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Purpose: The purpose of this paper is to provide a systematic review of the current state of physician leadership. Theory of expert leadership (TEL) was applied to explore the effects of physician inherent knowledge, industry experience and leadership capabilities on leader behaviors and outcomes. Design/methodology/approach: This review (August 2011–February 2022) applied the preferred reporting items for systematic review and meta-analysis strategy. Our search began with 3,537 studies and a final sample of 12 articles. Findings: The findings offer a number of studies that note the relationship between physician leadership and the three dimensions of TEL. How influential these are on leadership behaviors and health-related outcomes varies. We also found a number of studies that described general physician leadership behaviors that were not directly linked to factors of TEL, as well as two additional themes: leader identity and trust. Originality/value: To the best of the authors' knowledge, this is the first systematic review that has applied a highly cited theory (i.e. TEL) to the data and the first that has focused solely on a U.S. population. These findings offer healthcare organizations insight into the potential strengths and challenges of physician leadership. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to investigate the association of COVID-19 confirmed cases and deaths with mental health, unemployment and financial markets-related search terms for the USA, the UK, India and worldwide using Google Trends. Design/methodology/approach: The authors use Spearman's rank correlation coefficients to assess the relationship between relative search volumes (RSVs) and mental health, unemployment and financial markets-related search terms, with the total confirmed COVID-19 cases as well as deaths in the USA, UK, India and worldwide. The sample period starts from the day 100 cases were reported for the first time, which is 7 March 2020, 13 March 2020, 23 March 2020 and 28 January 2020 for the US, the UK, India and worldwide, respectively, and ends on 25 June 2020. Findings: The results indicate a significant increase in anxiety, depression and stress leading to sleeping disorders or insomnia, further deteriorating mental health. The RSVs of employment are negatively significant, implying that people are hesitant to search for new jobs due to being susceptible to exposure, imposed lockdown and social distancing measures and changing employment patterns. The RSVs for financial terms exhibit the varying associations of COVID-19 cases and deaths with the stock market, loans, rent, etc. Research limitations/implications: This study has implications for the policymakers, health experts and the government. The state governments must provide proper medical facilities and holistic care to the affected population. It may be noted that the findings of this study only lead us to conclude about the relationship between COVID-19 cases and deaths and Google Trends searches, and do not as such indicate the effect on actual behaviour. Originality/value: To the best of the authors' knowledge, this is the first attempt to investigate the relationship between the number of COVID-19 cases and deaths in the USA, UK and India and at the global level and RSVs for mental health-related, job-related and financial keywords. [ABSTRACT FROM AUTHOR]

The health and ecological harms created and spread by firms active in many unhealthy commodity industries (UCIs) have received considerable attention from the public health community. However, less focus has been paid to analysing the distribution of wealth and income – important social and economic determinants of health – by these industries. This study aimed to examine long-term trends in wealth and income distribution by publicly listed corporations active in four UCIs: fossil fuels; tobacco; ultra-processed foods; and alcohol. Quantitative analysis of a range of data was conducted for firms listed on stock exchanges in the United States (US). Wealth and income distribution metrics were analysed at the industry level, including effective corporate tax rates and shareholder value ratios. The equity ownership structures and investor location of 20 of the largest firms were also explored. Since the 1980s, US-listed firms in the examined UCIs have distributed much less of their wealth and income to governments and much more to shareholders and investors mostly based in high-income countries. The study provides evidence that firms active in UCIs create a 'double burden of maldistribution': their externalised social and ecological harms disproportionately affect disadvantaged population groups and governments in low- and middle-income countries; whilst, simultaneously, they are increasingly transferring wealth and income to a group over-represented by a small and privileged elite. The identified distributive injustice warrants increased policy attention. [ABSTRACT FROM AUTHOR]

