Healthy and Unhealthy Food Prices across Neighborhoods and Their Association with Neighborhood Socioeconomic Status and Proportion Black/Hispanic.

This paper evaluates variation in food prices within and between neighborhoods to improve our understanding of access to healthy foods in urbanized areas and potential economic incentives and barriers to consuming a higher-quality diet. Prices of a selection of healthier foods (dairy, fruit juice, and frozen vegetables) and unhealthy foods (soda, sweets, and salty snacks) were obtained from 1953 supermarkets across the USA during 2009-2012 and were linked to census block group socio-demographics. Analyses evaluated associations between neighborhood SES and proportion Black/Hispanic and the prices of healthier and unhealthy foods, and the relative price of healthier foods compared with unhealthy foods (healthy-to-unhealthy price ratio). Linear hierarchical regression models were used to explore geospatial variation and adjust for confounders. Overall, the price of healthier foods was nearly twice as high as the price of unhealthy foods ($0.590 vs $0.298 per serving; healthy-to-unhealthy price ratio of 1.99). This trend was consistent across all neighborhood characteristics. After adjusting for covariates, no association was found between food prices (healthy, unhealthy, or the healthy-to-unhealthy ratio) and neighborhood SES. Similarly, there was no association between the proportion Black/Hispanic and healthier food price, a very small positive association with unhealthy price, and a modest negative association with the healthy-to-unhealthy ratio. No major differences were seen in food prices across levels of neighborhood SES and proportion Black/Hispanic; however, the price of healthier food was twice as expensive as unhealthy food per serving on average.

Public Awareness of and Contact With Physicians Who Receive Industry Payments: A National Survey.

BACKGROUND: The Physician Payments Sunshine Act, part of the Affordable Care Act, requires pharmaceutical and medical device firms to report payments they make to physicians and, through its Open Payments program, makes this information publicly available. OBJECTIVE: To establish estimates of the exposure of the American patient population to physicians who accept industry payments, to compare these population-based estimates to physician-based estimates of industry contact, and to investigate Americans' awareness of industry payments. DESIGN: Cross-sectional survey conducted in late September and early October 2014, with data linkage of respondents' physicians to Open Payments data. PARTICIPANTS: A total of 3542 adults drawn from a large, nationally representative household panel. MAIN MEASURES: Respondents' contact with physicians reported in Open Payments to have received industry payments; respondents' awareness that physicians receive payments from industry and that payment information is publicly available; respondents' knowledge of whether their own physician received industry payments. KEY RESULTS: Among the 1987 respondents who could be matched to a specific physician, 65% saw a physician who had received an industry payment during the previous 12 months. This population-based estimate of exposure to industry contact is much higher than physician-based estimates from the same period, which indicate that 41% of physicians received an industry payment. Across the six most frequently visited specialties, patient contact with physicians who had received an industry payment ranged from 60 to 85%; the percentage of physicians with industry contact in these specialties was much lower (35-56%). Only 12% of survey respondents knew that payment information was publicly available, and only 5% knew whether their own doctor had received payments. CONCLUSIONS: Patients' contact with physicians who receive industry payments is more prevalent than physician-based measures of industry contact would suggest. Very few Americans know whether their own doctor has received industry payments or are aware that payment information is publicly available.

Attitudes, practices, and preparedness to care for patients with substance use disorder: Results from a survey of general internists.

BACKGROUND: Previous research demonstrates that most primary care physicians feel unprepared to diagnose and treat substance use disorder (SUD). Confidence in SUD management has been associated with improved clinical practices. METHODS: A cross-sectional survey of 290 inpatient and outpatient general internists in an academic medical center evaluating attitudes, preparedness, and clinical practice related to SUD. RESULTS: 149 general internists responded, a response rate of 51%. Forty-six percent frequently cared for patients with SUD. Sixteen percent frequently referred patients to treatment and 6% frequently prescribed a medication to treat SUD. Twenty percent felt very prepared to screen for SUD, 9% to provide a brief intervention, 7% to discuss behavioral treatments, and 9% to discuss medication treatments. Thirty-one percent felt that SUD is different from other chronic diseases because they believe using substances is a choice. Fourteen percent felt treatment with opioid agonists was replacing one addiction with another. Twelve percent of hospitalists and 6% of PCPs believe that someone who uses drugs is committing a crime and deserves punishment. Preparedness was significantly associated with evidence-based clinical practice and favorable attitudes. Frequently caring for patients with SUD was significantly associated with preparedness, clinical practice, and favorable attitudes. CONCLUSIONS: SUD is a treatable and prevalent disease, yet a majority of general internists do not feel very prepared to screen, diagnose, provide a brief intervention, refer to treatment, or discuss treatment options with patients. Very few frequently prescribe medications to treat SUD. Some physicians view substance use as a crime and a choice. Physician preparedness and exposure to SUD is associated with improved clinical practice and favorable attitudes towards SUD. Physicians need education and support to provide better care for patients with SUD.

