Research

Medicaid’s Remarkable Endurance

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                    [post_date] => 2018-11-12 02:00:52
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                    [post_content] => Among all forms of health insurance, Medicaid stands alone in its strength, its ability to evolve in response to emerging public health needs, and its resilience. Over more than five decades, Medicaid has become the nation’s largest public health program and one of its most indispensable. Today Medicaid finances half of all births and, along with its small companion the Children’s Health Insurance Program, 40% of all pediatric care. Medicaid is the means by which the nation has created community-based long-term services and supported children and adults with advanced health needs. Indeed, deinstitutionalization could not have happened without it.

Medicaid is how we pay for treatment for uninsured patients diagnosed with breast or cervical cancer. It is the single most important funder of treatment for people living with HIV/AIDS and the largest funder of health care safety net clinics and hospitals that anchor health care in the poorest communities. In times of public health disaster, whether naturally-occurring or man-made, the nation turns to Medicaid. It has, for example, been the go-to source for funding the range of health treatments needed to combat the opioid epidemic.

Over a half century, these and more responsibilities have been assigned to a program that, in its original state, was understood as a companion to Medicare, a pathway for covering a modest number of public assistance beneficiaries. In 1965, few could have foreseen Medicaid’s ultimate potential as a centerpiece of public health, owing to its ability to finance health care for populations and conditions excluded from both Medicare and the market norms of a voluntary insurance system.

Two factors account for Medicaid’s remarkable growth. First, unlike other forms of insurance, Medicaid financing rests on general federal, state, and local revenues coupled with broad-based provider taxes. Because Medicaid is not tied to premium contributions or payroll taxes, its reach is not limited by narrow funding structures that inevitably constrain program design and growth.
Its services—provided virtually free with only nominal cost-sharing—span the entire life-cycle, from pregnancy and birth through long-term care.  
Second, unlike private insurance or Medicare, Medicaid is designed to embrace risk rather than avoid it. From enactment, its beneficiaries have been the poorest and most medically vulnerable people. Its services—provided virtually free with only nominal cost-sharing—span the entire life-cycle, from pregnancy and birth through long-term care. Enrollment happens in community settings and at the point of care—something unheard of in insurance markets. Medicaid does not use waiting periods, and eligibility can be established retroactively in order to cover incurred costs. Because of Medicaid’s unique financing and structure, the program has become the solution of choice for policymakers on a host of public health priorities such as coverage for low-income children and pregnant women, creating an insurance pathway for low-income working parents without affordable workplace coverage, and community based services for children and adults with serious and lifelong disabilities. Most of this growth has come, not as top-down federal commands, but as state innovations under federal legislative options. When it finally came time to insure the nation’s poorest working age adults, it should surprise no one that, rather than relying on a restructured yet fragile individual insurance market, Congress chose to expand Medicaid (the hardy perennial rather than the hothouse flower).
Yet Medicaid’s flexibility and responsiveness have also triggered a deep challenge owing to its sheer size.  
A veritable deluge of studies over decades have built an unusually strong evidence base for the program. Yet Medicaid’s flexibility and responsiveness have also triggered a deep challenge owing to its sheer size. By 1967 policymakers, already aware of what they had unleashed, began to apply the brakes. The first legislative effort to cap overall Medicaid spending came in 1981, the first year of the Reagan presidency. Nearly 40 years ago, the effort to end Medicaid failed, as the program’s importance to the health care system was becoming clear for all to see. Since then, Medicaid has endured two more near-misses: first, during the 1995 Gingrich revolution that most famously produced welfare reform, and in 2017 when the program’s survival became a centerpiece of the battle over “repeal and replace.” The summer of 2017 witnessed a war worthy of Game of Thrones, with the stakes being not simply the Affordable Care Act’s adult Medicaid expansion but the entire program. Ultimately the repeal effort toppled. In good part, this collapse could be traced to the implacable opposition to the Medicaid provisions by the nation’s Governors, who understood better than anyone the degree to which Medicaid—insurer of 75 million people—has become the foundation on which the health system rests.
Medicaid needs progressive reforms that emphasize innovation in care delivery and increased efficiencies.  
Medicaid survived 2017. Still, it faces many challenges. Seventeen states remain outside the ACA adult expansion, leaving millions with no pathway to affordable health insurance. Perhaps the 2018 mid-term state election results will begin to change this, as was the case for Virginia in 2017. For all states, Medicaid’s sheer size and budgetary demands represent an ongoing challenge, even as Medicaid revenue helps fuel state economies. Medicaid needs progressive reforms that emphasize innovation in care delivery and increased efficiencies. We need to couple these reforms with a broader public health strategy aimed at integrating Medicaid services with health and social interventions aimed at addressing the root causes of poor health. The consequence of failure likely will be more legislative attacks—apparently a post-midterm-election priority for Republican Senate leaders—or, as we are now witnessing, efforts to drive away the poor through work “experiments” or immigration “reforms” designed to punish the poor rather than advance the public health and welfare. Feature image: Arwen TwinklePeony-2, used under CC BY-NC-ND 2.0 [post_title] => Medicaid’s Remarkable Endurance [post_excerpt] => Over more than five decades, Medicaid has become the nation’s largest public health program and one of its most indispensable. Its sheer size and budgetary demands represent an ongoing challenge, even as its revenue helps fuel state economies. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => medicaids-remarkable-endurance [to_ping] => [pinged] => [post_modified] => 2018-11-12 15:53:23 [post_modified_gmt] => 2018-11-12 20:53:23 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_research&p=5808 [menu_order] => 0 [post_type] => bu_research [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Over more than five decades, Medicaid has become the nation’s largest public health program and one of its most indispensable. Its sheer size and budgetary demands represent an ongoing challenge, even as its revenue helps fuel state economies.

