RESUMO
BACKGROUND: A collective trauma like COVID-19 impacts individuals differently due to socio-contextual and individual characteristics. Younger adults, minorities, affiliates of certain political parties, and residents of some regions of the United States reported experiencing poorer mental health during the pandemic. Being diagnosed with COVID-19, or losing a friend/family to it, was related to more adverse mental health symptoms. While the negative impact of COVID-19 on health outcomes has been studied, mental health changes during this pandemic need further exploration. METHODS: In a study of 8,612 U.S. households, using three surveys collected from a nationally representative panel between May 2020 and October 2021, using a repeated cross-sectional design, a linear mixed effect regression model was performed to investigate factors associated with the mental health status, based on the Mental Health Inventory-5, of individuals throughout different phases of the COVID-19 pandemic, and whether an improvement over time, especially after vaccines became available, was observed. RESULTS: An overall improvement in mental health was observed after vaccines became available. Individuals with no COVID-related death in their household, those not wearing masks, those identifying as members of the Republican Party, race/ethnicities other than Asian, men, older adults, and residents of the South were less likely than others to report mental health challenges. CONCLUSIONS: Our results highlight the need for widespread mental health interventions and health promotion to address challenges during the COVID-19 pandemic and beyond. Due to the worse mental health observed among Asians, younger adults, women, low-income families, those with a higher level of concern for COVID-19, people who lost someone to COVID-19, and/or individuals with histories of opioid use disorder and criminal legal involvement, over the period of this study, targeted attention needs to be given to the mental health of these groups.
Assuntos
Vacinas contra COVID-19 , COVID-19 , Saúde Mental , Feminino , Humanos , Masculino , COVID-19/epidemiologia , Estudos Transversais , Pandemias , Fatores SociodemográficosRESUMO
PURPOSE: The rise of fatal stimulant use among adults who use opioids is a public health problem. Internalized stigma is a barrier to substance use treatment, which is greater for women and populations with criminal justice involvement. METHODS: Using a nationally representative sample of adults in the United States from a probability-based survey on household opinions in 2021, we examined characteristics of women (n = 289) and men (n = 416) who misuse opioids. In gender-stratified multivariable linear regression, we investigated factors associated with internalized stigma, and tested for the interaction of stimulant use and criminal justice involvement. RESULTS: Compared to men, women reported greater mental health symptom severity (3.2 vs. 2.7 on a 1 to 6 scale, p < 0.001). Internalized stigma was similar between women (2.3 ± 1.1) and men (2.2 ± 0.1). Among women and not men, however, stimulant use was positively associated with internalized stigma (0.36, 95% CI [0.07, 0.65]; p = 0.02). Interaction between stimulant use and criminal justice involvement was negatively associated with internalized stigma among women (- 0.60, 95% CI [- 1.16, -0.04]; p = 0.04); among men, the interaction was not significant. Predictive margins illustrate among women, stimulant use eliminated the gap in internalized stigma such that women with no criminal justice involvement had a similar level of internalized stigma as women with criminal justice involvement. CONCLUSION: Internalized stigma between women and men who misuse opioids differed based on stimulant use and criminal justice involvement. Future research should assess whether internalized stigma influences treatment utilization among women with criminal justice involvement.
Assuntos
Analgésicos Opioides , Transtornos Relacionados ao Uso de Substâncias , Adulto , Humanos , Masculino , Feminino , Estados Unidos/epidemiologia , Analgésicos Opioides/uso terapêutico , Identidade de Gênero , Direito Penal , Estigma SocialRESUMO
Improving interactions between first responders and individuals experiencing behavioral crisis is a critical public health challenge. To gain insight into these interactions, key informant qualitative interviews were conducted with 25 Chicago stakeholders. Stakeholders included directors and staff of community organizations and shelters that frequently engage first responders. Interviews included granular depictions related to the expectations and outcomes of 911 behavioral crisis calls, and noted areas requiring improved response. Stakeholders called 911 an average of 2 to 3 times per month, most often for assistance related to involuntary hospitalization. Engagements with first responders included unnecessary escalation or coercive tactics, or conversely, refusal of service. While stakeholders lauded the value of police trained through the city's Crisis Intervention Team program, they emphasized the need for additional response strategies that reduce the role of armed police, and underscored the need for broader social and behavioral health services for individuals at-risk of such crises.
