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The aim of the study is to assess the use and levels of moderate-to-vigorous physical activity (MVPA) occurring in innovative playgrounds in London vs. traditional playgrounds in the US in neighborhoods with a similar population density. This is a cross-sectional observational study. We selected a sample of London playgrounds based on their innovative design. One group of eight playgrounds was matched to the US playgrounds by size and population density; a second group of very large London playgrounds was matched only by population density. Playground use and person-hours of MVPA were measured using direct observation at similar times of the day and days of the week in all locations. The number of playground visit hours was 58% higher in London than in the US (394 vs 249). The matched London playgrounds had 37.8% more children and 129% more adults who were, respectively, engaging in 90% and 116% more MVPA. While the London playgrounds were nearly 8.5 times larger than the US ones, they attracted a total of 5.8 times more visitors (1399 vs 243, P <.0001), and this included 10 times as many adults (679 vs. 66, P <.0001) and 7.5 times more seniors (23 vs. 3). The London playgrounds included more amenities targeting adults. The design of an innovative playground was associated with the amount of MVPA in similar-sized playgrounds, but the size of the playground was more strongly associated with the number of visitors. It is as important to design playgrounds for adults as it is for children to increase visit hours. Compared with US neighborhood playgrounds, innovative London playgrounds: • Attract more visitors. • Support more moderate-to-vigorous physical activity. • Attract a greater percentage of adults and seniors. • Offer a wider variety of play features. [ABSTRACT FROM AUTHOR]

Background: e-Cigarette (electronic cigarette) use has been a public health issue in the United States. On June 23, 2022, the US Food and Drug Administration (FDA) issued marketing denial orders (MDOs) to Juul Labs Inc for all their products currently marketed in the United States. However, one day later, on June 24, 2022, a federal appeals court granted a temporary reprieve to Juul Labs that allowed it to keep its e-cigarettes on the market. As the conversation around Juul continues to evolve, it is crucial to gain insights into the sentiments and opinions expressed by individuals on social media., Objective: This study aims to conduct a comprehensive analysis of tweets before and after the ban on Juul, aiming to shed light on public perceptions and sentiments surrounding this contentious topic and to better understand the life cycle of public health-related policy on social media., Methods: Natural language processing (NLP) techniques were used, including state-of-the-art BERTopic topic modeling and sentiment analysis. A total of 6023 tweets and 22,288 replies or retweets were collected from Twitter (rebranded as X in 2023) between June 2022 and October 2022. The encoded topics were used in time-trend analysis to depict the boom-and-bust cycle. Content analyses of retweets were also performed to better understand public perceptions and sentiments about this contentious topic., Results: The attention surrounding the FDA's ban on Juul lasted no longer than a week on Twitter. Not only the news (ie, tweets with a YouTube link that directs to the news site) related to the announcement itself, but the surrounding discussions (eg, potential consequences of this ban or block and concerns toward kids or youth health) diminished shortly after June 23, 2022, the date when the ban was officially announced. Although a short rebound was observed on July 4, 2022, which was contributed by the suspension on the following day, discussions dried out in 2 days. Out of the top 50 most retweeted tweets, we observed that, except for neutral (23/45, 51%) sentiment that broadcasted the announcement, posters responded more negatively (19/45, 42%) to the FDA's ban., Conclusions: We observed a short life cycle for this news announcement, with a preponderance of negative sentiment toward the FDA's ban on Juul. Policy makers could use tactics such as issuing ongoing updates and reminders about the ban, highlighting its impact on public health, and actively engaging with influential social media users who can help maintain the conversation., (©Shuo-Yu Lin, Sahithi Kiran Tulabandu, J Randy Koch, Rashelle Hayes, Andrew Barnes, Hemant Purohit, Songqing Chen, Bo Han, Hong Xue. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 01.10.2024.)

Background: Adults aged 21-29 have the highest past-month prevalence of tobacco, alcohol, and illicit drug use in the U.S. Currently, young adults often delay traditional adulthood milestones (e.g., marriage and childbearing), which may impact their household composition and substance use., Methods: We examined how the past-month prevalence of eight mutually exclusive substance use outcomes varied by household composition among young adults using the 2016-2019 National Surveys on Drug Use and Health (NSDUH) data. Bivariable and multivariable multinomial logistic regression analyses were applied., Results: Among young adults residing with their children, the most common household composition was residing with children and a spouse/partner (16.6%, 95% CI = 16.5-16.8%). Among those residing without children, common household compositions included residing with parents (22.8%, 95% CI = 22.2-23.4%) and residing only with a spouse/partner (17.9%, 95% CI = 17.6-18.3%). Past-month prevalence of binge alcohol, tobacco, and illicit drug use varied by household composition. Residing only with children and a spouse/partner was associated with a low prevalence of most examined substance use patterns. Across household compositions, those residing solely with unrelated individuals had the highest adjusted prevalence of tobacco, drug, and binge alcohol use (13.8%, 95% CI = 12.5-15.1%)., Conclusions: The prevalence of substance use patterns among U.S. young adults varies by household composition. Those residing solely with unrelated individuals had the highest prevalence of tobacco, binge alcohol, and drug use. The presence of a young adult's own children and a spouse/partner is associated with a lower prevalence of most examined substance use patterns. As household compositions continue to diversify, targeted substance use prevention/treatment strategies may be needed.

Background: Food insecurity is associated with poor glycemic control and increased risk for diabetes-related complications. The clinical benefit of addressing these challenges through a medically supportive grocery prescription (GRx) program in patients with type 2 diabetes mellitus (T2D) remains unclear. We report the aims and design of a randomized clinical trial to evaluate the effectiveness of a 6-month GRx intervention on hemoglobin A1c (HbA1c) levels among low-income adults with T2D., Methods: The Kaiser Permanente Evaluating Nutritional Interventions in Food-Insecure High-Risk Adults (KP ENRICH) Study is a pragmatic randomized trial enrolling 1100 participants within Kaiser Permanente Northern California and Southern California, two integrated health care delivery systems serving >9 million members. Medicaid-insured adults with T2D and baseline HbA1c ≥7.5% will be randomized at a 1:1 ratio to either GRx, delivered as $100 per month for select items from among a curated list of healthful food groups in an online grocery ordering and home-delivery platform along with biweekly digital nutrition educational materials, or control, consisting of free membership and deliveries from the online grocery platform but without curated food groups or purchasing dollars. The primary outcome is 6-month change in HbA1c. Secondary outcomes include 12-month change in HbA1c, and 6- and 12-month change in medical resource utilization, food security, nutrition security, dietary habits, diabetes-related quality of life, and dietary self-efficacy., Conclusions: The results of this large randomized clinical trial of GRx will help inform future policy and health system-based initiatives to improve food and nutrition security, disease management, and health equity among patients with T2D., Competing Interests: Declaration of competing interest Dr. Mozaffarian reports research funding from the National Institutes of Health, Gates Foundation, Kaiser Permanente Fund, National Association of Chain Drug Stores Foundation, and Rockefeller Foundation; personal fees from Acasti Pharma (ended); scientific advisory board, Beren Therapeutics, Brightseed, Calibrate, Elysium Health, Filtricine, HumanCo, Instacart Health, January Inc., Season Health, Validation Institute (ended: Perfect Day, Tiny Organics); an unrestricted gift from Google; stock ownership in Calibrate and HumanCo; and chapter royalties from UpToDate. Others at the Food is Medicine Institute have received research funding or gifts for investigator-initiated research from About Fresh, the American Diabetes Association, Kroger, and family foundations. The remaining authors declare no conflicts of interest., (Copyright © 2024. Published by Elsevier Inc.)

Background: The potentially fatal attacks experienced by porphyria carriers are triggered by various porphyrinogenic drugs. However, determining the safety of particular drugs is challenging., Methods: We retrospectively used the U.S. Food and Drug Administration's Adverse Event Reporting System (FAERS) to identify drugs associated with porphyria as an adverse event (AE) extracted from data from January 2004 to March 2022. The associated search terms included "Porphyria," "Porphyria screen," "Porphyria non-acute," "Porphyria acute," "Acquired porphyria," and "Pseudoporphyria." Signal mining analysis was performed to identify the association between drugs and AEs by four algorithms, namely the reporting odds ratio, proportional reporting ratio, Bayesian confidence propagation neural network, and multi-item gamma Poisson shrinker., Results: FAERS reported 1470 cases of porphyria-related AEs, and 406 drugs were screened after combining trade and generic names. All four algorithms identified 52 drugs with signals. The characteristics of all the reports and signaling drugs were analyzed., Conclusions: This is the first report of drug-associated porphyria that provides critical information on drug porphyrogenicity, facilitating rational and evidence-based drug prescription and improving the accuracy of porphyrogenicity prediction based on model algorithms. Moreover, this study serves a reference for clinicians to ensure that porphyrinogenic drugs are not prescribed to carriers of porphyria genetic mutations., (© 2024. The Author(s).)

