Association between dating app use and unhealthy weight control behaviors and muscle enhancing behaviors in sexual minority men: a cross-sectional study.

BACKGROUND: Body image concerns are prevalent and are viewed as risk factors for engaging in unhealthy weight control behaviors (UWCBs), such as purging, fasting, and the misuse of laxatives and diet pills. Studies have also linked UWCBs to the development of eating disorders. In the United States (U.S.), sexual minority men (e.g., bisexual, gay, and men who have sex with men) are prone to UWCBs often as a result of societal pressures to achieve certain standards of appearance - of which are often perpetuated through various media platforms. A growing number of studies have explored the possible role mobile dating applications ("dating apps") play in contributing to UWCBs. To our knowledge, such studies have not explored this possible relationship between dating apps and UWCBs in sexual minority men (SMM). To fill this gap in the scientific literature, the present study assessed the association between dating app use and UWCBs and muscle enhancing behaviors among a sample of adult SMM in the U.S. METHOD: 549 SMM participated in an anonymous survey from Qualtrics Survey Panels. UWCBs and muscle enhancing behaviors were assessed through items adapted from national surveys. Body image dissatisfaction was assessed using the Male Body Attitudes Scales. Participants also reported their history of dating app use. We performed descriptive statistics, chi-square tests, and student's t-tests. Multivariable logistic regression models assessed the relationship between dating app use and UWCBs and muscle enhancing behaviors. RESULTS: Dating app users had significantly higher body image dissatisfaction scores than non-users. Dating app users also demonstrated significantly elevated odds of engaging in four UWCBs and muscle enhancing behaviors: laxatives, diet pills, muscle-building supplements, and protein powders. CONCLUSIONS: This is one of the first studies to assess dating app use and its association with UWCBs and muscle enhancing behaviors in SMM. Increased surveillance and detection for such behaviors among SMM, particularly those using dating apps, are needed.

Association between perceived discrimination and food insecurity among sexual minority men.

Background: Despite numerous studies focusing on the burden of food insecurity, few have assessed its impact among sexual minority (LGB) populations. Sexual minority individuals are subject to chronic levels of stress, including stigma, prejudice, and discrimination as a result of their sexual orientation identity. While few studies have documented food insecurity among sexual minorities, the relationship between food insecurity and discrimination among this stigmatized population remains unclear. Aim: This study aimed to assess the toll of food insecurity among a sample of sexual minority men (i.e. bisexual and gay men) in the U.S. Guided by the Minority Stress Theory, the study also assessed the relationship between food insecurity and perceived discrimination. Methods: Researchers disseminated an online survey and recruited gay and bisexual men in the U.S. The survey collected participants' demographic information, perceived discrimination, and food insecurity. Multivariable logistic regression analyses were used to examine the association between perceived discrimination and food insecurity. Results: A total of 504 sexual minority men (49.2% bisexual and 50.8% gay) completed the survey. Results from logistic regression models suggest perceived discrimination was significantly associated with food insecurity (OR = 1.14, CI: 1.11-1.18). Those living with a partner demonstrated lower odds of food insecurity (OR = 0.38, CI: 0.18-0.71). Conclusion: The present study found a significant association between perceived discrimination and food insecurity among sexual minority men. The findings need to be replicated and further explored through additional research, including qualitative methods, to better elucidate how discrimination is related to experiences with food insecurity among gay and bisexual men.

Perceived Stress Scale, a tool to explore psychological stress in Mexican women.

OBJECTIVE: To examine the factor structure of the 4- and 10-item Perceived Stress Scale (PSS) among 1 310 Mexican women participating in a prospective cancer cohort study. MATERIALS AND METHODS: We performed exploratory and confirmatory factor analyses in two sub-samples of the Mexican Teachers' Cohort. We evaluated internal consistency, estimated the correlation between PSS-4 and PSS-10, and assessed their correlation with a depressive symptoms scale. RESULTS: Two-factor models were the solutions with the best fit to the data for both PSS-4 and -10, exhibiting strong factor loadings (0.39 to 0.75) and high internal consistency (Cronbach's alpha 0.72 and 0.83). The correlation between PSS-4 and PSS-10 was r=0.91 and the correlations of these two scales with a depressive symptoms scale were r=0.41 and r=0.46, respectively. CONCLUSIONS: PSS might be an adequate scale to assess perceived stress in this prospective cancer cohort study. PSS-4 may be advantageous due to its simplicity, low cost, and short application time in multicountry studies on stress and cancer.