Assuntos
Intervenção em Crise , Polícia , Humanos , Chicago , Comportamento CooperativoRESUMO
Policy Points In the preexpansion period, federally qualified health centers (FQHCs) in Medicaid expansion states were significantly different from those in nonexpansion states. This gap widened as revenues in expansion states continued to grow at a faster rate after the expansion. If Medicaid expansion had occurred nationwide, FQHCs' revenue and capacity could have increased substantially. Over time, Medicaid could play a bigger role as it becomes a more stable funding source to allow for capital investments. Section 330 grants appear to have a larger impact on access to care. Given the varying levels of reliance on Medicaid, investing through federal grants might be more effective and equitable. CONTEXT: The Health Resources and Services Administration's Health Center Program (HCP) plays a critical role as the national ambulatory safety net, delivering services to patients in medically underserved areas, regardless of their ability to pay. As the program has grown, health policy initiatives may have altered access to care for the underserved population. Understanding how federally qualified health centers (FQHCs) have been affected by past policies is important for anticipating the effects of future policies. METHODS: By analyzing a national data set from the Uniform Data System, we examined, using two sets of random effects regressions, the potential impact of alternative policy actions affecting FQHCs. Our primary equation models the number of full-time equivalent staff, of patients served, and of visits provided in the subsequent year as a function of Medicaid revenues, Section 330 grants, and other revenues. Our secondary equation is a difference-in-differences analysis that models Medicaid revenues as a function of the states' status of Medicaid expansion. FINDINGS: The expansion of Medicaid in nonexpansion states could have increased Medicaid revenues by 138%, staffing by 25%, and patients' visits by 24% in 2017. Compared to the impact of a "repeal" of Medicaid expansion, the percentage of reductions in staffing would be similar to those predicted by a 50% cut in Medicaid revenues or in Section 330 grants. On a dollar-for-dollar basis, the effects of one dollar of Section 330 grants were more than double that of one dollar of Medicaid revenue. CONCLUSIONS: Both Medicaid eligibility and Section 330 funding support are important to the HCP, and Section 330 grants are particularly closely related to staffing and the provision of services. States' decisions not to participate in or to repeal Medicaid expansion, to reduce Medicaid payment rates, and federal funding cuts all could have a negative impact on FQHCs, resulting in thousands of low-income patients losing access to primary care.
Assuntos
Medicaid , Patient Protection and Affordable Care Act , Centros Comunitários de Saúde , Definição da Elegibilidade , Acessibilidade aos Serviços de Saúde , Humanos , Estados Unidos , Recursos HumanosRESUMO
Political affiliation, racial attitudes, and opioid stigma influence public support for public health responses to address opioid use disorders (OUD). Prior studies suggest public perceptions of the opioid epidemic are less racialized and less politically polarized than were public perceptions of the crack cocaine epidemic. Analyzing a cross-sectional, nationally representative sample (n = 1161 U.S. adults) from the October 2020 AmeriSpeak survey, we explored how political affiliation, racial attitudes (as captured in the Color-Blind Racial Attitudes Scale [CoBRAS]), and OUD stigma were associated with respondents' expressed views regarding four critical domains. Respondents with unfavorable attitudes towards Black Americans were less likely to support expanding Medicaid funding, increasing government spending to provide services for people living with OUD, and distributing naloxone for overdose prevention. Democratic Party affiliation was associated with greater support for all three of the above measures, and increased support for mandatory treatment, which may be seen as a substitute for more punitive interventions. Black respondents were also less likely to support expanding Medicaid funding, increasing government spending to provide services for people living with OUD, and of distributing naloxone. Our finding suggest that negative attitudes towards African-Americans and political differences remain important factors of public opinion on responding to the OUD epidemic, even after controlling for opioid stigma. Our findings also suggest that culturally-competent dialogue within politically conservative and Black communities may be important to engage public support for evidence-informed treatment and prevention.