Importance: Parents' overdose death can have a profound short- and long-term impact on their children, yet little is known about the number of children who have lost a parent to drug overdose in the US., Objective: To estimate the number and rate of children who have lost a parent to drug overdose from 2011 to 2021 overall and by parental age, sex, and race and ethnicity., Design, Setting, and Participants: This was a cross-sectional study of US community-dwelling persons using data from the National Survey on Drug Use and Health (2010-2014 and 2015-2019) and the National Vital Statistics System (2011-2021). Data were analyzed from January to June 2023., Exposure: Parental drug overdose death, stratified by age group, sex, and race and ethnicity., Main Outcomes and Measures: Numbers, rates, and average annual percentage change (AAPC) in rates of children losing a parent aged 18 to 64 years to drug overdose, overall and by age, sex, and race and ethnicity., Results: From 2011 to 2021, 649 599 adults aged 18 to 64 years died from a drug overdose (mean [SD] age, 41.7 [12.0] years; 430 050 [66.2%] male and 219 549 [33.8%] female; 62 606 [9.6%] Hispanic, 6899 [1.1%] non-Hispanic American Indian or Alaska Native, 6133 [0.9%] non-Hispanic Asian or Pacific Islander, 82 313 [12.7%] non-Hispanic Black, 485 623 [74.8%] non-Hispanic White, and 6025 [0.9%] non-Hispanic with more than 1 race). Among these decedents, from 2011 to 2021, an estimated 321 566 (95% CI, 276 592-366 662) community-dwelling children lost a parent aged 18 to 64 years to drug overdose. The rate of community-dwelling children who lost a parent to drug overdose per 100 000 children increased from 27.0 per 100 000 in 2011 to 63.1 per 100 000 in 2021. The highest rates were found among children of non-Hispanic American Indian or Alaska Native individuals, who had a rate of 187.1 per 100 000 in 2021, more than double the rate among children of non-Hispanic White individuals (76.5 per 100 000) and non-Hispanic Black individuals (73.2 per 100 000). While rates increased consistently each year for all parental age, sex, and race and ethnicity groups, non-Hispanic Black parents aged 18 to 25 years had the largest AAPC (23.8%; 95% CI, 16.5-31.6). Rates increased for both fathers and mothers; however, more children overall lost fathers (estimated 192 459; 95% CI, 164 081-220 838) than mothers (estimated 129 107; 95% CI, 112 510-145 824)., Conclusions and Relevance: An estimated 321 566 children lost a parent to drug overdose in the US from 2011 to 2021, with significant disparities evident across racial and ethnic groups. Given the potential short- and long-term negative impact of parental loss, program and policy planning should ensure that responses to the overdose crisis account for the full burden of drug overdose on families and children, including addressing the economic, social, educational, and health care needs of children who have lost parents to overdose.

Objective: We examined prescription related opioid use disorder (POUD) prevalence, individual symptoms, severity, characteristics, and treatment by prescription opioid misuse status among adults with prescription opioid use., Methods: Cross-sectional study using nationally representative data from 47,291 adults aged ≥18 years who participated in the 2021 National Survey on Drug Use and Health. Past-year POUD used DSM-5 criteria., Results: Among US adults with past-year prescription opioid use, 12.1% (95% CI, 11.1%-13.1%) misused prescription opioids, and 7.0% (95% CI, 6.2%-8.9%) had POUD. Among adults with POUD, 62.0% (95% CI, 56.7%-67.2%) reported no prescription opioid misuse, including 49.1% (95% CI, 43.5%-54.7%) with mild POUD, 11.0% (95% CI, 6.5%-15.4%) with moderate POUD, and 1.9% (95% CI, 0.6%-3.2%) with severe POUD. Prevalence of POUD was 4.5 times higher (prevalence ratio = 4.5, 95% CI, 3.6-5.6) among those reporting prescription opioid misuse (22.0%, 95% CI, 18.6%-25.8%) than those reporting use without misuse (4.9%, 95% CI, 4.2%-5.7%). Among adults reporting prescription opioid use without misuse, high POUD prevalence was found for those with ≥3 emergency department visits (16.4%, 95% CI, 11.5%-23.0%), heroin use/use disorder (17.1%, 95% CI, 5.2%-43.8%), prescription sedative/ tranquilizer use disorder (36.2%, 95% CI, 23.6%-51.1%), and prescription stimulant use disorder (21.8%, 95% CI, 11.0%-38.7%)., Conclusions: Moderate-to-severe POUD is more frequent among adults who report misusing prescription opioids. However, 62% of adults with POUD do not report prescription opioid misuse, suggesting that adults who are treated with prescription opioids and report no misuse could be at risk for developing POUD. Results highlight the need to screen for and treat POUD among adults taking prescription opioids regardless of whether they report prescription opioid misuse., (© Copyright 2024 Physicians Postgraduate Press, Inc.)

In 2022, 81,806 opioid-involved overdose deaths were reported in the United States, more than in any previous year. Medications for opioid use disorder (OUD), particularly buprenorphine and methadone, substantially reduce overdose-related and overall mortality. However, only a small proportion of persons with OUD receive these medications. Data from the 2022 National Survey on Drug Use and Health were applied to a cascade of care framework to estimate and characterize U.S. adult populations who need OUD treatment, receive any OUD treatment, and receive medications for OUD. In 2022, 3.7% of U.S. adults aged ≥18 years needed OUD treatment. Among these, only 25.1% received medications for OUD. Most adults who needed OUD treatment either did not perceive that they needed it (42.7%) or received OUD treatment without medications for OUD (30.0%). Compared with non-Hispanic Black or African American and Hispanic or Latino adults, higher percentages of non-Hispanic White adults received any OUD treatment. Higher percentages of men and adults aged 35-49 years received medications for OUD than did women and younger or older adults. Expanded communication about the effectiveness of medications for OUD is needed. Increased efforts to engage persons with OUD in treatment that includes medications are essential. Clinicians and other treatment providers should offer or arrange evidence-based treatment, including medications, for patients with OUD. Pharmacists and payors can work to make these medications available without delays., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Wilson M. Compton reports ownership of stock in General Electric Company (sold September 2022), 3M companies, and Pfizer, Inc. Yngvild Olsen reports providing medical care to patients with opioid use disorder as an approved, part-time (4 hours per week) external activity to her work at the Substance Abuse and Mental Health Services Administration. No other potential conflicts of interest were reported.

Background: Most violent crimes (52 %) are committed by adults aged 18-34, who account for 23 % of the US population and have the highest prevalence of cannabis use and cannabis use disorder (CUD). We examined whether and how associations of cannabis use, use frequency, and CUD with violent behavior (i.e., attacking someone with the intent to harm seriously) vary by sex in U.S. young adults., Methods: Data were from 113,454 participants aged 18-34 in the 2015-2019 US National Surveys on Drug Use and Health, providing nationally representative data on cannabis use, CUD (using DSM-IV criteria), and violent behavior. Descriptive analyses and bivariate and multivariable logistic regression analyses were conducted., Results: Among U.S. adults aged 18-34, 28.9 % (95 % CI = 28.5-29.2 %) reported past-year cannabis use (with/without CUD), including 20.5 % (95 % CI = 20.2-20.8 %) with non-daily cannabis without CUD, 4.7 % (95 % CI = 4.5-4.8 %) with daily cannabis use without CUD, 2.1 % (95 % CI = 1.9-2.2 %) with non-daily cannabis use and CUD, and 1.7 % (95 % CI = 1.5-1.8 %) with daily cannabis use and CUD. Past-year adjusted prevalence of violent behavior was higher among males with daily cannabis use but without CUD (2.9 %, 95 % CI = 2.4-2.7 %; adjusted prevalence ratio (PR) = 1.7, 95 % CI = 1.3-2.2) and males with daily cannabis use and CUD (3.1 %, 95 % CI = 2.3-4.0 %; adjusted PR = 1.8, 95 % CI = 1.3-2.4) than males without past-year cannabis use (1.7 %, 95 % CI = 1.6-1.9 %). Adjusted prevalence of violent behavior was higher among females with cannabis use regardless of daily cannabis use/CUD status (adjusted prevalence = 1.6-2.4 %, 95 % CIs = 0.9-3.2 %; adjusted PRs = 1.6-2.4, 95 % CI = 1.3-3.2) than females without past-year cannabis use (1.0 %, 95 % CI = 0.9-1.1 %)., Conclusions: Research is needed to ascertain the directionality of the associations between cannabis use and violent behavior and underlying sex-specific mechanism(s). Our results point to complex sex-specific relationships between cannabis use frequency, CUD, and violent behavior and highlight the importance of early screening for and treatment of CUD and of preventive interventions addressing cannabis misuse., Competing Interests: Declaration of competing interest Unrelated to the submitted work, Compton reports ownership of stock in General Electric Co., 3M Co., and Pfizer Inc. Drs. Volkow. Blanco, Einstein, and Han have no conflicts to disclose., (Published by Elsevier B.V.)

