Racial resentment and support for decriminalization of drug possession in the United States.

Drug criminalization creates significant barriers to prevention and treatment of substance use disorders and racial equity objectives, and removal of criminal penalties for drug possession is increasingly being endorsed by health and justice advocates. We present empirical data estimating the share of U.S. adults who support eliminating criminal penalties for possession of all illicit drugs, and examine factors associated with public support. Data from the Johns Hopkins COVID-19 Civic Life and Public Health Survey, a probability-based nationally representative sample of 1222 U.S. adults, was collected from November 11-30, 2020. Support for decriminalizing drug possession was assessed overall and by sociodemographic factors and attitudes towards politics and race. Correlates of support were examined using multivariable logistic regression. Thirty-five percent of adults supported eliminating criminal penalties for drug possession in the U.S. In adjusted regression models, respondents who were younger or identified as politically liberal were more likely to support decriminalization relative to other groups, and respondents who were Hispanic or identified strongly with their religious beliefs were less likely to support decriminalization. Among white respondents, greater racial resentment was strongly associated with reduced support for drug decriminalization. Support for drug decriminalization varies considerably by beliefs about politics and race, with racial resentment among white Americans potentially comprising a barrier to drug policy reform. Findings can inform communication and advocacy efforts to promote drug policy reform in the United States.

Public Support for Social Safety-Net Policies for COVID-19 in the United States, April 2020.

Objectives. To examine public support for health insurance, income support, and unemployment policies during the initial phase of disease transmission and economic distress following the coronavirus disease 2019 (COVID-19) outbreak and to assess varying public support based on beliefs about the role of government.Methods. We fielded a nationally representative survey of US adults (n = 1468) from April 7, 2020, to April 13, 2020.Results. Of US adults, 77% supported paid sick leave, and a majority also supported universal health insurance, an increased minimum wage, and various unemployment support policies. Public support for an active government role in society to improve citizens' lives increased by 10 percentage points during this initial pandemic response relative to September 2019. Belief in a strong governmental role in society was associated with greater support for social safety-net policies.Conclusions. During the initial phase of the COVID-19 pandemic in early April 2020, most US adults favored a range of safety-net policies to ameliorate its negative health and economic consequences. For most safety-net policies, public support was highest among those favoring a stronger governmental role in society.

Evaluating the Revised National Institutes of Health Clinical Trial Definition Impact on Recruitment Progress.

Background: The National Institutes of Health (NIH) announced a revised, expanded definition of "clinical trial" in 2014 to improve trial identification and administrative compliance. Some stakeholders voiced concerns that the policy added administrative burden potentially slowing research progress. Methods: This quasi-experimental study examined the difference-in-differences impact of the new NIH clinical trial definition policy on participant recruitment progress in grants funded by the National Institute of Mental Health (NIMH). Results: 132 funded clinical trial grants were identified. While more grants were identified as clinical trials under the revised definition, the difference-in-differences in recruitment progress before and after the policy change was not statistically significant. Conclusions: The revised NIH clinical trial definition had no clear effect on recruitment progress in newly-identified NIMH-funded clinical trials as compared to traditionally-identified clinical trials. Concerns that administrative delays and burden could impact study progress may be alleviated by these initial results.

Regional and racial disparities in asthma hospitalizations in Mississippi.

BACKGROUND: In the United States, asthma hospitalization rates are disproportionately high among blacks compared with other racial/ethnic groups and vary by geographic region. These disparities among asthma hospitalizations might be affected by social, environmental, and health-care access factors. OBJECTIVE: To determine demographic risk factors for asthma hospitalizations in urban versus rural areas of Mississippi. METHODS: A cross-sectional study using data from the Mississippi Asthma Surveillance System was conducted to compare asthma hospitalizations in the urban Jackson metropolitan statistical area and rural Delta regions of Mississippi from 2003 to 2005. Factors including race, sex, age, and household income that might be associated with multiple hospitalizations for asthma (3 or more during the study period) were assessed using logistic regression. RESULTS: Asthma hospitalization rates were significantly higher among all demographic groups in the rural Delta region compared with the urban Jackson Metropolitan Statistical Area (P < .001). In both regions, hospitalization rates were higher among blacks and females (P < .001). Asthma hospitalization rates were highest among children (0-17 years) and older adults (>or=65 years). In both regions, blacks were more likely to have 3 or more asthma hospitalizations (P < .001). Residents of the Delta had higher odds for multiple hospitalizations controlling for race, sex, age, and household income (P < .05). CONCLUSION: Blacks with asthma are more likely to have multiple asthma hospitalizations in Mississippi. Higher odds of multiple asthma discharges for Delta residents were not explained by race, sex, age, or income, indicating that other contributing factors (eg, environmental, social, and access to care factors) need further investigation.

Potential benefits and burdens of National Institutes of Health and National Institute of Mental Health clinical trial policies.

