Search

Background: Prior investigations have documented disparities in the supply side of Maryland's Medical Marijuana program. Initially a disproportionate share of licenses to cultivate and distribute medical marijuana were awarded to Non-Hispanic White owned businesses. The state has implemented measures to ameliorate the inequity by prioritizing license awards to qualified minority owned businesses. Objectives: The objective of this study is to examine the racial and income characteristics of communities where licensed dispensaries are located. We quantify the racial and income characteristics of communities where Maryland medical cannabis dispensaries are located and explore whether Maryland medical marijuana dispensaries disproportionately locate in high-income, majority-White zip codes. Method: Using data from the Maryland Medical Cannabis Commission and the American Communities Survey, we create geocodes for each of the operating dispensaries as of December 2019. We examine the distribution of medical cannabis dispensaries by zip code level household income and zip code level racial distribution. The data set encompasses 85 operating cannabis dispensaries in Maryland and 6.1 million Marylanders distributed across 468 zip codes in 2018–2019. Results: The analysis indicates that dispensaries are concentrated in zip codes whose residents are racially diverse, and with higher concentrations of retail establishments. Conclusion: Community level racial or income disparities in access to medical cannabis were not observed in Maryland. Access to medical cannabis, based on ability to pay out of pocket for the product, may be uneven. [ABSTRACT FROM AUTHOR]

Background: The health and financial burden of the opioid epidemic has been disproportionately hard on reproductive-aged parenting women. This crisis not only impacts the well-being of the mothers but is also spilling over to their children and families. Objectives: Given the alarming rise of opioid use disorder (OUD) among mothers, this study seeks to examine the primary motivations and sources for the most recent prescription opioids misused among this population. Methods: Using data from 2015 to 2016 National Survey of Drug Use and Health (NSDUH), this study analyzes data on reproductive-aged parenting women who have misused any prescription opioids in the previous 12 months. All estimates were weighted to account for NSDUH's complex survey design and to make the estimates nationally representative (weighted N ≈ 14.4 million). Results: Results show that physicians (43%) are the most commonly reported source for obtaining prescription opioids among parenting women with OUD, whereas social sources (57%) are the most common source for parenting women who have misused opioids without OUD. A significant proportion of parenting women with OUD reported drug-related reasons (57%) and relief from physical pain (25%) as the two primary motivations for opioid misuse, while parenting women without OUD reported relief from physical pain (45%) and help with emotions or feelings (32%) as primary motivations. Conclusions: Opioid misuse and use disorder among parenting women are a significant health risk. Policy initiatives that encompasses a comprehensive approach toward the crisis are warranted. [ABSTRACT FROM AUTHOR]

The Affordable Care Act (ACA) provides financial incentives to prevent substance use disorders (SUDs). Local health departments (LHDs) can receive funds to establish care teams that partner with primary care providers and health systems. This study estimates the potential effect of LHDs on emergency visits for SUDs, using linked data sets from the Healthcare Cost and Utilization Project Emergency Department (ED) sample for the State of Maryland—2012, the National Association of County and City Health Officials Profiles Survey 2013, and Area Health Resource File 2013 to estimate potential effect of LHDs' provision of SUD preventive care and SUD-related policy implementation. Local health department involvement in SUD-related policy during the past 2 years and provision of preventive care for behavioral health in the past year significantly reduced the probability of having a SUD-related ED visit by 11% and 6%, respectively, after controlling for individual characteristics (odds ratio [OR] = 0.89, p <.001; OR = 0.93, p <.001). After adjusting for the individual and contextual factors, LHD involvement in policy was still associated with 14% reduction in SUD-related ED visits (OR = 0.86, p <.001). Results offer insights on the extent to which the LHD activities can possibly affect SUD-related ED visits and provide a foundation for future work to identify effective LHD interventions. [ABSTRACT FROM AUTHOR]

