Food and Housing Insecurity in Nevada During the COVID-19 Pandemic.

The COVID-19 pandemic intensified concerns regarding food and housing insecurity in the United States, particularly among vulnerable populations. After the pandemic prompted a shutdown of nonessential businesses in Nevada, unemployment rose dramatically as the gaming, tourism, and hospitality industries struggled. This study analyzed the results of two telephone surveys of Nevada adults' experiences in 2020 (n = 1000) and 2021 (n = 1002). The results demonstrate between 2020 and 2021 an 8.24 percentage point decline in food insecurity (FI) from 30.2% to 21.96% and a 12.58 percentage point increase in housing insecurity (HI) from 12.27% to 24.85%. Age, disability status, and certain categories of race/ethnicity and income were associated with both HI and FI in 2020, but disability was no longer significant in 2021. Instead, spouse/partner-status, living with children ≤ 18-years-old and receipt of SNAP benefits were significantly associated with FI in 2021. In particular, health status became a significant factor of both HI and FI. People of color experienced FI disparities compared to Whites. Asians/Hawaiians/Pacific Islanders were 3.22 times (95% CI 1.51, 6.86) more likely to experience FI in 2021 than Whites. A matched, longitudinal analysis also revealed that Whites experienced a significant 9.1 percentage point estimated decline in the probability of FI between 2020 and 2021. However, the reduction among non-White participants was statistically insignificant at 2.5 percentage points. Results indicate the importance of supporting the food and housing needs of people of color and individuals with disabilities. Further research should especially investigate the comparative FI rate among Asians/Hawaiians/Pacific Islanders in 2021 and offer solutions to the soaring prevalence of housing insecurity.

An assessment of the move your way program among hispanic adults in Las Vegas, Nevada.

BACKGROUND: Physical activity (PA) is important because of its associated health benefits. However, many Americans remain inactive. The 2018 guidelines recognize that PA bouts of less than 10 min are beneficial. The U.S. Department of Health and Human Services' Office of Disease Prevention and Health Promotion created the Move Your Way® (MYW) campaign to provide PA resources for communities and healthcare providers. This study aims to describe the reach of the MYW campaign, and assess whether having seen, heard, or read (SHR) about MYW, or having seen the MYW logo, was associated with PA knowledge, self-efficacy, and behavior among Hispanics residing in the Las Vegas, Nevada area. METHODS: Hispanics, aged 18-74, were surveyed at community events (n = 481) or via an online survey (n = 123). Respondents were asked if they had SHR of MYW, were aware of 2018 PA recommendations, and to report their personal PA behavior, PA knowledge, PA intentions, and demographics. RESULTS: Respondents (71% female) completed a 38-42-item survey. Approximately (12.4%) had SHR of the MYW campaign and 16.1% had seen the MYW logo. Only 3.4% and 15% identified, "150 minutes per week" and "75 minutes per week" as the 2018 guidelines for moderate physical activity (MPA) and vigorous physical activity (VPA), respectively. Those who had SHR of the MYW campaign were more likely to correctly identify 150 min per week as the MPA guideline and had greater confidence in overcoming selected PA barriers. Regression analysis showed that those who had seen the MYW logo were more likely to meet strength guidelines, and that those who had SHR of MYW or saw the logo were more likely to know the recommended minutes of MPA. CONCLUSIONS: Knowledge of the MYW program positively associates with some PA behaviors and PA correlates.

Food insecurity and risky sexual behaviors among college students during the COVID-19 pandemic.