The Changing Nature of Scientific Sharing and Withholding in Academic Life Sciences Research: Trends From National Surveys in 2000 and 2013.

PURPOSE: Since 2000, federal funders and many journals have established policies requiring more open sharing of data and materials post-publication, primarily through online supplements and third-party repositories. This study examined changes in sharing and withholding practices among academic life scientists, particularly geneticists, between 2000 and 2013. METHOD: In 2000 and 2013, the authors surveyed separate samples of 3,000 academic life scientists at the 100 U.S. universities receiving the most National Institutes of Health funding. Respondents were asked to estimate the number of requests for information, data, and materials they made to and received from other academic researchers in the past three years. They were also asked about potential consequences of sharing and withholding. RESULTS: Response rates were 63.9% (1,849/2,893) in 2000 and 40.8% (1,165/2,853) in 2013. Proportions of faculty in 2000 and 2013 who received, denied, made, or were denied at least one request were not statistically different. However, the total volume of requests received from or made to other scientists dropped substantially (19.4 received in 2000 versus 10.8 in 2013, P < .001; 8.4 made in 2000 versus 6.6 in 2013, P < .001). Faculty in 2013 also made an average of 8.4 requests to third-party repositories. Researchers in 2013 were less likely to report sharing resulted in new research or collaborations. CONCLUSIONS: The results show a dramatic shift in sharing mechanisms, away from a peer-to-peer sharing model toward one based on central repositories. This may increase efficiency, but collaborations may suffer if personal communication among scientists is deemphasized.

The growth and gaps of genetic data sharing policies in the United States.

The 1996 Bermuda Principles launched a new era in data sharing, reflecting a growing belief that the rapid public dissemination of research data was crucial to scientific progress in genetics. A historical review of data sharing policies in the field of genetics and genomics reflects changing scientific norms and evolving views of genomic data, particularly related to human subjects' protections and privacy concerns. The 2013 NIH Draft Genomic Data Sharing (GDS) Policy incorporates the most significant protections and guidelines to date. The GDS Policy, however, will face difficult challenges ahead as geneticists seek to balance the very real concerns of research participants and the scientific norms that propel research forward. This article provides a novel evaluation of genetic and GDS policies' treatment of human subjects' protections. The article examines not only the policies, but also some of the most pertinent scientific, legal, and regulatory developments that occurred alongside data sharing policies. This historical perspective highlights the challenges that future data sharing policies, including the recently disseminated NIH GDS Draft Policy, will encounter.

Trust, vulnerable populations, and genetic data sharing.

Recent policies and proposed regulations, including the Notice of Proposed Rulemaking for the Common Rule and the 2014 NIH Genetic Data Sharing Policy, seek to improve research subject protections. Protections for subjects whose genetic data is shared are critical to reduce risks such as loss of confidentiality, stigma, and discrimination. In the article 'It depends whose data are being shared: considerations for genomic data sharing policies', Robinson et al. provide a response to our article, 'The Growth and Gaps of Genetic Data Sharing Policies'. Robinson et al. highlight the importance of individual and group preferences. In this article, we extend the conversation on models for improving protections which will mitigate consequences for individuals and groups that are vulnerable to stigma and discrimination.

Medicine Resident Preparedness to Diagnose and Treat Substance Use Disorders: Impact of an Enhanced Curriculum.

BACKGROUND: The authors' previous study found that despite caring for many patients with addiction, most Massachusetts General Hospital (MGH) internal medicine residents feel unprepared to treat substance use disorders (SUDs) and rate SUD instruction during training as fair or poor. This follow-up study evaluates the impact of an enhanced curriculum on resident perceptions of the quality of instruction, knowledge base, and self-perceived preparedness to diagnose and treat SUDs. METHODS: Based on the findings of the earlier study, an enhanced SUD curriculum was designed and delivered to MGH medicine residents. Impact of the curriculum was evaluated using the same Web-based survey that was administered in the earlier study to compare pre- and posttest results. RESULTS: The authors' earlier study found that 75% of residents felt prepared to diagnose and 37% to treat SUDs and 45% of residents rated the overall quality of SUD instruction as good or excellent. Following the curriculum intervention, 87% of residents reported feeling prepared to diagnose (P=.028) and 60% to treat (P=.002) SUDs. Three quarters of residents rated the overall quality of instruction as good or excellent (P<.001), and 98% reported residency curriculum had a positive impact on their preparedness to care for patients with a SUDs. Residents who reported receiving an adequate amount of SUD instruction were more likely to feel prepared to diagnose and treat addiction (P<.001). Thirty-one percent of residents still rated the overall amount of SUD instruction as too little. The intervention did not significantly improve answers to knowledge questions. CONCLUSIONS: An enhanced SUDs curriculum for medicine residents increased self-perceived preparedness to diagnose and treat SUDs and educational quality ratings. However, there was no significant change in knowledge. Implementation of a more comprehensive curriculum and evaluation at other sites are necessary to determine the ideal SUD training model.

