Changes in Permanent Contraception Procedures Among Young Adults Following the Dobbs Decision.

This cross-sectional study evaluates changes in tubal ligation and vasectomy procedures among younger adults following the Dobbs v Jackson Women's Health Organization decision.

State Minimum Wage Increases As a Potential Policy Lever to Reduce Black-White Disparities in Hypertension.

Introduction: Black adults are disproportionately burdened by hypertension. Income inequality is associated with elevated risk of hypertension. Minimum wage increases have been explored as a potential policy lever to address the disparate impact of hypertension on this population. However, these increases may have no significant impact on health among Black adults due to structural racism and "diminished gain" of health effects from socioeconomic resources. This study assesses the relationship between state minimum wage increases and Black-White disparities in hypertension. Methods: We merged state-level minimum wage data with survey data from the Behavioral Risk Factor Surveillance System (2001-2019). Odd survey years included questions about hypertension. Separate difference-in-difference models estimated the odds of hypertension among Black and White adults in states with and without minimum wage increases. Difference-in-difference-in-difference models estimated the impact of minimum wage increases on hypertension among Black adults relative to White adults. Results: As state wage limits increase, the odds of hypertension significantly decreased among Black adults overall. This relationship is largely driven by the impact of these policies on Black women. However, the Black-White disparity in hypertension worsened as state minimum wage limits increased, and the magnitude of this disparity was larger among women. Conclusion: States having a minimum wage above the federal wage limit are not sufficient to combat structural racism and reduce the disparities in hypertension among Black adults. Rather, future research should explore livable wages as a policy lever to reduce disparities in hypertension among Black adults.

Association of Race With Urine Toxicology Testing Among Pregnant Patients During Labor and Delivery.

This cohort study assesses the association of race with receipt of urine toxicology testing and a positive test result among pregnant patients admitted to the hospital for delivery.

The Impact of Medicaid Expansion on Black-White Disparities in Cardiovascular Disease Mortality.

Cardiovascular disease (CVD) is a leading cause of mortality among U.S. adults, especially low-income and uninsured adults. Non-Hispanic Black adults, who are overrepresented among low-income and uninsured populations, are disproportionately burdened by CVD mortality compared with non-Hispanic White adults. Medicaid expansion is associated with improved insurance coverage and access to care among low-income adults as well as reduced CVD mortality. It is unclear whether Medicaid expansion has reduced the Black-White disparity in CVD mortality. This study estimated a difference-in-differences model to compare changes in county-level CVD mortality ratios between expansion and non-expansion states. Findings indicate that Medicaid expansion is not associated with a statistically significant reduction in Black-White disparities in CVD mortality (ß = -.039; p =.30). In conclusion, Medicaid expansion may be associated with improved health outcomes and access to care overall; however, it is insufficient to overcome other (i.e., social and economic) drivers of racial/ethnic disparities in CVD mortality.

Visual Impairment and Self-Efficacy in Diabetes Management.

PURPOSE: The purpose of this study is to examine the relationship between visual impairment and diabetes management self-efficacy. METHODS: The present study utilized pooled cross-sectional data (2008-2018) from the Medical Expenditure Panel Survey Household Component and Diabetes Care Survey. Binary and generalized ordinal logit regression models were used to compare diabetes management self-efficacy between patients with and without visual impairments. RESULTS: Compared to their non-visually impaired counterparts, visually impaired persons had a lower odds of reporting high diabetes management self-efficacy. Similarly, visually impaired adults with diabetes have a significantly lower odds of being very confident in their ability to manage their conditions compared with adults who reported being not confident, somewhat confident, or confident. Several control factors, including self-behaviors and receipt of diabetes self-management education (DSME), were also associated with diabetes management self-efficacy. CONCLUSIONS: Visually impaired persons experience significant disparities in diabetes management self-efficacy. Given the relationship between self-efficacy and diabetes-related outcomes, it is crucial that DSME be tailored to effectively meet the individual needs of this population. Future research should explore the relationship between DSME and self-care behaviors, self-efficacy, and diabetes-related outcomes in visually impaired persons.

Patient need and provider referrals to diabetes self-management education.

OBJECTIVES: This study measured the likelihood of adult patients with diabetes being referred to diabetes self-management education (DSME) when "in need" according to clinical guidelines and identified which types of clinical need predict a greater likelihood of provider referral to DSME. STUDY DESIGN: This repeated cross-sectional analysis utilized patient electronic health records (EHRs) and a statewide health information exchange database to examine a 7-year panel (2010-2016) of adult patients with diabetes. Our analytic sample included 8782 adult patients with diabetes with a total of 356,631 encounters. METHODS: Fixed-effects linear probability models with clustered robust standard errors estimated the association between patients' need for DSME and likelihood of being referred to the service. Models controlled for patients' health status, prior utilization, encounter setting, comorbidity risk scores, the state's expansion of Medicaid, and the count of accredited DSME program sites in the community. RESULTS: Most patient encounters indicated at least 1 type of need for DSME, but less than 7% of those encounters with a documented need resulted in a provider referral. In regression analysis, clinical indicators of need increased the likelihood that patients would be referred to DSME. Patients exhibiting multiple types of need were most likely to be referred to DSME. CONCLUSIONS: Although findings indicate that patient need for DSME does improve the likelihood of being referred, provider referral rates were significantly lower than anticipated. Future research should explore barriers to clinical guideline adherence and whether clinical decision support in EHR systems can facilitate provider referrals.

