Health Policy
Obesity, Cancer, and Health Equity
The causes of racial and ethnic disparities in cancer risk and outcomes in the U.S. are complex and multifaceted and require an appreciation of the importance of understanding and addressing social determinants of cancer in a health equity approach to disease prevention and control in the U.S.1 This commentary pertains to 1 specific contributor to racial and ethnic health disparities―the link between obesity and cancer―which is a growing focus of oncology research and clinical care.2 Thirteen cancers are associated with overweight (BMI≥25 kg/m2) and obesity (BMI≥30 kg/m2): adenocarcinoma of the esophagus, breast, colon and rectum, gallbladder, kidneys, liver, meningioma, multiple myeloma, ovaries, pancreas, thyroid, upper stomach, and uterus.Past Disruptions in Health Insurance Coverage and Access to Care Among Insured Adults
Although the association between health insurance coverage and access to care is well documented, it is unclear whether the deleterious effects of being uninsured are strictly contemporaneous or whether previous disruptions in coverage have persistent effects. This study addresses this issue using nationally representative data covering 2011–2019 to estimate the extent to which disruptions in health insurance coverage continued to be associated with poor access even after coverage was regained.Community Health Workers to Increase Cancer Screening: 3 Community Guide Systematic Reviews
Many in the U.S. are not up to date with cancer screening. This systematic review examined the effectiveness of interventions engaging community health workers to increase breast, cervical, and colorectal cancer screening.Community Guide Methods for Systematic Reviews of Economic Evidence
Community Guide systematic economic reviews provide information on the cost, economic benefit, cost-benefit, and cost-effectiveness of public health interventions recommended by the Community Preventive Services Task Force on the basis of evidence of effectiveness. The number and variety of economic evaluation studies in public health have grown substantially over time, contributing to methodologic challenges that required updates to the methods for Community Guide systematic economic reviews. This paper describes these updated methods.A Community Guide Systematic Review: School Dietary and Physical Activity Interventions
Schools can play an important role in supporting a healthy lifestyle by offering nutritious foods and beverages and providing opportunities for physical activity. A healthy diet and regular physical activity may reduce the risk of obesity. This manuscript reports on a Community Guide systematic review examining the effectiveness of interventions in schools combining school meal or fruit and vegetable snack programs and physical activity.Effects of Recent Medicaid Expansions on Infant Mortality by Race and Ethnicity
The purpose of this study is to examine year-by-year effects of the 2014 Affordable Care Act Medicaid expansion on infant mortality by race and ethnicity over the first 6 years.Incarceration History and Health Insurance and Coverage Changes in the U.S.
This study examines the association of incarceration history and health insurance coverage and coverage changes in the U.S.Leveling the Playing Field: Mailing Pharmacotherapy to Medicaid Members Who Smoke
Smoking rates differ by insurance type; rates are often double for Medicaid and uninsured compared with that for Medicare or privately insured. State-funded tobacco quitlines’ provision of free nicotine replacement therapy varies. In some states, Medicaid beneficiaries must obtain nicotine replacement therapy from a physician, whereas others get nicotine replacement therapy mailed to them.Urban–Rural Disparities in Deaths of Despair: A County-Level Analysis 2004–2016 in the U.S.
The purpose of this study is to examine nationwide disparities in drug, alcohol, and suicide mortality; evaluate the association between county-level characteristics and these mortality rates; and illustrate spatial patterns of mortality risk to identify areas with elevated risk.Impacts of the COVID-19 Pandemic on Nationwide Chronic Disease Prevention and Health Promotion Activities
The coronavirus disease 2019 (COVID-19) pandemic has underscored the need to prevent chronic disease and promote health.1,2 More than a million American lives have been lost to COVID-19, and life expectancy decreased between 2018 and 2020.3,4 Chronic diseases are major risk factors for COVID-19 morbidity and mortality.5 In addition, COVID-19 morbidity and mortality have been higher among persons from racial and ethnic groups such as those who are African American, Hispanic or Latino, and American Indian or Alaska Native as well as those living at lower SES.Economic Impact of Universal Hepatitis C Virus Testing for Middle-Aged Adults Who Inject Drugs
The objective of this study was to estimate the economic impact of providing universal hepatitis C virus testing in commercially insured middle-aged persons who inject drugs in the U.S.The PREVENT Pandemics Act: A National Road Map
On March 10, 2022, Senator Patty L. Murray (DWA), Chair of the Senate Health, education, labor, and pensions (HELP) committee, and ranking member, Senator Richard M. Burr, (RNC), introduced their long-awaited PREVENT Pandemics Act (S. 3799).1 The sweeping bipartisan bill, also known as the Prepare for and Respond to Existing Viruses, Emerging New Threats, and Pandemics Act, aims to counter future pandemic threats through preparation and planning.1 Potentially the signature pandemic preparedness bill of the 117th U.S.Cost-Effectiveness of 5 Public Health Approaches to Prevent Eating Disorders
Eating disorders cause suffering and a high risk of death. Accelerating the translation of research into implementation will require intervention cost-effectiveness estimates. The objective of this study was to estimate the cost-effectiveness of 5 public health approaches to preventing eating disorders among adolescents and young adults.Changes in Availability of ENDS: 2019–2020, U.S.
