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Carbon markets play an important role in firms' and governments' climate strategies. Carbon crediting mechanisms allow project developers to earn carbon credits through mitigation projects. Several studies have raised concerns about environmental integrity, though a systematic evaluation is missing. We synthesized studies relying on experimental or rigorous observational methods, covering 14 studies on 2346 carbon mitigation projects and 51 studies investigating similar field interventions implemented without issuing carbon credits. The analysis covers one-fifth of the credit volume issued to date, almost 1 billion tons of CO 2 e. We estimate that less than 16% of the carbon credits issued to the investigated projects constitute real emission reductions, with 11% for cookstoves, 16% for SF 6 destruction, 25% for avoided deforestation, 68% for HFC-23 abatement, and no statistically significant emission reductions from wind power and improved forest management projects. Carbon crediting mechanisms need to be reformed fundamentally to meaningfully contribute to climate change mitigation., Competing Interests: Competing interests The authors declare the following competing interests: L.S. is a member of the Executive Board of the Clean Development Mechanism. The other authors declare no competing interests., (© 2024. The Author(s).)

Without perspectives of low-wage workers in studies of worker health and well-being, researchers cannot comprehensively assess occupational health and health equity impacts of workplace exposures and interventions. Researchers and practitioners have noted particular challenges in engaging low-wage workers in worksite-based health survey research, yet little scholarship has described strategies for improving their engagement and response rates. To fill this gap, we present case examples from 5 occupational studies conducted between 2020 and 2024 in industries including health care, food service, and fulfillment centers. For each case, we describe how we identified barriers to worker engagement in surveys, explain specific strategies we used to address those barriers, and assess the effectiveness of these actions. Then, summarizing across case examples, we offer practical recommendations to researchers surveying low-wage populations, highlighting that high-touch recruitment, building trust with workers and managers, and obtaining manager support to take surveys during work time (for worksite-based studies) are critical for obtaining reliable, representative data. Our work contributes to broader discussions on improving survey response rates in vulnerable worker populations and aims to support future researchers undertaking similar efforts. ( Am J Public Health . Published online ahead of print November 14, 2024:e1-e8. https://doi.org/10.2105/AJPH.2024.307875).

During the initial year of the COVID-19 pandemic, a disproportionate share of COVID-19-related deaths occurred among nursing home residents. Initial estimates of all-cause mortality rates also spiked in early and late 2020 before falling to near or below historical rates by early 2021. During the first 3 years of the pandemic, the US nursing home resident population also decreased by 18% (239 000 fewer residents) compared with pre-pandemic levels. After accounting for these population changes, the all-cause nursing home mortality rate has remained above pre-pandemic levels through the middle of 2023. The peak was in December 2020 at 5692 deaths per 100 000 residents, which was 19% higher than estimates not accounting for the population decrease., Competing Interests: Conflicts of interest Please see ICMJE form(s) for author conflicts of interest. These have been provided as supplementary materials., (© The Author(s) 2024. Published by Oxford University Press on behalf of Project HOPE - The People-To-People Health Foundation, Inc.)

Objectives: To examine heterogeneity in physician batch ordering practices and measure the associations between a physician's tendency to batch order imaging tests on patient outcomes and resource utilization., Study Setting and Design: In this retrospective study, we used comprehensive EMR data from patients who visited the Mayo Clinic of Arizona Emergency Department (ED) between October 6, 2018 and December 31, 2019. Primary outcomes are patient length of stay (LOS) in the ED, number of diagnostic imaging tests ordered during a patient encounter, and patients' return with admission to the ED within 72 h. The association between outcomes and physician batch tendency was measured using a multivariable linear regression controlling for various covariates., Data Sources and Analytic Sample: The Mayo Clinic of Arizona Emergency Department recorded approximately 50,836 visits, all randomly assigned to physicians during the study period. After excluding rare complaints, we were left with an analytical sample of 43,299 patient encounters., Principal Findings: Findings show that having a physician with a batch tendency 1 standard deviation (SD) greater than the average physician was associated with a 4.5% increase in ED LOS (p < 0.001). It was also associated with a 14.8% (0.2 percentage points) decrease in the probability of a 72-h return with admission (p < 0.001), implying that batching may lead to more comprehensive evaluations, reducing the need for short-term revisits. A batch tendency 1SD greater than that of the average physician was also associated with an additional 8 imaging tests ordered per 100 patient encounters (p < 0.001), suggesting that batch ordering may be leading to tests that would not have been otherwise ordered had the physician waited for the results from one test before placing their next order., Conclusions: This study highlights the considerable impact of physicians' diagnostic test ordering strategies on ED efficiency and patient care. The results also highlight the need to develop guidelines to optimize ED test ordering practices., (© 2024 Health Research and Educational Trust.)

