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During the early days and months of the COVID-19 pandemic, healthcare facilities experienced a slump in non-COVID-related visits, and there was an increasing interest in telehealth to deliver healthcare services for adult and pediatric patients. The study investigated telehealth use variation by race/ethnicity and place of residence for the pediatric enrollees of the Alabama Medicaid program. This retrospective observational study examined Alabama Medicaid claims data from March to December 2020 for enrollees less than 19 years. There were 637,792 pediatric enrollees in the Alabama Medicaid program during the study period, and 16.9% of them had used telehealth to meet healthcare needs. This study employed a multivariate Poisson mixed-effects model with robust error variance to obtain differences in telehealth utilization and found that Non-Hispanic Black children were 80% as likely, Hispanic children were 55% as likely, and Asian Children were 46% as likely to have used telehealth compared to Non-Hispanic White children. Pediatric enrollees in large rural areas and isolated areas were significantly less likely (IRR: 0.90 for both, p<0.05) to use telehealth than those in urban areas. This study's findings suggest that attention needs to be paid to addressing race/ethnicity disparities in accessing telehealth services. [ABSTRACT FROM AUTHOR]

Objectives: Access to the full range of contraceptive methods, including long-acting reversible contraception (LARC), is key for preventing unintended pregnancies and improving health outcomes. In 2019, Alabama Medicaid started paying for LARC devices for postpartum women. In anticipation of evaluating the impact of this programmatic change, we conducted a baseline study exploring contraception use and pregnancy-end outcomes for enrollees before the change.Methods: A retrospective cohort of women enrolled in Alabama Medicaid from 2012 to 2017 was examined. Outcomes include pregnancy-end events for all enrollees, teen pregnancy-end events, and short-interval (SI) pregnancy-end events. Pregnancy events in year t are matched to contraception in year t - 1. Contraception is categorized as "no evidence," short-acting contraception (SAC), LARC, and sterilization. Bivariate and multivariate models were estimated.Results: Our final sample included 135,807 unique women who contributed 258,959 person-years. There was no evidence of contraception for 55.4% and evidence of SAC, LARC, and sterilization for 36.4%, 6.2%, and 2.0%, respectively. Relative risks for pregnancy-end events for SAC and LARC users were 0.63 (95% confidence interval [CI] 0.61-0.0.65) and 0.56 (95% CI 0.52-0.0.59), respectively, compared with women with no evidence of contraceptive use. For teen pregnancy-end events, relative risks for SAC and LARC users were 0.65 (95% CI 0.61-0.67) and 0.58 (95% CI 0.51-0.66), respectively. For SI pregnancy-end events, relative risks for SAC and LARC users were 0.71 (95% CI 0.68-0.76) and 0.40 (95% CI 0.34-0.46), respectively.Conclusions: LARC and SAC are associated with lower likelihood of pregnancy-end events compared with no evidence of contraception, and on average, LARC is associated with lower relative risk than SAC, especially for SI pregnancy-end events. [ABSTRACT FROM AUTHOR]

Objective: To determine whether preventive dental visits are associated with fewer subsequent nonpreventive dental visits and lower dental expenditures. Data Sources: Indiana Medicaid enrollment and claims data (2015–2018) and the Area Health Resource File. Study Design: A repeated measures design with individual and year fixed effects examining the relationship between preventive dental visits (PDVs) and nonpreventive dental visits (NPVs) and dental expenditures. Data Collection/Extraction Methods: Not applicable. Principal Findings: Of 28,152 adults (108,349 observation‐years) meeting inclusion criteria, 36.0% had a dental visit, 27.8% a PDV, and 22.1% a NPV. Compared to no PDV in the prior year, at least one was associated with fewer NPVs (β = −0.13; 95% CI –0.12, −0.11), lower NPV expenditures (β = −$29.12.53; 95% CI –28.07, −21.05), and lower total dental expenditures (−$70.12; 95% –74.92, −65.31), as well as fewer PDVs (β = −0.24; 95% CI –0.26, −0.23). Conclusions: Our findings suggest that prior year PDVs are associated with fewer subsequent NPVs and lower dental expenditures among Medicaid‐enrolled adults. Thus, from a public insurance program standpoint, supporting preventive dental care use may translate into improved population oral health outcomes and lower dental costs among certain low‐income adult populations, but barriers to consistent utilization of PDV prohibit definitive findings. [ABSTRACT FROM AUTHOR]

Objectives: There is evidence of substantial declines in pediatric emergency department (ED) utilization in the United States in the first several months of the coronavirus disease 2019 (COVID-19) pandemic. Less is known about whether utilization changed differentially for socioeconomically disadvantaged children. This study examined how changes in pediatric ED visits during the initial months of the COVID-19 pandemic differed by two markers of socioeconomic disadvantage: minoritized race (MR) (compared with non-Hispanic White [NHW]), and publicly insured (compared with privately insured). Methods : This study used electronic medical records from a large pediatric ED for the period January to June 2020. Three time periods in 2020 were compared with corresponding time periods in 2019. Changes in overall visits, visits for MR versus NHW children, and Medicaid-enrolled versus privately insured children were considered, and changes in the acuity mix of ED visits and share of visits resulting in inpatient admits were inspected. Results : Compared with 2019, total ED visits declined in time period (TP) 1 and TP2 of 2020 (54.3%, 48.9%). Declines were larger for MR children (57.3%, 57.8%) compared with NHW children (50.5%, 39.3%), and Medicaid enrollees (56.5%, 52.0%) compared with privately insured (48.3%, 39.0%). The MR children group experienced steeper percentage declines in high-acuity visits and visits, resulting in inpatient admissions compared with NHW children. In contrast, there was little evidence of difference between TP0s of 2019 and 2020. Conclusions : The role of socioeconomic disadvantage and the potential effects on pediatric ED visits during COVID-19 is understudied. Because disadvantaged children sometimes lack access to a usual source of health care, this raises concerns about unmet health needs and worsening health disparities. [ABSTRACT FROM AUTHOR]

Telehealth became a crucial vehicle for health care delivery in the United States during the COVID-19 pandemic. However, little research exists on inequities in telehealth utilization among the pediatric population. This study examines disparities in telehealth utilization in a population of publicly insured children. This observational, retrospective study used administrative data from Alabama's stand-alone Children's Health Insurance Program, ALL Kids. Rates of any telehealth use for March to December 2020 were examined. In addition—to capture lack of health care utilization—rates of having no medical claims were examined and compared with March to December 2019 and 2018. Multinomial logit models were estimated to investigate how telehealth use and having no medical claims (reference category: having medical claims but no telehealth) were associated with race/ethnicity, rural–urban residence, and family income. Of the 106,478 enrollees over March to December 2020, 13.4% had any telehealth use and 24.7% had no medical claims. The latter was greater than no medical claims in 2019 (19.5%) and 2018 (20.7%). Black and Hispanic children had lower odds of any telehealth use (odds ratio [OR]: 0.81, P < 0.01; OR: 0.68, P < 0.01) and higher odds of no medical claims (OR: 1.11, P < 0.05; OR: 1.73, P < 0.05) than non-Hispanic White children. Rural residents had lower odds of telehealth use than urban residents. Those in the highest family income-based fee group had higher odds of telehealth use than the lowest family income-based fee group. As telehealth will likely continue to play an important role in health care delivery, additional efforts/investments are required to ensure telehealth does not further exacerbate inequities in pediatric health care access. [ABSTRACT FROM AUTHOR]