Background: A growing body of research has found a link between firearm availability and police shootings of citizens across place. The problem, however, is that the previous studies on the topic tend to suffer from several limitations: a near exclusive focus on citizen fatalities, units of analysis at the state or county levels, and a variety of proxy measures tapping into community-level firearm access. The current study set out to address these issues by examining the relationship between different forms of firearm availability and both fatal and nonfatal injurious police shootings of citizens at the city level. Methods: More specifically, it merged The Trace's "Missing Pieces" measures of guns reported lost and stolen to police as well as licensed firearms dealers across jurisdictions from the Bureau of Alcohol, Tobacco, Firearms, and Explosives as proxies for firearm availability with data on police shootings of citizens in California and Florida from California's URSUS system and the Tampa Bay Times' "Why Cops Shoot" database, respectively. Negative binomial regression analyses were performed on a sample of 253 cities across the two states and a sub-sample of cities with licensed firearms dealers. Results: Findings uncovered a small positive association between rates of federally licensed guns stores and the number citizens shot by police as well as police shooting incidents while controlling for several community-level measures (e.g., concentrated disadvantage, gun homicide rates). Rates of guns lost or reported stolen were generally not significantly associated with the outcome measures in the multivariate models. Conclusions: Firearm availability is a significant correlate of police shootings. Pooled counts of both citizens shot by police and police shooting incidents are heightened in jurisdictions with higher rates of licensed gun dealers, which may be due to the fact that all firearms sold in the USA first make their way to the public through these mechanisms. Such licensed gun dealers must be appropriately monitored and audited to reduce illicit behavior and prevent firearms from making their way into secondary markets. Addressing access to firearms can be meaningful for a host of gun-related morbidity and mortality outcomes, including police shootings of citizens. [ABSTRACT FROM AUTHOR]

Despite the orthopedics markets in the US and the EU reaching a plateau, the market size in countries such as Brazil, Russia, India, and China is steadily growing. As a result, major orthopedic companies are shifting their focus towards these markets and developing products tailored to their needs. However, a significant challenge associated with this new opportunity is the requirement for the development of more affordable prostheses compared to those sold in the US and Europe. With the introduction of these lower-cost models into the market, this article aims to assess their performance in comparison to traditional models. A literature review was conducted, analyzing four parameters—the Hospital for Special Surgery Score, Knee Society Score, Range of Motion, and Western Ontario and McMaster Universities Arthritis Index—to evaluate different models. The findings indicated that low-cost models perform either equally well or, in some cases, slightly worse than traditional ones. It is worth to mention that the existing literature on this topic is limited, resulting in a relatively small number of models and studies included in this specific study. Nevertheless, this latter serves as a valuable foundation for future in-depth analyses and investigations. [ABSTRACT FROM AUTHOR]

In today's highly competitive world market, businesses can hardly maintain their competitiveness without strong innovation abilities. In the past, many Chinese enterprises have enjoyed success through imitation. But to continue to succeed in a global marketplace, they must develop ambidextrous innovation abilities. The resource‐based theory eloquently posits that competitive advantage is associated with different and heterogeneous resources. To obtain such resources, firms must establish an external network to acquire necessary knowledge and skills. In this paper, we develop a theoretical model linking network orientation, organisational improvisation, ambidexterity and competitive tension. We postulate that organisational improvisation has a mediating effect and competitive tension is a moderator. Empirical results (N = 340) show that (1) network orientation leads to both exploratory and exploitative innovations, (2) the above effect is mediated by organisational improvisation and (3) competitive tension positively moderates the effect between network orientation and organisational improvisation. [ABSTRACT FROM AUTHOR]

Research on family firms' employment practices remains equivocal with findings from studies framed on the basis of stewardship and socioemotional wealth (SEW) preservation perspectives suggesting that family firms are better employers than nonfamily peers, and findings from studies grounded on agency theory suggesting the opposite. Arguing that these two perspectives are not mutually exclusive, we theorize that, consistent with notions of compensating differentials, pay practices in family firms offer a compensatory balancing of lower base pay with pay forms and benefits signaling the kind of caring, support and long‐term commitment typical of such firms. Accordingly, while, consistent with an agentic perspective, pay rates in nonfamily firms may be higher than in family firms, consistent with the stewardship/SEW perspective, we argue that pay and benefits may be structured to offer greater long‐term reward security in family firms. Focusing on reward practices among employees in a single job in a single industry (i.e., truck drivers), we find that where there are differences, they generally favor family firms, with a significantly higher proportion of family firms paying on the basis of fixed salary (as opposed to more variable hourly/mile‐based rates), and with those firms paying hourly offering typical and "floor" rates higher than those offered by nonfamily firms. Implications for theory and practice are discussed. [ABSTRACT FROM AUTHOR]

