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There have been 188 rural hospital closures in the United States since 2010 with approximately 20% of these in Appalachia. Telehealth has become a way that nurses can reach rural patients who might not otherwise receive health care. The purpose of this paper is to (1) outline the federal policies enacted during COVID-19 for broadband expansion; and (2) suggest how advanced practice nursing care might be affected by broadband expansion and telehealth in the region. A search of PubMed was conducted in January 2023, using the search words, "policy", "telehealth", "broadband", and "Appalachia". New laws appropriated funds to expand broadband infrastructure that made it possible for telehealth to be used by nurses to deliver health care to rural patients. This discussion paper found that broadband legislation was instrumental in expanding telecommunications and telehealth by NPs. There is a great need for broadband to continue to expand and for trained nurses to provide care via telehealth. [ABSTRACT FROM AUTHOR]

Introduction: Innovative interventions are needed to address the growing burden of breast cancer globally, especially among vulnerable patient populations. Given the success of Community Health Workers (CHWs) in addressing communicable diseases and non-communicable diseases, this scoping review will investigate the roles and impacts of CHWs in breast cancer screening programs. This paper also seeks to determine the effectiveness and feasibility of these programs, with particular attention paid to differences between CHW-led interventions in low- and middle-income countries (LMICs) and high-income countries (HICs).Methods: A scoping review was performed using six databases with dates ranging from 1978 to 2019. Comprehensive definitions and search terms were established for 'Community Health Workers' and 'breast cancer screening', and studies were extracted using the World Bank definition of LMIC. Screening and data extraction were protocolized using multiple independent reviewers. Chi-square test of independence was used for statistical analysis of the incidence of themes in HICs and LMICs.Results: Of the 1,551 papers screened, 33 were included based on inclusion and exclusion criteria. Study locations included the United States (n=27), Bangladesh (n=1), Peru (n=1), Malawi (n=2), Rwanda (n=1), and South Africa (n=1). Three primary roles for CHWs in breast cancer screening were identified: education (n=30), direct assistance or performance of breast cancer screening (n=7), and navigational services (n=6). In these roles, CHWs improved rates of breast cancer screening (n=23) and overall community member knowledge (n=21). Two studies performed cost-analyses of CHW-led interventions.Conclusion: This review extends our understanding of CHW effectiveness to breast cancer screening. It illustrates how CHW involvement in screening programs can have a significant impact in LMICs and HICs, and highlights the three CHW roles of education, direct performance of screening, and navigational services that emerge as useful pillars around which governments and NGOs can design effective programs in this area. [ABSTRACT FROM AUTHOR]

Reproductive coercion (RC) can be conceptualized as any behavior that limits one's ability to make decisions about their reproductive health. Here, we broaden this definition to consider the impact of systemic and sociocultural factors on RC using an ecological model. Specifically, we use Bronfenbrenner's model as a framework for organizing the multilevel factors that influence reproductive coercion (RC) and its impacts on individual health. This paper is intended to offer a primer to historical, sociocultural, community, interpersonal, and individual processes that may interact to shape reproductive decision-making and its effect on individual health outcomes. We emphasize the importance of conceptualizing RC within the broader sociocultural and community context, and the potential implications for reproductive and sexual health research, clinical care, and policy in the United States. [ABSTRACT FROM AUTHOR]

In this paper, we apply the reproductive justice framework to discuss how gendered racism disadvantages pregnant and parenting young Black women aging out of foster care. Specifically, we highlight the reversal of Roe v Wade as reflective of the United States' long legacy of efforts to control Black women's reproduction. We then discuss the structural factors contributing to the reproductive injustices of young Black women aging out of care, including a lack of access to sexual and reproductive health education, barriers to educational attainment, and foster care-based relational and placement deficits. We conclude with research, practice, and policy enhancements. [ABSTRACT FROM AUTHOR]

Environmental health remains a niche topic in bioethics, despite being a prominent social determinant of health. In this paper we argue that if bioethicists are to take the project of health justice as a serious one, then we have to address environmental injustices and the threats they pose to our bioethics principles, health equity, and clinical care. To do this, we lay out three arguments supporting prioritizing environmental health in bioethics based on bioethics principles including a commitment to vulnerable populations and justice. We also highlight and advocate for environmental law efforts that align with these priorities, focusing specifically on the need for a right to a healthy environment. Our intention is to draw attention to the legal and ethical concepts that underlie the importance of a healthy environment, and urge bioethicists to prioritize both legal and ethical advocacy against environmental injustices in their practice. [ABSTRACT FROM AUTHOR]

Given the politicization of abortion, professionals working in U.S. health departments (HDs) may not be receptive to communications about abortion, despite often regulating abortion facilities. This paper reports results of a randomized, prospective, observational study to test the effects of e-mail language when disseminating evidence on abortion to HD professionals. Our sample was 302 HD employees who oversee healthcare facilities inspection/regulation in all 50 U.S. state HDs, clustered by HD and randomized into two study groups. In November–December 2019, we sent biweekly e-mails containing links to a website summarizing evidence on abortion facility regulation. E-mails/headers sent to one group emphasized public health values and did not include the word abortion; e-mails/headers to the other group used the word abortion. Primary outcome measures were e-mail open rates and click-through rates. Among 221 participants to whom e-mails were deliverable, the overall open rate was 36%. Open rate was 25% for PH values and 46% for abortion groups (p <.05). Effects were moderated by state abortion policy environment: in both supportive and restrictive environments, participants in the abortion messaging group were statistically more likely to open e-mails than those in the PH values group. There was no difference between groups in states with middle-ground abortion policy environments. Among participants opening at least one e-mail, 19% clicked through to the website, with no significant difference by group. This study demonstrates that repeated targeted e-mail campaigns can reach HD professionals with research summaries. Concerns that communications to HDs should avoid the word abortion are unsupported. [ABSTRACT FROM AUTHOR]