Pediatric Emergency Department (ED) utilization in the U.S. saw large declines during the COVID19 pandemic. What is relatively unexplored is whether the extent of declines differed by race and insurance status. An observational study was conducted using electronic medical record (EMR) data from the largest pediatric ED in Alabama for 2020 and 2019. The four subgroups of interest were African-American (AA), Non-Hispanic White (NHW), privately insured (PRIVATE), and publicly insured or self-insured (PUBLIC-SELF). Percentage changes in the 7-day moving average between dates in 2020 and 2019 were computed for total and high-severity ED visits by subgroup. Trends in percentage changes were plotted. T-tests were used to compare mean changes between subgroups. Large percentage declines in total ED visits and somewhat smaller percentage declines in high-severity visits were observed from March 2020. Declines were consistently larger for AA than NHW and for PUBLIC-SELF than PRIVATE. T-test results indicated mean date-specific percentage declines were significantly larger for AA than NHW for total visits (-38.92% [95% CI: -41.1, -36.8] versus -29.11% [95% CI: -30.8, -27.4]; p<0.001) and high-severity visits (-24.31% [95% CI: -26.2, -22.4] versus -19.49% [95% CI:-21.2, -17.8]; p<0.001), and larger for PUBLIC-SELF than PRIVATE for total visits (-36.32% [95% CI:-38.4, -34.3] versus 27.63% [95% CI:-29.2, -26.0]; p<0.001) and high-severity visits (-21.72% [95% CI: -23.5, -19.9] versus -20.01% [95% CI: -21.7, -18.3]; p = 0.04). In conclusion, significant differences by race and insurance status were observed in the decline in ED visits during the COVID19 pandemic, including high-severity visits. Minority-race and publicly insured or self-insured children often depend on the ED for health needs, lacking a usual source of care. Thus, these findings have worrisome implications regarding unmet healthcare needs and future exacerbations in health disparities. [ABSTRACT FROM AUTHOR]

State Medicaid programs increasingly use case management to manage enrollees with chronic conditions who may become cost intensive for the program. The authors examined the impact of Alabama Department of Public Health (ADPH)'s case management on care expenditures for Medicaid enrollees with various chronic diseases, over 2011 to 2014. The authors matched case-managed enrollees with three controls per case using health conditions and sociodemographics. Thereafter, the authors used a quasi-experimental approach to estimate how per-member-per-month costs changed following case management. Case -management appeared to result in program savings, driven largely by inpatient and emergency department cost-savings. There was noticeable variation in savings for members with different chronic conditions. [ABSTRACT FROM AUTHOR]

Purpose: The association between short sleep and obesity risk is well established. However, we explore a new pathway between short sleep and obesity: whether short sleep is linked to more time spent in secondary eating or drinking, that is, eating or drinking (beverages other than water, such as sugar-sweetened beverages) while primarily engaged in another activity, such as television watching.Design: This pooled cross-sectional study uses data from the American Time Use Survey (ATUS) from 2006 to 2008.Setting: The study takes place in the United States.Subjects: Subjects are 28,150 adults (55.8% female) aged 21 to 65 who were surveyed in the ATUS.Measures: Outcomes are time spent on (1) secondary eating and drinking and (2) primary eating and drinking. Our main predictor variable is sleep duration.Analysis: Controlling for demographic and socioeconomic characteristics of the respondents, we estimate multivariate regression-analysis models for the full sample, as well as by weekday/weekend status, race, and gender subgroups.Results: In multivariate models, compared to respondents reporting normal sleep, short sleep was associated with additional 8.7 (SE = 2.1) minutes per day of secondary eating (p < .01) and additional 28.6 (SE = 4.2) and 31.28 (SE = 5.0) minutes per day of secondary drinking on weekdays and weekends, respectively (p < .01).Conclusions: We find that short sleep is associated with more time spent in secondary eating and, in particular, secondary drinking. This potentially suggests a pathway from short sleep to increased caloric intake in the form of beverages and distracted eating and thus potential increased obesity risk, although more research is needed. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether early or regular preventive dental visit (PDV) reduces restorative or emergency dental care and costs for low-income children.Study Setting: Enrollees during 1998-2012 in the Alabama CHIP program, ALL Kids.Study Design: Retrospective cohort study using claims data for children continuously enrolled in ALL Kids for at least 4 years. Analyses are conducted separately for children 0-4 years, 4-9 years, and >9 years. For 0-4 years, the intervention of interest is whether they have at least one PDV before age 3. For the other two age groups, interventions of interest are if they have regular PDVs during each of the first 3 years, and if they have claims for a sealant in the first 3 years. Outcomes-namely restorative and emergency dental service and costs-are measured in the fourth year. To account for selection into PDV, a high-dimensional propensity scores approach is utilized.Data Extraction: Claims data were obtained from ALL Kids.Principal Findings: Only sealants are associated with a reduced likelihood of using restorative and emergency services and costs.Conclusions: Whether PDVs without sealants actually reduce restorative/emergency pediatric dental services is questionable. Further research into benefits of PDV is needed. [ABSTRACT FROM AUTHOR]

The 2002 'unborn child ruling' resulted in State Children's Health Insurance Program (SCHIP) expansion for states to cover prenatal care for low-income women without health insurance. Foreign-born Latinas who do not qualify for Medicaid coverage theoretically should have benefited most from the policy ruling given their documented low rates of prenatal care utilization. This study compares prenatal care utilization and subsequent birth outcomes among foreign-born Latinas in six states that used the unborn child ruling to expand coverage to those in ten states that did not implement the expansion. This policy analysis examines cross-sectional pooled US natality data from the pre-enactment years (2000-2003) versus post-enactment years (2004-2007) to estimate the effect of the UCR on prenatal care utilization and birth outcome measures for foreign-born Latinas. Then using a difference-in-difference estimator, we assessed these differences across time for states that did or did not enact the unborn child ruling. Analyses were then replicated on a high-risk subset of the population (single foreign-born Latinas with lower levels of education). The SCHIP unborn child ruling policy expansion increased PNCU over time in the six enacting states. Foreign-born Latinas in expansion enacting states experienced increases in prenatal care utilization though only the high-risk subset were statistically significant. Birth outcomes did not change. The SCHIP unborn child ruling policy was associated with enhanced PNC for a subset of high-risk foreign-born Latinas. [ABSTRACT FROM AUTHOR]

This chapter focuses on vulnerable youth, the challenges they face during their transitions to adulthood, and the adverse effects of limited support systems on those transitions. The authors offer recommendations on how adult educators can help facilitate smooth transitions into adulthood for vulnerable youth. [ABSTRACT FROM AUTHOR]

ObjectiveTo examine the extent to which the gendered division of labour persists within households in the USA in regard to meal planning/preparation and food shopping activities.DesignSecondary analysis of cross-sectional data.Setting2007–2008 US National Health and Nutrition Examination Survey.SubjectsSub-sample of 3195 adults at least 20 years old who had a spouse or partner.ResultsAnalyses revealed that the majority of women and men reported they shared in both meal planning/preparing and food shopping activities (meal planning/preparation: women 54 % and men 56 %; food shopping: women 60 % and men 57 %). Results from multinomial logistic regression analyses indicated that, compared with men, women were more likely to take primary responsibility than to share this responsibility and less likely to report having no responsibility for these tasks. Gender differences were observed for age/cohort, education and household size.ConclusionsThis study may have implications for public health nutritional initiatives and the well-being of families in the USA. [ABSTRACT FROM AUTHOR]

