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Hookahs have been rising in popularity in the United States (U.S.) especially among the youth yet not much research has been carried out to understand the various predictors of hookah use among youth. We have thus conducted a cross-sectional study with a mixed-methods triangulation design to identify the hookah use determinants at different levels of the Social Ecological Model among youth. Participants between the ages of 18–24 years were sampled purposively, between April to November 2023, following a snowballing technique from various communities in Virginia and California, United States. Data were collected via a survey, one-on-one interviews, and focus groups. The study had a total sample size of 20. We found that participants smoked for a median of 5 times in the past 30 days. The main determinants of hookah smoking included the limited knowledge of health effects and addiction, positive attitude, family and peer influence, use as a means to socially connect with others, culture, social acceptability, lack of education at school and work place, access to hookah bars and smoke shops, and lack of strict enforcement of laws to ban smoking of youth. Educational interventions should be implemented by public health authorities to target the youth, their social and communities to provide education on hookah harm and addictiveness and to restrict access to- and the production, distribution, marketing and sales of hookahs. [ABSTRACT FROM AUTHOR]

Background The COVID-19 pandemic has had a profound global impact on health-care systems and patient outcomes. However, the specific effects of the pandemic on cancer incidence rates in the United States during its initial year remain unknown. Methods In this study, we analyzed data from the Surveillance, Epidemiology, and End Results–22 registries, which encompass approximately 50% of the US population. We investigated changes in monthly incidence rates stratified by various factors, including cancer type, stage, age group, sex, race and ethnicity, socioeconomic status, rural-urban status, and registry locations. We compared the incidence rates observed during the pandemic with those from the previous year. Results Our findings revealed a decline in incidence rates for all cancer sites combined starting in March 2020, coinciding with the implementation of stay-at-home orders. This decline reached its lowest point in April 2020 and persisted at a lower level until May 2020. Notably, compared with April 2019, the incidence rates in April 2020 dropped by 48.1% and did not consistently return to prepandemic levels. The reduction in cancer rates was more pronounced in urban and affluent counties. Across all cancer types, there was a statistically significant decrease in incidence rates during the pandemic, with the largest declines observed in thyroid (71.2%), prostate (57.9%), breast (54.9%), and colon and rectum cancers (54.1%). Furthermore, these decreases were primarily observed in early stage rather than late-stage disease. Conclusions The COVID-19 pandemic had a statistically significant impact on cancer outcomes. Monitoring long-term consequences of the pandemic on cancer incidence, stage at diagnosis, and mortality trends will be crucial. [ABSTRACT FROM AUTHOR]

Objective: We estimated the caseload of providers, practices, and clinics for psychosocial services (including psychotherapy) to Medicaid-insured children to improve the understanding of the current supply of such services and to inform opportunities to increase their accessibility. Methods: We used 2012-2013 Medicaid claims data and data from the 2013 National Plan and Provider Enumeration System to identify and locate therapists, psychiatrists, and mental health centers along with primary, rehabilitative, and developmental care providers in the United States who provided psychosocial services to Medicaid-insured children. We estimated the per-provider, per-location, and state-level caseloads of providers offering these services to Medicaid-insured children in 34 states with sufficiently complete data to perform this analysis, by using the most recent year of Medicaid claims data available for each state. We measured caseload by calculating the number of psychosocial visits delivered by each provider in the selected year. We compared caseloads across states, urbanicity, provider specialty (eg, psychiatry, psychology, primary care), and practice setting (eg, mental health center, single practitioner). Results: We identified 63 314 providers, practices, or centers in the Medicaid claims data that provided psychosocial services to Medicaid-insured children in either 2012 or 2013. The median provider-level per-year caseload was <25 children and <250 visits across all provider types. Providers with a mental health center–related taxonomy accounted for >40% of visits for >30% of patients. Fewer than 10% of providers and locations accounted for >50% of patients and visits. Conclusions: Psychosocial services are concentrated in a few locations, thereby reducing geographic accessibility of providers. Providers should be incentivized to offer care in more locations and to accept more Medicaid-insured patients. [ABSTRACT FROM AUTHOR]