BACKGROUND: Sexually transmitted infections (STIs) and food insecurity are public health concerns in the United States (US) due to their growing prevalence and incidence among young people, and particularly in college students. Studies have reported that college students are at higher risk of STIs due to the high rates of risky sexual behavior (RSB). Most studies report a food insecurity prevalence of more than 30% among college students, which was more than twice the overall national food insecurity rate of 10.5% in 2020. This study aims to assess the relationship between food insecurity and RSB among college students during the early-stages of the COVID-19 pandemic. METHODS: This was a cross-sectional study from a convenience sample of 320 students enrolled at the University of Nevada, Las Vegas during the 2020 Fall semester. Data was collected using an online survey. Univariate and multivariate logistic regression analyses were conducted. RESULTS: Food insecure students were 2.9 times more likely to report receiving or giving fellatio without using a condom at least once in the past 6 months (P < 0.01) compared to food secure students. There was no significant association between food insecurity and other RSBs evaluated in this study. CONCLUSIONS: The current study provides valuable information on food insecurity and RSB among college students during the early stages of the COVID-19 pandemic. Larger and longitudinal studies are needed to assess the trajectory of the association between food insecurity and fellatio with no condom use and other RSB among college students.

The relationship between tree canopy and social capital on physical activity in college students.

OBJECTIVE: Rates of physical activity (PA) are low, especially among college students. Tree canopy and social capital have been correlated with higher rates of PA. This study assessed the relationship between tree canopy and social capital on minutes of PA. PARTICIPANTS: Students from the University of Nevada, Las Vegas, located in Southern Nevada, were surveyed on social capital and self-reported minutes of PA. METHODS: Tree canopy coverage was calculated within a 1 km walk buffer around each participant's home. Logistic regression was used to determine if tree canopy and social capital predicted meeting PA recommendations of 150 minutes/week. RESULTS: 42.4% of participants met the PA recommendations and males were more likely than females to meet them (odds ratio [OR] = 0.517). Social capital was a significant predictor of PA (OR = 1.308) while tree canopy was not. CONCLUSIONS: Exploration of social capital to increase PA and further investigations into correlates of PA for college students in sprawling desert environments are recommended.

Senior food insecurity in the USA: a systematic literature review.

OBJECTIVE: Understanding the factors associated with senior food insecurity is key to understanding senior-specific needs to develop targeted interventions and ultimately lower the prevalence and the incidence of food insecurity. We aimed to systematically review published literature and summarise the associated factors of food insecurity in older adults in the USA. DESIGN: We searched PubMed, Scopus, Web of science, EconLit and JSTOR databases for peer-reviewed articles published in English between January 2005 and September 2019 that assessed food security or its associated factors for US adults aged 60 years and older. After a two-step screening process, twenty articles were retained and included in the review. SETTING: NA. PARTICIPANTS: NA. RESULTS: The majority of studies were cross-sectional (70 %), consisted of data from one state (60 %), and had large sample sizes. Food-insecure individuals were more likely to be younger, less educated, Black or African American, female, a current smoker, low income, and self-report fair/poor health, have chronic conditions, and utilise government assistance programmes. Food insecurity was associated with medication non-adherence, poor mental health outcomes and limitations in physical functioning. Results were mixed for overweight/obesity status. There was no discernable pattern related to the consistency of findings by the assessed quality of the included studies. CONCLUSIONS: Food insecurity is a prevalent and pervasive issue for older adults. The numerous correlates identified suggest that interventions aimed at enhancing food and nutrition safety net and medication assistance programmes are warranted, and upstream, systemic-level interventions may be best suited to deal with the correlates of food insecurity.

A Mixed-Methods Assessment of Residential Housing Tenants' Concerns about Property Habitability and the Implementation of Habitability Laws in Southern Nevada.

Housing is a key health determinant. Habitability laws set minimum standards for adequate housing. However, accessing them to ensure adequate housing may be a challenge for many tenants. This paper explores the need for rental housing policy that would better support adequate and safe housing, particularly for low-income renters. A mixed-methods approach assessed residential tenant habitability concerns in Clark County, Nevada, through calls relayed to the Clark County Landlord-Tenant Hotline (CCLTH). Of the 2865 calls, 74.3% were from ZIP codes that were 80% of the median income and below. There was a significant relationship between the ZIP code-level income and the reporting of at least one essential habitability concern. Of the 266 participants that responded to a follow-up call, 34.6% reported that their complaint was resolved and there was no association between resolution and income. Qualitative data analysis from phone interviews revealed two central themes: (1) resources to navigate landlord-tenant laws are limiting and (2) housing policies need to be strengthened to help tenants and keep people housed. Understanding tenant concerns regarding substandard housing and related inequities can help inform rental housing policy and its implementation to promote healthy homes and improve health outcomes for communities burdened by poor rental housing conditions.