The objective was to estimate the association between health care expenditures and implementation of preventive mental health programs by local health departments (LHDs). Multilevel nationally representative data sets were linked to test the hypothesis that LHDs' provision of preventive mental health programs was associated with cost savings. A generalized linear model with log link and gamma distribution and state-fixed effects was used to estimate the association between LHDs' mental illness prevention services and total health care expenditures per person per year for adults aged 18 years and older. The main outcome measure was the annual total health care expenditure per person. The findings indicated that LHD provision of population-based prevention of mental illness was associated with an $824 reduction (95% confidence interval: -$1,562.94 to -$85.42, P < 0.05) in annual health care costs per person, after controlling for individual, LHD, community, and state characteristics. LHDs can play a critical role in establishing an integrated health care model. Their impact, however, has often been underestimated or neglected. Results showed that a small investment in LHDs may yield substantial cost savings at the societal level. The findings of this research are critical to inform policy decisions for the expansion of the Public Health 3.0 infrastructure. [ABSTRACT FROM AUTHOR]

The Affordable Care Act (ACA) aims to expand health insurance coverage and minimize financial barriers to receiving health care services for individuals. However, little is known about how the ACA has impacted individuals with mental health conditions. This study finds that the implementation of the ACA is associated with an increase in rate of health insurance coverage among nonelderly adults with serious psychological distress (SPD) and a reduction in delaying and forgoing necessary care. The ACA also reduced the odds of an individual with SPD not being able to afford mental health care. Mental health care access among racial and ethnic minority populations and people with low income has improved during 2014-2016, but gaps remain. [ABSTRACT FROM AUTHOR]

Research has shown a significant increase in overdose deaths among reproductive-aged parenting women in the United States. Given the alarming rise of opioid use disorder, this study analyzes polysubstance use among reproductive-aged parenting women. Using data from 2015 to 2016 National Survey of Drug Use and Health (NSDUH), this study examines data on prevalence and patterns of polysubstance use among US reproductive-aged parenting women who misused prescription opioids in the past 30 days. Results show that 87% of parenting women who misused prescription opioids reported using other substances concurrently in the past 30 days. [ABSTRACT FROM AUTHOR]

Objective: To estimate health care expenditure trends among young adults ages 19-25 before and after the 2010 implementation of the Affordable Care Act (ACA) provision that extended eligibility for dependent private health insurance coverage.Data Sources: Nationally representative Medical Expenditure Panel Survey data from 2008 to 2012.Study Design: We conducted repeated cross-sectional analyses and employed a difference-in-differences quantile regression model to estimate health care expenditure trends among young adults ages 19-25 (the treatment group) and ages 27-29 (the control group).Principal Findings: Our results show that the treatment group had 14 percent lower overall health care expenditures and 21 percent lower out-of-pocket payments compared with the control group in 2011-2012. The overall reduction in health care expenditures among young adults ages 19-25 in years 2011-2012 was more significant at the higher end of the health care expenditure distribution. Young adults ages 19-25 had significantly higher emergency department costs at the 10th percentile in 2011-2012. Differences in the trends of costs of private health insurance and doctor visits are not statistically significant.Conclusions: Increased health insurance enrollment as a consequence of the ACA provision for dependent coverage has successfully reduced spending and catastrophic expenditures, providing financial protections for young adults. [ABSTRACT FROM AUTHOR]

Objective The goal of this study was to assess the likelihood of purchasing antidepressants, number of antidepressants purchased, and out-of-pocket ( OOP) and total spending on antidepressants among people living with serious psychological distress ( SPD) from 2008 to 2014. Methods Data source: Medical Expenditure Panel Survey (MEPS) Data for the years from 2008 to 2014. Sample Design: A retrospective cross-sectional design was employed. MEPS is a nationally representative survey of the civilian, noninstitutionalised population in the U.S. The subset of individuals with serious psychological distress ( SPD) who used any antidepressant in the study period was 2401. Measurements: The study uses an established cut-off for serious psychological distress of a Kessler-6 score of ≥13. The Anderson Health Behavior model is used to select covariates. Data analysis: We calculated the mean number of scripts purchased, odds of any purchase, OOP, third-party and total payments for prescription antidepressants among people with SPD using Stata 14. Key findings The number of scripts purchased per person remained relatively stable between 2008 and 14. The odds of purchasing scripts were higher for Caucasian women, and were significantly lower for African Americans and people who spoke a language other than English at home. There was a significant decline in OOP among near poor, low-income and low-educational attainment people in 2014. Conclusions Evidence suggests that low-income, low-educational attainment people with SPD benefitted from health reform initiatives in the form of lower OOP in 2014. Maintenance of policies that enable insurance coverage of these people may have a role in ensuring access to needed antidepressants. [ABSTRACT FROM AUTHOR]

