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Merrill-Francis M, Chen MS, Dunphy C, Lennon NH, Grady C, Miller GF, McCourt AD. The Association Between State Minimum Wage and Firearm Homicides, 2000-2020. Am J Prev Med 2024:S0749-3797(24)00030-8. [PMID: 38309671 DOI: 10.1016/j.amepre.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/05/2024]
Abstract
INTRODUCTION Recent research has indicated an association between both poverty and income inequality and firearm homicides. Increased minimum wages may serve as a strategy for reducing firearm violence by increasing economic security among workers earning low wages and reducing the number of families living in poverty. This study aimed to examine the association between state minimum wage and firearm homicides in the U.S. between 2000 and 2020. METHODS State minimum wage, obtained from Temple's Law Atlas and augmented by legal research, was conceptualized using the Kaitz Index. State-level homicide counts were obtained from 2000 to 2020 multiple-cause-of death mortality data from the National Vital Statistics System. Log-linear regressions were conducted to model the associations between state minimum wage and firearm homicides, stratifying by demographic groups. Analyses were conducted in 2023. RESULTS A 1% point increase in a state's Kaitz Index was associated with a 1.3% (95% CI: -2.1% to -0.5%) decrease in a state's firearm homicide rate. When interacted with quartile of firearm ownership, the Kaitz Index was associated with decreases in firearm homicide in all except the lowest quartile. These findings were largely consistent across stratifications. CONCLUSIONS Changing a state's minimum wage, whereby a full-time minimum wage worker's salary is closer to a state's median income, may be an option for reducing firearm homicides.
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Affiliation(s)
- Molly Merrill-Francis
- Division of Violence Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia.
| | - May S Chen
- Division of Violence Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia
| | - Christopher Dunphy
- Division of Injury Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia
| | - Natalie H Lennon
- Division of Injury Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia
| | - Catherine Grady
- Division of Violence Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia
| | - Gabrielle F Miller
- Division of Injury Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia
| | - Alexander D McCourt
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Merrill-Francis M, Chen MS, Dunphy C, Swedo EA, Zhang Kudon H, Metzler M, Mercy JA, Zhang X, Rogers TM, Wu Shortt J. Advanced child tax credit payments and national child abuse hotline contacts, 2019-2022. Inj Prev 2024:ip-2023-045130. [PMID: 38182408 DOI: 10.1136/ip-2023-045130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/02/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Children in households experiencing poverty are disproportionately exposed to maltreatment. Income support policies have been associated with reductions in child abuse and neglect. The advance child tax credit (CTC) payments may reduce child maltreatment by improving the economic security of some families. No national studies have examined the association between advance CTC payments and child abuse and neglect. This study examines the association between the advance CTC payments and child abuse and neglect-related contacts to the Childhelp National Child Abuse Hotline. METHODS A time series study of contacts to the Childhelp National Child Abuse Hotline between January 2019 and December 2022 was used to examine the association between the payments and hotline contacts. An interrupted time series (ITS) exploiting the variation in the advance CTC payments was estimated using fixed effects. RESULTS The CTC advance payments were associated with an immediate 13.8% (95% CI -17.5% to -10.0%) decrease in contacts to the hotline in the ITS model. Following the expiration of the advance CTC payments, there was a significant and gradual 0.1% (95% CI +0.0% to +0.2%) daily increase in contacts. Sensitivity analyses found significant reductions in contacts following each payment, however, the reductions were associated with the last three of the six total payments. CONCLUSION These findings suggest the advance CTC payments may reduce child abuse and neglect-related hotline contacts and continue to build the evidence base for associations between income-support policies and reductions in child abuse and neglect.
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Affiliation(s)
- Molly Merrill-Francis
- Division of Violence Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia, USA
| | - May S Chen
- Division of Violence Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia, USA
| | - Christopher Dunphy
- Division of Injury Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia, USA
| | - Elizabeth A Swedo
- Division of Violence Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia, USA
| | - Hui Zhang Kudon
- Division of Violence Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia, USA
| | - Marilyn Metzler
- Division of Violence Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia, USA
| | - James A Mercy
- Division of Violence Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia, USA
| | - Xinjian Zhang
- Division of Injury Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia, USA
| | - Tia M Rogers
- Division of Violence Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia, USA
| | - Joann Wu Shortt
- Division of Violence Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia, USA
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Jackson H, Dunphy C, Grist MB, Jiang X, Xu L, Guy GP, Salvant-Valentine S. Weathering the Storm: Syringe Services Program Laws and Human Immunodeficiency Virus During the COVID-19 Pandemic. J Acquir Immune Defic Syndr 2023; 94:395-402. [PMID: 37949442 DOI: 10.1097/qai.0000000000003293] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/15/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Syringe services programs (SSPs) are community-based prevention programs that provide a range of harm reduction services to persons who inject drugs. Despite their benefits, SSP laws vary across the United States. Little is known regarding how legislation surrounding SSPs may have influenced HIV transmission over the COVID-19 pandemic, a period in which drug use increased. This study examined associations between state SSP laws and HIV transmission among the Medicaid population before and after the COVID-19 pandemic. METHODS State-by-month counts of new HIV diagnoses among the Medicaid population were produced using administrative claims data from the Transformed Medicaid Statistical Information System from 2019 to 2020. Data on SSP laws were collected from the Prescription Drug Abuse Policy System. Associations between state SSP laws and HIV transmission before and after the start of the COVID-19 pandemic were evaluated using an event study design, controlling for the implementation of COVID-19 nonpharmaceutical interventions and state and time fixed effects. RESULTS State laws allowing the operation of SSPs were associated with 0.54 (P = 0.044) to 1.18 (P = 0.001) fewer new monthly HIV diagnoses per 100,000 Medicaid enrollees relative to states without such laws in place during the 9 months after the start of the COVID-19 pandemic. The largest effects manifested for population subgroups disproportionately affected by HIV, such as male and non-Hispanic Black Medicaid enrollees. CONCLUSION Less restrictive laws on SSPs may have helped mitigate HIV transmission among the Medicaid population throughout the COVID-19 pandemic. Policymakers can consider implementing less restrictive SSP laws to mitigate HIV transmission resulting from future increases in injection drug use. DISCLAIMER The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