Unhealthy weight control behaviors among a sample of U.S. journalists.

OBJECTIVE: Research on body image and weight control behaviors among journalists is limited. To fill this knowledge gap, we conducted a cross-sectional study to assess the experiences of unhealthy weight control behaviors (UWCBs), binge eating, and appearance-related pressures among a sample of journalists in the United States (U.S.). METHOD: We administered an online survey to journalists assessing their roles in the news industry, engagement in UWCBs (e.g., vomiting, laxative use, dieting, fasting) and binge eating. Odds ratios of the outcomes were estimated using a series of multivariate logistic regression models. RESULTS: Over 68%, 19%, and 30% of participants reported they went on a diet, fasted for weight control, and binge ate, respectively. Our results suggest on-air journalists demonstrated higher odds of dieting compared to their counterparts who do not work in front of the camera. Furthermore, some journalists reported being subjected to appearance-related pressures in the industry. DISCUSSION: Our results provide a glimpse of weight control behaviors, binge eating, and appearance-related pressures among workers in the U.S. journalism industry. Given the concerning prevalence of purging and binge eating in our sample, future studies should assess whether journalists represent an occupation group that is at high risk of developing eating disorders.

Unhealthy weight control behaviors and health risk behaviors in American youth: a repeated cross-sectional study.

BACKGROUND: Unhealthy weight control behaviors (UWCBs) involve weight control strategies to reduce or maintain weight, such as fasting, taking diet pills, and vomiting or taking laxatives. UWCBs in teenagers can escalate into severe health issues such as eating disorders. Understanding the trends of UWCBs and their association with risk behaviors in teenagers is crucial, as early intervention and prevention strategies are pivotal. METHODS: This study utilized eight waves of the youth risk behavior surveillance system (YRBSS) data from 1999 to 2013. Our primary outcome was UWCBs engagement. We used multinomial logistic models to analyze the association between UWCBs and risk behaviors among adolescents including driving after alcohol consumption, suicide attempts, smoking, alcohol use, and sexual intercourse. RESULTS: Among 109,023 participants, UWCBs prevalence was 16.64%. Body Mass Index (BMI) was significantly associated with UWCBs risk. In addition, we found the intention of weight management confounded the relationship between BMI and UWCBs. The unadjusted logistic regression indicated a monotone-increasing association between BMI and the risk of UWCBs. In contrast, the adjusted logistic regression indicated a U-shaped curve with the lowest (BMI < 17 kg/m2) and highest (BMI > 30 kg/m2) BMI groups having significantly higher odds of engaging in UWCBs compared to the reference BMI group (18.5 ≤ BMI ≤ 24.9 kg/m2). CONCLUSIONS: The intention of weight management confounded the relationship between Body Mass Index (BMI) and the risk of UWCBs. These findings suggest that healthcare interventions for weight management behaviors should be tailored to adolescents with BMI ≥ 25 and BMI < 18.5.

This study looked at unhealthy weight control behaviors (UWCBs) in American teenagers, such as fasting, taking diet pills, or vomiting to control weight. These behaviors can lead to serious health problems, including eating disorders. The research analyzed data from over 100,000 teenagers between 1999 and 2013 to understand the connection between UWCBs and other risky behaviors like drinking alcohol, smoking, and attempting suicide. While previous research suggested that teens with higher body weight were more likely to engage in UWCBs, our findings showed a shift in this relationship after considering the teens' intentions to manage weight. Specifically, teens with very low body weight (BMI < 17) and a strong desire to lose weight had an increased risk of UWCBs. This highlights the need for healthcare providers to focus on the mental health and weight management goals of these teens to prevent harmful behaviors. Additionally, reconsidering the removal of UWCB-related questions from national surveys like YRBSS is important to continue monitoring these behaviors.

Noticing and Responding to Calorie Labels on Restaurant Menus: Patterns in Sexual-Minority Men.