Purpose. Existing literature shows negative relationships between gasoline price and motor vehicle crashes, particularly among teens. This paper extends that literature by evaluating the relationship between gasoline price and self-reported risky driving among teens. Design. Observational study using multivariate empirical analysis, using pooled data from the Youth Risk Behavior Survey, waves 2003-2009. Setting. Secondary data from survey administered in private and public high schools across the United States. Subjects. Students in grades 9 through 12, surveyed biennially from 2003 to 2009 (n - 58,749). Measures. Outcomes are (self-reported) driving without seatbelts, driving after consuming alcohol, and moderate physical activity (like walking or bicycling). State-level retail gasoline prices constitute the main predictor variable. Analysis. Multivariate logistic models are estimated for the full sample, as well as by gender, race/ethnicity, and age. Individual characteristics, state unemployment, and stale driving policies are controlled for. Standard errors are clustered at the state level. Results are reported in form of risk differences. Results. Higher gasoline prices are negatively and significantly associated with driving without seatbelts. Associations are particularly strong for males and minorities. There are fewer statistical associations between gasoline prices and driving after drinking. Higher gasoline prices are positively associated with more moderate physical activity. Conclusion. Higher gasoline prices are associated with less risky driving behaviors among teens, and they may be associated with more active forms of transportation, like walking and bicycling. The study limitations are discussed. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVE: Although preventive dental visits are considered important for maintaining pediatric oral health, there is relatively little research showing that they reduce subsequent nonpreventive dental visits or costs. At least 1 study seemed to find that early preventive dental care is associated with more restorative and emergency visits. Previous studies are limited by their inability to account for unmeasurable factors that may lead children to "select" into using both more preventive and nonpreventive dental care. We used econometric techniques that minimize selection bias to assess the effectiveness of preventive dental care in reducing subsequent nonpreventive dental service utilization among children. METHODS: Using data from Alabama's Children's Health Insurance Program (CHIP), 1998-2010., a cohort study of children's dental service utilization was conducted. Outcomes were 1-year lagged nonpreventive dental care and expenditures, and overall dental and medical expenditures. Children who were continuously enrolled for at least 3 years were included. Separate models were estimated for children aged <8 years (n = 14 972) and those aged ≥8 years (n = 21 833). RESULTS: More preventive visits were associated with fewer subsequent nonpreventive dental visits and lower nonpreventive dental expenditures for both groups. However, more preventive visits did not reduce overall dental or medical (inclusive of dental) expenditures. CONCLUSIONS: Preventive dental visits can reduce subsequent nonpreventive visits and expenditures for children continuously enrolled in CHIP. However, they may not reduce overall program costs. Effective empirical research in this area must continue to address unobserved confounders and selection issues. [ABSTRACT FROM AUTHOR]

Objectives. We conducted a systematic review of the literature examining the relationship between built environments (e.g., parks, trails, sidewalks) and physical activity (PA) or obesity rates. Methods. We performed a 2-step inclusion protocol to identify empirical articles examining any form of built environment and any form of PA (or obesity rate) as the outcome. We extracted data from included abstracts for analysis by using a standard code sheet developed for this study. Results. Of 169 included articles, 89.2% reported beneficial relationships-but virtually all articles utilized simple observational study designs not suited for determining causality. Studies utilizing objective PA measures (e.g., pedometer) were 18% less likely to identify a beneficial relationship. Articles focusing on children in community settings (-14.2%), those examining direct measures of obesity (-6.2%), or those with an academic first author (-3.4%) were less likely to find a beneficial relationship. Conclusions. Policymakers at federal and local levels should encourage more rigorous scientific research to determine whether altered built environments will result in increased PA and decreased obesity rates. [ABSTRACT FROM AUTHOR]

Abstract: Objective: This study examines the relationship between the types of background-information check required by states prior to firearm purchases, and firearm homicide and suicide deaths. Methods: Negative binomial models are used to analyze state-level data for homicides and suicides in the U.S. from 1996 to 2005. Data on types of background information are retrieved from the Surveys of State Procedures Related to Firearm Sales, and the violent death data are from the WISQARS. Several other state level factors were controlled for. Results: More background checks are associated with fewer homicide (IRR:0.93, 95% CI:0.91–0.96) and suicide (IRR:0.98, 95% CI:0.96–1.00) deaths. Firearm homicide deaths are lower when states have checks for restraining orders (IRR:0.87, 95% CI:0.79–0.95) and fugitive status (IRR:0.79, 95% CI:0.72–0.88). Firearm suicide deaths are lower when states have background checks for mental illness (IRR:0.96, 95% CI:0.92–0.99), fugitive status (IRR:0.95, 95% CI:0.90–0.99) and misdemeanors (IRR:0.95, 95% CI:0.92–1.00). It does not appear that reductions in firearm deaths are offset by increases in non-firearm violent deaths. Conclusions: More extensive background checks prior to gun purchase are mostly associated with reductions in firearm homicide and suicide deaths. Several study limitations are acknowledged, and further research is called for to ascertain causality. [Copyright &y& Elsevier]

Objective To explore whether health care utilization changed among enrollees in Alabama's CHIP program, ALL Kids, following copayment increases at the beginning of fiscal year 2004. Data Sources Data on all ALL Kids enrollees over 1999-2009 are obtained from claims files and the state's administrative database. Study Design We use pooled month-level data for all enrollees and conduct covariate-adjusted segmented regression models. Health services considered are inpatient care, emergency department ( ED) visits, brand-name prescription drugs, generic prescription drugs, physician office visits and outpatient-services, ambulance services, allergy treatments, and non-preventive dental services. Physician well-visits, preventive dental services, and service use by Native-Americans-which saw no copayment increases-serve as counterfactuals. Principal Findings There are significant declines in utilization for inpatient care, physician visits, brand-name medications, and ED visits following the copayment increases. By and large, utilization did not decline, or declined only temporarily, for those services and for those enrollees that who not subject to increased copayments. Conclusions Copayment increases reduced utilization of many health services among ALL Kids enrollees. Concerns remain regarding the long-term health consequences to low-income children of copayment-induced reductions in health care utilization. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this study is to explore whether, in the U.S., there are associations between state-level variations in mortality among young children and state abortion restriction policies – such as parental-consent requirements, parental-notification requirements, mandatory delay laws, and restrictions on Medicaid funding for abortion. To investigate this, we used NCHS Multiple Cause of Deaths public-use data files for the period 1983–2002, and compiled data on children ages 0–4 identified as having died as a result of assault/homicide in each state and year. Medicaid funding of abortion, mandatory delay laws, and parental involvement laws for minors seeking abortions were included as the main predictor variables of interest. Multivariate count data models using pooled state-year-age cohort data, with state and time fixed effects and other state-level controls, were estimated. Results indicated that, between 1983 and 2002, the average increase in the number of homicide deaths for children under 5 years of age was 5.70 per state among states that implemented stricter abortion policies over that time, and 2.00 per state for states that did not. In the count data models, parental-consent laws were associated with a 13 percent increase in child homicide deaths; parental-notification laws were associated with an 8 percent increase in child homicide deaths though the results were less robust to alternate model specifications; mandatory delay requirements were associated with a 13 percent increase in child homicide deaths. While these data do not allow us to discern precise pathways via which state abortion-restrictions can lead to more child homicide deaths, we speculate that state restrictions on abortion may result in a disproportionate increase in children born into relatively high-risk environments. Additional research is called for to explore the association of state abortion-restrictions with other measures of infant/child health and well-being. [Copyright &y& Elsevier]

