A State of Uncertainty: An Analysis of Recent State Legislative Proposals to Regulate Preventive Services in the United States

This policy brief examines preventive services state legislation trends in the United States during uncertainty regarding the Affordable Care Act (ACA), which requires certain coverage of 4 evidence-based preventive services categories without additional patient costs under §2713. We used a legal mapping approach to search for and analyze state legislation related to preventive services proposed or enacted over a 25-month period of ACA uncertainty. We screened 1231 bills and coded the 76 screened-in bills. Next, we determined their characteristics and examined trends. Bills originated in 28 states, and 69.7% were not enacted. Only 3.9% contained requirements contingent on ACA modifications. About 56.6% referenced services covered by §2713, but usually not entire §2713 categories. Bills also mentioned preventive services in general (53.9%) and services outside §2713’s scope (21.1%). About 55.3% applied to private insurance, and 75.0% only to one patient group. Bills generally promoted access, and 51.3% specifically prohibited cost-sharing. But 26.3% of the bills limited access to preventive services. State-level legislation targets preventive services, usually expanding, but sometimes limiting, access. Most bills single out specific services without fully incorporating evidence-based recommendations. State legislation may therefore promote access to preventive services but can favor certain services, deviate from experts’ recommendations, and increase nationwide variability. State legislation can function as an important lever for access to preventive services across patient groups. This may be especially important during uncertainty about federal policy. However, the design of state-level proposals is critical for maximizing access to preventive services.

An Evaluation of Food Insecurity and Its Correlates in a Filipino American Study Sample Residing in Clark County, Nevada

Purpose: Filipino Americans comprise over half of the Asian American population in Clark County, Nevada. Despite their large numbers, food insecurity rates are aggregated with the entire Asian American population. In 2016, 1.6% of Asian American households in Clark County were food insecure, yet, 22% of households reported annual incomes at or below 200% of the federal poverty level. This study aimed to assess the status and correlates of food insecurity specific to Filipino Americans in Clark County, Nevada.

Methods: The United States Department of Agriculture (USDA) Short Form Food Security Module was administered among 192 Filipino Americans residing in Clark County, NV. Results were viewed through the theoretical framework of the Social Ecological Model.

Results: 27.1% of respondents experienced food insecurity within the past year. Adjusted logistic regression revealed that incomes less than $20,000 (odds ratio [OR]=4.13, 95% confidence interval [CI]: 1.43–11.9), having no health insurance (OR=5.22, 95% CI: 1.67–16.34), and eating mainly American or Western foods (OR=7.3, 95% CI: 1.73–30.77) were significant predictors of food insecurity.

Conclusions: A significantly higher prevalence of food insecurity among Filipino American subpopulations, compared to the estimates for Asian Americans in Clark County, suggests the need to disaggregate data for Asian American subgroups. The Social Ecological Model provides greater context to the findings identifying that the intrapersonal and policy level factors were associated with food insecurity among our participants, thus suggesting the need to utilize multilevel interventions to address food insecurity in Filipino Americans. The findings may be utilized to inform future interventions aimed at improving the overall health and food security among Filipino Americans.

A Health Needs Assessment of the Filipino American Community in the Greater Las Vegas Area

Purpose: The number of Filipino Americans in Las Vegas, Nevada, is growing considerably, but no research to date has assessed the specific health needs of this burgeoning population. Thus, this study aims to assess health behaviors, perceived community health problems, and self-reported diseases/conditions among Filipino Americans in the Greater Las Vegas area and evaluate any difference by gender.

Methods: A cross-sectional survey was conducted among 200 Filipino American adults residing in the Greater Las Vegas area using a prevalidated instrument.

Results: The self-reported prevalence of hypertension, high cholesterol, and diabetes was 48%, 46%, and 25%, respectively. Adverse health behaviors, in terms of insufficient exercise and diets lacking in fruits and vegetables, were noted among our participants. Approximately 67% of participants reported exercising less than the recommended 150 min of physical activity per week and <3% of the study population ate the recommended five servings of fruits and vegetables a day. On the contrary, consumption of sweet snacks and salty condiments was high. More than two-thirds of respondents indicated that the Filipino American community should address the identified health conditions.

Conclusions: The high self-reported prevalence of hypertension, high cholesterol, and diabetes demonstrates a pressing public health problem among Filipino Americans in Las Vegas. Given that our study population comprised predominantly college-educated, middle-income, and insured individuals, the findings may be underestimated and thus the actual disease prevalence may be even higher. Results of this survey will be used to develop future interventions for the Filipino American community in Las Vegas using the principles of community-based participatory research.

Combination cyclopentolate and phenylephrine for mydriasis in premature infants with heavily pigmented irides

PURPOSE

This study examined whether safe and effective mydriasis can be achieved in premature infants with heavily pigmented irides using combination cyclopentolate 0.2% and phenylephrine 1% eyedrops.

METHODS

A prospective, randomized double-blind study was performed to compare combination cyclopentolate 0.2% and phenylephrine 1% eye-drops with triple instillation of tropicamide 0.5% and phenylephrine 2.5%. Twenty-eight consecutive babies with dark irides and birthweight <1600 g referred for screening for retinopathy of prematurity comprised the study population. Infants' eyes were randomly dilated twice with both regimens within a 2-week period. Blood pressure, heart rate, and pupil size were measured.

RESULTS

Good mydriasis was achieved in both groups with no significant differences in pupil size or blood pressure (systolic, diastolic, or mean arterial pressures) over starting baseline values. Pulse rates decelerated below the baseline values in both groups, but these differences were not large.

CONCLUSION

The single combination eyedrop of cyclopentolate 0.2% and phenylephrine 1% is as effective and safe a mydriatic for infants with dark irides as both tropicamide 0.5% and phenylephrine 2.5%.

Two tumor suppressive loci on chromosome 10 involved in human glioblastomas

A number of cytogenetic and molecular analyses have revealed very frequent and extensive losses of regions of chromosome 10 in human glioblastomas. Our recent studies have demonstrated that the transfer of a chromosome 10 into human glioblastoma cells resulted in suppression of their transformed and tumorigenic phenotype. To localize the suppressive region further, we isolated and characterized certain hybrid cells that had undergone chromosomal rearrangements to yield hybrid cells retaining only various regions of the inserted chromosome 10. One series of subclones showed the loss of the majority of the long arm of chromosome 10 (10q21-10qter) and regained the ability to grow under anchorage-independent conditions, but the cells still failed to exhibit significant tumorigenicity in nude mice. Another set of subclones exhibited major deletions of large segments of the long arm of chromosome 10 (10q21-q23; 10q26-qter), yet retained certain distal alleles associated with 10q24 to 10q26. These subclones were identical in their biological characteristics to the hybrids containing an intact chromosome 10, exhibiting no growth in soft agarose or in nude mice. These results implicate the presence of two independent phenotypically suppressive regions on chromosome 10 (10pter-q11 and 10q24-q26) that are involved in glioma progression.