Dawn Pepin

Introduction: In 2014, the Affordable Care Act (ACA) mandated that newly eligible Medicaid expansion beneficiaries receive recommended preventive services at no cost. Yet, evidence regarding the Medicaid expansion population's use of preventive services is limited. Methods: Medicaid claims data from 2011 to 2019. We focused on 12 selected preventive services that received new, revised, or upheld A or B USPSTF ratings since 2010. Results: We find that receipt of preventive services among the Medicaid Expansion population increased from 22% in 2014 to 26% in 2019, with 41% of beneficiaries receiving at least one of the 12 examined services from 2014 to 2019. The most received services were screening tests for HIV infection, cervical cancer, chlamydia and gonorrhea, and hepatitis C virus infection. Receipt of at least one preventive service was highest among non-Hispanic Asian, non-Hispanic Black, and Hispanic beneficiaries. Conclusion: Future changes to Medicaid expansion eligibility or preventive services recommendations could potentially disrupt these utilization patterns, with possible disproportionate effects on people from racial and ethnic minority populations.

The COVID-19 pandemic and associated prevention measures reshaped students’ lives. We estimated the effects of virtual learning during the pandemic on adolescents’ mental health, suicidal thoughts and behaviors, substance use, and violence-related experiences and behaviors. Using Youth Risk Behavior Survey data from 25 local jurisdictions, we compared overall and relative changes from 2019 (n = 49,740) to 2021 (n = 42,995) between jurisdictions where high school students predominantly attended school virtually vs. in-person during the 2020–2021 school year with Rao-Scott chi-square tests and difference-in-differences logistic regression. P-values<0.050 were considered significant. From 2019 to 2021, reported persistent feelings of sadness/hopelessness (2019 = 36.3%, 2021 = 41.3%), seriously considering suicide (17.0-18.7%), making suicide plan(s) (14.2-16.9%), and experiencing sexual dating violence in past 12 months (6.7-7.8%) increased significantly, while alcohol use (22.5-17.1%), binge drinking (8.5-6.2%), and marijuana use (20.2-14.3%) in past 30 days, ever prescription opioid misuse (16.0-13.2%), and gun-carrying (5.5-4.5%), physical fighting (22.3-17.3%), and any sexual violence (11.3-10.4%) in past 12 months decreased significantly. Students in virtual learning jurisdictions reported relative decreases in injury during suicide attempt(s) (OR=0.68, 95%CI = 0.52-0.88), experiencing sexual violence (OR=0.78, 95%CI = 0.67-0.91), using electronic vapor products (OR=0.81, 95%CI = 0.70-0.95), using alcohol (OR=0.84, 95%CI = 0.74-0.95), and misusing prescription opioids (OR=0.82, 95%CI = 0.72-0.94). Learning model was not associated with relative changes in persistent feelings of sadness/hopelessness, seriously considering suicide, making suicide plan(s), attempting suicide, binge drinking, marijuana use, gun-carrying, physical fighting, experiencing sexual dating violence, or being electronically bullied. Additional efforts to support schools in providing safe, supportive environments are needed, particularly where schools returned in-person in fall 2020.

In the United States, older adults have elevated prevalence of latent tuberculosis infection (LTBI) and incidence of tuberculosis (TB). To estimate the health benefits and cost-effectiveness of LTBI testing and treatment among the Medicare-eligible population. Model-based cost-effectiveness analysis. Nationally representative surveys and published evidence. Medicare-eligible persons aged 65 years or older with at least 1 of 15 factors associated with elevated TB risk, as identified by guidelines from the U.S. Preventive Services Task Force (USPSTF) and other organizations. Lifetime. Societal. One-time offer of LTBI testing and treatment versus no intervention. Lifetime TB cases and deaths averted, quality-adjusted life-years (QALYs) gained, costs, and incremental cost-effectiveness ratios (ICERs). In 2022, there were an estimated 29.9 million Medicare-eligible persons (95% uncertainty interval [UI], 28.4 to 31.6 million persons) aged 65 years or older with elevated TB risks, including 14.7 million (95% UI, 13.4 to 16.0 million) with USPSTF-recommended factors. In the target population, 4.9 million persons (95% UI, 4.0 to 5.8 million persons) (16.4% [95% UI, 13.9% to 19.1%]) were estimated to have LTBI. Testing and treatment of LTBI was estimated to prevent 10 946 TB cases (95% UI, 4684 to 20 579 cases) and 2579 TB deaths (95% UI, 1106 to 4882 deaths), with 13 234 lifetime QALYs (95% UI, 5343 to 25 519 lifetime QALYs) gained. For the overall target population and for persons with USPSTF-recommended factors, ICERs were $192 000 (95% UI, $92 000 to $503 000) and $155 000 (95% UI, $77 000 to $393 000) per QALY gained, respectively. The ICER was $109 000 (95% UI, $49 000 to $285 000) per QALY gained for 65-year-olds newly eligible for Medicare. Health benefits from averted post-TB sequelae were not estimated. Medicare-eligible persons represent approximately one third of all U.S. persons with LTBI. Testing and treatment of LTBI in this population could lead to substantial reductions in TB and TB-related mortality, particularly among 65-year-olds newly eligible for Medicare. Centers for Disease Control and Prevention.

