Cloudy with a chance of munchies: Assessing the impact of recreational marijuana legalization on obesity.

Obesity in the US arguably constitutes the most significant health epidemic over the past century. Recent legislative changes allowing for recreational marijuana use further create a need to better understand the relationship between marijuana use and health choices, leading to obesity. We examine this relationship by using a synthetic control approach to examine the impact of legalized recreational marijuana access on obesity rates by comparing Washington State to a synthetically constructed counterfactual. We find that recreational marijuana's introduction did not lead to increased obesity rates and may have led to decreases in obesity.

Social entrepreneurship, co-production, and post-disaster recovery.

Post-disaster recovery requires co-production; that is, the inputs of citizens are essential for successful community recovery to occur. Citizens contribute to post-disaster recovery by volunteering, taking on consultative and decision-making roles within their communities, and directly participating in post-disaster reconstruction efforts. Without meaning ful contributions from citizens-the intended beneficiaries-unilateral efforts by public officials and authorities will inevitably fail. This study shows that social entrepreneurs can thus play a critical role in spurring post-disaster recovery by facilitating co-production. It focuses on the role of social entrepreneurs after disasters and centres on one rural village, Giranchaur Namuna Basti in the Sindhupalchowk District of Nepal. Specifically, the study uses the case of the Dhurmus Suntali Foundation's Namuna village project in Giranchaur following the 7.8-magnitude earthquake that struck on 25 April 2015 to examine the pivotal role that social entrepreneurs assume in promoting voluntary activities, community engagement, and participation in post-disaster recovery efforts.

An iron triangle ROI model for health care.

OBJECTIVE: Few, if any, return on investment (ROI) analyses of health programs make systematic considerations of patient access, instead focusing principally on gains related to cost and quality. The objective of this study was to develop an open-source model that adds an estimation of gains in patient access to a traditional ROI analysis. A classification system for quantifying gains in patient access is proposed. MATERIALS AND METHODS: An Excel-based ROI model was built that not only incorporated traditional ROI considerations - cost savings and patient cases avoided - but also addressed changes in patient access. The model was then applied in a case study using New Mexico Medicaid data and two proposed initiatives - a statewide health information exchange (HIE) and a community health worker (CHW) program that focused on chronic disease patients. Savings, Health, Outreach, and Access estimates were derived from the literature. ROI estimates were produced that also incorporated relative gains in patient access. RESULTS: Combined, the HIE and CHW programs are predicted to generate a positive ROI by the fourth year, growing to 45% by the program's tenth year. Total estimated cumulative cost for both programs after 10 years is $9,555,226. Total estimated cumulative saving for both programs after 10 years is $11,332,899. Access-related costs begin moderately in year 1 at $122,766 and grow to $1,858,274 by year 10. The model estimates an Access score of 19 in year 1. This figure grew to 380 by year 10. CONCLUSION: Our model shows that a rough estimation of gains in to patient access can be incorporated to traditional ROI analyses. The results of our case study suggest that a CHW program and statewide HIE can generate a positive ROI for the state's Medicaid program.