Background: More than 50,000 older male veterans incarcerated in prisons are expected to return to their communities and utilize the Veterans Health Administration (VHA) and community healthcare systems. To support the continuity of healthcare and overall successful community reentry of older incarcerated veterans, an understanding of their health profiles and treatment utilization while in correctional care is needed., Objective: To assess the health status of older male veterans incarcerated in state prisons and explore demographic, military, and VHA-related factors associated with medical conditions, disabilities, behavioral conditions, and medical and behavioral treatment utilization., Design/participants: Cross-sectional observational study of 880 male veterans aged 50 + incarcerated in state prisons using data from the 2016 Bureau of Justice Statistics Survey of Prison Inmates., Main Measures: Veteran status, self-report health status, and treatment utilization since prison admission. Prevalence rates for conditions and treatment utilization were calculated. Logistic regression models were used to examine the association of characteristics with conditions and treatment utilization., Key Results: Among the 880 older male veterans in state prisons, the majority reported having a current medical condition (79.3%) or disability (61.6%), almost half had history of a mental health condition (44.5%), and more than a quarter (29%) had a substance use disorder. Compared to White veterans, Black veterans were less likely to report a disability or mental health condition. Few demographic, military, and VA-related characteristics were associated with medical or behavioral conditions or treatment utilization., Conclusion: Our results suggest that the VHA and community healthcare systems need to be prepared to address medical and disability conditions among the majority of older male veterans who will be leaving prison and returning to their communities. Integrated medical and behavioral healthcare delivery models may be especially important for these veterans as many did not receive behavioral health treatment while in prison., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Importance: Stress First Aid is an evidence-informed peer-to-peer support intervention to mitigate the effect of the COVID-19 pandemic on the well-being of health care workers (HCWs)., Objective: To evaluate the effectiveness of a tailored peer-to-peer support intervention compared with usual care to support HCWs' well-being at hospitals and federally qualified health centers (FQHCs) during the COVID-19 pandemic., Design, Setting, and Participants: This cluster randomized clinical trial comprised 3 cohorts of HCWs who were enrolled from March 2021 through July 2022 at 28 hospitals and FQHCs in the US. Participating sites were matched as pairs by type, size, and COVID-19 burden and then randomized to the intervention arm or usual care arm (any programs already in place to support HCW well-being). The HCWs were surveyed before and after peer-to-peer support intervention implementation. Intention-to-treat (ITT) analysis was used to evaluate the intervention's effect on outcomes, including general psychological distress and posttraumatic stress disorder (PTSD)., Intervention: The peer-to-peer support intervention was delivered to HCWs by site champions who received training and subsequently trained the HCWs at their site. Recipients of the intervention were taught to respond to their own and their peers' stress reactions., Main Outcomes and Measures: Primary outcomes were general psychological distress and PTSD. General psychological distress was measured with the Kessler 6 instrument, and PTSD was measured with the PTSD Checklist., Results: A total of 28 hospitals and FQHCs with 2077 HCWs participated. Both preintervention and postintervention surveys were completed by 2077 HCWs, for an overall response rate of 28% (41% at FQHCs and 26% at hospitals). A total of 862 individuals (696 females [80.7%]) were from sites that were randomly assigned to the intervention arm; the baseline mean (SD) psychological distress score was 5.86 (5.70) and the baseline mean (SD) PTSD score was 16.11 (16.07). A total of 1215 individuals (947 females [78.2%]) were from sites assigned to the usual care arm; the baseline mean (SD) psychological distress score was 5.98 (5.62) and the baseline mean (SD) PTSD score was 16.40 (16.43). Adherence to the intervention was 70% for FQHCs and 32% for hospitals. The ITT analyses revealed no overall treatment effect for psychological distress score (0.238 [95% CI, -0.310 to 0.785] points) or PTSD symptom score (0.189 [95% CI, -1.068 to 1.446] points). Post hoc analyses examined the heterogeneity of treatment effect by age group with consistent age effects observed across primary outcomes (psychological distress and PTSD). Among HCWs in FQHCs, there were significant and clinically meaningful treatment effects for HCWs 30 years or younger: a more than 4-point reduction for psychological distress (-4.552 [95% CI, -8.067 to -1.037]) and a nearly 7-point reduction for PTSD symptom scores (-6.771 [95% CI, -13.224 to -0.318])., Conclusions and Relevance: This trial found that this peer-to-peer support intervention did not improve well-being outcomes for HCWs overall but had a protective effect against general psychological distress and PTSD in HCWs aged 30 years or younger in FQHCs, which had higher intervention adherence. Incorporating this peer-to-peer support intervention into medical training, with ongoing support over time, may yield beneficial results in both standard care and during public health crises., Trial Registration: ClinicalTrials.gov Identifier: NCT04723576.

Background: There are large and persistent racial and ethnic disparities in the use of mental health care in the United States. Medicaid managed care plans have the potential to reduce racial and ethnic disparities in use of mental health care through monitoring of need and active management of use of services across the populations they cover. This study compares racial and ethnic disparities among Medicaid beneficiaries in managed care with those not in managed care., Methods: We compared Medicaid beneficiaries enrolled health maintenance organizations (HMOs) with those in fee-for-service (FFS) using data from the 2007-2015 Medical Expenditure Panel Survey (N = 26,113). We specified two-part propensity score adjusted models to estimate differences in mental health related emergency department visits, hospital stays, prescription fills, and outpatient visits overall and by race/ethnicity., Results: HMO enrollment was associated with lower odds of having a mental health prescription (OR = 0.86, 95 % CI 0.78-0.96) or outpatient visit (OR = 0.82 95 % CI 0.73-0.92). These differences were similar across racial and ethnic groups or larger among Non-Hispanic Black and Hispanic beneficiaries than among Non-Hispanic White beneficiaries., Conclusions: Medicaid managed care has not improved the inequitable allocation of mental health care across racial and ethnic groups. Explicit attention to monitoring of racial and ethnic differences in use of mental health care in Medicaid managed care is warranted., Implications: Improvement in racial and ethnic disparities in mental health care in Medicaid manage care is unlikely to occur without targeted accountability mechanisms, such as required reporting or other contracting requirements., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 RAND Corporation. Published by Elsevier Inc. All rights reserved.)