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Research

Feel the Churn

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                    [post_date] => 2018-11-09 05:30:45
                    [post_date_gmt] => 2018-11-09 10:30:45
                    [post_content] => Change is nothing new for young adults; they experience it as they move on from high school to college, from college to internships and jobs, and from one job to another. During these phases, health insurance is one of the many elements of a young adult’s life that keeps changing. Insurers call these changes “churning,” representing the rolling from one type of health plan to the next. Younger adults churn more than their elders.

Between 2008 and 2011, only 21% of adults of ages 19 to 35 had continuous health insurance coverage. Lack of complete or continuous coverage because of churning may result in few doctor visits and not enough preventive care. It may also lead to young adults delaying receiving care because of costly procedures and medications. Those not fluent in the language of healthcare coverage may struggle with navigating the insurance landscape during times of transition.

Researchers from University of California, San Francisco conducted a study to identify gaps in health insurance clarity among youth. They studied young adults in California, the state with the most people ages 18 to 34 in the country, and a state where income and wealth levels are particularly diverse. California was also one of the first to expand Medicaid in the wake of the Affordable Care Act, producing a historic drop in the number of uninsured people as a result. Still, California ranks high in the amount and frequency of churning.

The researchers interviewed health department administrators, state legislators, insurance company employees, and health advocates. These key informants explained why young adults are more vulnerable to churning, and how it affects their care.
When faced with the reality of having to independently manage their purchases of health insurance, many young adults have trouble grasping the meaning of basic health insurance lingo.  
The results demonstrated that when faced with the reality of having to independently manage their purchases of health insurance, many young adults have trouble grasping the meaning of basic health insurance lingo. Terms like deductible, cost-sharing, premium, and in-network are difficult to understand, and how they affect what insurers actually pay for is not always clear. One key informant indicated how this may be particularly true for young women who discover their contraception method is not covered under a new insurance plan. Further, this lack of clarity regarding coverage may act as a barrier to accessing services like behavioral health, which go underutilized. Some state policies exist to protect coverage in times of churning. In California, patients who have to change their insurance are still allowed to visit their primary health provider during the transition period. But this is not made clear to young adults before they experience churning. The researchers and their key informants emphasized how current information on health plans assumes that everyone understands insurance and health-specific terms. They called for simpler language and greater promotion of health care services that may be available through high schools and colleges where young adults can better access and receive care. The informants also mentioned how insurers need to focus on helping youths who are not fluent in English, are from low-income backgrounds, or lack stable housing—like foster youth; these young adults may be particularly vulnerable to missing out on the benefits of health insurance. Finally, any young adult-oriented information about health insurance may be delivered best online, as opposed to through the mail or phone. The Kaiser Family Foundation has compiled a list of frequently asked questions that may be a good place to start. Feature image: rawpixel on Unsplash [post_title] => Feel the Churn [post_excerpt] => Health insurance is one of the many elements of a young adult’s life that keeps changing. Insurers call these changes “churning," or rolling from one type of health plan to the next. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => feel-the-churn [to_ping] => [pinged] => [post_modified] => 2018-11-07 07:06:40 [post_modified_gmt] => 2018-11-07 12:06:40 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_research&p=5813 [menu_order] => 0 [post_type] => bu_research [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Health insurance is one of the many elements of a young adult’s life that keeps changing. Insurers call these changes “churning,” or rolling from one type of health plan to the next.

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Research

Black Church, Black Men(tal) Health

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                    [post_date] => 2018-11-08 06:30:58
                    [post_date_gmt] => 2018-11-08 11:30:58
                    [post_content] => Black men in the United States experience unique, sociocultural stressors that affect their physical and mental health. As a result, Black men not only have poor health outcomes, they also have the shortest life expectancy compared to other races and women. Despite these differences in health and life expectancy, developing a body of evidence on the health of Black men has been slow. More research on the physical and mental health of Black men is necessary.

