The Cooperative Extension System (CES) consists of 112 land-grant universities in the United States, including historically Black universities and Tribal colleges. In 2021, CES formed the Extension Collaborative on Immunization Teaching and Engagement (EXCITE) to increase confidence in and access to adult immunizations. From April 2021 to May 2023, EXCITE conducted 111 immunization education projects involving 76 land-grant universities. EXCITE reached more than 18 million individuals, and more than 48 000 COVID-19 and other adult-recommended vaccines were provided in partnership with local health organizations. (. 2025;115(12): 1978-1981. https://doi.org/10.2105/AJPH.2025.308258).

To evaluate the completeness and utility of influenza hospital data reported to the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN) from September 2021 to April 2024. Acute care and critical access hospitals in the United States reported daily numbers of new hospital admissions of patients with laboratory-confirmed influenza to NHSN during voluntary and mandatory reporting periods. To evaluate the completeness of data reported to NHSN, we compared the number of influenza hospital admissions reported to NHSN with data reported to the Influenza Hospitalization Surveillance Network (FluSurv-NET) among 13 states and overlapping counties reporting to both systems from September 2021 to April 2024. During voluntary reporting, about 77% of US hospitals reported daily influenza hospital admission counts to NHSN; during mandatory reporting, this increased to a mean of 94%. These data were highly correlated (0.978; 95% confidence interval = 0.968, 0.985;  < .001) with numbers from FluSurv-NET and in most states ( range = 0.861-0.988) within overlapping surveillance areas. Influenza hospital admissions reported to NHSN demonstrate high levels of complete reporting; overall counts are highly correlated with a high-quality, long-standing influenza hospitalization surveillance system. (. Published online ahead of print December 4, 2025:e1-e5. https://doi.org/10.2105/AJPH.2025.308282).

Firearm relinquishment laws aim to prevent intimate partner homicide, yet enforcement remains fragmented and underresourced. Drawing on 25 stakeholder interviews conducted in California in 2021 and 2024 to 2025, we examined implementation challenges related to domestic violence restraining orders and gun violence restraining orders and explored how recent federal funding cuts have impacted survivor access to legal protection. Findings reveal structural enforcement gaps, design misalignments, and the compounding effects of disinvestment, highlighting urgent needs for policy realignment, sustained investment, and survivor-centered systems. (. 2025;115(12): 1967-1970. https://doi.org/10.2105/AJPH.2025.308287).

To examine enrollment in Gus Schumacher Nutrition Incentive Program (GusNIP) produce prescriptions and identify opportunities to expand their reach. We conducted descriptive analyses of cross-sectional baseline surveys of 21 635 participants (living in the Southern, West, North Central, or Northeast region of the United States) in GusNIP produce prescriptions between 2020 and 2024. We applied geographic information system mapping and inferential statistics to fruit and vegetable intake data. At enrollment, 43.2% of participants were aged 45 to 65 years, 77% were women, 32.7% were Hispanic, 24.4% were non-Hispanic Black/African American, and 26.2% were non-Hispanic White. Mean fruit and vegetable intake was 2.39 cups (SD = 0.78) daily, varying by region. Approximately two thirds of participants reported food insecurity (67.2%). GusNIP produce prescriptions are reaching intended communities, including people with low fruit and vegetable intake, chronic disease risk, and food insecurity. Opportunities exist to broaden reach. GusNIP produce prescriptions offer a national lens on Farm Bill-funded policy in action. As "food is medicine" interventions, including GusNIP produce prescriptions, evolve, it is important to understand who enrolls, who is not yet represented, and who could benefit most by extending reach to individuals and their communities. (. 2025;115(12): 2015-2019. https://doi.org/10.2105/AJPH.2025.308293).

To examine the associations between discrimination, violence, and suicidality among and transgender women in Brazil. We analyzed baseline data from the cohort (2015-2023) in Rio de Janeiro, Brazil, which enrolled and transgender women aged 18 years and older. We assessed lifetime discrimination by using an 8-item scale reflecting transgender-related mistreatment experiences. We also measured physical and sexual violence, sociodemographics, and psychosocial factors. We categorized suicidality as no ideation, ideation only, and ideation with attempts, analyzed using a multivariable ordinal regression model. Among 662 participants, lifetime discrimination (adjusted odds ratio [AOR] = 1.21; 95% confidence interval [CI] = 1.11, 1.32;  < .001) and lifetime sexual assault (AOR = 1.60; 95% CI = 1.17, 2.19;  = .003) were significantly associated with increased odds of suicidality. Participants with positive body self-satisfaction, HIV, and increasing age had lower odds of suicidality. Our findings highlight the need for antidiscriminatory policies and health services tailored to the needs of this community to mitigate suicidality risk among and transgender women in Brazil. (. Published online ahead of print December 4, 2025:e1-e9. https://doi.org/10.2105/AJPH.2025.308280).

