49 training sessions and 20 matches). Internal and external load were measured during each athlete exposure. Player injury and illness status were documented daily by medical staff and categorized as healthy, medical attention, or time-loss. Associations between athlete exposures and injury/illness status were analyzed using a mixed-effects ordinal logistic regression model with player ID as a random intercept. A total of 1560 athlete observations were included. Higher daily mileage was associated with increased odds of injury or illness (OR = 1.67, 95% CI: 1.19–2.34). Training load was associated with reduced odds of injury or illness, with each unit increase lowering the odds by 42% (OR = 0.58, 95% CI: 0.41–0.83). Session-RPE was not significantly associated with injury or illness (OR = 0.96, 95% CI: 0.65–1.42). These findings indicate that accumulated mileage elevates injury and illness risk, while structured increases in training load enhance athlete resilience, and reduce injury and illness risk. Monitoring both internal and external workload provides performance staff with a practical approach to optimize training stress, augment recovery, and prepare athletes for the demands of competition in women’s soccer.

Major depressive disorder (MDD) is a leading contributor to the global burden of disease and commonly develops during adolescence. The COVID-19 pandemic was linked to significant increases in depressive symptoms among youth, but less is known about whether these increases have continued in recent years. Using the first four consecutive years of methodologically comparable national data since the pandemic, we examined changes in past-year major depressive episode (MDE) among U.S. adolescents aged 12-17 years from 2021 to 2024 and evaluated demographic and substance use factors. We analyzed pooled, cross-sectional data from the 2021-2024 National Survey on Drug Use and Health (NSDUH), a nationally representative survey of non-institutionalized U.S. residents. The sample included 43,828 adolescents aged 12-17 years. Past-year MDE was assessed using DSM-5-based criteria. Survey-weighted logistic regression models estimated changes over time and adjusted associations with age, sex, race/ethnicity, and past-year tobacco, alcohol, and marijuana use. Predicted prevalences and 95% confidence intervals were calculated using post-estimation margins. The prevalence of past-year MDE decreased from 20.5% in 2021 to 14.8% in 2024, reflecting a 38.5% relative reduction. Adjusted models showed decreasing odds of MDE over time. Girls had significantly higher odds of MDE compared to boys, and older adolescents were at greatest risk. Compared with non-Hispanic White adolescents, non-Hispanic Black/African American, non-Hispanic Asian, and non-Hispanic Native Hawaiian/Other Pacific Islander adolescents had lower odds of MDE, while non-Hispanic multiracial adolescents had higher odds. Alcohol and marijuana use were linked to increased odds of MDE. Past-year MDE among U.S. adolescents declined from 2021 to 2024, indicating partial recovery following pandemic-related increases. Despite overall improvements, ongoing disparities based on sex, age, race/ethnicity, and substance use highlight the continued need for targeted adolescent mental health prevention and early intervention efforts.

Suicide is the 15th leading cause of death among Black/African American individuals and remains a significant public health concern globally. Lesbian, gay, and bisexual (LGB) individuals are known to be at elevated risk for suicidality compared to their heterosexual counterparts. While recent evidence shows increasing rates of suicidality among Black/African American populations, few studies have examined these trends using nationally representative data, particularly at the intersection of race and sexual orientation. This study analyzed data from 4,543 Black/African American respondents from the 2023 National Survey on Drug Use and Health to assess risk factors associated with past-year suicidal ideation, planning, and attempts, with a focus on differences by sexual orientation. An estimated 3.70% of respondents reported past-year suicidal ideation, 1.27% reported planning, and 0.76% reported attempting suicide. Results indicated that Black/African American individuals identifying as bisexual had significantly higher risk across all suicidality outcomes. However, lesbian/gay Black/African American individuals did not significantly differ from their heterosexual peers in suicide planning or attempts. These findings underscore the importance of considering both racial and sexual identity when evaluating suicide risk and suggest the need for intersectional informed suicide prevention strategies, particularly for bisexual individuals within the Black/African American community.