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This study's goal was to characterize physical and social environments of stand-alone bars associated with indoor smoking despite California's smokefree workplace law. In a random sample of 121 stand-alone bars in San Francisco, trained observers collected data on patrons, staff, neighborhood, indoor settings and smoking behaviors. Using bivariate (chi-square) and hierarchical linear modeling analyses, we identified four correlates of patrons' indoor smoking: 1) bars serving predominantly Asian or Irish patrons, 2) ashtrays, 3) bartender smoking, and 4) female bartenders. Public health officials charged with enforcement of smokefree bar policies may need to attend to social practices within bars, and heighten perceptions of consistent enforcement of smokefree workplace laws.

"The more we know about HIV transmission, the more we know we need to improve collaboration and understand each others' approaches." (1) HIV, mental illness, and chemical dependency interact in […]

Background Sixty-eight percent of patients with pancreatic ductal adenocarcinoma (PDAC) are 65 years and older. Older adults are under-represented in clinical trials and their care is complicated with multiple age-related conditions. Research suggests that older patients can experience meaningful responses to treatment for PDAC. The objective of this study was to evaluate the characteristics, rate of treatment, and survival outcomes of patients with metastatic PDAC (mPDAC) based on age at diagnosis. Materials and Methods Data were extracted for patients diagnosed with mPDAC between January 1, 2015, and March 31, 2020, from the Flatiron Health database. Patients were stratified into 3 age groups: <70 years old, 70-79 years, and ≥80 years. The proportion of patients who received first-line therapy, the types of regimens received in the metastatic setting, overall survival (OS) from the start of treatment were evaluated. Results Of the 8382 patients included, 71.3% (n = 5973) received treatment. Among patients who received treatment 55.5% (n = 3313) were aged <70 years at diagnosis, 33.0% (n = 1972) were 70-79 years, and 11.5% (n = 688) were ≥80 years. Patients ≥80 years of age were more likely to receive gemcitabine monotherapy and less likely to receive FOLFIRINOX. Among first-line treated patients, median OS significantly decreased with age. However, when comparing patients treated with the same first-line regimen, no significant differences in median OS were observed by age. Conclusions This study highlights that older adults with mPDAC can benefit substantially by receiving appropriate levels of treatment. [ABSTRACT FROM AUTHOR]

Background: In recent years, the development of new therapies for multiple myeloma has improved the survival of patients, but newer treatments may also affect healthcare costs. To date, no real-world study has examined the concurrent changes in survival and total healthcare costs over time in patients with multiple myeloma., Objective: To examine the temporal changes in survival and healthcare costs among patients with multiple myeloma in the United States., Method: This retrospective claims-based cohort study is based on death files in the Truven Health MarketScan Research Commercial and Medicare Supplemental databases. The study included adults who had at least 1 inpatient or 2 outpatient claims with a diagnosis of multiple myeloma between January 1, 2006, and December 31, 2014; continuous insurance enrollment for at least 12 months before and at least 30 days after the first diagnosis (ie, index date); and no previous malignancy. Patients were followed from the index date through the earliest among (1) the date of death recorded in the death files, (2) the end of enrollment in the MarketScan database, or (3) end of the study (September 30, 2015). The mortality rates and the total all-cause and multiple myeloma-specific healthcare costs per patient per month were compared between patients diagnosed in 2006-2010 and those diagnosed in 2011-2014., Results: A total of 5199 patients were included in the study (2597 diagnosed between 2006 and 2010 and 2602 diagnosed between 2011 and 2014). We found a 35% decrease in the risk for death (hazard ratio, 0.65; 95% confidence interval, 0.57-0.74) among patients diagnosed in 2011-2014 compared with those diagnosed in 2006-2010. In addition, 18% and 26% increases were found in all-cause and multiple myeloma-specific healthcare costs, respectively, over the same time period (adjusted mean all-cause costs, $13,960 vs $16,449, respectively; adjusted mean multiple myeloma-specific costs, $7476 vs $9422, respectively)., Conclusion: The percent decrease in mortality in patients with multiple myeloma has been greater than the percent increase in healthcare costs in recent years, which may be attributable to improved treatments for multiple myeloma and changes in disease management. With the mortality rate having decreased more than the increase in healthcare costs over the same time period, the results of this study suggest that although healthcare spending has increased over time, there is a survival benefit.