Exploratory analysis of the associations between neonicotinoids and measures of adiposity among US adults: NHANES 2015-2016.

BACKGROUND: Toxicology studies suggest that neonicotinoids may be associated with adiposity development via thyroid hormone disruption and increased oxidative stress. Prior epidemiological studies report mixed results for the association between neonicotinoids and adiposity measures. OBJECTIVE: To examine the association between detectable concentrations of parent neonicotinoids (imidacloprid, acetamiprid, clothianidin) and neonicotinoid metabolites (5-hydroxy-imidacloprid, N-desmethyl-acetamiprid) with adiposity measures among US adults, and whether sex modifies the associations for neonicotinoid metabolites with adiposity. METHODS: National Health and Nutrition Examination Survey (NHANES) 2015-2016 data was utilized to estimate covariate-adjusted associations between detectable neonicotinoids and fat mass index (FMI), lean mass index (LMI), waist circumference, body fat percentage, and body mass index (BMI) using multiple linear regression. We estimated incidence rate ratios (IRRs) for overweight or obese status with detectable neonicotinoid concentrations using Poisson's modified regression. Sampling strategies were accounted for in the regression models. RESULTS: Detectable levels of acetamiprid were associated with a decrease in FMI (ß = -3.17 kg/m2, 95% CI [-4.79, -1.54]), LMI (ß = -3.17 kg/m2, 95% CI [-5.17, -1.17]), body fat percentage (ß = -4.41, 95% CI [-8.20, -0.62]), waist circumference (ß = -9.80 cm, 95% CI [-19.08, -0.51]), and BMI (ß = -3.88kg/m2, 95% CI [-7.25, -0.51]) among adults. In contrast, detectable levels of 5-hydroxy-imidacloprid were associated with greater rates of being overweight/obese (IRR = 1.11, 95% CI [1.04, 1.18)) and increased LMI (ß = 0.67 kg/m2, 95% CI [0.04, 1.29]). Sex modified the association between N-desmethyl-acetamiprid and LMI (pint = 0.075) with a positive association among males (ß = 1.14 kg/m2, 95% CI [0.38, 1.90]), and an insignificant inverse association in females. Sex also modified the association for N-desmethyl-acetamiprid with FMI (pint = 0.095) and body fat percentage (pint = 0.072), with suggestive evidence showing positive associations for males and inverse associations for females. CONCLUSION: Detectable concentrations of acetamiprid were inversely associated with adiposity, while there were mixed findings for 5-hydroxy-imidacloprid. Findings suggest sex differences, though results are not clear with regard to the directionality of the association by sex.

Assessing Determinants of COVID-19 Vaccine Hesitancy in Nevada.

In December 2020, we conducted a telephone survey to determine what factors are connected to COVID-19 vaccine hesitancy among adults in Nevada. The survey was based on factors identified in other studies, such as demographic variables (age, race, ethnicity, gender, household income, urbanicity, educational attainment), health status, previous COVID-19 infections, social media engagement, adherence to social distancing guidelines, beliefs about COVID-19, and political ideology identifications. Using a proportional odds model, we compared vaccine hesitancy levels to determine the odds of being more likely versus unlikely to get the COVID-19 vaccine. Of 1,000 people surveyed, 30.4% exhibited vaccine hesitancy. Findings showed that adults with significantly lower odds of vaccine hesitancy included those who were male, older, worried about COVID-19 infection or its community effects, adhered to social distancing, and reported higher incomes. Adults who identified as African American or Black or as multiple or "other" races exhibited significantly higher odds of vaccine hesitancy than White adults. Adults self-identifying as conservative had significantly higher odds of vaccine hesitancy than others. Vaccine hesitancy levels suggest possible hurdles to addressing the COVID-19 pandemic in a state with high visitor volumes and demographics that resemble the country's future as minority White, highlighting possible lessons for future pandemics. Most measures of COVID-19 worry were not significantly associated with vaccine hesitancy, suggesting that vaccination efforts should focus on other motivators. COVID-19 vaccination efforts should also directly encourage uptake by younger and middle-aged adults who are female, African American, have lower incomes, and identify as conservative.