Background: Bivalent mRNA COVID-19 vaccines were developed to provide protection against the original SARS-CoV-2 strain and Omicron BA.4/BA.5 variants, but uptake in the United States has been low. Sociodemographic disparities in COVID-19 vaccine uptake have been documented, but it is unclear if similar disparities persist among individuals who previously completed a primary series of monovalent COVID-19 vaccine., Methods: We conducted a retrospective cohort study at Kaiser Permanente Southern California (KPSC) including youth aged 5-17 years and adults aged ≥18 years who were KPSC members and had completed a primary series of monovalent COVID-19 vaccine. Individuals were followed from index date (date of eligibility for bivalent vaccine) to 03/31/2023 to ascertain receipt of any dose of bivalent mRNA COVID-19 vaccine or until disenrollment from KPSC or death. Multivariable robust Poisson regression was conducted to assess the adjusted relative risk and 95 % confidence intervals of factors associated with receipt of bivalent vaccine., Results: The final cohorts included 305,339 youth and 2,534,619 adults, of whom 19.5 % and 30.7 %, respectively, had received bivalent COVID-19 vaccine. Factors associated with being more likely to receive bivalent COVID-19 vaccine included older age, Asian race, more prior year outpatient and virtual visits, Charlson score ≥1, and immunocompromised status. Factors associated with being less likely to receive a bivalent COVID-19 vaccine included age 12-17 vs 5-11 years, Hispanic and non-Hispanic Black race/ethnicity, ≥1 prior year inpatient or emergency department visits, prior history of SARS-CoV-2 infection (adults only), Medicaid insurance, and higher neighborhood deprivation index., Conclusion: Even among youth and adults who had previously received a primary series of monovalent COVID-19 vaccine, sociodemographic and clinical disparities were observed in receipt of bivalent COVID-19 vaccine. These findings are critical to inform equitable strategies for the implementation of the updated monovalent COVID-19 vaccine targeting the Omicron XBB strain., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: KJB reports research support from Moderna for a COVID-19 vaccine effectiveness study and Dynavax, Gilead, GlaxoSmithKline, and Pfizer for research unrelated to this study. LSS reports research support from Moderna for a COVID-19 vaccine effectiveness study and GlaxoSmithKline, Dynavax, and Moderna for unrelated studies. LQ reports research support from Moderna for a COVID-19 vaccine effectiveness study and GlaxoSmithKline and Dynavax for unrelated studies., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: COVID-19 vaccination is crucial in combating the COVID-19 pandemic. Messenger RNA COVID-19 vaccines were initially authorized as a 2-dose primary series and have been widely used in the United States; completing the 2-dose primary series offers protection against infection, severe illness, and death. Understanding the risk factors for not completing the 2-dose primary series is critical to evaluate COVID-19 vaccination programs and promote completion of the 2-dose primary series., Objective: This study examined potential risk factors for not completing a 2-dose primary series of mRNA COVID-19 vaccination., Methods: We conducted a retrospective cohort study among members aged ≥18 years from a large integrated health care system, Kaiser Permanente Southern California, from December 14, 2020, to June 30, 2022. Noncompletion of the 2-dose primary series was defined as not completing the second dose within 6 months after receipt of the first dose. Crude noncompletion rates were estimated overall and by demographic characteristics, health care use patterns, comorbidity, and community-level socioeconomic factors. A Poisson regression model was fit to examine associations of individual-level and community-level risk factors with noncompletion of the 2-dose primary series., Results: Among 2.5 million recipients of ≥1 dose of mRNA COVID-19 vaccines, 3.3% (n=81,202) did not complete the second dose within 6 months. Members aged 25-44 years, 65-74 years, and ≥75 years were less likely to not complete the 2-dose primary series than those aged 18-24 years, while members aged 45-64 years were more likely to not complete the 2-dose primary series (adjusted risk ratio [aRR] 1.13, 95% CI 1.10-1.15). Male sex was associated with a higher risk of noncompletion (aRR 1.17, 95% CI 1.15-1.19). Hispanic and non-Hispanic Black race/ethnicity were associated with a lower risk of noncompletion (range aRR 0.78-0.91). Having Medicaid and prior influenza vaccination were associated with a higher risk of noncompletion. Having SARS-CoV-2 infection, experiencing an adverse event, or having an inpatient and emergency department visit during the minimum recommended dose intervals were associated with a higher risk of not completing the 2-dose primary series (aRR 1.98, 95% CI 1.85-2.12; 1.99, 95% CI 1.43-2.76; and 1.85, 95% CI 1.77-1.93, respectively). Those who received the first dose after June 30, 2021, were more likely to not complete the 2-dose primary series within 6 months of receipt of the first dose., Conclusions: Despite limitations such as being a single-site study and the inability to consider social factors such as employment and vaccine attitudes, our study identified several risk factors for not completing a 2-dose primary series of mRNA vaccination, including being male; having Medicaid coverage; and experiencing SARS-CoV-2 infection, adverse events, or inpatient and emergency department visits during the minimum recommended dose intervals. These findings can inform future efforts in developing effective strategies to enhance vaccination coverage and improve the completion rate of necessary doses., (©Stanley Xu, Vennis Hong, Lina S Sy, Katia J Bruxvoort, Bruno Lewin, Bing Han, Kimberly J Holmquist, Lei Qian. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 04.10.2023.)

Introduction: Physiologically based pharmacokinetics (PBPK) models are increasingly used in the drug research and development, especially in anti-cancer drugs. Between 2001 and 2020, a total of 89 small-molecule targeted antitumor drugs were approved in China and the United States, some of which already included PBPK modeling in their application or approval packages. This article intended to review the prevalence and application of PBPK model in these drugs., Method: Article search was performed in the PubMed to collect English research articles on small-molecule targeted anti-cancer drugs using PBPK modeling. The selected articles were classified into nine categorizes according to the application areas and further analyzed., Result: From 2001 to 2020, more than 60% of small-molecule targeted anti-cancer drugs (54/89) were studied using PBPK model with a wide range of application. Ninety research articles were included, of which 48 involved enzyme-mediated drug-drug interaction (DDI). Of these retrieved articles, Simcyp, GastroPlus, and PK-Sim were the most widely model building platforms, which account for 63.8%, 15.2%, and 8.6%, respectively., Conclusion: PBPK modeling is commonly and widely used to research small-molecule targeted anti-cancer drugs., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background and Aims: There are concerns that availability of recreational cannabis dispensaries (RCDs) and point-of-sale marketing may lead to increased cannabis use in jurisdictions where cannabis retail sale is legal. This paper examined whether the availability RCDs and the presence of storefront signage indicative of cannabis and signs promoting health benefits in RCDs were associated with cannabis use and risk perceptions., Design: Cross-sectional, secondary data analysis., Setting: California, USA., Participants: A representative sample of 3385 adults in California who participated in the 2020 probability-based Marijuana Use and Environment Survey., Measurements: Binary outcomes included past-month overall cannabis use, perceiving cannabis smoking as harmful and past-month cannabis use by purpose (medical only, recreational only and dual). The objectively assessed predictors included proximity and density of RCDs and presence of storefront signage indicative of cannabis and signs promoting health benefits in RCDs., Findings: In terms of proximity, thepresence of storefront signage in the nearest RCD was associated with smaller odds of perceiving cannabis smoking as harmful [odds ratio (OR) = 0.63, 95% confidence interval (CI) = 0.39, 0.99] if the RCD was located within 2 miles of home. Presence of health benefit signs in the nearest RCD was associated with greater odds of overall cannabis use (OR = 2.45, 95% CI = 1.17, 5.16) and recreational use (OR = 3.50, 95% CI = 1.027, 11.91) if the RCD was located within 2-4 miles of home. In terms of density, count of RCDs, count of RCDs with storefront signage and count of RCDs with health benefit signs within 2 miles of home were each separately associated with greater odds of overall cannabis use and cannabis use for dual purposes., Conclusions: The availability of recreational cannabis dispensaries within 2 miles of one's home and the presence of storefront signage indicating the availability of cannabis and signs promoting health benefits of cannabis appear to be associated with increased cannabis use and reduced risk perceptions among adults in California, USA., (© 2023 Society for the Study of Addiction.)

Importance: The 2018 Chronic Care Act allowed Medicare Advantage plans to have greater flexibility in offering supplemental benefits, such as meals and services, to address unmet needs of beneficiaries with certain chronic conditions. Based on earlier studies of community-based nutritional support, such programs may result in reduced use., Objective: To evaluate the association of a 4-week posthospitalization home-delivered meals benefit with 30-day all-cause rehospitalization and mortality in patients admitted for heart failure (HF) and other acute medical conditions (non-HF)., Design, Setting, and Participants: In this cohort study, patients who received meals (the meals group) were compared with 2 controls: (1) no meals in the 2019 historical cohort who would have been eligible for the benefit (the no meals-2019 group) and (2) no meals in the 2021 and 2022 concurrent cohort who were referred but did not receive the meals due to unsuccessful contacts and active declines (the no meals-2021/2022 group). This study took place in a large integrated health care system in southern California among Medicare Advantage members with a hospitalization for HF or other acute medical conditions at 15 Kaiser Permanente hospitals discharged to home., Exposure: The exposure was receipt of at least 1 and up to 4 shipments of home-delivered meals (total of 56 to 84 meals) after hospital discharge., Main Outcomes and Measures: The main outcomes were 30-day all-cause composite rehospitalization and death., Results: A total of 4032 adults with admission to the hospital for HF (mean [SD] age, 79 [9] years; 1951 [48%] White; 2001 [50%] female) and 7944 with non-HF admissions (mean [SD] age, 78 [8] years; 3890 [49%] White; 4149 [52%] female) were included in the analyses. Unadjusted rates of 30-day death and rehospitalization for the meals, no meals-2019, and no meals-2021/2022 cohorts were as follows: HF: 23.3%, 30.1%, and 38.5%; non-HF: 16.5%, 22.4%, and 32.9%, respectively. For HF, exposure to meals was significantly associated with lower odds of 30-day death and rehospitalization compared with the no meals-2021/2022 cohort (OR, 0.55; 95% CI, 0.43-0.71; P < .001) but was not significant compared with the no meals-2019 cohort (OR, 0.86; 95% CI, 0.72-1.04; P = .12). For non-HF, exposure to meals was associated with significantly lower odds of 30-day death and rehospitalization when compared with the no meals-2019 (OR, 0.64; 95% CI, 0.52-0.79; P < .001) and the no meals-2021/2022 (OR, 0.48; 95% CI, 0.37-0.62; P < .001) cohorts., Conclusions and Relevance: In this cohort study, exposure to posthospitalization home-delivered meals was associated with lower 30-day rehospitalization and mortality; randomized clinical trials are needed to confirm these findings.