High-intensity statins, beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and antiplatelet agents (ie, intensive medical management) reduce coronary heart disease (CHD) risk after myocardial infarction (MI). The objective of the study was to determine the risk of CHD events or death despite receiving intensive medical management after MI. We studied 16,853 United States adults with health insurance in the MarketScan and Medicare databases who underwent percutaneous coronary intervention while hospitalized for MI between January 1, 2014 and June 30, 2015 and received intensive medical management within 30 days after hospital discharge. MI, CHD, and all-cause mortality rates from 30 days after hospital discharge through December 31, 2015 were compared with 67,412 individuals in each of three groups: (1) the general MarketScan and Medicare populations, (2) with diabetes, and (3) with a CHD history. Among beneficiaries intensively medically managed after their MI, recurrent MI, CHD events, and all-cause mortality rates were 47.1, 72.0, and 57.5 per 1000 person-years, respectively. The multivariable-adjusted hazard ratio (95% CI) comparing intensively medically managed beneficiaries after MI to the general population, those with diabetes, and those with a history of CHD were 8.54 (7.52–9.70), 7.40 (6.61–8.28), and 5.45 (4.92–6.05), respectively, for recurrent MI; 7.82 (7.07–8.64), 6.27 (5.74–6.86), and 4.45 (4.10–4.82), respectively, for CHD events; and 1.15 (1.05–1.25), 1.05 (0.97–1.14), and 1.06 (0.97–1.15), respectively, for all-cause mortality. Substantial residual risk for MI and CHD events remains despite intensive medical management after MI. • Risk after myocardial infarction is high despite intensive secondary prevention. • AHA/ACC guideline risk-enhancing factors predict risk after myocardial infarction. • New therapies targeting residual risk after myocardial infarction are warranted. [ABSTRACT FROM AUTHOR]

Objective: To quantify the impact of multiyear utilization of preventive dental services on downstream dental care utilization and expenditures for children.Data Sources/study Setting: We followed 0.93 million Medicaid-enrolled children who were 3-6 years old in 2005 from 2005 to 2011. We used Medicaid claims data of Alabama, Georgia, Mississippi, North Carolina, South Carolina, and Texas.Study Design: We clustered each state's study population into four groups based on utilization of topical fluoride and dental sealants before caries-related treatment using machine learning algorithms. We evaluated utilization rates and expenditures across the four groups and quantified cost savings of preventive care for different levels of penetration.Data Extraction Method: We extracted all dental-related claims using CDT codes.Principal Findings: In all states, Medicaid expenditures were much lower for children who received topical fluoride and dental sealants before caries development than for all other children, with a per-member per-year difference ranging from $88 for Alabama to $156 for Mississippi.Conclusions: The cost savings from topical fluoride and sealants across the six states ranged from $1.1M/year in Mississippi to $12.9M/year in Texas at a 10 percent penetration level. Preventive dental care for children not only improves oral health outcomes but is also cost saving. [ABSTRACT FROM AUTHOR]

Objective: This article discusses the sources of overestimation of spatial access as recently provided by the Health Policy Institute (HPI) of the American Dental Association.Methods: Sources of overestimation of access included estimation of Medicaid participation and capacity and limitations of the access measurement approach.Results: While the HPI analysis used a 30% Medicaid acceptance rate for Florida, 10.2% of dentists accepted ≥100 Medicaid patients in 2015. The nationwide median number of Medicaid-enrolled children per provider ranges from 36 (Nebraska) to 265 (Florida). HPI estimated that 94% of publicly insured children in Georgia lived within 15 minutes of participating dentists. More rigorous modeling for access estimated that 23% of the total child population do not have access within the state access standards in Georgia.Conclusions: The estimates provided by HPI substantially overestimate access for children with public insurance. The overestimation comes from both the data limitations and the shortcomings of the methodology employed. [ABSTRACT FROM AUTHOR]