INTRODUCTION: A calorie-labeling policy for restaurant menus was implemented in 2018. Whether and how sexual-minority men use this information has not been evaluated. METHODS: The Men's Body Project, a 2020 cross-sectional survey study of 504 cisgender sexual-minority men (mean age=35.8±10.4 years, 71.0% White, 5.6% Asian, 14.3% Black, 9.1% another/multiple race identities) assessed respondents' awareness of calorie labels on restaurant menus and subsequent responses. Additional questions were asked about weight-change goals, body image, disordered eating behaviors, and muscle-enhancing supplement use. Analyses in 2022-2023 used multivariate logistic regression to assess the associations between noticing calories and weight- and muscularity-oriented behaviors and, among those who noticed calorie labels, whether participants reported using this information to order more or fewer calories. RESULTS: Approximately half of the participants reported noticing calorie labels. Those who did were more likely to report engaging in disordered eating behaviors (OR=2.03). Among participants who noticed menu labels, ordering fewer calories was the most frequent response, whereas 25% reported not changing the caloric content of their order. Many participants (21%) reported ordering both more and fewer calories, and this heterogeneous ordering pattern was associated with both disordered eating (OR=4.70) and muscle-enhancing behaviors (OR=9.42) compared with that among participants who did not report behaviors. Reporting weight-control efforts was associated with ordering fewer calories than participants not doing anything to change their weight (OR=2.53). CONCLUSIONS: Most participants noticed calorie labels on menus, and many reported subsequently ordering fewer calories. Disordered eating and muscle-enhancing behaviors were associated with behavior changes in response to calorie information.

Brugada Phenotype Following a Cocaine Overdose.

Brugada syndrome is a rare cardiac condition characterized by distinctive electrocardiogram patterns, predisposing individuals to fatal arrhythmias. While primarily linked to a loss-of-function mutation in the SCN5A gene, acquired forms of the syndrome have been associated with various factors, including drug use. We present a case of a 31-year-old female who presented to the emergency department unresponsive following cocaine use and developed type 1 Brugada ECG patterns alongside an incomplete right bundle branch block in V1-V3, ST elevations with biphasic waves, and diffuse repolarization abnormalities with J point deviations while in the intensive care unit. This study aimed to discuss the complexity of managing drug-induced Brugada-like findings and highlights the need for further research into the mechanisms underlying cocaine-induced cardiac effects. We aimed to discuss potential mechanisms for the impact of cocaine as its role as a sodium channel blocker and its potential effects on connexin 43 in the context of Brugada syndrome. This study also reinforced the importance of differentiating between true Brugada syndrome and other similar ECG changes for appropriate care management.

Discrimination and intimate partner violence among a sample of bisexual and gay men in the United States: a cross-sectional study.

Purpose: Intimate partner violence (IPV) is becoming more recognized as a public health concern among sexual minority men, including bisexual and gay men. Guided by the Minority Stress Model, we assessed the relationship between perceived discrimination and three forms of IPV among a sample of bisexual and gay men living in the United States. Methods: We analyzed data as part of the Men's Body Project, a cross-sectional study launched in 2020 to assess health behaviors of bisexual and gay men. Results: A total of 549 individuals participated in the survey, of which 52% were gay and 48% were bisexual men. Perceived discrimination was significantly associated with elevated odds ratios ranging from 1.15 to 1.18 across three forms of IPV, with Physical IPV odds ratio being highest. Conclusion: Given the significant association between perceived discrimination and IPV, interventions aimed at addressing IPV experiences among sexual minority men must consider the role of minority stress.

A Pilot Randomized Controlled Trial to Evaluate a Cognitive Behavioral Videogame Intervention: empowerED.

Objective: To design a cognitive behavioral videogame intervention and to evaluate its preliminary effect on improving youth's perceptions about themselves, their future, and their ability by incorporating skill development in cognitive reappraisal, an emotion regulation strategy to change perceptions. Materials and Methods: We conducted a pilot RCT to evaluate the preliminary efficacy of a videogame intervention, empowerED, in enhancing cognitive reappraisal skills. We also assessed beliefs/attitudes, self-efficacy, and emotional self-efficacy as well as user experience and feasibility. Youth (N = 100) aged 14-19 years from one school were enrolled in a pilot RCT assigned either to play empowerED or a control condition. Results: Improvements were noted in cognitive reappraisal in the empowerED group compared to the control group (LSM difference = 1.33, P = 0.01). There were no significant differences observed between treatment groups for beliefs/attitudes, self-efficacy, and emotional self-efficacy; however, the empowerED group reported improvements in beliefs/attitudes from pretest to posttest survey responses (M = 1.33, P = 0.01). Conclusion: Overall, the intervention was deemed easy to use and beneficial among youth, and feasibly delivered in a high school setting. Given the growing youth mental health needs in schools and the importance of school climate on healthy development, empowerED may offer an effective and innovative student-level approach to improve cognitive reappraisal and later empower youth to enact change in their school climate. Clinical Trials.gov Identifier: NCT04025294.