There is a growing recognition in the fields of public health and medicine that social determinants of health (SDOH) play a key role in driving health inequities and disparities among various groups, such that a focus upon individual-level medical interventions will have limited effects without the consideration of the macro-level factors that dictate how effectively individuals can manage their health. While the health impacts of mass incarceration have been explored, less attention has been paid to how the "war on drugs" in the United States exacerbates many of the factors that negatively impact health and wellbeing, disproportionately impacting low-income communities and people of colour who already experience structural challenges including discrimination, disinvestment, and racism. The U.S. war on drugs has subjected millions to criminalisation, incarceration, and lifelong criminal records, disrupting or altogether eliminating their access to adequate resources and supports to live healthy lives. This paper examines the ways that "drug war logic" has become embedded in key SDOH and systems, such as employment, education, housing, public benefits, family regulation (commonly referred to as the child welfare system), the drug treatment system, and the healthcare system. Rather than supporting the health and wellbeing of individuals, families, and communities, the U.S. drug war has exacerbated harm in these systems through practices such as drug testing, mandatory reporting, zero-tolerance policies, and coerced treatment. We argue that, because the drug war has become embedded in these systems, medical practitioners can play a significant role in promoting individual and community health by reducing the impact of criminalisation upon healthcare service provision and by becoming engaged in policy reform efforts. A drug war logic that prioritises and justifies drug prohibition, criminalisation, and punishment has fuelled the expansion of drug surveillance and control mechanisms in numerous facets of everyday life in the United States negatively impacting key social determinants of health, including housing, education, income, and employment. The U.S. drug war's frontline enforcers are no longer police alone but now include physicians, nurses, teachers, neighbours, social workers, employers, landlords, and others. Physicians and healthcare providers can play a significant role in promoting individual and community health by reducing the impact of criminalisation upon healthcare service provision and engaging in policy reform. [ABSTRACT FROM AUTHOR]

Health policy plays a critical role in determining a state's or nation's overall population health, and health system change has been a priority for a majority of Americans for at least a decade. News coverage can influence health policy development, but little research has examined the quality of that coverage, in part because no consensus exists regarding what information health policy stories should include. This paper describes a series of in-depth interviews with eight health policy experts and 12 experienced journalists who have covered health policy. While rejecting the notion of strict quality criteria that could be applied to all health policy stories, the interviewees agreed on several factors that would improve health policy coverage. They recommended that health policy stories should include information about financial costs to consumers, evidence that a policy will have its intended effect, historical context for the policy, and "relatable hooks" that help consumers understand which groups a policy will affect and how. In addition, the interviewees stressed the importance of building policy coverage on trustworthy sources representing multiple viewpoints and the need to recognize how audience members' values influence their acceptance and interpretation of evidence. These findings provide an important foundation for future research examining the impact of health policy reporting on both public opinion and public policy development. [ABSTRACT FROM AUTHOR]

Lesbian, gay, bisexual, and transgender (LGBT) high school students face challenges that impede their academic, social, and emotional well-being. School policies that provide resources and protections for LGBT students mitigate these challenges and lead to better outcomes for LGBT students. At the same time, LGBT individuals face challenges in sectors like employment protection and hate crime prevalence, and many states have passed laws that expand protections for these adults. This paper aims to investigate the relationship between state-level, LGBT anti-discrimination policies, and high school student well-being by analyzing patterns of policy diffusion and the policies' effects on four measures of students' well-being: self-reported (1) experiences with bullying at school, (2) cyberbullying, (3) school absences due to feeling unsafe at school, and (4) grades. Using data from the Center for Disease Control's Youth Risk Behavior Surveillance System and linear regression analysis with time and state fixed effects, the results of this analysis provide evidence on the benefits of expansive civil rights legislation for LGBT individuals and the spread of its externalities to students in the U.S. schools. [ABSTRACT FROM AUTHOR]

International graduate students deal with an array of stress when arriving in the United States for the purpose of their studies. This stress relates to various difficulties with regards to their acculturation process. In the absence of family and friends, the importance of counselling services on campus is a vital resource for the support of international graduate student. This paper highlights the provisions and importance of culturally competent counselling for international graduate students on US campuses. Key implications are discussed for how university practitioners and administrators might best provide resources and support international graduate students in the future. This could lead to more effective results in the improvement of international students' mental health. [ABSTRACT FROM AUTHOR]

This paper addresses the relevance of medical folklore for vaccine policy intended to increase vaccination uptake. There are two primary claims of this paper: First, that dominant approaches to increasing US vaccination uptake have largely been based on deficient understandings of the root causes of anti-vaccination behavior; and second, that superior approaches to evidence-based policy must enlarge the scope of that evidence base to include crucial findings on belief formation, technical, and risk communication, and the folklore of vaccination. The failure to attend to this evidence results in interventions that are disconnected from the factors actually driving vaccination refusal. The paper describes the deficiencies in dominant approaches, and based on its analysis of the root causes of anti-vaccination behavior recommends superior evidence-based policies that emphasize upstream structural determinants of health behaviors. [ABSTRACT FROM AUTHOR]

Foster parents are required to learn and to navigate a range of policies and regulations in order to make decisions that are in the best interest of the foster child. This paper reviews four policies and regulations (foster parent handbooks, pre-service and in-service training, respite care, and information on points of contact) intended to support family foster homes and examines whether these policies and regulations are available and accessible to the foster parents. Data were collected using a mixed methods research design, including an online search and a survey for child welfare administrators. Findings and implications for policy and practice are discussed. [ABSTRACT FROM AUTHOR]

The annual number of opioid prescriptions for pain relief has been increasing in the United States. This increase has raised concerns about prescription opioid abuse and overdose. The purpose of this study was to examine opioid risks (risk factors that increase the chance of opioid abuse) among uninsured primary care patients utilizing a free clinic. Data were collected using a self-administered paper survey in the waiting room of the free clinic from May to July 2017 (N = 506). Higher levels of somatic symptoms were associated with higher levels of opioid risks. U.S.-born English speakers had higher levels of opioid risk than non–U.S.-born English speakers and Spanish speakers. Being employed was associated with higher levels of opioid risk while attending college or being postcollegiate was related to lower levels of opioid risk. Research surrounding best practices, prescription trends, and population risk is vital in driving health and social policy. Further research would benefit from examining where people are obtaining opioids. In addition, further research on opioid abuse among Hispanic populations would be beneficial. Finally, future studies should examine how prescribing practices are different among free clinic health professionals in comparison to health care professionals working in-patient or at for-profit clinics. [ABSTRACT FROM AUTHOR]