Many studies in health services research rely on regression models with a large number of covariates or predictors. In this article, we introduce novel methodology to estimate and perform model selection for high-dimensional non-parametric multivariate regression problems, with application to many healthcare studies. We particularly focus on multi-responses or multi-task regression models. Because of the complexity of the dependence between predictors and the multiple responses, we exploit model selection approaches that consider various level of groupings between and within responses. The novelty of the method lies in its ability to account simultaneously for between and within group sparsity in the presence of non-linear effects. We also propose a new set of algorithms that can identify inactive and active predictors that are common to all responses or to a subset of responses. Our modeling approach is applied to uncover factors that impact healthcare expenditure for children insured through the Medicaid benefits program. We provide important findings on the association between healthcare expenditure and a large number of well-cited factors for two neighboring states, Georgia and North Carolina, which have similar demographics but different Medicaid systems. We also validate our methods with a benchmark cancer data set and simulated data examples. [ABSTRACT FROM AUTHOR]

Objective: To quantify disparities in accessibility and availability of pediatric primary care by modeling interventions across multiple states that compare publicly insured versus privately insured children, and urban versus rural communities.Data Sources: Secondary data sources include 2013 National Plan and Provider Enumeration System, 2009 MAX Medicaid claims, 2012 American Community Survey.Study Design: The study models accessibility and availability of care for all children in seven states.Methods: Optimization modeling with access constraints is used to estimate access. Statistical hypothesis testing is used to quantify systematic disparities.Principal Findings: California has the best accessibility for privately insured children and Minnesota for publicly insured children. Mississippi has the lowest availability for both populations. Overall, the disparities in availability for pediatric primary care are not as significant as in accessibility. Both rural and urban communities are in need of improvement in accessibility to primary care for publicly insured children, although at varying levels across states.Conclusions: Disparities in availability are not as significant as disparities in accessibility. Opportunities to improve access to pediatric primary care vary by state. Generating specific recommendations for small areas is critical to enabling health policy decision makers to improvement access. [ABSTRACT FROM AUTHOR]

Given the aging end-stage renal disease (ESRD) population, kidney transplant (KTx) centers may experience an increase in referrals of patients living in long-term care (LTC) settings (eg, skilled nursing facilities, assisted living facilities, group homes, and boarding homes).~Context~Background~To identify best practices among KTx professionals when considering individuals in LTC settings for transplantation.~Objective~Objective~A cross-sectional survey administered online to US transplant professionals via e-mail LISTSERVs and other professional networks.~Design and Setting~Methods~One hundred twenty-six KTx professionals working in the United States.~Participants~Methods~The survey was composed of demographic questions and 6 hypothetical scenarios. These scenarios asked participants to assess transplant candidacy of patients with ESRD living in LTC settings based on the information provided in the scenario. Each scenario presented a different variable that necessitated LTC placement, including lack of social support, moderate intellectual disability, stable neurological condition, mild dementia, a psychiatric condition controlled on medications, and limited mobility.~Main Outcome Measures~Methods~The only scenario that elicited an overwhelmingly negative response was mild dementia with 73.9% of participants unwilling to consider such patients for KTx. By contrast, the proportion of KTx professionals reluctant to proceed with KTx in the remaining scenarios ranged between 40.0% and 50.6%.~Results~Results~This survey of a large number of KTx professionals suggests that there is presently no best practice consensus regarding offering KTx to patients living in LTC settings. Further research should include a broader range of KTx professionals and should also include a study of outcomes with KTx in this particular patient population.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