To examine changes in abortion service delivery for the years before (July 2021‒June 2022) and after (July 2022‒June 2023) at 3 Planned Parenthood clinics in southern Michigan, when several states enacted laws further restricting abortion access, and Michigan became a destination for individuals in restrictive states. We used monthly abortion data from 3 Michigan clinics to calculate the mean number of monthly abortions and changes in proportions for gestation, method, and patient state of residence for the 2 time periods. Mean monthly abortions increased from 358 before to 575 after . Simultaneously, out-of-state patients increased from 383 before to 1145 after and received a larger share of total abortions. Methods shifted slightly, with medication abortions decreasing from 58% to 53% and procedural abortions at less than 14 weeks increasing from 31% to 36%. Most out-of-state patients came from Indiana and Ohio. The increasing number of out-of-state patients and increased provision of procedural abortions represent both increased need among patients from restrictive states and adaptability among providers in protective states such as Michigan-underscoring changes in care amid the rapidly evolving abortion landscape in the United States. (. Published online ahead of print November 20, 2025:e1-e8. https://doi.org/10.2105/AJPH.2025.308305).

To examine how gerrymandering affects federally qualified health center (FQHC) availability in North Carolina. We used data from 2004 to 2022 and spatial regression models to correlate gerrymandering metrics with FQHC availability and utilization at the zip code level. Gerrymandering severity is inversely associated with FQHC availability and utilization. For example, individuals in communities split evenly between 2 state senate districts in this 18-year period (from the end of 2004 through 2022) traveled about 30% farther to their nearest FQHC in 2022 than individuals in communities entirely within a district, and they were up to 20% less likely to visit an FQHC. Increased electoral competitiveness also reduced FQHC availability and utilization. Residential segregation was not linked to FQHC availability or gerrymandering severity. Gerrymandering weakens local political representation and may lead to reduced access to vital health care services-a structural issue with far-reaching implications for health equity and national policy reform. (. Published online ahead of print November 13, 2025:e1-e8. https://doi.org/10.2105/AJPH.2025.308284).

In this essay, we argue that policies that intentionally or unintentionally restrict reproductive autonomy constitute an act of violence. First, we discuss our guiding framework, highlighting the intersections between reproductive autonomy, reproductive justice, and violence. Second, we describe the importance of framing the restriction of reproductive autonomy as violence, emphasizing potential implications. Finally, we provide 3 illustrative examples of how governmental power-through the passage of laws-can both support and constrain reproductive autonomy across the life course: sex education, abortion restrictions, and parental leave policies. For each, we explain how the consequent harms overlap with those resulting from more traditional overt forms of violence. By framing the loss of reproductive autonomy as a form of violence, we underscore its profound and far-reaching harms, demanding urgent recognition and response as a critical public health and human rights issue. (. Published online ahead of print November 13, 2025:e1-e8. https://doi.org/10.2105/AJPH.2025.308276).

There are 1000 antitransgender bills across the United States, more than one quarter of which target educational settings. School districts are an increasingly critical policy domain through which transgender and nonbinary youth health is harmed and can be protected. Trans-led resistance, including activism and advocacy, has been found to lead to improved health. This case study describes one California school district's policy advocacy process as a model for building transgender youth health through a participatory process that, in itself, has supported transgender joy. (. Published online ahead of print November 13, 2025:e1-e4. https://doi.org/10.2105/AJPH.2025.308264).

Gender-affirming surgery can reduce distress about gender incongruence among transgender and gender-diverse adults, contributing to improved mental health and quality of life. However, a greater understanding of the psychosocial changes after surgery that influence well-being is needed to maximize these outcomes. In this analysis of interviews (conducted in New York City, January 2023-February 2025) with individuals in the first year after gender-affirming surgery, we identified one such mechanism: an increased sense of connection to one's body fosters the stability, comfort, and environmental awareness to live freely and connect with others. (. Published online ahead of print November 13, 2025:e1-e5. https://doi.org/10.2105/AJPH.2025.308263).