Calorie changes among food items sold in U.S. convenience stores and pizza restaurant chains from 2013 to 2017.

The aim of this study was to describe trends in calories among food items sold in U.S. convenience stores and pizza restaurant chains from 2013 to 2017 - a period leading up to the implementation of the federal menu labeling mandate. Using data from the MenuStat project, we conducted quantile regression analyses in 2018 to estimate the predicted median per-item calories among menu items available at convenience stores (n = 1522) and pizza restaurant chains (n = 2085) - two retailers that have been openly resistant to implementing menu labeling - and assessed whether core food items were reformulated during the study period. We also compared calories in food items available for sale on convenience store and pizza restaurant menus to calories in items that were newly added or dropped. We found that leading up to the national menu labeling implementation date, convenience stores showed a significant decreasing trend in median calories of overall menu items (390 kcals in 2013 vs. 334 kcals in 2017, p-value for trend <0.01) and among appetizers and sides (367 kcals in 2013 vs. 137 kcals in 2017, p-value for trend = 0.02). Pizza restaurants introduced lower-calorie pizza options in 2017, but no other significant changes in calories were observed. Going forward, it will be important to track calorie changes in convenience stores and pizza restaurant chains as both food establishments represent significant sources of calories for Americans.

Dating app use and unhealthy weight control behaviors among a sample of U.S. adults: a cross-sectional study.

BACKGROUND: Online dating has become increasingly popular over the years. Few research studies have examined the association between dating apps and disordered eating. In this study, we evaluated the association between dating app use and unhealthy weight control behaviors (UWCBs) among a sample of U.S. adults. METHODS: Our sample includes 1769 adults who completed an online survey assessing dating app use and UWCBs in the past year. Survey assessed participants' self-reported frequency of using dating apps within the past 30 days and engagement in six UWCBs with the purpose of lowering weight or changing their body shape within the past 12 months. UWCBs included vomiting, laxative use, fasting, diet pill use, muscle building supplement use, and use of anabolic steroids. RESULTS: Results of multivariate logistic regression models suggest dating app users had substantially elevated odds of UWCBs compared with non-users (odds ratios [OR] range = 2.7-16.2). These findings were supported by results of additional gender-stratified multivariate logistic regression analyses among women and men. CONCLUSIONS: This study's findings contribute to the limited literature exploring the association between dating app use and adverse health outcomes, particularly UWCBs. While additional longitudinal and representative research is needed, public health professionals ought to explore dating app use as a potential risk factor for UWCBs.

Research-to-policy translation for prevention of disordered weight and shape control behaviors: A case example targeting dietary supplements sold for weight loss and muscle building.

New approaches to universal eating disorders prevention and interventions targeting macro-environmental change are greatly needed, and research-to-policy translation efforts hold promise for advancing both of these goals. This paper describes as a policy-translation case example an academic-community-government partnership of the Strategic Training Initiative for the Prevention of Eating Disorders, Multi-Service Eating Disorders Association, and the office of Massachusetts Representative Kay Khan, all based in Massachusetts, USA. The partnership's research-to-policy translation project focused on dietary supplements sold for weight loss and muscle building, which have been linked with serious injury and death in consumers. Youth and people of all ages with eating disorders and body dysmorphic disorder may be especially vulnerable to use these products due to deceptive promises of fast and safe weight loss and muscle gain. The research-to-policy translation project was informed by a triggers-to-action framework to establish the evidentiary base of harm to consumers, operationalize policy solutions to mitigate harm through legislation, and generate political will to support action through legislation introduced in the Massachusetts legislature to restrict sales of weight-loss and muscle-building dietary supplements. The paper concludes with lessons learned from this unique policy translation effort for the prevention of disordered weight and shape control behaviors and offers recommendations for next steps for the field to advance research and practice for universal, macro-environmentally targeted prevention.