We have been exploring the ways in which the Black Church provides spiritually and culturally relevant services for Black men in their communities. Our work complements previous research about religion, spirituality, and health focused on Black women.

Previous research has shown that Black individuals are less likely to use mental health services even though they experience levels of distress similar to individuals of other racial/ethnic backgrounds. A Black man’s decision about whether to seek help for his mental or physical health is influenced by gender norms and cultural beliefs. Black men may also experience racism in the healthcare system or financial barriers to care. These factors result in Black men not using professional mental health services and instead relying on others such as clergy or family members.
Almost 50% of the Black individuals surveyed in 2014 by the Pew Research Center attended religious services weekly. Among those attending church 32% were men.  
The church has always been a significant institution within the Black community and it has connections to many other institutions such as Black colleges and universities and the NAACP (the National Association for the Advancement of Colored People). Membership in Black Churches has remained steady or increased at a time when many religious institutions have declining memberships. Almost 50% of the Black individuals surveyed in 2014 by the Pew Research Center attended religious services weekly. Among those attending church 32% were men. Those who attend church regularly are more likely to seek help for spiritual and personal problems from clergy. While Black Churches continue to positively affect the lives of many within the Black community, they can enhance the support they provide to many of their congregants. Two theoretical frameworks can help Black Churches to increase the effectiveness of the support they provide to congregants and Black men in particular. The Body, Mind, Spirit, Environment, Social, Transcendent (BMSEST) model is based on Maslow’s hierarchy of needs. It acknowledges the relationship between spirituality and well-being and thus complements the healing work being done in the Black Church. The Health, Illness, Men, and Masculinities (HIMM) model, by contrast, emphasizes understanding gender as a determinant of Black men’s physical and mental health.
Combined, these theoretical frameworks can improve the Black Church’s ability to address the mental health needs of Black men.  
These theoretical frameworks can assist professionals and academics working in the social sciences to organize the concepts that are most relevant to this problem and this population, such as spirituality and help-seeking behavior. The models can be used by Black Churches as a foundation upon which program developers can create spiritually-sensitive, culturally-competent, and empirically-based community interventions to support Black men’s mental and physical health needs. Combined, these theoretical frameworks can improve the Black Church’s ability to address the mental health needs of Black men. The church is a preexisting source of strength and support in the Black community, but it has a responsibility to do more for Black men given their poor physical and mental health outcomes. Our recently published review summarizes existing research and introduces these models as a strategy Black Churches can use to better meet the needs of men. Black academics and professionals need to collaborate with the clergy of Black Churches to develop and implement programs that are spiritually-sensitive, culturally appropriate, and grounded in evidenced-based practice. It is time to devote our attention to the mental health challenges experienced by Black men. Feature image: sevenstockstudio/Istock  [post_title] => Black Church, Black Men(tal) Health [post_excerpt] => Black Churches continue to positively affect the lives of many within the Black community. Black Churches have the potential to increase the effectiveness of the support they provide to congregants, and Black men in particular.  [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => black-mens-mental-health-black-church [to_ping] => [pinged] => [post_modified] => 2018-11-08 08:16:44 [post_modified_gmt] => 2018-11-08 13:16:44 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_research&p=5776 [menu_order] => 0 [post_type] => bu_research [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Black Churches continue to positively affect the lives of many within the Black community. Black Churches have the potential to increase the effectiveness of the support they provide to congregants, and Black men in particular. 

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Research

Undercounting Heroin

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                    [post_date] => 2018-11-07 07:00:17
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                    [post_content] => Heroin lasts in the human body for just a few minutes before being converted into morphine and other compounds. The drug’s short half-life may be one reason why it is so addictive. It also complicates the task of a medical examiner or coroner trying to identify the substance that caused an overdose death. A death from heroin may be labeled as “morphine intoxication,” “narcotic intoxication,” or “drug overdose” without any specific mention of the real culprit.

How often does heroin escape mention in death certificates for overdose? We (with colleagues) conducted a study using data from Maryland to find out.

