Policy Changes Research Articles

Spillovers From Medicaid Contraceptive Use to Non-Medicaid Patients: Evidence From New York.

This study examines spillovers from a 2014 New York Medicaid policy change that increased reimbursement for immediate postpartum long-acting reversible contraceptive (LARC) insertion. Using administrative data on hospital deliveries from 2011 through 2019, we analyze whether physicians who inserted immediate postpartum LARCs for Medicaid patients following the policy change were more likely to subsequently perform the procedure on non-Medicaid patients. We find significant spillovers, as physicians who first perform an immediate postpartum Medicaid LARC insertion following the 2014 payment reform are 9.3 percentage points more likely to perform immediate postpartum non-Medicaid LARC insertions; an association that increases with the physician's share of Medicaid deliveries. To distinguish between physician-specific and hospital-specific factors driving spillovers, we compare physicians within the same hospital-year. Results indicate approximately half the spillover is due to physician-specific factors and half to hospital-specific factors. Our findings highlight how targeted reimbursement policies can have broader impacts beyond the intended population and demonstrate the influence of both individual physician behavior and institutional factors in shaping clinical practice patterns. Understanding these spillover dynamics is important for policymakers and healthcare providers aiming to promote effective and equitable contraceptive care across patient populations.

Intersection of Race and Rurality With Health Care-Associated Infections and Subsequent Outcomes.

Health care-associated infections (HAIs) are a major cause of morbidity and mortality, but little is known about whether structural factors impacting race and rurality are associated with HAI and subsequent outcomes. To evaluate the association of race and rurality, which are proxies for structural disadvantage, with HAI and subsequent outcomes. This cohort study was conducted at 3 US urban and suburban hospitals. Participants were adults aged 18 years or older admitted for 48 hours or longer from January 1, 2017, to August 31, 2020. Statistical analysis was performed from November 2022 to April 2024. Patient race and rurality status were defined as the combination of race (Black or White) and residence (urban or rural per patient zip code). HAI was defined as a positive culture from a urine, blood, or respiratory specimen obtained 48 hours or longer after admission. To determine the association of race and rurality with HAIs, multivariable generalized estimating equations models were used to account for clustering of admissions by patient. Among patients with HAI admissions, similar models examined post-HAI intensive care unit admission and in-hospital death. Among 214 955 patients admitted to the hospital (median [IQR] age, 63 [51-73] years; 108 679 female patients [50.6%]; 72 490 Black patients [33.7%]; 142 465 White patients [66.3%]), recognized HAIs occurred during 6699 (3.1%). Compared with White urban patients, Black urban patients had a decreased risk of HAI (adjusted relative risk [aRR], 0.81; 95% CI, 0.75-0.87), White rural patients had an increased risk of HAI (aRR, 1.12; 95% CI, 1.05-1.20), and Black rural patients (aRR, 1.08; 95% CI, 0.81-1.44) had a similar risk of HAI. Among patients with HAI admissions, Black rural patients had an increased risk of intensive care unit admission (aRR, 1.92; 95% CI, 1.16-3.17) and in-hospital death (aRR, 1.78; 95% CI, 1.26-2.50). White rural and Black urban patients had outcomes similar to those of White urban patients. This cohort study of hospitalized adults identified inequities related to race and rurality in HAIs and adverse outcomes from HAIs. These findings suggest that factors such as structural racism and disinvestment in rural communities may be associated with individual HAI risk and post-HAI outcomes. Future work to further understand the reasons underpinning these disparities and methods to address structural factors through policy and process changes are critical to eliminate health inequities.

Strengthening work requirements? Forecasting impacts of reforming cash assistance rules

AbstractWork requirements are perhaps the most controversial aspect of the Temporary Assistance for Needy Families (TANF) program, America's sole federal cash assistance program for low‐income families with children. In 2025, for the first time in nearly 20 years, the Fiscal Responsibility Act of 2023 (FRA) will implement policy changes intended to strengthen states’ work requirements. However, researchers’ and policymakers’ understanding of how FRA will impact states’ compliance with federal requirements is hampered by a lack of research and publicly available data. We tie information from reports submitted to the U.S. Department of Health and Human Services that we collected to administrative caseload and expenditure data to document several strategies that states currently use to comply with federal work requirements. We estimate that FRA will increase the stringency of work requirements in 23 states and that five states will begin to fall short of requirements. We note that several compliance strategies available to these states do not encourage work. We discuss changes to states’ work requirements that would promote better long‐term economic and labor market outcomes for TANF recipients.