The objective of this article is to examine the association of teen motherhood and long-term physical and mental health outcomes. The physical and mental health components (PCS and MCS) of the SF-12 Healthy Survey in the NLSY79 health module were used to assess long-term health outcomes of women who experienced teenage motherhood. Various familial, demographic, and environmental characteristics were indentified and controlled for that may have predicted teen motherhood and long-term health outcomes. The two comparison groups for teen mothers were women who experienced teen-pregnancy only and women who were engaged in unprotected sexual activity as a teenage but did not experience pregnancy. Multivariate ordinary least squares regression was used for analysis. The average PCS and MCS for teen mothers was 49.91 and 50.89, respectively. Teen mothers exhibited poorer physical health later in life compared to all women as well as the comparison groups. When controlling for age, teen mothers had significantly lower PCS and MCS scores compared to all other women. Furthermore, when controlling for familial, demographic, and environmental characteristics, teen mothers exhibited significantly lower PCS and MCS scores. When comparing teen mothers to the two comparison groups, PCS was not statistically different although MCS was significantly lower in the teen-pregnancy group. Teen motherhood does lead to poorer physical health outcomes later in life. On the other hand, poorer mental health outcomes in later life may be attributed to the unmeasured factors leading to a teen pregnancy and not teen motherhood itself. Additional research needs to be conducted on the long-term consequences of teen motherhood. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To examine the association between frequency of family dinners (FFD) and selected problem behaviors for adolescents after adjusting for family connectedness, parental awareness, other family activities, and other potentially confounding factors. Methods: Data are drawn from the National Longitudinal Survey of Youth, 1997. The primary variable of interest is self-reported FFD in a typical week. Problem behaviors studied are substance-use, physical violence, property-destruction, stealing, running away from home, andgang membership. Multivariate logistic models are estimated for each behaviors. Linear regression models are estimated for behavior-frequency for the sub-samples engaging in them. Analysis is done separately by gender. Results: FFD is negatively associated with substance-use and running away for females; drinking, physical violence, property-destruction, stealing and running away for males. Conclusion: Family meals are negatively associated to certain problem behaviors for adolescents even after controlling rigorously for potentially confounding factors. Thus, programs that promote family meals are beneficial. [Copyright &y& Elsevier]

Various empirical studies find evidence of that women tend to under-estimate the probability that they will work in the market in the future. This can lead to initial under-investment in market human capital and resulting earnings penalties later in life. However, virtually no study investigates the familial, social and economic factors that cause women to plan/expect not to work. Thus the onus of "incorrect" plans is placed wholly on the women, and society absolved of any responsibilities in helping form those plans. This work uses data from the NLSYW and investigates the effects of a wide range of factors on women's future work plans. Results indicate that plans are definitely not formed in a vacuum, and that familial, social and economic circumstances all play a decisive role in shaping them. Some suggestions are made for policy formation to encourage women to plan on working in future. [ABSTRACT FROM AUTHOR]

This study investigates the causal link between alcohol-use and adolescent sexual activity. In a recent paper, using data from the 1995 wave of the National Longitudinal Study of Adolescent Health, Rees et al. [Journal of Health Economics 20 (5) (2001)] found little evidence of such a link. The data used here are from the National Longitudinal Study of Youth, 1997 (NLSY97), and results indicate that alcohol-use increases the probability of sexual intercourse, even after accounting for the potential endogeneity. However, consistent with Rees et al., there is less evidence that heavy drinking has a significant effect on sexual intercourse. [Copyright &y& Elsevier]

Over most of the twentieth century, the U.S. has witnessed considerable increases in divorce rates. Conventional economic literature believes that married women's entry into market work may have contributed to this by decreasing the gains from marriage arising from specialization between spouses. However, since the 1980s, divorce rates have ceased to increase though married women's labor supply continues to rise, suggesting that the relationship has changed across time and birth cohorts. Here I use two cohorts of women, those born between 1944-1954 and those born between 1957-1964, to test whether this is the case. My findings indicate that the detrimental effect of married women's market work on marital stability has indeed decreased substantially across cohorts, and such work may even be beneficial to marital stability among the recent cohort. Therefore, it appears that women's market work can no longer be held culpable for the breaking up of American families. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine the relationship between preventive dental visits (PDVs) and medical expenditures while mitigating bias from unobserved confounding factors. STUDY DESIGN: Retrospective data analysis of Indiana Medicaid enrollment and claims data (2015-2018) and the Area Health Resources Files. METHODS: An instrumental variable (IV) approach was used to estimate the relationship between PDVs and medical and pharmacy expenditures among Medicaid enrollees. The instrument was defined as the number of adult enrollees with at least 1 nonpreventive dental claim per total Medicaid enrollees within a Census tract per year. RESULTS: In naive analyses, enrollees had on average greater medical expenditures if they had a prior-year PDV (β = $397.21; 95% CI, $184.23-$610.18) and a PDV in the same year as expenditures were measured (β = $344.81; 95% CI, $193.06-$496.56). No significant differences in pharmacy expenditures were observed in naive analyses. Using the IV approach, point estimates of overall medical expenditures for the marginal enrollee who had a prioryear PDV (β = $325.17; 95% CI, -$708.03 to $1358.37) or same-year PDV (β = $170.31; 95% CI, -$598.89 to $939.52) were similar to naive results, although not significant. Our IV approach indicated that PDV was not endogenous in some specifications. CONCLUSIONS: This is the first study to present estimates with causal inference from a quasi-experimental study of the effect of PDVs on overall medical expenditures. We observed that prior- or same-year PDVs were not related to overall medical or pharmacy expenditures. [ABSTRACT FROM AUTHOR]

This study evaluated the impact of an interdisciplinary care teams (IDCT) care management program on cost and quality outcomes using a novel algorithm to identify 400 high-risk patients out of 48,235 Medicare Advantage (MA) beneficiaries. Of the 400, 252 were enrolled in the IDCT care management intervention program, while the remaining 148 were not enrolled. A second comparison group consisted of 660 who were referred to the IDCT program but not selected by the algorithm. The program's effectiveness was evaluated 1-year postintervention. Analyses found that health care costs for members enrolled in the IDCT program were reduced by US$1,121.76 and US$1,625.61 per member per month, respectively, relative to those not enrolled and those enrolled by referral. The cost reduction from the program generated a net savings of US$1.9MM, covering the program's cost. Findings suggest IDCTs can cost-effectively manage populations of high-risk patients with better selection and fostering greater interdependence. [ABSTRACT FROM AUTHOR]

A six-year statewide contraceptive access initiative focused on equitable access to contraception, removing cost barriers, capacity building and training, raising consumer awareness, and expanding contraceptive care at safety net clinics was implemented in South Carolina beginning in 2017. This study assessed changes in contraceptive method use among women enrolled in the South Carolina Medicaid program during the first three years of Choose Well. Contraception use among a retrospective cohort of women aged 15 to 45 enrolled in South Carolina Medicaid from 2012 to 2020 was examined. Interrupted time series regression analysis was used to assess changes in the use of intrauterine devices (IUDs) and contraceptive implants between 2012 and 2016 and 2017 and 2020. Analyses were conducted for all women and stratified by age groups. Long-acting reversible contraception use increased from 8.5% during the pre-Choose Well period to 10.9% during the Choose Well period (p <.001), with IUD use increasing from 4.3% to 5.2% (p <.001) and implant use increasing from 4.6% to 6.0% (p <.001). The interrupted time series analysis found a significant positive change in the average level of monthly IUD use after Choose Well began (0.493 percentage points; 95% confidence interval, 0.311–0.675). The effect was stronger among women 20 to 25 years of age. Choose Well significantly increased the trend in IUD use among all women by a positive 0.013 percentage points (95% confidence interval, 0.006–0.020) per month beyond expected values. At the mid-point of the Choose Well Evaluation, the use of IUD methods increased significantly beyond what would be expected had pre-Choose Well trends continued. This was particularly evident among women 20 to 25 years of age. These findings suggest that Choose Well succeeded in reducing barriers to the use of IUDs. [ABSTRACT FROM AUTHOR]

