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ABSTRACT: The Affordable Care Act (ACA) provides financial incentives to prevent substance use disorders (SUDs). Local health departments (LHDs) can receive funds to establish care teams that partner with primary care providers and health systems. This study estimates the potential effect of LHDs on emergency visits for SUDs, using linked data sets from the Healthcare Cost and Utilization Project Emergency Department (ED) sample for the State of Maryland-2012, the National Association of County and City Health Officials Profiles Survey 2013, and Area Health Resource File 2013 to estimate potential effect of LHDs' provision of SUD preventive care and SUD-related policy implementation. Local health department involvement in SUD-related policy during the past 2 years and provision of preventive care for behavioral health in the past year significantly reduced the probability of having a SUD-related ED visit by 11% and 6%, respectively, after controlling for individual characteristics (odds ratio [OR] = 0.89, p < .001; OR = 0.93, p < .001). After adjusting for the individual and contextual factors, LHD involvement in policy was still associated with 14% reduction in SUD-related ED visits (OR = 0.86, p < .001). Results offer insights on the extent to which the LHD activities can possibly affect SUD-related ED visits and provide a foundation for future work to identify effective LHD interventions. 

Background Prior research has documented a strong association between cigarette and marijuana use among young adults; it is critical to study patterns and risk factors for co-use. Methods Appended, cross-sectional National Health and Nutrition  Examination Survey (NHANES) data were used to assess prevalence and correlates of cigarette and marijuana co-use among young adults (ages 21–30) over a 10-year period (2005–2014). Respondents (unweighted sample = 4,948) were classified into four categories regarding past-month behavior: neither use, cigarette-only use, marijuana-only use, and co-use of both. Regression models were computed to predict these categories using three waves of NHANES (unweighted sample = 3,073). Results Prevalence of past-month cigarette use decreased from 30.9% in 2005–2006 to 23.7% in 2013–2014 (p = 0.024) while past-month marijuana use (average 18.0%) and past-month co-use (average 9.8%) remained stable during this time. Co-use differed significantly by gender (p < 0.001; average 12.9% men, 6.8% women). Co-users were less likely to be married, more likely to endorse non-Hispanic black racial identity, more likely to have engaged in non-marijuana drug use in their lifetime and more likely to drink alcohol monthly than cigarette-only users. Co-users were more likely to have depressive symptoms, ever use non-marijuana drugs, live with a smoker, and initiate marijuana at a younger age than marijuana-only users. Conclusions Co-use of cigarettes and marijuana remained stable but high over a ten-year period; understanding the unique characteristics, living situations, experiences, and substance use behaviors of co-users can contribute to more effective, tailored prevention and education strategies to reduce the burden of comorbid cigarette and marijuana use.

This study aims to examine the (a) probability of transition between stages of alcohol involvement and (b) influence of tobacco use and nicotine dependence on transitions. Data came from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Latent transition analysis estimated the probability of transitioning between stages of alcohol involvement across waves and the impact of tobacco use and nicotine dependence at Wave 1 on transitions. Males reporting current tobacco use but no dependence at Wave 1 were more likely to progress from No Problems to Moderate Problems (adjusted odds ratio [aOR] = 1.79; 95% confidence interval [CI] [1.44, 2.22]) and from No Problems to Severe Problems (aOR = 2.44; 95% CI [1.25, 4.77]) than nontobacco users. Females reporting current tobacco use but no dependence were more likely to progress from No Problems to Moderate Problems (aOR = 2.00; 95% CI [1.37, 2.94]) and from No Problems to Severe Problems (aOR = 2.87; 95% CI [1.34, 6.13]). Females reporting current tobacco use and dependence were more likely than females not using tobacco to transition from Moderate to No Problems (aOR = 2.10; 95% CI [1.04, 4.22]). Results suggest that tobacco use is a preceding correlate of progression in alcohol involvement among males and females. Among females, tobacco use and nicotine dependence are also related to alcohol involvement recovery.

Importance: Nearly 34 million adults – 17 percent of all American adults – have co-occurring mental and physical health conditions. However, the extent to which increased health insurance coverage has facilitated access to needed health care services among this population remains unclear. Objective: Prior research suggests that people with serious psychological distress (SPD) and cancer, heart disease, diabetes, asthma, or hypertension report worse access to care than people with the same physical conditions but no SPD. While the recent expansion in health insurance coverage was expected to improve access to care for people with SPD, access barriers that people with SPD report remain underexplored. Setting: Using the cross-sectional data from the National Health Interview Survey 2011-2015, we examined self-reported health care access barriers among adults (between ages 18 to 64) with SPD and co-occurring physical health conditions. Results: Our sample included 45,294 individuals with chronic conditions (heart disease, high blood pressure, diabetes, cancer, or asthma). Among them, 3,639 also had SPD. After controlling for demographic and socioeconomic factors, results of multivariate logistic regressions showed that individuals with co-occurring SPD and a physical health condition were significantly more likely to report that they had worse health insurance coverage compared to the prior year (OR=1.32, p<0.01), that doctor's office informed that they were not accepting new patients (OR=2.09, p<0.001), that the doctor's office stated they did not accept the particular health insurance they have (OR=1.98, p<0.001), that they couldn't get an appointment soon enough (OR=2.42, p<0.001), they had no transportation to get to the doctor (OR=3.23, p<0.001), and that overall they had trouble finding a doctor/provider (OR=2.12, p<0.001). Conclusions: Our results suggest that despite an increase in health insurance coverage between 2011 and 2015, barriers to access remain a significant concern for individuals with co-occurring SPD and physical health conditions.