Persons with disabilities (PWDs) are disproportionately unemployed, underpaid, and underemployed despite their desire and capacity to work. The U.S. federal/state vocational rehabilitation (VR) program, under the supervision of the Rehabilitation Services Administration (RSA), is charged with providing services to assist eligible PWDs (VR consumers) in achieving employment. Despite research showing that VR consumers closed to self-employment (vs. non-self-employment closures) have better outcomes, self-employment is often considered as a last resort. Moreover, some evidence suggests self-employment (like non-self-employment) outcomes are associated with VR consumers' gender and racial/ethnic identity. The objective of this study was to determine trends of case closures in self-employment among PWDs within the VR program from 2011–2013 to 2017–2019 and to examine the effects of gender and race/ethnicity on self-employment outcomes. Variables of interest were obtained from RSA's Case Service Report (RSA-911) data set for 2011, 2012, 2013, 2017, 2018, and 2019. Data were recoded and analyzed. The number of closures in self-employment declined significantly. Weekly earnings in self-employment increased. Time from application to closure in self-employment decreased. Differences in VR self-employment outcomes by race/ethnicity and gender were noted. Efforts should be made to increase competency in self-employment of VR counselors and promote self-employment within the VR program. [ABSTRACT FROM AUTHOR]

The number of music therapy private practices in the United States is growing. While it is thought that improving business skills can improve business success, it is not clear what business education was received by music therapy business owners (MTBOs). The purpose of this qualitative inquiry was to explore MTBOs business education in the United States and their views on business education for music therapists and music therapy students. Following an interpretivist theoretical framework, we conducted semi-structured interviews with 21 MTBOs representing all seven regions of the American Music Therapy Association. Using thematic analysis, we created five themes with supporting subthemes. Our findings indicate that the amount of business education participants received as students did not match the amount of business education they perceived necessary to be business owners, and that they sought out additional training from a variety of sources. Participants' views on music therapy business education and skills important for business ownership in the field of music therapy are explored. [ABSTRACT FROM AUTHOR]

The specific aim was to characterize retail purchases of red and processed meat and other major protein-rich foods in the U.S. and by state. Supermarket scanner data from grocery stores, supermarkets, and big box stores collected from 2017-2019 (NielsenIQ, New York, NY) was used to characterize retail purchases of red meat, processed meat, and other protein-rich foods in thirty-one states representative of US retail food sales. Red meat, processed meat, poultry, seafood, eggs, other meats, and non-meat foods (beans, nuts, seeds, meat alternatives) by weight accounted for 25.9%, 20.4%, 25.8%, 5.9%, 12.6%, 1.3%, and 10.1%, respectively of total sales in 2017-2019. Mean per capita purchases of red meat by weight was 30.1 g/d, ranging from 45.4 g/d in Mississippi to 21.9 g/d in New York. Mean per capita purchases of processed meat by weight was 23.8 g/d, ranging from 36.6 g/d in Mississippi to 15.2 g/d in California. We observed statistically significant correlations between red and processed meat purchases with cardiovascular mortality and colorectal cancer by state. Per capita retail purchases of red and processed meat appear to reflect a dietary pattern that is not consistent with current national and international dietary recommendations. [ABSTRACT FROM AUTHOR]

This article discusses four examples of risk regulations in the United States, namely vehicle emissions, appliance efficiency, chemical safety, and the labeling of genetically modified food. In each example, consumer or environmental regulations were initiated at the state level despite business opposition. But when faced with a multiplicity of state product regulations, the affected firms decided to support the expansion of federal regulations. They were willing to accept stronger federal standards in order to preempt individual states from enacting more stringent standards than the federal government. This, in turn, led to a conflict between firms who wanted federal preemption of state restrictions and states who wanted to be able to enact regulations more stringent than those of the federal government. The outcomes of each of these conflicts over the scope of federal preemption had important impacts on each multilevel governance regulatory regime. The ability of both levels of the American government to enact more innovative risk regulations – often referred to as dynamic federalism – has made it more likely that they will be strengthened. [ABSTRACT FROM AUTHOR]