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Affiliation(s)
- Hannah Jackson
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Christopher Dunphy
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Mary Blain Grist
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN; and
| | - Xinyi Jiang
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Likang Xu
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Gery P Guy
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sheila Salvant-Valentine
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
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4
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Schieber LZ, Dunphy C, Schieber RA, Lopes-Cardozo B, Moonesinghe R, Guy GP. Hospitalization Associated With Comorbid Psychiatric and Substance Use Disorders Among Adults With COVID-19 Treated in US Emergency Departments From April 2020 to August 2021. JAMA Psychiatry 2023; 80:331-341. [PMID: 36790774 PMCID: PMC9932946 DOI: 10.1001/jamapsychiatry.2022.5047] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/28/2022] [Indexed: 02/16/2023]
Abstract
Importance During the COVID-19 pandemic, US emergency department (ED) visits for psychiatric disorders (PDs) and drug overdoses increased. Psychiatric disorders and substance use disorders (SUDs) independently increased the risk of COVID-19 hospitalization, yet their effect together is unknown. Objective To assess how comorbid PD and SUD are associated with the probability of hospitalization among ED patients with COVID-19. Design, Setting, and Participants This retrospective cross-sectional study analyzed discharge data for adults (age ≥18 years) with a COVID-19 diagnosis treated in 970 EDs and inpatient hospitals in the United States from April 2020 to August 2021. Exposures Any past diagnosis of (1) SUD from opioids, stimulants, alcohol, cannabis, cocaine, sedatives, or other substances and/or (2) PD, including attention-deficit/hyperactivity disorder (ADHD), anxiety, bipolar disorder, major depression, other mood disorder, posttraumatic stress disorder (PTSD), or schizophrenia. Main Outcomes and Measures The main outcome was any hospitalization. Differences in probability of hospitalization were calculated to assess its association with both PD and SUD compared with PD alone, SUD alone, or neither condition. Results Of 1 274 219 ED patients with COVID-19 (mean [SD] age, 54.6 [19.1] years; 667 638 women [52.4%]), 18.6% had a PD (mean age, 59.0 years; 37.7% men), 4.6% had a SUD (mean age, 50.1 years; 61.7% men), and 2.3% had both (mean age, 50.4 years; 53.1% men). The most common PDs were anxiety (12.9%), major depression (9.8%), poly (≥2) PDs (6.4%), and schizophrenia (1.4%). The most common SUDs involved alcohol (2.1%), cannabis (1.3%), opioids (1.0%), and poly (≥2) SUDs (0.9%). Prevalence of SUD among patients with PTSD, schizophrenia, other mood disorder, or ADHD each exceeded 21%. Based on significant specific PD-SUD pairs (Q < .05), probability of hospitalization of those with both PD and SUD was higher than those with (1) neither condition by a weighted mean of 20 percentage points (range, 6 to 36; IQR, 16 to 25); (2) PD alone by 12 percentage points (range, -4 to 31; IQR, 8 to 16); and (3) SUD alone by 4 percentage points (range, -7 to 15; IQR, -2 to 7). Associations varied by types of PD and SUD. Substance use disorder was a stronger predictor of hospitalization than PD. Conclusions and Relevance This study found that patients with both PD and SUD had a greater probability of hospitalization, compared with those with either disorder alone or neither disorder. Substance use disorders appear to have a greater association than PDs with the probability of hospitalization. Overlooking possible coexisting PD and SUD in ED patients with COVID-19 can underestimate the likelihood of hospitalization. Screening and assessment of both conditions are needed.
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Affiliation(s)
- Lyna Z. Schieber
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher Dunphy
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard A. Schieber
- Office of Director, Center for Surveillance, Epidemiology, and Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Barbara Lopes-Cardozo
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ramal Moonesinghe
- Office of Genomics and Precision Public Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gery P. Guy
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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Dunphy C, Joo H, Sapiano MRP, Howard-Williams M, McCord R, Sunshine G, Kao SY, Guy GP, Weber R, Gakh M, Ekwueme DU. The Association Between State-Issued Mask Mandates and County COVID-19 Hospitalization Rates. J Public Health Manag Pract 2022; 28:712-719. [PMID: 36194816 PMCID: PMC9560902 DOI: 10.1097/phh.0000000000001602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
CONTEXT Mask mandates are one form of nonpharmaceutical intervention that has been utilized to combat the spread of SARS-CoV2, the virus that causes COVID-19. OBJECTIVE This study examines the association between state-issued mask mandates and changes in county-level and hospital referral region (HRR)-level COVID-19 hospitalizations across the United States. DESIGN Difference-in-difference and event study models were estimated to examine the association between state-issued mask mandates and COVID-19 hospitalization outcomes. PARTICIPANTS All analyses were conducted with US county-level data. INTERVENTIONS State-issued mask mandates. County-level data on the mandates were collected from executive orders identified on state government Web sites from April 1, 2020, to December 31, 2020. MAIN OUTCOME MEASURES Daily county-level (and HRR-level) estimates of inpatient beds occupied by patients with confirmed or suspected COVID-19 were collected by the US Department of Health and Human Services. RESULTS The state issuing of mask mandates was associated with an average of 3.6 fewer daily COVID-19 hospitalizations per 100 000 people (P < .05) and a 1.2-percentage-point decrease in the percentage of county beds occupied with COVID-19 patients (P < .05) within 70 days of taking effect. Event study results suggest that this association increased the longer mask mandates were in effect. In addition, the results were robust to analyses conducted at the HRR level. CONCLUSIONS This study demonstrated that state-issued mask mandates were associated with reduction in COVID-19 hospitalizations across the United States during the earlier portion of the pandemic. As new variants of the virus cause spikes in COVID-19 cases, reimposing mask mandates in indoor and congested public areas, as part of a layered approach to community mitigation, may reduce the spread of COVID-19 and lessen the burden on our health care system.