Introduction: Firearm injury is a major U.S. public health concern. This study aims to evaluate whether the relationship between state firearm laws and state firearm deaths are affected by comparatively lenient firearm laws in neighboring states.Methods: This observational study used 2000‒2017 data on firearm deaths and firearm laws of the 48 contiguous states of the U.S. (Alaska, Hawaii, and the District of Columbia excluded). The associations among state firearm deaths, state firearm laws, and presence of neighboring states with more lenient laws were analyzed using negative binomial regression models with state- and year-fixed effects. Analyses were conducted in 2019‒2020.Results: There were 578,022 firearm deaths of all intents during the study period or 11.1 firearm deaths (IQR=8.5-14.0) per 100,000 population. The presence of more state firearm laws was associated with decreased firearm deaths (incident rate ratio=0.991, 95% CI=0.987, 0.996). However, weaker firearm laws in neighboring states correlated with more firearm deaths within a state (incident rate ratio=1.016, 95% CI=1.004, 1.028). Failing to account for weaker laws in neighboring states led to the underestimation of the impact of 1 additional law on state's own firearm deaths (incident rate ratio=0.994, 95% CI=0.989, 0.998 vs 0.991, 95% CI=0.987, 0.996) by approximately 20%.Conclusions: Weaker firearm laws in neighboring states may undermine the effectiveness of a state's own firearm laws in curbing firearm deaths. Coordinated legislative action across neighboring states may be more effective than an individual state taking legislative action. [ABSTRACT FROM AUTHOR]

The objective was to assess whether a Comprehensive Wellness Assessment (CWA) is associated with reduced emergency department (ED) visits for Special Needs Program (SNP) enrollees with diabetes. This retrospective panel study used a Medicare Advantage plan's administrative claims data for 2010–2017 and pooled member-month observations. Multivariate regression and individual fixed-effects regression models were estimated. The outcome was ED visits measured as binary and continuous outcomes. Data were derived from claims data that included at least 1 ICD-9 or 10 code between January 2010 and December 2017. Regression results indicated that SNP enrollees completing a CWA was associated with a lower probability of any monthly ED use (β = -0.005, t-stat = -2.98) and fewer monthly visits (β = -0.008, t-stat = -2.95). Individual fixed-effects models also demonstrated a significant decline in SNP ED use after a CWA, though the strongest effects were confined to the first 4 months after a CWA. Care models with components such as CWAs may contribute an additional benefit in the form of a reduction in ED utilization. Completing a CWA appears to be effective in reducing ED utilization among SNP members with diabetes. [ABSTRACT FROM AUTHOR]

The epidemiology of human immunodeficiency virus (HIV) has shifted such that Black individuals disproportionately represent incident HIV diagnoses. While risk of end-stage kidney disease (ESKD) among people with HIV (PWH) has declined with effective antiretroviral therapies, a substantial racial disparity in ESKD burden exists with the greatest prevalence among Black PWH. Disparities in waitlisting for kidney transplantation, the optimal treatment for ESKD, exist for both PWH and Black individuals without HIV, but it is unknown whether these characteristics together exacerbate such disparities. Six hundred two thousand six ESKD patients were identified from the United States Renal Data System (January 1, 2007 to December 31, 2017), and HIV-status was determined through Medicare claims. Cox proportional hazards regression was used to determine waitlisting rates. Multiplicative interaction terms between HIV-status and race were examined. The 6250 PWH were significantly younger, more commonly Black, and less commonly female than those without HIV. HIV-status and race were independently associated with 50% and 12% lower likelihood of waitlisting, respectively [adjusted hazard ratio (aHR): 0.50, 95% confidence interval (CI): 0.36–0.69, p < 0.001; aHR: 0.88, 95% CI: 0.87–0.90, p < 0.001]. There was also a significant interaction present between HIV-status and Black race (aHR: 0.80, 95% CI: 0.66–0.98, p < 0.001) such that, while HIV-status and Black race were independently associated with decreased waitlisting, the interaction of Black race and HIV-status exacerbated those disparities. While limited by lack of HIV-specific data that may impact inferences with respect to race, additional studies are urgently needed to understand the interplay between HIV risk factors, HIV-stigma, and racism, and how intersectionality may exacerbate disparities in transplantation among PWH. [ABSTRACT FROM AUTHOR]

Background: Telehealth can improve access to evidence-based care at a lower cost for patients, especially those living in underserved and remote areas. The barriers to the widespread adoption of telehealth have been well documented in the literature. However, the barriers may not be the same for pediatric patients, who must rely on their parents or guardians to make healthcare decisions. This paper presents some of the leading barriers parents or guardians of pediatric patients report in using telehealth to meet their children's healthcare needs. Methods: This cross-sectional survey was conducted in a tertiary care pediatric Emergency Department (ED) at a children's hospital in Alabama between September 2020 to December 2020. The parents or guardians of pediatric patients were asked about their reasons for not using telehealth despite having healthcare needs for their children, whether they canceled or rescheduled healthcare provider visits and facility visits, and whether the child's health conditions changed over the past three months. Descriptive analyses were conducted that explored the distribution of telehealth use across the variables listed above. Results: Five hundred ninety-seven parents or guardians of pediatric patients participated in the survey, and 578 answered the question of whether they used telehealth or not over the past three months. Of them, 33.1% used telehealth, 54.3% did not, and 12.6% did not have healthcare needs for their child. The leading reason for not using telehealth was that the doctor or health provider did not give them a telehealth option, the second main reason was that they did not know what telehealth is, and the third leading reason was that the parents did not think telehealth would help meet healthcare needs for their child. Conclusions: This study highlights the telehealth utilization barriers among underserved pediatric populations, including the need for physicians to proactively offer telehealth options to parents or guardians of pediatric patients. Improving health literacy is of paramount importance, given that a substantial proportion of parents were not familiar with telehealth. Policymakers and healthcare organizations should raise awareness about the benefits of telehealth which can improve healthcare access for underserved pediatric patients. [ABSTRACT FROM AUTHOR]