Background: Many patients report adverse reactions to, and may not tolerate, statin therapy. These patients may be at increased risk for coronary heart disease (CHD) events and mortality.Objectives: This study evaluated the risk for recurrent myocardial infarction (MI), CHD events, and all-cause mortality in Medicare beneficiaries with statin intolerance and in those with high adherence to statin therapy.Methods: We studied 105,329 Medicare beneficiaries who began a moderate- or high-intensity statin dosage after hospitalization for MI between 2007 and 2013. Statin intolerance was defined as down-titrating statins and initiating ezetimibe therapy, switching from statins to ezetimibe monotherapy, having International Classification of Diseases, 9th revision, diagnostic codes for rhabdomyolysis or an antihyperlipidemic adverse event, followed by statin down-titration or discontinuation, or switching between ≥3 types of statins within 1 year after initiation. High statin adherence over the year following hospital discharge was defined as proportion of days covered ≥80%. Recurrent MI, CHD events (recurrent MI or a coronary revascularization procedure), and mortality were identified from 1 year after hospital discharge through December 2014.Results: Overall, 1,741 patients (1.65%) had statin intolerance, and 55,567 patients (52.8%) had high statin adherence. Over a median of 1.9 to 2.3 years of follow-up, there were 4,450 recurrent MIs, 6,250 CHD events, and 14,311 deaths. Compared to beneficiaries with high statin adherence, statin intolerance was associated with a 36% higher rate of recurrent MI (41.1 vs. 30.1 per 1,000 person-years, respectively), a 43% higher rate of CHD events (62.5 vs. 43.8 per 1,000 person-years, respectively), and a 15% lower rate of all-cause mortality (79.9 vs. 94.2 per 1,000 person-years, respectively). The multivariate-adjusted hazard ratios (HR) comparing beneficiaries with statin intolerance versus those with high statin adherence were 1.50 (95% confidence interval [CI]: 1.30 to 1.73) for recurrent MI, 1.51 (95% CI: 1.34 to 1.70) for CHD events, and 0.96 (95% CI: 0.87 to 1.06) for all-cause mortality.Conclusions: Statin intolerance was associated with an increased risk for recurrent MI and CHD events but not all-cause mortality. [ABSTRACT FROM AUTHOR]

Accessibility and equity across populations are important measures in public health. This paper is specifically concerned with potential spatial accessibility, or the opportunity to receive care as moderated by geographic factors, and with horizontal equity, or fairness across populations regardless of need. Both accessibility and equity were goals of the 2009 vaccination campaign for the novel H1N1a influenza virus, including during the period when demand for vaccine exceeded supply. Distribution system design can influence equity and accessibility at the local level. We develop a general methodology that integrates optimization, game theory, and spatial statistics to measure potential spatial accessibility across a network, where we quantify spatial accessibility by travel distance and scarcity. We estimate and make inference on local (census-tract level) associations between accessibility and geographic, socioeconomic, and health care infrastructure factors to identify potential inequities in vaccine accessibility during the 2009 H1N1 vaccination campaign in the U.S. We find that there were inequities in access to vaccine at the local level and that these were associated with factors including population density and health care infrastructure. Our methodology for measuring and explaining accessibility leads to policy recommendations for federal, state, and local public health officials. The spatial-specific results inform the development of equitable distribution plans for future public health efforts. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate how met need for accessibility and availability of primary care among nonelderly individuals in Georgia will be affected by the Patient Protection and Affordable Care Act (ACA) over the next 10 years. Methods. We used a stock-and-flow model to predict the number of available visits from 2013 to 2025, regression models to project needed visits, and an optimization model to estimatemet need. The outputs of thesemodelswere used to estimate unmet need and the availability and accessibility of primary care. Results. Our findings showed that the number of primary care providers will increase by 9.2% to 11.7% by 2025 and that the number of needed visits will increase by 20%. Under Medicaid expansion, the percentage of met need will increase from 67% to 80%. Accessibility will improve by 20% under expansion, and availability will decrease by 13% to 19% under expansion. Conclusions. The ACAs' provisions will reduce unmet need and positively affect accessibility while reducing availability in some communities. Increased need because of a larger Medicaid population under Medicaid expansion will not be a significant burden on the privately insured population. [ABSTRACT FROM AUTHOR]

