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Background Opioid use disorders (OUDs) have devastating effects on individuals, families, and communities. While medication treatments for OUD save lives and are increasingly utilized, rates of treatment dropout are very high. In addition, most existing medication treatments for OUD may often neglect the impact of untreated OUD on relationships and ignore the potential role support persons (SPs) could have on encouraging long-term recovery, which can also impact patient treatment retention. Methods/design The current study adapts Community Reinforcement and Family Training (CRAFT) for use with SPs (family member, spouse or friend) of patients using buprenorphine/naloxone (buprenorphine) in an outpatient community clinic setting. The study will evaluate whether the adapted intervention, also known as integrating support persons into recovery (INSPIRE), is effective in increasing patient retention on buprenorphine when compared to usual care. We will utilize a two-group randomized design where patients starting or restarting buprenorphine will be screened for support person status and recruited with their support person if eligible. Support persons will be randomly assigned to the INSPIRE intervention, which will consist of 10 rolling group sessions led by two facilitators. Patients and SPs will each be assessed at baseline, 3 months post-baseline, and 12 months post-baseline. Patient electronic medical record data will be collected at six and 12 months post-baseline. We will examine mechanisms of intervention effectiveness and also conduct pre/post-implementation surveys with clinic staff to assess issues that would affect sustainability. Discussion Incorporating the patient’s support system may be an important way to improve treatment retention in medication treatments for OUD. If SPs can serve to support patient retention, this study would significantly advance work to help support the delivery of effective treatments that prevent the devastating consequences associated with OUD. Trial registration This study was registered with ClinicalTrials.gov, NCT04239235. Registered 27 January 2020, https://clinicaltrials.gov/ct2/show/NCT04239235.

Americans' online shopping habits have continued to shift during the coronavirus disease 2019 pandemic. More Americans are shopping online, and people who report shopping online more frequently also report spending more money on online purchases. People who reported spending less on online purchases were likely to have lost employment during the pandemic.

Section 122 of the Federal Aviation Administration (FAA) Reauthorization Act of 2018 directed the FAA to contract with an independent research organization to address questions and provide recommendations related to infrastructure funding and financing at commercial service airports. This executive summary presents the full report's core findings, recommendations, and answers to the questions listed in Section 122.

Despite widespread stay-at-home orders as a response to the coronavirus disease 2019 (COVID-19) pandemic, most Americans have not changed their online shopping habits. RAND researchers examine who was more likely to increase their online shopping habits and why. People in more-affluent households and those who are younger were more likely to increase their online shopping habits. Gender and urbanicity made very little difference.

What might the future of mobility be in China in 2030? “Mobility” is defined as the ability to travel from one location to another regardless of mode or purpose. Researchers at RAND Corporation working with the German Institute for Mobility Research developed two scenarios that address this question with a six-step process: ( a) select influence areas (domains that affect mobility directly) and factors, ( b) elicit projections on factors (via expert workshops in Washington, D.C., and Beijing), ( c) integrate these projections into scenario frameworks (using two analysis methods and a computer-based tool), ( d) produce scenario narratives (based on the clusters produced by the tool), ( e) draw qualitative consequences for future mobility, and ( f) create a wild-card scenario (by looking at events that might disrupt trends). The two resulting scenarios—The Great Reset and Slowing but Growing—are differentiated by three key drivers: economic growth, environmental issues, and constraints on vehicle ownership and driving. Because of a lack of available data on past travel trends, some types of estimates of future travel demand, such as vehicle miles traveled, could not be developed. The scenarios include estimates of future vehicle ownership and production as well as more qualitative estimates for demand on other modes.

Motor vehicle crashes account for a large number of deaths and injuries. In the United States, in 2015, more than 35,000 people were killed and approximately 2.44 million were injured in motor vehicle crashes. In 2010, the economic costs associated with motor vehicle crashes in the United States were substantial, estimated to be $242 billion. Fortunately, a wide range of evidence-based interventions, including both policies and programs, can help prevent motor vehicle-related injuries and deaths. In 2014, RAND researchers developed an online tool, the Motor Vehicle Prioritizing Interventions and Cost Calculator for States (MV PICCS), to help determine the costs and effectiveness of various interventions to reduce injuries and deaths from motor vehicle crashes and what interventions together generate the largest reductions in injuries and deaths for a given implementation budget. A 2015 update added two new interventions and produced a series of reports about allocating traffic safety funds. The 2017 update, MV PICCS 3.0, determined whether to add new interventions, updated information on the interventions' effectiveness and costs, and redesigned the tool's user interface to be more user-friendly.