Importance: Poverty is associated with greater barriers to health care and worse health outcomes, but it remains unclear whether income support can improve health., Objective: To examine the effect of cash benefits on health care utilization and health., Design, Setting, and Participants: The City of Chelsea, Massachusetts, a low-income community near Boston, randomly assigned individuals by lottery to receive cash benefits. Participants' medical records were linked across multiple health systems. Outcomes were assessed during the intervention period from November 24, 2020, to August 31, 2021., Intervention: Cash benefits via debit card of up to $400 per month for 9 months., Main Outcomes and Measures: The primary outcome was emergency department visits. Secondary outcomes included specific types of emergency department visits, outpatient use overall and by specialty, COVID-19 vaccination, and biomarkers such as cholesterol levels., Results: Among 2880 individuals who applied for the lottery, mean age was 45.1 years and 77% were female. The 1746 participants randomized to receive the cash benefits had significantly fewer emergency department visits compared with the control group (217.1 vs 317.5 emergency department visits per 1000 persons; adjusted difference, -87.0 per 1000 persons [95% CI, -160.2 to -13.8]). This included reductions in emergency department visits related to behavioral health (-21.6 visits per 1000 persons [95% CI, -40.2 to -3.1]) and substance use (-12.8 visits per 1000 persons [95% CI, -25.0 to -0.6]) as well as those that resulted in a hospitalization (-27.3 visits per 1000 persons [95% CI, -53.6 to -1.1]). The cash benefit had no statistically significant effect on total outpatient visits (424.3 visits per 1000 persons [95% CI, -118.6 to 967.2]), visits to primary care (-90.4 visits per 1000 persons [95% CI, -308.1 to 127.2]), or outpatient behavioral health (83.5 visits per 1000 persons [95% CI, -182.9 to 349.9]). Outpatient visits to other subspecialties were higher in the cash benefit group compared with the control group (303.1 visits per 1000 persons [95% CI, 32.9 to 573.2]), particularly for individuals without a car. The cash benefit had no statistically significant effect on COVID-19 vaccination, blood pressure, body weight, glycated hemoglobin, or cholesterol level., Conclusions and Relevance: In this randomized study, individuals who received a cash benefit had significantly fewer emergency department visits, including those related to behavioral health and substance use, fewer admissions to the hospital from the emergency department, and increased use of outpatient subspecialty care. Study results suggest that policies that seek to alleviate poverty by providing income support may have important benefits for health and access to care.