Objective: Young adults with behavioral health conditions (mental or substance use disorders) often lack access to care. In 2010, the Affordable Care Act (ACA) extended eligibility for dependent coverage under private health insurance, allowing young adults to continue on family plans until age 26. The objective of this study was to analyze out-of-pocket (OOP) spending as a share of total health care expenditures for young adults with behavioral health conditions before and after the implementation of the ACA dependent care provision. The study examined the population of young adults with behavioral health conditions overall and by race and ethnicity.Methods: The study analyzed 2008-2009 and 2011-2012 nationally representative data from the Medical Expenditure Panel Survey with zero-or-one inflated beta regression models in a difference-in-differences framework to estimate the impact of the ACA's dependent coverage expansion. OOP spending was examined as a share of total health care expenditures among young adults with behavioral health disorders. The study compared the treatment group of individuals ages 19-25 (unweighted N=1,158) with a group ages 27-29 (unweighted N=668).Results: Young adults ages 19-25 with behavioral health disorders were significantly less likely than the older group to have high levels of OOP spending after the implementation of the ACA's dependent coverage expansion. The reduction was pronounced among young adults from racial-ethnic minority groups.Conclusions: The extension of health insurance coverage to young adults with behavioral health disorders has provided them with additional financial protection, which can be important given the low incomes and high debt burden that characterize the age group. [ABSTRACT FROM AUTHOR]

Designing culturally sensitive personalized interventions is essential to sustain patients’ involvement in their treatment and encourage patients to take an active role in their own health and health care. We consider patient activation and empowerment as a cyclical process defined through patient accumulation of knowledge, confidence, and self-determination for their own health and health care. We propose a patient-centered, multilevel activation and empowerment framework (individual-, health care professional-, community-, and health care delivery system-level) to inform the development of culturally informed personalized patient activation and empowerment (P-PAE) interventions to improve population health and reduce racial and ethnic disparities. We discuss relevant Affordable Care Act payment and delivery policy reforms and how they affect patient activation and empowerment. Such policies include Accountable Care Organizations and value-based purchasing, patient-centered medical homes, and the community health benefit. Challenges and possible solutions to implementing the P-PAE are discussed. Comprehensive and longitudinal data sets with consistent P-PAE measures are needed to conduct comparative effectiveness analyses to evaluate the optimal P-PAE model. We believe the P-PAE model is timely and sustainable and will be critical to engaging patients in their treatment, developing patients’ abilities to manage their health, helping patients express concerns and preferences regarding treatment, empowering patients to ask questions about treatment options, and building up strategic patient–provider partnerships through shared decision making. [ABSTRACT FROM AUTHOR]

Priscilla Novak, Ph.D., Maria X. Sanmartin, Ph.D., Mir M. Ali, Ph.D., Jie Chen, Ph.D. Individuals with serious mental illness have more chronic medical conditions that increase their risk for contracting severe COVID-19 compared with individuals without serious mental illness and are more likely to be distinctly affected by the pandemic. Underlying medical conditions of individuals with and without serious mental illness a Nicotine dependence Obesity Kidney disease Liver cirrhosis Heart disease Hypertension Cancer Diabetes Asthma Bronchitis 010 20 30 40 50 Percentage Serious mental illness No serious mental illness a TheNsforthepercentagesshownhereareinAppendixTable1oftheonlinesupplement. [Extracted from the article]