Does Less Education Harm Health? Evidence From a Natural Experiment in a Developing Country

ABSTRACTWe investigate the health outcome effects of a reduction in years of schooling in Egypt in 1988, a policy change that moves in the opposite direction in relation to the extant literature. We exploit this policy change as a natural experiment and employ a fuzzy regression discontinuity design to investigate a range of objectively measured health outcomes and behaviours. Despite the policy's adverse effect on students' years of schooling and ability to complete educational milestones, there is no statistical effect on any health outcomes. Results also suggest that the reduction in years of schooling had no effect on labour market outcomes, thus providing a rationale for the lack of effect on health outcomes. While increasing education often leads to improved health outcomes, our findings suggest that decreasing education does not necessarily result in poorer health outcomes.

Redefining ‘state’ and ‘market’

In a moment of substantial changes in state economic policy around the world, Alami's analysis of the recent proliferation of foreign investment screening mechanisms contributes empirically and conceptually to heated debates about the future of globalization, including the urgent task of understanding law's role in mediating shifting state–capital relations. This commentary situates Alami's account in comparison to changes in foreign sovereign immunity law since the 1950s in order to add further weight to some of his key arguments, while also suggesting areas for more elaboration with respect to the intersection of law, neoliberalism, and (US) power.

Change in Allocation Pattern of Pediatric Deceased Donor Kidneys Following the Implementation of a New Allocation Policy With Pediatric Priority in Korea.

The Organ Transplantation Act of Korea was amended to state that kidneys from deceased donors under age 19 (previously age 11) must be initially allocated to a waitlisted patient under age 19. The aim of this study was to analyze the change in allocation pattern of kidneys from pediatric donors following implementation of the new policy. Data from the Korean Network for Organ Sharing database included donor and recipient information of kidney transplants from pediatric donors from October 2014 to September 2020. There were 2958 deceased donors. One hundred and sixty-three were under age 19 (163/2958, 5.5%). The study period was divided into two periods: Before policy change and after policy change. A total of 256 kidneys from 163 pediatric donors were allocated to waitlist patients. The proportion of kidneys allocated to recipients under age 19 was significantly higher after policy change (59/65, 90.8%) compared to before policy change (28/191, 14.7%, p < 0.01), with the increase most prominent in recipients aged 11-18 years. Mean time on the waitlist for all pediatric recipients of kidneys from pediatric deceased donors was 545.5 days before the change and 922.0 days after the change (p = 0.02). Mean time on the waitlist for recipients aged 1-10 years was not significantly different and that of recipients aged 11-18 years increased from 801.1 days to 1017.4 days. A sharp increase in proportion of pediatric kidney recipients from pediatric donors was observed following implementation of amended allocation policy in October 2018.

It's Getting Better All the Time: Decreased Cumulative Incidence of Waitlist Mortality in Pediatric Candidates Following 2018 Heart Allocation Policy Change.

In October 2018, the OPTN changed adult heart transplant (HT) allocation policy, increasing the number of adult candidates that had higher priority than pediatric candidates, potentially disadvantaging pediatric waitlist registrants. To understand the impact of this policy change, we used SRTR data to identify 1469 pre-policy (7/2016-9/2018) and 2901 (10/2018-12/2022) post-policy pediatric (< 18 years) HT registrants. We quantified mortality and transplant risks using weighted cause-specific hazard models, and then using weighted competing risks regression. We further stratified these analyses by age to understand risks for those in direct competition with adults for organs (≥ 12 years). Post-policy, patients were more likely to need VAD prior to HT. There were no changes in post-policy access to HT (weighted hazard ratio [wHR] = 0.96 1.03 1.11, p = 0.43). Mortality risk censoring for transplantation declined by 20% post-policy (wHR = 0.64 0.80 1.02, p = 0.05). When accounting for competing risks of transplantation, post policy, mortality decreased by 24% compared to pre-policy (weighted subdistribution HR [wSHR] = 0.61 0.76 0.94, p = 0.02). Post policy, 1-year transplant rate did not change in those < 12years (68.2%-71.0%, p = 0.77), but in those ≥ 12years, transplant rate increased (77.3%-81.0%, p = 0.003). Mortality on the waitlist decreased and access to HT for pediatric registrants did not decline following the 2018 policy change. The decreased mortality rate may reflect changes in patient casemix and/or improved patient care. Continued surveillance is important in ensuring equity in pediatric, and adult, HT.

