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Wilkinson R, Byrne T, Cowden RG, Long KNG, Kuhn JH, Koh HK, Tsai J. First Decade of Supportive Services for Veteran Families Program and Homelessness, 2012-2022. Am J Public Health 2024; 114:610-618. [PMID: 38718339 PMCID: PMC11079843 DOI: 10.2105/ajph.2024.307625] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
As homelessness remains an urgent public health crisis in the United States, specific programs in the US Department of Veterans Affairs (VA) system may serve as a roadmap for addressing it. We examine lessons learned from the first decade (2012-2022) of the Supportive Services for Veteran Families (SSVF) program, a cornerstone in the VA continuum of homeless services aimed at both preventing homelessness among those at risk and providing rapid rehousing for veterans and their families who are currently experiencing homelessness. Drawing on information from annual reports and other relevant literature, we have identified 3 themes of SSVF that emerged as features to comprehensively deliver support for homeless veterans and their families: (1) responsiveness and flexibility, (2) coordination and integration, and (3) social resource engagement. Using these strategies, SSVF reached nearly three quarters of a million veterans and their families in its first decade, thereby becoming one of the VA's most substantial programmatic efforts designed to address homelessness. We discuss how each feature might apply to addressing homelessness in the general population as well as future research directions. (Am J Public Health. 2024;114(6):610-618. https://doi.org/10.2105/AJPH.2024.307625).
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Affiliation(s)
- Renae Wilkinson
- Renae Wilkinson, Richard G. Cowden, and Katelyn N. G. Long are with the Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA. Thomas Byrne is with the School of Social Work, Boston University, Boston, MA. John H. Kuhn is with the VA Greater Los Angeles Healthcare System, Los Angeles, CA. Howard K. Koh is with the Harvard T. H. Chan School of Public Health, Boston, MA. Jack Tsai is with the US Department of Veterans Affairs, National Center on Homelessness Among Veterans, Washington DC
| | - Thomas Byrne
- Renae Wilkinson, Richard G. Cowden, and Katelyn N. G. Long are with the Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA. Thomas Byrne is with the School of Social Work, Boston University, Boston, MA. John H. Kuhn is with the VA Greater Los Angeles Healthcare System, Los Angeles, CA. Howard K. Koh is with the Harvard T. H. Chan School of Public Health, Boston, MA. Jack Tsai is with the US Department of Veterans Affairs, National Center on Homelessness Among Veterans, Washington DC
| | - Richard G Cowden
- Renae Wilkinson, Richard G. Cowden, and Katelyn N. G. Long are with the Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA. Thomas Byrne is with the School of Social Work, Boston University, Boston, MA. John H. Kuhn is with the VA Greater Los Angeles Healthcare System, Los Angeles, CA. Howard K. Koh is with the Harvard T. H. Chan School of Public Health, Boston, MA. Jack Tsai is with the US Department of Veterans Affairs, National Center on Homelessness Among Veterans, Washington DC
| | - Katelyn N G Long
- Renae Wilkinson, Richard G. Cowden, and Katelyn N. G. Long are with the Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA. Thomas Byrne is with the School of Social Work, Boston University, Boston, MA. John H. Kuhn is with the VA Greater Los Angeles Healthcare System, Los Angeles, CA. Howard K. Koh is with the Harvard T. H. Chan School of Public Health, Boston, MA. Jack Tsai is with the US Department of Veterans Affairs, National Center on Homelessness Among Veterans, Washington DC
| | - John H Kuhn
- Renae Wilkinson, Richard G. Cowden, and Katelyn N. G. Long are with the Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA. Thomas Byrne is with the School of Social Work, Boston University, Boston, MA. John H. Kuhn is with the VA Greater Los Angeles Healthcare System, Los Angeles, CA. Howard K. Koh is with the Harvard T. H. Chan School of Public Health, Boston, MA. Jack Tsai is with the US Department of Veterans Affairs, National Center on Homelessness Among Veterans, Washington DC
| | - Howard K Koh
- Renae Wilkinson, Richard G. Cowden, and Katelyn N. G. Long are with the Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA. Thomas Byrne is with the School of Social Work, Boston University, Boston, MA. John H. Kuhn is with the VA Greater Los Angeles Healthcare System, Los Angeles, CA. Howard K. Koh is with the Harvard T. H. Chan School of Public Health, Boston, MA. Jack Tsai is with the US Department of Veterans Affairs, National Center on Homelessness Among Veterans, Washington DC
| | - Jack Tsai
- Renae Wilkinson, Richard G. Cowden, and Katelyn N. G. Long are with the Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA. Thomas Byrne is with the School of Social Work, Boston University, Boston, MA. John H. Kuhn is with the VA Greater Los Angeles Healthcare System, Los Angeles, CA. Howard K. Koh is with the Harvard T. H. Chan School of Public Health, Boston, MA. Jack Tsai is with the US Department of Veterans Affairs, National Center on Homelessness Among Veterans, Washington DC
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Abstract
This cross-sectional study systematically examines the contributions of COVID-19 and other underlying causes of death to the widened gender life expectancy gap from 2010 to 2021.
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Affiliation(s)
- Brandon W. Yan
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Elizabeth Arias
- Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Alan C. Geller
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Donald R. Miller
- Boston University School of Public Health, Boston, Massachusetts
| | - Kenneth D. Kochanek
- Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Howard K. Koh
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Savoia E, Piltch-Loeb R, Stanton EH, Koh HK. Learning from COVID-19: government leaders' perspectives to improve emergency risk communication. Global Health 2023; 19:86. [PMID: 37968676 PMCID: PMC10652548 DOI: 10.1186/s12992-023-00993-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 11/08/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic highlighted the challenges of effective emergency risk communication (ERC) to protect public health, including the difficulty in tackling the spread of inaccurate information. This study aimed to understand those challenges and potential solutions by interviewing leading government spokespersons and their advisors from around the world with experience during large scale emergencies. Interviews were conducted with 27 individuals representing governments from 19 countries across five continents. Thematic analysis, using both a deductive and inductive approach, organized and identified salient themes and patterns that emerged from the interview data. RESULTS The thematic analysis of the interviews' data led to the identification of 9 principles of communication: 1) Timeliness, 2) Transparency, 3) Coordination, 4) Accuracy and Consistency, 5) Accountability and Integrity, 6) Independence from politics, 7) Responsiveness, 8) Equity, 9) Trust and Empathy. We also developed 36 recommendations actionable by government agencies to enhance the practice of the 9 principles. Examples include the need for: proactive communication strategies, permanent communication task forces integrated into preparedness and response efforts, robust processes to enhance open discussion of controversial topics within government agencies, clarification of how various branches of government coordinate to oversee specific aspects of the overall communication, and development of relationships across public and private entities ahead of a crisis. CONCLUSIONS Our findings suggest key practical recommendations for leaders of government agencies to enhance ERC capabilities going forward. Before a crisis, they must constantly review internal processes and integrate ERC functions into overall communication planning efforts. During a crisis, they must coordinate roles and responsibilities across branches of governments, strive to communicate to a range of populations to uphold equity, maintain transparency by avoiding information voids on controversial issues and build trust by building relationships with a variety of community leaders. After a crisis, government agencies should continue the practice of social listening to hear more about the public's informational needs, strengthen civic participation processes, and understand how an always evolving information environment can best be leveraged during future crises.