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Affiliation(s)
- Christopher Dunphy
- COVID-19 Response (Drs Dunphy, Joo, Howard-Williams, McCord, Sunshine, Kao, Guy, Weber, and Ekwueme) and Division of Healthcare Quality Promotion (Dr Sapiano), Centers for Disease Control and Prevention, Atlanta, Georgia; Lantana Consulting Group, Thetford, Vermont (Dr Sapiano); and School of Public Health, University of Nevada, Las Vegas, Nevada (Dr Gakh)
| | - Heesoo Joo
- COVID-19 Response (Drs Dunphy, Joo, Howard-Williams, McCord, Sunshine, Kao, Guy, Weber, and Ekwueme) and Division of Healthcare Quality Promotion (Dr Sapiano), Centers for Disease Control and Prevention, Atlanta, Georgia; Lantana Consulting Group, Thetford, Vermont (Dr Sapiano); and School of Public Health, University of Nevada, Las Vegas, Nevada (Dr Gakh)
| | - Mathew R. P. Sapiano
- COVID-19 Response (Drs Dunphy, Joo, Howard-Williams, McCord, Sunshine, Kao, Guy, Weber, and Ekwueme) and Division of Healthcare Quality Promotion (Dr Sapiano), Centers for Disease Control and Prevention, Atlanta, Georgia; Lantana Consulting Group, Thetford, Vermont (Dr Sapiano); and School of Public Health, University of Nevada, Las Vegas, Nevada (Dr Gakh)
| | - Mara Howard-Williams
- COVID-19 Response (Drs Dunphy, Joo, Howard-Williams, McCord, Sunshine, Kao, Guy, Weber, and Ekwueme) and Division of Healthcare Quality Promotion (Dr Sapiano), Centers for Disease Control and Prevention, Atlanta, Georgia; Lantana Consulting Group, Thetford, Vermont (Dr Sapiano); and School of Public Health, University of Nevada, Las Vegas, Nevada (Dr Gakh)
| | - Russell McCord
- COVID-19 Response (Drs Dunphy, Joo, Howard-Williams, McCord, Sunshine, Kao, Guy, Weber, and Ekwueme) and Division of Healthcare Quality Promotion (Dr Sapiano), Centers for Disease Control and Prevention, Atlanta, Georgia; Lantana Consulting Group, Thetford, Vermont (Dr Sapiano); and School of Public Health, University of Nevada, Las Vegas, Nevada (Dr Gakh)
| | - Gregory Sunshine
- COVID-19 Response (Drs Dunphy, Joo, Howard-Williams, McCord, Sunshine, Kao, Guy, Weber, and Ekwueme) and Division of Healthcare Quality Promotion (Dr Sapiano), Centers for Disease Control and Prevention, Atlanta, Georgia; Lantana Consulting Group, Thetford, Vermont (Dr Sapiano); and School of Public Health, University of Nevada, Las Vegas, Nevada (Dr Gakh)
| | - Szu-Yu Kao
- COVID-19 Response (Drs Dunphy, Joo, Howard-Williams, McCord, Sunshine, Kao, Guy, Weber, and Ekwueme) and Division of Healthcare Quality Promotion (Dr Sapiano), Centers for Disease Control and Prevention, Atlanta, Georgia; Lantana Consulting Group, Thetford, Vermont (Dr Sapiano); and School of Public Health, University of Nevada, Las Vegas, Nevada (Dr Gakh)
| | - Gery P. Guy
- COVID-19 Response (Drs Dunphy, Joo, Howard-Williams, McCord, Sunshine, Kao, Guy, Weber, and Ekwueme) and Division of Healthcare Quality Promotion (Dr Sapiano), Centers for Disease Control and Prevention, Atlanta, Georgia; Lantana Consulting Group, Thetford, Vermont (Dr Sapiano); and School of Public Health, University of Nevada, Las Vegas, Nevada (Dr Gakh)
| | - Regen Weber
- COVID-19 Response (Drs Dunphy, Joo, Howard-Williams, McCord, Sunshine, Kao, Guy, Weber, and Ekwueme) and Division of Healthcare Quality Promotion (Dr Sapiano), Centers for Disease Control and Prevention, Atlanta, Georgia; Lantana Consulting Group, Thetford, Vermont (Dr Sapiano); and School of Public Health, University of Nevada, Las Vegas, Nevada (Dr Gakh)
| | - Maxim Gakh
- COVID-19 Response (Drs Dunphy, Joo, Howard-Williams, McCord, Sunshine, Kao, Guy, Weber, and Ekwueme) and Division of Healthcare Quality Promotion (Dr Sapiano), Centers for Disease Control and Prevention, Atlanta, Georgia; Lantana Consulting Group, Thetford, Vermont (Dr Sapiano); and School of Public Health, University of Nevada, Las Vegas, Nevada (Dr Gakh)
| | - Donatus U. Ekwueme
- COVID-19 Response (Drs Dunphy, Joo, Howard-Williams, McCord, Sunshine, Kao, Guy, Weber, and Ekwueme) and Division of Healthcare Quality Promotion (Dr Sapiano), Centers for Disease Control and Prevention, Atlanta, Georgia; Lantana Consulting Group, Thetford, Vermont (Dr Sapiano); and School of Public Health, University of Nevada, Las Vegas, Nevada (Dr Gakh)
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Howard-Williams M, Soelaeman RH, Fischer LS, McCord R, Davison R, Dunphy C. Association Between State-Issued COVID-19 Vaccine Mandates and Vaccine Administration Rates in 12 US States and the District of Columbia. JAMA Health Forum 2022; 3:e223810. [PMID: 36306119 PMCID: PMC9617176 DOI: 10.1001/jamahealthforum.2022.3810] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Importance Some US states have issued COVID-19 vaccine mandates; however, the association of these mandates with vaccination rates remains unknown. Objective To examine the association between announcing state-issued COVID-19 vaccine mandates that did not provide a test-out option for workers and the vaccine administration rates in terms of state-level first-dose vaccine administration and series completion coverage. Design, Setting, and Participants This cross-sectional study used publicly available, state-level aggregated panel data to fit linear regression models with 2-way fixed effects (state and time) estimating vaccine coverage changes 8 weeks before and 8 weeks after a state-issued COVID-19 vaccine mandate was announced. Mandates were announced on or after July 26, 2021, and were included only if they went into effect before December 31, 2021. Data were included from 13 state-level jurisdictions with a vaccine mandate in effect as of December 31, 2021, that did not allow recurring testing in lieu of vaccination (mandate group), and 14 state-level jurisdictions that allowed a test-out option and/or did not restrict vaccine requirements (comparison group). Interventions/Exposures The event of interest was the announcement of a state-issued COVID-19 vaccine mandate applicable to specific groups of workers. Main Outcomes and Measures The outcome measures were state-level daily COVID-19 vaccine first-dose administration and series completion coverage, reported as mean percentage point changes. Results Of 5 508 539 first-dose administrations in the 8-week postannouncement period, an estimated 634 831 (11.5%) were associated with the mandate announcement. First-dose administration coverage among 13 jurisdictions increased starting at 3 weeks after the mandate announcement, with statistically significant differences of 0.20, 0.33, 0.39, 0.45, 0.49, and 0.59 percentage points higher than the referent category coverage of 62.9%. Increases in vaccine series completion coverage were observed from 5 to 8 weeks after the announcement, but statistically significant differences from the referent category coverage of 56.3% were observed only during weeks 7 and 8 after the announcement (both differed by 0.2 percentage points; P = .05 and P = .02, respectively). Conclusions and Relevance The findings of this cross-sectional event study suggest that the announcement of state-issued vaccine mandates may be associated with short-term increases in vaccine uptake. This observed association may be a product of both a direct outcome experienced by groups governed by the mandate as well as the spillover outcome due to a government signaling the importance of vaccination to the general population of the state.