The Impact of an Educational Intervention on Distracted Driving Knowledge, Attitudes, and Behaviors Among College Students.

Distracted driving indiscriminately kills nearly 3500 people each year with young adults having greater risks associated with this phenomenon. Prevention programs targeting the distracted driving habits of young adults are necessary to ameliorate the high costs, both in dollars and in lives, associated with this behavior. Few health education and prevention programs have been assessed for their effectiveness in changing knowledge, attitudes, and behaviors related to distracted driving. This study explores a distracted driving intervention among undergraduate students enrolled in an introductory public health course. A quasi-experimental study design was used to compare the pre- and post-data of the group receiving 5-weeks of a distracted driving intervention to a control group. Questionnaires were administered to both groups prior to and 2 weeks following the intervention to assess changes in knowledge, attitudes, and behaviors related to distracted driving. A Difference-in-Difference technique showed significant changes in knowledge (ß = 0.40, p = 0.03) and total scores (ß = 2.48, p = 0.04) in the intervention (n = 97) compared to the control (n = 131). T-tests examining pre- and post-scores for individual behaviors showed the intervention group displayed positive changes for some behaviors (talking, texting, cellphone use, grooming) compared to the control. The results support the impact that a classroom-based distracted driving intervention can have on undergraduate college students. Implications for this type of health education program may lead to improvements in distracted driving attitudes and behavior among this age-group.

Using the Multi-Theory Model (MTM) of Health Behavior Change to Explain the Correlates of Mammography Screening among Asian American Women.

Globally, breast cancer is the most common malignancy affecting women. The incidence of breast cancer has been growing among Asian American women. Mammography is a screening procedure that provides early diagnosis for the timely treatment to reduce premature mortality due to breast cancer. However, there are no national data available that summarize the rates of mammography screening among Asian American women. Some small-scale studies have reported low rates of mammography uptake among Asian American women. This cross-sectional study utilized the fourth-generation, multi-theory model (MTM) of health behavior change to explain the correlates of mammography screening among Asian American women between the ages of 45-54 years. A 44-item instrument was evaluated for face, content, and construct validity (using structural equation modeling) and reliability (Cronbach's alpha) and administered electronically to a nationally representative sample of Asian American women (n = 374). The study found that Asian American women who have had received mammograms in the past 12 months as per recommendations, all three constructs of MTM, namely, participatory dialogue (ß = 0.156, p < 0.05), behavioral confidence (ß = 0.236, p < 0.001), and changes in the physical environment (ß = 0.426, p < 0.001) were statistically significant and crucial in their decision to initiate getting a mammogram, accounting for a substantial 49.9% of the variance in the decision to seek mammography. The study also found that the MTM constructs of emotional transformation (ß = 0.437, p < 0.001) and practice for change (ß = 0.303, p < 0.001) were significant for maintaining the repeated behavior of getting annual mammograms and were responsible for 53.9% of the variance. This evidence-based study validates the use of MTM in designing and evaluating mammography screening promotion programs among Asian American women aged 45-54 years.

School absenteeism is linked to household food insecurity in school catchment areas in Southern Nevada.