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Affiliation(s)
- Elena Savoia
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
- Emergency Preparedness Research Evaluation and Practice (EPREP) Program, Division of Policy Translation and Leadership Development, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Rachael Piltch-Loeb
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
- Emergency Preparedness Research Evaluation and Practice (EPREP) Program, Division of Policy Translation and Leadership Development, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Eva H Stanton
- Emergency Preparedness Research Evaluation and Practice (EPREP) Program, Division of Policy Translation and Leadership Development, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Howard K Koh
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
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Koh HK, Tso CC, Dougherty CP, Lazowy EE, Heberlein CP, Phelps FA. Exploring the spiritual foundations of public health leadership. Front Public Health 2023; 11:1210160. [PMID: 37954055 PMCID: PMC10634334 DOI: 10.3389/fpubh.2023.1210160] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 10/03/2023] [Indexed: 11/14/2023] Open
Abstract
The Covid-19 pandemic has laid bare the challenges of public health leadership. Faced with criticism, threats, and even violence, many public health leaders have left the field. A healthier future for the nation may well rest on training aspiring public health leaders to build deeper capacity for perseverance, healing, and resilience. Reflecting the growing experience of a team of public health educators at the Harvard T.H. Chan School of Public Health (Harvard Chan), this article offers recommendations for public health schools to recognize, and incorporate into leadership education, themes of spirituality-ie, the way people seek ultimate meaning and purpose and deep connectedness to something larger than themselves. Doing so can serve as a foundation for the lifelong journey of leadership. Over the past decade, Harvard Chan has incorporated meaning, purpose, and connectedness themes to complement more traditional coursework addressing research and translation. While many established leadership frameworks address the "what" and "how" of career development, the spirituality framework can support aspiring leaders to more fully understand their "why" and its alignment with challenging work. Such a deeply personal topic, traditionally kept private, has been shared and nurtured in Harvard Chan classrooms through a range of pedagogical strategies including personal reflection, one-on- one coaching, experiential learning, case discussions, and candid conversations with public health leaders. By encouraging a values-based foundation for decision-making in crises and difficult leadership moments, such grounding can help aspiring leaders navigate the challenges of public health leadership that inevitably lie ahead.
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Affiliation(s)
- Howard K. Koh
- Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Harvard Kennedy School, Cambridge, MA, United States
| | - Cathy C. Tso
- Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | | | - Emily E. Lazowy
- Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | | | - Fawn A. Phelps
- Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Do EK, Aarvig K, Muller-Tabanera H, Mills S, Sumibcay JR, Koh HK, Vallone DM, Hair EC. E-cigarette use behaviors of Asian American, Native Hawaiian, and Pacific Islander youth in the contiguous United States: Insights from the Monitoring the Future Study (2018-2019). Prev Med Rep 2023; 35:102376. [PMID: 37662868 PMCID: PMC10472302 DOI: 10.1016/j.pmedr.2023.102376] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 08/02/2023] [Accepted: 08/19/2023] [Indexed: 09/05/2023] Open
Abstract
This study examines e-cigarette use behaviors of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) youth, in relation to other racial/ethnic groups in the United States. Data were obtained from the 2018 and 2019 Monitoring the Future surveys, which include a random, probability-based sample of youth in 8th, 10th, and 12th grades surveyed annually across the contiguous United States. Respondents provided information on race/ethnicity and e-cigarette use (n = 42,980). Measures of e-cigarette use included current (1 + of past 30 days) and regular use (10 + of past 30 days). Chi-square tests were used to determine differences in e-cigarette use by race/ethnicity. Associations between race/ethnicity, other sociodemographic factors, and e-cigarette use were explored using logistic regression analyses. Approximately 5.1% (n = 2,410) of the sample identified as AANHPI. A greater proportion of Native Hawaiian and Pacific Islanders reported current e-cigarette use (NHPI, 28.0%), relative to Asian American (AA, 10.3%), Black (9.5%), Hispanic or Latino (15.0%), American Indian or Alaskan Native (AIAN, 16.5%), multiracial (22.3%), and non-Hispanic White (25.2%) youth. Regular e-cigarette use was highest among non-Hispanic White (12.3%), followed by multiracial (10.7%), AIAN (7.8%), Hispanic or Latino (5.0%), AA (4.3%), and Black (3.0%) youth. Associations between race/ethnicity and e-cigarette use remained significant, after controlling for other sociodemographic factors. Continued monitoring of e-cigarette use is needed among AANHPI, a historically underrepresented population in tobacco research. Special attention should be paid to NHPI, who reported the highest rates of e-cigarette use.
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Affiliation(s)
- Elizabeth K. Do
- Schroeder Institute, Truth Initiative, Washington, DC, USA
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | | | - Sarah Mills
- Schroeder Institute, Truth Initiative, Washington, DC, USA
| | | | - Howard K. Koh
- T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Donna M. Vallone
- Schroeder Institute, Truth Initiative, Washington, DC, USA
- Department of Health, Behavior and Society, Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, USA
- School of Global Public Health, New York University, New York, NY, USA
| | - Elizabeth C. Hair
- Schroeder Institute, Truth Initiative, Washington, DC, USA
- Department of Health, Behavior and Society, Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, USA
- School of Global Public Health, New York University, New York, NY, USA
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Koh HK, Hrabchak Molinsky J, Koh KA, Roncarati JS, Sullivan MM, Lazowy EE, O’Connell JJ. Establishing Academic Homes for Homelessness: A Call to Action. Public Health Rep 2023; 138:838-844. [PMID: 36062354 PMCID: PMC10467508 DOI: 10.1177/00333549221120453] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Although homelessness ranks as one of society's most pressing and visible health equity challenges, the academic community has not actively addressed its health impacts, root causes, and potential solutions. Few schools and programs of public health even offer a basic course for students. In the COVID-19 pandemic era, academia must demonstrate urgency to address homelessness and educate learners, motivate fledgling researchers, inform policy makers, offer community-engaged and evidence-based studies, and join in the growing national debate about best approaches. At a minimum, every public health student should understand the interdisciplinary challenges of homelessness, its implications for health equity, and opportunities to address the crisis. We call for academia, particularly schools and programs of public health, to engage more fully in national partnerships to care for members of society who are most marginalized, in terms of health and behavioral health outcomes, quality of life, and connectedness.
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Affiliation(s)
- Howard K. Koh
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Kennedy School, Cambridge, MA, USA
| | | | - Katherine A. Koh
- Boston Health Care for the Homeless Program, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | | | - Margaret M. Sullivan
- Boston Health Care for the Homeless Program, Boston, MA, USA
- FXB Center for Health and Human Rights at Harvard University, Boston, MA, USA
| | | | - James J. O’Connell
- Boston Health Care for the Homeless Program, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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7
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Valdiserri RO, Koh HK, Ward JW. Overcome Health Inequities to Eliminate Viral Hepatitis. JAMA 2023; 329:1637-1638. [PMID: 37067806 DOI: 10.1001/jama.2023.5381] [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] [Indexed: 04/18/2023]
Abstract
This Viewpoint outlines the progress made toward eliminating hepatitis B and C but emphasizes the work that remains to prioritize diagnosis and treatment of populations disproportionately affected by viral hepatitis, including ensuring that there are systems in place to treat those infected and care for those at risk.