Act II of the Sunshine Act.

To coincide with the introduction in the United States of the Sunshine Act, Genevieve Pham-Kanter discusses what we need to look for to fight hidden bias and deliberate or unconscious corruption. Please see later in the article for the Editors' Summary.

Codifying collegiality: recent developments in data sharing policy in the life sciences.

Over the last decade, there have been significant changes in data sharing policies and in the data sharing environment faced by life science researchers. Using data from a 2013 survey of over 1600 life science researchers, we analyze the effects of sharing policies of funding agencies and journals. We also examine the effects of new sharing infrastructure and tools (i.e., third party repositories and online supplements). We find that recently enacted data sharing policies and new sharing infrastructure and tools have had a sizable effect on encouraging data sharing. In particular, third party repositories and online supplements as well as data sharing requirements of funding agencies, particularly the NIH and the National Human Genome Research Institute, were perceived by scientists to have had a large effect on facilitating data sharing. In addition, we found a high degree of compliance with these new policies, although noncompliance resulted in few formal or informal sanctions. Despite the overall effectiveness of data sharing policies, some significant gaps remain: about one third of grant reviewers placed no weight on data sharing plans in their reviews, and a similar percentage ignored the requirements of material transfer agreements. These patterns suggest that although most of these new policies have been effective, there is still room for policy improvement.

Revisiting financial conflicts of interest in FDA advisory committees.

CONTEXT: The Food and Drug Administration (FDA) Safety and Innovation Act has recently relaxed conflict-of-interest rules for FDA advisory committee members, but concerns remain about the influence of members' financial relationships on the FDA's drug approval process. Using a large newly available data set, this study carefully examined the relationship between the financial interests of FDA Center for Drug Evaluation and Research (CDER) advisory committee members and whether members voted in a way favorable to these interests. METHODS: The study used a data set of voting behavior and reported financial interests of 1,379 FDA advisory committee members who voted in CDER committee meetings that were convened during the 15-year period of 1997-2011. Data on 1,168 questions and 15,739 question-votes from 379 meetings were used in the analyses. Multivariable logit models were used to estimate the relationship between committee members' financial interests and their voting behavior. FINDINGS: Individuals with financial interests solely in the sponsoring firm were more likely to vote in favor of the sponsor than members with no financial ties (OR = 1.49, p = 0.03). Members with interests in both the sponsoring firm and its competitors were no more likely to vote in favor of the sponsor than those with no financial ties to any potentially affected firm (OR = 1.16, p = 0.48). Members who served on advisory boards solely for the sponsor were significantly more likely to vote in favor of the sponsor (OR = 4.97, p = 0.005). CONCLUSIONS: There appears to be a pro-sponsor voting bias among advisory committee members who have exclusive financial relationships with the sponsoring firm but not among members who have nonexclusive financial relationships (ie, those with ties to both the sponsor and its competitors). These findings point to important heterogeneities in financial ties and suggest that policymakers will need to be nuanced in their management of financial relationships of FDA advisory committee members.

Internal medicine residents' training in substance use disorders: a survey of the quality of instruction and residents' self-perceived preparedness to diagnose and treat addiction.

BACKGROUND: Resident physicians are the direct care providers for many patients with addiction. This study assesses residents' self-perceived preparedness to diagnose and treat addiction, measures residents' perceptions of the quality of addictions instruction, and evaluates basic knowledge of addictions. METHODS: A survey was e-mailed to 184 internal medicine residents at Massachusetts General Hospital in May 2012. RESULTS: Responses were obtained from 55% of residents. Residents estimated that 26% of inpatients they cared for met criteria for a substance use disorder (SUD). Twenty-five percent of residents felt unprepared to diagnose and 62% felt unprepared to treat addiction. Only 13% felt very prepared to diagnose addiction. No residents felt very prepared to treat addiction. Preparedness to diagnose or treat addiction did not differ significantly across postgraduate year (PGY) level. Fifty-five percent rated the overall instruction in addictions as poor or fair. Seventy-two percent of residents rated the quality of addictions training as poor or fair in the outpatient clinical setting, and 56% in the inpatient setting. No resident answered all 6 knowledge questions correctly. Slightly more than half correctly identified the mechanism of buprenorphine and 19% correctly answered a question about naltrexone. Nine percent of residents responded that someone had expressed concern about the respondent's substance use. CONCLUSIONS: Despite providing care for a substantial population with addiction, the majority of internal medicine residents in this study feel unprepared to treat SUDs. More than half rate the quality of addictions instruction as fair or poor. Structured and comprehensive addictions curriculum and faculty development are needed to address the deficiencies of the current training system.