OBJECTIVES: Food security and school attendance are both important for health, well-being and academic performance of children and adolescents. However, their intersection remains underexamined, especially in the USA. The current study considered the association between elementary school-level absenteeism and household food insecurity. DESIGN: The current study linked school-level absenteeism and household food insecurity rates using geographic information system mapping and applied the tobit regression model to examine their association. SETTING: The Clark County, Nevada, public school district - the fifth largest in the USA and in a state with disproportionate food insecurity and chronic school absenteeism rates. PARTICIPANTS: Data consisted of school-level absenteeism rates from 185 elementary schools and census tract-level household food insecurity rates. RESULTS: Average daily attendance rates were lower for schools with catchment areas that had higher average household food insecurity (FI), decreasing by -0·0232 % per 1 % increase in FI rate (P-value = 0·022). They were also significantly associated with most absenteeism risk factors. Average daily attendance rate was negatively associated with Free and Reduced Lunch eligibility percentage (-0·010 per 1 % increase in FI, P-value < 0·001) and Individualized Education Program participation percentage (-0·039 % per 1 % increase in FI, P-value = 0·033), but positively associated with parent-teacher conference participation rate (0·006 % per 1 % increase in FI, P-value = 0·025) and white student percentage (0·011 % per 1 % increase in FI, P-value = 0·022). CONCLUSIONS: The current study suggests a link between household food insecurity and elementary school-level absenteeism. Understanding this link is important for policy and practice because schools are frequent settings for food insecurity mitigation interventions.

Changes in Depression and Physical Activity Among College Students on a Diverse Campus After a COVID-19 Stay-at-Home Order.

The numerous negative health impacts of COVID-19, which include expected changes to psychiatric illness and physical activity (PA), are disproportionately distributed in the United States. Mental illnesses and physical inactivity are prevalent among U.S. college students. This study examined whether there was a change in minutes of PA and depression scores after a stay-at-home order and examined predictors of these changes. An online survey was sent to all undergraduate and graduate students attending a large, diverse university via an electronic newsletter. The survey requested information about demographic and academic data, cardiorespiratory fitness, and depression symptoms. Paired t-tests and logistic regression were employed. Our sample (n = 194) was predominantly female (73%), young (mean age of 25), not a sexual minority (82%), and had a mean 3.4 GPA. Students reported worse depression scores (p < 0.01) and fewer minutes of PA (p = 0.01) after the stay-at-home order. There was a small but significant (p = 0.04) correlation between changes in total minutes of PA and depression scores. Senior (p = 0.05) and Hispanic (p = 0.03) students were less likely to report worsening depression scores than freshmen and white students, respectively. Asian students were significantly more likely than white students to report decreased PA. This study suggests that COVID-19 and its consequences may be contributing to reduced PA and greater depression symptoms in college students and that sub-groups have been affected differently. Targeted interventions to promote PA and support mental health may bolster the ability for resilience of college students.

Correction to: Temporal trend of research related to gun violence from 1981 to 2018 in the United States: a bibliometric analysis.

An amendment to this paper has been published and can be accessed via the original article.

Temporal trend of research related to gun violence from 1981 to 2018 in the United States: a bibliometric analysis.

BACKGROUND: We aimed to evaluate the variation in gun violence-related research in the US over time to determine if there are meaningful changes in frequency of research at certain time points. Related publications were searched from the Web of Science. METHODS: We searched articles from Web of Science to collect publication data of gun violence research in three disciplines (clinical sciences, life sciences, and social behavior sciences) from 1981 to 2018. The joinpoint regression approach was applied to evaluate the trend of publication ratio. We also adopted the generalized additive mixed model to compare the publication ratio among the three research disciplines. RESULTS: During the study period, each research discipline had a significant decrease in publication ratios, especially social behavioral sciences from 2001 to 2011, with an annual percentage change = - 9.77% (95% CI = - 13.45, - 5.93; p-value < .0001). After combining the three research disciplines, the average change of the publication ratio was significantly increased 9.18% (95% CI = 6.42, 12.01; p-value < .0001) per year from 1981 to 2018. Compared to social behavioral sciences, both clinical sciences and life sciences had a significantly smaller publication ratio. CONCLUSIONS: Gun violence research exhibited a significant downward trend in publications in the early 2000s, which may be attributed at least in part to limited federal funding, but the publication ratio increased since the 2010s. To enhance the amount of peer-reviewed gun violence research so that research-informed gun violence interventions are more likely to succeed, decision-makers should keep supporting quality research.