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Affiliation(s)
- Ronald O Valdiserri
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Howard K Koh
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - John W Ward
- Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Leider JP, Castrucci BC, Robins M, Hare Bork R, Fraser MR, Savoia E, Piltch-Loeb R, Koh HK. The Exodus Of State And Local Public Health Employees: Separations Started Before And Continued Throughout COVID-19. Health Aff (Millwood) 2023; 42:338-348. [PMID: 36877909 DOI: 10.1377/hlthaff.2022.01251] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Understanding the size and composition of the state and local governmental public health workforce in the United States is critical for promoting and protecting the health of the public. Using pandemic-era data from the Public Health Workforce Interests and Needs Survey fielded in 2017 and 2021, this study compared intent to leave or retire in 2017 with actual separations through 2021 among state and local public health agency staff. We also examined how employee age, region, and intent to leave correlated with separations and considered the effect on the workforce if trends were to continue. In our analytic sample, nearly half of all employees in state and local public health agencies left between 2017 and 2021, a proportion that rose to three-quarters for those ages thirty-five and younger or with shorter tenures. If separation trends continue, by 2025 this would represent more than 100,000 staff leaving their organizations, or as much as half of the governmental public health workforce in total. Given the likelihood of increasing outbreaks and future global pandemics, strategies to improve recruitment and retention must be prioritized.
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Affiliation(s)
| | | | | | | | - Michael R Fraser
- Michael R. Fraser, Association of State and Territorial Health Officials, Arlington, Virginia
| | - Elena Savoia
- Elena Savoia, Harvard University, Boston, Massachusetts
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Benchimol-Elkaim B, Dryden-Peterson S, Miller DR, Koh HK, Geller AC. Oral Antiviral Therapy Utilization Among Adults with Recent COVID-19 in the United States. J Gen Intern Med 2023; 38:1717-1721. [PMID: 36853557 PMCID: PMC9973233 DOI: 10.1007/s11606-023-08106-6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/13/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND This is the first study, to our knowledge, to assess uptake of oral antiviral treatment (OAV) for COVID-19 in the US and assess whether it is reaching recommended groups. OBJECTIVE The study evaluated uptake among persons of all ages, with emphasis on utilization among individuals ages 65 + who comprise 75% of all COVID-19 deaths. To maximize public health outreach and benefit, we sought to understand reasons for use and non-use of OAV among individuals 65 + with at least mild COVID-19 symptoms. DESIGN Data were collected from phase 3.5 of the US Census Household Pulse Survey, during three 2022 time periods: June 1-13, June 29-July 11, and July 27-August 8. PARTICIPANTS Respondents (n = 12,299) were ages 18 + with active or resolved COVID-19 within the last 4 weeks of their survey participation. MAIN MEASURE(S) Comparisons of demographic variables were made for OAV uptake using the chi-square test of independence. A logistic regression was conducted to identify characteristics of participants independently associated with receipt of an OAV. Comparisons were made with chi-square testing, between those ages 65 + with at least mild symptoms who endorsed one of a number of specific reasons for not using OAV. KEY RESULTS Utilization was low-17.9% of all respondents, 20.5% of respondents ages 50-64, and 33.9% of respondents 65 years and older received guideline-concordant treatment for their infection. Receipt did not differ by income or sex. The average response across the three phases was 5.4%. Most common reasons for not receiving treatment included having minimal symptoms, not thinking that they needed treatment, and not receiving a recommendation from their healthcare provider. CONCLUSIONS A minority of increased-risk US residents have accessed early therapy for COVID-19 despite being made available without cost. Responses suggest that efforts to improve patient and provider knowledge could improve utilization to mitigate future COVID-19 hospitalizations.
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Affiliation(s)
| | - Scott Dryden-Peterson
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Donald R Miller
- Center for Population Health, Department of Biomedical and Nutritional Sciences, University of Massachusetts, Lowell, MA, USA
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA
| | - Howard K Koh
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alan C Geller
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Abstract
This Viewpoint discusses the ways in which the tobacco industry can advance their stated goals of harm reduction and a smoke-free future.
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Affiliation(s)
- Howard K Koh
- Harvard T.H. Chan School of Public Health, Harvard Kennedy School, Boston, Massachusetts
| | - Michael C Fiore
- University of Wisconsin-Madison Center for Tobacco Research and Intervention, Madison
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Ma J, Yabroff KR, Siegel RL, Cance WG, Koh HK, Jemal A. Progress in Reducing Disparities in Premature Mortality in the USA: a Descriptive Study. J Gen Intern Med 2022; 37:2923-2930. [PMID: 35731369 PMCID: PMC9485393 DOI: 10.1007/s11606-021-07268-5] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Eliminating health disparities among different segments of the US population is an overarching goal of the US Healthy People 2020 objectives. OBJECTIVE Examine changes in educational, rural-urban, and racial disparities in premature mortality during the past 10 years. DESIGN AND PARTICIPANTS Descriptive analysis of US mortality data from 2007 to 2017. MAIN MEASURES Relative and absolute rural-urban, educational attainment, and Black-White disparities in premature mortality for all-cause and top 10 causes of death among persons ages 25-74 years, estimated as rate ratios and rate differences between ≤12 and ≥16 years of education, rural versus urban, and non-Hispanic Black (Black) versus non-Hispanic White (White), respectively, in 2007 and 2017. KEY RESULTS During 2007-2017, mortality rates in persons aged 25-74 years in the USA increased for several leading causes of death, especially in persons with <16 years of education, rural residents, and White people. As a result, disparity in mortality between 2007 and 2017 widened on both relative and absolute scales for all-cause and for 6 of the top 10 causes of death by education and for all-cause and for 9 of the top 10 causes by rural/urban residence. In contrast, Black-White disparities narrowed for all-cause and for all 7 causes that Black people had a higher rate than White people. For all-cause mortality for example, absolute disparities in the number of deaths per 100,000 person-years between 2007 and 2017 increased from 454.0 (95%CI, 446.0-462.1) to 542.7 (535.6-549.7) for educational attainment and from 85.8 (82.8-88.8) to 140.5 (137.6-143.4) for rural versus urban; in contrast, absolute Black-White disparity decreased from 315.3 (311.0-319.7) to 221.7 (218.1-225.3). CONCLUSIONS Educational and rural-urban disparities in premature mortality widened, whereas Black-White disparities narrowed in the USA between 2007 and 2017, though overall rates remained considerably higher in Black people.
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Affiliation(s)
- Jiemin Ma
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - K Robin Yabroff
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - Rebecca L Siegel
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - William G Cance
- Office of the Chief Medical and Scientific Officer, American Cancer Society, Atlanta, GA, USA
| | - Howard K Koh
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ahmedin Jemal
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, GA, USA.
