Self-Assembled Matrigel-Free iPSC-Derived Liver Organoids Demonstrate Wide-Ranging Highly Differentiated Liver Functions.

Human induced pluripotent stem cell (iPSC)-derived liver organoids serve as models of organogenesis, disease, drug screening, and regenerative medicine. Prevailing methods for generating organoids rely on Matrigel, whose batch-to-batch variability and xenogeneic source pose challenges to mechanistic research and translation to human clinical therapy. In this report, we demonstrate that self-assembled Matrigel-free iPSC-derived organoids developed in rotating wall vessels (RWVs) exhibit greater hepatocyte-specific functions than organoids formed on Matrigel. We show that RWVs produce highly functional liver organoids in part by eliminating the need for Matrigel, which has adverse effects on hepatic lineage differentiation. RWV liver organoids sustain durable function over long-term culture and express a range of mature functional genes at levels comparable to adult human liver, while retaining some fetal features. Our results indicate that RWVs provide a simple and high-throughput way to generate Matrigel-free liver organoids suitable for research and clinical applications.

Irreversible Electroporation of the Liver Increases the Transplant Engraftment of Hepatocytes.

INTRODUCTION: Irreversible electroporation (IRE) is a tissue ablation technology that kills cells with short electrical pulses that do not induce thermal damage, thereby preserving the extracellular matrix. Preclinical research suggests that IRE may be developed as a tool for regenerative surgery by clearing existing host cells within a solid organ and creating a supportive niche for new cell engraftment. We hypothesized that hepatocytes transplanted by injection into the portal circulation would preferentially engraft within liver parenchyma pretreated with IRE. METHODS: Transgene-positive ß-galactosidase-expressing hepatocytes were isolated from B6.129S7-Gt(ROSA)26Sor/J (ROSA26) mice and transplanted by intrasplenic injection into wild-type littermates that received liver IRE pretreatment or control sham treatment. Engraftment of donor hepatocytes in recipient livers was determined by X-gal staining. RESULTS: Significantly higher numbers of X-gal+ donor hepatocytes engrafted in the livers of IRE-treated mice as compared to sham-treated mice. X-gal+ hepatocytes persisted in IRE-treated recipients for at least 11 d post-transplant and formed clusters. Immunostaining demonstrated the presence of HNF4A/Ki67/ß-galactosidase triple-positive cells within IRE-ablation zones, indicating that transplanted hepatocytes preferentially engrafted in IRE-treated liver parenchyma and proliferated. CONCLUSIONS: IRE pretreatment of the liver increased engraftment of transplanted hepatocytes within the IRE-ablation zone. IRE treatment of the host liver may be developed clinically as a strategy to increase engraftment efficiency of primary hepatocytes and/or hepatocytes derived from stem cells in cell transplant therapies.

Metastatic melanoma to small bowel: metastasectomy is supported in the era of immunotherapy and checkpoint inhibitors.

BACKGROUND: Metastatic melanoma to the small bowel is an aggressive disease often accompanied by obstruction, abdominal pain, and gastrointestinal bleeding. With advancements in melanoma treatment, the role for metastasectomy continues to evolve. Inclusion of novel immunotherapeutic agents, such as checkpoint inhibitors, into standard treatment regimens presents potential survival benefits for patients receiving metastasectomy. CASE PRESENTATION: We report an institutional experience of 15 patients (12 male, 3 female) between 2014-2022 that underwent small bowel metastasectomy for metastatic melanoma and received perioperative systemic treatment. Median age of patients was 64 years (range: 35-83 years). No patients died within 30 days of their surgery, and the median hospital length of stay was 5 days. Median overall survival in these patients was 30.1 months (range: 2-115 months). Five patients died from disease (67 days, 252 days, 426 days, 572 days, 692 days postoperatively), one patient died of non-disease related causes (1312 days postoperatively), six patients are alive with disease, and three remain disease free. CONCLUSIONS: This case series presents an updated perspective of the utility of metastasectomy for small bowel metastasis in the age of novel immunotherapeutic agents as standard systemic treatment. Small bowel metastasectomy for advanced melanoma performed in conjunction with perioperative systemic therapy is safe and appears to promote long-term survival and enhanced quality of life.

Youth experiences with and perspectives on long covid.