Objective: To examine how a novel payer-provider joint venture (JV) between one payer and multiple competitive delivery systems in New Hampshire (NH), which included value-based payment, care management, and non-financial supports, impacted healthcare value and payer and provider group experiences., Study Setting and Design: We conducted a mixed-methods study. We used a quasi-experimental longitudinal difference-in-differences design to examine the impact of the JV (which started in January 2016 and ended in December 2020) on healthcare utilization, quality, and spending, using members in Maine (ME) as a control group. We also analyzed patient uptake of the JV's care management program using routinely collected administrative data and assessed payer and provider group leaders' perspectives about the JV via semi-structured interviews., Data Sources and Analytic Sample: We used administrative and claims data from 2013 to 2019 in a commercially insured population under 65 years in NH and ME. We also used administrative data on care management eligibility and uptake and conducted semi-structured interviews with payer and provider group leaders affiliated with the JV., Principal Findings: The JV was associated with no sustained change in medical utilization, quality, and spending throughout the study period. In the first year of the JV, there was a $142 (95% confidence interval: $41, $243) increase in pharmaceutical spending per member and a 13% (4.4%, 25%) relative increase in days covered for diabetes medications. Only 15% of eligible members engaged in care management, which was a key component of the JV's multi-pronged approach. In a disconnect from the empirical findings, payer and provider group leaders believed that the JV reduced healthcare costs and improved quality., Conclusions: Our findings provide evidence for future payer-provider JVs and demonstrate the importance of having a valid control group when evaluating JVs and value-based payment arrangements., (© 2024 Health Research and Educational Trust.)

COVID-19 precipitated sharp job losses, concentrated in the service sector. Prior research suggests that such shocks would negatively affect health and wellbeing. However, the nature of the pandemic crisis was distinct in ways that may have mitigated any such negative effects, and historic expansions in unemployment insurance (UI) may have buffered workers from negative health consequences. We draw on employer-employee linked cross-sectional (N = 15,219) and panel (N = 3307) data from service sector workers to estimate the effects of job loss on health and wellbeing during COVID-19. Using employer fixed-effects, lagged dependent variables, and models that focus on job loss due to establishment closure to minimize confounding, we find negative effects of unemployment on health and wellbeing. However, in periods when UI was most generous or in cases where UI fully replaced pre-job loss wages, unemployed workers who received UI were no worse off than those who remained employed. Although UI protected against worsening health, receiving generous UI benefits did not confer a health advantage relative to working at the height of the pandemic., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Benzodiazepines are commonly prescribed for post-acute ischemic stroke for anxiety, insomnia, and agitation. While guidelines discourage use in those aged ≥65 years, little is known about prescription patterns at the national level., Methods: We analyzed a 20% sample of US Medicare claims from April 1, 2013, to September 30, 2021. We selected beneficiaries aged ≥65 years discharged alive following an acute ischemic stroke who had traditional Medicare coverage and 6 months' prior enrollment in Parts A (hospital insurance), B (Medical insurance), and D (drug coverage). We excluded those with prior benzodiazepine prescriptions, self-discharges, or discharge to skilled nursing facilities. We examined demographics, comorbidities, first prescription days' supply, cumulative incidences of benzodiazepine first prescription fills within 90 days after discharge, and geographic and yearly trends., Results: We included 126 050 beneficiaries with a mean age of 78 years (SD, 8); 54% were female and 82% were White. Within 90 days, 6127 (4.9%) initiated a benzodiazepine. Among new prescriptions, lorazepam (40%) and alprazolam (33%) were the most prescribed. Most (76%) of first fills had a day's supply over 7 days and 55% between 15 and 30 days. Female initiation rates were higher (5.5% [95% CI, 5.3-5.7]) than male initiation rates (3.8% [95% CI, 3.6%-3.9%]). Rates were highest in the southeast (5.1% [95% CI, 4.8%-5.3%]) and lowest in the midwest (4.0% [95% CI, 3.8%-4.3%]), with a modest nationwide initiation decline from 2013 to 2021 (cumulative incidence difference, 1.6%)., Conclusions: Despite a gradual decline in benzodiazepine initiation from 2013 to 2021, we noted excessive supplies in prescriptions post-acute ischemic stroke discharge, underscoring the need for improved policies., Competing Interests: Dr Hsu receives support from the National Institutes of Health, the Agency for Healthcare Research and Quality, Brandies University, Altmed, Cambridge Health Alliance, Columbia University, Invitrx, and the University of South Carolina and reports no conflict of interest. Dr Blacker receives support from the National Institute of Neurological Disorders and Stroke and the National Institute on Aging and reports no conflict of interest. Dr Newhouse is the director of the National Committee for Quality Assurance and reports no conflict of interest. Dr Moura receives support from the Epilepsy Foundation of America and reports no conflict of interest. The other authors report no conflicts.

