Milbank Quarterly最新文献

{"title":"Legal Barriers to Safer Smoking Supplies Cause Harm and Should Be Removed.","authors":"Corey Davis, Amy Lieberman, Czarina Behrends","doi":"10.1111/1468-0009.70034","DOIUrl":"https://doi.org/10.1111/1468-0009.70034","url":null,"abstract":"<p><p>Policy Points There has been a pronounced shift from injecting to smoking drugs in the United States. This shift has the potential to reduce many health harms associated with illicit drug use. State laws are structural barriers to the provision of safer smoking supplies, cause preventable harm, and should be repealed.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incarceration and Psychiatric Emergency Department Visits Among Black Americans.","authors":"Abhery DAS, Michael Esposito, Tim A Bruckner, Hedwig Lee","doi":"10.1111/1468-0009.70032","DOIUrl":"https://doi.org/10.1111/1468-0009.70032","url":null,"abstract":"<p><p>Policy Points The spillover effects of jail and prison incarceration extend to acute psychiatric emergencies in Black communities. State-level drug reform policies and policies that reduce labor market and housing discrimination for former inmates may have salutary mental health benefits for the broader community.</p><p><strong>Context: </strong>The justice system incarcerates nearly 2.3 million individuals in the United States. Black Americans comprise 40% of those incarcerated despite representing less than 15% of the population. Theoretical work posits that mass incarceration can erode social capital by straining social and family networks as well as inducing carceral churn and coercive mobility within Black communities. Scholars report that greater incarceration may influence population-level health, specifically in communities of color. However, previous work does not address whether incarceration, as well as the racial disparity in incarceration, corresponds with psychiatric help seeking in the Black community.</p><p><strong>Methods: </strong>We examine the relation between incarceration and psychiatric emergency department (ED) visits among Black Americans from 2006 to 2015. As the exposure, we use 1) jail and prison incarceration among Black Americans (per 100,000 population), and 2) the ratio of non-Hispanic Black to non-Hispanic White American incarcerated populations as a measure of racial inequity in the criminal legal system. We examine, as the outcome, annual psychiatric ED visits (per 100,000 population) among Black Americans in 404 counties from ten US states between 2006 and 2015 (2,360 county-years). Linear fixed effects analyses control for time-invariant county factors as well as percentage below the federal poverty line, percentage unemployed, number of hospitals, and arrests for violent crime.</p><p><strong>Findings: </strong>One additional individual incarcerated (per 100,000 population) corresponds with a 1.4% increase in psychiatric ED visits in Black communities (p < 0.001). An increase in racial inequity in incarceration (non-Hispanic Black to non-Hispanic White American ratio) also coincides with a 2.2% increase in psychiatric emergencies among Black Americans (p < 0.001).</p><p><strong>Conclusions: </strong>The long arm of incarceration may extend to psychiatric emergencies among Black Americans in the broader community. Researchers and policymakers may consider measures, such as drug reform or other social policies, to reduce the influence of mass incarceration on acute and adverse mental health in the Black community.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Turf Wars: How Growth and Competitive Shocks Have Affected the Performance and Stability of Community Health Centers.","authors":"Justin Markowski","doi":"10.1111/1468-0009.70031","DOIUrl":"https://doi.org/10.1111/1468-0009.70031","url":null,"abstract":"<p><p>Policy Points Community health centers (CHCs) are mandated to simultaneously maintain collaborative relationships with all other health care providers in their service area while consistently expanding their footprint to serve more patients, creating a contradictory policy environment. This study suggests that CHCs may respond to competitive shocks by engaging in a turf war with encroaching rivals at the expense of their financial solvency and social mission. Compounded in part by mounting fiscal austerity that may exacerbate competitive pressures, new approaches are needed that strengthen guardrails against patient selection and create incentives for CHCs to move into persistently underserved communities.</p><p><strong>Context: </strong>Community health centers (CHCs) are a critical and growing part of the health care safety net, doubling over the past 15 years to expand access to essential health care services to over 31 million patients in traditionally underserved communities. However, increasingly, CHCs have opened care delivery locations in communities already served by another CHC, potentially creating competitive markets with unknown implications for how this safety net operates.</p><p><strong>Methods: </strong>This retrospective cohort study was performed in 810 CHCs that operated between 2009 and 2023. A difference-in-differences design was used with staggered implementation to examine the impacts of competitive shocks on clinic performance and, consequently, whether this changes the types of patients served and how clinics operate.</p><p><strong>Findings: </strong>When a rival CHCs' growth results in a competitive shock, 95% of new sites are located no more than ten miles away from their existing service area. After a competitive shock, incumbent CHCs on average experienced significant decreases in financial stability and shifts in their patient mix toward those with Medicaid and away from patients who are uninsured and have more chronic conditions. Clinics also reallocated 11% of their resources closer to the encroaching rival, recentering and concentrating their organizations. Strikingly, multiple competitive shocks increased the annual probability of a closure, acquisition, or loss of CHC status from 0% to 1.67%.