Provider Bias in prescribing opioid analgesics: a study of electronic medical Records at a Hospital Emergency Department.

BACKGROUND: Physicians do not prescribe opioid analgesics for pain treatment equally across groups, and such disparities may pose significant public health concerns. Although research suggests that institutional constraints and cultural stereotypes influence doctors' treatment of pain, prior quantitative evidence is mixed. The objective of this secondary analysis is therefore to clarify which institutional constraints and patient demographics bias provider prescribing of opioid analgesics. METHODS: We used electronic medical record data from an emergency department of a large U.S hospital during years 2008-2014. We ran multi-level logistic regression models to estimate factors associated with providing an opioid prescription during a given visit while controlling for ICD-9 diagnosis codes and between-patient heterogeneity. RESULTS: A total of 180,829 patient visits for 63,513 unique patients were recorded during the period of analysis. Overall, providers were significantly less likely to prescribe opioids to the same individual patient when the visit occurred during higher rates of emergency department crowding, later times of day, earlier in the week, later years in our sample, and when the patient had received fewer previous opioid prescriptions. Across all patients, providers were significantly more likely to prescribe opioids to patients who were middle-aged, white, and married. We found no bias towards women and no interaction effects between race and crowding or between race and sex. CONCLUSIONS: Providers tend to prescribe fewer opioids during constrained diagnostic situations and undertreat pain for patients from high-risk and marginalized demographic groups. Potential harms resulting from previous treatment decisions may accumulate by informing future treatment decisions.

Young Men's Social Network Characteristics and Associations with Sexual Partnership Concurrency in Tanzania.

Social network influence on young people's sexual behavior is understudied in sub-Saharan Africa. Previous research identified networks of mostly young men in Dar es Salaam who socialize in "camps". This study describes network characteristics within camps and their relationship to young men's concurrent sexual partnerships. We conducted surveys with a nearly complete census of ten camp networks (490 men and 160 women). Surveys included name generators to identify camp-based networks. Fifty seven percent of sexually active men (n = 471) reported past year concurrency, measured using the UNAIDS method. In a multivariable model, men's individual concurrency was associated with being a member of a closer knit camp in which concurrency was the normative behavior. Younger men who had older members in their networks were more likely to engage in concurrency. Respondent concurrency was also associated with inequitable personal gender norms. Our findings suggest strategies for leveraging social networks for HIV prevention among young men.

Rural Kids and Wealth.

Wealth ownership is a critical component of economic well-being, and wealth in early adulthood provides important clues about the trajectories along which individuals move throughout their lives. Using data from the National Longitudinal Study of Adolescent Health (Add Health), we find an association between growing up rural and adult wealth that varies across the components of wealth. We also find that growing up rural has unique implications for young adult wealth ownership that differ from growing up in other geographic regions, particularly in urban areas. Our results highlight an important outcome that is conditioned by growing up rural and underscores the importance of context for understanding how families save and accumulate wealth.

Reproducibility in the Social Sciences.

Concern over social scientists' inability to reproduce empirical research has spawned a vast and rapidly growing literature. The size and growth of this literature make it difficult for newly interested academics to come up to speed. Here, we provide a formal text modeling approach to characterize the entirety of the field, which allows us to summarize the breadth of this literature and identify core themes. We construct and analyze text networks built from 1,947 articles to reveal differences across social science disciplines within the body of reproducibility publications and to discuss the diversity of subtopics addressed in the literature. This field-wide view suggests that reproducibility is a heterogeneous problem with multiple sources for errors and strategies for solutions, a finding that is somewhat at odds with calls for largely passive remedies reliant on open science. We propose an alternative rigor and reproducibility model that takes an active approach to rigor prior to publication, which may overcome some of the shortfalls of the postpublication model.

Visualizing COVID Restrictions: Activity Patterns Before, During, and After COVID-19 Lockdowns in Uttar Pradesh, India.

Globally, restrictions implemented to limit the spread of COVID-19 have highlighted deeply rooted social divisions, raising concerns about differential impacts on members of different groups. Inequalities among households of different castes are ubiquitous in certain regions of India. Drawing on a novel data set of 8,564 households in Uttar Pradesh, the authors use radar plots to examine differences between castes in rates of activity for several typical behaviors before, during, and upon lifting strict lockdown restrictions. The visualization reveals that members of all castes experienced comparable reductions in activity rates during lockdown and recovery rates following it. Nonetheless, members of less privileged castes procure water outside the household more often than their more privileged peers, highlighting an avenue of improvement for future public health efforts.

Community Effectiveness of Masks and Vaccines.

Recent controversies about wearing masks and getting vaccinated to slow the spread of coronavirus disease 2019 highlight the potential for individual rights and decision making to create widespread community-level outcomes. There is little work demonstrating the collective spillover effects of pandemic mitigation efforts. The authors contribute by visualizing the proportion of unvaccinated people who would become infected at different combinations of mask wearing and vaccination in a hypothetical community. A common pattern emerges across all assumptions: below some joint threshold of mask and vaccination rates, almost all unvaccinated people will eventually become infected, and beyond that threshold there is a steep drop leading to widespread community-level protection. What differs across settings is the timing and shape of the drop-off after crossing the threshold. The authors conclude that masking and vaccination are sensible and in the best interest of the population.