Expanding Access to Care: Scope of Practice Laws.

Allied health professionals play an integral role in providing safe, affordable care to communities in need. Laws that define the permissible scope of practice for these professionals may take full advantage of these providers and may unnecessarily restrict safe and effective care. Nurse practitioners in many states may provide care independent of a physician; research reveals that this care is safe, affordable and accessible. Yet hurdles exist that prevent communities from securing the full benefit of NPs in independent practice. The scope of independent practice for allied dental providers varies greatly across the country, often including stringent supervision requirements. Emerging approaches to allowing allied dental providers to practice independently in certain settings or with dentist supervision via telemedicine and creating the intermediate provider, the dental therapist, may increase access to safe, affordable dental care. Research on the impact of laws that allow broader independent practice by NPs to ferret out the hurdles to full implementation of the spirit of such laws is needed. That research could support expanded independent scope for allied dental providers and other allied health care providers.

Exploring the Case for Eminent Domain of Hepatitis C Virus Treatment Patents.

Hepatitis C virus (HCV) is a silent epidemic affecting millions of patients and represents the leading indication for liver transplantation in the United States and worldwide. New direct-acting antiviral agents offer the potential to cure patients infected with HCV but it comes at a staggering cost. Given the recent attention to these high-priced HCV therapies and the impact treating individuals with HCV is having on drug expenditures in the United States, there may be a need to revisit drug patent laws and the options the federal government has to ensure patient access to care.

Effect of Maryland's 2011 Alcohol Sales Tax Increase on Alcohol-Positive Driving.

INTRODUCTION: The 2011 Maryland alcohol sales tax increase from 6% to 9% provided an opportunity to evaluate the impact on rates of alcohol-positive drivers involved in injury crashes. METHODS: Maryland police crash reports from 2001 to 2013 were analyzed using an interrupted time series design and a multivariable analysis employing generalized estimating equations models with a negative binomial distribution. Data were analyzed in 2014-2015. RESULTS: There was a significant gradual annual reduction of 6% in the population-based rate of all alcohol-positive drivers (p<0.03), and a 12% reduction for drivers aged 15-20 years (p<0.007), and 21-34 years (p<0.001) following the alcohol sales tax increase. There were no significant changes in rates of alcohol-positive drivers aged 35-54 years (rate ratio, 0.98; 95% CI=0.89, 1.09). Drivers aged ≥55 years had a significant immediate 10% increase in the rate of alcohol-positive drivers (rate ratio, 1.10; 95% CI=1.04, 1.16) and a gradual increase of 4.8% per year after the intervention. Models using different denominators and controlling for multiple factors including a proxy for unmeasured factors found similar results overall. CONCLUSIONS: The 2011 Maryland alcohol sales tax increase led to a significant reduction in the rate of all alcohol-positive drivers involved in injury crashes especially among drivers aged 15-34 years. This is the first study to examine the impact of alcohol sales taxes on crashes; previous research focused on excise tax. Increasing alcohol taxes is an important but often neglected intervention to reduce alcohol-impaired driving.

Tobacco policies and on-premise smoking in bars and clubs that cater to young African Americans following the Maryland Clean Indoor Air Act of 2007.

African American young adults ages 18-25 smoke less than their Caucasian peers, yet the burden of tobacco-related illness is significantly higher in African Americans than in Caucasians across the lifespan. Little is known about how clean indoor air laws affect tobacco smoking among African American young adults. We conducted a systematic observation of bars and clubs with events targeted to African American adults 18-25 in Baltimore City at two timepoints (October and November of 2008 and 2010) after enforcement of the Maryland Clean Indoor Air Act (CIAA). Twenty venues-selected on the basis of youth reports of popular venues-were rated during peak hours. All surveillance checklist items were restricted to what was observable in the public domain. There was a significant decrease in observed indoor smoking after CIAA enforcement. Observed outdoor smoking also decreased, but this change was not significant. Facilities for smoking outdoors increased significantly. The statewide smoking ban became effective February 1, 2008, yet measurable changes in smoking behavior in bars were not evident until the City engaged in stringent enforcement of the ban several months later.

Out of view but in plain sight: the illegal sale of single cigarettes.

The practice of selling single cigarettes (loosies) through an informal economy is prevalent in urban, low socioeconomic (low SES) communities. Although US state and federal laws make this practice illegal, it may be occurring more frequently with the recent increase in taxes on cigarettes. This investigation provides information concerning the illegal practice of selling single cigarettes to better understand this behavior and to inform intervention programs and policymakers. A total of 488 African American young adults were recruited and surveyed at two education and employment training programs in Baltimore City from 2005 to 2008. Fifty-one percent of the sample reported smoking cigarettes in the past month; only 3.7% of the sample were former smokers. Approximately 65% of respondents reported seeing single cigarettes sold daily on the street. Multivariate logistic regression modeling found that respondents who reported seeing single cigarettes sold on the street several times a week were more than two times as likely to be current smokers compared to participants who reported that they never or infrequently saw single cigarettes being sold, after controlling for demographics (OR = 2.16; p = 0.034). Tax increases have led to an overall reduction in cigarette smoking. However, smoking rates in urban, low SES communities and among young adults remain high. Attention and resources are needed to address the environmental, normative, and behavioral conditions influencing tobacco use and the disparities it causes. Addressing these factors would help reduce future health care costs and save lives.

Cigarillo use among high-risk urban young adults.

In the U.S., cigar use doubled from 5.0 to 10.6 billion cigars consumed annually between 1997 and 2007, driven in large part by increased sales of cigarette-sized "little cigars" and narrow, mid-sized "cigarillos." The present study examined prevalence of cigarillo use as well as attitudes, knowledge and behaviors related to cigarillo use among a sample of predominantly urban African American young adults 18-24 not in school and not employed. Survey data were collected from 131 young adults attending education and job training centers in Baltimore, Maryland and from 78 young adults attending education, job training, or recreational programs in Washington, D.C. In Baltimore, 22% of young adults had smoked a cigarillo in the past 30 days, compared with nearly 63% in D.C. Both populations were heavily exposed to cigarillo advertising and marketing. Cigarillo use in this urban young adult population is a growing public health problem and undermines the progress made in decreasing cigarette use.

NUTORC-a transdisciplinary health services and outcomes research team in transplantation.

The field of solid organ transplantation has historically concentrated research efforts on basic science and translational studies. However, there has been increasing interest in health services and outcomes research. The aim was to build an effective and sustainable, inter- and transdisciplinary health services and outcomes research team (NUTORC), that leveraged institutional strengths in social science, engineering, and management disciplines, coupled with an international recognized transplant program. In 2008, leading methodological experts across the university were identified and intramural funding was obtained for the NUTORC initiative. Inter- and transdisciplinary collaborative teams were created across departments and schools within the university. Within 3 years, NUTORC became fiscally sustainable, yielding more than tenfold return of the initial investment. Academic productivity included funding for 39 grants, publication of 60 manuscripts, and 166 national presentations. Sustainable educational opportunities for students were created. Inter- and transdisciplinary health services and outcomes research in transplant can be innovative and sustainable.