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Affiliation(s)
- Mara Howard-Williams
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rieza H. Soelaeman
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leah S. Fischer
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Russell McCord
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robin Davison
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher Dunphy
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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Dunphy C, Miller GF, Sunshine G, McCord R, Howard-Williams M, Proia K, Stephens J. The Differential Impact of Reopening States With and Without COVID-19 Face Mask Mandates on County-Level Consumer Spending. Public Health Rep 2022; 137:1000-1006. [PMID: 35792601 PMCID: PMC9357652 DOI: 10.1177/00333549221103816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives: By the end of 2020, 38 states and the District of Columbia had issued
requirements that people wear face masks when in public settings to counter
SARS-CoV-2 transmission. To examine the role face mask mandates played in
economic recovery, we analyzed the interactive effect of having a state face
mask mandate in place on county-level consumer spending after state
reopening, adjusting for county rates of new COVID-19 cases and deaths, time
trends, and county-specific effects. Methods: We collected county-specific data from state executive orders, consumer
spending data from the Opportunity Insights Economic Tracker, and COVID-19
case and death data from the Centers for Disease Control and Prevention
COVID-19 tracker. Using an event study approach, we compared county-level
changes in consumer spending before and after state-issued closure orders
were lifted and assessed the interactive effect of state-issued face mask
mandates. Results: The lifting of state-issued closures was associated with an average increase
in consumer spending across all counties studied within 1 month. However,
the increase was 1.2-1.7 percentage points higher in counties with a state
face mask mandate in place than in counties without a state face mask
mandate. Conclusions: In addition to their public health benefits, face mask mandates may have
assisted economic recovery during the COVID-19 pandemic, suggesting they are
a strong public health strategy for policy makers to consider now and for
potential future pandemics arising from airborne viruses.
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Affiliation(s)
- Christopher Dunphy
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gabrielle F Miller
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gregory Sunshine
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Russell McCord
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mara Howard-Williams
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Krista Proia
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - James Stephens
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
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8
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Kacha-Ochana A, Jones CM, Green JL, Dunphy C, Govoni TD, Robbins RS, Guy GP. Characteristics of Adults Aged ≥18 Years Evaluated for Substance Use and Treatment Planning — United States, 2019. MMWR Morb Mortal Wkly Rep 2022; 71:749-756. [PMID: 35679167 PMCID: PMC9181053 DOI: 10.15585/mmwr.mm7123a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Miller MJ, Himschoot A, Fitch N, Jawalkar S, Freeman D, Hilton C, Berney K, Guy GP, Benoit TJ, Clarke KE, Busch MP, Opsomer JD, Stramer SL, Hall AJ, Gundlapalli AV, MacNeil A, McCord R, Sunshine G, Howard-Williams M, Dunphy C, Jones JM. Association of Trends in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Seroprevalence and State-Issued Nonpharmaceutical Interventions: United States, 1 August 2020 to 30 March 2021. Clin Infect Dis 2022; 75:S264-S270. [PMID: 35684974 PMCID: PMC9214164 DOI: 10.1093/cid/ciac469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We assess if state-issued nonpharmaceutical interventions (NPIs) are associated with reduced rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection as measured through anti-nucleocapsid (anti-N) seroprevalence, a proxy for cumulative prior infection that distinguishes seropositivity from vaccination. METHODS Monthly anti-N seroprevalence during 1 August 2020 to 30 March 2021 was estimated using a nationwide blood donor serosurvey. Using multivariable logistic regression models, we measured the association of seropositivity and state-issued, county-specific NPIs for mask mandates, gathering bans, and bar closures. RESULTS Compared with individuals living in a county with all three NPIs in place, the odds of having anti-N antibodies were 2.2 (95% confidence interval [CI]: 2.0-2.3) times higher for people living in a county that did not have any of the 3 NPIs, 1.6 (95% CI: 1.5-1.7) times higher for people living in a county that only had a mask mandate and gathering ban policy, and 1.4 (95% CI: 1.3-1.5) times higher for people living in a county that had only a mask mandate. CONCLUSIONS Consistent with studies assessing NPIs relative to COVID-19 incidence and mortality, the presence of NPIs were associated with lower SARS-CoV-2 seroprevalence indicating lower rates of cumulative infections. Multiple NPIs are likely more effective than single NPIs.
