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Objectives: To assess changes in private insurance coverage and behavioral treatment of people aged 19 to 25 years and 26 to 35 years following the 2010 Affordable Care Act (ACA) dependent care provision and 2014 insurance reforms., Methods: We extracted data from the 2008 to 2016 US National Surveys on Drug Use and Health. We used an adjusted difference-in-differences approach to assess effects of age group on change in coverage. Replications in subgroups with serious psychological distress or substance use disorders also assessed change in mental health and substance use treatment., Results: Between 2008 to 2010 and 2011 to 2013, the increase in coverage of the younger group significantly differed from the decrease in the older group, but the 2 groups did not significantly differ between 2011 to 2013 and 2014 to 2016 (+3.2 percentage points; P < .001; and +3.8 percentage points; P < .001). Similar trends occurred among the distressed subgroups and the younger but not older substance use subgroup who reported no significant coverage changes in either period. A minority in the distressed (31.4%-45.4%) and substance use (5.1%-8.5%) subgroups received treatment., Conclusions: Although implementation of the ACA provisions coincided with coverage gains for young adults, challenges persist in engaging those with mental health and substance use problems in treatment.

Objectives: To assess whether the use of firearms explains rural-urban differences in suicide rates., Methods: We performed a retrospective analysis on all 6196 well-characterized adult suicides in Maryland from 2003 through 2015. We computed rate ratios by using census data and then stratified by sex, with adjustment for age and race., Results: Suicide rates were higher in rural compared with urban counties. However, the higher rural suicide rates were limited to firearm suicides (incident rate ratio [IRR] = 1.66; 95% confidence interval [CI] = 1.20, 2.31). Nonfirearm suicide rates were not significantly higher in rural settings. Furthermore, 89% of firearm suicides occurred in men and the higher rural firearm suicide rate was limited to men (IRR = 1.36; 95% CI = 1.09, 1.69). Women were significantly less likely to complete suicide in rural areas (IRR = 0.63; 95% CI = 0.43, 0.94), regardless of method., Conclusions: Male firearm use drives the increased rate of suicide in rural areas. The opposite associations between urbanicity and suicide in men and women may be driven by the male preference for firearms as a method for committing suicide.

Objectives: To assess trends in continuing and new prescriptions for sedative-hypnotic medications, including benzodiazepines (BZDs) and non-BZD receptor agonists (nBZRAs)., Methods: Data came from the National Ambulatory Medical Care Survey and comprised 287 288 randomly sampled patient visits. Physicians reported medications prescribed and whether they were "continuing" or "new" prescriptions. We assessed trends in continuing BZD, new BZD, continuing nBZRA, and new nBZRA prescriptions from 2005 to 2012., Results: Proportions of visits with continuing prescriptions increased from 3.4% in 2005 to 4.7% in 2012 (P < .01) for BZDs, and from 1.0% to 1.7% (P < .01) for nBZRAs. We noted no changes in new prescriptions. We observed the same patterns across patient age and physician specialties, except psychiatry. Despite no growth over time, the prevalence of visits involving continuing and new BZD and nBZRA prescriptions was much higher in psychiatry than in primary care and other specialties., Conclusions: Increased sedative-hypnotic prescribing in recent years may be attributable to long-term growth in continuing prescriptions, rather than new prescriptions. Public Health Implications. Findings call for renewed efforts to limit continuing prescribing of sedative-hypnotics to reduce their use in the population.

Asian Americans are more likely than non-Latino Whites to report binge eating, but are equally likely to meet binge eating disorder (BED) criteria. Using nationally representative data, we assessed whether differences in symptom reporting contributed to this disparity. Asian Americans were less likely than Whites to endorse BED symptoms related to distress or loss of control despite a higher prevalence of binge eating; they were also less likely to receive services for eating problems. Findings suggest cultural differences might lead to under-recognition of binge eating in Asian Americans.

Objectives: We assessed whether homeless adults entering substance abuse treatment in Massachusetts were less likely than others to enroll in Medicaid after implementation of the MassHealth Medicaid expansion program in 1997., Methods: We used interrupted time-series analysis in data on substance abuse treatment admissions from the Treatment 0Episode Data Set (1992-2009) to evaluate Medicaid coverage rates in Massachusetts and to identify whether trends differed between homeless and housed participants. We also compared Massachusetts data with data from 17 other states and the District of Columbia combined., Results: The percentage of both homeless and housed people entering treatment with Medicaid increased approximately 21% after expansion (P = .01), with an average increase of 5.4% per year over 12 years (P = .01). The increase in coverage was specific to Massachusetts, providing evidence that the MassHealth policy was the cause of this increase., Conclusions: Findings provide evidence in favor of state participation in the Medicaid expansion in January 2014 under the Affordable Care Act and suggest that hard-to-reach vulnerable groups such as substance-abusing homeless adults are as likely as other population groups to benefit from this policy.