Jordan M. Rook

Introduction: Despite the association of meth/amphetamine use with risk for unintentional injury and interpersonal violence, screening for meth/amphetamine use among injured patients is not required at US trauma centers. Methods: Using data from the American College of Surgeons Trauma Quality Programs dataset, we examined the prevalence of meth/amphetamine positivity on urine drug screen and its association with clinical outcomes at 873 trauma centers. Results: Of 4.5 million adult trauma patients, 1.5 million (33%) received a urine drug screen, of which 11% were positive for meth/amphetamines. Rates of positivity increased from 9% in 2017 to 12% in 2022. Prevalence among those screened varied widely across trauma centers (interquartile range 4%-16%). Patients who screened positive for meth/amphetamine presented with more severe injuries and required longer hospitalizations. Conclusion: Our findings indicate that meth/amphetamine use is common among trauma patients, with a prevalence several times higher than national averages. For this population, improved screening and intervention for meth/amphetamine use disorder at US trauma centers may represent an opportunity to prevent reinjury and improve the health of patients and their communities.

Objectives. To assess the relationship between the expiration of the expanded child tax credit (ECTC) and changes in energy insecurity among US households with children from 2021 to 2022. Methods. We used nationally representative survey data to evaluate changes in energy insecurity among credit-eligible versus -ineligible households during and after the ECTC expansion. We performed difference-in-differences analyses to estimate changes in energy insecurity in the 2 groups and conducted stratified analyses by percentage of the federal poverty line. Results. There was a 0.95 percentage point increase in inability to pay energy bills (95% confidence interval = 0.07, 1.85) among households with children but no difference in other measures of energy insecurity. Stratified analyses showed that households at 200% to 399% and 400% to 599% of the federal poverty line experienced increases in energy insecurity after expiration of the ECTC. We saw no differences in the lowest-income groups (< 200% federal poverty line). Conclusions. The expiration of the ECTC was associated with increased inability to pay energy bills, suggesting that the credit prevented some forms of energy insecurity in households with children. Associations were limited to middle-income groups, indicating benefits were limited to this income stratum. ( Am J Public Health. 2025;115(8):1312–1321. https://doi.org/10.2105/AJPH.2025.308105 )

Objective: To determine whether high-deductible health plans (HDHPs) are associated with complicated disease and hospitalization costs for children with appendicitis. Background: Nearly 60% of families with non-governmental employer-sponsored insurance are enrolled in HDHPs. It is unknown how these plans affect children who require surgical care. Methods: This retrospective cohort study used the 2016 to 2020 MarketScan data set. We included children aged 17 years and younger with non-governmental employer-sponsored insurance who were treated for acute appendicitis. The exposure was a binary variable indicating family enrollment in a HDHP. We assessed the outcomes of complicated appendicitis and hospitalization costs. We used machine learning-based propensity score weights and multivariable regression to assess the association between HDHP enrollment and outcomes. Covariates included age, sex, geographic region, comorbidities, prior health care utilization, and month and year treated. Results: Of 18,291 children treated for appendicitis, 40.6% (n = 7434) were enrolled in HDHPs. Groups exhibited covariate balance after propensity score weighting. HDHP enrollment was associated with a 2.6 percentage point (95% CI: 1.2 to 3.9; P < 0.001) increase in the likelihood of presenting with complicated appendicitis (33.2% vs 30.6%), a $2491 (95% CI: $2428 to $2555; P < 0.001) increase in out-of-pocket costs ($4341 vs $1850), and a $703 (95% CI: $185 to $1222; P = 0.008) increase in total costs ($24,556 vs $23,852). Conclusions: Children in HDHPs more often present with complicated appendicitis and require more costly hospitalizations. High levels of cost sharing, a dominant component of most private insurance plans, may not serve the needs of children with acute illnesses and can increase costs to patients and society.

Cox model stratified by ‘Treatment Site’, three category model

Specified rates of misdiagnosis given to patients with gastric adenocarcinoma

Comparison of the Kaplan Meier curves for overall survival and disease specific survival for patients with gastric adenocarcinoma.

Cox model stratified by ‘Misdiagnosed’