Assuntos
Analgésicos Opioides , Transtornos Relacionados ao Uso de Opioides , Adulto , Analgésicos Opioides/uso terapêutico , Atitude , Estudos Transversais , Humanos , Naloxona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Políticas , Estados UnidosRESUMO
Just one in ten nonfatal shootings in Chicago lead to an arrest. Unlike in fatal cases, gunshot victims who survive can often provide information of use in the police investigation. Nonetheless, nonfatal shooting cases in Chicago and elsewhere have much lower arrest rates than fatal cases, in part because most victims do not cooperate. We use data from the Chicago Inmate Survey (CIS) to analyze the potential value that gunshot-victim cooperation could have for increasing arrest rates. Half of CIS respondents reported they had been shot before. Very few cooperated with police investigations of these shootings, although at least half of them could have provided useful information. In fact, victims were more likely to speak with the police when they did not have any information on their shooter. Respondents explained their choice not to cooperate by reference to "street codes" against snitching, mistrust of the police, and the desire to retaliate against the shooter personally. If more shooting victims could be persuaded to cooperate, the police could solve more cases and hence be more effective in curtailing gun violence.
Assuntos
Violência com Arma de Fogo , Ferimentos por Arma de Fogo , Chicago , Humanos , Polícia , Inquéritos e QuestionáriosRESUMO
The COVID-19 pandemic is just one of two public health crises the new Biden administration will confront. The addiction crisis is the other. The opioid epidemic has already killed more Americans than World Wars I and II combined. And it is but the most visible sign of a broader population health challenge that includes methamphetamine, cocaine, benzodiazepines, and alcohol. This article presents practical legislative and executive actions that are required for addressing these challenges. The authors focus on two broad policy challenges: (1) improving financing and delivery of treatment for substance use disorders, and (2) reducing population exposure to addictive and lethal substances. Through both of these channels, a portfolio of well-implemented, evidence-informed policies can save many thousands of lives every year.
Assuntos
Comportamento Aditivo/prevenção & controle , Atenção à Saúde/economia , Atenção à Saúde/normas , Epidemia de Opioides/prevenção & controle , Políticas , Saúde Pública , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Governo Federal , Órgãos Governamentais , Humanos , Setor Privado , Setor Público , Estados UnidosRESUMO
The United States is now experiencing public health catastrophe on a scale not seen for more than a century. COVID-19 puts into stark relief the mutual obligations that reflect interdependence among participants in a common society. Drawing on the work of Amartya Sen concerning famine and related challenges, the author discusses the accompanying implications for social justice. Social justice in catastrophe requires strong social insurance structures and legal protections for the most vulnerable people, who would otherwise lack economic resources and political influence to protect their essential interests. Social justice also requires greater and more sustained attention to disaster preparedness and public health infrastructure-both of which are characteristically neglected, in part because the public health enterprise is identified with politically weak and often stigmatized populations.
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COVID-19/epidemiologia , Pandemias , Saúde Pública , Justiça Social , Disparidades nos Níveis de Saúde , Humanos , Estados Unidos/epidemiologia , Populações VulneráveisRESUMO
CONTEXT: In contrast to the Affordable Care Act, some have suggested the opioid epidemic represents an area of bipartisanship. This raises an important question: to what extent are Democrat-led and Republican-led states different or similar in their policy responses to the opioid epidemic? METHODS: Three main methodological approaches were used to assess state-level policy responses to the opioid epidemic: a legislative analysis across all 50 states, an online survey of 50 state Medicaid agencies, and in-depth case studies with policy stakeholders in five states. FINDINGS: Conservative states pursue hidden and targeted Medicaid expansions, and a number of legislative initiatives, to address the opioid crisis. However, the total fiscal commitment among these Republican-led states pales in comparison to states that adopt the ACA Medicaid expansion. Because the state legislative initiatives do not provide treatment, these states spend substantially less than states with Democratic control. CONCLUSIONS: Rather than persistently working to retrench all programs, conservatives have relied on policy designs that emphasize devolution, fragmentation, and inequality to both expand and retrench benefits. This strategy, which allocates benefits differentially to different social groups and obfuscates responsibility, allows conservatives to avoid political blame typically associated with retrenchment.