The health disparities that are prevalent among American Indian and Alaska Native (AI/AN) communities are connected to the ideology of sovereignty and often ignored in social work and public health literature. Therefore, the purpose of this paper is to examine the health outcomes of American Indians from the time of contact with European settlers to the present through the ideology of sovereignty and federal government AI health policy. The foundation for the health outcomes of AIs and the governmental policies affecting them lie in the ideology of tribal sovereignty. This ideology has greatly impacted how the government views and treats AIs and consequently, how it has impacted their health. From the earliest treaties between European settlers and AIs, this legal relationship has been and remains a perplexing issue. With the examination of tribal sovereignty comes the realization that colonization and governmental polices have greatly contributed to the many social and health problems that AIs suffer from today. Understanding that the health disparities that exist among AI/AN populations cannot only be attributed to individual behavior and choice but is driven by societal, economic and political factors may be used to inform social work education, practice, and research. [ABSTRACT FROM AUTHOR]

This paper reconsiders the Ebola response in the US as a panic that was both predictable and problematic. Public health professionals and policy-makers have historically drawn attention to and prepared for emerging infectious diseases by raising the specter of catastrophe, generating fears that the media and politicians are often willing to amplify. Although this approach can increase awareness of and funding for global health threats, it also sows the seeds of panic, stigmatizing people associated with the disease, and compromising an effective, evidence-based response. We offer lessons for public health leaders as they review the US Ebola response in order to prepare more responsibly for future disease scares such as that posed by the Zika virus. [ABSTRACT FROM PUBLISHER]

The article discusses that the Brian Earp and his colleagues argue in this issue's target article that racial justice requires ending the War on Drugs (Earp, Lewis, and Hart 2021). It mentions that they are absolutely correct, and the article's title, the authors seem to recognize that ending the War on Drugs is ethically over determined.

Every country will have to prepare for climate change. Despite obvious risks to national security in terms of safety, food, and infrastructure as well as impending economic losses, countries like the United States (US) have declined to pursue meaningful federal action. The human impact of climate change – specifically climate migration and its health implications – has been largely neglected at a policy level. Yet climate migration is predicted to have tremendous consequences for people in the next 30 years and beyond, and with it comes a host of difficulties – political, cultural, economic, and structural. Preparedness will be of great importance to potential migrants and how they adapt to their receiving (host) locations. Health systems are one of the most significant institutions impacting long-term migration and these systems' strengths and weaknesses will determine the integration and well-being of migrants for years to come. A critical analysis of existing literature exposes that there is little current research on health system preparedness as it relates to climate migration, especially in the US. To help address this gap, this paper focuses on how the American health system, already fraught with limitations, can prepare for the expected increase in mostly internal migrants in the face of climate change. Key policy insights Climate migration in the US will pose huge challenges for health systems because of the American health system's unique, pre-existing weaknesses. To prepare for climate migration, federal, state, local, tribal, and territorial governments should focus on adopting a universal healthcare policy, shifting primary care tasks away from physicians and towards other qualified and more ubiquitous professionals, and investing in telemedicine, retail clinics, and a national electronic health record system. A 'health in all policies' approach, which applies a health lens to legislation, needs to be applied in the context of health system strengthening for climate migration since countless environmental determinants of health and infrastructural decisions shape the vulnerability of communities. [ABSTRACT FROM AUTHOR]

The emergence of molecular HIV surveillance (MHS) and cluster detection and response (CDR) programs as key features of the United States (US) HIV strategy since 2018 has caused major controversies. HIV surveillance programs that re-use individuals' routinely collected clinical HIV data do not require consent on the basis that the public benefit of these programs outweighs individuals' rights to opt out. However, criticisms of MHS/CDR have questioned whether expanded uses of HIV genetic sequence data for prevention reach beyond traditional public health ethics frameworks. This study aimed to explore views on consent within MHS/CDR among critical stakeholders. In 2021 we interviewed 26 US HIV stakeholders who identified as being critical or concerned about the rollout of MHS/CDR. Stakeholders included participants belonging to networks of people living with HIV, other advocates, academics, and public health professionals. This analysis focused on identifying the range of positions among critical and concerned stakeholders on consent affordances, opt-outs, how to best inform people living with HIV about how data about them are used in public health programs, and related ethical issues. Participants were broadly supportive of introducing some forms of consent into MHS/CDR. However, they differed on the specifics of implementing consent. While some participants did not support introducing consent affordances, all supported the idea that people living with HIV should be informed about how HIV surveillance and prevention is conducted and how individuals' data are used. MHS/CDR has caused sustained controversy. Among critical stakeholders, consent is generally desirable but contested, although the right for people living with HIV to be informed was centrally supported. In an era of big data-driven public health interventions and routine uses of HIV genetic sequence data in surveillance and prevention, CDC and other agencies should revisit public health ethics frameworks and consider the possibility of consent processes. [ABSTRACT FROM AUTHOR]

Throughout the COVID-19 pandemic, politicization of public health policy has loomed over the governmental response in the United States. The scope of politicization is underscored by instances of political pressures faced by public employees across state and local government. Observation of such instances prompts questions regarding the implications of highly politicized crisis on public personnel systems. Using systematic qualitative content analysis of data from syndicated news articles, this study identifies publicized instances of adverse personnel actions experienced by public employees during the first six months of the COVID-19 pandemic. Following the identification of publicized instances, this study also explores legislative trends focusing on public personnel systems during highly politicized emergency conditions. Results outline the positional roles subject to adverse actions, along with traits of legislative activity changing public personnel systems in the states identified. Implications of the study and considerations for future research are then discussed. [ABSTRACT FROM AUTHOR]