Objectives: We examined the use of data from social media for surveillance of physical activity prevalence in the USA. Methods: We obtained data from the social media site Twitter from April 2015 to March 2016. The data consisted of 1382 284 geotagged physical activity tweets from 481146 users (55.7% men and 44.3% women) in more than 2900 counties. We applied machine learning and statistical modelling to demonstrate sex and regional variations in preferred exercises, and assessed the association between reports of physical activity on Twitter and population-level inactivity prevalence from the US Centers for Disease Control and Prevention. Results: The association between physical inactivity tweet patterns and physical activity prevalence varied by sex and region. Walking was the most popular physical activity for both men and women across all regions (15.94% (95% CI 15.85% to 16.02%) and 18.74% (95% CI 18.64% to 18.88%) of tweets, respectively). Men and women mentioned performing gym-based activities at approximately the same rates (4.68% (95% CI 4.63% to 4.72%) and 4.13% (95% CI 4.08% to 4.18%) of tweets, respectively). CrossFit was most popular among men (14.91% (95% CI 14.52% to 15.31%)) among gym-based tweets, whereas yoga was most popular among women (26.66% (95% CI 26.03% to 27.19%)). Men mentioned engaging in higher intensity activities than women. Overall, counties with higher physical activity tweets also had lower leisure-time physical inactivity prevalence for both sexes. Conclusions: The regional-specific and sex-specific activity patterns captured on Twitter may allow public health officials to identify changes in health behaviours at small geographical scales and to design interventions best suited for specific populations.

This paper examines whether Medicaid adult vision coverage affects labor market activity using state-by-year changes to these benefits.We find that vision benefits increase hours worked and occupational skill requirements, but no consistent evidence of changes on the extensive employment margin. Intensive margin effects could be facilitated by decreased barriers to transportation - when a state covers vision services, beneficiaries are more likely to commute to work by car or motorcycle rather than other modes. Our study suggests that, conditional on eligibility, Medicaid can have a positive effect on labor market activity by expanding access to services that enable work. JEL codes:I13, I18, J22, H75. Link to online-before-print version

This article examines the role of Black American nurses during the 1918–1919 influenza pandemic and the aftermath of World War I. The pandemic caused at least 50 million deaths worldwide and 675 000 in the United States. It occurred during a period of pervasive segregation and racial violence, in which Black Americans were routinely denied access to health, educational, and political institutions. We discuss how an unsuccessful campaign by Black leaders for admission of Black nurses to the Red Cross, the Army Nurse Corps, and the Navy Nurse Corps during World War I eventually created opportunities for 18 Black nurses to serve in the army during the pandemic and the war’s aftermath. Analyzing archival sources, news reports, and published materials, we examine these events in the context of nursing and early civil rights history. This analysis demonstrates that the pandemic incrementally advanced civil rights in the Army Nurse Corps and Red Cross, while providing ephemeral opportunities for Black nurses overall. This case study reframes the response to epidemics and other public health emergencies as potential opportunities to advance health equity. In 1918, Aileen Cole and Clara Rollins ached to become Red Cross war nurses. 1  Cole, aged 24 years, had recently passed her registration exams, and Rollins, 34, had years of nursing experience. 2  The two boarded with other nurses in a Washington, DC, brick row house near Freedmen’s Hospital, where they had all graduated from the rigorous nurse training school. The Red Cross had enrolled Cole and Rollins on paper, but had done nothing else: the US Army and Navy, for which the Red Cross served as the official recruiter, did not accept Black nurses. 3 In October, the influenza pandemic brought change. The Red Cross called up Cole, Rollins, and several other Black nurses for civilian duty, and sent them to West Virginia to battle pandemic influenza. 4  This 1918–1919 pandemic was responsible for at least 50 million deaths worldwide and 675 000 in the United States. 5  It also created opportunities for previously excluded Black nurses, including the first 18 to serve in the Army Nurse Corps (ANC) between December 1918 and August 1919. 6 Although Black nurses’ roles in World War I and the pandemic have been noted by numerous historians, this article represents the first effort to move these nurses from periphery to center, and to critically analyze their struggle to serve as a seminal episode in the long and ongoing movement for civil rights and racial health equity. 7  Using archival materials, news reports, census records, and published literature, we highlight how Black nurses fulfilled a critical need for skilled care during the pandemic and the war’s aftermath, but received little recognition. We also show how nurses and Black community leaders viewed this service as a political act. We present this story as a historical case study of nursing and racism in a public health emergency, while raising transhistorical questions: Do public health emergencies spur advancements in health equity? Or do they merely allow exploitation of already-marginalized persons? Although a single case study cannot offer definitive answers, it can provide valuable insights.

