The Centers for Disease Control and Prevention (CDC) receives large volumes of data and identifiable human biospecimens annually for public health purposes that can serve as an important resource for scientists to conduct public health research. However, documented informed consent from the human contributor that either permits or prohibits future uses is rarely provided. While research using existing data and biospecimens without informed consent is permitted by human research regulations, ethical challenges remain. CDC seeks to better understand the ethical considerations for the secondary use of identifiable data and biospecimens for research without informed consent. CDC’s Office of Science convened a panel (n=10) to deliberate on the ethics of using existing biospecimens and personal information originally collected for public health practice for secondary research when informed consent was not obtained for the secondary use. In March 2023 the panel shared its recommendations to strengthen ethical deliberation and practice regarding use of existing identifiable data and biospecimens. CDC is currently assessing its research portfolio to consider current practices, fostering collaboration with other federal agencies, and exploring ways to engage the public and other entities to discuss such practices. Although permitted by law, ethical challenges persist for uses of identifiable data and biospecimens. This topic deserves greater discussion and deliberation that includes engagement of the public, academia, non-profits, and government agencies to inform ethical practices and scientific integrity while fostering public health advances. CDC seeks to engage diverse voices to expand our understanding and advance collaborative guidance on this ethical challenge.

Objective. To describe nitrite “poppers” adverse event (AE) data from the United States Food and Drug Administration (FDA) Center for Food Safety and Applied Nutrition Adverse Event Reporting System (CAERS) and exposure cases from the America’s Poison Centers National Poison Data System (NPDS).

Background. Consumers use nitrite “poppers” for recreational and other purposes, including euphoria and sexual enhancement; however, they have been implicated in deaths and serious medical consequences.

Methods. We assessed CAERS 1/1/2020-4/15/2023 AE report and NPDS 1/1/2020-12/31/2021 exposure case information to characterize demographics, symptoms, and outcomes.

Results. Mean age (y) among 16 CAERS poppers reports was 44 (range: 24-59), with 2 (12.5%) females, 13 (81.3%) males, and 1 (6.3%) individual described as undifferentiated. Reporters most often specified nervous system (n=6, 37.5%) and respiratory/thoracic/mediastinal (n=5, 31.3%) symptoms. Outcomes included deaths (n=3, 18.8%) and other serious medical consequences (n=20).

NPDS poppers cases increased from 240 (42.3%) in 2020 to 327 (57.7%) in 2021, with 465 (82.0%) indicating poppers only and 102 (18.0%) citing poppers plus other co-consumed substances. Mean age was 34.6 (range: 1-83), with 88 (15.5%) females, 473 (83.4%) males, and 6 (1.1%) individuals of unknown sex/gender. Among poppers only cases, 8 (1.7%) deaths occurred; 125 (26.9%) indicated major or moderate medical outcomes. Among poppers plus cases, 5 (4.9%) deaths occurred; 59 (57.8%) involved moderate or major effects.

Conclusions. Outreach and education for consumers and healthcare providers about dangers of poppers need to continue to help prevent and reduce further deaths and other harms to the public.

COVID-19 vaccination provides the best protection against severe illness and death from SARS-CoV-2. A new XBB.1.5 formulation of COVID-19 vaccine has been approved by FDA and may be recommended for adults in the United States in fall 2023. We use National Immunization Survey Adult COVID Module (NIS-ACM) data from interviews conducted January 2023 through May 2023 (n=299,166) to assess trends and characteristics of adults who had not received any COVID-19 vaccinations. NIS-ACM is a random-digit-dial telephone survey of adults aged ≥18 years. COVID-19 vaccination status was assessed by question: “Have you received at least one dose of a COVID-19 vaccine?” Multivariable logistic regression and predictive marginals were conducted to assess factors associated with non-vaccination for COVID-19. NIS-ACM estimates indicate the percentage of adults unvaccinated for COVID-19 in the United States declined from 39.8% in May 2021 to 12.1% in May 2023. About 22% of those aged 18-29 years were COVID-19 unvaccinated, as were 21.0% of American Indian or Alaska Native adults, 20.6% of those living in rural areas, 19.2% of those living in the Midwest and 14.8% of those living in the south. Among those with less than a high school education, 18.0% were unvaccinated for COVID-19 as were 15.9% who lived in a household below the poverty level and 25.1% among the uninsured. Enhanced outreach is needed for these COVID-19 unvaccinated populations to ensure equitable ongoing protection against COVID-19 as new strains circulate and updated COVID-19 vaccines are recommended.

Background: Inflation generates stress, which may lead to high rates of anxiety and depression. With the recent surge and subsequent decline in the inflation rate in the United States, we investigated the association between stress due to inflation and anxiety and depression among working-age adults from October 2022 to April-May 2023.

Methods: We conducted a repeated cross-sectional analysis using Census Household Pulse Survey (HPS) data (Week 50 (October 2022) and Week 57 (April-May 2023). Beginning in October 2022, HPS introduced questions about individuals’ stress levels due to price increases in the past two months. We used logistic regression to examine the association between inflation-related stress and depression and anxiety among working-age adults controlling for several factors, including demographic factors and social determinants of health (e.g. education).

Results: From October 2022 to April-May 2023, the prevalence of stress due to inflation (high and moderate) remained very high and stable at 78%, while the prevalence of both depression and anxiety decreased by three percentage points. We found a significant association between high and moderate stress due to inflation with depression (Adjusted odds ratio (AOR) [95% CI] = 2.23 [1.92, 2.58]) and anxiety (AOR [95% CI] = 2.47 [2.16, 2.83]).

Conclusions: The prevalence of moderate and high stress due to inflation remained very high. Inflation-related stress was associated with poor mental health and may be a distinct and persistent public health issue.