BACKGROUND: Research on the long-term effects of COVID-19 infection is ongoing, and the psychological and physical impacts of Long Covid on youth is poorly understood. To assess these impacts, we surveyed youth regarding their experiences with, and perspectives on, the long-term effects of COVID-19. METHODS: We conducted a nationwide text message survey of youth ages 14-24 years in the United States. The survey asked four open ended questions regarding their experiences and perceptions regarding the long-term effects of COVID-19. Qualitative data was analyzed independently by three investigators using thematic analysis. Prevalence of codes were summarized using descriptive statistics. RESULTS: Among 1150 participants, 991 responded to at least one survey question (response rate 86.1%). The vast majority of our sample had COVID-19 or knew someone who did (75%), and approximately one third (32%) of youth indicated that they knew someone who had experienced symptoms consistent with Long Covid. Many youth (50%) reported worry and concern about Long Covid even if they, or someone they knew, did not have Long Covid. Among youth who were not concerned about Long Covid, the most commonly reported reasons were having received the vaccine (29%) and not having a prior COVID-19 infection (24%). CONCLUSIONS: Our findings suggest that among younger populations, there is significant concern regarding the long-term effects of COVID-19. Vaccination campaigns and youth-centered public health communication about Long Covid may not only reduce COVID-19 transmission, but also alleviate worries and concerns about Long Covid among youth.

A Qualitative Assessment of the Experiences with Eye Health and Barriers to Eyeglasses among U.S. Youth.

SIGNIFICANCE: Uncorrected refractive error is the main cause of visual impairment in U.S. youth and has profound impacts on individuals and society. Identifying and addressing barriers to eyeglasses in this population are critical to maximize youth academic performance, workplace productivity, and quality of life. PURPOSE: We aimed to understand youth experiences with eye health, assess the value that youth place on vision, and identify barriers to refractive correction directly from a nationwide sample of youth to inform interventions to address uncorrected refractive error in this population. METHODS: An open-ended poll was distributed to the MyVoice Text Message Cohort of U.S. youth eliciting youth experiences with eye health and barriers to wearing eyeglasses. Text message responses were coded using grounded theory. RESULTS: Of 1204 recipients, 88.3% (n = 1063) responded. The mean age ± standard deviation was 20.3 ± 2.4 years, 58.8% (n = 625) were male, 74.0% (n = 787) were White, and 41.4% (n = 440) reported low socioeconomic status. Four major themes emerged from the open-ended responses: (1) many youth have experienced problems with their eyes or eyesight (n = 699 [65.8%]); (2) many youth value their eyesight highly (n = 905 [85.1%]; e.g., "Eyesight is one of the most important aspects of my health, particularly in our digital world…"); (3) common reasons youth might not wear glasses even if they need them include concerns over appearance (n = 553 [52.0%]; e.g., "I thought every pair made me look ugly…"), cost (n = 171 [16.1%]), inconvenience (n = 166 [15.6%]), and discomfort (n = 104 [9.8%]); and (4) youth are open to purchasing eyeglasses online (n = 539 [50.7%]). CONCLUSIONS: Appearance, cost, inconvenience, and discomfort are critical barriers to wearing eyeglasses among U.S. youth. A multisectoral response is necessary to address these barriers.

Youths' Knowledge and Perceptions of Health Risks Associated With Unprotected Oral Sex.

PURPOSE: Although rates of sexually transmitted infections (STIs) and human papillomavirus (HPV)-related head and neck cancers associated with oral sex are increasing, less than 10% of youths report using protection. This study aims to assess youths' knowledge and perceptions of oral sex risk and barriers to protection use. METHODS: Our study uses MyVoice, a national text message poll of youths aged 14-24 years. Four open-ended probes were fielded to 1,215 youths in March 2019. Qualitative data were analyzed using thematic analysis and quantitative data were summarized with descriptive statistics. RESULTS: Nine hundred and nine youths responded to the survey (relative risk [RR]=74.8%). Youths' responses regarding why protection is frequently not used centered around: lack of education (22.4%), no perceived STI risk (19.8%), decreased pleasure (19.3%), and no pregnancy risk (15.7%). Youths believed that comprehensive education (53.7%), normalization in popular culture and media (19.1%), increased access to protection (15%), and improved protection options (10.5%) would increase protection use during oral sex. CONCLUSION: Youths demonstrated limited knowledge of the risks of oral sex, dissatisfaction with current protection options, and a need for normalization in popular culture. Programs developed with youths in mind may be able to successfully increase protection use and decrease rates of STI transmission and oral sex-related HPV head and neck cancer.VISUAL ABSTRACT.