Background Pulmonary arterial hypertension (PAH) is a rare condition that can ultimately lead to right heart failure and death. In this study we estimated the health care costs and resource utilization associated with PAH in a large US managed care health plan. Methods Subjects with claims-based evidence of PAH from 1/1/2004 to 6/30/2010 (identification period) were selected. To be included in the final PAH study sample, subjects were required to have ≥2 claims with a primary PH diagnosis; ≥2 claims with a PAH related-diagnosis (connective tissue diseases, congenital heart diseases, portal hypertension); and α1 claim with evidence of a PAH-indicated medication. The earliest date of a claim with evidence of PAHindicated medication during the identification period was set as the index date. Health care costs and resource utilization were compared between an annualized baseline period and a 12 month follow-up period. Results 504 PAH subjects were selected for the final study cohort. Estimated average total health care costs were approximately 16% lower in the follow-up period compared to the baseline period (follow-up costs = $98,243 [SD = 110,615] vs. baseline costs = $116,681 [SD = 368,094], p < 0.001), but substantively high in each period relative to costs reported for other chronic diseases. Pharmacy costs were significantly higher in the follow-up period vs. the baseline period, ($38,514 [SD = 34,817] vs. $6,440 [SD = 12,186], p < 0.001) but medical costs were significantly lower in the follow-up vs. baseline ($59,729 [SD = 106,683] vs. $110,241 [SD = 368,725], p < 0.001). These costs were mirrored in health-care resource utilization estimates. The average counts of ambulatory visits and inpatient stays were lower in the follow-up vs. the baseline (both p < 0.001). Results varied in exploratory analyses when less restrictive subject identification algorithms were used. Conclusions Subjects with evidence of PAH had substantively high health care costs. Medical costs appeared to decrease following PAH medication use, but with a concomitant increase in pharmacy costs. [ABSTRACT FROM AUTHOR]

The article reports on the distribution of treatment for cervix uteri, vagina and vulva carcinomas before the implementation of human papillomavirus (HPV) vaccination in the U.S. It states that the treatment patterns of HPV-associated carcinomas are correlated with both clinical and demographic characteristics. It mentions that the use of hysterectomy for the treatment of gynecologic malignancies was highest for women ages 30 to 64 years.

Background: Invasive squamous cell carcinoma (SCC) of the penis is rare in the United States. Although human papillomavirus (HPV) infection is an established etiologic agent in at least 40% of penile SCCs, relatively little is known about the epidemiology of this malignancy.Methods: Population-based data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program, the Centers for Disease Control and Prevention's National Program for Cancer Registries, and the National Center for Health Statistics were used to examine invasive penile SCC incidence and mortality in the United States. SEER data were used to examine treatment of penile SCC.Results: From 1998 to 2003, 4967 men were diagnosed with histologically confirmed invasive penile SCC in the United States, representing less than 1% of new cancers in men. The annual, average age-adjusted incidence rate was 0.81 cases per 100,000 men, and rates increased steadily with age. Overall, penile SCC incidence was comparable in whites and blacks, but approximately 2-fold lower in Asians/Pacific Islanders. Rates among Hispanics were 72% higher compared with non-Hispanics. Blacks compared with whites and Asians/Pacific Islanders and Hispanics compared with non-Hispanics were diagnosed at significantly younger ages. Higher rates of mortality were also observed among blacks compared with whites and Hispanics compared with non-Hispanics. Penile SCC incidence and mortality were elevated in Southern states and in regions of low socioeconomic status (SES). Some histologic and anatomic site differences were observed by race and ethnicity. Treatment of penile SCC varied with age, stage, and other tumor characteristics.Conclusions: There are considerable disparities in invasive penile cancer incidence and mortality in the United States. Key risk factors for excess incidence include Hispanic ethnicity and residence in the South and in low SES regions. Risks for excess mortality include these factors in addition to black race. Decreases in penile cancer incidence and mortality in the United States may be realized in the future as the indirect result of prophylactic HPV vaccination of females. Further research is needed to better understand the epidemiology of penile cancer including the role of HPV. [ABSTRACT FROM AUTHOR]

Focuses on a study which provides a comparison of performance funding programs in nine states in the United States. Context of the performance funding in most the states; Origin and adoption of performance funding; Implementation and evaluation of the performance funding; Performance funding levels.