There is a growing interest in HIV infection and sexually transmitted infection (STI) disease burden and risk among transgender people globally; however, the majority of work has been conducted with male-to-female transgender populations. This research synthesis comprehensively reviews HIV and STI research in female-to-male (FTM) transgender adults. A paucity of research exists about HIV and STIs in FTMs. Only 25 peer-reviewed papers (18 quantitative, 7 qualitative) and 11 ‘grey literature’ reports were identified, most in the US or Canada, that include data identifying HIV and STI risks in FTMs (five with fully laboratory-confirmed HIV and/or STIs, and five with partial laboratory confirmation). Little is known about the sexual and drug use risk behaviours contributing to HIV and STIs in FTMs. Future directions are suggested, including the need for routine surveillance and monitoring of HIV and STIs globally by transgender identity, more standardised sexual risk assessment measures, targeted data collection in lower- and middle-income countries, and explicit consideration of the rationale for inclusion/exclusion of FTMs in category-based prevention approaches with MSM and transgender people. Implications for research, policy, programming, and interventions are discussed, including the need to address diverse sexual identities, attractions, and behaviours and engage local FTM communities. [ABSTRACT FROM AUTHOR]

The opening of the Thai tobacco market, following action brought by the US Trade Representative under the General Agreement on Tariffs and Trade, is seen as a key case study of the tensions between trade and health policy. Interpretations of the dispute cast it, either as an example of how trade agreements undermine national policy-making, or how governments can adopt effective public health protections compliant with international trade rules. As a UK-based company, British American Tobacco has been regarded as peripheral to this dispute. This paper argues that its close monitoring of the illegal trade during this period, the role of smuggling in the company's global business strategy, and its management of the relative supply and pricing of legal and illegal products after market opening provide a fuller understanding of the interests and roles of transnational tobacco companies and the government in this dispute. The findings have important policy implications, notably the role of effective governance in countries facing pressure to open their tobacco sectors, need to better understand corporate-level activities within an increasingly globalised tobacco industry, and need to address the intertwined legal and illegal trade in implementing the WHO Framework Convention on Tobacco Control Protocol to Eliminate Illicit Trade in Tobacco Products. [ABSTRACT FROM PUBLISHER]

In 2017, the Trump Administration reinstated and expanded the Global Gag Rule (GGR). This policy requires non-governmental organisations (NGOs) not based in the US to certify that they will not provide, counsel, refer, or advocate for abortion as a method of family planning in order to receive most categories of US global health assistance. Robust empirical evidence demonstrating the policy's impacts is acutely lacking. This paper describes the effects of the expanded GGR policy in Kenya eighteen months after its reinstatement. We conducted semi-structured interviews with purposively selected representatives of US- and non-US-based NGOs, as well as managers and health providers at public and private health facilities, between September 2018 and March 2019. Organisations reported critical funding loss as they were forced to choose between US government-funded projects and projects supporting safe abortion. This resulted in the fragmentation of sexual and reproductive health and HIV services, and closure of some service delivery programmes. At public and private health facilities, participants reported staffing shortages and increased stock-outs of family planning and safe abortion commodities. The expanded GGR's effects transcended abortion care by also disrupting collaboration and health promotion activities, strengthening opposition to sexual and reproductive health and rights in some segments of Kenyan civil society and government. Our findings indicate that the GGR exposes and exacerbates the weaknesses and vulnerabilities of the Kenyan health system, and illuminates the need for action to mitigate these harms. [ABSTRACT FROM AUTHOR]

'Evidence-based' is the key criterion for decision making not only in medicine and other health professions, where it originated and revolutionized what was previously subjective, opinion-based practice, but also across policy and service development. The 'evidence-based' epistemology uses the hierarchy of evidence - a qualitative ranking of information for consideration, as to its cogency - based on a biomedical view of human health. Evidence-based medicine originally proposed that it would contribute to justice by providing the means to make objective, and therefore, fair and equitable decisions, as well as helping to stop the use of ineffective treatments, thus minimizing costs. In this paper, we argue, however, that due to the epistemological ranking of evidence and its implications, only one type of question can ever be answered using this framework and that some groups are unjustly disregarded or excluded because of the limitations inherent in its epistemology; therefore, evidence-based decision making, whether in medicine, other health professions, or policy settings, using the hierarchy of evidence, in fact, can contribute to injustice. This injustice occurs through preferenced evidence generation set against a highly pressurized and competitive research environment, where funding is restricted and the mantra 'publish or perish' creates separate drivers and considerations for research design other than the research problem. We provide evidence of the lack of evidence generation for three specific minority groups and suggest that the epistemological foundations of an evidence-based strategy be revised to include measures of quality that reflect a connectedness not only between the researchers and the affected stakeholders (patient population, service providers, etc.) but also between the methodology/analysis and the problem trying to be solved. [ABSTRACT FROM AUTHOR]

In 2001, Portugal enacted what, for some, was a radical shift in its national drug policy, decriminalized drugs, and implemented a treatment-driven response to drug use. Empirical evaluation of the impacts of this policy “U-turn” continues and the evidence produced so far is both consistent and convincing. It seems by almost any measurement, the Portuguese experiment of drug decriminalization/treatment-driven responses, has been a resounding success. However, these empirical findings do not yet appear to have influenced national drug policy in the USA, which continue to regard decriminalization as “radical” and “extreme”. Similarly disturbing is the lack of substantive contributions to this debate from nurses, especially Psychiatric/Mental Health (P/MH) nurses, which is troubling in a number of ways. Therefore what the authors do in this paper is: first, highlight Portugal's drug decriminalization policy and the evidence forthcoming from evaluations. Second, illuminate the disconcerting lack of substantive contributions to this debate that have been made by P/MH nurses. Third, examine the congruence between Humanistic approaches to P/MH nursing and many of the tenets of Libertarian thinking and policies. And then in drawing these three elements together, the authors exhort P/MH nurses to fulfill their rhetorical, macro-care role and contribute to this much-needed debate. [ABSTRACT FROM AUTHOR]

Older Americans rely heavily on Social Security benefits (SSBs) to support independent lifestyles, and many have few or no additional sources of income. We establish the extent to which SSBs adequately support economic security, benchmarked by the Elder Economic Security Standard Index. We document variability across U.S. counties in the adequacy levels of SSBs among older adults. We find that the average SSBs fall short of what is required for economic security in every county in the United States, but the level of shortfall varies considerably by location. Policy implications relating to strengthening Social Security and other forms of retirement income are discussed. [ABSTRACT FROM AUTHOR]