The National Institutes of Health (NIH) and the National Institute of Mental Health (NIMH) have implemented numerous clinical trial policies in recent years. These policies have well-intended goals but concerns of undue burden have been raised by professional societies. This study identified the new and revised NIH and NIMH clinical trial policies from 2005 to 2019 and summarized the publicly-identified potential benefits and burdens of those policies. Five new/revised NIH-wide and four NIMH-only clinical trial policies were identified. Potential benefits were improved identification, review, conduct, and reporting of publicly-funded clinical trials. Potential burdens were loss of researcher time, potential loss of future research funding opportunities for basic behavioral researchers, and researcher confusion resulting from perceived definition overlap between clinical trials and basic science. Future clinical trial policy development may benefit from early engagement of researchers as stakeholders. Policymakers may benefit from publicly incorporating benefit/burden analyses and outcome evaluations into future policy development.

National Institute of Mental Health Recruitment Monitoring Policy and Clinical Trial Impact.

BACKGROUND/AIMS: The National Institutes of Health (NIH) implemented a recruitment milestone and progress reporting policy in fiscal year 2019. While too recent to evaluate, the National Institute of Mental Health (NIMH) previously implemented a similar policy in fiscal year 2006 which may forecast likely effects of the NIH-wide policy. METHODS: An observational, single-group, pre/post evaluation of the association between the NIMH policy and the Relative Citation Ratio was conducted for non-fellowship, competing clinical trial grants funded from fiscal years 2004-2007. RESULTS: 124 clinical trial grants were identified. After adjusting for covariates, the clinical trial grants subject to the NIMH recruitment monitoring policy were associated with a statistically significant mean-per-grant citation ratio (citations relative to the field norm) 1.98 times that of the clinical trial grants that were not subject to the policy (p = 0.005; 95% CI: [1.23, 3.20]). The clinical trial grants subject to the policy were also associated with a non-statistically significant 1.58 times maximum-per-grant citation ratio compared to the clinical trial grants not covered by the policy (p = 0.24; 95% CI: [0.73, 3.44]). CONCLUSIONS: The NIMH recruitment monitoring and reporting policy was associated with a statistically significant increase in the mean-per-grant Relative Citation Ratio. NIMH-specific results suggest that the NIH-wide policy might also be positively associated with improved Relative Citation Ratio.

Studying how state health services delivery policies can mitigate the effects of disasters on drug addiction treatment and overdose: Protocol for a mixed-methods study.

BACKGROUND: The United States is experiencing a drug addiction and overdose crisis, made worse by the COVID-19 pandemic. Relative to other types of health services, addiction treatment and overdose prevention services are particularly vulnerable to disaster-related disruptions for multiple reasons including fragmentation from the general medical system and stigma, which may lead decisionmakers and providers to de-prioritize these services during disasters. In response to the COVID-19 pandemic, U.S. states implemented multiple policies designed to mitigate disruptions to addiction treatment and overdose prevention services, for example policies expanding access to addiction treatment delivered via telehealth and policies designed to support continuity of naloxone distribution programs. There is limited evidence on the effects of these policies on addiction treatment and overdose. This evidence is needed to inform state policy design in future disasters, as well as to inform decisions regarding whether to sustain these policies post-pandemic. METHODS: The overall study uses a concurrent-embedded design. Aims 1-2 use difference-in-differences analyses of large-scale observational databases to examine how state policies designed to mitigate the effects of the COVID-19 pandemic on health services delivery influenced addiction treatment delivery and overdose during the pandemic. Aim 3 uses a qualitative embedded multiple case study approach, in which we characterize local implementation of the state policies of interest; most public health disaster policies are enacted at the state level but implemented at the local level by healthcare systems and local public health authorities. DISCUSSION: Triangulation of results across methods will yield robust understanding of whether and how state disaster-response policies influenced drug addiction treatment and overdose during the COVID-19 pandemic. Results will inform policy enactment and implementation in future public health disasters. Results will also inform decisions about whether to sustain COVID-19 pandemic-related changes to policies governing delivery addiction and overdose prevention services long-term.

Adapting the Comprehensive Unit Safety Program (CUSP) implementation strategy to increase delivery of evidence-based cardiovascular risk factor care in community mental health organizations: protocol for a pilot study.