From 2012 to 2015, death certificates in Maryland noted heroin in 1130 cases of overdose. Using a protocol of enhanced surveillance, the Department of Health and Mental Hygiene assessed for heroin in a different way. Reviewing the toxicology results and the death scene records, the Department (where we worked) counted a death as heroin-related if at least one of the following criteria were met:
  1. Heroin was listed in the cause of death section of the death certificate;
  2. Toxicology screen showed a positive result for 6-monacetylmorphine, a metabolite of heroin;
  3. Toxicology screen showed positive results for quinine in combination with either morphine or free morphine; or
  4. Scene investigation notes suggested that heroin was likely to have been involved in the death.
  We found 2,182 cases of heroin-related overdose, nearly double the original number. Our finding, which is consistent with other research, suggests heroin may be undercounted as a cause of opioid overdose. It is known that the epidemic of opioid overdoses in the United States began to shift around 2010 from prescription drugs to illicit drugs. Our results suggest this shift might have been more abrupt and significant than recognized to date.
We found 2,182 cases of heroin-related overdose, nearly double the original number.  
Appreciating the magnitude of this shift is important for the response to the opioid epidemic. When the goal is reducing overdoses from prescription drugs (regardless of whether the pills find their way to illegal markets), then work tends to focus on changing clinician prescribing behavior. The federal government and states spend substantial resources on prescription drug monitoring programs and educational efforts to facilitate judicious prescribing. However, when the goal is reducing deaths from heroin and other illicit opioids (such as illicitly manufactured fentanyl), then policymakers should do much more. They should expand rapid access to effective treatment for opioid use disorder with the medications methadone, buprenorphine, and depot naltrexone in emergency departments, jails and prisons, and primary care. They should also expand harm reduction and engagement programs such as naloxone distribution, syringe exchange, and fentanyl checking. These efforts help people who use illicit drugs to reduce their risk of a fatal overdose and provide opportunities to connect them to effective treatment and to begin the process of recovery. The opioid epidemic in the United States involves much more than prescription drugs. Higher quality data on what is driving the increase in overdoses can improve public understanding of our national crisis and shine a light on what is needed to be done. Feature image Barry Robinson/iStock [post_title] => Undercounting Heroin [post_excerpt] => Heroin lasts in the human body for just a few minutes before being converted into morphine and other compounds. This complicates the task of a medical examiner trying to identify the substance that caused an overdose death. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => undercounting-heroin [to_ping] => [pinged] => [post_modified] => 2018-11-07 07:08:46 [post_modified_gmt] => 2018-11-07 12:08:46 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_research&p=5779 [menu_order] => 0 [post_type] => bu_research [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Heroin lasts in the human body for just a few minutes before being converted into morphine and other compounds. This complicates the task of a medical examiner trying to identify the substance that caused an overdose death.

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Research

Prison Chaplain Views on Criminality and Reform

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                    [post_date] => 2018-11-01 05:30:59
                    [post_date_gmt] => 2018-11-01 09:30:59
                    [post_content] => Religion is an important force in the history of American prisons. Through the early efforts of the Quakers in colonial America and the formative years of the United States, religion was ingrained into the DNA of corrections. Penitentiaries derive their name from the act of penitence and inmates were sentenced to repent their sinful (i.e., criminal) ways. Prison chaplains were entrusted with overseeing this moral reform.

Starting in the 1850s, crime was increasingly seen through a scientific lens. Explanations based in biology, psychology and sociology gradually replaced demonic influences as the primary explanation for criminal behavior. The role of prison chaplains slowly changed as many of their original job duties fell to licensed counselors and social workers.
The role of prison chaplains slowly changed as many of their original job duties fell to licensed counselors and social workers.  
Passage of the Religious Land Use and Institutionalized Persons Act (RLUIPA) in 2000 ushered in a new era for prison chaplains with a shift to primarily administrative duties. RLUIPA ensures the religious rights of the 2.2 million inmates currently incarcerated in 1,100 state and federal US prisons. Consequently, the estimated 1,600 chaplains are responsible for connecting inmates with religious groups inside and outside of prison. A key duty of modern prison chaplains is overseeing faith-based volunteers from a variety of religions to lead inmate worship. (Chaplains rarely lead worship services.) As such, the primary role of modern prison chaplains is to protect their institutions from costly lawsuits brought as RLUIPA violations. Approximately 630,000 inmates are released from prison every year and 67.8% return to prison within three years. In the face of such high recidivism, I decided to explore the role chaplains currently play and explore the possibilities for better targeting their skills to meet prisoners’ psychological and emotional needs. I conducted in-depth interviews with 19 prison chaplains employed by a department of corrections in a Midwestern US state to understand their perceptions about criminal behavior and recidivism. Chaplains answered a series of questions focused on 1) causes of crime, 2) successful practices for reducing recidivism, and 3) the role that personal religion or faith can play in recidivism. Four prominent themes emerged. Chaplains overwhelmingly viewed illegal drug-use, poor social support, low self-control, and having a ‘criminal mind’ as primary reasons for criminal behavior. Nearly half perceived offenders as having a ‘criminal mind’ that psychologically sets them apart. Some chaplains reported that changing ‘criminal thinking’ is imperative, echoing some basic tenants of cognitive behavioral therapy (CBT). That is, changing criminals’ general thinking patterns to make non-criminal choices.
The chaplains who participated in this study noted that people leaving prison face many barriers to successful reentry, such as unemployment and poor social support.  
Most chaplains saw religion and faith as essential to building a moral code and avoiding criminal choices. Religion and spirituality, they explained, offer offenders a sense of community support. Conversely, nearly 25% of the chaplains did not view religion or faith as necessary for desistance. The chaplains who participated in this study noted that people leaving prison face many barriers to successful reentry, such as unemployment and poor social support. Many chaplains explained that these and other challenges such as substance use disorders and problematic reasoning must be addressed. Some chaplains reported that they had the ability to create new programs to meet these needs. Findings suggest that many prison chaplains still have influence over institutional programming. As such, prison administrators should encourage prison chaplains to assume a more hands-on role with substance abuse treatment programming and CBT and simultaneously reduce their administrative responsibilities. Ultimately, a shift back to their original hands-on role may help to ease the transition from prison to society and reduce recidivism. [post_title] => Prison Chaplain Views on Criminality and Reform [post_excerpt] => Prison chaplains answered a series of questions focused on causes of crime, reducing recidivism, and the role that personal religtion can play in recidivism. Four prominent themes emerged. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => prison-chaplain-views-on-criminality-and-reform [to_ping] => [pinged] => [post_modified] => 2018-11-06 05:41:54 [post_modified_gmt] => 2018-11-06 10:41:54 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_research&p=5729 [menu_order] => 0 [post_type] => bu_research [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Prison chaplains answered a series of questions focused on causes of crime, reducing recidivism, and the role that personal religtion can play in recidivism. Four prominent themes emerged.