Evaluating the impact of Canadian cannabis legalization on cannabis use outcomes in emerging adults: Comparisons to a US control sample via a natural experiment.

Recreational cannabis legalization marked a significant policy shift in Canada, but has been difficult to evaluate because of the absence of a control group. Although it is unfeasible to evaluate legalization using a randomized controlled trial design, sophisticated statistical techniques can employ quasi-experimental designs using natural experiments. This study evaluates the impact of cannabis legalization in a longitudinal cohort of Canadian emerging adults by comparing changes in cannabis use frequency and related consequences over time to changes in a similar cohort in a United States jurisdiction where no policy change took place. Two samples of emerging adults from Hamilton, Ontario, and Memphis, Tennessee, were followed longitudinally in 4-month intervals from March 16, 2018 to March 11, 2020, with three pre-legalization and four post-legalization assessments. Doubly robust difference-in-difference (DiD) estimation was used to assess whether cannabis legalization impacted cannabis use frequency or cannabis-related consequences in the Canadian sample over time. The impact of cannabis legalization on alcohol use and alcohol-related consequences was also assessed as a control form of substance use for which no policy change took place. Cohort differences were adjusted within DiD estimation using propensity score balancing. Against a general trend of decreasing use over time, the DiD estimation revealed significantly greater cannabis use frequency approximately 6-months post legalization (ATT (95% CI): 0.2245 (0.0154, 0.4336)) and approximately one year post legalization (ATT (95% CI):0.3091 (0.0473, 0.5709)) in the Canadian sample compared to the American sample. Cannabis-related consequences were also greater in the Canadian sample at both of these time points (ATT (95% CI): 0.0.7610 (0.0797, 1.4423)), (ATT (95% CI): 1.0396 (0.1864, 1.8928)). These higher levels reflected less steep declines over time (i.e., attenuated 'aging out'). Alcohol changes showed no impact of legalization at any time point, as expected. Findings suggest that cannabis legalization was associated with smaller reductions in cannabis use frequency and adverse consequences than expected in the Canadian sample compared to the American control sample. Although the magnitude of these impacts was small, these findings suggest the start of diverging cannabis trajectories. Given that effects of legalization are hypothesized to be long-term rather than immediate, further monitoring of the impacts of cannabis legalization on developmental trends in cannabis use and related consequences is warranted.

Nasopharyngeal carriage of Streptococcus pneumoniae among children and their household members in southern Mozambique five years after PCV10 introduction.

Streptococcus pneumoniae is an important cause of pneumonia, sepsis, and meningitis, which are leading causes of child mortality. Pneumococcal conjugate vaccines (PCVs) protect against disease and nasopharyngeal colonization with vaccine serotypes, reducing transmission to and among unvaccinated individuals. Mozambique introduced 10-valent PCV (PCV10) in 2013. In 2017-2019, 13-valent PCV (PCV13) replaced PCV10, and in September 2019 the schedule changed from three primary doses to two primary doses and a booster; the booster-containing schedule may increase indirect effects. We examined pneumococcal carriage in Mozambique to establish a baseline for estimating the impact of policy changes and to estimate the long-term impact of PCV10 in children aged <5years. We calculated prevalence of carriage of PCV10 serotypes and the 3 additional PCV13 serotypes ('PCV13-unique') among children aged <5years and their household members in southern Mozambique, between October 2018 and July 2019. Nasopharyngeal swabs were cultured, and isolates underwent Quellung serotyping. For children, we compared these "long-term post-PCV10" data with prior surveys ("pre-PCV" (2012-2013) and "post-PCV10" (2015-2016)) that used the same methods. In 2018-2019, among 1319 children aged under five years, 1064 (80.7%) were colonized with pneumococcus, among 614 children aged 5-<18years, 355 (57.8%) were colonized, and among 804 adults (aged ≥18years), 285 (35.4%) were colonized. The most frequently observed serotypes were 19A (n=154, 8.5% of isolates) and 6A (n=107, 5.9%), both PCV13-unique serotypes. Overall carriage prevalence among children under five years remained stable at approximately 80% across the carriage studies conducted between 2012 and 2019; between 2015 and 2016 and 2018-2019, the prevalence of PCV10-type carriage declined from 17.7% to 10.1%. Despite substantial declines in PCV10-type carriage initially following vaccine introduction, the continued circulation of PCV10 serotypes and relative high prevalence of PCV13-unique serotypes underscore the need to understand the impact of policy changes on pneumococcus transmission.