Health care systems throughout the United States are developing programmes to address patients' 'social determinants of health' – such as housing, food, income and transportation. I investigate the concepts, technologies and infrastructures through which health care systems are turning towards 'the social' as an object of clinical knowledge and intervention. Proponents of this movement suggest that developing the clinical capacity to prescribe social resources promises to improve the 'value' of care, defined as the amount of health achieved per dollar spent. I argue that initiatives to improve value through social intervention are reconstituting broader arrangements of welfare provisioning. [ABSTRACT FROM AUTHOR]

Global health researchers often discount mutual learning and benefit to address shared health challenges across high and low- and middle-income settings. Drawing from a 30-year partnership called AMPATH that started between Indiana University in the US and Moi University in Kenya, we describe an innovative approach and program for mutual learning and benefit coined 'reciprocal innovation.' Reciprocal innovation harnesses a bidirectional, co-constituted, and iterative exchange of ideas, resources, and innovations to address shared health challenges across diverse global settings. The success of AMPATH in Kenya, particularly in HIV/AIDS and community health, resulted in several innovations being 'brought back' to the US. To promote the bidirectional flow of learning and innovations, the Indiana CTSI reciprocal innovation program hosts annual meetings of multinational researchers and practitioners to identify shared health challenges, supports pilot grants for projects with reciprocal exchange and benefit, and produces educational and training materials for investigators. The transformative power of global health to address systemic health inequities embraces equitable and reciprocal partnerships with mutual benefit across countries and communities of academics, practitioners, and policymakers. Leveraging a long-standing partnership, the Indiana CTSI has built a reciprocal innovation program with promise to redefine global health for shared wellbeing at a global scale. [ABSTRACT FROM AUTHOR]

We examined Latinx immigrants' perceptions of US policy related to restrictions on immigrants' use of public resources and their thoughts about the influence of these on immigrants' healthcare utilization. A series of 16 focus group discussions with Latinx immigrant men and women (documented and undocumented) (N = 130) were conducted between May and July 2017 across four US cities. Four central themes emerged: participants attributed the limited resources available for affordable healthcare for many uninsured US immigrants (both documented and undocumented) to the US government's view of immigrants as burdens on public resources and its subsequent unwillingness to dedicate funds for their care; participants expressed concerns, some unfounded, about negative immigration ramifications arising from diagnosis with health conditions perceived to be serious and/or expensive to treat; participants noted that some immigrants avoided using health programs and services to which they were entitled because of immigration concerns; finally, participants described how access to information on immigration laws and healthcare resources, and conversely, misinformation about these, influenced healthcare utilization. Participants were acutely aware of the image of immigrants as public charges or potential burdens on government resources that underlies US immigration policy. In some cases, participants came to inaccurate and potentially harmful conclusions about the substance of laws and regulations based on their beliefs about the government's rejection of immigrants who may burden public resources. This underscores the importance of ensuring that immigrants have access to information on immigration-related laws and regulations and on healthcare resources available to them. Participants noted that access to information also fostered resilience to widespread misinformation. Importantly, however, participants' beliefs had some basis in US immigration policy discourse. Law and policy makers should reconsider legislation and political commentary that frame self-reliance, the guiding principle of US immigration policy, in terms of immigrants' use of publicly funded healthcare resources. [ABSTRACT FROM AUTHOR]

Over the last decade, many countries have adopted policies addressing menstrual needs. Our research explores the opportunities and challenges that have shaped these initiatives and critically examines their scope and substantive focus. Our study analyses developments in four countries: India, Kenya, Senegal, and the United States. It is based on an analysis of 34 policy documents and interviews with 85 participants active in policy-making or advocacy. Across countries, we found a predominant policy focus on tangible and material outcomes, such as menstrual products and facilities, that is informed by a narrow perception of menstrual needs as the management of bleeding. A number of drivers influenced policy-makers to keep this focus, especially the key narrative around menstrual pads as a perceived solution to school absenteeism combined with sensationalisation in the media and the quest for quantifiable results. Menstrual stigma is so ingrained that it continues to constrain policy-makers and advocates themselves by perceiving and presenting menstruation as a problem to be fixed, managed, and hidden. When considering new policy directions, we need to create capacity for a holistic menstrual policy landscape that overcomes systemic barriers to addressing the needs of menstruators that are largely rooted in menstrual stigma. [ABSTRACT FROM AUTHOR]

Early in the coronavirus pandemic, U.S. states implemented several different types of containment measures to slow the disease's spread. Early evidence indicates containment measures were associated with changes in individuals' mental health. This study explores the associations between U.S. state containment measures and older adults' mental health and importantly, whether the associations vary by living arrangement and gender. The study analyzed national sample of adults aged 50 or older from 12 waves (April-July 2020) of the U.S. Household Pulse Survey (N = 394,934). State fixed-effects models linked four state containment measures (stay-at-home order, restaurant closure, bar closure, and movie theater closure) to levels of depression and anxiety across different types of living arrangements, net of controls. Men and women were analyzed separately. Stay-at-home order and restaurant and bar closure, but not movie theater closure, were associated with higher levels of depression and anxiety in older adults. Living arrangements moderated the associations for women but not men. For women, compared to living alone, living with a spouse or intergenerational family was associated with higher levels of anxiety and depression during stay-at-home order and restaurant closure. The associations between containment measures and mental health vary by type of living arrangement and were gendered, likely because household situations create different demands and supports that men and woman experience differently. Although containment measures are necessary to protect public health, paying attention to these underlying dynamics can inform policymakers' efforts to implement policies that balance harms and benefits for older adults. [ABSTRACT FROM AUTHOR]

