Association Between the Maryland Medicaid Behavioral Health Home Program and Cancer Screening in People With Serious Mental Illness.

OBJECTIVE: This study evaluated the association of the Maryland Medicaid behavioral health home (BHH) integrated care program with cancer screening. METHODS: Using administrative claims data from October 2012 to September 2016, the authors measured cancer screening among 12,176 adults in Maryland's psychiatric rehabilitation program who were eligible for cervical (N=6,811), breast (N=1,658), and colorectal (N=3,430) cancer screening. Marginal structural modeling was used to examine the association between receipt of annual cancer screening and whether participants had ever enrolled in a BHH (enrolled: N=3,298, 27%; not enrolled: N=8,878, 73%). RESULTS: Relative to nonenrollment, BHH enrollment was associated with increased screening for cervical and breast cancer but not for colorectal cancer. Predicted annual rates remained low, even in BHHs. CONCLUSIONS: Despite estimates of improvements in cervical and breast cancer screening after BHH implementation, cancer screening rates remained suboptimal. Broader cancer screening interventions are needed to improve cancer screening for people with mental illness.

Is screening and intervention associated with treatment receipt among individuals with alcohol use disorder? Evidence from a national survey.

BACKGROUND: Most individuals with alcohol use disorder do not receive treatment and little national-level United States (U.S.) data exist on the association between screening and intervention with receipt of treatment. METHODS: The sample includes adults 18 years and older reporting prior year symptoms of alcohol use disorder from 2013 and 2014 National Survey on Drug Use and Health. Survey-weight adjusted prevalence of prior year receipt of ambulatory care, alcohol screening in a medical setting, alcohol intervention in a medical setting and alcohol treatment receipt and setting were calculated. Regression-adjusted odds ratios were calculated for alcohol treatment outcomes of interest. RESULTS: Despite high use of ambulatory care (74.4%, 95%CI: 72.8, 75.6), prevalence of screening (52.5%, 95%CI: 50.5, 54.5), intervention (13.5%, 95%CI: 12.1, 15.0) and treatment (6.8%, 95%CI: 5.8, 7.9) were low. Screening (AOR: 1.7, p < 0.050) and intervention (AOR: 4.7, p < 0.001) were associated with increased odds of treatment. Screening and intervention were associated with increased odds of receiving treatment in medical and specialty behavioral health settings and decreased odds of receiving treatment in only self-help groups. CONCLUSIONS: While prior year receipt of screening and intervention were low overall among adults with alcohol use disorder, receipt of these services was strongly associated with use of alcohol treatment. This likely indicates a missed opportunity to encourage a high-risk population to access treatment services. Receipt of screening and intervention was most strongly associated with treatment in medical and specialty behavioral health settings. Future research should examine this prospectively to assess whether entry into treatment settings may be mediated by screening and intervention in ambulatory care settings or if brief intervention is occurring at the time of treatment.

The emerging public discourse on state legalization of marijuana for recreational use in the US: Analysis of news media coverage, 2010-2014.

OBJECTIVES: US states have begun to legalize marijuana for recreational use. In the absence of clear scientific evidence regarding the likely public health consequences of legalization, it is important to understand how the risks and benefits of this policy are being discussed in the national dialogue. To assess the public discourse on recreational marijuana policy, we assessed the volume and content of US news media coverage of the topic. METHOD: We analyzed the content of a 20% random sample of news stories published/aired in high circulation/viewership print, television, and Internet news sources from 2010 to 2014 (N=610). RESULTS: News media coverage of recreational marijuana policy was heavily concentrated in news outlets from the four states (AK, CO, OR, WA) and DC that legalized marijuana for recreational use during the study period. Overall, 53% of news stories mentioned pro-legalization arguments and 47% mentioned anti-legalization arguments. The most frequent pro-legalization arguments posited that legalization would reduce criminal justice involvement/costs (20% of news stories) and increase tax revenue (19%). Anti-legalization arguments centered on adverse public health consequences, such as detriments to youth health and well-being (22%) and marijuana-impaired driving (6%). Some evidence-informed public health regulatory options, like marketing and packaging restrictions, were mentioned in 5% of news stories or fewer. CONCLUSION: As additional states continue to debate legalization of marijuana for recreational use, it is critical for the public health community to develop communication strategies that accurately convey the rapidly evolving research evidence regarding recreational marijuana policy.