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Research

All Aboard for Light Rail Transit

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                    [post_date] => 2018-10-30 07:00:15
                    [post_date_gmt] => 2018-10-30 11:00:15
                    [post_content] => Air pollution from vehicle exhaust has a substantial impact on health. Exhaust pollutants are linked to increased risk of lung and respiratory infections, cardiovascular disease, and high blood pressure, and stroke.

Public transportation is known to reduce transport-related air pollution.

Public transit moves many people efficiently, producing significantly less air pollution  and increasing health benefits in surrounding neighborhoods. For example, one study from Atlanta found increased public transportation corresponded with improved air quality and a decrease in child asthma during the 1996 Olympic Games. While interventions exist to improve people’s health by decreasing air pollution, few studies have measured how pollution interventions can impact cardiovascular outcomes. Researchers Eun Park and Ipek Sener took advantage of the 2004 light rail installation in Harris County, TX  to study if the transit system decreased vehicle emissions and in turn affected deaths from stroke between 2002-2005.

Traffic exhaust pollution was estimated as ambient acetylene concentration data from ten volatile organic compound (VOC) monitoring sites. Acetylene is a chemical specific to vehicle exhaust emissions, and thus a good measure of traffic census. Mortality data was collected from the Texas Department of State Health Services Center.
The researchers found that, after the installation of a light rail transit (LRT), average acetylene levels were reduced by 13% and stroke mortality was reduced by more than 30% within a 10-mile radius.  
The researchers found that, after the installation of a light rail transit (LRT), average acetylene levels were reduced by 13% and stroke mortality was reduced by more than 30% within a 10-mile radius. In contrast, control areas experienced a less than 10% reduction of stroke mortality, and less than 1% reduction in acetylene levels. Although there was a reduction in vehicle exhaust pollution, there were other factors associated with light rail transit stations that could have contributed to the decline in stroke deaths. A LRT station mitigates exposure to traffic noise pollution, which also could reduce the risk of stroke. Increased physical activity is another effect from installing a LRT system, and also decreases people’s risk of stroke. Since passing the Clean Air Act in 1970, the EPA has been in charge of regulating air pollution, and supports the development of public transportation infrastructure. California is the only state that has successfully bargained for a Greenhouse Gas Federal Waiver to regulate its own vehicle pollution, adopting stricter emissions standards than those of the EPA’s. California’s regulations has since been embraced by thirteen states. As seen from Park and Sener’s study, reducing vehicle exhaust pollution can have positive health impacts on the surrounding community. These findings may be important to keep in mind as the current administration has announced plans to revoke California’s stricter emissions waiver. Feature image: Michael ChuSunset TC Station, Portland MAX light rail train at Sunset Transit Center. [post_title] => All Aboard for Light Rail Transit [post_excerpt] => Public transit moves many people efficiently, producing significantly less air pollution than vehicles. Park and Sener measured how light rail transit decreased vehicle emissions and in turn affected deaths from stroke. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => all-aboard-for-light-rail-transit [to_ping] => [pinged] => [post_modified] => 2018-10-30 07:28:28 [post_modified_gmt] => 2018-10-30 11:28:28 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_research&p=5770 [menu_order] => 0 [post_type] => bu_research [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Public transit moves many people efficiently, producing significantly less air pollution than vehicles. Park and Sener measured how light rail transit decreased vehicle emissions and in turn affected deaths from stroke.

