An ongoing mental healthcare crisis has been exacerbated by COVID-19, particularly for youth. However, one unexpected effect of this pandemic is that access to digital mental healthcare has rapidly expanded. We argue that eHealth interventions, including telehealth and mobile interventions (mHealth), can effectively address mental health challenges, reduce costs for individuals and institutions, and broadly expand access to mental healthcare. For the promise of eHealth to be fully realized, FDA regulation must thoughtfully balance the promotion of evidence-based interventions with broad public accessibility. Furthermore, youth involvement throughout the design process and consideration of youth-specific needs when establishing regulations are critical to the success of eHealth in addressing youth mental health in the United States.

Ready access to synthetic DNA has enabled vast progress in health and biotechnology in recent decades. However, it also makes it easier for malicious actors to develop biological weapons that threaten public health. Thus, it is crucial to regulate who can order synthetic DNA of pathogens from commercial providers. Some synthetic DNA providers screen customers and ordered sequences; however, there is no federal legislation addressing the responsibilities of these companies. Voluntary compliance with the screening Guidance issued by the US Department of Health and Human Services (HHS) is not sustainable, as it disadvantages companies who screen against those who do not. Here, we consider two policy solutions. Option 1 is to mandate minimum screening standards for all US-based synthetic DNA providers. This regulatory burden may weaken the US DNA synthesis sector, so we recommend Option 2, which requires government-funded researchers to only use synthetic DNA from accredited screening-compliant providers.

In just twenty years, humanity has progressed from the first sequenced human genome to the ability to sequence one in a matter of hours and for only hundreds of dollars. This rise in affordability and speed has enabled physicians to use whole genome sequencing (WGS) as a diagnostic tool, particularly in cases of rare disease in pediatric patients where it has already demonstrated immense potential. However, such a rapid development in technology powerful enough to unlock a person’s genetic information has also led to necessary questions regarding when and how it is applied. In this assessment, we discuss the implications of WGS adoption in pediatric healthcare, focusing specifically on ensuring ethical and equitable collection and communication of genomic data as well as the need for secure and accessible data storage methods. We identify several key areas where further policy is most pressing and provide value-driven recommendations centered on guaranteeing pediatric patient safety, equity, and empowerment during the broader introduction of WGS tools. In particular, we advocate for legal frameworks that limit present usage of WGS to only those patients with a clear and present need, guidelines that expand the labor force that can conduct WGS, increasing access and equity, improved standards for storage, access, and sharing of WGS data, and finally expanding Medicaid coverage to include WGS use in critical care settings.

Gender-affirming care has been established as essential healthcare for transgender and non-binary (TNB) youth but many patients face prohibitive barriers when accessing this kind of care. These roadblocks span a wide array of arenas, from digital privacy protections to simply accessing gender affirming care. Many TNB youth lack familial and community support to seek care, geographical access to specialized providers, insurance coverage sufficient to make this care affordable, and legal protections for existing as a TNB person in society. During the COVID-19 pandemic, digital technologies and health legislation expanded patients' access to out-of-state or remote care. Telemedicine in particular has the potential to reduce barriers to accessing gender-affirming care. However, without guidance and oversight in the form of concrete federal or state policies, these benefits may not be extended to those most in need of support. How telehealth providers manage the data collected using these technologies is also of great concern; this health information could be used to prevent and criminalize youth and families seeking care. We thus propose a suite of policy actions to protect and expand access to gender-affirming care for TNB youth: ensuring legal protections for data relating to gender identity and gender-affirming healthcare, establishing nationwide access to gender-affirming care via insurance waivers and support for remote care, and expanding the pool of providers trained in TNB healthcare.

Existing health disparities in the United States are partially driven by the way healthcare is delivered. There is interest in using Artificial Intelligence (AI)-driven software as medical devices (SaMD) to aid in healthcare delivery and reduce health disparities. However, AI-driven tools have the potential to codify bias in healthcare settings. Some AI-driven SaMDs have displayed substandard performance among racial and ethnic minorities. Auditing these tools for biased output can help produce more equitable outcomes across populations. However, there are currently no explicit Food and Drug Administration (FDA) regulations that examine bias in AI software in healthcare. Therefore, we propose the FDA develop a distinct regulatory process for AI-driven SaMDs that includes assessing equitable output across populations and avoiding potential health disparity exacerbation. This change could help prevent AI-driven health disparities nationwide.

Broadband adoption is a determinant of health that intersects with other sociological determinants such as education and employment. Due to the rising reliance on digital technology, lack of broadband adoption prevents individuals from accessing the essential resources needed to fully participate in 21st century educational and employment opportunities. Vulnerable populations experience greater impacts of divestment, and therefore experience greater sociological stressors and worse health outcomes. These communities are left behind with slower services and more expensive internet service plans, as physical proximity to broadband does not necessarily predict broadband adoption. The benefits of broadband adoption and the harms of its absence are magnified for youth and other vulnerable groups, with youth relying more heavily on digital services. The author recommends that the Federal Communications Commission (FCC) Task Force to Prevent Digital Discrimination increase broadband adoption for vulnerable communities by strengthening community-based partnerships to provide culturally competent resources and adopting equity-based national digital health standards that provide greater transparency of data and accountability for discriminatory deployment decisions.