Persons without family or friends to serve as healthcare agents may become "unrepresented" in healthcare, with no one to serve as healthcare agents when decisional support is needed. Surveys of clinicians (N = 81) and attorneys/guardians (N = 23) in Massachusetts reveal that unrepresented adults experience prolonged hospital stays (66%), delays in receiving palliative care (52%), delays in treatment (49%), and other negative consequences. Clinicians say guardianship is most helpful in resolving issues related to care transitions, medical treatment, quality of life, housing, finances, and safety. However, experiences with guardianship are varied, with delays often/always in court appointments (43%) and actions after appointments (24%). Policy solutions include legal reform, education, and alternate models. [ABSTRACT FROM AUTHOR]

Background: The current United States presidential administration's statements and policies have, in a shockingly short time, catastrophically affected people of color and LGBTQIAþcommunities. And although these numerous discriminatory policies and policy revisions have negatively affected both US people of color and LGBTQIAþpeople, trans women of color have been disproportionately affected. Even more specifically, when focusing on vulnerability to violence--including murder--it is Black trans women who are most directly affected by the intersections of transphobia and racism in the US. This article explores a Black trans woman's experiences with mental health professionals across two decades and different regions of the US. Aims: This article argues for the necessity of understanding trans people's mental health experiences as necessarily intersectional, in order to more fully appreciate and address the degrees to which factors such as race, socioeconomic class, and geographic context matter in trans people's efforts to access ethical and effective mental healthcare. Methods: Using a theoretical framework informed by Kimberlé Crenshaw's single-axis concept, the authors fully center Aryah's intersectional experiences and counter a single-axis in exploring trans mental health issues, our article relies on a narrative-based approach. As narrative inquiry is a broad field, we selected Butler-Kisber's narrative analytic approach, "Starting with the Story" as our method. The narratives are pulled from approximately 10 intensive qualitative interviews over the course of several months. Discussion: These narratives disrupt the common threads in the literature that ignore the degrees to which race and class matter alongside being a trans woman. In addition, as we noted that nearly all of the mental health literature relied on large-scale survey-based data, this article offers a qualitative narrative exploration of Aryah's experiences and works to humanize trans mental health challenges and needs, while emphasizing the multilayered oppressions and obstacles that affected Aryah. [ABSTRACT FROM AUTHOR]

Background: Several aspects of the opioid epidemic and of public health care organization in the United States (US) make the conduct of economic evaluation and the design of policies to respond to this crisis particularly challenging. Objectives: This commentary offers suggestions for how economic evaluation may address and overcome four key features of the opioid epidemic: 1) its magnitude and geographical distribution, 2) its intersection with multiple epidemics, 3) its rapidly changing dynamics, 4) its multi-sectoral causes and consequences. Results: We first offer pragmatic suggestions to address the difficulties in delivering a coordinated response given the fragmented nature of health care in the US. In view of the broad suite of responses required to address opioid use disorder and its associated comorbidities, we highlight the need for economic evaluations which consider interventions throughout the continuum of care (i.e. primary, secondary and tertiary levels of prevention). We examine how the use of predictive modelling alongside economic evaluation might be adopted to address the rapidly evolving situation affecting distinct populations and geographic areas and encourage investments in epidemic preparedness. Finally, we propose methods to capture the interdependence of various sectors of government affected by the opioid crisis in economic evaluations to ensure optimal levels of investment towards a comprehensive response. Conclusions: The opioid epidemic in the US represents an unprecedented public health challenge, but sound epidemiological modelling and economic analysis can help to guide use of limited resources committed to addressing it in ways that can have greatest impact in limiting its adverse consequences. [ABSTRACT FROM AUTHOR]

Limited attention has focused on midlife health. Yet, this is a time of great change, including onset of chronic conditions and changes in mental health. To examine unmet healthcare needs among midlife adults (50–64 years) in the US with severe psychological distress (SPD) and/or multiple chronic conditions (MCC). Nationally representative data for midlife adults (50–64 years) from NHIS 2014–2018 were examined (n = 39,329). Multimorbidity status: no MCC/SPD, MCC alone, SPD alone, or both. We used logistic regression to estimate adjusted odds ratios (AOR) of delayed or foregone care by multimorbidity status. Nearly 40% of midlife adults had MCC, SPD, or SPD/MCC. SPD with or without MCC had higher prevalence of social disadvantage, fair/poor health, activity limitations, and delayed/foregone healthcare. Compared to those with neither, adults with SPD/MCC were more likely to delay care due to limited office hours (AOR = 4.2, 95% CI 3.1–5.5) and had nearly three to four times higher odds of delays for all other reasons. Those with SPD/MCC had higher odds of needing but not getting mental healthcare (AOR = 6.4, 95% CI 4.5–9.1), prescriptions (AOR = 4.8, 95% CI 3.9–5.9), or follow-up care (AOR = 5.0, 95% CI 3.7–6.6), and three to four times higher odds of all other types of foregone care. Midlife adults with SPD/MCC have substantial unmet healthcare needs. Midlife is a critical time to manage both chronic conditions and mental illness. Coordinated efforts by policymakers and healthcare systems are crucial to address complex healthcare needs of this population at a critical stage of the life-course. [ABSTRACT FROM AUTHOR]

This study investigated the association between interest in Pre-exposure Prophylaxis (PrEP) in the US using Google Health Trends as a source of big data and state policy variables of Medicaid expansions under the Affordable Care Act (ACA) and initiation of PrEP Assistance Programs (PrEP-AP). As of December 2019, thirty-three states and the District of Columbia have accepted federal Medicaid funding provided through the ACA to expand eligibility to low-income adults. Among these expansion states, eight states also implemented PrEP-AP, a program that finances PrEP. A difference-in-differences approach estimated how changes in Google search for PrEP before and after the expansion differed across expansion and non-expansion states. Analyses also gauged whether the magnitude of the correlation between Medicaid expansions and Google searches was higher in states that also initiated PrEP-AP. Findings indicated that the Medicaid expansions were associated with a higher share of Google searches for PrEP keywords ( β = 1.536 , S.E. =.36, p <.001). Moreover, the magnitude of correlation for some keywords was higher in states that also implemented PrEP-APs. [ABSTRACT FROM AUTHOR]

The article focuses on debates on access to medical products and disability bioethics that claims challenges and mentions appealing work on cognitive biases and theoretical work on problems of partial representation. Topics include optimism concerning sharing insights across experimental gaps, concerns raised by bioethics community on approaches weakening regulatory authority of U.S. Food & Drug Administration (FDA), and providing access on evidence to patients to interfere with trials.