Objectives: Those underage should not use tobacco products, including electronic nicotine delivery systems. A technologically-based solution developed by Juul Labs Inc to restrict underage access seeks to automate transactions, structurally mandate age-verification, and limit the quantity of JUUL products purchased per transaction. A pilot of this standards-based approach, referred to as RACS™ (Retail Access Control Standards), was conducted to assess efficacy. Methods: RACS was implemented at 171 stores within 3 retail chains selling tobacco products in 3 states. "Secret shopper" compliance audits, in which a mystery shopper attempted to purchase JUUL products, were conducted at participating stores before and after implementation of RACS, to test compliance with age-verification and product-quantity limits. Audit failure rates were compared pre- and post-RACS implementation to assess effectiveness. Comparisons were made overall, by chain, state, and failure type. Results: A total of 3990 audits were conducted. We found large, statistically significant reductions (p < .001) in failure rates for age-verification and compliance with product-quantity limits after implementing RACS, as compared to pre- RACS rates, declining to near zero. Conclusions: Utilizing enhanced access controls can be part of a comprehensive, evidence-based tobacco-control strategy to address underage use of all tobacco products, including JUUL. ACKNOWLEDGMENT & CONFLICT OF INTEREST STATEMENT: Funding for this study was provided by Juul Labs Inc. Through Pinney Associates, Saul Shiffman provides consulting services on tobacco harm reduction on an exclusive basis to Juul Labs Inc. In that role, he acted as internal editor and coordinator for the papers in this special issue. Erik Augustson is a full-time employee of Juul Labs Inc. As Senior Director of Behavioral Affairs at JLI, he oversaw the conduct of the behavioral research reported in this special issue. [ABSTRACT FROM AUTHOR]

Background: Drug shortages are a growing global problem, posing clinical and economic challenges. To understand them better, we conducted an inventory of national public drug shortage registers and their comparability in Europe and the USA.Methods: The study was based on openly accessible drug shortage notifications published by national drug authorities. These data were obtained from all national data sources mentioned on the European Medicines Agency's (EMA's) web page and FDA in the USA. After selection of the countries with comparable data, descriptive statistics were used to present characteristics of the shortages both across countries and within countries for 9 months (January-September) in 2020. We studied whether the shortages that occurred in these countries were the same, and how shortages were distributed by therapeutic uses and formulations. We also investigated price variation between the United States and Finland among drugs in shortage in one formulation category (creams and gels).Results: Finland, Sweden, Norway, Spain, and the United States had suitable registers and were included. Altogether 5132 shortage reports from Finland (n = 1522), Sweden (n = 890), Norway (n = 800), Spain (n = 814), and the United States (n = 1106) were published during the study period. Of active ingredient level shortages 54% occurred in only one country, and 1% occurred in all five. However, at the country level, where there was one or more shortage notifications in an ATC active ingredient category, 19-41% were in a single country. The distributions by ATC therapeutic class and drug formulation differed substantially between countries, particularly between the USA and European countries. Injectables had a high shortage risk in the USA (57% of all shortages versus 17-31% of all shortages in the European countries). By contrast, shortages in gels and creams occurred only in European data (4-6% of all shortages). In the price comparison, creams and gels in shortage in Finland were 160% more expensive in the USA where these shortages were not detected.Conclusions: Public drug shortage registers are vital data sources for proactively maintaining and managing a reliable drug supply. However, our study demonstrates that much work remains to standardize the contents and quality of public register data. Shortages may not be solely a consequence of manufacturing disruptions but may reflect other contributing factors in the international drug distribution and supply mechanisms, including price differences and profit margins between national pharmaceutical markets. Data to perform practical and useful international comparisons to understand these shortages are required. [ABSTRACT FROM AUTHOR]

Two-thirds of American hospitals have chaplains. This article explores the organizational and business models that underlie how chaplains are integrated into hospitals. Based on interviews with 14 chaplain managers and the 11 healthcare executives to whom they report at 18 hospitals in 9 systems, we identify three central findings. First, there is significant variation in how spiritual care programs are staffed and integrated into their hospitals. Second, executives and chaplain managers see the value of chaplains in terms of their quality of care, reliability and responsivity to emergent patient and staff needs, and clinical training and experience working within a complex environment. Third, few departments rely on empirical data when making decisions about staffing, tending instead to default to the budgetary status quo. These findings provide the basis for a larger more systematic study. [ABSTRACT FROM AUTHOR]