Mandated Benefits for Diabetes Education and the Availability of Accredited Programs and Certified Diabetes Educators.

States have the latitude to mandate coverage of diabetes self-management education (DSME) services for privately insured and Medicaid patients. The impact of these mandates on the supply of DSME resources is unknown. This study compared changes in the supply of DSME programs and program sites accredited by the American Association for Diabetes Educators (AADE) and certified diabetes educators (CDE) between states that did and did not mandate benefits for DSME. Using a unique combination of legal and programmatic data sources, the authors employed fixed effects regression models with clustered robust standard errors to compare changes in the supply of AADE-accredited DSME programs, program sites, and CDEs in states that mandated benefits with states that did not. Given the variation in state mandates, models also estimated the impact of "flexible" reimbursement provisions on the supply of resources among adopting states. The supply of DSME resources has increased over time, but results indicate that mandated benefits were not a significant driver of these changes in the supply. The impact of flexible reimbursement provisions varied. Interestingly, provisions of the Affordable Care Act were associated with an increased supply of resources. Results suggest that extending benefits to previously insured patients does not increase the supply of DSME resources, but a rapid increase in patients entering the health system does encourage growth.

Graduation and Academic Placement of Underrepresented Racial/Ethnic Minority Doctoral Recipients in Public Health Disciplines, United States, 2003-2015.

OBJECTIVES: Given public health's emphasis on health disparities in underrepresented racial/ethnic minority communities, having a racially and ethnically diverse faculty is important to ensure adequate public health training. We examined trends in the number of underrepresented racial/ethnic minority (ie, non-Hispanic black, Hispanic, American Indian/Alaska Native, Native Hawaiian, and Pacific Islander) doctoral graduates from public health fields and determined the proportion of persons from underrepresented racial/ethnic minority groups who entered academia. METHODS: We analyzed repeated cross-sectional data from restricted files collected by the National Science Foundation on doctoral graduates from US institutions during 2003-2015. Our dependent variables were the number of all underrepresented racial/ethnic minority public health doctoral recipients and underrepresented racial/ethnic minority graduates who had accepted academic positions. Using logistic regression models and adjusted odds ratios (aORs), we examined correlates of these variables over time, controlling for all independent variables (eg, gender, age, relationship status, number of dependents). RESULTS: The percentage of underrepresented racial/ethnic minority doctoral graduates increased from 15.4% (91 of 592) in 2003 to 23.4% (296 of 1264) in 2015, with the largest increase occurring among black graduates (from 6.6% in 2003 to 14.1% in 2015). Black graduates (310 of 1241, 25.0%) were significantly less likely than white graduates (2258 of 5913, 38.2%) and, frequently, less likely than graduates from other underrepresented racial/ethnic minority groups to indicate having accepted an academic position (all P < .001). CONCLUSIONS: Stakeholders should consider targeted programs to increase the number of racial/ethnic minority faculty members in academic public health fields.

Employment Trends Among Public Health Doctoral Recipients, 2003-2015.

OBJECTIVES: To examine postgraduation employment trends among graduates of doctoral programs in public health from 2003 to 2015. METHODS: We analyzed pooled cross-sectional data from a census of graduates receiving a research doctorate from US accredited institutions. The outcome of interest was employment status. Covariates included public health discipline, sociodemographic characteristics, and institutional attributes. RESULTS: Of 11 771 graduates, nearly two thirds secured employment in either academic (34.8%) or nonacademic (31.4%) settings at the time of graduation. The proportion of those still seeking employment increased over time. Individuals who were White, younger, trained in either biostatistics or epidemiology, or from an institution with the highest level of research intensity were significantly more likely to secure employment. Academic employment was the most common setting for all 5 public health disciplines, but we observed differences in employment patterns (e.g., government, nonprofit, for-profit) across disciplines. CONCLUSIONS: Certain characteristics among public health doctoral recipients are correlated with postgraduation employment. More research is needed, but the observed increase in individuals still seeking employment may be attributable to increases in general public health graduates from for-profit institutions.

Pain clinic definitions in the medical literature and U.S. state laws: an integrative systematic review and comparison.