Prenatal cannabis exposure and the risk of subsequent maltreatment.

Parental substance use can increase the risk of child maltreatment. The purpose of this study was to assess racial bias in newborn drug testing and to investigate the association between prenatal tetrahydrocannabinol (THC) exposure and subsequent child maltreatment. This retrospective cohort study (n=35,437) linked University of Michigan Hospital birth data and Michigan Department of Health and Human Services child maltreatment data relative to a 2018 policy change. Prior to 2018, prenatal THC exposure was routinely substantiated as physical abuse; after 2018 THC exposure was investigated but not automatically substantiated. We defined prenatal THC exposure as a positive newborn meconium drug test for THC. The primary outcome was a substantiated Child Protective Services (CPS) report of maltreatment before and after the policy change. Demographic variables included parent age, race, ethnicity, zip code and insurance type. Covariates included prenatal urine drug test orders and results, and newborn drug test orders and results. Regression models estimated the rate of subsequent maltreatment and racial disparities associated with newborn testing. Regression analyses indicated that Black and multiracial newborns were significantly more likely to be tested for substance exposure at birth. Newborns with a test positive for THC only were not more likely to experience maltreatment after the policy change as compared with newborns that tested negative and newborns not tested. The evidence strongly supports a policy to end routine CPS investigations for cannabis exposure and eliminate racially biased drug testing practices.

Association of Hospital Consolidation with Cancer Outcomes.

Hospital mergers have increased significantly since 2010, driven by factors such as healthcare policy changes, reimbursement, economies of scale, and quality improvement goals. However, limited evidence exists about how these mergers affect the quality of care and cancer outcomes. We conducted a difference-in-differences analysis to assess the impact of hospital consolidation on cancer outcomes. Using data from the Surveillance, Epidemiology, and End Results (SEER) program, we identified cancer patients diagnosed between 2008 and 2016, then used the Health Cost Institute's Healthy Marketplace Index to assess hospital consolidation as measured by the Herfindahl-Hirschman Index (HHI). The HHI is a measure of market concentration and competition between firms in a given industry. We found that increases in hospital consolidation were associated with a higher likelihood of early-stage cancer diagnosis compared to control areas (-1.1%, 95% confidence interval (CI) -2.3 to 0.0%), and improved overall survival (hazard ratio 0.94, CI 0.90-0.98). These improvements were restricted to cancers with screening recommendations. Our study suggests that hospital consolidation may have some benefits for cancer patients. However, these benefits may not be evenly distributed across all cancer types. Further research is needed to confirm these findings and to understand the mechanisms by which hospital consolidation affects cancer outcomes.

Emerging trends in managed care pharmacy: A mixed-method study.

Over the past 5 years, managed care pharmacy has been shaped by a global pandemic, advancements in generative artificial intelligence (AI), Medicare drug price negotiation policies, and significant therapeutic developments. Collective intelligence methods can be used to anticipate future developments in practice to help organizations plan and develop new strategies around those changes. To identify emerging trends in managed care pharmacy. In this sequential mixed-method study, we invited experts to participate in a multidisciplinary advisory panel to develop a survey with 5 overarching domains. The qualitative analysis for our advisory panel meetings used a thematic analysis approach. To analyze the cross-sectional survey results, we used descriptive statistics and exploratory bivariate statistics to test for possible relationships with survey respondent demographics and likelihood predictions. To assess respondent opinions on the overall likelihood of an event occurring in the next 5 years, we combined "Highly likely/Somewhat likely" responses and compared with "Highly unlikely/Somewhat unlikely" responses. Following our advisory panel focus groups, a total of 53 scenarios were developed for inclusion in the quantitative survey under the domains of (1) information technology, (2) therapeutics and diagnostics, (3) payment models, (4) pharmacy operations, and (5) public policy. A total of 1,238 individuals were invited to participate in the survey. Of eligible participants, 201 complete survey responses were received for a final response rate of 16.2%. Survey participants rated increased use of glucagon-like peptide-1 receptor agonists by at least 25%, at least 1 major data breach, more than 10 new orphan drug approvals, and AI use in more than half of prior authorization reviews as the most likely scenarios to occur in the next 5 years. Respondents identified the following broad issues as those most likely to impact their organizations (employers) in the next 5 years: federal and state policy changes impacting managed care, cell and gene therapies, impact of AI on managed care operations, and emerging payment models. This study provides valuable insights into the emerging trends that are expected to shape managed care pharmacy over the next 5 years. The integration of advanced technologies, such as AI, along with the increasing focus on specialty therapeutics, represents both opportunities and challenges for managed care organizations. However, areas with lower consensus highlight the need for caution in strategic planning.

