AJPM focus最新文献

{"title":"Pediatric Produce Prescription Program Grounded in Community Connection Improves Fruit Intake in Hawaiʻi","authors":"Monica K. Esquivel PhD, RDN ,&nbsp;Cherese Shelton BS ,&nbsp;Alicia Higa BS ,&nbsp;Hyeong Jun Ahn PhD ,&nbsp;May Okhiro MD, MS","doi":"10.1016/j.focus.2025.100365","DOIUrl":"10.1016/j.focus.2025.100365","url":null,"abstract":"<div><h3>Introduction</h3><div>In Hawai‘i, 50% of Native Hawaiian and Pacific Islander children live in a household experiencing food insecurity. Individuals from food insecure households experience increased risk for chronic health conditions that may be alleviated with healthy food. Wellness for Native Hawaiian and Pacific Islander populations can be achieved through the Pilinahā framework, comprising connection to self; community; past, present, and future; and land. The Keiki (child) Produce Prescription Program was designed to address the Pilinahā framework through a 6-month intervention that provided pediatric participants with vouchers totaling $50 per month to exchange for local, fresh fruits and vegetables from the farmers market along with nutrition education kits.</div></div><div><h3>Methods</h3><div>The community-designed intervention connected pediatric patients from a large federally qualified health center with the community farmers’ market. Eligibility consisted of children aged 2–17 years who screened positive for a nutrition-related chronic disease or food insecurity. Baseline survey and 6-month data collected included sociodemographic data, household food security, and fruit and vegetable consumption. Monthly voucher redemption was tracked.</div></div><div><h3>Results</h3><div>One hundred and twenty-one participants enrolled, 90 participants redeemed vouchers for 6 months, and 75 (62%) completed 6-month survey data. Participants redeemed $210 (70%) in vouchers on average. Children’s fruit consumption increased by 1.0 cups per day (p=0.014), whereas parent fruit consumption increased by 1.2 cups per day (<em>p</em>=0.0001). No changes to household food security or total fruit and vegetable consumption were observed.</div></div><div><h3>Conclusions</h3><div>The Keiki Produce Prescription Program improved fruit intake among households with children. High levels of program participation and completion reinforce the importance of community-engaged approaches to program development. Rigorous testing through RCTs and increasing engagement with nutrition education are recommended for future studies.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100365"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State Medical Cannabis Policy Implementation and Racial Disparities in Opioid Prescribing Among Medicare Beneficiaries: A Policy Impact Analysis","authors":"Tyler J. Dunn PhD ,&nbsp;Erin Holmes PhD ,&nbsp;Yi Yang PhD ,&nbsp;John P. Bentley PhD ,&nbsp;Saim Kashmiri PhD ,&nbsp;Sujith Ramachandran PhD","doi":"10.1016/j.focus.2025.100391","DOIUrl":"10.1016/j.focus.2025.100391","url":null,"abstract":"<div><h3>Introduction</h3><div>U.S. cannabis policies have a history of racial disparities, highlighting the need for research surrounding racial inequities, particularly within the context of medicalization of cannabis and opioid prescribing. This study evaluated racial disparities in the relationship between state-level medical cannabis policy implementation and changes in opioid-prescribing patterns among Medicare beneficiaries.</div></div><div><h3>Methods</h3><div>Utilizing Medicare claims data from 2012 to 2015, beneficiaries aged ≥65 years were categorized into 3 state categories: Medical marijuana law implementation states, existing medical marijuana law states, and nonmedical marijuana law states. A difference-in-difference analysis was used to determine whether race moderated the relationship between medical cannabis policy implementation and opioid doses filled before and after policy implementation.</div></div><div><h3>Results</h3><div>A total of 449,336 Medicare beneficiaries were included in the study, comprising 387,713 White individuals (86.3%) and 61,623 racial minority individuals (13.7%). Nearly half of all (49.3%) beneficiaries received at least 1 opioid prescription. White individuals were significantly more likely to receive at least 1 opioid prescription than racial minorities (49.7% vs 46.8%, <em>p</em>&lt;0.001). Morphine milligram equivalent per patient per month significantly increased for both White and racial minority individuals in all state categories, except for racial minority individuals in the medical marijuana law states. There were no significant differences in opioid-prescribing changes between White and racial minority individuals between state categories.</div></div><div><h3>Conclusions</h3><div>The study found no clear indication of racial disparities in the impact of medical cannabis policies on opioid prescribing. Future research should focus on access to medical cannabis and prescriber attitudes toward treating racial minority patients experiencing pain with cannabis.