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Affiliation(s)
- Maureen J. Miller
- Corresponding author: Maureen J. Miller, MD MPH, CDC COVID-19 Response, 1600 Clifton Rd. NE, MS 10-1, Atlanta, GA 30329-4027 ()
| | | | - Natalie Fitch
- Georgia Tech Research Institute, Atlanta, Georgia, USA
| | | | - Dane Freeman
- Georgia Tech Research Institute, Atlanta, Georgia, USA
| | | | - Kevin Berney
- Geospatial Research, Analysis, and Services Program (GRASP), Agency for Toxic Substances and Disease Registry, CDC, Atlanta, Georgia, USA
| | - Gery P. Guy
- CDC COVID-19 Response, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Tina J. Benoit
- CDC COVID-19 Response, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Kristie E.N. Clarke
- CDC COVID-19 Response, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | | | | | - Susan L. Stramer
- Scientific Affairs, American Red Cross, Gaithersburg, Maryland, USA
| | - Aron J. Hall
- CDC COVID-19 Response, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Adi V. Gundlapalli
- CDC COVID-19 Response, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Adam MacNeil
- CDC COVID-19 Response, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Russell McCord
- CDC COVID-19 Response, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Gregory Sunshine
- CDC COVID-19 Response, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Mara Howard-Williams
- CDC COVID-19 Response, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Christopher Dunphy
- CDC COVID-19 Response, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Jefferson M. Jones
- CDC COVID-19 Response, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
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10
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Dunphy C, Miller GF, Rice K, Vo L, Sunshine G, McCord R, Howard-Williams M, Coronado F. The Impact of Covid-19 State Closure Orders on Consumer Spending, Employment, and Business Revenue. J Public Health Manag Pract 2022; 28:43-49. [PMID: 34016904 PMCID: PMC8589864 DOI: 10.1097/phh.0000000000001376] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT In response to the COVID-19 pandemic, states across the United States implemented various strategies to mitigate transmission of SARS-CoV-2 (the virus that causes COVID-19). OBJECTIVE To examine the effect of COVID-19-related state closures on consumer spending, business revenue, and employment, while controlling for changes in COVID-19 incidence and death. DESIGN The analysis estimated a difference-in-difference model, utilizing temporal and geographic variation in state closure orders to analyze their impact on the economy, while controlling for COVID-19 incidence and death. PARTICIPANTS State-level data on economic outcomes from the Opportunity Insights data tracker and COVID-19 cases and death data from usafacts.org. INTERVENTIONS The mitigation strategy analyzed within this study was COVID-19-related state closure orders. Data on these orders were obtained from state government Web sites containing executive or administrative orders. MAIN OUTCOME MEASURES Outcomes include state-level estimates of consumer spending, business revenue, and employment levels. RESULTS Analyses showed that although state closures led to a decrease in consumer spending, business revenue, and employment, they accounted for only a small portion of the observed decreases in these outcomes over the first wave of COVID-19. CONCLUSIONS The impact of COVID-19 on economic activity likely reflects a combination of factors, in addition to state closures, such as individuals' perceptions of risk related to COVID-19 incidence, which may play significant roles in impacting economic activity.
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Affiliation(s)
- Christopher Dunphy
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
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11
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Dunphy C, Zhang K, Guy GP, Jones CM. Naloxone dispensing among the commercially insured population in the United States from 2015 to 2018. Prev Med 2021; 153:106820. [PMID: 34599923 PMCID: PMC9086913 DOI: 10.1016/j.ypmed.2021.106820] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 09/08/2021] [Accepted: 09/26/2021] [Indexed: 11/16/2022]
Abstract
The Centers for Disease Control and Prevention's (CDC) Guideline for Prescribing Opioids for Chronic Pain recommends that providers consider co-prescribing naloxone when factors that increase the risk of overdose are present. Naloxone is an opioid receptor antagonist that counteracts the effects of an opioid overdose. This paper explores trends in naloxone dispensing and out-of-pocket costs among commercially insured individuals in the United States. Administrative claims data from the IBM Watson Health MarketScan database are analyzed to assess trends in naloxone dispensing from 2015 to 2018. Descriptive statistics on concurrent dispensing of naloxone with opioid analgesics are performed among several at-risk populations. The rate of commercially insured individuals being co-dispensed naloxone increased between 2015 and 2018 across all population sub-groups. In 2018, 16.2 individuals were co-dispensed naloxone for every 1000 receiving an opioid dosage ≥ 90 MME/day compared to 0.9 in 2015, 27.6 individuals were co-dispensed naloxone for every 1000 concurrently dispensed benzodiazepines and an opioid dosage ≥ 90 MME/day compared to 7.6 in 2015, and 43.7 individuals were co-dispensed naloxone for every 1000 receiving an opioid dosage ≥90 MME/day with a past overdose compared to 17.6 in 2015. Median out-of-pocket cost for naloxone increased from $12 in 2015 to $25 in 2018. Despite increases in naloxone dispensing from 2015 to 2018, the provision of naloxone to the commercially insured population remains low. Opportunities remain to increase the supply of naloxone to at-risk populations. Considering ways to reduce out-of-pocket costs associated with naloxone may be a potential strategy to increase access to this life-saving drug.
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Affiliation(s)
- Christopher Dunphy
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Overdose Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, USA.
| | - Kun Zhang
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Overdose Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, USA
| | - Gery P Guy
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Overdose Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, USA
| | - Christopher M Jones
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Overdose Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, USA
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12
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Jiang X, Guy GP, Dunphy C, Pickens CM, Jones CM. Characteristics of adults reporting illicitly manufactured fentanyl or heroin use or prescription opioid misuse in the United States, 2019. Drug Alcohol Depend 2021; 229:109160. [PMID: 34740067 PMCID: PMC8671312 DOI: 10.1016/j.drugalcdep.2021.109160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/22/2021] [Accepted: 10/16/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Deaths involving illicitly manufactured fentanyl (IMF) have increased since 2013 in the United States. Little research has examined individuals using IMF. This study aims to explore the characteristics of US adults who used IMF, heroin, or misused prescription opioids and examine the associations between demographic, clinical, psychosocial characteristics and IMF use. METHODS A convenience sample of adults aged ≥ 18 years being assessed for substance use disorder (SUD) treatment was collected between January-December 2019 using the Addiction Severity Index-Multimedia Version instrument. We used a multivariable logistic regression model to examine the associations between demographic, clinical, psychosocial characteristics and IMF use. RESULTS Adults reporting IMF as their primary lifetime substance use problem also reported using other substances-most often alcohol or heroin-both in the past 30 days and during their lifetime. Characteristics associated with increased odds of reporting IMF as the primary lifetime substance use problem included age 18-24 years (adjusted odds ratio (aOR) = 1.68; 95% confidence interval (CI) = 1.18-2.38) versus 45-54 years, non-Hispanic Black persons (aOR = 1.44; 95% CI = 1.11-1.85) versus non-Hispanic White persons, being assessed in Northeast (aOR = 15.46; 95% CI = 8.67-27.56) versus West, and having a history of at least one lifetime overdose (1 overdose (aOR = 1.91; 95% CI = 1.49-2.44); 2 overdoses (aOR = 1.95; 95% CI = 1.48-2.58); 3 or more overdoses (aOR = 2.27; 95% CI = 1.82-2.82)). CONCLUSIONS These findings provide new insights into this high-risk population and help identify strategies to address increasing overdose death rates involving IMF. Opportunities for intervention include expanding naloxone distribution and harm reduction programs and connecting individuals with nonfatal overdoses to SUD treatment.