Objectives. To describe provision of HIV telehealth services during the COVID-19 pandemic using data from the Centers for Disease Control and Prevention (CDC) Medical Monitoring Project Facility Survey for the Ending the HIV Epidemic in the United States initiative, which aims to achieve an at least 90% reduction in new HIV infections by 2030 and highlights telehealth as an important strategy. Methods. During 2021, we surveyed 1023 facilities providing HIV care to a nationally representative sample of US adults with diagnosed HIV, of which 45% responded. We calculated weighted percentages with 95% confidence intervals comparing the characteristics of facilities providing telehealth services. Results. Overall, 83.4% of facilities provided HIV care telehealth services by the facility’s own providers (82.0%) or by outside providers through remote conferencing (27.0%). Gaps in coverage were identified in smaller facilities and in facilities in rural and primary care health professional shortage areas. Conclusions. Although most HIV care facilities provided telehealth services during the COVID-19 pandemic, gaps were identified, which must be addressed to meet Ending the HIV Epidemic in the United States goals and better prepare for future health emergencies. ( Am J Public Health. 2025;115(3):349–353. https://doi.org/10.2105/AJPH.2024.307908 )

Context: Public health policy can play an important role in improving public health outcomes. Accordingly, there has been an increasing emphasis by policy makers on identifying and implementing evidence-informed public health policy interventions. Program or Policy: Growth and refinement of the field of research assessing the impact of legal interventions on health outcomes, known as legal epidemiology, prompted this review of studies on the relationship between laws and health or economic outcomes. Implementation: Authors systematically searched 8 major literature databases for all English language journal articles that assessed the effect of a law on health and economic outcomes published between January 1, 2009, and September 18, 2019. This search generated 12 570 unique articles 177 of which met inclusion criteria. The team conducting the systematic review was a multidisciplinary team that included health economists and public health policy researchers, as well as public health lawyers with expertise in legal epidemiological research methods. The authors identified and assessed the types of methods used to measure the laws' health impact. Evaluation: In this review, the authors examine how legal epidemiological research methods have been described in the literature as well as trends among the studies. Overall, 3 major themes emerged from this study: (1) limited variability in the sources of the health data across the studies, (2) limited differences in the methodological approaches used to connect law to health outcomes, and (3) lack of transparency surrounding the source and quality of the legal data relied upon. Discussion: Through highlighting public health law research methodologies, this systematic review may inform researchers, practitioners, and lawmakers on how to better examine and understand the impacts of legal interventions on health and economic outcomes. Findings may serve as a source of suggested practices in conducting legal epidemiological outcomes research and identifying conceptual and method-related gaps in the literature.

Opioid-involved drug overdose deaths have been a growing concern in the United States for several decades. The Centers for Disease Control and Prevention identified several strategies to address the opioid overdose epidemic, including increased availability of and access to medication-assisted treatment and guidance on safer opioid prescribing practices. Telehealth offers the potential for increasing access and availability to these strategies, and laws governing telehealth have implications for their utilization. To understand how state telehealth laws intersect with the opioid overdose epidemic, we conducted a legal mapping study, a type of legal epidemiological assessment, of statutes and regulations that intersect at telehealth and opioids. This search yielded 28 laws from 17 states. These laws intersect both telehealth and the opioid overdose epidemic in different ways including prescribing limitations, opioid treatment through medication and counseling, patient plan review, and professional collaboration. Continued legal and policy surveillance is needed to be able to evaluate the impact of law in addressing opioid overdose outcomes.

In 2014 in the United States, an infant with neonatal abstinence syndrome (NAS) was born every 15 minutes. Historically, NAS surveillance has depended on hospital discharge data, frequently with a time lag, limiting ability to rapidly direct public health resources.

Objectives: In all health system sectors, electronic health information (EHI) is created, used, released, and reused. We examined states’ efforts to address EHI uses in law to provide an understanding of the EHI legal environment.Methods: Attorney researchers used WestlawNext to search for EHI-related statutes and regulations of the US states, US territories, and the District of Columbia in effect as of January 2014. The researchers independently catalogued provisions by the EHI use described in the law. Researchers resolved discrepancies through peer review meetings and recorded the consensus codes for each law.Results: This study identified 2364 EHI-related laws representing 49 EHI uses in 54 jurisdictions. A total of 18 EHI uses were regulated by ≥10 jurisdictions. More than 750 laws addressed 2 or more EHI uses. Jurisdictions varied by the number of EHI laws in effect, with a mean of 44 laws. Texas had the most EHI laws (n = 145). Hawaii and South Carolina had the fewest (n = 14 each).Conclusions: The EHI legal landscape is complex. The large quantity and diversity of laws complicate legal analysis, likely delay implementation of public health solutions, and might be detrimental to the development of emerging health information technology. Research is needed to understand the effect of EHI-related laws.