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100391"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145010216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Religious Service Attendance, COVID-19 Vaccine Attitudes, and COVID-19 Vaccination Status: A Vaccine Safety Datalink Member Survey, 2022–2023","authors":"Joshua T.B. Williams MD ,&nbsp;Kate Kurlandsky BA ,&nbsp;Kristin Breslin MPH ,&nbsp;Hannah Cruz MPH ,&nbsp;Amy Stein PhD ,&nbsp;Jo Ann Shoup PhD ,&nbsp;Liza M. Reifler MPH ,&nbsp;Matthew F. Daley MD ,&nbsp;Bruno Lewin MD, DTMH ,&nbsp;Kristin Goddard MPH ,&nbsp;Michelle L. Henninger PhD ,&nbsp;Jennifer C. Nelson PhD ,&nbsp;Gabriela Vazquez-Benitez PhD, MSC ,&nbsp;Kayla E. Hanson MPH ,&nbsp;Candace C. Fuller PhD, MPH ,&nbsp;Simon J. Hambidge MD, PhD","doi":"10.1016/j.focus.2025.100404","DOIUrl":"10.1016/j.focus.2025.100404","url":null,"abstract":"<div><h3>Introduction</h3><div>The intersections of religion and vaccination became visible early in the COVID-19 pandemic. Yet, initial pandemic data reporting associations between religiosity and COVID-19 vaccine hesitancy is nearly 5 years old and has methodologic limitations. The aim of this study was to examine the associations between religious service attendance, COVID-19 attitudes, and COVID-19 vaccination at the midpoint of the COVID-19 public health emergency.</div></div><div><h3>Methods</h3><div>A survey of Vaccine Safety Datalink members, purposefully sampled by race, ethnicity, language, and pregnancy status (N=2,856), was administered from November 2022 through February 2023. Data were analyzed through weighting and multivariable logistic regression.</div></div><div><h3>Results</h3><div>Overall, 960 people (33%) responded; 22.8% (95% CI=15.2%, 30.3%) identified as Catholic, and 21.7% (95% CI=14.6%, 28.9%) identified as just Christian. Overall, 28.1% (95% CI=19.4%, 36.8%) reported never attending services, whereas 19.0% (95% CI=12.3%, 25.7%) attended weekly or more often. Compared with never attending services, religious service attendance weekly or more often was associated with increasing bivalent COVID-19 Omicron booster vaccine hesitancy (<em>p</em>&lt;0.01) and decreasing trust in the Centers for Disease Control and Prevention for COVID-19 or COVID-19 vaccine information (<em>p</em>=0.033). Self-reported COVID-19 vaccination ever (AOR=0.65; 95% CI=0.23, 1.84) or any bivalent COVID-19 Omicron booster vaccination (AOR=0.36; 95% CI=0.06, 2.20) were not associated with religious service attendance weekly or more often, compared with never attending services.</div></div><div><h3>Conclusions</h3><div>Observed associations between religious service attendance, vaccine attitudes, and trust in the Centers for Disease Control and Prevention encourage meaningfully redefining public health and faith community partnerships oriented toward COVID-19–related education and disease prevention.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100404"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 Pandemic, Parental Protective Factors, and Substance Use Onset Among Early Adolescents in Appalachia","authors":"Hannah M. Layman PhD ,&nbsp;Christa L. Lilly PhD ,&nbsp;Geri A. Dino PhD ,&nbsp;Traci D. Jarrett PhD ,&nbsp;Carrie W. Rishel PhD ,&nbsp;Alfgeir L. Kristjansson PhD","doi":"10.1016/j.focus.2025.100390","DOIUrl":"10.1016/j.focus.2025.100390","url":null,"abstract":"<div><h3>Introduction</h3><div>During the pandemic, adolescents spent significantly more time at home with their families than during nonpandemic eras. This change could be beneficial because time spent with family has been linked to positive health outcomes; however, given the stress and strains accompanied by COVID-19, research has yet to assess the potential effect that increased family time may have had on youth substance use onset and development during this strenuous period.</div></div><div><h3>Methods</h3><div>School-based survey data from 2,322 students in the Young Mountaineer Health Study were collected during the fall of 2020 (Wave 1), spring of 2021 (Wave 2), and fall of 2021 (Wave3) and were used to create logistic regression models to identify variables at Wave 1 that related to 3 types of substance use onset in the sample at Wave 2 and Wave 3. The study’s primary independent variable was COVID-19–related emotional impact (scale range: 5–25).</div></div><div><h3>Results</h3><div>Average age of participants at Wave 1 was 11.50 years (males=42.9%). COVID-19–related emotional impact was positively associated with an increase in cigarette (AOR=1.06, <em>p</em>=0.008) and E-cigarette use onset (AOR=1.06, <em>p</em>&lt;0.001). Parental monitoring (AOR=0.89, <em>p</em>=0.013) and parental social support (AOR=0.93, <em>p</em>=0.026) were associated with a decreased initiation of cigarette use, respectively.