Skin cancer prevention: knowledge and perceptions of a nationwide sample of youth.

Context: Skin cancer is the most common type of cancer in the United States and incidence continues to rise. The leading risk factor for skin cancer is sun exposure in adolescence. Given this, sun protection in young adults is an effective way to reduce the occurrence of skin cancer. The goal of this study is to identify knowledge, behaviors, and barriers among young adults toward the use of sunscreen. Primary care physicians interact with a large number of young adults and have the ideal opportunity to counsel this population. Objective: To identify youths' knowledge and experiences with sun protection and elicit recommendations to increase protection usage. Study Design: Data was obtained using MyVoice, a national poll of youth (www.hearmyvoicenow.org). Five open-ended questions were sent via text message to 1,151 youth on April 9, 2021. Responses were analyzed by two independent investigators after using a modified grounded theory approach to iteratively develop codes based on salient themes. Setting: Participants are youth from the United States aged 14-24 years old who were recruited from social media to meet national benchmarks based on weighted samples of the American Community Survey. Results: Of 1,151 youth, 977 responded to at least one question (response rate= 84.9%). Respondents' mean age was 19.3 years (SD=2.4), 48.1% identified as male, and 62.2% as non-Hispanic white. Nearly all respondents stated "It is very important" or "It's important!" (62.1%, 25.5% respectively) to protect your skin from the sun. The most frequently reported reason for using sun protection was to "reduce the risk of getting skin cancer" (51.7%). Nearly all (90.1%) youth reported use of sunscreen, but 81.1% of respondents have had at least one sunburn and 28.4% have had 5 or more "Many [sunburns], and yes some have blistered". Participants commonly recommended emphasizing the consequences of sun exposure to encourage sun protection use, "Inform people about the dangers of not wearing sun protection" (41.1%). Conclusions: Youth in our nationwide sample understand both the short and long term risks of sun exposure and believe that sun protection is important. Though nearly all reported sunscreen use, youth struggle with implementation of consistent sun protective behaviors with a large number reporting numerous sunburns. These youth reported insights can inform more effective strategies to improve the use of sun protection by youth.

Adolescent and emerging adult perceptions of eating disorder severity and stigma.

OBJECTIVE: Eating disorders are one of the deadliest mental health conditions, yet most individuals with eating disorders never receive treatment. Previous research has explored barriers to treatment among individuals diagnosed with eating disorders, but little is known about general adolescent and emerging adult perceptions of eating disorders, as compared to other mental health illnesses, a population at greatest risk for developing an eating disorder, and a population that may be important sources of information or support for peers. METHOD: A sample of adolescents and emerging adults aged 14-24 years (mean age 19 years) from MyVoice, a national text-message-based cohort (53% female, 38% male, 9% other, race/ethnicity 63% White, 10% Black or African American, 13% Asian, 9% Mixed Race, and 5% Other) provided open-ended responses to questions on the severity of eating disorders as compared to other mental health diagnoses, others' perceptions of eating disorders and potential treatment barriers. Responses were collected using a secure online platform and analyzed using content analysis. RESULTS: Among respondents (n = 792/1283), 91% felt that eating disorders were a mental health condition and 65% felt that eating disorders were as serious as other mental health conditions, while 21% said they were more serious than other mental health conditions. Responses to questions related to perception and barriers illustrated that beliefs of eating disorders involve blame, stigma, and overall lack of understanding. DISCUSSION: Findings from this study illustrate that there is a lack of understanding around eating disorders that could be addressed in youth-focused initiatives. PUBLIC SIGNIFICANCE: Adolescents and emerging adults understand that eating disorders are severe mental illnesses that are not taken seriously by others, especially in comparison with other mental health diagnoses. Adolescents and emerging adults report that individuals with eating disorders are blamed for their condition and face shame and stigma. The lack of understanding around eating disorders should be addressed in youth-focused prevention initiatives.

Multi-Defect Detection in Additively Manufactured Lattice Structures Using 3D Electrical Resistance Tomography.

