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Context: Graduated drivers license (GDL) programs have been shown to reduce motor vehicle fatalities among 15- to 17-year-olds. However, the 20 most rural states have been the least likely to enact more stringent GDL policies. Purpose: Estimate the relationship of GDL programs and the number of traffic fatalities among 15- to 17-year-olds on rural interstate and noninterstate roadways. Methods: Analysis of 1992-2002 Fatality Analysis Reporting System data and a compendium of state laws using a conditional negative binominal regression model with full fixed effects to control for unobservable differences across states and years. Findings: Overall, GDL programs were associated with a 7.8% reduction in rural traffic fatalities among 15- to 17-year-olds. Virtually all of this reduction took place on noninterstate roadways. The most stringent GDL programs were associated with a nearly 22% reduction in this age group and were the only programs associated with reductions in fatalities among 15- to 17-year-old drivers. Conclusions: Rural states should consider enacting stringent GDL programs. Had the 19 of the 20 most rural states without such programs all adopted the most stringent GDL programs in 2002, the analysis suggests that 64 traffic deaths among 15- to 17-years-olds could have been prevented.

Objectives: As emergency department (ED) visits for non‐traumatic dental complaints continue to rise in the United States (U.S.), some states are implementing initiatives to expand access to the oral health workforce. This study examines the associations between the 2014 Dental Hygiene Professional Practice Index (DHPPI) and preventable dental ED visits. Methods: In 2020, we used ED data from 10 U.S. states and ordinary least squares models to examine the relationship between the states' DHPPI scores and preventable dental ED use. We stratified regressions by age to examine this relationship across different age cohorts and introduced interaction terms to assess the same relationship among rural and urban residents. Results: On average, 23.8% of all non‐traumatic dental ED visits were identified as preventable. Controlling for other factors, a one‐point increase in DHPPI scores was associated with a decrease of 0.01 (95% CI −0.03, −0.02) preventable dental ED visits per 1000 county population in each year‐quarter. In the age‐stratified models, the strength of the association between DHPPI scores and preventable dental ED visits was higher in the 20 to 34 (−0.03, 95% CI −0.04, −0.02), and the 35 to 50 age cohorts (−0.17, 95% CI −0.00, −0.00). U.S. states with DHPPI scores below 60 saw significantly higher preventable dental ED visits among rural residents. Conclusions: This study demonstrates that stringent state policies regarding the dental hygienist workforce are associated with higher preventable dental ED visits in the U.S. Policy makers and stake holders must address the scope of practice policies to alleviate the burden of access to oral healthcare. [ABSTRACT FROM AUTHOR]

Purpose: We attempt to determine whether older workers and early retirees avoid managed care plans and to explore whether health plan choices are linked to the health status of workers or their spouses. Design and Methods: We use the responses of those born between 1931 and 1941 to the 1994 and 1998 waves of the Health and Retirement Survey. We analyze current workers and early retirees separately, using cross-tabular and multinomial logit techniques. Results: Among older adults with active worker coverage, 60% were enrolled in either a health maintenance organization or preferred provider organization in 1998; 42% of early retirees were enrolled in these plans. Those with a choice of plans were even more likely to be in managed care. When demographic characteristics, time, and differences in the benefits and cost of the various plans offered by an employer are controlled for, health status (measured in a variety of ways) has little bearing on an older worker's choice of health plan. Implications: These findings suggest that older workers choose plans much as younger workers do. Employers are likely to continue to offer managed care as their workers age. The lack of unidirectional findings on health status bodes well for the long-term practicality of managed care under Medicare. Many workers are choosing an insurance type early in their tenure and remaining with that type of plan as they age.

We investigated asthma quality measures to understand patient characteristics associated with non-attainment of quality care and measure the association with asthma-related emergency department (ED) visits or inpatient hospitalizations (IPs). Using administrative data from ALL Kids, Alabama's Children's Health Insurance Program, from 2013 to 2019 we calculated non-attainment of the Medication Management for Asthma (MMA) and Asthma Medication Ratio (AMR) quality measures. Patient characteristics and asthma-related ED visits and IPs associated with non-attainment of the MMA and AMR measures were assessed using logit regression models and Marginal effects at the mean. Among 2528 children with asthma, 53.2% failed to attain the MMA measure and 8.5% the AMR measure. Prior asthma-related ED visits or IP stays increased likelihood of non-attainment by 14.8 percentage points (95% CI 8.6–20.9) for MMA and 7.3 percentage points (95% CI 2.8–11.8) for AMR. Among 868 children (34.3%) with three years of continuous enrollment, AMR non-attainment was associated with a 6.1 percentage point increase in ED or IP utilization (95% CI 1.3–10.9), however MMA non-attainment was not associated with either outcome. Prior ED visit/IP stay was associated with a 17.2 percentage point (95% CI 8.3–26.1) increase in the likelihood of a subsequent ED visit/IP stay among those with non-attainment MMA and a 15.5 percentage point increase (95% CI 6.9–24.2) for non-attainment AMR. Patient characteristics associated with non-attainment of asthma quality measures presents actionable evidence to guide improvement efforts as non-attainment AMR increases the risk of subsequent ED visits and IP stays. [ABSTRACT FROM AUTHOR]

Use nationally representative data to examine retiree health insurance. Concluded that retiree health coverage was widespread and typical benefits were more generous than those in medigap policies. Overlay of typical retiree plan on Medicare resulted in more generous total insurance benefits that those held by working nonelderly or beneficiaries with medigap. (Author/NB)