Estimated car cost as a predictor of driver yielding behaviors for pedestrians.

INTRODUCTION: Pedestrian crashes are not equitably distributed; people of color and males are overburdened. The aim of this study was to examine if driver yielding behavior differed based on gender and skin color of the pedestrian, and the estimated car cost at two midblock crosswalks in the Las Vegas metropolitan area. METHODS: One white and one black female and one white and one black male crossed the intersection in a similar, prescribed manner. Crossings were video recorded. Driver yielding behavior was documented. The cost of car was estimated by cross referencing manufacturing websites and averaging the high and low values of estimated private sale. Generalized linear mixed model was applied, nesting within crossing attempt and within streets. RESULTS: Of 461 cars, 27.98% yielded to pedestrians. Cars yielded more frequently for females (31.33%) and whites (31.17%) compared to males (24.06%) and non-whites (24.78%). Cost of car was a significant predictor of driver yielding (OR = 0.97; p = 0.0307); odds of yielding decreased 3% per $1000 increase. DISCUSSION: Driver yielding differed by cost of cars. Given previous findings, future research is needed to further examine gender and racial disparities in pedestrian crashes. Findings are significant for public health and pedestrian safety, especially given the upward trend in crash rates.

The Relationship between School Absenteeism and Substance Use: An Integrative Literature Review.

Background: Chronic school absenteeism is prevalent among high school students in the United States. Its impacts on academic success and health are cause for concern. One specific area of concern is its relationship to youth substance use; chronic absenteeism is associated with using alcohol, marijuana, tobacco, and other drugs. Despite important findings, absent from the literature is a recent and systematic synthesis of related research. Objective: We aimed to examine the literature to provide a better understanding of the relationship between chronic school absenteeism and the use of alcohol, tobacco, marijuana and other drugs among U.S. high school students. Methods: We conducted an integrative review of existing peer-reviewed literature using key terms in five databases from the education and health sectors. We included English-language, quantitative and qualitative studies published between 1992 and October 2017 and focused on U.S. students in grades 9 through 12 and between ages 13 and 21. We extracted data and study quality measures for included studies. Results: After screening 3,130 articles using titles and abstracts and reviewing 99 full-text articles, 37 met inclusion criteria. Most were cross-sectional, used local-level data, widely varied in sampling, were of limited generalizability, and simultaneously considered school absenteeism and the use of multiple substances. Due to methodological issues, the relationship between chronic absenteeism and substance use is difficult to fully understand. Conclusions: We confirm the connection between school absenteeism and substance use among U.S. youth, highlight a limited understanding of how and why this relationship manifests, and call for absenteeism research that uses longitudinal methods, national data, and clearly articulated methodologies and self-appraised limitations.

An Evaluation of Food Insecurity and Its Correlates in a Filipino American Study Sample Residing in Clark County, Nevada.

Purpose: Filipino Americans comprise over half of the Asian American population in Clark County, Nevada. Despite their large numbers, food insecurity rates are aggregated with the entire Asian American population. In 2016, 1.6% of Asian American households in Clark County were food insecure, yet, 22% of households reported annual incomes at or below 200% of the federal poverty level. This study aimed to assess the status and correlates of food insecurity specific to Filipino Americans in Clark County, Nevada. Methods: The United States Department of Agriculture (USDA) Short Form Food Security Module was administered among 192 Filipino Americans residing in Clark County, NV. Results were viewed through the theoretical framework of the Social Ecological Model. Results: 27.1% of respondents experienced food insecurity within the past year. Adjusted logistic regression revealed that incomes less than $20,000 (odds ratio [OR]=4.13, 95% confidence interval [CI]: 1.43-11.9), having no health insurance (OR=5.22, 95% CI: 1.67-16.34), and eating mainly American or Western foods (OR=7.3, 95% CI: 1.73-30.77) were significant predictors of food insecurity. Conclusions: A significantly higher prevalence of food insecurity among Filipino American subpopulations, compared to the estimates for Asian Americans in Clark County, suggests the need to disaggregate data for Asian American subgroups. The Social Ecological Model provides greater context to the findings identifying that the intrapersonal and policy level factors were associated with food insecurity among our participants, thus suggesting the need to utilize multilevel interventions to address food insecurity in Filipino Americans. The findings may be utilized to inform future interventions aimed at improving the overall health and food security among Filipino Americans.