If there are patterns of the distribution of services and treatments across the population of people with ASD, these patterns should be based along clinical characteristics or other service needs and not sociodemographic characteristics unrelated to evidence-based care. We examined how individuals in a broad, nationally representative sample "grouped together" based on service utilization and services needed but not covered by insurance. By understanding various treatment patterns, clinicians, researchers, policymakers, and self-advocates and their families can better advocate for high-quality, evidence-based services to be provided equitably. Using the 2011 Survey of Pathways to Diagnosis and Services, a cluster analysis was performed to explore patterns in this population based on medication use, private services use, school-based service use, and services not covered by insurance. Differences in clusters were then explored through multinomial logistic regression. Six clusters emerged, showing differences in the level of service/medication usage and insurance coverage. Differences across clusters were associated with the level of functional limitation and age at ASD diagnosis. Disparities by insurance type, functional limitation, and age at diagnosis exist among patterns of ASD service provision. Our analysis showed that intervention for children with ASD can be across several scales – high and low users of services (both private and school-based), high and low users of medications, and high and low levels of reported non-covered services. The differences were clustered in multiple ways. Further research should incorporate longitudinal and nationally representative data to explore these relationships further. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Injuries are the leading cause of death among children and youth in the United States, representing a major concern to society and to the public and private health plans covering pediatric patients. Data from ALL Kids, Alabama's Children's Health Insurance Program, were used to evaluate the relationship between community-level social determinants of health (SDOH) and pediatric emergency department (ED) use and differences in these associations by age and race. STUDY DESIGN: This was a retrospective, pooled cross- sectional analysis. METHODS: We used ALL Kids data to identify ED visits (injury and all-cause) among children who were enrolled at any time from 2015 to 2017. Exploratory factor analysis was used to categorize SDOH from 18 selected Census tract-- level variables. Multilevel Poisson regression models were used to evaluate the effects of community and individual factors and their interactions. RESULTS: Census tract--level SDOH were grouped as low socioeconomic status (SES), urbanicity, and immigrant- density factors. Low SES and urbanicity factors were associated with ED visits (injury and all-cause). The low SES and urbanicity factors also moderated the association between race and ED visits (injury and all-cause). CONCLUSIONS: The environment in which children live influences their ED use; however, the impact varies by age, race, and Census tract factors. Further studies should focus on specific community factors to better understand the relationship among SDOH, individual characteristics, and ED utilization. [ABSTRACT FROM AUTHOR]

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]

This study assesses cost savings associated with specific contraceptive methods provided to beneficiaries enrolled in South Carolina Medicaid between 2012 and 2018. Incremental cost-effectiveness ratios, defined as the additional cost of contraception provision per live birth averted, were estimated for 4 contraceptive methods (intrauterine devices [IUDs], implants, injectable contraceptives, and pills), relative to no prescription method provision, and savings per dollar spent on method provision were calculated. Costs associated with publicly funded live births were derived from published sources. The analysis was conducted for the entire Medicaid sample and separately for individuals enrolled under low-income families (LIFs), family planning, and partners for healthy children (PHC) eligibility programs. Sensitivity analysis was performed on contraceptive method costs. IUDs and implants were the most cost-effective with cost savings of up to $14.4 and $7.2 for every dollar spent in method provision, respectively. Injectable contraceptives and pills each yielded up to $4.8 per dollar spent. However, IUDs and implants were less cost-effective than injectable contraceptives and pills if the average length of use was less than 2 years. Medicaid's savings varied across Medicaid eligibility programs, with the highest and lowest savings from contraceptive provision to women in the LIFs and PHC eligibility programs, respectively. The results suggest the need to account for unique needs and preferences of beneficiaries in different Medicaid eligibility categories during contraception provision. The findings also inform program administration and provide evidence to justify legislative appropriations for Medicaid reproductive health care services. [ABSTRACT FROM AUTHOR]

Introduction: Racial disparities in obesity exist at the individual and community levels. Retail food environment has been hypothesized to be associated with racial disparities in obesity prevalence. This study aimed to quantify how much food environment measures explain racial disparities in obesity at the county level.Methods: Data from 2009 to 2010 on 3,135 U.S. counties were extracted from the U.S. Department of Agriculture Food Environment Atlas and the Behavioral Risk Factor Surveillance System and analyzed in 2013. Oaxaca-Blinder decomposition was used to quantify the portion of the gap in adult obesity prevalence observed between counties with a high and low proportion of African-American residents is explained by food environment measures (e.g., proximity to grocery stores, per capita fast-food restaurants). Counties were considered to have a high African-American population if the percentage of African-American residents was >13.1%, which represents the 2010 U.S. Census national estimate of percentage African-American citizens.Results: There were 665 counties (21%) classified as a high African-American county. The total gap in mean adult obesity prevalence between high and low African-American counties was found to be 3.35 percentage points (32.98% vs 29.63%). Retail food environment measures explained 13.81% of the gap in mean age-adjusted adult obesity prevalence.Conclusions: Retail food environment explains a proportion of the gap in adult obesity prevalence observed between counties with a high proportion of African-American residents and counties with a low proportion of African-American residents. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the effects of medical home support on the use of clinical services and Medicaid expenditures.Data Source: Medicaid claims.Study Design: A difference-in-differences model where changes in utilization and expenditures of the intervention group are compared to changes in the nonintervention group.Extraction Methods: Using Medicaid claims from October 2010 through September 2013, service use and expenditures are measured for 12 months before and 21 months after implementation. Changes for four health status groups are examined separately.Principal Findings: The introduction of community-based support was associated with a small reduction in use and no statistically significant overall effect on expenditures. However, among those with chronic and/or mental health conditions, there were modest, statistically significant increases in use of and expenditures for a range of ambulatory and inpatient health care services, while service use for those without these conditions declined. Emergency department use increased for all groups.Conclusions: Community-based support for medical home practices is associated with a shift in the service mix provided to higher cost, more vulnerable subgroups in Medicaid. Such systems are unlikely to be associated with significant overall cost savings, at least in the short term, but may have other benefits. [ABSTRACT FROM AUTHOR]

Background A well-functioning primary care system has the capacity to provide effective care for patients to avoid nonurgent emergency department (ED) use and related costs. Objective This study examined how patients' perceived deficiency in ambulatory care is associated with nonurgent ED care costs nationwide. Methods This retrospective cohort study used data from the 2010–2011 Medical Expenditure Panel Survey. This study chose usual source of care, convenience of needed medical care, and patient evaluation of care quality as the main independent variables. The marginal effect following a multivariate logit model was employed to analyze the urgent vs. nonurgent ED care costs in 2011, after controlling for covariates in 2010. The endogeneity was accounted for by the time lag effect and controlling for education levels. Sample weights and variance were adjusted with the survey procedures to make results nationally representative. Results Patient-perceived poor and intermediate levels of primary care quality had higher odds of nonurgent ED care costs (odds ratio [OR] = 2.22, p = 0.035, and OR = 2.05, p = 0.011, respectively) compared to high-quality care, with a marginal effect (at means) of 13.0% and 11.5% higher predicted probability of nonurgent ED care costs. Costs related to these ambulatory care quality deficiencies amounted to $229 million for private plans (95% confidence interval [CI] $100 million–$358 million), $58.5 million for public plans (95% CI $33.9 million–$83.1 million), and an overall of $379 million (95% CI $229 million–$529 million) nationally. Conclusions These findings highlight the improvement in ambulatory care quality as the potential target area to effectively reduce nonurgent ED care costs. [ABSTRACT FROM AUTHOR]

We also found that patients treated by primary care and advanced practice were more likely to be Black and Hispanic and have injection drug use diagnoses, suggesting greater treatment uptake by non-specialists to these most vulnerable populations. Patients treated by gastroenterologists were significantly less likely to be Black or Hispanic than those treated by primary care physicians, and less likely to have an injection drug use diagnosis. Our findings demonstrate substantial state variation in the specialties providing HCV treatment, implying that policy or healthcare supply may play important roles for the HCV treatment landscape. [Extracted from the article]

Using a panel study design, we examined the effects of differenttypesoftextingbans on motor vehicular fatalities. We used the Fatality Analysis Reporting System and a difference-in-differences approach to examine the incidence of fatal crashes in 2000 through 2010 in 48 US states with and without texting bans. Age cohorts were constructed to examine the impact of these bans on age-specific traffic fatalities. Primarily enforced laws banning all drivers from texting were significantly associated with a 3% reduction in traffic fatalities in all age groups, and those banning only young drivers from texting had the greatest impact on reducing deaths among those aged 15 to 21 years. Secondarily enforced restrictions were not associated with traffic fatality reductions in any of our analyses. [ABSTRACT FROM AUTHOR]