In 1980, the U.S. military instituted a zero-tolerance policy for illicit substance use that led to a reduction in such use during military services. Long-term post-military effects have not been studied. National survey data from 2012-2013 were used to compared veteran versus non-veteran differences in sociodemographic, behavioral and substance use and psychiatric diagnoses among women by cohort (i.e., those younger than 52 who would have entered the military under the no tolerance policy, and those older than 52 who would have entered before this policy was implemented). Multivariate interaction analyses between cohorts and veteran status were used to identify significant changes in veteran-non-veteran differences between these age cohorts on during the decades following the implementation of the zero-tolerance policy. Significant interactions primarily involved substance use diagnoses which were less frequent among veterans than non-veterans in the younger group of women, in contrast to the older group in which veterans had greater rates of substance use than non-veterans. These patterns were less robust for alcohol than substance use disorders and were not significant for psychiatric disorders. The zero-tolerance policy appears to have had a long-term effect resulting in less substance use disorder and, to some extent, less alcohol use disorder among veterans as compared to non-veterans who served in the military after the zero-tolerance policy was implemented. [ABSTRACT FROM AUTHOR]

Objective To examine health behavior and environmental perception differences among vegetarian and nonvegetarian students. Participants: First-year university students (n = 1078) from eight United States universities. Methods: Data were obtained from base 2015 and followup 2016 assessments. Vegetarians and nonvegetarians were compared for anthropometrics, lifestyle behaviors, and campus environmental perceptions (CEPS). Results: Vegetarians had smaller waist circumference, lower systolic blood pressure, higher fruit and vegetable consumption, lower percentage of energy obtained from fat, and higher perceived stress. Vegetarians expressed a lower rating of perceptions of health policies on campus. Conclusion: A clear difference in indicators of physical health does not appear, however, vegetarian students show positive dietary patterns which can promote positive health outcomes. Further, vegetarians had lower perceptions of health policies on campus. Results can be used by administrators to ensure policies are in place to support health of students as currently vegetarian students see limitations in the environmental health policies. [ABSTRACT FROM AUTHOR]

The Global Gag Rule is a United States policy that blocks global health funding to foreign non-governmental organisations if they engage in abortion-related activities. It has been implemented by every Republican administration since 1984 and remains in operation at the time of writing in its most stringent and extensive form. It has been criticised for its implications for women's bodily autonomy, its censorship of non-governmental organisations and health professionals, and for its impact on the health of populations in affected countries. To capture the effects of the policy to date, we conducted a scoping review in April 2020. Forty-eight articles met our eligibility criteria, and were analysed thematically, noting the effects on: the operations of non-governmental organisations; maternal health; sexually transmitted infections; marginalised groups; reproductive rights. We found that the policy increased the abortion rate and had a negative impact on maternal health, STIs, and the health of marginalised groups. We conclude that the policy amounts to the neocolonial co-optation of sexual and reproductive health in the Global South to advance an ideological agenda in the Global North. We urge that the policy be repealed as part of the broader project of protecting and decolonising sexual and reproductive health globally. [ABSTRACT FROM AUTHOR]

Research suggests that a major barrier to mental health treatment is not knowing where to go for services, yet little is known about the specific steps people take to find treatment. To (1) understand the process people would undertake if they decided they needed mental health treatment and (2) examine how well the process that current non-treatment-seeking individuals describe matches that used by individuals currently in treatment. Adults recruited online via Amazon's Mechanical Turk (N = 669) answered questions about finding a mental health provider. Participants who had (N = 167) and had not (N = 502) seen a mental health provider in the past month were compared. Both groups indicated they would rely on Internet searches and recommendations of family, friends and physicians to find mental health providers. The order in which participants indicated they would use each step was similar across groups as was participants' confidence these steps would help them find a provider. Differences emerged in the factors each group indicated were important to their selection of a provider. Results can inform mental health providers and policy makers regarding the importance of clear and informative online mental health information, including thorough information about appropriate mental health providers. [ABSTRACT FROM AUTHOR]

In 2019, several US states passed "heartbeat" bills. Should such bills go into effect, they would outlaw abortion once an embryonic heartbeat can be detected, thereby severely limiting an individual's access to abortion. Many states allow health care professionals to refuse to provide an abortion for reasons of conscience. Yet heartbeat bills do not include a positive conscience clause that would allow health care professionals to provide an abortion for reasons of conscience. I argue that this asymmetry is unjustified. The same criteria that justify protecting conscientious refusals to provide abortion also justify protecting positive conscientious appeals regarding abortion. Thus, if the law provides legal exemptions for health care professionals who, as a matter of conscience, refuse to provide abortions where it is legal, it should also provide exemptions for health care professionals who, as a matter of conscience, feel obligated to provide abortions where it is illegal. [ABSTRACT FROM AUTHOR]

Deeply rooted on human rights principles, there is a growing international agreement to prohibit non-consensual medical interventions to intersex persons. In contrast, medical protocols for intersex care in the United States are guided by clinical wisdom and guidelines that are not legally binding. But as the medical profession is called to respect and to champion the right to health within human rights principles, expert opinion in the United States has become unsettled when confronted with current standards of intersex care. In this study, we tracked the human rights arguments by international institutions that effectively impacted clinical standards for the care of intersex persons around the globe during this decade, and we studied the use of rhetoric by key policy stakeholders that seek to uphold intersex medical care in the United States to these international standards. We conclude that the medical establishment in the United States does not meet international standards of human rights as it enforces an outdated definition of 'sex'. [ABSTRACT FROM AUTHOR]