Imagine that, in 2050, not a single person in the United States dies in a traffic crash. This is the scenario described in this article, in which RAND researchers set forth a vision and strategy for achieving zero roadway deaths by 2050. The authors propose that a combination of three approaches can realize this scenario. The first is doubling down on programs and policies that have already been shown to be effective, including laws and enforcement, changes to roadway infrastructure designed to reduce traffic conflicts, reductions in speeds where crashes are likely, improvements to emergency response and trauma care, and more safety education and outreach. The second is accelerating advanced technology, beginning with advanced driver assistance systems (many of which are already in the market) and progressing up to fully automated vehicles. The third is prioritizing safety, which includes both (1) embracing a new safety culture that will lead Americans to think differently about our individual and collective choices and (2) widespread adoption of the "Safe System" approach, a paradigm shift in addressing the causes and prevention of roadway deaths and injuries. The authors conclude with a list of actions that key stakeholders-including professional engineering and planning organizations, public-sector organizations, safety advocates, vehicle manufacturers, technology developers, public health, emergency medical and trauma care organizations, and law enforcement and judicial system representatives-can take to bring about the changes needed to achieve zero roadway deaths by 2050.

Motor vehicle crashes account for a large number of deaths and injuries. In the United States, in 2015, more than 35,000 people were killed and approximately 2.44 million were injured in motor vehicle crashes. In 2010, the economic costs associated with motor vehicle crashes in the United States were substantial, estimated to be $242 billion. Fortunately, a wide range of evidence-based interventions, including both policies and programs, can help prevent motor vehicle-related injuries and deaths. In 2014, RAND researchers developed an online tool, the Motor Vehicle Prioritizing Interventions and Cost Calculator for States (MV PICCS), to help determine the costs and effectiveness of various interventions to reduce injuries and deaths from motor vehicle crashes and what interventions together generate the largest reductions in injuries and deaths for a given implementation budget. A 2015 update added two new interventions and produced a series of reports about allocating traffic safety funds. The 2017 update, MV PICCS 3.0, determined whether to add new interventions, updated information on the interventions' effectiveness and costs, and redesigned the tool's user interface to be more user-friendly.

The Centers for Disease Control and Prevention's interactive Motor Vehicle Prioritizing Interventions and Cost Calculator for States (MV PICCS) can help state decisionmakers prioritize motor vehicle injury–prevention interventions. For each intervention, MV PICCS calculates the expected number of injuries prevented and lives saved and the costs of implementation. This new version provides a more user-friendly interface and updated data.

The authors review traffic safety in the United States, with specific reference to military personnel, focusing on safety interventions and attempts to change driver behavior and decisions. Overall, driving has become safer over the last 20 years: A variety of factors seem to have contributed to this increased safety-better vehicle safety features, better road safety features, decreases in teenage drunk driving, more seat belt use, and at least recently, fewer vehicle miles traveled. In contrast, motorcycle riding, a topic of particular interest to the military, is becoming more dangerous. The main difference between the military and civilian population is the proportion of military crash fatalities on motorcycles-the U.S. rate is currently about 15 percent of fatalities, while in some military branches the rate is on average 35-40 percent. This review shows that the following safety interventions tend to help in the reduction of vehicle crashes and that some in particular may be useful in the military setting: (1) better enforcement of underage drinking laws and continuation of alcohol deglamorization campaigns (Department of Defense regulations exist, but underage drinking seems to be relatively common); (2) high-visibility enforcement techniques for sobriety checkpoints; (3) high-visibility enforcement techniques for seat belt use; (4) adoption of a lower blood alcohol concentration level (such as 0.05) for motorcyclists, since the evidence shows that motorcyclists' ability to drive safely begins declining at lower levels than those for car drivers; (5) screening-perhaps as part of military medical assessment-and brief intervention with a trained counselor for at-risk drinkers, since they are at higher risk for drinking and driving; (6) media campaigns that are paired with community activities that also emphasize driver safety, such as workshops or fairs and with enforcement of driving regulations, and targeted at the drivers at highest risk (men in their teens and early 20s); (7) requirements that motorcyclists be licensed and own their vehicles.

