July 2019 Highlights

Date: Jul 18 2019

CONTACT: Megan Lowry, 202-777-3913

American Journal of Public Health September issue research highlights:

1 in 8 men who have sex with men live in PrEP access desert

Using data from PrEP providers and census tracts, researchers found 1 in 8 PrEP-eligible men who have sex with men lived at least a 30-minute drive from the nearest PrEP provider, and a sizable minority lived in 60-minute-drive deserts. Location in the South and lower urbanicity were strongly associated with increased odds of PrEP desert status. Desert status is defined if one-way driving time to the nearest PrEP provider exceeds 30 or 60 minutes. 

Authors concluded a substantial number of persons at high risk for HIV transmission live in locations with no nearby PrEP provider. Rural and southern areas are disproportionately affected. For maximum implementation effectiveness of PrEP, geography should not determine access. Programs to train clinicians, expand venues for PrEP care and provide telemedicine services are needed.

[Author Contact: Aaron J. Siegler, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. “Geographic Access to Preexposure Prophylaxis Clinics Among Men Who Have Sex with Men in the United States”].

12% of prescription opioid users misuse the drug

Using data from the 2016-2017 National Surveys on Drug Use and Health, researchers found 12% of prescription opioid users were misusers, and 58% of misusers misused their own prescriptions. Misusers had higher rates of substance use than did medical users. Compared with with-prescription-only misusers, without-and-with-prescription misusers and without-prescription-only misusers had higher rates of marijuana use and benzodiazepine misuse; without-and-with-prescription misusers had higher ratesof heroin use. Most misusers, especially with-prescription-only misusers, used prescription opioids to relieve pain. Misusers were more likely to be depressed than medical users.

Authors concluded that prescription opioid misusers who misused both their own prescriptions and prescription opioid drugs not prescribed to them may be most at risk for overdose.

[Author Contact: Denise B. Kandel, Department of Psychiatry, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY. “Medical Use and Misuse of Prescription Opioids in the US Adult Population: 2016–2017”]. 

Medicaid expansion states saw drop in very low food security

This study found that among low-income, nonelderly childless adults, very low food security rose from 17.4% before the implementation of the Affordable Care Act to 17.5% after implementation in states that did not expand Medicaid. Very low food security fell from 17.6% to 15.9% in states that did expand Medicaid. In difference-in-difference analysis, Medicaid expansion was associated with a significant adjusted 2.2-percentage-point decline in rates of very low food security, equivalent to a 12.5% relative reduction. Study authors concluded the improvement in food security after the ACA’s health insurance expansion suggests that health insurance provision has spillover effects that reduce other dimensions of poverty.

[Author Contact: Gracie Himmelstein, Princeton University, Princeton, NJ. “Effect of the Affordable Care Act’s Medicaid Expansions on Food Security, 2010–2016”].

Individuals living in poverty, young adults ages 18-29, sexual minorities, less educated, uninsured more likely to have ever used electronic nicotine delivery systems

Based on national survey data, researchers found that those ages 18-29, those living in poverty, those with high school education or less, sexual minorities, Hispanics, those on Medicaid or state assistance or uninsured, and those not working or disabled were more likely to have ever used electronic nicotine delivery systems (e-cigarettes, e-cigars, e-hookahs, e-pipes, vape pens, hookah pens, personal vaporizers/mods).

Those younger than 60 years; people living at or above the poverty level; those with at least some college education; whites; people with private or Veterans Affairs, Department of Defense or military health insurance; and those currently employed were more likely to be aware of electronic nicotine delivery systems. However, ENDS awareness was generally high across all sociodemographic groups.

Authors concluded the impact of electronic nicotine delivery systems on tobacco disparities will ultimately depend on whether electronic nicotine delivery systems are used to transition completely away from combustible tobacco products, and how this may differ across priority populations who use diverse tobacco products.

[Author Contact: Claire Adams Spears, Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA. “Sociodemographic Correlates of Electronic Nicotine Delivery Systems (ENDS) Use in the United States, 2016–2017”].

Medicaid expansion not associated with improvements in subjective well-being

This study measured changes in subjective well-being outcomes in states following Medicaid expansion. Researchers found that in states that expanded Medicaid access, health care increased and difficulty affording health care declined following the Medicaid expansion. Medicaid expansion was not associated with changes to emotional states or life satisfaction over the study period in either the low-income population who newly gained health insurance or in the general adult population as a spillover effect of the policy change.

The study’s authors concluded that although the public health benefits of the Medicaid expansion are increasingly apparent, improved population well-being does not appear to be among them.

[Author Contact: Lisa F. Berkman, Harvard Center for Population and Development Studies, Cambridge, MA. “Effects of the Affordable Care Act Medicaid Expansion on Subjective Well-Being in the US Adult Population, 2010–2016”].

Find a full list of AJPH research papers published online below:

  • Affordable Care Act Medicaid Expansion and Subjective Well-Being, Us Adult Population, 2010 To 2016
  • Increasing Organ Donor Designation Rates in Adolescents: A Cluster Randomized Trial
  • Trends and Disparities in Mortality and Progression to AIDS in The Highly Active Antiretroviral Therapy Era, Tennessee 1996-2016
  • Letter to the Editor re: Police-Related Correlates of Client-Perpetrated Violence Among Female Sex Workers in Baltimore City, Maryland
  • A 15-Year Population-Based Investigation of Sexual Assault Cases Across the Province of Ontario, Canada (2002-2016)
  • Changes in Veterans? Coverage and Access to Care Following the Affordable Care Act, 2011-2017
  • Involvement in The Public Health Workforce of Alumni Of CDC? Public Health Associate Program
  • Impact of The Food Labeling and Advertising Law Banning Competitive Food and Beverages in Chilean Public Schools, 2014-2016
  • Sociodemographic Correlates of Electronic Nicotine Delivery Systems (ENDS) In the United States, 2016-2017
  • Post-Legalization Opening of Retail Cannabis Stores and Adult Cannabis Use in Washington State, 2009-2016
  • Medical Use and Misuse of Prescription Opioids in The US Adult Population: 2016-2017
  • Middle East Respiratory Syndrome Corona Virus: Analysis of The Line List (2013-2018)
  • Standardization of State Definitions for Neonatal Abstinence Syndrome Surveillance and The Opioid Epidemic 
  • Ethnic Disparities in Childhood Prevalence of Maltreatment: Evidence from A New Zealand Birth Cohort
  • Improving Hurricane Harvey Disaster Research Response Through Academic-Practice Partnerships
  • Ensuring Compliance with Quarantine by Undocumented Immigrants and Other Vulnerable Groups: Public Health Vs. Politics
  • Health Toll from Open Flame and Cigarette-Started Fires on Flame Retardant Furniture in Massachusetts, 2003-2016
  • Prep Deserts: Documenting Areas of Limited Geographic Access To Prep Clinics Among Men Who Have Sex with Men in The United States
  • Included, But Deportable: A New Public Health Approach to Policies That Criminalize and Integrate Immigrants
  • Effect of The Affordable Care Act's Medicaid Expansions on Food Security, 2010-2016

The articles above will be published online July 18, 2019, at 4 p.m. EDT by AJPH under “First Look.”

“First Look” articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. AJPH is published by the American Public Health Association, and is available at www.ajph.org.

Complimentary online access to the Journal is available to credentialed members of the media. Address inquiries to Megan Lowry at APHA. A single print issue of the Journal is available for $35 from the Journal’s Subscriptions Department. If you are not a member of the press, a member of APHA or a subscriber, online single-issue access is $30, and online single-article access is $22 at www.ajph.org. For direct customer service, call 202-777-2516, or email us.
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