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Affiliation(s)
- Xinyi Jiang
- Division of Overdose Prevention, National Center for Injury Prevention and Control, CDC, 4700 Buford Highway NE, Atlanta, GA 30341, United States
| | - Gery P. Guy
- Division of Overdose Prevention, National Center for Injury Prevention and Control, CDC, 4700 Buford Highway NE, Atlanta, GA 30341, United States
| | - Christopher Dunphy
- Division of Overdose Prevention, National Center for Injury Prevention and Control, CDC, 4700 Buford Highway NE, Atlanta, GA 30341, United States
| | - Cassandra M. Pickens
- Division of Overdose Prevention, National Center for Injury Prevention and Control, CDC, 4700 Buford Highway NE, Atlanta, GA 30341, United States
| | - Christopher M. Jones
- National Center for Injury Prevention and Control, CDC, 4700 Buford Highway NE, Atlanta, GA 30341, United States,Correspondence to: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341, United States. (C.M. Jones)
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13
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Dunphy C, Peterson C, Zhang K, Jones CM. Do out-of-pocket costs influence retention and adherence to medications for opioid use disorder? Drug Alcohol Depend 2021; 225:108784. [PMID: 34049104 PMCID: PMC8314254 DOI: 10.1016/j.drugalcdep.2021.108784] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Availability of medications for opioid use disorder (MOUD) has increased during the past two decades but treatment retention and adherence remain low. This study aimed to measure the impact of out-of-pocket buprenorphine cost on treatment retention and adherence among US commercially insured patients. METHODS Medical payment records from IBM MarketScan were analyzed for 6,439 adults age 18-64 years with commercial insurance who initiated buprenorphine treatment during January 1, 2016 to June 30, 2017. Regression models analyzed the relationship between patients' average daily out-of-pocket buprenorphine cost and buprenorphine retention (at least 80 % days covered by buprenorphine) at three different thresholds (180, 360, and 540 days) and adherence (the number of days of buprenorphine coverage) within each retention threshold. Models controlled for patient demographic and clinical characteristics including age, sex, presence of other substance use disorders, psychiatric and pain diagnoses, and receipt of prescription medications. RESULTS A one dollar increase in daily out-of-pocket buprenorphine cost was associated with a 12-14 % decrease in the odds of retention and a 5-8 % increase in the number of days without buprenorphine coverage during each analyzed retention threshold. CONCLUSION Recent policies have attempted to address supply-side barriers to MOUD treatment. This study highlights patient cost-sharing as a demand-side barrier to MOUD. While the average out-of-pocket buprenorphine cost is lower than two decades ago, this study suggests even at current levels such costs decrease retention and adherence among commercially insured patients. Efforts to address demand-side barriers could help maximize the health and social benefits of buprenorphine-based MOUD.
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Affiliation(s)
- Christopher Dunphy
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
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14
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Guy GP, Lee FC, Sunshine G, McCord R, Howard-Williams M, Kompaniyets L, Dunphy C, Gakh M, Weber R, Sauber-Schatz E, Omura JD, Massetti GM. Association of State-Issued Mask Mandates and Allowing On-Premises Restaurant Dining with County-Level COVID-19 Case and Death Growth Rates - United States, March 1-December 31, 2020. MMWR Morb Mortal Wkly Rep 2021; 70:350-354. [PMID: 33705364 PMCID: PMC7951820 DOI: 10.15585/mmwr.mm7010e3] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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15
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Duncan S, Annunziato RA, Dunphy C, LaPointe Rudow D, Shneider BL, Shemesh E. A systematic review of immunosuppressant adherence interventions in transplant recipients: Decoding the streetlight effect. Pediatr Transplant 2018; 22:10.1111/petr.13086. [PMID: 29218760 PMCID: PMC5811374 DOI: 10.1111/petr.13086] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 12/23/2022]
Abstract
Non-adherence to immunosuppressant medications is an important risk factor for graft dysfunction. To evaluate the effectiveness of adherence-enhancing interventions, we reviewed adherence intervention studies in solid organ transplant recipients (all ages). Using the following databases: PsycINFO, PubMed, Scopus, and ScienceDirect, we identified 41 eligible studies. Only three non-randomized trials showed a possible positive effect on objective indicators of transplant outcomes (such as rejection, liver enzyme levels, kidney function). None of the 21 RCTs showed an improvement in transplant outcomes. Three studies showed a higher rate of adverse events in the intervention group as compared with controls, although this may be related to ascertainment bias. Improvement in adherence as measured indirectly (eg, with electronic monitoring devices) was not aligned with effects on transplant outcomes. We conclude that adherence interventions, to date, have largely been ineffective in improving transplant outcomes. To improve this track record, intervention efforts may wish to concentrate on non-adherent patients (rather than use convenience sampling, which excludes many of the patients who need the intervention), use direct measures of adherence to guide the interventions, and employ strategies that are intensive and yet engaging enough to ensure that non-adherent patients are able to participate.
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Affiliation(s)
- S Duncan
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, NY, USA
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - R A Annunziato
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, NY, USA
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - C Dunphy
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, NY, USA
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - D LaPointe Rudow
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, NY, USA
| | - B L Shneider
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - E Shemesh
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, NY, USA
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16
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McEwen S, Dunphy C, Norman Rios J, Davis A, Jones J, Lam A, Poon I, Martino R, Ringash J. Development and pre-testing of a rehabilitation planning consultation for head-and-neck cancer. ACTA ACUST UNITED AC 2017; 24:153-160. [PMID: 28680274 DOI: 10.3747/co.24.3529] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In contrast with other major chronic conditions such as heart disease and stroke, cancer care does not routinely integrate evidence-based rehabilitation services within the standard continuum. The objectives of the present project were to develop a rehabilitation planning consultation (rpc) for survivors of head-and-neck (hn) cancer, to test its feasibility, and to make refinements. METHODS Using intervention mapping, the rpc-alpha was developed by examining potential theoretical methods and practical applications relative to the program objectives. During feasibility testing, a single case series was conducted with survivors of hn cancer who had completed their cancer treatment within the preceding 11 months; iterative refinements were made after each case. RESULTS The rpc-alpha was led by a rehabilitation professional and was based on self-management principles. The initial consultation included instruction in a global cognitive strategy, goal-setting, introduction to available resources, action planning, and coping planning. A follow-up consultation was conducted a few weeks later. Of 9 participants recruited, 5 completed post-intervention assessments. Participants reported that the rpc helped them to make rehabilitation plans. CONCLUSIONS The rpc was feasible to use and satisfactory to a small group of hn cancer survivors. A pilot test of the refined version is in process.
