August 2020 Highlights

Date: Jun 18 2020

To request a full copy of any of these studies or for information on scheduling interviews with an expert, contact APHA Media Relations

American Journal of Public Health August issue research highlights:

  • Medicaid expansion tied to higher disenrollment
  • Employers can play bigger role in opioid crisis
  • Gaps in climate and health information, especially at local level
  • Most U.S. workers cannot work from home during a pandemic

Medicaid expansion tied to higher disenrollment

Medicaid work requirements are associated with higher disenrollment rates, especially among people with chronic health conditions, finds a study in the August issue of AJPH.

Researchers designed the study to learn about the impact of Arkansas’ decision to enact Medicaid work requirements. More specifically, to identify the risk factors that led to thousands of Arkansans losing Medicaid coverage.

Arkansas implemented work requirements in June 2018; by the end of that year, more than 18,000 Arkansans had been disenrolled from the state’s Medicaid program. Medicaid work requirements have since been struck down in court.

The study is based on data from a 2018 telephone survey of about 1,200 low-income adults ages 30 to 49 in four states: Arkansas, an Medicaid expansion state with work requirements; Kentucky, an expansion state with work requirements that never went into effect; Louisiana, an expansion state with no work requirements; and Texas, a state that rejected Medicaid expansion.

Overall, Medicaid disenrollment was highest in Texas, at 12.8%, followed by Arkansas, at 10.5%, Kentucky, at 5.8%, and Louisiana, at less than 3%. However, living in Arkansas was associated with a significantly higher disenrollment rate, compared to the three other states. Among Arkansas respondents, having a chronic condition was associated with higher disenrollment.

“Access to care is an important public health challenge, and improving Medicaid retention is a key strategy to increase access,” authors wrote

[Author contact: Lucy Chen, Harvard Business School, Boston, Massachusetts. “Work Requirements and Medicaid Disenrollment in Arkansas, Kentucky, Louisiana and Texas, 2018.”]

Employers can play bigger role in opioid crisis

Workplace settings and policies are promising intervention points for tackling the country’s ongoing opioid crisis, according to a new analytic essay in the August issue of APHA’s American Journal of Public Health.

A growing body of research underscores the associations between working conditions, chronic pain and initiation of pain medication, authors wrote. For example, opioid overdose rates are highest among occupations with the greatest physical demands and the least access to paid sick leave. One study cited in the analysis found that 57% of opioid-related overdose deaths occurred after a work injury.

Psychosocial work stressors, such as job insecurity, may also be a factor in opioid use. For example, temporary and seasonal workers may feel added pressure to work while in pain or risk losing critical income, authors noted.

While engaging employers in reducing opioid addiction and overdose is challenging, authors offered a number of recommendations, including stronger regulatory guidance, better employee education and expanded health benefits that include nonpharmacological pain management.

“The workplace is an important public health venue and, to date, employers have not been adequately included in state and local efforts to combat the opioid crisis,” they wrote. “We believe that that this is a critical gap in prevention efforts.”

[Author contact: William Shaw, PhD, Division of Occupational and Environment Medicine, Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut. “Work Environment Factors and Prevention of Opioid-Related Deaths.”]

Gaps in climate and health information, especially at local level

Climate change is considered one of the greatest public health challenges of the 21st century. However, few local health departments provide clear information about its many health effects, finds a study in the August AJPH.

While climate change is impacting health in a number of ways — from poorer air quality and more allergens to hotter temperatures and frequent natural disasters — previous research shows many Americans have a hard time linking it to specific health outcomes. State and local health departments, however, may be particularly well-positioned to help fill that gap.

To better understand if and how health departments currently present climate change information to the public, study authors gathered data from every functioning state, county and city public health department website in the U.S. in 2019 and 2020. They found that fewer than half, or 40%, of state health department sites and only 1.6% of county and about 4% of city websites provided clear ways to find climate change information.

Among the websites that offered original content, almost half provided no explanation on the causes of climate change.

“These results evidence a significant gap between the identification of climate change as a national public health emergency and the information about climate change provided to communities by state and local public health departments on their most visible, readily accessible, and public-facing platform,” researchers wrote.

[Author contact: Karen Albright, PhD, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado. “Dissemination of Information About Climate Change by State and Local Public Health Departments: United States, 2019-2020.”]

Most U.S. workers cannot work from home during a pandemic

The vast majority of U.S. workers cannot do their jobs from home, putting tens of millions of people at greater risk during a disease pandemic, finds a new study published in the August issue of AJPH.

Study author Marissa Baker, PhD, an assistant professor at the University of Washington, set out to characterize which U.S. workers could likely work from home during a pandemic. Using employment, wage and workplace data from the U.S. Bureau of Labor Statistics, she found that about 25% — or more than 35 million workers — have jobs that can be done at home.

The remaining 75% — workers in fields such as health care, manufacturing and retail — cannot easily do their jobs at home. Workers least able to do their jobs at home and who face some of the highest health risks during a pandemic — — such as those in food service, retail and beauty sectors — also had the lowest annual median wage.

Baker noted that such workers also tend to lack protections such as paid sick leave and employer-based health coverage, which could exacerbate their vulnerability during a pandemic.

“While all workers will be disrupted during a pandemic event such as COVID-19, increased public health focus should be on those who are the most vulnerable, including ensuring these workers are adequately protected at work and have social protections in the event they are no longer able to work,” Baker wrote.

[Author contact: Marissa Baker, PhD, Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington. “Nonrelocatable Occupations at Increased Risk During Pandemics: United States, 2018.”]

Check out the full list of AJPH research papers that published online April 16:

  • Impact of the voluntary safety standard for liquid laundry packets on child injuries treated In U.S. hospital emergency departments, 2012-2018
  • Changes to contraceptive method use at Title X clinics following Delaware contraceptive access now, 2008-2017
  • Community wound care program within a syringe exchange program, Chicago, 2018-19
  • The mortality effects of reduced Medicaid coverage among international migrants in Hawai’i (2012-2018)
  • A history of prescription drug monitoring programs in the United States: Political appeal and public health efficacy
  • Work requirements and Medicaid disenrollment in Arkansas, Kentucky, Louisiana, and Texas, 2018
  • Self-reported conversion efforts and suicidality among U.S. LGBTQ youth and young adults, 2018
  • Inequalities and deteriorations in cardiovascular health in pre-menopausal U.S. women, 1990-2016
  • Work environment factors and prevention of opioid-related deaths
  • Mandatory bicycle helmet laws in the United States: Origins, context, and controversies
  • Dissemination of information about climate change by U.S. state and local public health departments, 2019-2020
  • Non-relocatable occupations at increased risk during pandemics: United States, 2018
  • From ‘infodemics’ to health promotion: A novel framework for the role of social media in public health
  • No detectable surge in SARS-CoV-2 transmission due to the April 7, 2020, Wisconsin election
  • Personal protective equipment for COVID-19: Distributed fabrication and additive manufacturing
  • COVID-19 pandemic and wildfire smoke: Potentially concomitant disasters?

The articles above were published online June 18, at 4 p.m. ET by AJPH.

These 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 ajph.org

Complimentary online access to the Journal is available to credentialed members of the media. Address inquiries to Arnice Cottom 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 AJPH.org. For direct customer service, call 202-777-2516, or  email us.

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