</p><p><strong>Conclusions: </strong>Despite explicit policy guardrails, this pattern of rapid, recent, and localized growth has distorted incentives for individual clinics, weakening this critical safety net. Clinics may respond to such mounting pressures by engaging in a turf war, reallocating and concentrating resources closer toward the encroaching rival at the expense of their social mission and financial solvency. Both state and federal policymakers must incentivize CHCs to disperse into communities without established clinics and introduce new protections against underservice by stabilizing clinic budgets.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lobbying in the Shadows: A Comparative Analysis of Government Lobbyist Registers.","authors":"Jennifer Lacy-Nichols, Hedeeyeh Baradar, Eric Crosbie, Katherine Cullerton","doi":"10.1111/1468-0009.70033","DOIUrl":"https://doi.org/10.1111/1468-0009.70033","url":null,"abstract":"<p><p>Policy Points Our research provides a starting point to benchmark government transparency measures to improve the quality and accessibility of information about lobbying. Policymakers and regulators can use our framework to develop or strengthen their own lobbying registers. Countries like Canada are a good example of how to design an accessible database about lobbying, and Chile, Ireland, and Scotland provide examples of comprehensive contact logs.</p><p><strong>Context: </strong>Information about lobbying is crucial to alert the public about undue influence in government decision making. Yet, government disclosures of lobbying activities are rare internationally and vary considerably in their completeness and accessibility. Building on a framework to measure lobbying transparency, this study benchmarked national government disclosures to understand what information was shared and to develop recommendations to strengthen political transparency.</p><p><strong>Methods: </strong>To identify lobbyist registers, we reviewed four international surveys that assessed lobbying transparency in 128 countries. For each country with an online register, we assessed the 50 indicators in the Framework for Comprehensive and Accessible Lobbying (FOCAL), generating an overall score for each government. To highlight the importance of transparency for public health, we compared the visibility of tobacco industry lobbying across all registers by documenting the information provided about two prominent tobacco companies: Philip Morris International and British American Tobacco.</p><p><strong>Findings: </strong>We identified 28 countries with online lobbyist registers, all from upper or upper-middle income countries. No country fulfilled all 50 indicators in the FOCAL. The category of \"scope\" had the highest scores across countries, whereas the \"revolving door\" and \"financial\" categories had the lowest scores. We found evidence of lobbying by Philip Morris International, British American Tobacco, or one of their subsidiaries in 14 of the 28 countries with online lobbyist registers.</p><p><strong>Conclusions: </strong>Our study empirically demonstrates the hidden nature of lobbying internationally. In the case of industries whose interests conflict with public health, poor lobbying transparency presents a risk that vested interests may undermine public health policymaking without anyone knowing. To ensure that health harming industry interests cannot escape scrutiny, public health advocates should support efforts to strengthen political transparency measures. Open access publishing facilitated by The University of Melbourne, as part of the Wiley - The University of Melbourne agreement via the Council of Australian University Librarians.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No Data, No Problem: Quantifying Latine Individuals Eligible for but Not Enrolled in Medicaid or Affordable Care Act Marketplace-Based Insurance in North Carolina.","authors":"Gabriela Plasencia, Kamaria Kaalund, Olurotimi Kukoyi, Viviana Martinez-Bianchi, Andrea Thoumi","doi":"10.1111/1468-0009.70030","DOIUrl":"https://doi.org/10.1111/1468-0009.70030","url":null,"abstract":"<p><p>Policy Points Latine communities in the United States experience disproportionately high uninsurance rates because of systemic barriers, including limited language equity, lack of provider (clinical or nonclinical) concordance, discrimination, misinformation, and immigration-related fears. Data on individuals eligible for but not enrolled in insurance programs are lacking, which prevents the identification of barriers, population impacted, and tailored approaches to meet specific needs of vulnerable communities. We propose community-informed policy strategies, including culturally tailored outreach, involvement of trusted community health workers, and improved health equity data collection. Framing data in terms of eligible but not enrolled individuals shifts the focus to existing coverage gaps and the potential for improvement, encouraging states to take more proactive enrollment actions.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laws Governing Substance Use During Pregnancy: Next Steps for Health Equity Research.","authors":"Hannah L F Cooper, Anna L Mullany, Snigdha Peddireddy, Simone Wien, Melvin Doug Livingston, Whitney S Rice, Anne L Dunlop, Michael R Kramer, Madison Haiman, Lasha S Clarke, Natalie D Hernandez-Green, Angélica Meinhofer","doi":"10.1111/1468-0009.70026","DOIUrl":"https://doi.org/10.1111/1468-0009.70026","url":null,"abstract":"<p><p>Policy Points Laws on drug use during pregnancy are enforced more harshly against structurally marginalized people. Despite this pattern, these laws' impacts on health and health care inequities are understudied. We offer recommendations for novel, robust research to generate evidence on this essential topic.