Brightening up: the effect of the Physician Payment Sunshine Act on existing regulation of pharmaceutical marketing.

With the passage of the Physician Payment Sunshine Act as part of the federal health care reform law, pharmaceutical manufacturers are now required to disclose a wide range of payments made by manufacturers to physicians. We review current state regulation of pharmaceutical marketing and consider how the federal sunshine provision will affect existing marketing regulation. We analyze the legal and practical implications of the Physician Payment Sunshine Act.

Do sons reduce parental mortality?

BACKGROUND: Although sons are thought to impose greater physiological costs on mothers than daughters, sons may be advantageous for parental survival in some social contexts. The authors examined the relationship between the sex composition of offspring and parental survival in contemporary China and Taiwan. Because of the importance of sons for the provision of support to elderly parents in these populations, the authors hypothesised that sons would have a beneficial effect on parental survival relative to daughters. METHODS: The authors used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and the Taiwan Longitudinal Study of Aging (TLSA). The CLHLS sample consisted of 4132 individuals aged 65 years and over in 2002. The TLSA sample comprised two cohorts: 3409 persons aged 60 years and over in 1989 and 2193 persons aged 50-66 years in 1996. These cohorts were followed up for 3, 18 and 11 years, respectively. The Cox proportional hazards model was used to estimate the relationship between the sex composition of offspring and parental mortality. RESULTS: Based on seven measures of sex composition, no protective effect of sons was found in either China or Taiwan. For example, in the 1989 Taiwan sample, the hazard ratio (HR) for maternal mortality associated with having an eldest son was 0.979 (95% CI 0.863 to 1.111). In Taiwan, daughters may have been more beneficial than sons in reducing mortality in recent years. CONCLUSION: The authors offer several explanations for these findings, including possible benefits associated with emotional and interpersonal forms of support provided by daughters and negative impacts of conflicts arising between parents and resident daughters-in-law.

Social comparisons and health: can having richer friends and neighbors make you sick?

Do richer friends and neighbors improve your health through positive material effects, or do they make you feel worse through the negative effect of social comparison and relative deprivation? Using the newly available National Social Life, Health, and Aging Project (NSHAP) data set that reports individuals' income positions within their self-defined social networks, this paper examines whether there is an association between relative position and health in the US. Because this study uses measures of individuals' positions within their self-defined social groups rather than researcher-imputed measures of relative position, I am able to more precisely examine linkages between individual relative position and health. I find a relationship between relative position and health status, and find indirect support for the biological mechanism underlying the relative deprivation model: lower relative position tends to be associated with those health conditions thought to be linked to physiological stress. I also find, however, that only extremes of relative position matter: very low relative position is associated with worse self-rated physical health and mobility, increased overall disease burden, and increased reporting of cardiovascular morbidity; very high relative position is associated with lower probabilities of reporting diabetes, ulcers, and hypertension. I observe few associations between health and either moderately high or moderately low positions. This analysis suggests that the mechanism underlying the relative deprivation model may only have significant effects for those at the very bottom or the very top.

Measures of chronic conditions and diseases associated with aging in the national social life, health, and aging project.

OBJECTIVES: This paper presents a description of the methods used in the National Social Life, Health, and Aging Project to detect the presence of chronic conditions and diseases associated with aging. It also discusses the validity and distribution of these measures. METHODS: Markers associated with common chronic diseases and conditions of aging were collected from 3,005 community-dwelling older adults living in the United States, aged 57-85 years, during 2006. Dried blood spots, physical function tests, anthropometric measurements, self-reported history, and self-rated assessments were used to detect the presence of chronic conditions associated with aging or of risk factors associated with the development of chronic diseases. RESULTS: The distribution of each measure, disaggregated by age group and gender, is presented. CONCLUSIONS: This paper describes the methodology used as well as the distribution of each of these measures. In addition, we discuss how the measures used in the study relate to specific chronic diseases and conditions associated with aging and how these measures might be used in social science analyses.