Lack of trust is a key barrier to collaboration in organizations and is exacerbated in contexts when employees subscribe to different ideological beliefs. Across five preregistered experiments, we find that people judge ideological opponents as more trustworthy when opposing opinions are expressed through a self-revealing personal narrative than through either data or stories about third parties-even when the content of the messages is carefully controlled to be consistent. Trust does not suffer when explanations grounded in self-revealing personal narratives are augmented with data, suggesting that our results are not driven by quantitative aversion. Perceptions of trustworthiness are mediated by the speaker's apparent vulnerability and are greater when the self-revelation is of a more sensitive nature. Consequently, people are more willing to collaborate with ideological opponents who support their views by embedding data in a self-revealing personal narrative, rather than relying on data-only explanations. We discuss the implications of these results for future research on trust as well as for organizational practice. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Humanity's long-term welfare may lie in the hands of those who are presently living, raising the question of whether people today hold the generations of tomorrow in their moral circles. Five studies (N Total = 1652; Prolific) reveal present-oriented bias in the moral standing of future generations, with greater perceived moral obligation, moral concern, and prosocial intentions for proximal relative to distal future targets. Yet, present-oriented bias appears stronger for socially close compared with socially distant targets and for human targets relative to non-human animals and entities in nature. Individual differences, including longtermism beliefs and subjective imaginative vividness, predict greater concern for and obligation to the future. Likewise, concern and obligation predict greater future-oriented generosity. Our studies are among the first to explore moral considerations for targets across deep temporal expanses, reconcile conflicting evidence in the extant literature on moral judgment and future-thinking, and offer practical implications for bettering the shared societal future., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Clinical prediction models (CPMs) are tools that compute the risk of an outcome given a set of patient characteristics and are routinely used to inform patients, guide treatment decision-making, and resource allocation. Although much hope has been placed on CPMs to mitigate human biases, CPMs may potentially contribute to racial disparities in decision-making and resource allocation. While some policymakers, professional organizations, and scholars have called for eliminating race as a variable from CPMs, others raise concerns that excluding race may exacerbate healthcare disparities and this controversy remains unresolved. The Guidance for Unbiased predictive Information for healthcare Decision-making and Equity (GUIDE) provides expert guidelines for model developers and health system administrators on the transparent use of race in CPMs and mitigation of algorithmic bias across contexts developed through a 5-round, modified Delphi process from a diverse 14-person technical expert panel (TEP). Deliberations affirmed that race is a social construct and that the goals of prediction are distinct from those of causal inference, and emphasized: the importance of decisional context (e.g., shared decision-making versus healthcare rationing); the conflicting nature of different anti-discrimination principles (e.g., anticlassification versus antisubordination principles); and the importance of identifying and balancing trade-offs in achieving equity-related goals with race-aware versus race-unaware CPMs for conditions where racial identity is prognostically informative. The GUIDE, comprising 31 key items in the development and use of CPMs in healthcare, outlines foundational principles, distinguishes between bias and fairness, and offers guidance for examining subgroup invalidity and using race as a variable in CPMs. This GUIDE presents a living document that supports appraisal and reporting of bias in CPMs to support best practice in CPM development and use., (© 2024. The Author(s).)

Scholars warn that partisan divisions in the mass public threaten the health of American democracy. We conducted a megastudy ( n = 32,059 participants) testing 25 treatments designed by academics and practitioners to reduce Americans' partisan animosity and antidemocratic attitudes. We find that many treatments reduced partisan animosity, most strongly by highlighting relatable sympathetic individuals with different political beliefs or by emphasizing common identities shared by rival partisans. We also identify several treatments that reduced support for undemocratic practices-most strongly by correcting misperceptions of rival partisans' views or highlighting the threat of democratic collapse-which shows that antidemocratic attitudes are not intractable. Taken together, the study's findings identify promising general strategies for reducing partisan division and improving democratic attitudes, shedding theoretical light on challenges facing American democracy.