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Affiliation(s)
- S McEwen
- Sunnybrook Research Institute, St. John's Rehab Research Program, Toronto.,University of Toronto, Toronto
| | - C Dunphy
- University Health Network, Princess Margaret Cancer Centre, Toronto
| | - J Norman Rios
- Sunnybrook Research Institute, St. John's Rehab Research Program, Toronto
| | - A Davis
- University of Toronto, Toronto.,University Health Network, Toronto Western Research Institute, Toronto
| | - J Jones
- University of Toronto, Toronto.,University Health Network, Princess Margaret Cancer Centre, Toronto
| | - A Lam
- University Health Network, Princess Margaret Cancer Centre, Toronto.,The University of Western Ontario, London; and
| | - I Poon
- University of Toronto, Toronto.,Odette Cancer Centre, Sunnybrook Hospital, Toronto, ON
| | | | - J Ringash
- University of Toronto, Toronto.,University Health Network, Princess Margaret Cancer Centre, Toronto
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Castellino S, Keller F, Voss S, Cho S, Constine L, Thompson J, Dunphy C, McCarten K, Chen L, Schwartz C. Outcomes and Patterns of Failure in Children/Adolescents with Low Risk Hodgkin Lymphoma (HL) who Are FDG-PET (PET3) Positive after AVPC Therapy. Klin Padiatr 2014. [DOI: 10.1055/s-0034-1371113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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Keller F, Castellino S, Constine L, Voss S, Thomson J, Dunphy C, McCarten K, Chen L, Schwartz C. Intensive Therapy Free Survival (ITFS) for Early-Stage Hodgkin Lymphoma (cHL) Including Chemotherapy and Radiation Therapy (IFRT) for Recurrence after Chemotherapy alone. Klin Padiatr 2014. [DOI: 10.1055/s-0034-1371119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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19
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Shea T, Serody J, Gabriel D, Comeauu T, Morris D, Irons R, Harvey D, Sharf A, Krasnov C, Dunphy C, Banderenko N, Brecher M. High relapse rate following alemtuzamab use in allogeneic transplants for myeloid hematologic malignancies. Biol Blood Marrow Transplant 2005. [DOI: 10.1016/j.bbmt.2004.12.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Critchlow CW, Surawicz CM, Holmes KK, Kuypers J, Daling JR, Hawes SE, Goldbaum GM, Sayer J, Hurt C, Dunphy C. Prospective study of high grade anal squamous intraepithelial neoplasia in a cohort of homosexual men: influence of HIV infection, immunosuppression and human papillomavirus infection. AIDS 1995; 9:1255-62. [PMID: 8561979 DOI: 10.1097/00002030-199511000-00007] [Citation(s) in RCA: 148] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To determine the risk of developing high grade anal squamous intraepithelial neoplasia (HG-AIN) in relation to HIV infection and immunosuppression, after controlling for the effects of human papillomavirus (HPV) infection. DESIGN Prospective cohort study of 158 HIV-seropositive and 147 HIV-seronegative homosexual men presenting to a community-based clinic with initially negative anal cytologic and colposcopic findings. METHODS Subjects completed self-administered questionnaires, underwent cytologic screening, and standardized unaided and colposcopic examination of the proximal anal canal for presence of abnormalities suggestive of AIN. Anal specimens were screened for HPV DNA. RESULTS HG-AIN developed in eight (5.4%) and 24 (15.2%) HIV-seronegative and -seropositive men, respectively. Risk of HG-AIN among HIV-seronegative men was associated with detection of anal HPV types 16 or 18 by Southern transfer hybridization (STH), detection of HPV 16 or 18 at the lower levels by polymerase chain reaction but not by STH, and with number of positive HPV tests; HG-AIN risk among HIV-seropositive men was associated with detection of HPV 16 or 18 only by STH, detection of HPV types other than 16 or 18, CD4 count < or = 500 x 10(6)/l, and number of positive HPV tests. HIV-induced immunosuppression remained an independent predictor of HG-AIN after adjusting for type and level of detection of HPV; HIV infection predicted HG-AIN risk after adjustment for number of positive HPV tests. CONCLUSIONS The association of HG-AIN with HIV, independent of HPV type, level of HPV detection and number of positive HPV tests, suggests that this increased risk cannot be entirely explained by an effect of HIV on HPV detection. Future studies focusing on factors more specific to the local microenvironment in the anal canal should help clarify these issues.
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Affiliation(s)
- C W Critchlow
- Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle 98195, USA
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21
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Abstract
BACKGROUND Both anal squamous cell cancer and human papilloma virus (HPV) are increased in homosexual men. This study evaluates histology of internal anal abnormalities in a high-risk population of human immunodeficiency virus (HIV) seropositive and seronegative homosexual men. METHODS Ninety men with abnormalities of the internal anal canal (referred from a cross-sectional study of 512 homosexual men) were evaluated by anoscopy, anal cytology, and directed biopsy. CD4 cell counts from blood and HPV types from anal tissue were also obtained. RESULTS Seventy-eight (86%) men had HPV-associated abnormalities: discrete warts in 39 (43%), a wart ring in 23 (26%), and flat white epithelium in 18 (20%). Dysplasia was detected by cytology in 36% and by biopsy in 92% (27% high grade). High-grade dysplasia was equally common in HIV-seropositive and -seronegative men. The morphology of anal lesions did not predict the presence of dysplasia. Both high- and low-risk HPV types were common in many of the biopsy specimens. CONCLUSIONS Anal dysplasia is common in biopsy specimens from homosexual men with visible HPV-associated internal anal abnormalities. Natural history studies are needed to determine the clinical significance of anal dysplasia, rates of progression to cancer, and the role of screening and therapy.