The Environmental Impact and Formation of Meals from the Pilot Year of a Las Vegas Convention Food Rescue Program.

Annually, millions of tonnes of leftover edible foods are sent to landfill. Not only does this harm the environment by increasing the release of greenhouse gases which contribute to climate change, but it poses a question of ethics given that nearly 16 million households are food insecure in the US, and hundreds of millions of people around the globe. The purpose of this study was to document the amount of food diverted from landfill in the pilot year of a convention food rescue program and to determine the amount of greenhouse gas (GHG) emissions avoided by the diversion of such food. In the pilot year of the convention food rescue program 24,703 kg of food were diverted. It is estimated that 108 metric tonnes of GHG emmisions were avoided as a result, while 45,383 meals for food insecure individuals were produced. These findings have significant implications for public and environmental health, as GHG emissions have a destructive effect on the earth's atmosphere and rescued food can be redistributed to food insecure individuals.

A State of Uncertainty: An Analysis of Recent State Legislative Proposals to Regulate Preventive Services in the United States.

This policy brief examines preventive services state legislation trends in the United States during uncertainty regarding the Affordable Care Act (ACA), which requires certain coverage of 4 evidence-based preventive services categories without additional patient costs under §2713. We used a legal mapping approach to search for and analyze state legislation related to preventive services proposed or enacted over a 25-month period of ACA uncertainty. We screened 1231 bills and coded the 76 screened-in bills. Next, we determined their characteristics and examined trends. Bills originated in 28 states, and 69.7% were not enacted. Only 3.9% contained requirements contingent on ACA modifications. About 56.6% referenced services covered by §2713, but usually not entire §2713 categories. Bills also mentioned preventive services in general (53.9%) and services outside §2713's scope (21.1%). About 55.3% applied to private insurance, and 75.0% only to one patient group. Bills generally promoted access, and 51.3% specifically prohibited cost-sharing. But 26.3% of the bills limited access to preventive services. State-level legislation targets preventive services, usually expanding, but sometimes limiting, access. Most bills single out specific services without fully incorporating evidence-based recommendations. State legislation may therefore promote access to preventive services but can favor certain services, deviate from experts' recommendations, and increase nationwide variability. State legislation can function as an important lever for access to preventive services across patient groups. This may be especially important during uncertainty about federal policy. However, the design of state-level proposals is critical for maximizing access to preventive services.

A Qualitative Study on Parental and Community Stakeholder Views of the Link between Full-Day Kindergarten and Health in Southern Nevada.

Studies show that children who attend full-day kindergarten (FDK) experience both academic and developmental benefits compared to children who attend half-day programs. Sectors outside of health, such as education, can have important intended and unintended impacts on health. The purpose of this qualitative study was to understand perceptions of parental and other stakeholders in Southern Nevada (USA) about the education⁻health link, and to understand priorities regarding how FDK access could affect health. Two 90-minute focus groups were conducted with 14 adult stakeholder participants representing parents, current and former teachers, and community members. Transcripts were analyzed using conventional content analysis. Eight major themes and several subthemes emerged; findings related to each are discussed. 'Access' was mentioned most frequently (n = 43), followed by 'Time' (n = 25), and 'Lifetime educational attainment' (n = 17). Participants were overall in favor of expanding access to FDK and felt that FDK could improve social skills, increase the amount of physical activity, and provide additional time for educators to detect additional learning disabilities when compared to half-day programs. Although the purpose was to understand priorities related to the education⁻health link, participants spent little time discussing this, suggesting this association is not inherently considered. Health and education stakeholders should collaborate to increase awareness, as this link may serve as an upstream approach to downstream effects on population health outcomes.