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Cobertura do Seguro/legislação & jurisprudência , Medicaid/legislação & jurisprudência , Epidemia de Opioides , Patient Protection and Affordable Care Act/legislação & jurisprudência , Políticas , Política , Governo Estadual , Humanos , Cobertura do Seguro/economia , Medicaid/economia , Patient Protection and Affordable Care Act/economia , Estados UnidosRESUMO
Objectives. To assess states' provision of technical assistance and allocation of block grants for treatment, prevention, and outreach after the expansion of health insurance coverage for addiction treatment in the United States under the Affordable Care Act (ACA). Methods. We used 2 waves of survey data collected from Single State Agencies in 2014 and 2017 as part of the National Drug Abuse Treatment System Survey. Results. The percentage of states providing technical assistance for cross-sector collaboration and workforce development increased. States also shifted funds from outpatient to residential treatment services. However, resources for opioid use disorder medications changed little. Subanalyses indicated that technical assistance priorities and allocation of funds for treatment services differed between Medicaid expansion and nonexpansion states. Public Health Implications. The ACA's infusion of new public and private funds enabled states to reallocate funds to residential services, which are not as likely to be covered by health insurance. The limited allocation of block grant funds for effective opioid medications is concerning in light of the opioid crisis, especially in states that did not implement the ACA's Medicaid expansion.
Assuntos
Financiamento Governamental , Cobertura do Seguro/economia , Patient Protection and Affordable Care Act/economia , Governo Estadual , Transtornos Relacionados ao Uso de Substâncias/terapia , Alocação de Custos , Humanos , Medicaid/economia , Medicaid/organização & administração , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/terapia , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Estados UnidosRESUMO
OBJECTIVES: To examine how utilization restrictions on state Medicaid benefits for buprenorphine are related to addiction treatment programs' decision to offer the drug. METHODS: We used data from 2 waves of the National Drug Abuse Treatment System Survey conducted in 2014 and 2017 in the United States to assess the relationship of utilization restrictions to buprenorphine availability. RESULTS: The proportion of programs offering buprenorphine was 43.2% in states that did not impose any utilization restrictions, 25.5% in states that imposed only annual limits, 17.3% in states that imposed only prior authorization, and 12.8% in states that imposed both. Programs in states requiring prior authorization from Medicaid had substantially lower odds of offering buprenorphine (odds ratio = 0.50; 95% confidence interval = 0.29, 0.87). CONCLUSIONS: Medicaid prior authorization was linked to lower odds of buprenorphine provision among addiction treatment programs. Public Health Implications. State Medicaid prior authorization requirements are linked to reduced odds of buprenorphine provision among addiction treatment programs and may discourage prescribing.
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Buprenorfina/provisão & distribuição , Buprenorfina/uso terapêutico , Equipamentos e Provisões Hospitalares/economia , Medicaid/economia , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Centros de Tratamento de Abuso de Substâncias/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados UnidosRESUMO
OBJECTIVES: To identify individuals at risk for behavioral health (BH)-involved encounters with police in Chicago, Illinois. METHODS: We linked Chicago Police Department (CPD) arrest and Fire Department (CFD) BH-involved ambulance event data. We identified at-risk individuals who accumulated at least 1 BH-involved ambulance and at least 1 arrest event between May 2016 and April 2017. We identified a high-use subgroup displaying most intensive services use. We identified high-use locations with highest volume of ambulance events with only CFD data. RESULTS: Of 83 392 individuals and 116 105 events in the linked emergency events data, 1842 at-risk individuals accounted for 2.2% of individuals, 5.6% of all events, and 16% of BH-involved CFD events with police involvement. A total of 330 high-use individuals accounted for 0.4% of individuals, 2% of events, and 4.7% of CFD events with police involvement. Top-100 high-use locations accounted for 9% of CFD events, and individuals of high-use location events are largely distinct from high-use individuals. CONCLUSIONS: Integrated police and ambulance data hold promise to identify individuals at risk for BH-involved encounters with police and to support proactive interventions to prevent or improve response at these encounters.
Assuntos
Ambulâncias/estatística & dados numéricos , Intervenção em Crise/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Polícia , Adulto , Chicago , Feminino , Humanos , Masculino , Transtornos Mentais/psicologiaRESUMO
Guns that are used in crime and recovered by the police typically have changed hands often since first retail sale and are quite old. While there is an extensive literature on "time to crime" for guns, defined as the elapsed time from first retail sale to known use in a crime, there is little information available on the duration of the "last link"-the elapsed time from the transaction that actually provided the offender with the gun in question. In this article, we use data from the new Chicago Inmate Survey (CIS) to estimate the duration of the last link. The median is just 2 months. Many of the gun-involved respondents to the CIS (42%) did not have any gun 6 months prior to their arrest for the current crime. The CIS respondents were almost all barred from purchasing a gun from a gun store because of their prior criminal record-as a result, their guns were obtained by illegal transactions with friends, relatives, and the underground market. We conclude that more effective enforcement of the laws governing gun transactions may have a quick and pervasive effect on gun use in crime.