Cellular lattice structures possess high strength-to-weight ratios suitable for advanced lightweight engineering applications. However, their quality and mechanical performance can degrade because of defects introduced during manufacturing or in-service. Their complexity and small length scale features make defects difficult to detect using conventional nondestructive evaluation methods. Here we propose a current injection-based method, electrical resistance tomography (ERT), that can be used to detect damaged struts in conductive cellular lattice structures with their intrinsic electromechanical properties. The reconstructed conductivity distributions from ERT can reveal the severity and location of damaged struts without having to probe each strut. However, the low central sensitivity of ERT may result in image artifacts and inaccurate localization of damaged struts. To address this issue, this study introduces an absolute, high throughput, conductivity reconstruction algorithm for 3D ERT. The algorithm incorporates a strut-based normalized sensitivity map to compensate for lower interior sensitivity and suppresses reconstruction artifacts. Numerical simulations and experiments on fabricated representative cellular lattice structures were performed to verify the ability of ERT to quantitatively identify single and multiple damaged struts. The improved performance of this method compared with classical ERT was observed, based on greatly decreased imaging and reconstructed value errors.

Perspectives on Telemedicine from a National Study of Youth in the United States.

Introduction: Telemedicine is increasingly popular with the recent surge in use due to the COVID-19 pandemic. Despite youth status as "tech natives," limited data are available on their perspectives on telemedicine. Our study seeks to understand youth telemedicine knowledge, prior experiences, preferences for use, and the impact of COVID-19 on these perspectives. Methods: Participants in MyVoice, a national text message cohort of U.S. youth age 14-24, were sent five open-ended questions in October 2019 and October 2020. A codebook was iteratively developed by using inductive analysis. Responses were independently coded by two investigators, with discrepancies resolved by discussion or a third investigator. Results: Sixty-five percent (836/1,283) and 77% (887/1,129) of participants responded to at least 1 question in 2019 and 2020, respectively. Most youth reported awareness of telemedicine and although many have not used it, COVID-19 has increased use. Further, many are willing to try telemedicine services. Most youth noted a preference for video rather than phone visits, but they believe both to be less effective than in person. Youth also reported varied preferences on services best suited for telemedicine, with COVID-19 positively impacting their views. Discussion: Youth are aware of and willing to use telemedicine services, with many reporting use during the COVID-19 pandemic. Youth are willing to accept a wide variety of telemedicine services, though they still desire in-person options. Health systems and clinics should offer a wide range of services via telemedicine to fit the varying needs of youth both during and after the COVID-19 pandemic.

Focal adhesion kinase (FAK) promotes cholangiocarcinoma development and progression via YAP activation.

BACKGROUND & AIMS: Focal adhesion kinase (FAK) is a non-receptor tyrosine kinase that is upregulated in many tumor types and is a promising target for cancer therapy. Herein, we elucidated the functional role of FAK in intrahepatic cholangiocarcinoma (iCCA) development and progression. METHODS: Expression levels and activation status of FAK were determined in human iCCA samples. The functional contribution of FAK to Akt/YAP murine iCCA initiation and progression was investigated using conditional Fak knockout mice and constitutive Cre or inducible Cre mice, respectively. The oncogenic potential of FAK was further examined via overexpression of FAK in mice. In vitro cell line studies and in vivo drug treatment were applied to address the therapeutic potential of targeting FAK for iCCA treatment. RESULTS: FAK was ubiquitously upregulated and activated in iCCA lesions. Ablation of FAK strongly delayed Akt/YAP-driven mouse iCCA initiation. FAK overexpression synergized with activated AKT to promote iCCA development and accelerated Akt/Jag1-driven cholangiocarcinogenesis. Mechanistically, FAK was required for YAP(Y357) phosphorylation, supporting the role of FAK as a central YAP regulator in iCCA. Significantly, ablation of FAK after Akt/YAP-dependent iCCA formation strongly suppressed tumor progression in mice. Furthermore, a remarkable iCCA growth reduction was achieved when a FAK inhibitor and palbociclib, a CDK4/6 inhibitor, were administered simultaneously in human iCCA cell lines and Akt/YAP mice. CONCLUSIONS: FAK activation contributes to the initiation and progression of iCCA by inducing the YAP proto-oncogene. Targeting FAK, either alone or in combination with anti-CDK4/6 inhibitors, may be an effective strategy for iCCA treatment. LAY SUMMARY: We found that the protein FAK (focal adhesion kinase) is upregulated and activated in human and mouse intrahepatic cholangiocarcinoma samples. FAK promotes intrahepatic cholangiocarcinoma development, whereas deletion of FAK strongly suppresses its initiation and progression. Combined FAK and CDK4/6 inhibitor treatment had a strong anti-cancer effect in in vitro and in vivo models. This combination therapy might represent a valuable and novel treatment against human intrahepatic cholangiocarcinoma.