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Research

Access to Paid Sick Leave is a Public Health Issue

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                    [post_date] => 2018-10-29 07:00:09
                    [post_date_gmt] => 2018-10-29 11:00:09
                    [post_content] => You wake up in the middle of the night and hear your daughter crying. You place your hand on her forehead and notice she has a fever.  For over a quarter of American workers, this is a situation that could compromise their family’s livelihood. Indeed, most workers occasionally need to take off time from work to recuperate from an illness or to seek preventive or acute medical care for themselves or a loved one. As a result, 28% of workers risk losing a day’s wage and are at risk of being fired.

Most people are probably not aware that vigorous legislative activity is happening around the country regarding a little-understood public health issue: paid sick leave. Indeed, in the last decade, 9 states and 32 localities have passed laws mandating paid sick leave benefits for certain groups of employees. At the same time, 15 states have passed preemptive legislation that prevents such mandates. Our team of researchers from Cleveland State University and Florida Atlantic University, led by myself, Dr. LeaAnne DeRigne, and Dr. Linda Quinn has been working to develop an evidence base that can be used to inform these political decisions. We used two highly regarded, nationally representative datasets to analyze trends, while controlling for other variables that might explain the relationships we found. We reported our findings in a series of peer reviewed published papers over the last four years.

Time and again we found paid sick leave is significantly related to health-related variables. Indeed, workers who lack paid sick leave are less likely to receive eight preventive care services including monitoring of blood pressure, cholesterol, and blood sugar; certain cancer screenings; and the flu shot. This is particularly important since workers who lack paid sick leave are also more likely to attend work while sick, which increases the spread of disease.
A cascading effect occurs where workers who lack paid sick leave are more likely to delay or forgo needed care for themselves and their family members.  
A cascading effect occurs where workers who lack paid sick leave are more likely to delay or forgo needed care for themselves and their family members. As a result, medical conditions may become more complicated and expensive to treat. Not surprisingly, workers who lack paid sick leave are more likely to have higher health care costs compared to workers who have paid sick leave benefits. Correspondingly, workers who lack paid sick leave are more likely to worry about finances and have symptoms of psychological distress. They are also more likely to be poor and need welfare benefits. The American Public Health Association endorses paid sick leave, but currently the United States lags behind other nations when it comes to mandating paid sick leave benefits. Some initial research regarding the ideal number of paid sick days suggests six to ten or more paid sick days are needed before changes in worker’s preventive health care seeking are observed.  More research is needed.
Offering paid sick leave benefits is good for business, reducing "presenteeism" costs, errors in production, workplace injuries, and the spread of contagious illness in the workplace.  
Offering paid sick leave benefits is good for business, reducing "presenteeism" costs (i.e. reduced productivity due to attending work while sick), errors in production, workplace injuries, and the spread of contagious illness in the workplace. Public health advocates have constructed a possible policy option for paid sick leave distinct from Family Medical Leave Act, which provides up to 12 weeks of unpaid, job-protected leave for some workers with long-term chronic health conditions. At the federal level, The Healthy Families Act has been proposed to provide workers employed by businesses with at least 15 employees an opportunity to earn up to seven paid sick days annually. Workers employed by businesses with fewer than 15 workers could earn up to 7 unpaid sick days. Overall, the evidence base regarding paid sick leave has rapidly increased over the last five years.  Our hope is that existing and future policy will be evaluated in light of the evidence. Feature image: Lucaa15/iStock [post_title] => Access to Paid Sick Leave is a Public Health Issue [post_excerpt] => The American Public Health Association endorses paid sick leave, but currently the United States lags behind other nations when it comes to mandating paid sick leave benefits. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => access-to-paid-sick-leave-is-a-public-health-issue [to_ping] => [pinged] => [post_modified] => 2018-11-02 06:40:03 [post_modified_gmt] => 2018-11-02 10:40:03 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_research&p=5765 [menu_order] => 0 [post_type] => bu_research [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

The American Public Health Association endorses paid sick leave, but currently the United States lags behind other nations when it comes to mandating paid sick leave benefits.

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Research

Breaking Down Barriers: Video Mental Health Treatment

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                    [ID] => 5725
                    [post_author] => 8
                    [post_date] => 2018-10-26 05:25:02
                    [post_date_gmt] => 2018-10-26 09:25:02
                    [post_content] => Half of US adults experience mental illness during their lifetime and 1 in 5 each year. Less than half receive treatment. Barriers to mental health care include a shortage of providers, particularly in rural areas, and logistical challenges like difficulty taking time off work or school, arranging childcare, and other family responsibilities. For some individuals, symptoms of anxiety or depression make it difficult to leave their homes for treatment. Inability to pay for services and stigma also stand in the way of seeking and receiving mental health care.

Technology solutions such as web-based treatments, mobile apps, and telehealth address some of the barriers. Recent advances in telehealth include the expansion of mental health services directly to patients’ homes, allowing mental health providers to reach patients who are unable to attend in-person appointments. While there seems to be great potential in connecting patients to care using video and other technologies, questions remain about how virtual delivery compares to in-person care.