Background The Coronavirus Disease 2019 (COVID-19) pandemic warranted a myriad of government-ordered business closures across the USA in efforts to mitigate the spread of the virus. This study aims to discover the implications of government-enforced health policies of reopening public businesses amidst the pandemic and its effect on county-level infection rates. Methods Eighty-three US counties (n = 83) that reported at least 20 000 cases as of 4 November 2020 were selected for this study. The dates when businesses (restaurants, bars, retail, gyms, salons/barbers and public schools) partially and fully reopened, as well as infection rates on the 1st and 14th days following each businesses' reopening, were recorded. Regression analysis was conducted to deduce potential associations between the 14-day change in infection rate and mask usage frequency, median household income, population density and social distancing. Results On average, infection rates rose significantly as businesses reopened. The average 14-day change in infection rate was higher for fully reopened businesses (infection rate = +0.100) compared to partially reopened businesses (infection rate = +0.0454). The P -value of the two distributions was 0.001692, indicating statistical significance (P < 0.01). Conclusion This research provides insight into the transmission of COVID-19 and promotes evidence-driven policymaking for disease prevention and community health. [ABSTRACT FROM AUTHOR]

Background: Quality early childhood education (ECE) sets the foundation for children's healthy development. Families make choices regarding the ECE options available to them, and families who desire smaller, more personal, flexible, and less expensive options, often select family child care (FCC) providers over center-based care. In addition, trending research in the United States indicates that there is a decline of FCC providers leading to a gap in the available resources for families. Objective: This study explored the experiences of family child care providers regarding the challenges and benefits of their profession. Methods: Two focus groups (N = 27) comprised of licensed and unlicensed FCC providers were conducted to understand their perspectives on the perceived challenges and benefits of their work. Results: Using Bromer and Korfmacher's conceptual model of high-quality support, we conducted a thematic analysis and found providers identified several challenges including: feeling uncomfortable in their home, payment and scheduling issues, frustration with parents, limited resources, and role conflicts. Providers also described strategies for managing their family childcare program including utilizing critical early childhood education learning strategies with children, separating personal and work spaces, using contracts, and the importance of networking with other professionals. Providers also shared benefits of FCC for the children in their care, themselves, and their own families. Conclusions: The findings align with Bromer and Korfmacher's (2017) conceptual model and suggest a need for networking opportunities to provide information and support amongst FCC providers, improved resource sharing, more accessible funding opportunities, and the need for business training tools. [ABSTRACT FROM AUTHOR]

While universal healthcare provisions are the global norm rather than the exception, the United States exists in the latter category. The paradox remains that while the right to health is both increasingly implemented and recognized on a global scale, the United States seems to run farther away from the arguments and global examples that might pave its way. I suggest that an understanding of the imposition of healthcare as "coercive," and hence as an impingement on individual agency, activates its criticism as an inhibition of freedom that in turn motivates the libertarianism at the heart of the dominant, market‐based approach to health insurance provisions. At least one of the underlying assumptions of this view is that universal healthcare would impose or impinge on individual rights, and that such an impingement is a violation of autonomy. In this article, I aim to challenge this assumption by suggesting that the pitting of individual health rights against collective burdens stems in part from a related assumption of general health or welfare on the part of the collective: that disability and debility alike are anomalies or anomalous to the general health of the population. In other words, it will be my contention that individual health rights are only at odds with "collective rights" when the collective is perceived to be able‐bodied. [ABSTRACT FROM AUTHOR]

Objectives: The patent linkage system upgraded patent challenges to an important factor in granting timely market approval for generic drugs. We aim to understand patent challenges and identify the factors that are associated with successful patent challengers under the patent linkage system in South Korea.Methods: We constructed a novel dataset that combined information on manufacturers with detailed data about their patent challenges after introduction of the patent linkage system. Based on the number of successful patent challenges, manufacturers were categorized into non-challengers, passive challengers, and aggressive challengers. Then, two types of logistic models were applied to identify the factors associated with successful and aggressive challengers.Findings: Only 39 active ingredients were challenged by 77 manufacturers from March 2015 to December 2019. Of 171 manufacturers, 94 (55 %) were non-challengers, 58 (34 %) were passive challengers who had succeeded in fewer than 4 patent challenges, and 19 (11 %) were aggressive challengers who had succeeded in 4 or more patent challenges. Higher sales, more employees, and a greater number of reimbursed drugs were associated with being a patent challenger, while a greater number of reimbursed drugs was associated with being an aggressive challenger.Conclusion: Some manufacturers utilize patent challenges to strengthen their product portfolios in the market. However, under the patent linkage system, the frequency of patent challenges is limited in South Korea compared to the United States. In particular, patent challenges against drugs in injection form and biologics are very rare. [ABSTRACT FROM AUTHOR]