Assuntos
Criminosos/estatística & dados numéricos , Armas de Fogo/estatística & dados numéricos , Chicago , Comércio/estatística & dados numéricos , Crime/estatística & dados numéricos , Humanos , Masculino , Polícia , Inquéritos e Questionários , Fatores de TempoRESUMO
The dental setting is a largely untapped venue to identify patients with undiagnosed HIV infection. Yet, uptake of rapid HIV testing within the dental community remains low. This study sought to better understand the experiences of dental professionals who have administered the test and how these experiences might inform efforts to promote greater uptake of rapid HIV testing in dental settings. Qualitative interviews were conducted with United States dentists (N = 37) and hygienists (N = 5) who offered rapid HIV testing in their practices. The data revealed both the impeding and facilitating factors they experienced in implementing testing in their setting, as well as the reactions of their staff, colleagues, and patients. Overall, participants viewed rapid HIV testing favorably, regarding it as a valuable public health service that is simple to administer, generally well accepted by patients and staff, and easily integrated into clinical practice. Many had experience with a reactive test result. Participants described facilitating factors, such as supportive follow-up resources. However, they also cited persistent barriers that limit acceptance by their dental colleagues, including insufficient reimbursement and perceived incompatibility with scope of practice. The widespread adoption of routine HIV testing amongst dental professionals will likely require an expanded notion of the proper scope of their professional role in overall patient health, along with greater support from national dental organizations, dental education, and dental insurance companies, especially in the form of sufficient reimbursement.
Assuntos
Atitude do Pessoal de Saúde , Odontólogos/psicologia , Infecções por HIV/diagnóstico , Programas de Rastreamento/métodos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Papel Profissional , Adulto , Relações Dentista-Paciente , Estudos de Viabilidade , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Percepção , Pesquisa Qualitativa , Estados UnidosRESUMO
This Viewpoint discusses 3 types of systemic health inequity experienced by individuals with intellectual and developmental disabilitiesstigma, exclusion, and devaluation of worth; underrepresentation in population epidemiology and research; and inadequate access to care and social servicesand suggests potential approaches to ameliorating inequities in each of these areas.
Assuntos
Deficiências do Desenvolvimento , Pessoas com Deficiência , Equidade em Saúde , Deficiência Intelectual , Criança , Humanos , Deficiências do Desenvolvimento/terapia , Equidade em Saúde/normas , Disparidades em Assistência à Saúde , Deficiência Intelectual/terapiaAssuntos
Analgésicos Opioides/intoxicação , Overdose de Drogas/prevenção & controle , Controle de Medicamentos e Entorpecentes , Fentanila/intoxicação , Transtornos Relacionados ao Uso de Opioides/mortalidade , Overdose de Drogas/tratamento farmacológico , Overdose de Drogas/mortalidade , Humanos , Drogas Ilícitas/química , Drogas Ilícitas/intoxicação , Naloxona/administração & dosagem , Antagonistas de Entorpecentes/administração & dosagem , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/terapia , Saúde Pública , Estados Unidos/epidemiologiaRESUMO
Gun violence exacts a lethal toll on public health. This paper focuses on reducing access to firearms by dangerous offenders, contributing original empirical data on the gun transactions that arm offenders in Chicago. Conducted in the fall of 2013, analysis of an open-ended survey of 99 inmates of Cook County Jail focuses on a subset of violence-prone individuals with the goal of improving law enforcement actions. Among our principal findings: *Our respondents (adult offenders living in Chicago or nearby) obtain most of their guns from their social network of personal connections. Rarely is the proximate source either direct purchase from a gun store, or theft. *Only about 60% of guns in the possession of respondents were obtained by purchase or trade. Other common arrangements include sharing guns and holding guns for others. *About one in seven respondents report selling guns, but in only a few cases as a regular source of income. *Gangs continue to play some role in Chicago in organizing gun buys and in distributing guns to members as needed. *The Chicago Police Department has a considerable effect on the workings of the underground gun market through deterrence. Transactions with strangers and less-trusted associates are limited by concerns over arrest risk (if the buyer should happen to be an undercover officer or a snitch), and about being caught with a "dirty" gun (one that has been fired in a crime).