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Bernstein AS, Stevens KL, Koh HK. Patient-Centered Climate Action and Health Equity. JAMA 2022; 328:419-420. [PMID: 35834232 DOI: 10.1001/jama.2022.12404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Aaron S Bernstein
- Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | | | - Howard K Koh
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Balboni TA, VanderWeele TJ, Doan-Soares SD, Long KNG, Ferrell BR, Fitchett G, Koenig HG, Bain PA, Puchalski C, Steinhauser KE, Sulmasy DP, Koh HK. Spirituality in Serious Illness and Health. JAMA 2022; 328:184-197. [PMID: 35819420 DOI: 10.1001/jama.2022.11086] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [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] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Despite growing evidence, the role of spirituality in serious illness and health has not been systematically assessed. OBJECTIVE To review evidence concerning spirituality in serious illness and health and to identify implications for patient care and health outcomes. EVIDENCE REVIEW Searches of PubMed, PsycINFO, and Web of Science identified articles with evidence addressing spirituality in serious illness or health, published January 2000 to April 2022. Independent reviewers screened, summarized, and graded articles that met eligibility criteria. Eligible serious illness studies included 100 or more participants; were prospective cohort studies, cross-sectional descriptive studies, meta-analyses, or randomized clinical trials; and included validated spirituality measures. Eligible health outcome studies prospectively examined associations with spirituality as cohort studies, case-control studies, or meta-analyses with samples of at least 1000 or were randomized trials with samples of at least 100 and used validated spirituality measures. Applying Cochrane criteria, studies were graded as having low, moderate, serious, or critical risk of bias, and studies with serious and critical risk of bias were excluded. Multidisciplinary Delphi panels consisting of clinicians, public health personnel, researchers, health systems leaders, and medical ethicists qualitatively synthesized and assessed the evidence and offered implications for health care. Evidence-synthesis statements and implications were derived from panelists' qualitative input; panelists rated the former on a 9-point scale (from "inconclusive" to "strongest evidence") and ranked the latter by order of priority. FINDINGS Of 8946 articles identified, 371 articles met inclusion criteria for serious illness; of these, 76.9% had low to moderate risk of bias. The Delphi panel review yielded 8 evidence statements supported by evidence categorized as strong and proposed 3 top-ranked implications of this evidence for serious illness: (1) incorporate spiritual care into care for patients with serious illness; (2) incorporate spiritual care education into training of interdisciplinary teams caring for persons with serious illness; and (3) include specialty practitioners of spiritual care in care of patients with serious illness. Of 6485 health outcomes articles, 215 met inclusion criteria; of these, 66.0% had low to moderate risk of bias. The Delphi panel review yielded 8 evidence statements supported by evidence categorized as strong and proposed 3 top-ranked implications of this evidence for health outcomes: (1) incorporate patient-centered and evidence-based approaches regarding associations of spiritual community with improved patient and population health outcomes; (2) increase awareness among health professionals of evidence for protective health associations of spiritual community; and (3) recognize spirituality as a social factor associated with health in research, community assessments, and program implementation. CONCLUSIONS AND RELEVANCE This systematic review, analysis, and process, based on highest-quality evidence available and expert consensus, provided suggested implications for addressing spirituality in serious illness and health outcomes as part of person-centered, value-sensitive care.
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Affiliation(s)
- Tracy A Balboni
- Departments of Radiation Oncology and Psychosocial Oncology and Palliative Care, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Tyler J VanderWeele
- Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts
| | - Stephanie D Doan-Soares
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Katelyn N G Long
- Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts
| | - Betty R Ferrell
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, California
| | - George Fitchett
- Department of Religion, Health, and Human Values, Rush University Medical Center, Chicago, Illinois
| | - Harold G Koenig
- Departments of Psychiatry and Behavioral Sciences and Medicine, Duke University Medical Center, Duke University, Durham, North Carolina
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Paul A Bain
- Harvard Medical School, Boston, Massachusetts
| | - Christina Puchalski
- The George Washington Institute for Spirituality and Health, Departments of Medicine and Health Care Sciences, George Washington University, Washington, DC
| | - Karen E Steinhauser
- Division of Palliative Medicine, Department of Medicine, Duke University Medical Center, Duke University, Durham, North Carolina
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
| | - Daniel P Sulmasy
- Kennedy Institute of Ethics, Departments of Medicine and Philosophy and the Pellegrino Center for Clinical Bioethics, Georgetown University, Washington, DC
| | - Howard K Koh
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- John F. Kennedy School of Government, Harvard University, Boston, Massachusetts
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Kim KE, Humphrey HJ, Koh HK. Prioritizing Asian Americans, Native Hawaiians, and Pacific Islanders in the U.S. Health Equity Agenda. Acad Med 2022; 97:786-789. [PMID: 35320122 DOI: 10.1097/acm.0000000000004673] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations are growing rapidly in the United States, yet AANHPIs remain understudied, overlooked, and misunderstood. During the COVID-19 pandemic, themes from the tragic history of anti-Asian bias and marginalization have resurfaced in a surge of renewed bigotry and xenophobic violence against AANHPIs. In this commentary, the authors discuss the role of medical schools in combating anti-Asian sentiment as an important step toward achieving health equity. Based on their collective expertise in health disparities research, medical education, and policy, they offer suggestions about how to disrupt the pattern of invisibility and exclusion faced by AANHPI populations. They consider ways that representative data, leadership in medical education, research funding, national policies, and broad partnerships can help address AANHPI health disparities.
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Affiliation(s)
- Karen E Kim
- K.E. Kim is vice provost for research, professor of medicine, and director, Center for Asian Health Equity, University of Chicago, Chicago, Illinois
| | - Holly J Humphrey
- H.J. Humphrey is president, Josiah Macy Jr. Foundation, New York, New York
| | - Howard K Koh
- H.K. Koh is Harvey V. Fineberg Professor of the Practice of Public Health Leadership, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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15
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Humphreys K, Shover CL, Andrews CM, Bohnert ASB, Brandeau ML, Caulkins JP, Chen JH, Cuéllar MF, Hurd YL, Juurlink DN, Koh HK, Krebs EE, Lembke A, Mackey SC, Larrimore Ouellette L, Suffoletto B, Timko C. Responding to the opioid crisis in North America and beyond: recommendations of the Stanford-Lancet Commission. Lancet 2022; 399:555-604. [PMID: 35122753 PMCID: PMC9261968 DOI: 10.1016/s0140-6736(21)02252-2] [Citation(s) in RCA: 157] [Impact Index Per Article: 78.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 08/01/2021] [Accepted: 10/06/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Keith Humphreys
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
| | - Chelsea L Shover
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - Christina M Andrews
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Amy S B Bohnert
- Department of Psychiatry and Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA; Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Margaret L Brandeau
- Department of Management Science and Engineering, Huang Engineering Center, Stanford University, Stanford, CA USA
| | | | - Jonathan H Chen
- Stanford Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, USA; Division of Hospital Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Yasmin L Hurd
- Addiction Institute, Icahn School of Medicine, New York, NY, USA
| | - David N Juurlink
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Howard K Koh
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Erin E Krebs
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Center for Care Delivery and Outcomes Research, Veterans Affairs Minneapolis Health Care System, Minneapolis, MN, USA
| | - Anna Lembke
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Brian Suffoletto
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Christine Timko
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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16
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VanderWeele TJ, Balboni TA, Koh HK. Invited Commentary: Religious Service Attendance and Implications for Clinical Care, Community Participation, and Public Health. Am J Epidemiol 2022; 191:31-35. [PMID: 33977296 PMCID: PMC8751781 DOI: 10.1093/aje/kwab134] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 12/17/2022] Open
Abstract
In this commentary, we review the evidence concerning associations between religious service attendance and subsequent health and wellbeing outcomes. The evidence base for a link between religious service attendance and health has increased substantially over the past 2 decades. The interpretation and implications of this research require careful consideration (Am J Epidemiol. 2022;191(1):20-30). It would be inappropriate to universally promote service attendance solely on the grounds of the associations with health. Nevertheless, a more nuanced approach, within both clinical care and public health, may be possible-one that encouraged participation in religious community for those who already positively self-identified with a religious or spiritual tradition and encouraged other forms of community participation for those who did not. Discussion is given to potential future research directions and the challenges and opportunities for promotion efforts by the public health community.