Aim: To examine prevalence of mental health conditions and receipt of mental health care (MHC) by illicit lysergic acid diethylamide (LSD) use status (past-year; lifetime without-past-year; never) among young adults., Design: Cross-sectional, annual survey data from 2015 to 2019 National Surveys on Drug Use and Health (NSDUH)., Setting: United States., Participants: A total of 69 916 NSDUH participants ages 18 to 25., Measurements: Outcomes included past-year serious psychological distress (SPD), suicidal ideation, Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV major depressive episode (MDE), any mental illness, serious mental illness, receipt of mental health care (MHC, inpatient/outpatient or receipt of prescription medications), and number of days of being unable to work or attend normal activities because of mental health conditions., Findings: Multivariable analyses found that compared with those who never used illicit LSD, adults with past-year illicit LSD use had greater risk of suicidal ideation (adjusted risk ratio [ARR] = 1.2, 95% CI = 1.06-1.41), SPD (ARR = 1.2, 95% CI = 1.04-1.28), MDE (ARR = 1.3, 95% CI = 1.17-1.52), and any/serious mental illness (ARRs = 1.2-1.3, 95% CI = 1.02-1.41) and reported missing more days because of mental health conditions (adjusted incidence rate ratio = 1.6, 95% CI = 1.31-1.86). Lifetime (without past-year) use showed similar, although less consistent, associations. Compared with those never using illicit LSD, adults with past-year use were less likely to receive prescription medications for MHC (ARR = 0.7, 95% CI = 0.60-0.84) and to receive overall MHC (ARR = 0.7, 95% CI= 0.64-0.84). Compared with those using in the past-year, adults with lifetime (without past-year) use were more likely to receive prescription medications for MHC (ARR = 1.2, 95% CI = 1.01-1.46) and receive overall MHC (ARR = 1.2, 95% CI = 1.03-1.45)., Conclusions: Young adults with past-year illicit lysergic acid diethylamide use have elevated prevalence of mental health conditions and are less likely to receive prescription medications for mental health care and overall mental health care. Regardless of past-year use status, young adults with lifetime illicit lysergic acid diethylamide use may benefit from mental illness prevention and interventions., (Published 2022. This article is a U.S. Government work and is in the public domain in the USA.)

The Coronavirus Disease (COVID) pandemic has aroused challenges to emotional well-being of the individuals. With 1,582 respondents from the Health and Retirement Survey (HRS), this study investigates the heterogeneity in older adults' vulnerability and examines the relationship between vulnerability types, aging attitudes, and emotional responses. International Positive and Negative Affect Schedule Short-form (I-PANAS-SF) and Attitudes toward own aging (ATOT) were used to assess the emotional experiences and aging attitudes, and 14 kinds of pandemic-related deprivations evaluated vulnerability of individuals. Latent class analysis (LCA) was used to explore the vulnerability types, and weighted linear regressions examined the relationship between vulnerability, aging attitudes, and emotional responses. The results showed that the proportion for individuals with mild vulnerability (MV), healthcare use vulnerability (HV), and dual vulnerability in healthcare use and financial sustainment (DVs) was 67, 22, and 11%, respectively. Older adults aged below 65, Hispanics and non-Hispanic Blacks, and those not eligible for Medicaid were more likely to have HV or DVs. The relationship between vulnerability and positive emotions (PAs) was non-significant, yet individuals with HV (beta = 0.10, standard error [SE] = 0.16) or DVs (beta = 0.09, SE = 0.28) were likely to have more negative emotions (NAs) than their mildly vulnerable counterparts. Furthermore, aging attitudes moderated the relationship between vulnerability and emotions. The salutary effect of positive aging attitudes on emotional well-being was more significant among people with DVs than those with MV (beta = 0.20, SE = 0.04 for positive responses; beta = -0.15, SE = 0.04 for negative responses). Thus, we urge more attention for vulnerable older adults in a pandemic context. Meanwhile, encouraging positive aging attitudes might be helpful for older adults to have better emotional well-being, especially for those with DVs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Fu, Guo, Chen, Han, Ahmed, Shahid and Zhang.)

Recent attention has focused on the growing role of psychostimulants, such as methamphetamine in overdose deaths. Methamphetamine is an addictive and potent stimulant, and its use is associated with a range of physical and mental health harms, overdose, and mortality. Adding to the complexity of this resurgent methamphetamine threat is the reality that the increases in methamphetamine availability and harms are occurring in the midst of and intertwined with the ongoing opioid overdose crisis. Opioid involvement in psychostimulant-involved overdose deaths increased from 34.5% of overdose deaths in 2010 to 53.5% in 2019-an increase of more than 50%. This latest evolution of the nation's overdose epidemic poses novel challenges for prevention, treatment, and harm reduction. This narrative review synthesizes what is known about changing patterns of methamphetamine use with and without opioids in the United States, other characteristics associated with methamphetamine use, the contributions of the changing illicit drug supply to use patterns and overdose risk, motivations for couse of methamphetamine and opioids, and awareness of exposure to opioids via the illicit methamphetamine supply. Finally, the review summarizes illustrative community and health system strategies and research opportunities to advance prevention, treatment, and harm reduction policies, programs, and practices., (Published 2021. This article is a U.S. government work and is in the public domain in the USA.)

Importance: Mortality associated with methamphetamine use has increased markedly in the US. Understanding patterns of methamphetamine use may help inform related prevention and treatment., Objective: To assess the national trends in and correlates of past-year methamphetamine use, methamphetamine use disorder (MUD), injection, frequent use, and associated overdose mortality from 2015 to 2019., Design, Setting, and Participants: This cross-sectional study analyzed methamphetamine use, MUD, injection, and frequent use data from participants in the 2015 to 2019 National Surveys on Drug Use and Health (NSDUH). Mortality data were obtained from the 2015 to 2019 National Vital Statistics System Multiple Cause of Death files., Exposures: Methamphetamine use., Main Outcomes and Measures: Methamphetamine use, MUD, injection, frequent use, and overdose deaths., Results: Of 195 711 NSDUH respondents aged 18 to 64 years, 104 408 were women (weighted percentage, 50.9%), 35 686 were Hispanic individuals (weighted percentage, 18.0%), 25 389 were non-Hispanic Black (hereafter, Black) individuals (weighted percentage, 12.6%), and 114 248 were non-Hispanic White (hereafter, White) individuals (weighted percentage, 60.6%). From 2015 to 2019, overdose deaths involving psychostimulants other than cocaine (largely methamphetamine) increased 180% (from 5526 to 15 489; P for trend <.001); methamphetamine use increased 43% (from 1.4 million [95% CI, 1.2-1.6 million] to 2.0 million [95% CI, 1.7-2.3 million]; P for trend = .002); frequent methamphetamine use increased 66% (from 615 000 [95% CI, 512 000-717 000] to 1 021 000 [95% CI, 860 000-1 183 000]; P for trend = .002); methamphetamine and cocaine use increased 60% (from 402 000 [95% CI, 306 000-499 000] to 645 000 [95% CI, 477 000-813 000]; P for trend = .001); and MUD without injection increased 105% (from 397 000 [95% CI, 299 000-496 000] to 815 000 [95% CI, 598 000-1 033 000]; P for trend = .006). The prevalence of MUD or injection surpassed the prevalence of methamphetamine use without MUD or injection in each year from 2017 to 2019 (60% to 67% vs 37% to 40%; P for trend ≤.001). Adults with MUD or using injection were more likely to use methamphetamine frequently (52.68%-53.84% vs 32.59%; adjusted risk ratio, 1.62-1.65; 95% CI, 1.35-1.94). From 2015 to 2019, the adjusted prevalence of MUD without injection more than tripled among heterosexual women (from 0.24% to 0.74%; P < .001) and lesbian or bisexual women (from 0.21% to 0.71%; P < .001) and more than doubled among heterosexual men (from 0.29% to 0.79%; P < .001) and homosexual or bisexual men (from 0.29% to 0.80%; P = .007). It increased over 10-fold among Black individuals (from 0.06% to 0.64%; P < .001), nearly tripled among White individuals (from 0.28% to 0.78%; P < .001), and more than doubled among Hispanic individuals (from 0.39% to 0.82%; P < .001). Risk factors for methamphetamine use, MUD, injection, and frequent use included lower educational attainment, lower annual household income, lack of insurance, housing instability, criminal justice involvement, comorbidities (eg, HIV/AIDS, hepatitis B or C virus, depression), suicidal ideation, and polysubstance use., Conclusions and Relevance: This cross-sectional study found consistent upward trends in overdose mortality, greater risk patterns of methamphetamine use, and populations at higher risk for MUD diversifying rapidly, particularly those with socioeconomic risk factors and comorbidities. Evidence-based prevention and treatment interventions are needed to address surges in methamphetamine use and MUD.