Background Few studies have investigated the consequences of caregiving on the objectively measured physiological health outcomes in China. This study used population-based longitudinal data to examine the association between parental caregiving and blood pressure among Chinese women. Method This is a retrospective analysis of 2586 women using five waves of data from the Ever-Married Women Survey component of the China Health and Nutrition Survey (2000, 2004, 2006, 2009, and 2011). We applied growth curve models to examine trajectories of systolic blood pressure (SBP) and diastolic blood pressure (DBP) associated with parental caregiving among women in China. Results In multivariable analyses of blood pressure trajectories adjusting for potential confounders, parental caregivers had higher systolic (β-coefficient (β) = 1.16; p ≤ 0.01) and diastolic blood pressure (β = 0.75; p ≤ 0.01) compared with non-caregivers across multiple waves. Caregivers and non-caregivers had similar levels of systolic blood pressure at baseline, but caregivers exhibited relatively higher growth rate over time. Diastolic blood pressure was much higher among caregivers at the baseline measure, and across time relative to non-caregivers. Moreover, low-intensity but not high-intensity caregivers showed higher growth rate compared with non-caregivers for both SBP and DBP. Discussion Our results demonstrate the negative cardiovascular consequences of parental caregiving among Chinese women. Findings from the study can be used to develop future stress management interventions to decrease hypertension risk within women who provide care to their parents.

Introduction Accountable care organizations have been successful in improving quality of care, but little is known about who is benefiting from accountable care organizations and through what mechanism. This study examined variation of potentially preventable hospitalizations for chronic conditions with coexisting depression in adults by hospital accountable care organization affiliation and care coordination strategies by race/ethnicity. Methods Data  files of 11 states from 2015 State Inpatient Databases were used to identify potentially preventable hospitalizations for chronic conditions with coexisting depression by race/ethnicity; the 2015 American Hospital Association's Annual Survey was used to identify hospital accountable care organization affiliation; and American Hospital Association's Survey of Care Systems and Payment (collected from January to August 2016) was used to identify hospital Accountable care organizations affiliation and hospital-based care coordination strategies, such as telephonic outreach, and chronic care management. In 2019, multiple logistic regressions was used to test the probability of potentially preventable hospitalization by accountable care organization affiliation and race/ethnicity. The test was repeated on a subsample analysis of accountable care organization–affiliated hospitals by care coordination strategy. Results Preventable hospitalizations were significantly lower among accountable care organization–affiliated hospitals than accountable care organization–unaffiliated hospitals. Lower preventable hospitalization rates were observed among white, African American, Native American, and Hispanic patients. Effective care coordination strategies varied by patients’ race. Results also showed variation of the adoption of specific care coordination strategies among accountable care organization–affiliated hospitals. Analysis further indicated effective care coordination strategies varied by patients’ race. Conclusions Accountable care organizations and specifically designed care coordination strategies can potentially improve preventable hospitalization rates and racial disparities among patients with depression. Findings support the integration of mental and physical health services and provide insights for Centers for Medicare and Medicaid Services risk adjustment efforts across race/ethnicity and socioeconomic status.

Background: While alcohol consumption is pervasive in the country of Georgia, the extent of alcohol consumption among pregnant women is yet to be examined. The goal of this study is to examine prevalence and correlates of alcohol consumption during pregnancy in Georgia. Methods: Using data from the World Health Organization’s Stepwise approach to noncommunicable disease risk factor surveillance in Georgia, this study examined prevalence and sociodemographic correlates of alcohol use among pregnant women in Georgia. The study sample of reproductive age (18-45) women was drawn from the STEPS, which is a large and nationally representative survey of adults with a 95% participation rate. Frequencies, multivariate analyses and related statistics were computed to describe and study associations among the target population and the odds of alcohol consumption during pregnancy. Results: Only 66 individuals in the sample were pregnant. About 13% of pregnant women consumed alcohol in the past 30 days and nearly 70% of them engaged in binge drinking on at least one occasion. Pregnant women who were young, married, homemakers, living in two-member households and in the lowest bracket of monthly income had the highest likelihood of consuming alcohol and binge drinking. The study results were statistically significant (p< .05). Conclusions: This study reveals the magnitude of alcohol consumption and binge drinking among reproductive age women in Georgia. This study also shows prevalence and correlates of alcohol consumption during pregnancy in Georgia. The results identify characteristics of women who are most likely to use alcohol during pregnancy. Given that, alcohol use is a modifiable behavioral risk factor, the findings in this study provide the foundation for evidence-based prevention strategies that target pregnant and reproductive age women.