Well-child visits focus on health promotion and disease detection and are critical to the appropriate provision of care. Evidence has shown that participation in well-child visits is associated with various patient-level factors; however, there has been an increasing focus on the influence of community-level social determinants of health (SDoH). This study explored associations between well-child visits and community-level SDoH at the census tract level among children enrolled in Alabama Medicaid. Through this analysis, it is possible to understand the distribution of care among this underserved population in different geographic settings, thus identifying potential disparities and areas for targeted intervention. Using administrative data from 2015 to 2017 enrollees in Alabama Medicaid that have been geographically linked to information on urbanicity and poverty, logistic regressions (both in total and stratified by age group) were estimated with separate community-level urbanicity, poverty variables, and individual characteristics. The regressions were repeated using a combined urbanicity/poverty variable. Looking at urbanicity and poverty together, with the exception of the least urban areas, it was those living in census tracts where there was discordance in urbanicity and poverty that had the highest likelihood of receiving well-child visits compared with those in census tracts classified as medium poverty (all urbanicity levels). There is a positive effect for Medicaid enrollees in the middle tertile of urbanicity in areas of low and high poverty and in wealthier more urban areas. If poverty and urbanicity were explored separately, some of the nuances would not have been apparent. [ABSTRACT FROM AUTHOR]

Since 2011, U.S. states have enacted more than 400 policies restricting abortion access. As structural determinants, abortion policies have the potential to influence maternal and child health access, outcomes, and equity through multiple mechanisms. Limited research has examined their implications for birth outcomes. We created a state-level abortion restrictiveness index composed of 18 restrictive abortion policies and evaluated the association between this index and individual-level probabilities of preterm birth (PTB) and low birthweight (LBW) within the United States and by Census Region, using data from the 2005–2015 National Center for Health Statistics Period Linked Live Birth-Infant Death Files. We used logistic multivariable regression modeling, adjusting for individual- and state-level factors and state and year fixed effects. Among 2,500,000 live births, 269,253 (12.0%) were PTBs and 182,960 (8.1%) were LBW. On average from 2005 to 2015, states had approximately seven restrictive abortion policies enacted, with more policies enacted in the Midwest and South. Nationally, relationships between state restrictiveness indices and adverse birth outcomes were insignificant. Regional analyses revealed that a 1 standard deviation increase in a state's restrictiveness index was associated with a 2% increase in PTB in the Midwest (marginal effect [ME], 0.25; 95% confidence interval [CI], 0.04–0.45; p <.01), a 15% increase in LBW in the Northeast (ME, 1.24; 95% CI, 0.12–2.35; p <.05), and a 2% increase in LBW in the West (ME, 0.12; 95% CI, 0.01–0.25; p <.05). Variation in restrictive abortion policy environments may have downstream implications for birth outcomes, and increases in abortion restrictions were associated with adverse birth outcomes in three out of four Census Regions. [ABSTRACT FROM AUTHOR]

Background: Previous literature has asserted that family meals are a key protective factor for certain adolescent risk behaviors. It is suggested that the frequency of eating with the family is associated with better psychological well-being and a lower risk of substance use and delinquency. However, it is unclear whether there is evidence of causal links between family meals and adolescent health-risk behaviors. Purpose: The purpose of this article is to review the empirical literature on family meals and adolescent health behaviors and outcomes in the US. Data sources: A search was conducted in four academic databases: Social Sciences Full Text, Sociological Abstracts, PsycINFO®, and PubMed/MEDLINE. Study selection: We included studies that quantitatively estimated the relationship between family meals and health-risk behaviors. Data extraction: Data were extracted on study sample, study design, family meal measurement, outcomes, empirical methods, findings, and major issues. Data synthesis: Fourteen studies met the inclusion criteria for the review that measured the relationship between frequent family meals and various risk-behavior outcomes. The outcomes considered by most studies were alcohol use (n=10), tobacco use (n=9), and marijuana use (n=6). Other outcomes included sexual activity (n=2); depression, suicidal ideation, and suicide attempts (n=4); violence and delinquency (n=4); school-related issues (n=2); and well-being (n=5). The associations between family meals and the outcomes of interest were most likely to be statistically significant in unadjusted models or models controlling for basic family characteristics. Associations were less likely to be statistically significant when other measures of family connectedness were included. Relatively few analyses used sophisticated empirical techniques available to control for confounders in secondary data. Conclusion: More research is required to establish whether or not the relationship between family dinners and risky adolescent behaviors is an artifact of underlying confounders. We recommend that researchers make more frequent use of sophisticated methods to reduce the problem of confounders in secondary data, and that the scope of adolescent problem behaviors also be further widened. [ABSTRACT FROM AUTHOR]

Background: Scientific authors who overreach in presenting results can potentially, without intending to, distort the state of knowledge and inappropriately influence clinicians, decision makers, the media, and the public. Purpose: The goal of the study was to determine the extent to which authors present overreaching statements in the obesity and nutrition literature, and whether journal, author, or study characteristics are associated with this practice. Methods: A total of 937 papers on nutrition or obesity published in 2001 and 2011 in leading specialty, medical, and public health journals were systematically studied to estimate the extent to which authors overstate the results of their study in the published abstract. Focus was placed on overreaching statements that may include (1) reporting an associative relationship as causal; (2) making policy recommendations based on observational data that show associations only (e.g., not cause and effect); and (3) generalizing to a population not represented by their sample. Data were compiled in 2012 and analyzed in 2013. Results: Results indicate that 8.9% of studies have overreaching conclusions with a higher percentage in 2011 compared to 2001 (OR=2.14, risk difference=+3.9%, p=0.020). Unfunded studies (OR=2.41, p=0.039) were more likely to have an overstatement of results of the type described here. In contrast, those with a greater number of coauthors were significantly less likely than those with four or fewer authors (the reference group) to have overstated results (seven or eight authors: OR=0.30, risk difference=−6.1%, p=0.008; ≥9 authors: OR=0.41, risk difference= −4.0%, p=0.037). Conclusions: Overreaching in presenting results in studies focused on nutrition and obesity topics is common in articles published in leading journals. Testable strategies are proposed to reduce the prevalence of such instances in the literature. [Copyright &y& Elsevier]

Objective: State medicaid programs provide access to effective contraception for people with lower incomes. This study examined contraception use and pregnancy among reproductive-age women enrolled in the South Carolina Medicaid, by eligibility program and socio-demographic sub-groups. Methods: A retrospective cohort of women aged 15–45 who were newly eligible for South Carolina Medicaid from 2012 to 2016 was examined. Log-binomial regression and average marginal effects assessed relationships between contraception use and pregnancies ending in live and non-live births. Contraception was categorized as permanent, long acting reversible contraception (LARC), short-acting hormonal contraception (SAC), or no contraceptive claims. Women with family planning or full-benefit medicaid coverage were included. Results: Approximately 11% of women used LARC methods, 41% used SAC methods, and 46% had no evidence of contraceptive claims. Method utilization varied by eligibility program, race/ethnicity and age. The likelihood of pregnancy was lower among SAC users and lowest among LARC users compared to women with no evidence of contraception across all three programs (family planning APR = 0.44; 95% CI 0.41–0.49 and APR = 0.13, 95% CI 0.10–0.17; Low income families APR = 0.82; 95% CI 0.77–0.88 and APR = 0.33, 95% CI 0.28–0.38; Partners for Healthy Children APR = 0.72; 95% CI 0.68–0.77 and APR = 0.35, 95% CI 0.30–0.43, respectively). Non-Hispanic Black and Hispanic teens were less likely to experience a pregnancy than non-Hispanic white teens. Conclusions for Practice: The likelihood of pregnancy was lower among women using SAC methods and markedly lower among women using LARC. Variation in contraceptive use among racial/ethnic groups was noted despite Medicaid coverage. As new policies and initiatives emerge, these findings provide important context for understanding the role of Medicaid programs in reducing financial barriers to contraceptive services and ensuring access to effective contraception, while fostering reproductive health autonomy among women. [ABSTRACT FROM AUTHOR]