Competing Interests: Declaration of interests In the past 5 years, HW received grant funding for gambling-related research by the Economic and Social Research Council, National Institute for Health Research, Wellcome Trust, the Gambling Commission (including their regulatory settlement fund), Office of Health Disparities and Improvements–Public Health England, Greater London Authority, Greater Manchester Combined Authority, Blackburn with Darwen Local Authority, and the Department of Digital Culture Media and Sport; received funding from GambleAware for a project on gambling and suicide in 2018–19; received consulting fees from the Institute of Public Health, Ireland, and the National Institute for Economic and Social Research; received payment for delivery of seminars from McGill University, the University of Birmingham, Johns Hopkins University, and from the British Broadcasting Corporation; has been paid as an expert witness by Lambeth and Middlesborough Borough Councils; received travel costs paid by Gambling Regulators European Forum, the Turkish Green Crescent Society, Alberta Gambling Research Institute, the REITOX Academy (administered through the Austrian National Public Health Institute), and the University of Helsinki; served as Deputy Chair of the Advisory Board for Safer Gambling between 2015 and 2020, remunerated by the Gambling Commission; is a Member of the WHO panel on gambling (ongoing) and provided unpaid advice on research to GamCare for their Safer Gambling Standard (from 2019 until mid-2021); runs a research consultancy for public and third-sector bodies only; has not, and does not, provide consultancy services to gambling industry actors; in researching the gambling industry and their practices, HW declares occasional attendance at events where gambling industry actors are present (including industry-sponsored conferences); as part of her work on the Gambling Survey for Great Britain, HW is required by the Gambling Commission (the funder) to participate in events disseminating research findings to their stakeholders, which includes the industry; her attendance at events where industry is present is independently funded and does not involve collaborations or partnerships with industry. AR discloses grant funding for gambling-related projects from Suicide Prevention Australia, The Winston Churchill Memorial Trust, Australia's National Research Organisation for Women's Safety, Victorian Responsible Gambling Foundation, Federation University Australia, and membership of the WHO panel on gambling; received funding for travel for the 2019 WHO meeting by the Turkish Green Crescent Society; received consultancy funding from WHO to prepare a factsheet on Gambling and conducted a paid peer reviews for Auckland University of Technology and the British Academic Forum for the Study of Gambling, administered via Gambling Research Exchange Ontario and funded through regulatory settlements. VM discloses grant funding for gambling-related projects from the Academy of Finland (projects 349589, 31834), the Finnish Ministry of Social Affairs and Health, and the Finnish Ministry of Justice; as a member of the Gambling Harms Evaluation Committee (2021–ongoing) and the Indicators for Gambling Harms work group (2019–21) under the Finnish Ministry of Social Affairs and Health, she interacts with the Finnish gambling monopoly to evaluate company products and practices and to analyse company data; discloses a fee for delivering a webinar from Bochum University, paid peer review from Routledge, and funding for travel from the Finnish Foundation for Alcohol Studies, University of Bergen, and the Council of Europe; provides consultation for public and third-sector actors, but not the gambling industry. CL discloses funding in the past 5 years for gambling-related research from the Royal Society for Public Health, Australian Research Council, Foundation for Alcohol Research and Education, and Victorian Responsible Gambling Foundation; provided a paid consultancy report on electronic gambling machines gambling for a 2023 appeal against a decision of the Northern Territory (Australia) Licensing Commission to expand electronic gambling machine availability in venues in Alice Springs; received travel support from the Turkish Green Crescent Society to attend a WHO meeting in 2019 and travel support from Monash University to attend the Fourth WHO Forum on Alcohol, Drugs and Addictive Behaviours and to attend a Commission meeting in London; is a member of the WHO panel on gambling and was engaged as a consultant in 2023 to prepare a WHO Technical Brief on gambling and gambling disorder; is an Editorial Board Member of Critical Gambling studies; provided submissions to Royal Commissions and Inquiries into casinos