</div></div><div><h3>Conclusions</h3><div>The authors found that higher levels of COVID-19–related emotional impact were predictive of increased cigarette and E-cigarette onset but were only marginally related to alcohol use onset. The authors also identified that increased parental monitoring and parental social support might decrease the onset risks for cigarette and alcohol use among early adolescents.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100390"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations Between Transportation Barriers in the Context of Other Social Needs and Cancer Screening Adherence","authors":"Anna M. Morenz MD, MPH ,&nbsp;Gloria D. Coronado PhD ,&nbsp;Lingmei Zhou MS ,&nbsp;Celia Valenzuela MD ,&nbsp;Joshua M. Liao MD, MSc","doi":"10.1016/j.focus.2025.100385","DOIUrl":"10.1016/j.focus.2025.100385","url":null,"abstract":"<div><h3>Introduction</h3><div>Socioeconomic inequities in breast and cervical cancer screening persist and may be driven by unmet social needs, such as transportation barriers. The association between transportation barriers and screening adherence, while adjusting for other social needs, remains poorly characterized.</div></div><div><h3>Methods</h3><div>A cross-sectional analysis of 2023 National Health Interview Survey data was conducted from October to December 2024. Multivariable logistic regression was used to assess associations between transportation barriers and breast and cervical cancer screening adherence.</div></div><div><h3>Results</h3><div>A total of 5,851 (survey-weighted 42.3 million) and 8,461 (survey-weighted 78.6 million) individuals were eligible for breast and cervical cancer screening, respectively. In adjusted analyses, transportation barriers were associated with lower likelihood of breast cancer screening (AOR=0.6; 95% CI=0.5, 0.9) but no difference in the likelihood of cervical cancer screening (AOR=0.9; 95% CI=0.7, 1.1). Low income, lack of health insurance, and low levels of formal education were also associated with lower adherence for both breast and cervical cancer screening.</div></div><div><h3>Conclusion</h3><div>After accounting for other social needs, transportation barriers are associated with lower likelihood of breast cancer screening—an inequity that may benefit from public health and healthcare interventions. Additional work is needed to understand the relationship between SES and cervical cancer screening adherence to inform future interventions.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100385"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145010213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Whole Health Engagement Among Homeless-Experienced Veterans in an Emergency Shelter: A Quality Improvement Study","authors":"Tawny Saleh MD, MS ,&nbsp;Lillian Gelberg MD, MSPH, FAAFP ,&nbsp;Melissa Y. Chinchilla PhD, MCP, MSHPM ,&nbsp;Jennifer E. Allen ANP-BC, MSN ,&nbsp;Kristen L. Connor MSPH ,&nbsp;Lisa Altman MD ,&nbsp;Peter Capone-Newton MD, PhD, MPH","doi":"10.1016/j.focus.2025.100383","DOIUrl":"10.1016/j.focus.2025.100383","url":null,"abstract":"<div><h3>Introduction</h3><div>Whole Health programs aim to integrate mental, physical, and social health to improve veteran well-being. Homeless-experienced veterans may face barriers to engagement owing to housing instability and comorbidities. This study evaluated Whole Health participation among homeless-experienced veterans at the VA Greater Los Angeles Care, Treatment, and Rehabilitation Service site compared with that among the broader VA Greater Los Angeles Healthcare System veteran population.</div></div><div><h3>Methods</h3><div>A retrospective quality improvement study analyzed Whole Health participation among 619 homeless-experienced veterans at Care, Treatment, and Rehabilitation Service; 25,520 Whole Health participants at VA Greater Los Angeles Healthcare System; and 84,358 total VA Greater Los Angeles Healthcare System veterans. Chi-square and <em>t</em>-tests assessed demographic and health differences. Thematic analysis of personal health inventory reflections explored wellness priorities.</div></div><div><h3>Results</h3><div>Whole Health participation was higher among Care, Treatment, and Rehabilitation Service homeless-experienced veterans (42%) than among the broader VA Greater Los Angeles Healthcare System Whole Health population (22%) (<em>p</em>&lt;0.001). Whole Health participants at Care, Treatment, and Rehabilitation Service were older (56.8±13.4 vs 53.8±13.7 years; <em>p</em>=0.006), with different age group distribution (<em>p</em>=0.02). Chronic pain, post-traumatic stress disorder, depression, and substance use were more prevalent among homeless-experienced veterans than among the general veteran population (<em>p</em>&lt;0.001). Early Whole Health engagement was associated with longer shelter stays. Personal health inventory themes included personal development (88%), housing (68%), and family/social connection (56%).