To request copies of articles or for information on scheduling interviews with an expert, please contact Megan Lowry. All research is EMBARGOED UNTIL April 19, 2018, 4 p.m. ET.

American Journal of Public Health June Issue research highlights:


Racial divide in opioid prescribing narrowing

This study is the first evidence of a narrowing divide in opioid prescribing by race. Researchers found that in 2015, the percentage of black adults using opioids approximated that of white adults (23 percent). Prior to 2015, the percentage of white adults using opioids was greater than that of black adults. Authors say their findings suggest elevated opioid use among black individuals, despite improvements in self-reported health status.

Study authors discuss how emerging guidelines and policy efforts that emphasize the use of nonopioid pain medications and nonpharmacological treatment strategies for chronic pain may lead to increased disparities across racial/ethnic groups dependent on access to alternative treatments that may be more costly and resource intensive. Future policies should be mindful of these shifting disparities in the treatment of pain and focus on ensuring equitable treatment across racial/ethnic groups.

[Author Contact: Jordan M. Harrison, PhD, RN, Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA. “Trends in Prescription Pain Medication Use by Race/Ethnicity Among US Adults With Noncancer Pain, 2000–2015”].


Current methods may undercount heroin overdose deaths by half

Death certificates, the primary source of state and national data on overdose deaths, may underestimate the contribution of heroin to drug-related mortality. In a review of Maryland data, researchers found that death certificates identified 1,130 heroin-related deaths. Enhanced surveillance identified 2,182 cases, nearly double the number found through the standard approach.

Authors concluded enhanced surveillance efforts should be considered to allow a better understanding of the contribution of heroin to the overdose crisis. Their findings may suggest that the problem of overdose deaths is even worse than believed.

 [Author Contact: Joshua M. Sharfstein, MD, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. “Standard Death Certificates Versus Enhanced Surveillance to Identify Heroin Overdose–Related Deaths.”].


One-third of pregnant women don’t have recommended folate levels

This study of women enrolled in the Boston Birth Cohort from 1999 to 2014 found that fewer than 5 percent of mothers enrolled in the study started folic acid supplements before pregnancy, and approximately one-third of mothers had either too low or too high plasma folate levels, which may have important health consequences on both the mother and the child.

Researchers also found the percentage of mothers taking folic acid supplementation almost daily during preconception and the first, second and third trimesters were 4.3 percent, 55.9 percent, 59.4 percent and 58 percent, respectively. Most striking, researchers observed a wide range of maternal plasma folate concentrations, with approximately 11 percent insufficient and 23 percent elevated.

[Author Contact: Tina L. Cheng, MD, MPH, Charlotte Bloomberg Children’s Center, Baltimore, MD. "Folate Nutrition Status in Mothers of the Boston Birth Cohort, a Sample of US Urban Low-Income Population."].



Earlier age of sexual initiation linked to poorer health in 30s

Data from the Seattle Social Development Project showed that age of sexual initiation was related to nicotine and marijuana disorders, physical health and obesity, but not alcohol disorder or depression for study participants when they reached their 30s.

Researchers noted that the nature of the association remains unclear, but did examine the link between sex-related consequences of initiation (STI, adolescent pregnancy, high number of sexual partners) and negative health outcomes. Authors concluded interventions targeting safe sexual practices may be one important strategy for preventing some substance use disorders in adulthood.

[Author Contact: Marina Epstein, PhD, Social Development Research Group, School of Social Work, University of Washington, Seattle. "Adolescent Age of Sexual Initiation and Subsequent Adult Health Outcomes"].


Islamophobia associated with poor mental health, suboptimal health behaviors

This literature review of 53 published studies showed that together, these studies reveal associations between Islamophobia and poor mental health, suboptimal health behaviors and unfavorable health care–seeking behaviors.

Researchers concluded additional methodologically rigorous research on Islamophobia and health is needed to address health disparities and promote health equity for all.

[Author Contact: Goleen Samari, Oakland, CA. " Islamophobia, Health, and Public Health: A Systematic Literature Review."].


Find a full list of AJPH research papers published online below:

  • Austerity policies and mortality in Spain after the financial crisis of 2008.
  • Assessing the efficacy of a community-based intervention for health workers and people who inject drugs in Vietnam: a clustered randomized trial
  • Trends in prescription pain medication use by race and ethnicity among us adults who have non-cancer pain
  • Access to aid-in-dying in the United States: shifting the debate from rights to justice
  • Can child care providers possess or use marijuana, tobacco, or alcohol while caring for children: a comparison of us state regulations
  • Mistrust in medicine: the rise and fall of America’s first vaccine institute
  • Folate nutrition status in mothers of the Boston birth cohort, a sample of US urban low-income population: a public health perspective
  • The collaborative improvement and innovation network (COIIN) to reduce infant mortality: an outcome evaluation from the US South, 2011-2014
  • A longitudinal study of healthcare utilization and expenditures of homeless family members before and after emergency housing
  • Adolescent age of sexual initiation and subsequent adult health outcomes
  • Suicide prevention training: policies for healthcare professionals across the united states
  • Partnering medical students with barbers to cut hypertension in black men
  • Enhanced surveillance to identify heroin-related deaths
  • Increasing sexually transmitted infection testing through a coordinated, community-wide approach
  • The relationship between islamophobia and health: a systematic literature review
  • What's the standard? Examining methodological approaches for the determination of a standard population to use for adjusting suicide rates in a military population

The articles above will be published online April 19, 2018, at 4 p.m. ET by AJPH under “First Look.”

“First Look” articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. AJPH is published by the American Public Health Association, and is available at

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The American Journal of Public Health is the monthly journal of the American Public Health Association. APHA champions the health of all people and all communities. We strengthen the public health profession, promote best practices and share the latest public health research and information. We are the only organization that influences federal policy, has a nearly 150-year perspective and brings together members from all fields of public health. Learn more at