Perceived Stress Scale, a tool to explorepsychological stress in Mexican women / Escala de Estrés Percibido, un instrumento para explorar estrés psicológico en mujeres mexicanas

Abstract: Objective: To examine the factor structure of the 4- and 10-item Perceived Stress Scale (PSS) among 1 310 Mexican women participating in a prospective cancer cohort study. Materials and methods: We performed exploratory and confirmatory factor analyses in two sub-samples of the Mexican Teachers' Cohort. We evaluated internal consistency, estimated the correlation between PSS-4 and PSS-10, and assessed their correlation with a depressive symptoms scale. Results: Two-factor models were the solutions with the best fit to the data for both PSS-4 and -10, exhibiting strong factor loadings (0.39 to 0.75) and high internal consistency (Cronbach's alpha 0.72 and 0.83). The correlation between PSS-4 and PSS-10 was r=0.91 and the correlations of these two scales with a depressive symptoms scale were r=0.41 and r=0.46, respectively. Conclusions: PSS might be an adequate scale to assess perceived stress in this prospective cancer cohort study. PSS-4 may be advantageous due to its simplicity, low cost, and short application time in multicountry studies on stress and cancer.

Resumen: Objetivo: Evaluar la estructura factorial de la Escala de Estrés Percibido (PSS, por sus siglas en inglés) de 4 y 10 ítems en 1 310 mujeres mexicanas que participan en un estudio de cohorte sobre cáncer. Material y métodos: Se realizó análisis factorial exploratorio y confirmatorio en dos submuestras distintas del estudio ESMaestras. También se evaluó la consistencia interna, la correlación entre la PSS-4 y la PSS-10, y la correlación de estas escalas con una escala de síntomas depresivos. Resultados: El modelo de dos factores fue la solución con los mejores índices para ambas escalas, exhibiendo cargas factoriales fuertes (0.39-0.75), y alta consistencia interna (alfa de Cronbach=0.72 y 0.83). La correlación entre la PSS-4 y la PSS-10 fue r=0.91 y la correlación de estas escalas con la escala de síntomas depresivos fue r=0.41 y 0.46. Conclusiones: La PSS es una escala adecuada para evaluar el estrés percibido en este estudio de cohorte sobre cáncer. La PSS-4 puede ser ventajosa por su simplicidad, bajo costo y corto tiempo de aplicación en estudios multipaís sobre estrés y cáncer.

Healthy Foods, Healthy Families: combining incentives and exposure interventions at urban farmers' markets to improve nutrition among recipients of US federal food assistance.

BACKGROUND: Healthy Foods, Healthy Families (HFHF) is a fruit and vegetable (F&V) exposure/incentive program implemented at farmers' markets in low-income neighborhoods, targeting families receiving US federal food assistance. We examined program effects on participants' diet and associations between attendance, demographics and dietary change. METHODS: Exposure activities included F&V tastings and cooking demonstrations. Incentives included 40% F&V bonus for electronic benefit transfer (EBT) card users and $20 for use purchasing F&V at every third market visit. Self-report surveys measuring nutritional behaviors/literacy were administered to participants upon enrollment (n = 425, 46.2% Hispanic, 94.8%female). Participants were sampled for follow-up at markets during mid-season (n = 186) and at season end (n = 146). Attendance was tracked over 16 weeks. RESULTS: Participants post-intervention reported significantly higher vegetable consumption(P = 0.005) and lower soda consumption (P = 0.005). Participants reporting largest F&V increases attended the market 6-8 times and received $40 in incentives. No change in food assistance spent on F&V (P = 0.94); 70% reported significant increases in family consumption of F&V,indicating subsidies increased overall F&V purchasing. Participants reported exposure activities and incentives similarly affected program attendance. CONCLUSION: Interventions combining exposure activities and modest financial incentives at farmers' markets in low-income neighborhoods show strong potential to improve diet quality of families receiving federal food assistance.

A Cascade of Champions: A Qualitative Study about the MA-CORD Media Competition Implementation.

A media competition was part of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) Study. Criss et al., previously outlined the development and implementation of the competition, including variation in reach and adoption of the intervention across schools and afterschool programs. In this qualitative study, we examine community, provider, and organizational factors that explain the variation of media competition reach in school and afterschool programs, and describe the awareness of the media competition across other community sectors. Durlak and DuPre's ecological framework for understanding effective implementation provided the theoretical underpinnings for this study. Fifty-four key informant interviews were conducted, transcribed, and analyzed. Organizational capacity of committed teachers/staff and adaptability of the media competition seemed to be drivers for higher reach within school and afterschool programs. Salient themes that emerged as facilitators of effective implementation were having a cascade of champions and providing opportunity to participate in the media competition outside traditional class time. Clinics and coalitions were identified as additional sectors aware of the media competition. Specifically, our findings offer a new perspective on intervention design and a recommended direction for further study.