</div></div><div><h3>Conclusions</h3><div>Whole Health programs may be effective and acceptable among homeless-experienced veterans when integrated into supportive housing environments.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100383"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144750719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Submaximal Exercise Testing for Metabolic Flexibility: A Possible Window Into Mitochondrial Function","authors":"Dale I. Lovell PhD ,&nbsp;Max Stuelcken PhD ,&nbsp;Alexander Eagles MD, PhD","doi":"10.1016/j.focus.2025.100398","DOIUrl":"10.1016/j.focus.2025.100398","url":null,"abstract":"","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100398"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144903194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial and Ethnic Disparities in Cannabis Use Among U.S. Youth Who Use Tobacco: Findings From the Population Assessment of Tobacco and Health Study","authors":"Allison A. Temourian PhD ,&nbsp;Pamela M. Ling MD, MPH ,&nbsp;Vuong V. Do PhD ,&nbsp;Nhung Nguyen PhD","doi":"10.1016/j.focus.2025.100392","DOIUrl":"10.1016/j.focus.2025.100392","url":null,"abstract":"<div><h3>Introduction</h3><div>Limited research on youth tobacco use addresses cannabis use across different tobacco products and racial/ethnic subgroups. This study examines these patterns of cannabis use among youth who use tobacco using 6 waves of nationally representative data.</div></div><div><h3>Methods</h3><div>This study analyzed the Population Assessment of Tobacco and Health Study data Waves 1–6 (during 2013–2021) in 2024. The authors conducted cross-sectional weighted analyses for each wave. The authors estimated past 30-day use of cannabis among youth who reported past 30-day use of any tobacco, combustible tobacco, and e-cigarette for the total sample and for each racial and ethnic group (Hispanic, non-Hispanic White, non-Hispanic Black, and non-Hispanic other).</div></div><div><h3>Results</h3><div>Across 6 waves, cannabis-use prevalence was over 36% among youth who used any tobacco product, over 40% among those who used combustible tobacco, and 36% among those who used e-cigarettes. There were racial/ethnic disparities in cannabis use among youth who used e-cigarettes, with non-Hispanic Black, non-Hispanic other, and Hispanic youth reporting the highest cannabis-use prevalence. There were no significant racial/ethnic differences in cannabis use among youth who used combustible tobacco.</div></div><div><h3>Conclusions</h3><div>Cannabis use is highly prevalent among youth who use tobacco, with significant disparities by tobacco product and race/ethnicity. The disproportionately high prevalence of cannabis use among non-White youth highlights the need for tailored interventions to address these disparities in cannabis and tobacco use among youth.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100392"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145010215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comfort With Sharing Food Insecurity Risk for Clinical Care Among Individuals With and Without a Cancer History: Findings From a National Survey","authors":"Steven A. Benyahia BA ,&nbsp;Johnathan Torikashvili BS ,&nbsp;Tejasvi Paturu BA ,&nbsp;Marian Mikhael BS ,&nbsp;Oliver T. Nguyen MSHI ,&nbsp;Jessica Y. Islam PhD, MPH ,&nbsp;Amir Alishahi Tabriz MD, PhD, MPH ,&nbsp;Young-Rock Hong PhD, MPH ,&nbsp;Kea L. Turner PhD, MPH, MA","doi":"10.1016/j.focus.2025.100395","DOIUrl":"10.1016/j.focus.2025.100395","url":null,"abstract":"<div><h3>Introduction</h3><div>Food insecurity negatively affects timely access to care, treatment adherence, quality of life, and survival among cancer survivors. There is limited knowledge about cancer survivors’ comfort with sharing food insecurity risk for clinical care on a national scale. This study aims to assess comfort with sharing food insecurity risk for clinical care among adults with and without a cancer history and to identify factors that may be associated with comfort for sharing food insecurity risk.</div></div><div><h3>Methods</h3><div>Data were obtained from the National Cancer Institute’s Health Information National Trends Survey 6, which was administered from March 7, 2022, to November 8, 2022. Descriptive statistics were calculated to describe the study sample, and sample characteristics were compared by comfort with sharing food insecurity risk for clinical care. A multivariable logistic regression model was conducted to estimate the probability of comfort with sharing food insecurity risk for clinical care. Full-sample weights were applied to calculate population-level estimates, and jackknife replicate weights were applied to calculate SEs.