This paper introduces an innovative methodology to answer the question, Toward which levels of automobility are the BRIC countries (Brazil, Russia, India, and China) headed? The authors applied this methodology as an aid to understanding why long-term saturation levels for car travel differed across the countries of the Organisation for Economic Co-operation and Development study and what this difference meant for the saturation levels that the BRIC countries might attain. This approach factored out development of the gross domestic product (GDP) to focus on the ways in which other factors influenced specific paths of automobility in individual countries. The focus was on this question: Why were the long-term automobility saturation levels so much higher for some countries than for others, even at similar levels of GDP? The methodology drew on quantitative analysis of historical developments in four industrialized countries (the United States, Australia, Germany, and Japan) that served as case studies representing prototypical paths of automobility with extremely different levels of per capita automobility, in combination with qualitative data derived from an expert-based approach. The qualitative approach was used to transfer historical experiences about the ways in which (a) automobility evolution was shaped in industrialized countries and (b) these experiences might affect the future of automobility in the BRIC countries. On the basis of this analysis, Brazil proved the most car-oriented country of the BRICs, with a potential long-term level of automobility between those of Germany and Australia. Russia was the second most car-oriented country, also with a likely long-term level of automobility above that of Germany. China and India, in contrast, were heading toward lower levels of automobility, below that of Germany but higher than that of Japan.

This paper presents two scenarios for mobility in the United States in 2030 and describes the rigorous qualitative and quantitative methodology used to develop them. This research should be of interest to transportation agencies at all levels–-federal, state, and local–-because innovative approaches to dealing with uncertainty about the future of mobility in the United States are necessary for long-term strategic transportation planning. Decision makers in transportation policy and planning need robust information about how and how much Americans will travel; such information can be used to determine whether the U.S. roadway infrastructure will be adequate, whether existing funding sources will be sufficient, and how new circumstances will change mode shares (percentages of travelers using various types of transportation). Instead of trying to predict these situations, or extrapolate from existing trends, the research team used a scenario approach to explore probable mobility futures. Two scenarios, no free lunch and fueled and freewheeling, resulted. Data were based on expert opinions about the long-term future in five areas: demographics, economics, energy, transportation funding, and technology. These data were analyzed with cross-impact and cluster analysis to produce scenario frameworks from which scenario narratives were constructed. The scenarios allow legislators, public agencies, and private-sector entities to assess and understand how today's decisions might play out in the future.

Inflation and improved fuel economy have undermined revenue from federal and state excise taxes on gasoline and diesel; this situation has made it challenging to maintain and expand the nation's road network. With more stringent federal fuel economy standards and the emergence of alternative fuels threatening to accelerate this problem in future years, policymakers have begun to explore mileage-based user fees as a long-term replacement for fuel taxes. Unaffected by fuel type or fuel economy, mileage fees would provide more sustainable revenue, and the system could be structured to promote more efficient use of the roads, offer value-added motorist services, and collect travel data to support better network planning and operations. Mileage fees will likely cost more to administer than will fuel taxes, however, and the concept faces acceptance challenges related to privacy protection and other concerns. These obstacles in turn have spurred great innovation. On the basis of recent studies, trials, and implementation efforts, this paper presents a review of promising mileage-fee design and implementation strategies intended to reduce system costs and foster greater public acceptance.

By 2035 UK transport infrastructure may be severely congested. Innovate UK commissioned this study to explore how technology might address the congestion problem by using capacity more efficiently, supporting modal choice and managing travel demand.

In this study, we developed future scenarios to examine the influence of technologies on travel and interviewed experts about the key policy implications. From these, we developed a strategic roadmap to inform future UK policies and investments.

Transportation policy makers increasingly consider congestion pricing a promising option for addressing urban traffic congestion problems. Although some congestion pricing projects have been undertaken in the United States, many proposals have been rejected because of concerns that congestion pricing is inequitable. This paper identifies and assesses ways of making congestion pricing equitable. The authors review notions of equity applicable to congestion pricing and explore the equity issues that arise in the context of cordon and area pricing systems and high-occupancy toll lanes.

This article discusses research into policies to manage greenhouse gases in the U.S. Debates in the U.S. Congress regarding the distribution of economic impacts associated with different mechanisms designed to encourage the reduction of greenhouse gas emissions are considered.

The federal tax code allows employers to provide tax-free transit benefits to employees. Although transit benefits programs are commonly promoted as having advantages for transit agencies, such as increasing transit ridership and transit agency revenues, their effects and effectiveness are not well understood and need to be better assessed. This research is designed to help transit agencies, policymakers, and organizations that promote transit benefits better understand what effects they might expect from a transit benefits program and how to quantify these effects. Overall, the research found that transit benefits programs can be effective for transit agencies attempting to meet various goals, in terms of increasing ridership and revenues, and decreasing costs. However, it is critical to set realistic expectations and conduct valid evaluations to assess these effects.