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Affiliation(s)
- Tyler J VanderWeele
- Correspondence to Dr. Tyler J. VanderWeele, Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 (e-mail: )
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17
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Affiliation(s)
- Howard K Koh
- Harvard T.H. Chan School of Public Health, Harvard Kennedy School, Boston, Massachusetts
| | - Juliet K Choi
- Asian and Pacific Islander American Health Forum, Washington, DC
| | - Jeffrey B Caballero
- Association of Asian Pacific Community Health Organizations, San Francisco, California
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18
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Koh HK, Blakey C, Ochiai E. Flourishing After a Pandemic: Healthy People 2030. J Public Health Manag Pract 2021; 27:S215-S217. [PMID: 34559737 PMCID: PMC8478293 DOI: 10.1097/phh.0000000000001415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Howard K. Koh
- Harvard T. H. Chan School of Public Health and Harvard Kennedy School, Boston, Massachusetts (Dr Koh); and Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, Maryland (Ms Blakey and Ms Ochiai)
| | - Carter Blakey
- Harvard T. H. Chan School of Public Health and Harvard Kennedy School, Boston, Massachusetts (Dr Koh); and Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, Maryland (Ms Blakey and Ms Ochiai)
| | - Emmeline Ochiai
- Harvard T. H. Chan School of Public Health and Harvard Kennedy School, Boston, Massachusetts (Dr Koh); and Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, Maryland (Ms Blakey and Ms Ochiai)
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19
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Sullivan MM, Lazowy EE, Roncarati JS, Koh HK, O'Connell JJ. Training Clinicians to Care for Patients Where They Are. AMA J Ethics 2021; 23:E852-857. [PMID: 34874253 DOI: 10.1001/amajethics.2021.852] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Homelessness remains a pervasive, long-standing problem in the United States and is poised to increase as a result of the COVID-19 pandemic. Individuals experiencing homelessness bear a higher burden of complex medical and mental health illnesses and often struggle to obtain quality and timely health care. The United States desperately needs to train a workforce to confront this large and growing crisis, but few health professional schools currently devote curricula to the clinical needs of people experiencing homelessness. This article discusses educational and curricular strategies for health professional students. Understanding the health needs of-and the social influences on the lives of-people experiencing homelessness is crucial for addressing this health equity challenge.
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Affiliation(s)
- Margaret M Sullivan
- Primary care clinician at Boston Health Care for the Homeless in Massachusetts and a postdoctoral research fellow at the FXB Center for Health and Human Rights at Harvard University
| | - Emily E Lazowy
- Program manager of the Initiative on Health and Homelessness at the Harvard T.H. Chan School of Public Health in Boston, Massachusetts
| | - Jill S Roncarati
- Postdoctoral fellow at the Center for Healthcare Organization and Implementation Research at VA Bedford Healthcare System in Massachusetts
| | - Howard K Koh
- Harvey V. Fineberg Professor of the Practice of Public Health Leadership at the Harvard T.H. Chan School of Public Health in Boston, Massachusetts, as well as the faculty chair of the school's Initiative on Health and Homelessness
| | - James J O'Connell
- Assistant professor of medicine at Harvard Medical School and the president and founding physician of Boston Health Care for the Homeless Program in Massachusetts
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20
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Affiliation(s)
- Howard K Koh
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Harvard Kennedy School, Cambridge, Massachusetts
| | - Juliet K Choi
- The Asian & Pacific Islander American Health Forum, Oakland, California
- The Asian & Pacific Islander American Health Forum, Washington, DC
| | - Jeffrey B Caballero
- The Association of Asian Pacific Community Health Organizations, San Francisco, California
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21
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Affiliation(s)
- Howard K Koh
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Harvard Kennedy School, Cambridge, Massachusetts
| | - Alan C Geller
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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22
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Jalali MS, Botticelli M, Hwang RC, Koh HK, McHugh RK. The opioid crisis: need for systems science research. Health Res Policy Syst 2020; 18:88. [PMID: 32771004 PMCID: PMC7414582 DOI: 10.1186/s12961-020-00598-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 04/03/2020] [Accepted: 06/29/2020] [Indexed: 01/07/2023] Open
Abstract
The opioid epidemic in the United States has had a devastating impact on millions of people as well as on their families and communities. The increased prevalence of opioid misuse, use disorder and overdose in recent years has highlighted the need for improved public health approaches for reducing the tremendous harms of this illness. In this paper, we explain and call for the need for more systems science approaches, which can uncover the complexities of the opioid crisis, and help evaluate, analyse and forecast the effectiveness of ongoing and new policy interventions. Similar to how a stream of systems science research helped policy development in infectious diseases and obesity, more systems science research is needed in opioids.
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Affiliation(s)
- Mohammad S. Jalali
- grid.38142.3c000000041936754XMGH Institute for Technology Assessment, Harvard Medical School, 101 Merrimac St, Suite 1010, Boston, MA 02114 United States of America ,grid.116068.80000 0001 2341 2786MIT Sloan School of Management, 100 Main St, Cambridge, MA 02142 United States of America
| | - Michael Botticelli
- grid.239424.a0000 0001 2183 6745Grayken Center for Addiction, Boston Medical Center, Boston, MA United States of America
| | - Rachael C. Hwang
- grid.116068.80000 0001 2341 2786MIT Sloan School of Management, 100 Main St, Cambridge, MA 02142 United States of America
| | - Howard K. Koh
- grid.38142.3c000000041936754XT.H. Chan School of Public Health, Harvard
University, Boston, MA United States of America ,grid.38142.3c000000041936754XHarvard Kennedy School, Harvard University, Cambridge, MA United States of America
| | - R. Kathryn McHugh
- grid.38142.3c000000041936754XMGH Institute for Technology Assessment, Harvard Medical School, 101 Merrimac St, Suite 1010, Boston, MA 02114 United States of America ,grid.240206.20000 0000 8795 072XDivision of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA United States of America
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23
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Jalali MS, Botticelli M, Hwang RC, Koh HK, McHugh RK. The opioid crisis: a contextual, social-ecological framework. Health Res Policy Syst 2020; 18:87. [PMID: 32762700 PMCID: PMC7409444 DOI: 10.1186/s12961-020-00596-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 06/29/2020] [Indexed: 12/14/2022] Open
Abstract
The prevalence of opioid use and misuse has provoked a staggering number of deaths over the past two and a half decades. Much attention has focused on individual risks according to various characteristics and experiences. However, broader social and contextual domains are also essential contributors to the opioid crisis such as interpersonal relationships and the conditions of the community and society that people live in. Despite efforts to tackle the issue, the rates of opioid misuse and non-fatal and fatal overdose remain high. Many call for a broad public health approach, but articulation of what such a strategy could entail has not been fully realised. In order to improve the awareness surrounding opioid misuse, we developed a social-ecological framework that helps conceptualise the multivariable risk factors of opioid misuse and facilitates reviewing them in individual, interpersonal, communal and societal levels. Our framework illustrates the multi-layer complexity of the opioid crisis that more completely captures the crisis as a multidimensional issue requiring a broader and integrated approach to prevention and treatment.
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Affiliation(s)
- Mohammad S Jalali
- Harvard Medical School, Harvard University, Boston, MA, United States of America.
- Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St, Suite 1010, Room 1032, Boston, MA, 02114, United States of America.
| | - Michael Botticelli
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, United States of America
| | - Rachael C Hwang
- Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St, Suite 1010, Room 1032, Boston, MA, 02114, United States of America
| | - Howard K Koh
- T.H. Chan School of Public Health, Harvard University, Boston, MA, United States of America
- Harvard Kennedy School, Harvard University, Cambridge, MA, United States of America
| | - R Kathryn McHugh
- Harvard Medical School, Harvard University, Boston, MA, United States of America
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA, United States of America
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24
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Affiliation(s)
| | | | - Howard K Koh
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Harvard Kennedy School, Cambridge, Massachusetts
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Chen Y, Koh HK, Kawachi I, Botticelli M, VanderWeele TJ. Religious Service Attendance and Deaths Related to Drugs, Alcohol, and Suicide Among US Health Care Professionals. JAMA Psychiatry 2020; 77:737-744. [PMID: 32374360 PMCID: PMC7203669 DOI: 10.1001/jamapsychiatry.2020.0175] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [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] [Indexed: 12/20/2022]
Abstract
IMPORTANCE The increase in deaths related to drugs, alcohol, and suicide (referred to as deaths from despair) has been identified as a public health crisis. The antecedents associated with these deaths have, however, seldom been investigated empirically. OBJECTIVE To prospectively examine the association between religious service attendance and deaths from despair. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used data extracted from self-reported questionnaires and medical records of 66 492 female registered nurses who participated in the Nurses' Health Study II (NHSII) from 2001 through 2017 and 43 141 male health care professionals (eg, dentist, pharmacist, optometrist, osteopath, podiatrist, and veterinarian) who participated in the Health Professionals Follow-up Study (HPFS) from 1988 through 2014. Data on causes of death were obtained from death certificates and medical records. Data analysis was conducted from September 2, 2018, to July 14, 2019. EXPOSURE Religious service attendance was self-reported at study baseline in response to the question, "How often do you go to religious meetings or services?" MAIN OUTCOMES AND MEASURES Deaths from despair, defined specifically as deaths from suicide, unintentional poisoning by alcohol or drug overdose, and chronic liver diseases and cirrhosis. Cox proportional hazards regression models were used to estimate the hazard ratio (HR) of deaths from despair by religious service attendance at study baseline, with adjustment for baseline sociodemographic characteristics, lifestyle factors, psychological distress, medical history, and other aspects of social integration. RESULTS Among the 66 492 female participants in NHSII (mean [SD] age, 46.33 [4.66] years), 75 incident deaths from despair were identified (during 1 039 465 person-years of follow-up). Among the 43 141 male participants in HPFS (mean [SD] age, 55.12 [9.53] years), there were 306 incident deaths from despair (during 973 736 person-years of follow-up). In the fully adjusted models, compared with those who never attended religious services, participants who attended services at least once per week had a 68% lower hazard (HR, 0.32; 95% CI, 0.16-0.62) of death from despair in NHSII and a 33% lower hazard (HR, 0.67; 95% CI, 0.48-0.94) of death from despair in HPFS. CONCLUSIONS AND RELEVANCE The findings suggest that religious service attendance is associated with a lower risk of death from despair among health care professionals. These results may be important in understanding trends in deaths from despair in the general population.
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Affiliation(s)
- Ying Chen
- Human Flourishing Program, Harvard Institute for Quantitative Social Science, Cambridge, Massachusetts,Harvard T. H. Chan School of Public Health, Department of Epidemiology, Boston, Massachusetts
| | - Howard K. Koh
- Harvard T. H. Chan School of Public Health, Department of Health Policy and Management, Boston, Massachusetts,Harvard Kennedy School, Cambridge, Massachusetts
| | - Ichiro Kawachi
- Harvard T. H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, Massachusetts
| | - Michael Botticelli
- Grayken Center for Addiction at Boston Medical Center, Boston, Massachusetts
| | - Tyler J. VanderWeele
- Human Flourishing Program, Harvard Institute for Quantitative Social Science, Cambridge, Massachusetts,Harvard T. H. Chan School of Public Health, Department of Epidemiology, Boston, Massachusetts
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Blake KD, Klein AL, Walpert L, Casey L, Hallett C, Douglas C, Sinha B, Koh HK. Smoke-free and tobacco-free colleges and universities in the United States. Tob Control 2020; 29:289-294. [PMID: 31266902 DOI: 10.1136/tobaccocontrol-2018-054829] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/15/2019] [Accepted: 03/20/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe the number and proportion of accredited, degree-granting institutions with 100% smoke-free and 100% tobacco-free protections across the USA and by state. METHODS Data on postsecondary education institutions from the US Department of Education National Center for Education Statistics Integrated Postsecondary Education Data System 2015, and smoke-free and tobacco-free campus protections from the American Nonsmokers' Rights Foundation's Smokefree and Tobacco-Free Colleges and Universities List 2017, were integrated to calculate the number and proportion of: (1) smoke-free and tobacco-free accredited, degree-granting institutions and (2) students and staff protected by campus policies and state laws. Campus protections are given a 100% smoke-free designation if smoking is not allowed on campus anywhere, at any time; 100% tobacco-free designations extend smoke-free protections to include non-combustible products such as smokeless tobacco. RESULTS 823 accredited, degree-granting institutions (16.7%) representing 1816 individual campuses, sites and schools have either 100% smoke-free or 100% tobacco-free protections. An estimated 14.9 million college students (26.9%) and 8.9 million faculty and staff (25.4%) are protected by campus policies and state laws. Only three states and two territories have 100% smoke-free or 100% tobacco-free protections in over half of their institutions; four states and six territories have no known 100% smoke-free or 100% tobacco-free campus protections. CONCLUSIONS In 2017, just 16.7% of accredited, degree-granting institutions in the USA had 100% smoke-free or 100% tobacco-free protections. Despite progress, more efforts can ensure that students and staff benefit from comprehensive 100% smoke-free and 100% tobacco-free protections at US colleges and universities.
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Affiliation(s)
- Kelly D Blake
- HCIRB/BRP/DCCPS, National Cancer Institute, Bethesda, Maryland, USA
| | | | - Laura Walpert
- American Nonsmokers' Rights Foundation, Berkeley, California, USA
| | - Len Casey
- American Nonsmokers' Rights Foundation, Berkeley, California, USA
| | - Cynthia Hallett
- American Nonsmokers' Rights Foundation, Berkeley, California, USA
| | | | | | - Howard K Koh
- Harvard TH Chan School of Public Health and Harvard Kennedy School, Boston, Massachusetts, USA
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Xu MR, Kelly AMB, Kushi LH, Reed ME, Koh HK, Spiegelman D. Impact of the Affordable Care Act on Colorectal Cancer Outcomes: A Systematic Review. Am J Prev Med 2020; 58:596-603. [PMID: 32008799 PMCID: PMC7175922 DOI: 10.1016/j.amepre.2019.11.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 02/08/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 12/24/2022]
Abstract
CONTEXT The Patient Protection and Affordable Care Act increases healthcare access and includes provisions that directly impact access to and cost of evidence-based colorectal cancer screening. The Affordable Care Act's removal of cost sharing for colorectal cancer screening as well as Medicaid expansion have been hypothesized to increase screening and improve other health outcomes. However, since its passage in 2010, there is little consensus on the Affordable Care Act's impact. EVIDENCE ACQUISITION Data from March 2010 to June 2019 were reviewed and 21 relevant studies were identified; 19 studies examined colorectal cancer screening with most finding increased screening rates. EVIDENCE SYNTHESIS Eleven studies found significant increases, 5 found nonsignificant increases, 3 found nonsignificant decreases, and 1 study found a significant decrease in colorectal cancer screening. Three studies examined the impact on colorectal cancer incidence and stage of diagnosis, where a significant 2.4% increase in early diagnosis was found in one and a nonsignificant increase in incidence in another. However, survival improved after Medicaid expansion. CONCLUSIONS Free preventive colorectal cancer screening and Medicaid expansion because of passage of the Affordable Care Act have been, in general, positively associated with modest improvements in screening rates across the country. Future studies are needed that investigate the longer-term impact of the Affordable Care Act on colorectal cancer morbidity and mortality rates, as screening is only the first step in treatment of cancerous and precancerous lesions, preventing them from progressing. Moreover, more studies examining subpopulations are needed to better assess where gaps in care remain.