As a music therapy private practice is both a business and a healthcare service, it should adhere to ethical standards from both disciplines. However, this topic has rarely been examined in the music therapy literature. The purpose of this phenomenological study was to explore ethical dilemmas experienced by music therapy business owners (MTBOs) in their private practice and how MTBOs avoid or address ethical dilemmas. Utilizing convenience and snowball sampling techniques, 21 MTBOs in the United States were interviewed using semi-structured interviews. To answer the two areas of inquiry, we identified three themes and 12 subthemes: (1) Ethical issues related to client welfare, (2) Ethical issues related to business relationships and operation, and (3) Strategies to address or avoid ethical dilemmas. MTBOs also shared how they ensure ethical behavior in themselves, with their employees or independent contractors, and when interacting with professionals outside the private practice. These findings provide a better understanding of MTBOs' lived experiences of ethics in their private practice and may benefit other music therapists who are in private practice or are wanting to go into private practice. Limitations and recommendations for further research are provided. [ABSTRACT FROM AUTHOR]

Introduction: The smokeless tobacco (SLT) industry in the U.S. continues to transform with novel products amid an evolving regulatory environment. We report SLT sales trends in the U.S. by analyzing retail market scanner data from 2011 through 2019.Methods: National SLT sales data were obtained from Nielsen's Convenience Track System for January 2011 to December 2019. UPC codes were used to classify products by attributes including type, parent company, brand, form, and flavor. Market share was calculated as percentage of total unit sales. Detailed product analysis was presented for moist snuff, snus, and tobacco-free nicotine products.Results: SLT sales increased by 5.8% between 2011 and 2016 but declined by 3.9% from 2016 to 2019. Moist snuff sales increased by 8.1% between 2011 and 2016 and then declined 7.4% from 2016 to 2019 but still accounted for roughly 90% of the overall market annually. Between 2011 and 2019, snus sales consistently increased while sales of chew, dry snuff, and dissolvables decreased. Tobacco-free nicotine products emerged in 2016 and captured 4.0% of the market by 2019. Portion pouch packaging and flavors showed consistent growth although their popularity varied by the type of smokeless product.Conclusion: This study extends our previous work on U.S. SLT market trends through 2019. Overall sales increased between 2011 and 2016 but there were signs of leveling off including declining sales of moist snuff. Newer products continue to gain market share. Continued monitoring of SLT sales is needed, particularly given the new modified risk status of several products.Implications: This study analyzed the last 9 years of smokeless tobacco market data (2011-2019) to describe recent trends in sales. Overall, the smokeless product category is quite resilient although signs suggest downward trends among some product categories and features. New types of smokeless tobacco products (eg, snus and tobacco-free nicotine pouches) account for a growing share of the market. [ABSTRACT FROM AUTHOR]

On April 8, 2020, the Navajo Nation issued an administrative order limiting business operations. Facing high coronavirus disease 2019 (COVID-19) rates and limited food infrastructure, a survey was conducted among Navajo Nation store managers to assess: (1) COVID-19 adaptations; (2) challenges; (3) changes in customer volume and purchasing; and (4) suggestions for additional support. Purposive sampling identified 29 stores in Navajo communities. Representatives from 20 stores (19 store managers/owners, 1 other; 7 grocery, and 13 convenience/other stores) were interviewed by phone or in-person to reach saturation (new information threshold < 5%). Responses were coded using frequencies and inductive thematic analysis. All 20 stores implemented COVID-19 guidelines (Centers for Disease Control and Prevention [CDC]/Navajo Nation) and most received orientation/support from local chapters, community organizations, or health centers. Stores implemented staff policies (50%, handwashing, vaccinations, protective personal equipment (PPE), sick leave, temperature checks), environmental changes (50%, hand sanitizer, checkout dividers), customer protocols (40%, limit customers, mask requirements, closed restrooms), and deep cleaning (40%). Most stores (65%) reported challenges including stress/anxiety, changing guidelines, supply chain and customer compliance; 30% reported infection or loss of staff. Weekday customer volume was slightly higher vs. pre-COVID, but weekend lower. Stores reported consistent or more healthy food purchases (50%), more nonfood essentials (20%), or shelf-stable foods (10%). Desired support included further orientation (30%), leadership support (20%), overtime/time to learn guidelines (20%), and signage/handouts (15%). Despite a high COVID-19 burden and limited food store infrastructure, Navajo Nation stores adapted by implementing staff, environmental and customer policies. Local support, staffing, and small store offerings were key factors in healthy food access. [ABSTRACT FROM AUTHOR]