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating Mental Health and Substance Use Treatment With Emergency and Primary Care: the Case of Opioid Use Disorder and Suicide.","authors":"Noa Krawczyk, Hillary Samples","doi":"10.1111/1468-0009.70028","DOIUrl":"https://doi.org/10.1111/1468-0009.70028","url":null,"abstract":"<p><p>Policy Points There have been significant advancements in expanding care for opioid use disorder and suicide in general medical settings in the first quarter of the 21st century. Incessant barriers in the US health system continue to hinder progress in sufficiently scaling up evidence-based behavioral health interventions and getting them to those at highest risk. State policymakers have multiple levers available to make significant improvements to address ongoing challenges and improve access to evidence-based behavioral health services in emergency and primary care settings.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stemming the Tide of the US Overdose Crisis: How Can We Leverage the Power of Data Science and Artificial Intelligence?","authors":"Magdalena Cerdá, Daniel B Neill, Ellicott C Matthay, Johnathan A Jenkins, Brandon D L Marshall, Katherine M Keyes","doi":"10.1111/1468-0009.70025","DOIUrl":"https://doi.org/10.1111/1468-0009.70025","url":null,"abstract":"<p><p>Policy Points We can leverage data science and artificial intelligence to inform state and local resource allocation for overdose prevention. Data science and artificial intelligence can help us answer four questions: (1) What is the impact of laws on access to interventions and overdose risk? (2) Where should interventions be targeted? (3) Which types of demographic subgroups benefit the most and the least from interventions? and (4) Which types of interventions should they invest in for each setting and population? Advances in data science and artificial intelligence can accelerate the pace at which we can answer these critical questions and help inform an effective overdose prevention response.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Framework for Assessing the Permissibility of Academic Leaders' Outside Activities.","authors":"Matthew S McCOY, Martha E Gaines, Steven Joffe, Genevieve P Kanter, Emily A Largent, Bernard Lo, Holly Fernandez Lynch, Allison M Whelan, Michelle M Mello","doi":"10.1111/1468-0009.70024","DOIUrl":"https://doi.org/10.1111/1468-0009.70024","url":null,"abstract":"<p><p>Policy Points Many have urged academic institutions to rethink conflict of interest policies governing leaders' outside activities, which pose not only individual conflicts for leaders themselves but institutional conflicts for their academic employers. Although the American Association of Medical Colleges and Association of American Universities have provided guidance on managing such conflicts, neither offer a structured approach for determining when and under what conditions it is appropriate for a leader to engage in specific outside activities. To address this gap, this article develops a decision-making framework that institutional oversight bodies can use to assess the permissibility of academic leaders' proposed outside activities.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"US State Policies Regarding Social Media: Do Policies Match the Evidence?","authors":"Marco Thimm-Kaiser, Katherine M Keyes","doi":"10.1111/1468-0009.70021","DOIUrl":"https://doi.org/10.1111/1468-0009.70021","url":null,"abstract":"<p><p>Policy Points State policymakers have moved rapidly to regulate adolescent social media use, frequently stating concerns about mental health, harmful content exposure, and developmental impacts. The degree to which policymakers' arguments in favor of state social media regulations correspond to the state of the current scientific evidence remains questionable. The evidence to substantiate policymakers' assertions has substantial limitations in the ability to answer causal questions, but some promising directions are emerging around targeted protections for highly susceptible youth.</p><p><strong>Context: </strong>The potential adverse effects of social media use for adolescents have received substantial attention. In response, a growing number of state-level social media regulations are emerging in the United States. These policy interventions are being implemented in the context of mixed scientific evidence, forcing policymakers to weigh the need for proactive regulation against the limitations of extant research. We explore policymakers' publicly stated rationales for social media regulations and contextualize their claims within extant scientific literature.</p><p><strong>Methods: </strong>We conducted a media content analysis of elected government officials' statements about 69 state social media legislative initiatives that were adopted or enacted prior to September 2024 using Google News. Subsequently, we critically reviewed the strength of the evidence underlying common themes.</p><p><strong>Findings: </strong>We screened 637 documents, included 161, and extracted three main themes connected to claims about social media-related adolescent harms: (1) harm to adolescents' mental health (mentioned in 55 articles), including six subthemes (e.g., social media addiction, self-harm or suicide, anxiety and depression); (2) exposure to dangerous online content (73 mentions), including five subthemes (e.g., access to pornography, risks of sexual exploitation); and (3) harm to adolescent development (38 mentions), including three subthemes (i.e., negative impacts on learning, social relationships, and brain development). We identified some evidence to support associations between social media use and adverse outcomes, particularly for vulnerable youth, but, overall, the current research base has significant limitations and cannot definitively establish causal effects.</p><p><strong>Conclusions: </strong>State policymakers have moved rapidly to regulate adolescent social media use, often citing concerns about mental health, harmful content, and developmental impacts. The evidence to substantiate these assertions remains preliminary, but some promising directions are emerging around targeted protections for highly susceptible youth. We formulate a research agenda to inform evidence-based policy.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}