BACKGROUND: People with serious mental illnesses (SMI) such as schizophrenia and bipolar disorder experience excess mortality driven in large part by high rates of poorly controlled and under-treated cardiovascular risk factors. In the USA, integrated "behavioral health home" models in which specialty mental health organizations coordinate and manage physical health care for people with SMI are designed to improve guideline-concordant cardiovascular care for this group. Such models have been shown to improve cardiovascular care for clients with SMI in randomized clinical trials, but real-world implementation has fallen short. Key implementation barriers include lack of alignment of specialty mental health program culture and physical health care coordination and management for clients with SMI and lack of structured protocols for conducting effective physical health care coordination and management in the specialty mental health program context. This protocol describes a pilot study of an implementation intervention designed to overcome these barriers. METHODS: This pilot study uses a single-group, pre/post-study design to examine the effects of an adapted Comprehensive Unit Safety Program (CUSP) implementation strategy designed to support behavioral health home programs in conducting effective cardiovascular care coordination and management for clients with SMI. The CUSP strategy, which was originally designed to improve inpatient safety, includes provider training, expert facilitation, and implementation of a five-step quality improvement process. We will examine the acceptability, appropriateness, and feasibility of the implementation strategy and how this strategy influences mental health organization culture; specialty mental health providers' self-efficacy to conduct evidence-based cardiovascular care coordination and management; and receipt of guideline-concordant care for hypertension, dyslipidemia, and diabetes mellitus among people with SMI. DISCUSSION: While we apply CUSP to the implementation of evidence-based hypertension, dyslipidemia, and diabetes care, this implementation strategy could be used in the future to support the delivery of other types of evidence-based care, such as smoking cessation treatment, in behavioral health home programs. CUSP is designed to be fully integrated into organizations, sustained indefinitely, and used to continually improve evidence-based practice delivery. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04696653 . Registered on January 6, 2021.

Potentially preventable medical hospitalizations among Maryland residents with mental illness, 2005-2010.

OBJECTIVE: The goal of this study was to assess the association between mental illness and potentially preventable ambulatory care-sensitive (ACS) hospitalizations among children, adults, and older adults. METHODS: This was a retrospective, cross-sectional study that used 2005-2010 Maryland hospital discharge data (N=508,142 hospitalizations). Logistic regression was used to assess the associations between mental illness and ACS hospitalizations. RESULTS: Any mental illness diagnosis was associated with heightened odds of ACS hospitalization in all three age groups. Any mental illness diagnosis was associated with 84% higher odds of ACS hospitalization among children, 32% higher odds of ACS hospitalization among adults, and 30% higher odds of ACS hospitalization among older adults. CONCLUSIONS: Mental illness was associated with increased odds of ACS hospitalization across the life span. Future research should examine the potential for integrated medical and behavioral health care models to address the poorly controlled somatic conditions that lead to ACS hospitalizations among persons with mental illness.

Gun policy and serious mental illness: priorities for future research and policy.

OBJECTIVE: In response to recent mass shootings, policy makers have proposed multiple policies to prevent persons with serious mental illness from having guns. The political debate about these proposals is often uninformed by research. To address this gap, this review article summarizes the research related to gun restriction policies that focus on serious mental illness. METHODS: Gun restriction policies were identified by researching the THOMAS legislative database, state legislative databases, prior review articles, and the news media. PubMed, PsycINFO, and Web of Science databases were searched for publications between 1970 and 2013 that addressed the relationship between serious mental illness and violence, the effectiveness of gun policies focused on serious mental illness, the potential for such policies to exacerbate negative public attitudes, and the potential for gun restriction policies to deter mental health treatment seeking. RESULTS: Limited research suggests that federal law restricting gun possession by persons with serious mental illness may prevent gun violence from this population. Promotion of policies to prevent persons with serious mental illness from having guns does not seem to exacerbate negative public attitudes toward this group. Little is known about how restricting gun possession among persons with serious mental illness affects suicide risk or mental health treatment seeking. CONCLUSIONS: Future studies should examine how gun restriction policies for serious mental illness affect suicide, how such policies are implemented by states, how persons with serious mental illness perceive policies that restrict their possession of guns, and how gun restriction policies influence mental health treatment seeking among persons with serious mental illness.

Cancer incidence in a sample of Maryland residents with serious mental illness.

OBJECTIVE: Persons with serious mental illness have an increased mortality rate and a higher burden of many medical conditions compared with persons without serious mental illness. Cancer risk in the population with serious mental illness is uncertain, and its incidence was examined by race, sex, and cancer site in a community-based cohort of adults with schizophrenia or bipolar disorder. METHODS: The authors calculated standardized incidence ratios of total and site-specific cancers in a cohort of 3,317 Maryland Medicaid adult beneficiaries with schizophrenia or bipolar disorder followed from 1994 through 2004 for comparison with the U.S. population. RESULTS: Total cancer incidence for adults with schizophrenia or bipolar disorder was 2.6 times higher in the cohort. Elevated risk was greatest for cancer of the lung. No differences in risk were found for African-American versus white Medicaid beneficiaries with serious mental illness. CONCLUSIONS: These findings suggest that there is a heightened risk of cancer among adults with schizophrenia or bipolar disorder. Clinicians should promote appropriate cancer screening and work to reduce modifiable risk factors, such as smoking, among persons with serious mental illness.