This study evaluates the impact of coverage in ALL Kids, the Alabama Child Health Insurance Program (CHIP), by examining asthma-related utilization and outcomes among children continuously enrolled for 3 years (N = 1954)with persistent asthma at enrollment. Outcomes and costs were compared for the first, second, and third years of enrollment using repeated measures analysis of variance and controlling for age, gender, and year fixed-effects. Compared with subsequent years, first year enrollment utilization was higher for asthma-related hospitalizations (6% vs 2% vs 2%; P < .0001) and emergency visits (10% vs 3% vs 2%; P < .0001). Also decreasing were asthma-related outpatient visits (1.46 vs 1.12 vs 0.94; P < .0001), quick-relief prescriptions (2.6 vs 2.2 vs 2.1; P < .0001), and long-term control prescriptions (5.8 vs 5.2 vs 4.4; P < .0001). As a result, significant declines in the mean costs per child were observed. Ongoing ALL Kids coverage is associated with improved disease-management and lower costs for persistent asthma. [ABSTRACT FROM PUBLISHER]

Background: To examine racial/ethnic and educational inequities in the relationship between state-level restrictive abortion policies and adverse birth outcomes from 2005 to 2015 in the United States.Methods: Using a state-level abortion restrictiveness index comprised of 18 restrictive abortion policies, we conducted a retrospective longitudinal analysis examining whether race/ethnicity and education level moderated the relationship between the restrictiveness index and individual-level probabilities of preterm birth (PTB) and low birthweight (LBW). Data were obtained from the 2005-2015 National Center for Health Statistics Period Linked Live Birth-Infant Death Files and analyzed with linear probability models adjusted for individual- and state-level characteristics and state and year fixed-effects.Results: Among 2,250,000 live births, 269,253 (12.0%) were PTBs and 182,960 (8.1%) were LBW. On average, states had approximately seven restrictive abortion policies enacted from 2005 to 2015. Black individuals experienced increased probability of PTB with additional exposure to restrictive abortion policies compared to non-Black individuals. Similarly, those with less than a college degree experienced increased probability of LBW with additional exposure to restrictive abortion policies compared to college graduates. For all analyses, inequities worsened as state environments grew increasingly restrictive.Conclusion: Findings demonstrate that Black individuals at all educational levels and those with fewer years of education disproportionately experienced adverse birth outcomes associated with restrictive abortion policies. Restrictive abortion policies may compound existing racial/ethnic, socioeconomic, and intersecting racial/ethnic and socioeconomic perinatal and infant health inequities. [ABSTRACT FROM AUTHOR]

Objective: To propose a tailored social ecological model for Autism Spectrum Disorders and explore relationships between variables in a large nationally-representative dataset. Methods: A tailored social-ecological model was developed and examined across variables in the 2016/2017 National Survey of Children's Health. A series of iterative multivariable logistic regressions were performed including individual, family, and community/neighborhood variables. A multivariable logistic regression using state-level fixed effects was performed to understand dynamics related to macro-level policies. Results: In the full model, gender, disability severity, certain types of insurance coverage and household income were significantly related to ASD diagnosis. Females had lower odds of a diagnosis compared to males (aOR: 0.27; CI:0.18–0.41). Children with at least one other moderate/severe disability had odds 7.61 higher (CI:5.36–10.82) of a diagnosis than children without moderate/severe disabilities. Children with public insurance only (aOR:1.66; CI:1.14–2.41) or both private and public insurance coverage (aOR: 2.62; CI:1.6–4.16) had higher odds of a diagnosis compared to children with private insurance only. For those who reported it was "somewhat" or "very often" hard to cover basics with their income, odds of a diagnosis were higher compared to those who reported it was "never" or "hardly ever" hard to cover basics (aOR: 1.676; CI:0.21–2.56). Conclusions for Practice: Patterns of ASD diagnosis are related to individual and family characteristics. There is some evidence that a child's environment has some relationship to reported ASD diagnosis. Professionals should be aware of an individual's environmental factors or context when assessing for ASD. [ABSTRACT FROM AUTHOR]

Reducing caries and improving access to dental care is a public health challenge. Understanding low use of dental care is of critical importance. This study estimated parent- or caregiver-reported prevalence and identified factors associated with children's dental care use, including the association with children's oral health. A cross-sectional analysis of children enrolled in Medicaid in Alabama, using data from the 2017 statewide Consumer Assessment of Healthcare Providers and Systems Health Plan Survey, was conducted. Associations were measured using adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) from logit regression and generalized linear model postestimation of least-squares means. The 6-month prevalence of children receiving dental care was 70.4%. Children aged 0 through 3 years (aPR, 0.72; 95% CI, 0.53 to 0.91) had lower prevalence of care than other age groups. The prevalence of low-rated oral health was 9.2%. Low-rated oral health was associated with not receiving dental care (aPR, 1.50; 95% CI, 1.12 to 1.87) and parental education of 8th grade or less (aPR, 2.59; 95% CI, 1.20 to 3.98). Falsification tests determined that dental care use was not associated with ratings for overall health (aPR, 1.18; 95% CI, 0.83 to 1.52) or emotional health (aPR, 1.06; 95% CI, 0.79 to 1.33). It was observed that children not receiving dental care had low-rated oral health; however, as a cross-sectional study, it was not possible to assess the temporality of this relationship. Oral health care providers should continue to recognize their role in educating parents and providing anticipatory guidance on children's oral health. [ABSTRACT FROM AUTHOR]

Objective: To identify hospital/county characteristics and sources of regional heterogeneity associated with readmission penalties.Data Sources/study Setting: Acute care hospitals under the Hospital Readmissions Reduction Program from fiscal years 2013 to 2018 were linked to data from the Annual Hospital Association, Centers for Medicare and Medicaid Services, Medicare claims, Hospital Compare, Nursing Home Compare, Area Resource File, Health Inequity Project, and Long-term Care Focus. The final sample contained 3,156 hospitals in 1,504 counties.Data Collection/extraction Methods: Data sources were combined using Medicare hospital identifiers or Federal Information Processing Standard codes.Study Design: A two-level hierarchical model with correlated random effects, also known as the Mundlak correction, was employed with hospitals nested within counties.Principal Findings: Over a third of the variation in readmission penalties was attributed to the county level. Patient sociodemographics and the surrounding access to and quality of care were significantly associated with penalties. Hospital measures of Medicare volume, percentage dual-eligible and Black patients, and patient experience were correlated with unobserved area-level factors that also impact penalties.Conclusions: As the readmission risk adjustment does not include any community-level characteristics or geographic controls, the resulting endogeneity bias has the potential to disparately penalize certain hospitals. [ABSTRACT FROM AUTHOR]

This article discusses a study aimed to assess whether a comprehensive wellness assessment (CWA) program helps improve medication adherence for oral diabetic medications, statins, and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in the Medicare Advantage (MA) plan diabetic population. Topics covered include why the issue of medication nonadherence has generated much interest in the U.S. and the study's data, intervention of interest and outcomes of interest.