and electronic gambling machine venues in the Australian states of Victoria, New South Wales, and Western Australia, and has been consulted by Ministers and Ministerial staff for the governments of New South Wales, Victoria, and the Australian Government in relation to reform of gambling regulation, in an unpaid capacity; provides policy advice to local governments and non-governmental organisations in relation to reform of gambling regulation (unpaid); does not provide advice to the gambling industry or members of its ecosystem. GR discloses funding for gambling-related projects from The British Academy, the Economic and Social Research Council, the National Institute for Health Research, The Medical Research Council, the Glasgow Centre for International Development, the Department of Culture Media and Sport; acted as an advisor for a project on gambling advertising carried out by the Institute of Social Marketing at the University of Stirling in 2018, funded by GambleAware; was a Commissioner on the Howard League for Penal Reform's Commission on Crime and Gambling Related Harms 2019–22; is currently a member of the WHO panel on gambling and an Associate Editor of the journal Critical Gambling Studies; and received travel and accommodation expenses paid by the Turkish Green Crescent Society, the University of Helsinki Centre for Research on Addiction, Control and Governance–Finnish Ministry of Social Affairs and Health, the University of Sydney (via the Australian Research Council), the University of Bremen, the Ruhr Universität, Bochum, Scottish Parliament, the UK Society for the Study of Addiction, and the Howard League for Crime and Penal Reform's Commission on Crime and Gambling Related Harms (via the Gambling Commission). CB discloses grant funding for gambling-related projects from The British Academy, The Economic and Social Research Council, the National Institute of Health Research, Blackburn with Darwen Local Authority, and the Department of Culture Media and Sport. KS discloses grant funding for gambling-related projects from the Indonesian Ministry of Research and Technology and the University of Indonesia; and is a member of the WHO panel on gambling. RV discloses grant funding for gambling-related projects from Massachusetts Gaming Commission, Connecticut Dept of Mental Health & Addiction Services, the Evergreen Council for Problem Gambling, The University of Massachusetts Donahue Institute, Gambling Research Exchange Ontario, NORC Boston, North Dakota Department of Health & Human Services, British Gambling Commission, Public Health Agency of Sweden, Canadian Centre on Substance Abuse and the Center for Gambling Studies, and Rutgers University; received consultancy fees from for gambling-related research from the National Centre for Social Research (UK), Gambling Research Exchange Ontario, and the Karolinska Institute; received honorarium from McGill University for delivery of a webinar, from the Evergreen Council on Problem Gambling, the Institut fur Glucksspiel und Gesellschaft, and New York State Council on Problem Gambling; and received travel costs from the Alberta Gambling Research Institute in 2022 and 2023 and from the Nigerian National Lotteries Regulatory Commission in 2023. DU discloses funding for gambling-related projects from the Wellcome Trust (via a fellowship award to HW) and Blackburn with Darwen Local Authority. BB discloses funding for gambling-related projects from the Wellcome Trust (via a fellowship award to HW), the National Institute for Health Research, and Blackburn with Darwen Local Authority; and is a member of the Academic Forum for Gambling Research, with remuneration provided by the Gambling Commission, via Gambling Research Exchange Ontario. VK discloses funding for gambling-related projects from the Wellcome Trust (via a fellowship award to HW), the Gambling Commission, and Gambling Research Exchange Ontario; and has received funding for travel from the RANGES network, funded by the Canadian government. JR discloses funding from Canadian Institutes of Health Research, US National Institutes of Health, EU, and WHO; and has received funding for travel from WHO. LD received untied educational grant funding from Indivior and Seqirus for the study of new opioid medications in Australia, in the past 5 years. SS has been a senior advisor to McKinsey Health Institute since 2023 for issues on mental health. JQ is employed by the School of Public Health, University of Hong Kong; the School of Public Health receives funding from the Hong Kong Jockey Club Charities Trust outside of this project. JSY received funding for gambling-related research by the British Academy in 2020. VP was a staff member of WHO until 2024. All other authors declare no competing interests.