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Affiliation(s)
- Michelle R Xu
- Georgetown University School of Medicine, Washington, District of Columbia.
| | - Amanda M B Kelly
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Oakland, Oakland, California
| | - Mary E Reed
- Division of Research, Kaiser Permanente Oakland, Oakland, California
| | - Howard K Koh
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Donna Spiegelman
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
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28
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Affiliation(s)
- Howard K Koh
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Harvard Kennedy School, Cambridge, Massachusetts
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29
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Koh HK, Gellin BG. Measles as Metaphor. JAMA Health Forum 2020; 1:e200085. [DOI: 10.1001/jamahealthforum.2020.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Howard K. Koh
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Harvard Kennedy School, Cambridge, Massachusetts
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30
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Koh HK, Bantham A, Geller AC, Rukavina MA, Emmons KM, Yatsko P, Restuccia R. Anchor Institutions: Best Practices to Address Social Needs and Social Determinants of Health. Am J Public Health 2020; 110:309-316. [PMID: 31944837 DOI: 10.2105/ajph.2019.305472] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
"Anchor Institutions"-universities, hospitals, and other large, place-based organizations-invest in their communities as a way of doing business. Anchor "meds" (anchor institutions dedicated to health) that address social needs and social determinants of health have generated considerable community-based activity over the past several decades.Yet to date, virtually no research has analyzed their current status or effect on community health. To assess the current state and potential best practices of anchor meds, we conducted a search of the literature, a review of Web sites and related public documents of all declared anchor meds in the country, and interviews with 14 key informants.We identified potential best practices in adopting, operationalizing, and implementing an anchor mission and using specific social determinants of health strategies, noting early outcomes and lessons learned. Future dedicated research can bring heightened attention to this emerging force for community health.
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Affiliation(s)
- Howard K Koh
- Howard K. Koh, Amy Bantham, Alan C. Geller, Karen M. Emmons, and Pamela Yatsko are with the Harvard T. H. Chan School of Public Health, Boston, MA. Mark A. Rukavina and Robert Restuccia are with Community Catalyst, Boston, MA
| | - Amy Bantham
- Howard K. Koh, Amy Bantham, Alan C. Geller, Karen M. Emmons, and Pamela Yatsko are with the Harvard T. H. Chan School of Public Health, Boston, MA. Mark A. Rukavina and Robert Restuccia are with Community Catalyst, Boston, MA
| | - Alan C Geller
- Howard K. Koh, Amy Bantham, Alan C. Geller, Karen M. Emmons, and Pamela Yatsko are with the Harvard T. H. Chan School of Public Health, Boston, MA. Mark A. Rukavina and Robert Restuccia are with Community Catalyst, Boston, MA
| | - Mark A Rukavina
- Howard K. Koh, Amy Bantham, Alan C. Geller, Karen M. Emmons, and Pamela Yatsko are with the Harvard T. H. Chan School of Public Health, Boston, MA. Mark A. Rukavina and Robert Restuccia are with Community Catalyst, Boston, MA
| | - Karen M Emmons
- Howard K. Koh, Amy Bantham, Alan C. Geller, Karen M. Emmons, and Pamela Yatsko are with the Harvard T. H. Chan School of Public Health, Boston, MA. Mark A. Rukavina and Robert Restuccia are with Community Catalyst, Boston, MA
| | - Pamela Yatsko
- Howard K. Koh, Amy Bantham, Alan C. Geller, Karen M. Emmons, and Pamela Yatsko are with the Harvard T. H. Chan School of Public Health, Boston, MA. Mark A. Rukavina and Robert Restuccia are with Community Catalyst, Boston, MA
| | - Robert Restuccia
- Howard K. Koh, Amy Bantham, Alan C. Geller, Karen M. Emmons, and Pamela Yatsko are with the Harvard T. H. Chan School of Public Health, Boston, MA. Mark A. Rukavina and Robert Restuccia are with Community Catalyst, Boston, MA
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31
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Affiliation(s)
- Howard K Koh
- Harvard T.H. Chan School of Public Health and Harvard Kennedy School, Boston, Massachusetts
| | | | - John J Park
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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32
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Park JJ, Sommers BD, Humble S, Epstein AM, Colditz GA, Koh HK. Medicaid And Private Insurance Coverage For Low-Income Asian Americans, Native Hawaiians, And Pacific Islanders, 2010-16. Health Aff (Millwood) 2019; 38:1911-1917. [PMID: 31682495 DOI: 10.1377/hlthaff.2019.00316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To determine how low-income Asian American, Native Hawaiian, and Pacific Islander (AANHPI) adults gained health insurance coverage-specifically, via Medicaid or private insurance-under the Affordable Care Act, we used a difference-in-differences approach to compare uninsurance rates in 2010-13 and 2015-16. In Medicaid expansion states, adjusted Medicaid coverage gains were 9.67 percentage points larger than in nonexpansion states; however, adjusted private coverage gains in expansion states were 10.19 percentage points lower. These results indicate that, in contrast to the case for other racial/ethnic groups, for AANHPI the Medicaid coverage increases in expansion states were of similar magnitude to the private insurance coverage increases in nonexpansion states. Reasons for this may include differences in willingness to enroll in public versus private coverage, barriers related to language or citizenship status, or other factors. Future studies are needed to understand these patterns and promote health equity for this population.
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Affiliation(s)
- John J Park
- John J. Park ( john. park@mail. harvard. edu ) is a Knox Fellow in the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, in Boston, Massachusetts
| | - Benjamin D Sommers
- Benjamin D. Sommers is a professor of health policy and economics in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, and a professor of medicine at Brigham and Women's Hospital, in Boston
| | - Sarah Humble
- Sarah Humble is a senior statistical data analyst in the Public Health Sciences Division, Washington University School of Medicine, in St. Louis, Missouri
| | - Arnold M Epstein
- Arnold M. Epstein is the John H. Foster Professor of Health Policy and Management in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health
| | - Graham A Colditz
- Graham A. Colditz is the Neiss-Gain Professor in the Public Health Sciences Division, Washington University School of Medicine
| | - Howard K Koh
- Howard K. Koh is the Harvey V. Fineberg Professor of the Practice of Public Health Leadership in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health
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33
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Affiliation(s)
- Howard K Koh
- Harvey V. Fineberg professor of the practice of public health leadership at the Harvard T.H. Chan School of Public Health and the Harvard Kennedy School, Boston
| | - Clifford E Douglas
- Vice president for tobacco control and director, Center for Tobacco Control, American Cancer Society
- Adjunct professor at the University of Michigan School of Public Health, Ann Arbor
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34
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VanderWeele TJ, McNeely E, Koh HK. Flourishing as a Definition of Health-Reply. JAMA 2019; 322:981-982. [PMID: 31503305 DOI: 10.1001/jama.2019.10355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Eileen McNeely
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Howard K Koh
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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35
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Kobau R, Sapkota S, Koh HK, Zack MM. National declines in the percentages of uninsured among adults aged 18-64 years with active epilepsy, 2010 and 2013 to 2015 and 2017-U.S. National Health Interview Survey. Epilepsy Behav 2019; 97:316-318. [PMID: 31255566 PMCID: PMC8483588 DOI: 10.1016/j.yebeh.2019.05.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
Abstract
Epilepsy is more common among children and adults living in households at lowest incomes. Like those living with any complex chronic condition, people with epilepsy need quality healthcare to improve their health and social outcomes. The purpose of this study was to use the latest national data to provide updated estimates of the percentages of adults aged 18-64 years with active epilepsy who were uninsured in 2010, 2013, 2015, and 2017 and to examine changes in health insurance coverage during these years. We analyzed nationally representative samples of adults (aged 18-64 years) from the 2010, 2013, 2015, and 2017 National Health Interview Survey (NHIS). We used a validated epilepsy surveillance case definition to classify adults as having active epilepsy during 2010 and 2013 (n = 507) and during 2015 and 2017 (n = 582). We used the NHIS recode variables available in each year that account for a series of questions posed to respondents to confirm coverage and that ultimately classify respondents with different healthcare coverage types. Overall, the percentage of uninsured adults among respondents aged 18-64 years with active epilepsy decreased by more than half (59%), from 17.7% (95% confidence interval [CI] = 13.6%-22.7%) in 2010 and 2013 to 7.3% (95% CI = 4.8%-10.7%) in 2015 and 2017. The decrease in the percentage of uninsured adults with active epilepsy after 2010 and 2013 was balanced by a similar increase in public insurance coverage and private insurance coverage in 2015 and 2017. Epilepsy stakeholders can ensure that all uninsured adults with epilepsy obtain access to health insurance coverage. National Health Interview Survey data on epilepsy, when available, can be used to monitor trends in insurance status in the new decade.