Objectives: To compare antiretroviral therapy (ART) adherence and persistence and total healthcare expenditures in Medicaid-insured patients with human immunodeficiency virus (HIV) initiating preferred or nonpreferred first-line ART based on March 2012 HHS HIV treatment guidelines., Study Design: Retrospective observational study using Medicaid administrative healthcare claims from 15 states., Methods: Subjects were HIV patients 18 to 64 years who initiated first-line HIV-related ART between January 1, 2007, and September 30, 2011, with continuous enrollment for 6 months prior to and at least 3 months following ART initiation. Patients were classified as having initiated preferred or nonpreferred ART based on March 2012 HHS HIV treatment guidelines. Outcomes were: ART adherence (proportion of days covered dichotomized at ≥80% and ≥95%), time to ART nonpersistence, and per patient per month (PPPM) total healthcare expenditures. Outcomes were evaluated using multivariable regressions., Results: Sample included 1979 patients initiating preferred ART regimens and 1614 patients initiating nonpreferred ART; overall mean age was 41 years; 48% of subjects were female. In the multivariable analyses, patients initiating preferred ART regimens had significantly greater odds of adherence ≥80% (odds ratio [OR], 1.38; 95% CI, 1.07-1.77) and adherence ≥95% (OR, 1.26; 95% CI, 1.05-1.51), and a significantly lower hazard of nonpersistence (HR, 0.48; 95% CI, 0.44-0.52). PPPM total healthcare expenditures were numerically lower for patients initiating preferred ART regimens (-$341; 95% CI, -$888 to $255) but the difference was not deemed significant., Conclusions: This study reinforces the value of HHS recommendations for first-line ART. The potential impact of these findings will grow as more HIV patients become Medicaid-eligible under the Patient Protection and Affordable Care Act.

Objectives: To evaluate the effect of asthma on direct and indirect costs among US working adults., Study Design: A case-control retrospective analysis was conducted. Data between January 1, 2003, and December 31, 2006, among patients aged 18 to 64 years with vs without asthma were extracted from MarketScan Research Databases. Patients with chronic obstructive pulmonary disease or emphysema were excluded, and all patients were required to have 12-month continuous enrollment before and after the index date. Outcomes included direct medical costs, the number of absence days, the number of short-term disability days, and associated indirect costs., Methods: Patients with asthma were propensity score-matched to patients without asthma using nearest neighbor 1:1 with caliper. Subsequent multivariate analysis was conducted on matched samples to examine the marginal effect of asthma on direct and indirect costs., Results: A total of 13,379 patients with asthma were propensity score-matched to 13,379 patients without asthma; in each cohort, 3453 patients had absence eligibility, and 8497 patients had short-term disability eligibility. Direct costs for patients with asthma were $3762, and indirect costs were $4572. Compared with the matched cohort without asthma, patients with asthma had $1785 higher direct medical expenditures (P <.001). Incremental indirect costs were $191 for absenteeism (P = .007) and $172 for short-term disability (P<.001)., Conclusions: Compared with patients without asthma, patients with asthma experience significantly higher direct medical costs and, although modest, significantly higher work loss. Treatments or interventions that prevent or reduce asthma symptoms may have a beneficial effect on medical costs and work absenteeism.

Objectives: To quantify employees' preferences, as measured by willingness to pay, to prevent influenza in themselves and in their child and adult household members and to examine factors associated with willingness to pay., Study Design: Prospective observational cohort study of a convenience sample of employees from 3 large US employers. Participants had at least 1 child (< or = 17 years) living in their household for at least 4 days per week., Methods: Each month from November 2007 to April 2008, employees completed Web-based surveys regarding acute respiratory illness in their household. In the final survey, employees were presented with descriptions of influenza and questions regarding their willingness to pay to prevent influenza. Factors associated with willingness to pay were examined using multivariate ordinary least squares regression analysis of the log of willingness to pay., Results: Among 2006 employees, 31.3% were female, the mean age was 41.7 years, 85.3% were of white race/ethnicity, and the mean household size was 4.0. Employees' median (mean) willingness to pay to prevent influenza was $25 ($72) for themselves, $25 ($82) for their adult household members, and $50 ($142) (P <.01) for children. However, influenza vaccination rates were approximately equal for children (27.5%), employees (31.5%), and other adult household members (24.5%). This finding may be explained by barriers such as cost, dislike of vaccinations, and disagreement with national influenza vaccination recommendations, which were significantly associated with lower willingness to pay for prevention of influenza (P <.05)., Conclusion: Employees expressed a stronger preference to prevent influenza in their children than in themselves or other household members; however, modifiable barriers depress vaccination rates.