</div></div><div><h3>Results</h3><div>The weighted sample included 188,146,395 participants (6.7% were cancer survivors). Overall, most cancer survivors (64.9%) and adults without a cancer history (58.7%) reported comfort with sharing food insecurity risk for clinical care. Controlling other factors, cancer survivors reported a similar comfort level with sharing food insecurity risk (OR=1.33; 95% CI=0.97, 1.80) compared to individuals without a cancer history. Controlling other factors, individuals reporting at or above the mean patient-centered communication (OR=1.52; 95% CI=1.24, 1.87) were more likely to report comfort with sharing food insecurity risk than individuals reporting below the mean patient-centered communication. Individuals experiencing food insecurity reported a similar comfort level with sharing food insecurity risk (OR=0.93; 95% CI=0.5, 1.31) compared to adults not experiencing food insecurity.</div></div><div><h3>Conclusions</h3><div>Study findings suggest that screening for food insecurity risk may be acceptable to cancer survivors and that patient-centered communication may support participation in food insecurity screening. Future studies are needed to assess cancer survivors’ preferences for sharing food insecurity risk for clinical care (what, when, where, and how data are shared) to ensure that implementation is aligned with patient preferences.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100395"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State-Level Prevalence of Maternity Care Deserts: Association With Healthcare Access, Utilization, and Outcomes Among Medicaid Recipients","authors":"Dara E. Gleeson MPH, CHES ,&nbsp;Susan H. Busch PhD ,&nbsp;Jeannette R. Ickovics PhD","doi":"10.1016/j.focus.2025.100362","DOIUrl":"10.1016/j.focus.2025.100362","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;More than 2 million women of childbearing age live in U.S. counties without access to maternity care—counties referred to as maternity care deserts. The objective of this study was to identify whether living in a state with a high prevalence of maternity care deserts is associated with maternal and child health access and utilization and contributing to adverse health outcomes among Medicaid recipients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This is a descriptive, cross-sectional, secondary data analysis using most recent data available (2021–2023) from multiple existing state-level sources (e.g., Medicaid Health Care Core Data Sets, March of Dimes Peristats, Pregnancy Risk Assessment Monitoring System). State-level analyses included all U.S. states, District of Columbia, and Puerto Rico (N=52). Analyses were stratified by state prevalence of maternity care deserts (high=states where ≥21% of counties have no hospital/birth center providing obstetric services). Multivariate analyses of covariance were used to test associations with 3 domains of dependent variables: healthcare access (i.e., mental health, pediatrics, family medicine), utilization (e.g., timely access to pre and postnatal care, vaccinations), and maternal/child health outcomes (e.g., maternal and infant mortality).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Three multivariate analysis of covariance tests indicated significant main effects for state-level maternity care desert prevalence and all domains (all &lt;em&gt;p&lt;/em&gt;&lt;0.009), with large effect sizes (η2≥0.14). Effects were durable, even after controlling for state-level covariates. States/territories with high prevalence of maternity care deserts had more rural counties (t= −4.22, &lt;em&gt;p&lt;/em&gt;&lt;0.001), lower levels of educational attainment (t= −2.32, &lt;em&gt;p&lt;/em&gt;=0.024), and lower median household income (t=3.09, &lt;em&gt;p&lt;/em&gt;=0.004). Those living in states/territories with high prevalence of maternity care deserts had 30% fewer mental healthcare providers (487.50 vs 696.50/100,000 population) and 36% fewer pediatricians (14.25 vs 22.31/100,000 population). They were ∼14% less likely to receive timely prenatal and postpartum care. Infants were 28.62% less likely to receive influenza vaccinations before second birthday. Critically, those in states/territories with high prevalence of maternity care deserts had 34.20% greater risk of maternal mortality, 18.34% greater risk of infant mortality, and 8.92% greater risk of low birthweight.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;High state-level prevalence of maternity care deserts is associated with adverse maternal and child outcomes; exacerbating concerns as health during the perinatal period sets the trajectory for health across the lifespan. Policy and practice solutions must address pervasive health inequities associated with maternity care deserts (e.g., expanding access to maternity care through family medicine physicians, doulas, telehealth access, and suppo","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100362"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}