Perspectives of US Adolescents on Diverted Stimulant Use.

OBJECTIVE: To evaluate perspectives of youth regarding diverted stimulant use among a contemporary sample of adolescents and young adults. STUDY DESIGN: This study used MyVoice, a longitudinal national text message survey of American youth. In February 2019, 1228 MyVoice youth were asked 4 open-ended questions to elicit their perspectives on diverted stimulant use. Responses were assessed using thematic analysis, and quantitative results were summarized using descriptive statistics. RESULTS: Of 1228 youth, 906 responded to at least one survey question (relative risk, 74%). Respondents' ages ranged from 14 to 24 years with a mean age of 18.8 ± 2.9 years, 57% were female, and 66% identified as White. Peer pressure and coping were commonly perceived reasons for diversion, and respondents believed that many youth misuse stimulants. Many were aware of health risks of misuse, but few mentioned potential legal consequences. Youth thought stimulants could be obtained from peers, people with a prescription, dealers, and family, and some mentioned access through unnecessary prescriptions. CONCLUSIONS: The perspectives of a national sample of youth suggest that stimulant diversion continues to be a significant problem among American youth, with many noting that diverted stimulants are easy to obtain and are used to self-treat mental health issues. Standardized interventions at schools and in healthcare settings, as well as universal screening for diversion and mental health conditions, may combat this public health concern.

Defining the "New Normal" in Primary Care.

Health care organizations in the United States have transformed at an unprecedented rate since March 2020 due to COVID-19, most notably with a shift to telemedicine. Despite rapidly adapting health care delivery in light of new safety considerations and a shifting insurance landscape, primary care offices across the country are facing drastic decreases in revenue and potential bankruptcy. To survive, primary care's adaptations will need to go beyond virtual versions of traditional office visits. Primary care is faced with a chance to redefine what it means to care for and support patients wherever they are. This opportunity to shape the "new normal" is a critical step for primary care to meet its full potential to lead a paradigm shift to patient-centered health care reform in America during this time when we need it most.

Perspectives of US Youth During Initial Month of the COVID-19 Pandemic.

PURPOSE: Asymptomatic youth in the United States acting as "silent spreaders" during the coronavirus disease 2019 (COVID-19) pandemic are an ongoing public health concern, particularly given their depiction as unengaged with recommendations. Our goal was to understand the knowledge, beliefs, and experiences of US youth at the onset of the COVID-19 pandemic. METHODS: We posed 2 open-ended surveys to the national MyVoice text message cohort of youth, aged 14-24 years. On March 6, 2020, 4 questions were asked regarding knowledge and experiences during the COVID-19 pandemic with 3 questions repeated on March 20, 2020. Qualitative responses were coded using thematic analysis and summarized with descriptive statistics. RESULTS: Of 1,174 youth, 1,087 responded to at least 1 question (response rate of 88%). The average age of respondents was 19 (SD 2.8) years with 52% female and 56% non-Hispanic White respondents. On March 6, 2020, most (70%) respondents reported knowing about COVID-19 and primarily cited the news (46%) as their source of information. Nearly all (95%) respondents reported impact by March 20, 2020, and respondents expressing worry increased from 25% to 51%. In both surveys, worried youth primarily cited concern for others (26% and 34%). Regarding preparation, respondents primarily reported doing nothing (36%) on March 6, 2020, and practicing social distancing (50%) on March 20, 2020. CONCLUSIONS: Many youths in our sample are engaged with the COVID-19 pandemic and most are feeling knowledgeable, are concerned about its impacts on others, and are practicing social distancing. Sustained public health efforts should focus on maintaining youth engagement with accurate public information and youth-centered messaging promoting prevention measures to protect the health and well-being of youth and their friends and family.

Exploring the beliefs and perceptions of spending time in nature among U.S. youth.