Background: We report the potential negative health consequences of immigration policies and enforcement actions, such as the increase of at-risk drinking, in the US Latino seasonal farmworker (LSFW) community. Method: Logistic regression analysis was performed using data from 213 female LSFWs over age 18 years. Results: The prevalence of at-risk drinking varied across participants' age groups: 18% for ages 21–29, 14% ages 30–39, 12% ages 40–49, and 32% ages 50 and older. Half of the participants reported being worried/tense, because they had difficulties finding legal services for their immigration status, and 65% reported that they have been questioned about their legal status. Of participants, 55% reported feeling worried/tense, because they were treated badly due to their lack of English; 42% because they have felt unaccepted by others due to their Latino culture; and 44% because they have been discriminated against. Legal and discrimination concerns were associated with at-risk drinking. Discussion: Enactment of new immigration policies and enforcement of existing immigration policies should consider negative public health implications. Novel approaches should be explored to more effectively reach and engage LSFW at-risk of problematic alcohol use or in need of substance use treatment. [ABSTRACT FROM AUTHOR]

As the opioid crisis in the United States evolved, so did the relationship between prescribers and pharmaceutical companies that manufacture prescription opioids, with policymakers at both the state and national levels focused on the issue of prescription opioid misuse. This article discusses the role of the prescriber–pharmaceutical company relationship with respect to opioid over- and underprescribing, the evolution of that relationship over time, and its contribution to what is now commonly known as the U.S. opioid crisis or overdose epidemic. The United States saw several "waves" of prescription opioid misuse, and this article characterizes the relationship between prescribers and pharmaceutical companies in similar waves. The article proposes several prescriber- and manufacturer-focused "solutions" that can be implemented to address and lessen the effects of the ongoing crisis. Changes directed at prescribers and manufacturers must be implemented in tandem to ensure such solutions do not, in attempting to fill the existing cracks in the system, create even more. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the authors discuss the various topics tackled within the issue, like trial home visits of children in out-of-home care, foster care, and the risk factors for maltreatment after permanency through adoption.

Background: Health messages become most pertinent during elections, when citizens are more receptive to political messages. Political communication tools work to create a 'climate of opinion' to influence public sentiment and reporters' perceptions of health political ideologies and priorities. In considering how parties communicate with voters about health, this study aimed to examine the health-related discourse during presidential elections. Method: A content analysis was undertaken, including the political manifestos and the first address to the parliament of the elected candidate in the latest presidential elections of France, Spain, and the US. Results: A total of 266 content units were identified and analyzed. Findings revealed the dominance of the health-related political debate around the following themes: 'costs' (n = 89), 'health systems' (n = 59), 'healthcare' (n = 59), 'welfare' (n = 42), 'preventive care' (n = 22), and 'telehealth' (n = 21). The French campaign highlighted some current public health challenges, such as 'prevention' and 'health inequalities'. Conclusions: In the three analyzed countries, a narrow dimensional view of health was found in political communication materials, mainly focusing on health costs and healthcare services. The theoretical and practical implications of the findings are further discussed. [ABSTRACT FROM AUTHOR]

The passage of the 2018 United States Agriculture Improvement Act removed industrial hemp, defined as Cannabis sativa L. containing less than 0.3% THC content by dry weight, from Schedule I of the Controlled Substances Act and made it an agricultural commodity. Following these changes, the popularity of hemp-derived cannabidiol (CBD) dietary supplements by consumers has greatly exceeded the scientific understanding of purported benefits, safety and composition of these botanical extracts. Further complicating CBD hemp supplement regulation, Food and Drug Administration (FDA) considers CBD to be an approved drug (Epidiolex) in the treatment of severe epilepsy disorders, Dravet and Lennox-Gastaut syndromes. At the same time, hemp-derived CBD supplements can contain a complex phytochemical matrix from the hemp plant, distinguishing the composition of these products from isolated CBD preparations. This work aims to provide clarity on differentiating botanical full-spectrum hemp extracts containing CBD from isolates, from a phytochemical, toxicological and regulatory perspective. [ABSTRACT FROM AUTHOR]

In the United States, the older adult population will reach over 70 million by 2030. Impaired function and falls from unsupportive housing result in high healthcare costs. Due to the state of housing, there is a need for home modifications to support older adults. This article reviews the current state of home modifications for this population in the United States. There is a dearth of programs and financial support to provide these interventions. Various initiatives exist, however, the lack of national models results in unmet needs. Replicable, high-quality home modification interventions should be supported to serve older adults. [ABSTRACT FROM AUTHOR]

This article explores why racial and income health disparities continue to exist in the United States. Poverty and racism are the primary drivers of the social problem which impact social determinants of health for vulnerable populations. The theoretical frameworks of conflict theory and critical race theory contextualize the causes and provide direction for overhauling public health policy in general and the Patient Protection and Affordable Care Act (Affordable Care Act) in particular. Although the Affordable Care Act was implemented to increase health coverage, economic and racial health inequities still exist in the United States. Policy recommendations for improving the health and welfare of low-income minorities include: 1) impacting poverty itself by desegregating urban areas of concentrated poverty, and 2) impacting racial discrimination in health care by putting the voices of African-American patients in the forefront to inform culturally relevant policy and practice. [ABSTRACT FROM AUTHOR]

The disproportionate burden of HIV-related inequities borne by African Americans in the US South amplifies the role of social determinants of health (SDH) in shaping social patterning of illness. Despite some attention, SDH remain overlooked in a biomedically oriented, federal HIV policy. Mississippi is the poorest state with the worst HIV outcomes, nationally. Using qualitative methods, we investigated how primarily African American, HIV-positive Mississippians experienced SDH and health inequities in their daily lives. Employing grounded theory and in-depth interviews (n = 25) in an urban and rural site in 2015 yielded these findings: (1) absence of an enabling structural environment; (a) HIV-stigma constructed via social discourse; (b) lack of psycho-social support and HIV education; (c) insufficient economic and social support resources; and (2) presence of family support for coping. Due to stigma, being HIV-positive seemed to lead to further status loss; diminished social position; reduced life chances; and contractions in particular freedoms. Stigma further compounded existing inequalities – contributing to the moral, social experience of those living with HIV. Trump's plan to end HIV by 2030 creates the opportunity to rethink the biomedical-paradigm and fully engage SDH – using social science theory and methods that address multi-level social determinants in ways that are also policy-responsive. [ABSTRACT FROM AUTHOR]