Problem Drinking Behaviors: Differential Effects of Stress and School Type on College Students.

Given that alcohol use is highly prevalent at US colleges, we explored factors related to problem drinking behaviors (PDB; binge drinking, driving after drinking, sexual intercourse after drinking) among 4098 Black and White students from two- and four-year colleges who completed an online survey. We found an interaction between race and sex such that, among Whites, females had less PDB than males (B = 0.09, CI: 0.05; 0.40, p = 0.01). An interaction between race and school type also existed, such that White students from four-year schools had greater PDB (B = 0.11, CI: 0.20; 0.54, p < 0.001). An interaction between race and stress suggested that Black students were more negatively affected by stress in terms of PBD (B = 0.12, CI: 0.01; 0.07, p = 0.01).

Prevalence of Substance Use and Intimate Partner Violence in a Sample of A/PI MSM.

This study evaluates the prevalence of three forms of intimate partner violence (IPV) (i.e., experience of physical, psychological/symbolic, and sexual battering) among a national sample of Asian/Pacific Islander (A/PI) men who have sex with men (MSM) in the United States and identifies their characteristics. The study also reports the differences of substance use behavior between MSM with and without a previous history of IPV. Our sample was recruited through venue-based sampling from seven metropolitan cities as part of the national Men of Asia Testing for HIV (MATH) study. Among 412 MSM, 29.1% experienced IPV perpetrated from a boyfriend or same-gender partner in the past 5 years. Within the previous 5 years, 62.5%, 78.3%, and 40.8% of participants experienced physical, psychological/symbolic, and sexual battering, respectively. Collectively, 35.8% of participants reported that they have experienced at least one type of victimization and 64.2% have experienced multiple victimizations (two or three types of battering victimization). Overall, 21.2% of our sample reported any substance use within the past 12 months. The present findings suggest that individuals with a history of IPV in the past 5 years were more likely to report substance use (33.6%) compared to those without a history of IPV experience (16.1%).

Sexually transmitted infection testing practices among 'money boys' and general men who have sex with men in Shanghai, China: objective versus self-reported status.

Little is known about sexually transmitted infection (STI) testing among Chinese men who have sex with men (MSM). This study describes the prevalence of STI testing, associated factors and the validity of STI self-reporting among Chinese MSM. Findings indicated a high prevalence of STIs and low testing rates among MSM in Shanghai. Monthly income was significantly associated with STI testing (odds ratio: 0.37, 95% confidence interval (CI): 0.18 to 0.76). Depression was significantly associated with STI testing for general MSM (odds ratio: 1.09, 95% CI: 1.01 to 1.17). Syphilis self-reported status had the highest validity (k=0.33, χ(2)=3.76, 95% CI: -0.003 to 0.65). Efforts are needed to ensure that STI testing services are accessible to MSM in China. Future HIV and STI interventions should be tailored to the needs of different subsets of MSM.

Infection prevention and control standards in assisted living facilities: are residents' needs being met?

BACKGROUND: Assisted living facilities (ALFs) provide housing and care to persons unable to live independently, and who often have increasing medical needs. Disease outbreaks illustrate challenges of maintaining adequate resident protections in these facilities. OBJECTIVES: Describe current state laws on assisted living admissions criteria, medical oversight, medication administration, vaccination requirements, and standards for infection control training. METHODS: We abstracted laws and regulations governing assisted living facilities for the 50 states using a structured abstraction tool. Selected characteristics were compared according to the time period in which the regulation took effect. Selected state health departments were queried regarding outbreaks identified in assisted living facilities. RESULTS: Of the 50 states, 84% specify health-based admissions criteria to assisted living facilities; 60% require licensed health care professionals to oversee medical care; 88% specifically allow subcontracting with outside entities to provide routine medical services onsite; 64% address medication administration by assisted living facility staff; 54% specify requirements for some form of initial infection control training for all staff; 50% require reporting of disease outbreaks to the health department; 18% specify requirements to offer or require vaccines to staff; 30% specify requirements to offer or require vaccines to residents. Twelve states identified approximately 1600 outbreaks from 2010 to 2013, with influenza or norovirus infections predominating. CONCLUSIONS: There is wide variation in how assisted living facilities are regulated in the United States. States may wish to consider regulatory changes that ensure safe health care delivery, and minimize risks of infections, outbreaks of disease, and other forms of harm among assisted living residents.