To compare changes in the number of facility-based abortions among Texas residents in different age groups following the state's 2021 law prohibiting abortion after detection of embryonic cardiac activity. We obtained data from Texas and 6 surrounding states on Texas residents' age at abortion from state vital statistics and data provided directly by out-of-state abortion facilities. Using negative binomial regression, we estimated the percentage change in abortions before (September 2020-May 2021) and after (September 2021-May 2022) the law went into effect. After the law's implementation, total (in-state and out-of-state) facility-based abortions decreased by 26.1% (95% confidence interval [CI] = -32.7%, -18.8%) among Texans younger than 18 years, by 19.6% (95% CI = -21.4%, -17.7%) among young adult Texans aged 18 to 24 years, and by 17.0% (95% CI = -19.1%, -14.8%) among Texans aged 25 to 29 years. Texas's law disproportionately affected access to facility-based abortion care among Texans aged 24 years and younger. State laws prohibiting abortions in early pregnancy disproportionately affect young people's reproductive autonomy, likely by compounding long-standing financial and logistical barriers to facility-based care. (. Published online ahead of print November 13, 2025:e1-e4. https://doi.org/10.2105/AJPH.2025.308289).

Hearing loss affects approximately two thirds of adults in the United States aged 70 years or older and frequently remains untreated despite its well-documented harms, including accelerated cognitive decline, increased caregiver burden, and higher health care expenditures. We examine the major barriers to accessing high-quality hearing care, with particular attention to the complex and fragmented landscape of insurance coverage across Medicare, Medicaid, the US Department of Veterans Affairs, private plans, and over-the-counter (OTC) products. We review key legislative and regulatory developments over the past decade, most notably the 2022 establishment of OTC hearing aids, and summarize early opportunities and remaining gaps. We then propose targeted reforms to improve access and affordability, including more consistent Medicaid benefits, selective Medicare expansion, integration of teleaudiology, and strengthened oversight and consumer protections for OTC devices. Finally, we advance a technology-driven policy framework that integrates artificial intelligence-supported risk prediction, teleaudiology, real-time insurance verification, and a transparent device marketplace to modernize delivery and evaluation. Together, these strategies can catalyze a fundamental rethinking of how hearing health is prioritized and managed within the broader United States health care ecosystem. (. Published online ahead of print November 20, 2025:e1-e10. https://doi.org/10.2105/AJPH.2025.308298).

The antitransgender executive orders and legislation enacted by the Trump administration since January 2025 have focused on enforcing a gender binary and restricting access to gender-affirming care for youths. These actions have had sweeping effects on health policy and access to care in an already strained health care system. Here we contextualize these attacks on transgender health by exploring the historical pathologization and policing of transgender bodies in the United States and Europe while tracing the legacy of medical gatekeeping alongside evolving standards of care. We critique the scientific inaccuracies within the administration's executive orders while outlining the harmful impact of related and recent legislation, including . Restrictions on gender-affirming care and the rights of transgender people to exist not only exacerbate health disparities but also undermine the ethical responsibility of medical practitioners and institutions to provide patient-centered, evidence-based care. We must not capitulate to political efforts that attempt to harm and erase an already marginalized population. (. Published online ahead of print October 30, 2025:e1-e5. https://doi.org/10.2105/AJPH.2025.308265).

Beginning with the emergence of the HIV/AIDS epidemic in the early 1980s, community-led lesbian, gay, bisexual, and transgender health organizations created prevention materials that affirmed and celebrated gay identity, positing safer sex as a radical method of keeping their communities healthy and liberated past the onset of the virus. Often prioritizing pleasure and featuring erotic imagery, these strengths-based prevention messages implied that community members shared a collective responsibility to care for each other and stop the spread of HIV. Using archival public health materials from the early HIV/AIDS crisis and data collected through oral history interviews with former members of AIDS service organizations, this article explores the roles that gay liberation, community connectedness, and eroticism played in the first decade of HIV prevention messaging. As a case study, this article highlights the works created by GMHC (formally Gay Men's Health Crisis), New York City's premier AIDS service organization and a global leader in these campaigns. Lastly, we note similarities between historic examples of sex-positive prevention messaging and those used by community health organizations and practitioners in the 21st century. (. Published online ahead of print October 30, 2025:e1-e8. https://doi.org/10.2105/AJPH.2025.308214).