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Affiliation(s)
- C M Surawicz
- Department of Medicine, University of Washington School of Medicine, Seattle
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22
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Kiviat NB, Critchlow CW, Holmes KK, Kuypers J, Sayer J, Dunphy C, Surawicz C, Kirby P, Wood R, Daling JR. Association of anal dysplasia and human papillomavirus with immunosuppression and HIV infection among homosexual men. AIDS 1993; 7:43-9. [PMID: 8382927 DOI: 10.1097/00002030-199301000-00007] [Citation(s) in RCA: 108] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To examine and quantify the association between anal squamous intraepithelial lesions (ASIL), anal human papillomavirus (HPV) infection and immunosuppression among HIV-seropositive and HIV-seronegative homosexual men. DESIGN Cross-sectional study among homosexual men presenting at a community-based clinic for HIV serologic screening. RESULTS Anal HPV DNA was detected in 55 and 23% of 285 HIV-seropositive and 204 HIV-seronegative men, respectively, by Southern transfer hybridization (STH) [odds ratio (OR), 4.0; 95% confidence interval (CI), 2.7-6.2], and in 92 and 78% by polymerase chain reaction (PCR) (OR, 3.1; 95% CI, 1.6-5.8). ASIL was noted in 26% of HIV-seropositive men and in 8% of HIV-seronegative men (compared with men with negative cytologic findings: OR, 5.6; 95% CI, 3.0-10.5), with high-grade lesions noted in 4% of HIV-seropositive and in 0.5% of HIV-seronegative men. Among HIV-infected men, ASIL, detection of specific anal HPV types, and detection of high levels of anal HPV DNA (i.e., levels of HPV DNA detectable by both STH and PCR) were all associated with immunosuppression. Nevertheless, HIV-seropositive men with CD4 counts > 500 x 10(6)/l had a higher prevalence of both anal HPV and ASIL than men without HIV infection. Overall, detection of HPV at high levels was associated with ASIL. However, after adjustment for level of detectable HPV DNA, the risk of ASIL among HIV-seropositive men with CD4 counts < 500 x 10(6)/l was increased 2.9-fold (95% CI, 1.4-6.2) over that of HIV-seropositive men with CD4 counts > 500 x 10(6)/l. CONCLUSION Given the high rates of ASIL in HIV-seronegative and both immunosuppressed and non-immunosuppressed HIV-seropositive homosexual men, natural history studies are now needed to assist in the development of strategies for the detection and management of such lesions. The increased prevalence of ASIL seen among immunosuppressed HIV-seropositive men may be the result of both a non-specific increase in productive HPV infection and HIV-induced immune alterations of HIV-related neoplasia.
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Affiliation(s)
- N B Kiviat
- Department of Pathology, University of Washington, Seattle
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23
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Critchlow CW, Holmes KK, Wood R, Krueger L, Dunphy C, Vernon DA, Daling JR, Kiviat NB. Association of human immunodeficiency virus and anal human papillomavirus infection among homosexual men. Arch Intern Med 1992; 152:1673-6. [PMID: 1323247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND A previous study of men with proctitis, proctocolitis, or enteritis showed an association of anal human papillomavirus (HPV) infection with human immunodeficiency virus (HIV) infection. Because anorectal abnormalities may confound an observed association between anal HPV DNA and HIV seropositivity, the present study was undertaken among consecutive homosexual men seeking HIV serologic testing who were unselected for anorectal symptoms. METHODS Consecutive homosexual men underwent a standardized interview, physical examination, and collection of specimens for HIV serologic testing and detection of anal HPV DNA. RESULTS Anal HPV DNA was detected in eight (31%) of 26 HIV-seropositive men and in 10 (8%) of 119 HIV-seronegative men (odds ratio, 5.8; 95% confidence interval, 1.1 to 30.1, adjusted for history of sexually transmitted disease, current anorectal symptoms, and age). When men with anorectal symptoms were excluded from the analysis, anal HPV DNA was detected in 27% of seropositive men compared with 8% of seronegative men (odds ratio, 4.4; 95% confidence interval, 1.4 to 13.4). There was no difference between HIV-seropositive and HIV-seronegative men with respect to distribution of type of HPV DNA. Men with group II or III and group IV HIV disease were 4.1 and 10.9 times, respectively, more likely than HIV-seronegative men to have anal HPV DNA detected. CONCLUSIONS Because HIV-seropositive men appear to be at increased risk for the detection of anal HPV DNA, the natural course of anal HPV infection should be compared among HIV-seropositive and HIV-seronegative homosexual men.
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Affiliation(s)
- C W Critchlow
- Department of Biostatistics, University of Washington, Seattle 98195
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24
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Melnick SL, Engel D, Truelove E, DeRouen T, Morton T, Schubert M, Dunphy C, Wood RW. Oral mucosal lesions: association with the presence of antibodies to the human immunodeficiency virus. Oral Surg Oral Med Oral Pathol 1989; 68:37-43. [PMID: 2755688 DOI: 10.1016/0030-4220(89)90112-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
To assess the relationship between oral lesions and antibodies to the human immunodeficiency virus, oral examinations of 803 homosexual males were conducted at the time of serologic testing. Nineteen percent were HIV seropositive. Thirty percent of antibody-positive subjects had one or more oral lesion(s), as compared with 7% of antibody-negative subjects (p less than 0.001). The presence of oral lesions was significantly associated with HIV seropositivity: a subject was 5.7 times as likely to have serum antibodies if he had one or more oral lesions (95% confidence interval, 3.5 to 9.1; p less than 0.001). This significant association with HIV seropositivity was only partially explained by cigarette smoking (adjusted odds ratio 3.1; 1.4-6.8; less than 0.006). Specific conditions that were significantly associated with seropositivity included candidiasis, hairy leukoplakia, periodontal disease, and Kaposi's sarcoma. Other diseases identified included acute necrotizing ulcerative gingivitis, mucocutaneous ulcerations, and oral warts. Oral findings may occur earlier in the natural history of infection than previously reported.
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Affiliation(s)
- S L Melnick
- Division of Epidemiology, School of Public Health, University of Minnesota
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Dunphy C. Stress management on the job. Wash Nurse 1985; 15:9. [PMID: 3920833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Dunphy C. AIDS. Wash Nurse 1984; 14:9. [PMID: 6435316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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