Although the development and lending communities have become much more aware of transit-oriented development (TOD) in the past 5 years, the lending process remains highly institutionalized and compartmentalized. TOD developers still face significant challenges in obtaining financing and structuring deals. After a brief review of common sources and structures of financing, this paper details obstacles to financing that TOD developers face, starting with the increasingly high risk attached to construction lending and the Federal Deposit Insurance Corporation's recent actions emphasizing increased bank oversight in this area. Complexity, design, and construction challenges, along with mixed-use and related lender concerns, compound the difficulties presented by the relative newness of the mixed-use, TOD product, as compared with the conventional real estate products that are more commonly underwritten and traded on the secondary market. This puts more pressure on TOD developers to present a solid equity position and prove that they have the know-how and wherewithal to carry a risky project through. Strategies to overcome these barriers to TOD financing include the structuring of uses to align with existing product categories, value engineering and the use of alternative building methods and materials, use of advanced information management systems, addition of large or experienced partners, and gain of higher-equity, patient investment. Finally, presenting the local and national market demand for TOD may help increase financiers' understanding of the unique benefits offered by TOD, and of its potential upside. Local governments can help by developing supportive plans and appropriate zoning, building public support, and streamlining the process to create a more predictable environment for developers and lenders.

According to analysis with a free new tool, allocating increased federal traffic safety funding by cost-effectiveness ratios rather than equally among states would save more than double the number of lives and prevent almost five times the injuries.

This report documents production of an online tool to help assess costs and effectiveness of implementing up to 14 interventions and select those most effective in reducing death and injury from motor vehicle crashes for a given implementation budget.

This brief describes an interactive tool that can help statedecisionmakers choose policies that are effective in reducing motor vehicle accidents in their states and appropriate to state budgets, saving lives and reducing economic and societal loss.

The American Association of State Highway and Transportation Officials established the National Cooperative Highway Research Program (NCHRP) Project 20-83 research series to examine global and domestic long-range strategic issues and their implications for departments of transportation (DOTs) to help prepare the DOTs for the challenges and benefits created by these trends. NCHRP Report 750: Strategic Issues Facing Transportation, Volume 5: Preparing State Transportation Agencies for an Uncertain Energy Future is the fifth report in this series. This report examines how the mandate, role, funding, and operations of state departments of transportation (DOTs) will likely be affected by changes in energy supply and demand in the next 30 to 50 years, and identifies potential strategies and actions that DOTs can employ to plan and prepare for these effects. The report describes how robust decision-making techniques can be used to help navigate the potential risks and rewards of different policy and management responses under differing surface transportation energy supply-and- demand scenarios. The report will be useful to senior policy analysts and long-range planning officials who want to more effectively understand and manage energy uncertainty as part of policy development and long-range planning activities.

Automobility — travel in personal vehicles — varies between countries. This brief summarizes a study of the factors besides economic development that affect automobility and how automobility might evolve in developing countries.

As traditional transportation revenue sources primarily based on gas tax continue to dwindle or stay even at best, the notion of transitioning to a vehicle-miles-traveled fee or mileage-based user fee has come under consideration. This webinar to the American Association of State Highway and Transportation Officials presents research finding on design strategies to reduce system costs and increase public acceptance of mileage-based fees.

In an effort to share different perspectives on potential climate policy solutions, RAND convened three workshops — one each on climate change policy, energy, and transportation — in which stakeholders addressed climate policy ideas and challenges.

This report discusses a review of Pennsylvania's regulatory and statutory authority over passenger and freight railroad transportation. It also suggests possible courses of action that Pennsylvania might take to increase the security and safety of railroads.

The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the Department of Veterans Affairs (VA) current and projected health care capabilities and resources. An examination of data from a variety of sources, along with a survey of VA medical facility leaders, revealed the breadth and depth of VA resources and capabilities: fiscal resources, workforce and human resources, physical infrastructure, interorganizational relationships, and information resources. The assessment identified barriers to the effective use of these resources and capabilities. Analysis of data on access to VA care and the quality of that care showed that almost all veterans live within 40 miles of a VA health facility, but fewer have access to VA specialty care. Veterans usually receive care within 14 days of their desired appointment date, but wait times vary considerably across VA facilities. VA has long played a national leadership role in measuring the quality of health care. The assessment showed that VA health care quality was as good or better on most measures compared with other health systems, but quality performance lagged at some VA facilities. VA will require more resources and capabilities to meet a projected increase in veterans' demand for VA care over the next five years. Options for increasing capacity include accelerated hiring, full nurse practice authority, and expanded use of telehealth.