BACKGROUND: In response to widespread opioid misuse, ten U.S. states have implemented regulations for facilities that primarily manage and treat chronic pain, called "pain clinics." Whether a clinic falls into a state's pain clinic definition determines the extent to which it is subject to oversight. It is unclear whether state pain clinic definitions model those found in the medical literature, and potential differences lead to discrepancies between scientific and professionally guided advice found in the medical literature and actual pain clinic practice. Identifying discrepancies could assist states to design laws that are more compatible with best practices suggested in the medical literature. METHODS: We conducted an integrative systematic review to create a taxonomy of pain clinic definitions using academic medical literature. We then identified existing U.S. state pain clinic statutes and regulations and compared the developed taxonomy using a content analysis approach to understand the extent to which medical literature definitions are reflected in state policy. RESULTS: In the medical literature, we identified eight categories of pain clinic definitions: 1) patient case mix; 2) single-modality treatment; 3) multidisciplinary treatment; 4) interdisciplinary treatment; 5) provider supervision; 6) provider composition; 7) marketing; and 8) outcome. We identified ten states with pain clinic laws. State laws primarily include the following definitional categories: patient case mix; single-modality treatment, and marketing. Some definitional categories commonly found in the medical literature, such as multidisciplinary treatment and interdisciplinary treatment, rarely appear in state law definitions. CONCLUSIONS: This is the first study to our knowledge to develop a taxonomy of pain clinic definitions and to identify differences between pain clinic definitions in U.S. state law and medical literature. Future work should explore the impact of different legal pain clinic definitions on provider decision-making and state-level health outcomes.

Interdisciplinary Dissertation Research Among Public Health Doctoral Trainees, 2003-2015.

OBJECTIVES: Given the call for more interdisciplinary research in public health, the objectives of this study were to (1) examine the correlates of interdisciplinary dissertation completion and (2) identify secondary fields most common among interdisciplinary public health graduates. METHODS: We analyzed pooled cross-sectional data from 11 120 doctoral graduates in the Survey of Earned Doctorates, 2003-2015. The primary outcome was interdisciplinary dissertation completion. Covariates included primary public health field, sociodemographic characteristics, and institutional attributes. RESULTS: From 2003 to 2015, a total of 4005 of 11 120 (36.0%) doctoral graduates in public health reported interdisciplinary dissertations, with significant increases observed in recent years. Compared with general public health graduates, graduates of environmental health (odds ratio [OR] = 1.74; P < .001) and health services administration (OR = 1.38; P < .001) doctoral programs were significantly more likely to report completing interdisciplinary dissertation work, whereas graduates from biostatistics (OR = 0.51; P < .001) and epidemiology (OR = 0.76; P < .001) were less likely to do so. Completing an interdisciplinary dissertation was associated with being male, a non-US citizen, a graduate of a private institution, and a graduate of an institution with high but not the highest level of research activity. Many secondary dissertation fields reported by interdisciplinary graduates included other public health fields. CONCLUSION: Although interdisciplinary dissertation research among doctoral graduates in public health has increased in recent years, such work is bounded in certain fields of public health and certain types of graduates and institutions. Academic administrators and other stakeholders may use these results to inform greater interdisciplinary activity during doctoral training and to evaluate current and future collaborations across departments or schools.

The Association Between State-Level Health Information Exchange Laws and Hospital Participation in Community Health Information Organizations.

Evidence suggests that health information exchange (HIE) is an effective strategy to improve efficiency and quality of care, as well as reduce costs. A complex patchwork of federal and state legislation has developed over time to encourage HIE activity. Hospitals and health systems have adopted various HIE models to meet the requirements of these statutes and regulations. Given the complexity of HIE laws, it is important to understand how these legal levers influence HIE engagement. We combined data from two unique data sources to examine the association between state-level HIE laws and hospital engagement in community HIEs. Our results identified three legal provisions of state laws (HIE authorization, financial & non-financial incentives, opt-out consent) that increased the likelihood of community HIE engagement. Other provisions decreased the likelihood of engagement. This analysis provides foundational evidence about the utility of HIE laws. More research is needed to determine causal relationships.

Developing a Multiple Caregiver Group for Caregivers of Adolescents With Disruptive Behaviors.

This article describes the development of a 6-week multiple caregiver group intervention for primary caregivers of adolescents diagnosed with Oppositional Defiant Disorder or Conduct Disorder in low-income African American families. The intervention is aimed at increasing the primary caregivers' self-efficacy in managing interactions within the family and especially with child serving educational, mental health, juvenile justice, and child welfare systems. Development of the intervention involved seven iterative activities performed in a collaborative effort between an interdisciplinary academic team, community engagement specialists, members of the targeted population, and clinical partners from a large public mental health system. The intervention development process described in this article can provide guidance for teams that aim to develop new mental health interventions that target specific outcomes in populations with unique needs.