We reviewed the current literature on video-to-home mental health care to examine how this type of virtual delivery compares to in-person mental health treatment in terms of clinical effectiveness, patient and provider satisfaction, and cost. We analyzed ten studies reporting on the clinical effectiveness, cost, feasibility, and satisfaction of video telehealth.
Adult patients of all ages reported high rates of satisfaction with video delivery of mental health care, with 77-99% reporting they would like to receive their care this way again.  
Nine studies reported on the clinical effectiveness of video for delivering psychotherapy and one reported on video delivery of psychiatric medication management services. The treatments targeted a variety of mental health concerns including depression, post-traumatic stress disorder, obsessive compulsive disorder, and substance use. Eight studies were randomized controlled trials comparing video-to-home delivery with in-person treatment. These studies reported comparable treatment effectiveness for the two types of delivery, suggesting that mental health treatment delivered to patients’ homes by video is as effective as in-person meetings. Adult patients of all ages reported high rates of satisfaction with video delivery of mental health care, with 77-99% reporting they would like to receive their care this way again. Patients identified several benefits of video mental health treatment including convenience, the ability to see and connect with their provider virtually, and privacy. The few studies reporting on provider satisfaction highlighted differences between providers experienced with video-to-home delivery and those without. Providers with no experience reported concerns about whether video would be a good fit for their patients, whereas providers experienced with video-to-home delivery viewed it as an effective method of providing needed mental health treatment to patients with limited access to care.
Three studies examining cost effectiveness of video-to-home healthcare delivery found that outcomes were influenced by the type of technology being used.  
Three studies examining cost effectiveness of video-to-home healthcare delivery found that outcomes were influenced by the type of technology being used. Video-to-home delivery was less costly than in-person care when patients used their personal computers, tablets, or smartphones to connect to their providers rather than devices supplied by their mental health provider. Overall, these results suggest that video telehealth is an effective and efficient way to deliver mental health care. For patients facing barriers to in-person care, video telehealth may be the only feasible option to access needed mental health care. Mental health providers should embrace video telehealth as an effective mode of delivery and integrate this service into their current practices. First steps may include becoming familiar with best practices in video telehealth, consulting with colleagues, and reviewing federal and state telehealth guidelines. Feature image by Oliur on Unsplash [post_title] => Breaking Down Barriers: Video Mental Health Treatment [post_excerpt] => There seems to be great potential in connecting patients to care using video and other technologies, but questions remain about how virtual delivery compares to in-person care. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => breaking-down-barriers-video-mental-health-treatment [to_ping] => [pinged] => [post_modified] => 2018-10-26 05:26:04 [post_modified_gmt] => 2018-10-26 09:26:04 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_research&p=5725 [menu_order] => 0 [post_type] => bu_research [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

There seems to be great potential in connecting patients to care using video and other technologies, but questions remain about how virtual delivery compares to in-person care.

...more
Research

Hearing Loss is Memory Loss

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                    [ID] => 5727
                    [post_author] => 8
                    [post_date] => 2018-10-25 07:00:35
                    [post_date_gmt] => 2018-10-25 11:00:35
                    [post_content] => According to the 2016 World Alzheimer Report, 47 million people have dementia. By 2050, that number is expected to exceed 130 million. Since at least 1989, researchers have documented that hearing loss is associated with dementia. One-third of adults age 65-74 and almost half over age 75 experience hearing loss.

Two hypotheses explain the relationship between hearing loss and cognitive decline. The common cause hypothesis assumes that degeneration of the central nervous system accounts for both hearing loss and cognitive decline. The cascade hypothesis suggests that hearing loss leads to less stimulation of the brain, which then leads to cognitive decline.

A recent study published by Asri Maharani and colleagues in the Journal of the American Geriatrics Society followed patients for 18 years to measure associations between hearing aid use and episodic memory, defined as “the ability to recall and mentally re-experience specific episodes from one’s personal past.” The researchers measured the rate of cognitive decline both before and after hearing aid use began in over 2,000 people.