PURPOSE: The prevalence of poor mental health continues to rise among youth; however, large-scale interventions to improve mental and physical health remain a public health challenge. Time spent in nature is associated with improved health among youth. This study aimed to assess youth experiences with nature and the self-perceived impact on their mental and physical health among a nationwide sample of US youth. METHODS: In September 2020, five open-ended questions that aimed to assess perceptions regarding nature were posed to 1174 MyVoice youth, aged 14-24 years. Qualitative responses were analyzed using thematic analysis, and data were summarized using descriptive statistics. RESULTS: The mean (SD) age of the 994 respondents (RR = 84.7%) was 18.9 (2.7) years; 47.4% were female, and 57.4% Non-Hispanic White. Among youth, many felt that spending time in nature positively impacted their mental health, with 51.6% mentioning that it made them "feel calm when I am out in nature"; 22.1% said that it relieved stress or "reduces my anxiety," and 17.1% felt that being in nature positively impacted their physical health and "makes me feel more active and in shape." However, 7.0% said it negatively impacted their health, such as "It makes me feel isolated." Most youth (87.8%) want to spend more time in nature, with 22% mentioning barriers (i.e., busy schedules, built environment, and COVID-19) impeding them from doing so. CONCLUSIONS: Youth in our sample generally report feeling physically and mentally better when spending time in nature and want to spend more time in nature. Public health policies and practices that eliminate barriers and actively support time spent outside may be a feasible and acceptable practice to promote overall well-being among youth.

The future of STI screening and treatment for youth: a National Survey of youth perspectives and intentions.

BACKGROUND: Sexually transmitted infection (STI) rates continue to rise in the U.S., with disproportionately high rates among those aged 15-24 years. Effective programs and policies are necessary to address this growing public health problem. The purpose of this study is to assess the perspectives of a national sample of youth on access to STI care and behaviors regarding STIs. METHODS: MyVoice, a national text message survey of youth, was used to pose four open-ended questions on STI screening and treatment to 1115 youth aged 14-24 in August 2018. A mixed-methods strategy was employed for the study. Qualitative data was analyzed using a modified grounded theory approach. Summary statistics were calculated for demographic data and prevalence of themes. RESULTS: Of the 800 participants who responded to at least one question (72% response rate), mean age was 19 years (SD = 3.1), 55% identified as female, 61% identified as non-Hispanic white, and 33% qualified for free/reduced lunch. A majority felt it would be easy to get screened (69%) or treated (68%) for an STI. Nearly all respondents (95%) stated they would share an STI diagnosis with their sexual partners. CONCLUSIONS: Despite high rates of STIs among youth, most respondents reported that STI screening and treatment is accessible, and they would share an STI diagnosis with their partner.

Youth Perspectives of Prescription Pain Medication in the Opioid Crisis.

OBJECTIVE: To characterize current youth perspectives of prescription pain medication. STUDY DESIGN: In total, 1047 youths aged 14-24 years were recruited by targeted social media advertisements to match national demographic benchmarks. Youths were queried by open-ended text message prompts about exposure and access to prescription pain medication, perceived safety of prescribed and nonprescribed medication, and associations with the word "opioid." Responses were analyzed inductively for emerging themes and frequencies. RESULTS: Among 745 respondents (71.2% response rate), 439 identified as female (59.3%), 561 as white (75.8%), and mean age was 18.3 ± 3.2 years. Previous exposure to prescription pain medication was reported by 377 respondents (52.0%), most commonly related to dentistry (32.8%), surgery (19.2%), and injury (12.0%). Nonmedical sources of access to prescription pain medication were identified by 256 respondents (36.9%) and medical sources other than their doctor by an additional 111 respondents (16.0%). Three additional themes emerged from youth responses: (1) prescribed medication was thought to be safer than nonprescribed medication, based on trust in doctors; (2) risks of addiction and overdose were thought to be greater for nonprescribed medication; (3) respondents had a widely ranging understanding of the word "opioid," from historical to current events, medical to illicit substances, and personal to public associations. CONCLUSIONS: Although youths are aware of the opioid crisis, they perceive less risk of prescription pain medication prescribed by a doctor, than from other sources. Policies should target education to youth in clinical and nonclinical settings, highlighting the risks of addiction and overdose with all opioids.

Engagement with Health Risk Assessments and Commitment to Healthy Behaviors in Michigan's Medicaid Expansion Program.