Background: In 2017, the American College of Cardiology/ American Heart Association (ACC/AHA) guidelines redefined the threshold of high blood pressure (BP) for non-pregnant adults. Several studies aimed to determine whether lowering these thresholds should be considered for pregnancies to prevent poor neonatal outcomes, but the results were inconclusive., Methods: We perform a systematic review and meta-analysis to evaluate the association between BP groups defined by the 2017 ACC/AHA guidelines and pregnancy outcomes. Relevant literature was searched in PubMed, Google Scholar, Embase, and Web of Science up to 18 May 2021., Results: Sixteen eligible studies from twelve articles with a total of 303,131 pregnancies were identified, encompassing 233,084, 20,859, 39,379 individuals with normal BP, elevated BP, and stage 1 hypertension, respectively. When compared with normal BP, the combined odds ratio (95% confidence interval) of elevated BP for adverse pregnancy outcomes was not significant; whereas, that of stage 1 hypertension were 1.25 (1.13-1.39), 1.16 (1.03-1.31), 1.50 (1.28-1.77) and 1.12 (1.00-1.25) for preterm delivery, small for gestational age, low birth weight, and early-term delivery, respectively., Conclusion: Our results indicated that stage 1 hypertension increased the risk of poor neonatal outcomes, highlighting the importance of recognition of stage 1 hypertension as a risk indicator for poor pregnancy outcomes., (Copyright © 2021 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.)

Importance: During the past decade, cannabis use among US adults has increased markedly, with a parallel increase in suicidality (ideation, plan, attempt, and death). However, associations between cannabis use and suicidality among young adults are poorly understood., Objective: To determine whether cannabis use and cannabis use disorder (CUD) are associated with a higher prevalence of suicidality among young adults with or without depression and to assess whether these associations vary by sex., Design, Setting, and Participants: This survey study examined data from 281 650 adults aged 18 to 34 years who participated in the National Surveys on Drug Use and Health. Data were collected from January 1, 2008, to December 31, 2019., Exposures: Prevalence of past-year daily or near-daily cannabis use (≥300 days in the past year), CUD, and major depressive episode (MDE). Past-year CUD and MDE were based on DSM-IV diagnostic criteria., Main Outcomes and Measures: Past-year suicidal ideation, plan, and attempt., Results: Among the 281 650 adults aged 18 to 34 (men, 49.9% [95% CI, 49.6%-50.2%]; women, 50.1% [95% CI, 49.8%-50.4%]) included in the analysis, past-year suicidal ideation and plan along with daily cannabis use increased among all examined sociodemographic subgroups (except daily cannabis use among current high-school students), and past-year suicide attempt increased among most subgroups. National trends in adjusted prevalence of past-year suicidal ideation, plan, and attempt varied by daily and nondaily cannabis use and CUD among adults with or without MDE. After controlling for MDE, CUD, cannabis use status, and potential confounding factors, the adjusted prevalence of suicidal ideation, plan, and attempt increased 1.4 to 1.6 times from the 2008-2009 to 2018-2019 periods (adjusted risk ratio [ARR] for suicidal ideation, 1.4 [95% CI, 1.3-1.5]; ARR for suicide plan, 1.6 [95% CI, 1.5-1.9]; ARR for suicide attempt, 1.4 [95% CI, 1.2-1.7]), with 2008 to 2009 as the reference period. Past-year CUD, daily cannabis use, and nondaily cannabis use were associated with a higher prevalence of past-year suicidal ideation, plan, and attempt in both sexes (eg, among individuals without MDE, prevalence of suicidal ideation for those with vs without CUD was 13.9% vs 3.5% among women and 9.9% vs 3.0% among men; P < .001), but significantly more so in women than men (eg, suicide plan among those with CUD and MDE was 52% higher for women [23.7%] than men [15.6%]; P < .001)., Conclusions and Relevance: From 2008 to 2019, suicidal ideation, plan, and attempt increased 40% to 60% over increases ascribed to cannabis use and MDE. Future research is needed to examine this increase in suicidality and to determine whether it is due to cannabis use or overlapping risk factors.

This study explores whether the perceived decision-making power between partners in married and cohabitating unions varies by the composition of race and gender of the couple, using three types of interracial/intraracial couplings involving Asian Americans. Although interracial unions have dramatically increased and symbolized racial integration in the United States, the association between racial/gender make-up in couples and perceived spousal power dynamics has received less attention. Using multinomial logistic regressions on data from the National Latino and Asian American Survey (NLAAS), the present study revealed that Asian men partnering with White women perceive less male-dominant, more egalitarian decision-making power than Asian men partnering with Asian women. In contrast, there was no significant difference in the perceived decision-making power between Asian women partnering with White men and their endogenously partnered counterparts. These findings suggest the necessity to look closely at the intersections of race and gender in power relations among intimate unions., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Providing physical health care in specialty mental health clinics is a promising approach to improving the health status of adults with serious mental illness, but most programs examined in prior studies are not financially sustainable. This study assessed the impact on quality of care of a low-cost program implemented in New York State that allowed mental health clinics to be reimbursed by Medicaid for provision of health monitoring and health physicals (HM/HP). Medicaid claims data were analyzed with generalized linear multilevel models to examine change over time in quality of physical health care associated with HM/HP services. Recipients of HM/HP services were compared to control clinic patients [Per protocol (PP)] and with non-recipients of HM/HP services from both intervention and control clinics [As-Treated (AT)]. HM/HP clinic patients, regardless of receipt of HM/HP services, were compared with control clinic patients [Intent-to-Treat (ITT)]. Analyses were conducted with adjustment for patient demographic and clinical characteristics and prior year service use. The PP and AT analyses found significant improvement in measure of blood glucose screening for patients on antipsychotic medication and HbA1C testing for patients with diabetes (AOR range 1.26-1.33) and the AT analysis found significant improvement in cholesterol screening for patients on antipsychotic medication (AOR 1.24). However, ITT analysis found no significant changes in quality of care in HM/HP clinic caseloads relative to control clinics. The low-cost HM/HP program has the potential to benefit patients who receive supported services, but its impact is limited by remaining barriers to service implementation.

Background: The medical home (MH) model has been promoted by both the federal and state governments in the United States in recent years. To ascertain American children's MH status, many studies have relied on a large set of survey items, posing a considerable burden on their parents. We aimed to identify individual survey items or domains that best predict MH status for children and use them to develop brief markers of MH status. We also examined whether the identified items differed by status of special health care needs and by racial/ethnic group., Method: Using the 9-year data from Medical Expenditure Panel Survey, we examined associations between children's MH status and individual survey items or domains. We randomly split the data into two halves with the first half (training sample, n = 8611) used to identify promising items, and the second half (validation sample, n = 8779) used to calculate all statistical measures. After discovering significant predictors of children's MH status, we incorporated them into several brief markers of MH status. We also conducted stratified analyses by status of special health care needs and by racial/ethnic group., Results: Less than half (48.7%) of the 8779 study children had a MH. The accessibility domain has stronger association with children's MH status (specificity = 0.84, sensitivity = 1, Kappa = 0.83) than other domains. The top two items with the strongest association with MH status asked about after-hours primary care access, including doctors' office hours at night or on the weekend and children's difficulty accessing care after hours. Both belong to the accessibility domain and are one of several reliable markers for children's MH status. While each of the two items did not differ significantly by status of special health care needs, there were considerable disparities across racial/ethnic groups with Latino children lagging behind other children., Conclusion: Accessibility, especially the ability to access health care after regular office hours, appears to be the major predictor of having a MH among children. The ongoing efforts to promote the MH model need to target improving accessibility of health care after regular hours for children overall and especially for Latino children.