Events during 2019 and 2020, such as the outbreak of e-cigarette, or vaping, product use‒associated lung injury; manufacturer product withdrawals; federal regulations; and coronavirus disease 2019, potentially affected the retail availability of ENDS in the U.S. Measuring changes in ENDS availability informs the understanding of the ENDS marketplace and contextualizes sales trends.Before and During Pandemic Telemedicine Use: An Analysis of Rural and Urban Safety-Net Clinics
Differences in face-to-face and telemedicine visits before and during the COVID-19 pandemic among rural and urban safety-net clinic patients were evaluated. In addition, this study investigated whether rural patients were as likely to utilize telemedicine for primary care during the pandemic as urban patients.Two-Year Utilization and Expenditures for Children After a Firearm Injury
Firearm injuries are a leading cause of morbidity among children, but data on healthcare utilization and expenditures after injury are limited. This study sought to analyze healthcare encounters and expenditures for 2 years after a nonfatal firearm injury.Social Needs Identified by Diagnostic Codes in Privately Insured U.S. Adults
The relationships between healthcare use and social needs are not fully understood. In 2015, International Classification of Diseases, Tenth Revision coding introduced voluntary Z codes for social needs‒related healthcare encounters. This study evaluated early national patterns of Z codes in privately insured adults.Accessibility of HIV Services in Philadelphia: Location-Allocation Analysis
As the first step in the HIV care continuum, timely diagnosis is central to reducing transmission of the virus and ending the HIV epidemic. Studies have shown that distance from a testing site is essential for ease of access to services and educational material. This study shows how location-allocation analysis can be used to improve allocation of HIV testing services utilizing existing publicly available data from 2015 to 2019 on HIV prevalence, testing site location, and factors related to HIV in Philadelphia, Pennsylvania.Failing Grade: The Pandemic Legacy of HHS
On January 27, 2022, the Government Accountability Office (GAO) issued its ninth report on the efforts of the federal government to respond to and recover from the coronavirus disease 2019 (COVID-19) pandemic.1 The GAO report reaches as far back as January 2020 to encompass both the Trump and Biden Administrations. Turning its attention to HHS (home to agencies such as the Food and Drug Administration and the Centers for Disease Control and Prevention [CDC]), the GAO found persistent deficiencies in the preparedness and response efforts in several areas.U.S. State Preemption Laws and Working-Age Mortality
The goal of this study was to estimate how state preemption laws that prohibit local authority to raise the minimum wage or mandate paid sick leave have contributed to working-age mortality from suicide, homicide, drug overdose, alcohol poisoning, and transport accidents.Influenza Vaccination Coverage Among Medicare Fee-for-Service Beneficiaries
Influenza vaccination is the best prevention strategy to protect against influenza infection. Determining accurate influenza vaccination coverage is critical. This study assesses the concordance between self-reported and claimed-based influenza vaccination coverage and examines vaccination disparities in the U.S.Concordance in Adolescent and Caregiver Report of Social Determinants of Health
Screening youth for negative social determinants of health is a widespread practice across healthcare settings in the U.S., with such systems almost exclusively relying on caregiver reports. Little work has sought to identify the social determinants of health adolescents identify as having the largest influence on their health and well-being or the extent to which adolescents agree with their caregiver. This study sought to (1) identify the most prevalent and influential negative social determinants of health, according to adolescent reports, and (2) assess concordance between adolescent and caregiver reports of social determinants of health.Impacts of Medicaid Expansion on Stage at Cancer Diagnosis by Patient Insurance Type
The expansion of Medicaid under the Affordable Care Act increased access to health care for millions of low-income Americans. However, the longer-term impacts of the policy on cancer outcomes remain unknown. This study examined the impact of Medicaid expansion on early- and late-stage diagnosis for 4 common cancers (breast, cervical, colorectal, and lung) using 4 full years of postpolicy data.Adjusting for Patient Economic/Access Issues in a Hypertension Quality Measure
The American Heart Association and American College of Cardiology have proposed adjusting hypertension-related care quality measures by excluding patients with economic/access issues from the denominator of rate calculations. No research to date has explored the methods to operationalize this recommendation or how to measure economic/access issues. This study applied and compared different approaches to populating these denominator exceptions.Health Institutions and the Political Determinants of Health
Health institutions, such as hospitals and hospital systems, are investing in programs to address upstream drivers of health. These drivers include the macrolevel forces that comprise social-structural influences on health institutions; government policies; and the social, physical, economic, and environmental factors that affect health. Historically, health institutions have mostly invested in mitigating the harmful aspects of social determinants of health—the most publicized upstream driver of health—for their patients.