BACKGROUND: Health risk assessments (HRAs) and healthy behavior incentives are increasingly used by state Medicaid programs to promote enrollees' health. OBJECTIVE: To evaluate enrollee experiences with HRAs and healthy behavior engagement in the Healthy Michigan Plan (HMP), a state Medicaid expansion program. DESIGN: Telephone survey conducted in Michigan January-October 2016. PARTICIPANTS: A random sample of HMP enrollees aged 19-64 with ≥ 12 months of enrollment, stratified by income and geographic region. MAIN MEASURES: Self-reported completion of an HRA, reasons for completing an HRA, commitment to a healthy behavior, and choice of healthy behavior. KEY RESULTS: Among respondents (N = 4090), 49.3% (95% CI 47.3-51.2%) reported completing an HRA; among those with a primary care provider (PCP) (n = 3851), 85.2% (95% CI 83.5-86.7%) reported visiting their PCP during the last 12 months. Most enrollees having a recent PCP visit reported discussing healthy behaviors with them (91.1%, 95% CI 89.6-92.3%) and were more likely to have completed an HRA than enrollees without a recent PCP visit (52.7%, 95% CI 50.5-52.8% vs. 36.2%, 95% CI 31.7-41.1%; p < 0.01). Among enrollees completing an HRA, nearly half said they did it because their PCP suggested it (45.9%, 95% CI 43.2-48.7%), and most reported it helped their PCP understand their health needs (89.7%). Awareness of financial incentives was limited (28.1%, 95% CI 26.3-30.0%), and very few reported it as the primary reason for HRA completion (2.5%, 95% CI 1.8-3.4%). Most committed to a healthy behavior (80.7%, 95% CI 78.5-82.8%), and common behaviors chosen were nutrition/diet (57.2%, 95% CI 54.2-60.2%) and exercise/activity (52.6%, 95% CI 49.5-55.7%). CONCLUSIONS: In the Healthy Michigan Plan, PCPs appeared influential in enrollees' completion of HRAs and healthy behavior engagement, while knowledge of financial incentives was limited. Additional study is needed to understand the relative importance of financial incentives and PCP engagement in impacting healthy behaviors in state Medicaid programs.

Primary Care, Health Promotion, and Disease Prevention with Michigan Medicaid Expansion.

BACKGROUND: Medicaid expansion in Michigan, known as the Healthy Michigan Plan (HMP), emphasizes primary care and preventive services. OBJECTIVE: Evaluate the impact of enrollment in HMP on access to and receipt of care, particularly primary care and preventive services. DESIGN: Telephone survey conducted during January-November 2016 with stratified random sampling by income and geographic region (response rate = 53.7%). Logistic regression analyses accounted for sampling and nonresponse adjustment. PARTICIPANTS: 4090 HMP enrollees aged 19-64 with ≥ 12 months of HMP coverage MAIN MEASURES: Surveys assessed demographic factors, health, access to and use of health care before and after HMP enrollment, health behaviors, receipt of counseling for health risks, and knowledge of preventive services' copayments. Utilization of preventive services was assessed using Medicaid claims. KEY RESULTS: In the 12 months prior to HMP enrollment, 33.0% of enrollees reported not getting health care they needed. Three quarters (73.8%) of enrollees reported having a regular source of care (RSOC) before enrollment; 65.1% of those reported a doctor's office/clinic, while 16.2% reported the emergency room. After HMP enrollment, 92.2% of enrollees reported having a RSOC; 91.7% had a doctor's office/clinic and 1.7% the emergency room. One fifth (20.6%) of enrollees reported that, before HMP enrollment, it had been over 5 years since their last primary care visit. Enrollees who reported a visit with their primary care provider after HMP enrollment (79.3%) were significantly more likely than those who did not report a visit to receive counseling about health behaviors, improved access to cancer screening, new diagnoses of chronic conditions, and nearly all preventive services. Enrollee knowledge that some services have no copayments was also associated with greater utilization of most preventive services. CONCLUSIONS: After enrolling in Michigan's Medicaid expansion program, beneficiaries reported less forgone care and improved access to primary care and preventive services.

Availability of Sexually Transmitted Infection Screening and Expedited Partner Therapy at Federally Qualified Health Centers in Michigan.

Via secret shopper study, we assessed: (1) availability of sexually transmitted infection (STI) screening; (2) provision of expedited partner therapy; and (3) wait times for new patient STI screening appointments at Michigan federally qualified health centers. Of the 147 clinics with STI screening availability, 10.2% (15) confirmed expedited partner therapy provision.