The American College of Cardiology (ACC) collaborated with the American Heart Association, American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and the Society of Pediatric Echocardiography to develop Appropriate Use Criteria (AUC) for multimodality imaging during the follow-up care of patients with congenital heart disease (CHD). This is the first AUC to address cardiac imaging in adult and pediatric patients with established CHD. A number of common patient scenarios (also termed "indications") and associated assumptions and definitions were developed using guidelines, clinical trial data, and expert opinion in the field of CHD. 1 The indications relate primarily to evaluation before and after cardiac surgery or catheter-based intervention, and they address routine surveillance as well as evaluation of new-onset signs or symptoms. The writing group developed 324 clinical indications, which they separated into 19 tables according to the type of cardiac lesion. Noninvasive cardiac imaging modalities that could potentially be used for these indications were incorporated into the tables, resulting in a total of 1,035 unique scenarios. These scenarios were presented to a separate, independent panel for rating, with each being scored on a scale of 1 to 9, with 1 to 3 categorized as "Rarely Appropriate," 4 to 6 as "May Be Appropriate," and 7 to 9 as "Appropriate." Forty-four percent of the scenarios were rated as Appropriate, 39% as May Be Appropriate, and 17% as Rarely Appropriate. This AUC document will provide guidance to clinicians in the care of patients with established CHD by identifying the reasonable imaging modality options available for evaluation and surveillance of such patients. It will also serve as an educational and quality improvement tool to identify patterns of care and reduce the number of Rarely Appropriate tests in clinical practice., (Copyright © 2020 The American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: The Affordable Care Act's Medicaid expansions (ME) increased insurance coverage for low-income Americans, among whom unmet need for mental health care is high. Empirical evidence regarding the impact of expanding insurance coverage on use of mental health services among low income and minority populations is lacking., Methods: Data on mental health service use collected between 2007 and 2015 by the Medical Expenditures Panel Survey from nationally representative cross-sectional samples of low income (income<138% of the federal poverty line) adults were analyzed. Use trends among people in states that expanded Medicaid (ME states; n=29,827) were compared with concurrent trends among people in states that did not (non-ME states; n=22,873), with statistical adjustment for demographic characteristics and psychological distress., Results: Annual outpatient visits for mental health conditions increased by 0.513 (0.053-0.974) visits per person, from a baseline rate in ME states of 0.894 visits per person. However, no significant changes were observed in number of mental health related hospital stays, emergency department visits or prescription fills. The increase outpatient visits was limited to Hispanics and non-Hispanic Whites, with no increase in service use observed among non-Hispanic Blacks. There was no apparent increase in the number of users of outpatient mental health care (AOR=0.992, P=0.942) and a marginally significant (P=0.096) increase of 3.144 visits per user., Discussion: ME had a limited but positive impact on use of mental health services by low income Americans, although it may also have increased racial/ethnic disparities.

Background: The outbreak of coronavirus disease 2019 (COVID-19) began in December 2019 and continues to spread worldwide. Rapid and accurate identification of suspected cases is critical in slowing spread of the virus that causes the disease. We aimed to highlight discrepancies in the various criteria used by international agencies and highly impacted individual countries around the world., Methods: We reviewed the criteria for identifying a suspected case of COVID-19 used by two international public health agencies and 10 countries across Asia, Europe, and North America. The criteria included information on the clinical causes of illness and epidemiological risk factors. Non-English language guidelines were translated into English by a co-author who is fluent in that particular language., Results: Although most criteria are modifications of World Health Organization recommendations, the specific clinical features and epidemiological risks for triggering evaluation of patients with suspected COVID-19 differed widely among countries. The rationale for these differences may be related to each country's resources, politics, experience with previous outbreaks or pandemics, health insurance system, COVID-19 outbreak severity, and other undetermined factors., Conclusion: We found no consensus regarding the best diagnostic criteria for identifying a suspected case of COVID-19.

All people need to engage in routine physical activity and children require it daily. Playgrounds are settings designed for children to be physically active, yet there has been little research assessing which play elements and structures are associated with more moderate-to-vigorous physical activity (MVPA) among both youth and adults. We conducted a national study of neighborhood parks with the goal of identifying factors that promote more MVPA. We selected a nationally representative sample of 162 parks between 3 and 22 acres in 25 U.S. cities with a population >100,000. We used direct observation to measure MVPA in 147 playgrounds during spring and summer of 2016, documented playground characteristics and assessed hours of use and MVPA by age group and gender. We analyzed data using descriptive statistics and generalized linear models. The most common play elements and structures were slides and ladders (92% of parks) and swings (81%); elements supporting balancing, crawling, spinning, sand and water play were in <30% of playgrounds. Each additional play element was associated with about 50% more users and 50% more MVPA. Spinning structures and splash pads were associated with more playground use and more MVPA. Playgrounds with signage advertising park programs and on-site restrooms had more person-hours of use, but only half the parks had restrooms and <30% had signage. To address insufficient physical activity, upgrades to playgrounds should include restrooms, structures that support a wide variety of movements, and elements that also encourage adults to be active., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Using U.S. National Surveys on Drug Use and Health (NSDUH) data, researchers found that prevalence of cannabis use among adults increased in recent years, but prevalence of DSM-IV cannabis use disorder (CUD) was stable. Examining trends of all individual CUD criteria and of CUD severity may elucidate reasons for the lack of increases in CUD., Methods: Data were from 749,500 persons aged 18 or older who participated in the 2002-2017 NSDUH. Descriptive analyses and logistic regressions were applied., Results: Among adults during 2002-2017, past-year prevalence of DSM-IV CUD remained stable at 1.5% to 1.4%, but cannabis use increased from 10.4% to 15.3%, daily/near daily use increased from 1.9% to 4.2%, and mild DSM-5 CUD increased from 1.4% to 1.9%. Among adult cannabis users, past-year prevalence of DSM-IV CUD decreased from 14.8% to 9.3%, daily/near daily use increased from 18.0% to 27.2%, and DSM-5 moderate (4-5 criteria) and severe (6+ criteria) CUD decreased from 4.3% to 3.1% and from 2.4% to 1.3%, respectively. Examining trends in individual CUD criteria during 2002-2017 among adults overall revealed increases in two criteria (tolerance; spending a lot of time getting/using cannabis or getting over cannabis effects) and decreases/no changes in other criteria; among adult cannabis users, there was no change in one criterion (tolerance) and decreases in other criteria., Conclusions: DSM-5's single dimension CUD measure may be more sensitive to diagnosis prevalence changes than the separate DSM-IV cannabis dependence and abuse categories. Future diagnostic approaches to assessing CUD may benefit from quantitatively oriented criteria., (Published by Elsevier B.V.)

The United States lacks surveillance to monitor park use and conditions. The purpose of this study was to use the System for Observing Play and Recreation in Communities (SOPARC) as a surveillance tool to describe the conditions, user characteristics, and physical activity of a national sample of neighborhood parks at two time points. Using a stratified multistage sampling strategy, a representative sample of 174 neighborhood parks in 25 major United States' cities were selected. During 2014 and 2016, park-related use, conditions, and physical activity were assessed using SOPARC in 169 parks. Overall, 74,106 park users were observed at baseline and 69,150 park users were observed two years later (p = 0.37). There were persistent disparities in park use by gender and age, with disproportionately more male than female users in each age group (child, teenager, adult, older adult). Older adults used the park less than other age groups. Almost two-thirds of park users were observed being sedentary (61.9% in 2014, 60.7% in 2016), followed by moderate (30.8%, 32.0%) and vigorous (7.3%, 7.3%) activity. Empty target areas increased over two years (75.3%, 77.6%; p = 0.01) and those that were equipped (2.6%, 1.2%; p = 0.0003), accessible (95.4%, 94.3%; p = 0.01), and organized (2.6%, 1.7%; p = 0.01) decreased. Areas that were usable (97.5%, 97.4%) or provided supervised activities (2.0%, 2.4%) did not change significantly. The findings demonstrate the value of SOPARC as a surveillance tool, identify user groups under represented at parks, and suggest an opportunity to encourage more park-based physical activity among park visitors., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Aim: This study estimated whether and how the 12-month prevalence of cannabis use disorder among US youth aged 12-17 and emerging adults aged 18-25 varied by time since first cannabis use., Design: Repeated cross-sectional survey data from the 2015-17 National Surveys on Drug Use and Health (NSDUH)., Setting: United States., Participants: A total of 101 000 NSDUH participants aged 12-25., Measurements: Past 12-month cannabis use disorder was assessed using DSM-IV criteria., Findings: Among youth, the life-time prevalence of cannabis use was 15.3% [95% confidence interval (CI) = 14.86-15.65%]. Among emerging adults, the life-time prevalence of cannabis use was 52.4% (95% CI = 51.77-53.01%). The adjusted 12-month prevalence of cannabis use disorder among youth with life-time cannabis use was 10.9% (95% CI = 9.24-12.75%) in the first year after starting cannabis use, 15.3% (95% CI = 13.68-17.12%) in the second year, 17.7% (95% CI = 15.55-19.97%) in the third year and 20.6% (95% CI = 18.23-23.17%) in the fourth year and beyond, which was consistently higher after the first year (linear trend only: P < 0.0001). The adjusted 12-month prevalence of cannabis use disorder among emerging adults with life-time use ranged from 5.6% (95% CI = 4.26-7.23%) in the first year after starting cannabis use, 7.7% (95% CI = 6.45-9.17%) in the second year and 9.1% (95% CI = 7.81-10.57%) in the third year to 10.5% (95% CI = 9.87%-11.12%) in the fourth year and beyond, which was consistently higher after the first year (linear trend only: P < 0.0001). Within each time-frame since first cannabis use, the adjusted 12-month prevalence of cannabis use disorder was higher among youth life-time users than their emerging adult counterparts., Conclusions: Among youth and emerging adults in the United States, the prevalence of cannabis use disorder appears to increase with time since initiation of use and is higher among youth than among emerging adults during each examined time-frame., (Published 2018. This article is a U.S. Government work and is in the public domain in the USA.)