Episodic memory and cognitive decline were measured using a word recall test. Participants were read a list of ten words and then asked to repeat them immediately and again after a short delay. The researchers note that they focused on episodic memory because it is age-sensitive and strongly correlated with dementia. Study participants also self-reported hearing aid use.
Episodic memory scores decreased as participants aged. However, the researchers found that memory loss slowed after participants started using hearing aids.  
Episodic memory scores decreased as participants aged. However, the researchers found that memory loss slowed after participants started using hearing aids. These findings support the cascade hypothesis that memory loss is caused by lack of stimulation. When asked about the implications of these results in an email interview, Dr. Maharani, the lead author, said, “Our finding underlines just how important it is to overcome the barriers which deny people from accessing hearing and visual aids. Treating age-related hearing impairment has a significant consequence on cognitive status; the earlier hearing impairment is identified and treated, the better the probable outcome.” Many persons do not seek treatment for hearing loss because of the costs, as state-of-the art prescription hearing aids can cost thousands of dollars. Others do not seek treatment because of a lack of awareness of hearing impairment, which often occurs gradually. Still others resist hearing aid usage due pride or vanity. The researchers highlight that steps need to be taken to ensure that those who are low-income have access to evaluation of hearing loss and to treatment. Some forms of insurance cover the cost of hearing aids, including Medicaid in many states. The FDA is currently drafting legislation on a new category of over-the-counter hearing aids, which is expected to put pressure on current manufacturers to lower prices. The market for hearing aids is expected to expand as the population ages. Families and physician need to be attentive to hearing loss beginning in middle age. You can’t remember what you can’t hear. Feature image: BackyardProduction/iStock [post_title] => Hearing Loss is Memory Loss [post_excerpt] => Asri Maharani and colleagues followed patients for 18 years to measure associations between hearing aid use and episodic memory. Memory loss slowed after participants started using hearing aids. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => hearing-loss-is-memory-loss [to_ping] => [pinged] => [post_modified] => 2018-10-22 07:26:19 [post_modified_gmt] => 2018-10-22 11:26:19 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_research&p=5727 [menu_order] => 0 [post_type] => bu_research [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Asri Maharani and colleagues followed patients for 18 years to measure associations between hearing aid use and episodic memory. Memory loss slowed after participants started using hearing aids.

...more
Research

Tantrums in the Snack Aisle

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                    [ID] => 5736
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                    [post_date] => 2018-10-24 05:30:57
                    [post_date_gmt] => 2018-10-24 09:30:57
                    [post_content] => When young children do not get their way, things can get hairy for their parents. In grocery stores, parents denying their children a favorite snack can end in tantrums. And the last thing a stressed parent may want is a screaming, crying child in a public space, drawing unwanted attention. The American Psychological Association explains that these outbursts occur because children are still learning how to process their emotions and frustrations and recognize a sense of power.

In supermarkets, children’s interests are heavily influenced by their parents, their friends, and media advertisements; kids between ages 2 and 7 years old are particularly impressionable. Young kids skillfully use their pester power to convince parents to give in to their demands, which typically involve highly-marketed, prepared foods.

Food is incredibly powerful, not only in terms of nutrition, but also because it can be used as an agent to control behavior. Most research addressing this method to manage youth behavior has focused on the home setting. Kathryn Lively and colleagues set out to understand how mothers respond to the requests children make in the grocery store, and how such responses relate to their feeding habits.

The researchers collected information from mothers with children between 2 and 7 years old through an online survey. In addition to sharing their feeding practices, participants responded to questions about how often their children requested food purchases. The questionnaire asked about mothers’ willingness to purchase the foods their kids requested, and mothers were presented with images of food types. The researchers categorized these food types into two groups: nutrient-dense and nutrient-poor.
Mothers who tended to use food as a reward were generally more willing to buy nutrient-poor items requested by their kids, compared to those who did not reward children with food.  
Mothers were questioned about three types of food-related practices, which were assessed with elements from the Comprehensive Feeding Practices Questionnaire: using food as rewards, for emotion regulation, and to model eating habits. Rewarding children included offering something sweet or a favorite food item in exchange for good behavior. Emotion regulation captured giving children food or drinks when fussy, bored, or upset. And modeling described those times when mothers actively and enthusiastically ate nutrient-dense food in front of their children. Mothers who tended to use food as a reward were generally more willing to buy nutrient-poor items requested by their kids, compared to those who did not reward children with food. Similarly, the likelihood of giving into nutrient-poor food requests was greater among mothers who used food to manage their children’s emotions, compared to mothers who did not. Willingness to purchase nutrient-dense foods was found to be higher among mothers who responded that they modeled healthy eating habits. Understanding the dynamic between mothers and children in the snack aisle of a grocery store may provide insight into health promotion efforts about nutrition. The researchers suggest that mothers engaging in conversations with their children about eating habits can influence food purchasing trends. They also acknowledge, however, that their study captures the experiences of more affluent mothers, and propose exploring how income may factor into the relationship between grocery store behavior and child nutrition. Feature image: Filipovic018/iStock [post_title] => Tantrums in the Snack Aisle [post_excerpt] => Understanding the dynamic between mothers and children in the snack aisle of a grocery store may provide insight into health promotion efforts about nutrition. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => tantrums-in-the-snack-aisle [to_ping] => [pinged] => [post_modified] => 2018-10-24 05:47:51 [post_modified_gmt] => 2018-10-24 09:47:51 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_research&p=5736 [menu_order] => 0 [post_type] => bu_research [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Understanding the dynamic between mothers and children in the snack aisle of a grocery store may provide insight into health promotion efforts about nutrition.

...more
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