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Affiliation(s)
- Rosemarie Kobau
- Epilepsy Program, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Mail Stop 107-6, 4770 Buford Hwy, 30341, GA, United States.
| | - Sanjeeb Sapkota
- G2S Corporation, Epilepsy Program, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Mail Stop 107-6, 4770 Buford Hwy, 30341, GA, United States
| | - Howard K Koh
- Harvard T.H. Chan School of Public Health, Department of Health Policy and Management, 677 Huntington Ave., 4th Floor, Boston, MA 02115, United States
| | - Matthew M Zack
- Epilepsy Program, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Mail Stop 107-6, 4770 Buford Hwy, 30341, GA, United States
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36
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Affiliation(s)
- Howard K Koh
- Harvey V. Fineberg professor of the practice of public health leadership at the Harvard T.H. Chan School of Public Health and the Harvard Kennedy School
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37
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Koh HK, Singer SJ, Edmondson AC. Business Strategies to Promote Health-Reply. JAMA 2019; 321:2134. [PMID: 31162565 DOI: 10.1001/jama.2019.2803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Howard K Koh
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Sara J Singer
- Stanford University School of Medicine, Stanford, California
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38
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Affiliation(s)
- Tyler J VanderWeele
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Human Flourishing Program, Harvard University, Cambridge, Massachusetts
| | - Eileen McNeely
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Howard K Koh
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Harvard Kennedy School, Cambridge, Massachusetts
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39
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Chen Y, Kim ES, Koh HK, Frazier AL, VanderWeele TJ. Sense of Mission and Subsequent Health and Well-Being Among Young Adults: An Outcome-Wide Analysis. Am J Epidemiol 2019; 188:664-673. [PMID: 30649174 PMCID: PMC6438813 DOI: 10.1093/aje/kwz009] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 09/19/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose in life is potentially a modifiable “health asset” that enhances health and well-being. However, the association between purpose and health in younger populations remains understudied. In this study, we prospectively examined an aspect of purpose in life—specifically having a sense of mission—and a wide range of outcomes related to psychosocial well-being, mental health, health behaviors, and physical health in young adults. Longitudinal data from the Growing Up Today Study (2007–2010 or 2007–2013, depending on outcome; mean baseline age = 22.97 years) were analyzed using generalized estimating equations. Sample sizes ranged from 6,323 to 7,463, depending on outcome. Bonferroni correction was used to correct for multiple testing. All models controlled for sociodemographic characteristics, religious service attendance, maternal attachment, and prior values of the outcome variables. Greater sense of mission was associated with greater psychological well-being (including life satisfaction, positive affect, self-esteem, emotional processing, and emotional expression), greater use of preventive health care, more volunteer activities, and possibly fewer depressive symptoms. However, there was little association with physical health or other behavioral outcomes. The formation of a sense of mission may provide a novel target for promoting multiple facets of psychological well-being, prosocial character, and possibly mental health among young adults.
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Affiliation(s)
- Ying Chen
- Human Flourishing Program, Harvard Institute for Quantitative Social Science, Cambridge, Massachusetts
- Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Eric S Kim
- Department of Social and Behavioral Sciences, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Howard K Koh
- Department of Health Policy and Management, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Harvard Kennedy School, Cambridge, Massachusetts
| | - A Lindsay Frazier
- Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Pediatric Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Tyler J VanderWeele
- Human Flourishing Program, Harvard Institute for Quantitative Social Science, Cambridge, Massachusetts
- Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
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40
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Affiliation(s)
- Howard K Koh
- Howard K. Koh and Eric Coles are with the Harvard T. H. Chan School of Public Health, Boston, MA
| | - Eric Coles
- Howard K. Koh and Eric Coles are with the Harvard T. H. Chan School of Public Health, Boston, MA
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41
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Affiliation(s)
- Howard K Koh
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Harvard Kennedy School, Cambridge, Massachusetts
| | - Sara J Singer
- Stanford University School of Medicine, Stanford, California
- Graduate School of Business, Stanford, California
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42
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Affiliation(s)
- Howard K Koh
- Harvey V. Fineberg professor of the practice of public health leadership at the Harvard T.H. Chan School of Public Health and the Harvard Kennedy School
| | - R Gil Kerlikowske
- Four-decade career in law enforcement, serving as chief of police in Seattle and Buffalo
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43
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Park JJ, Humble S, Sommers BD, Colditz GA, Epstein AM, Koh HK. Health Insurance for Asian Americans, Native Hawaiians, and Pacific Islanders Under the Affordable Care Act. JAMA Intern Med 2018; 178:1128-1129. [PMID: 29710340 PMCID: PMC6143094 DOI: 10.1001/jamainternmed.2018.1476] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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] [Indexed: 11/14/2022]
Abstract
This cohort study analyzed the extent of post–Affordable Care Act (ACA) health insurance coverage gains for Asian Americans, Native Hawaiians, and Pacific Islanders and whether disparities in coverage have narrowed over time.
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Affiliation(s)
- John J Park
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Sarah Humble
- Washington University School of Medicine, St Louis, Missouri
| | | | | | - Arnold M Epstein
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Howard K Koh
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Harvard Kennedy School, Cambridge, Massachusetts
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44
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Affiliation(s)
- Howard K Koh
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Harvard Kennedy School, Cambridge, Massachusetts
| | - Alan C Geller
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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45
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Affiliation(s)
- Howard K Koh
- Harvey V. Fineberg professor of the practice of public health leadership at the Harvard T. H. Chan School of Public Health and the Harvard Kennedy School
| | - Gina A McCarthy
- Director of Harvard Chan's Center for Health and the Global Environment
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46
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Affiliation(s)
- Howard K Koh
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Harvard Kennedy School, Cambridge, Massachusetts
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47
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Affiliation(s)
- Howard K Koh
- Harvey V. Fineberg professor of the practice of public health leadership at the Harvard T. H. Chan School of Public Health and the Harvard Kennedy School
| | - Robert Restuccia
- executive director of Community Catalyst, a national nonprofit consumer health organization
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48
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VanderWeele TJ, Balboni TA, Koh HK. Spiritual Care in Medicine-Reply. JAMA 2017; 318:2496. [PMID: 29279922 DOI: 10.1001/jama.2017.16571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | | | - Howard K Koh
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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49
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Affiliation(s)
- Howard K Koh
- Howard K. Koh, MD, MPH, is the Harvey V. Fineberg professor of the practice of public health leadership at the Harvard T. H. Chan School of Public Health and the Harvard Kennedy School
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50
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Affiliation(s)
| | - Tracy A Balboni
- Dana Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Howard K Koh
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Harvard Kennedy School, Cambridge, Massachusetts
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