We examine the impact of insurance expansion under the Affordable Care Act's Dependent Care Expansion (DCE) on allocation of mental health care across illness severity, types of care and racial/ethnic groups. Evidence suggests that the increase in mental health care utilization resulting from the DCE was restricted to individuals with clinically significant mental health conditions. There is no evidence suggesting that the increase occurred disproportionately in medication-only treatment or that it increased racial/ethnic disparities. The DCE appears to have been successful in increasing utilization of mental health care among a high need group without lowering quality or increasing disparities.

Objectives: The study aims to investigate apparently contradictory evidence regarding racial/ethnic differences in perceived need for behavioral health treatment in two prominent surveys of the U.S. population, the National Comorbidity Survey Replication (NCS-R) and the National Survey of Drug Use and Health (NSDUH)., Methods: The two surveys were compared with respect to two components of perceived need: service use and perceived need among the untreated. Logistic regression models were estimated to adjust comparisons for demographic characteristics. Comparisons were conducted in samples representing the entire population, without selection on a mental health assessment, and for samples meeting criteria for lifetime major depression., Results: The surveys are concordant with respect to racial/ethnic differences in service use and discordant with respect to perceived need among the untreated. For instance, among untreated individuals, the odds of perceiving a need for treatment are significantly higher in Blacks than Whites in the NCS-R (OR = 1.8, 95% CI [1.1, 2.9]) but do not differ between these groups in the NSDUH (OR = 0.9, 95% CI [0.7, 1.2]). Temporal trends do not appear to explain this discordance., Conclusion: Assessments of racial/ethnic differences in perceived need among untreated individuals are affected by methodological differences across surveys. Resolving contradictory evidence is critical to efforts to reduce racial/ethnic disparities., (© 2018 John Wiley & Sons, Ltd.)

Objective: Although benzodiazepine misuse and use disorders are associated with adverse health effects, it is unknown what proportion of benzodiazepine users misuse them or meet criteria for benzodiazepine use disorders. The goal of this study was to examine the prevalence and correlates of benzodiazepine use, misuse, and use disorders among US adults., Methods: Data from 102,000 adults 18 years and older who participated in the 2015-2016 National Surveys on Drug Use and Health were used. IMS Health Total Patient Tracker data were also examined. Descriptive analyses and multinomial logistic regressions were applied., Results: Among US adults in 2015-2016, 12.5% (annual average, 95% CI, 12.19%-12.81%) used benzodiazepines, 2.1% (95% CI, 2.03%-2.25%) misused benzodiazepines at least once, and 0.2% (95% CI, 0.15%-0.22%) had benzodiazepine use disorders. Among benzodiazepine users, 17.1% (95% CI, 16.30%-17.93%) misused benzodiazepines, and 1.5% (95% CI, 1.26%-1.72%) had benzodiazepine use disorders. Benzodiazepine use was associated with emergency room visits, suicidal ideation, use of most substances, and mental disorders. Benzodiazepine misuse without use disorders was associated with younger age, male sex, being black, poor educational attainment, being uninsured and unemployed, being single, having family income below $50,000, and having suicidal ideation and other specific substance use problems. Correlates of benzodiazepine use disorders were similar, but most correlates were associated with benzodiazepine use disorders more strongly than with misuse without use disorders., Conclusions: While benzodiazepine use is highly prevalent among US adults, benzodiazepine use disorders are relatively rare among benzodiazepine users. Our results help characterize benzodiazepine users and identify adults at risk for misuse and use disorders., (© Copyright 2018 Physicians Postgraduate Press, Inc.)

The current study examined racial/ethnic differences in use of parks and park facilities and features and self-reported park use and perceptions. We conducted observations in a nationally representative sample of 193 neighborhood parks in 27 US cities over a 1-week period between April and August of 2016 using the System of Observing Play and Recreation in Communities (SOPARC). To determine the propensity of different racial/ethnic groups to use parks relative to expectation based on their representation in the surrounding neighborhood, we calculated the percentages of park users of each race/ethnicity and compared these to the percentages of racial/ethnic groups residing in the neighborhood within a 1-mile radius of the park based on 2010 U.S. Census data. In the same parks, we administered an intercept survey to assess park users' self-reported use and perceptions of the park (N = 1872). We examined racial/ethnic differences in self-reported use and perceptions of parks using GEE models that adjusted for several individual- and park-level covariates. Hispanics comprised a disproportionate percentage of observed park users. Racial/ethnic groups generally did not differ in their self-reported park use and perceptions, except for the social context of park visits. In adjusted models, Hispanics had significantly higher odds of visiting with a child family member (OR = 1.44) and lower odds of visiting alone than non-Hispanic whites (OR = .55). Findings highlight Hispanics' greater propensity to use parks and indicate that parks may serve a communal purpose for Hispanics that they do not serve for other racial/ethnic groups.

Objective: To simultaneously examine characteristics associated with prescription opioid use, misuse, and use disorders among US adults and assess correlates of their motivations for prescription opioid misuse., Methods: Data were examined from 51,200 adults 18 years or older who participated in the 2015 National Survey on Drug Use and Health. Prescription opioid use disorders were based on DSM-IV criteria. Bivariable and multivariable multinomial logistic regressions were applied., Results: Prescription opioid use disorders were associated with ages 18-29 and 30-49 years, male sex, good/fair/poor health, suicidal ideation, and tobacco use, alcohol or cocaine use disorders, heroin use or use disorders, and other psychotropic medication misuse or use disorders. Among US adult prescription opioid misusers, 63.4% reported that the main motivation for their most recent misuse was to relieve physical pain, followed by seeking to get high (11.6%) or to relax (10.9%). Sociodemographic characteristics, mental illness, and specific substance use and use disorders were associated with specific motivations for misusing prescription opioids. Among adults with prescription opioid use, reporting pain relief as a motivation for prescription opioid misuse was associated with suicidal ideation, cannabis and heroin use or use disorders, cocaine use disorders, and other psychotropic misuse or use disorders., Conclusions: Our results suggest that clinicians should assess prescription opioid misuse and its motivations and screen for multiple co-occurring behavioral health conditions in patients who misuse prescription opioids., (© Copyright 2018 Physicians Postgraduate Press, Inc.)

The prevalence of substance use disorders in adults is higher if substance use is initiated during adolescence, underscoring the importance of youth substance use prevention. We examined whether the use of one substance by adolescents is associated with increased risk for using any other substance, regardless of use sequences. In 2017 we examined data from 17,000 youth aged 12-17 who participated in the 2014 National Survey on Drug Use and Health, a sample of nationally representative data on substance use among the U.S. civilian, noninstitutionalized population aged 12 or older. Descriptive analyses and multivariable logistic regression models were applied. After controlling for age, sex, and race/ethnicity, compared with youth without past-month marijuana use, youth with past-month marijuana use were 8.9 times more likely to report past-month cigarette use, 5.6, 7.9 and 15.8 times more likely to report past-month alcohol use, binge use, or heavy use (respectively), and 9.9 times more likely to report past-month use of other illicit drugs. The prevalence of past-month use of cigarettes, marijuana, and other illicit drugs was significantly higher among past-month alcohol users compared with youth without past-month alcohol use, and increased as intensity of alcohol use rose. Among past-month cigarette smokers, the prevalence of marijuana, other illicit drugs, and alcohol use were each significantly higher than youth without past-month cigarette use. Youth marijuana use, cigarette smoking, or alcohol consumption is associated with other substance use. This finding has importance for youth prevention, supporting a message no use by youth of any substance., (Copyright © 2018 Elsevier Inc. All rights reserved.)