This article describes the status of performance funding and presents the overall results of a large opinion and attitude survey of state policymakers and campus leaders related to performance funding programs in nine states, namely Arkansas, Colorado, Florida, Kentucky, Minnesota, Missouri, Ohio, South Carolina, and Tennessee. Performance funding for public higher education has emerged in response to decreases in tax support and to the public's concern for accountability and results. Although states have initiated numerous changes aimed at improving higher education, performance funding is the only reform to date that directly links at least part of the funding for public higher education to achieve, rather than promised, results in policy areas states deem important.

Introduction: Wheel-chair dependend individuals are often the target of aggressors, due to the fact that they can't protect themselves in order to escape from a conflictual situation. Self defense for the wheel-chair users have a special semnification, because of the fact that men with disabilityes are two times more susceptible for being attacked, according to the USA Buireau of Justice. The aggressors are perceiving the person in wheelchair as an easy victim. This psychological aspect can provide the element of surprise, because the aggressor can be countered through self-defense techniques performed by the victim. Obiectives: The acquisition of self defense techniques and procedures in the young pacient with wheelchair independed paraplegia, with he purpose of protection in dangerous situations. Material and methods: Having the patient consent and the approval of the Ethics Committee of "Bagdasar- Arseni" Clinical Emergency Hospital, N.O. 17464/14.06.2019, this paper presents a young patient with the diagnosis of complete paraplegia AIS-A, with T11 neurological level, independent with wheelchair, ex sportsman, witch was instructed with various taekwondo techniques and maneuvres such as: blocking an attack with the hand at the head region (Olgul Jireugi), hand block (Olgul Maki), hand counteratack (Momntong Jireugi), foot attack at the head region (Olgul Dollyo Chagi), hand block (Sonnal Olgul Maki), hand counterattack (Arae Jireugi) etc. The person who has the role of the attacker has a black belt in taekwondo, therefore the maneuvres were performed in total safety, without endangering the young pacient. Results: We realized photographs and films that demonstrate the possible scenarios of aggression that the victim can experience. Conclusions: Prevention, as a self defense method, is essential. The best way is to avoid conflictual situations, but ideal is to be prepared for any situation. The purpose of this paper is the acquisition of self defense techniques for the pacient with wheel chair independent paraplegia, with the purpose of improving: safty, grade of participation, self-esteem and the quality of life. [ABSTRACT FROM AUTHOR]

The contents of the current issue are reviewed. [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the issue, including one by Willard Hom on an approach to form peer groups in relation to the comparison of institutional performance across like colleges in the U.S., and one by Eddy A. Ruiz on college accreditation.

Objective: Prior studies have identified low rates of engagement in mental health (MH) services in clinic settings among children enrolled in Medicaid. Yet, little is known about whether the delivery of in-home MH treatment (in which the clinician travels to the child's home) improves engagement for this population. This study examines the association between the delivery of in-home psychosocial treatment and engagement in services among Medicaid-enrolled youth.Method: We used 2010 to 2014 Georgia Medicaid claims data to identify 53,508 children and adolescents (aged 5-17 years) with a MH diagnosis that initiated new psychosocial treatment. We estimated regression models controlling for covariates to examine the relationship of the receipt of any in-home psychosocial treatment in the home setting with 3 outcome measures of engagement: receipt of at least 4 psychosocial visits during the first 12 weeks; total number of psychosocial visits during the first 12 weeks; and total duration of service use.Results: Those who received any in-home psychosocial treatment (compared to those who did not) had 4.3 times the odds (odds ratio = 4.3, 95% CI = 4.0, 4.7) of receiving at least 4 visits during the first 12 weeks, had 4.5 (95% CI = 4.3, 4.7) more predicted visits during the first 12 weeks, and had a longer treatment episode duration (mean rate ratio = 1.54, 95% CI = 1.48,1.59).Conclusion: Although many Medicaid-enrolled youth do not receive a sufficient number of MH services to achieve positive outcomes, our findings suggest that providing in-home psychosocial treatment can improve service engagement and potentially help address this challenge. [ABSTRACT FROM AUTHOR]