Comprehensive Dementia Care Models: State of the Science and Future Directions.

The rising prevalence of Alzheimer's disease and Alzheimer's disease-related dementias has led to renewed public discourse and policy changes in response to the care needs of persons living with dementia and their care partners. Comprehensive dementia care models are central to many recent policy initiatives, most notably the Centers for Medicare & Medicaid Services Guiding an Improved Dementia Experience model. Gerontological nursing research is uniquely positioned to design and lead research investigating the effectiveness of these initiatives, as well as the dissemination and scaling of existing comprehensive dementia care models. The current Annual State of the Science Review provides an overview of the current state of comprehensive dementia care models in the United States and relevant policies. Challenges and opportunities for nursing education, research, and implementation across the translational research continuum are also outlined. [Research in Gerontological Nursing, 18(1), 7-16.].

Nationwide analysis of Medicare expenditure and utilization of EGFR inhibitors from 2018-2022.

112 Background: EGFR inhibitors are used extensively for treatment of metastatic colorectal cancer ranging from first line drugs in combination with chemotherapy to monotherapy for refractory disease. As we increasingly move towards targeted treatments for cancer, financial implications of these drugs must be taken into consideration. In this study we aim to analyze changes in Medicare spending for Cetuximab and Panitumumab to better understand the financial impact of these therapies. Methods: We obtained data from the publicly available Medicare Part D database from Centers for Medicare and Medicaid Services. Data on total spending, total claims, total beneficiaries, average spending per claim, and average spending per beneficiary was extracted from the database. We adjusted the data for 2018 for 2022 using a standard annual inflation rate. Percentage change was calculated using the adjusted data. Results: For Cetuximab, we saw a sharp increase in total spending by 38.77%, from $4,912,903.87 in 2018 to $6,811,781.05 in 2022. The number of claims rose by 31.96%, while the total number of beneficiaries saw a modest increase of 2.44%. Average spending per claim increased by 16.04%, and average spending per beneficiary grew by 49.44%. Panitumumab showed a similar rise in total spending by 43.23%, from $1,594,347.66 in 2018 to $2,283,142.83 in 2022. Claims increased by 25.42%, and beneficiaries grew by 47.83%. Average spending per claim increased by 25.97%, and average spending per beneficiary saw a substantial rise of 65.75%. Conclusions: Our results indicate a significant increase in the financial burden related to EGFR inhibitors. As we move away from chemotherapy and shift our focus to targeted therapies, it is imperative to explore generic alternatives and direct policy changes to ensure equitable access across various racial and socio-economic groups. These findings highlight the need for further research into healthcare policy reforms to ease the burden on our health system. Drug Year Total Spending ($) Total Claims Total Beneficiaries Avg Spending/Claim ($) Avg Spending/Beneficiary ($) Cetuximab 2018 4,912,903.87 551 123 8,072.80 36,163.51 2022 6,811,781.05 727 126 9,369.71 54,061.75 % Change 0.3877 0.3196 0.0244 0.1604 0.4944 Panitumumab 2018 1,594,347.66 5,955 184 242.72 30,714.91 2022 2,283,142.83 7,470 272 305.81 50,736.51 % Change 0.4323 0.2542 0.4783 0.2597 0.6575

Assessment of residential renewable energy investment under dynamic market environment: Aspect from household benefits.

The adoption of residential renewable energy is pivotal for achieving the 'Net Zero' goal, yet financial assessments of household investments in this area remain complex due to dynamic market conditions. This study introduces a novel closed-form financial valuation framework for residential solar photovoltaic (PV) systems, explicitly addressing the uncertainties of electricity market price fluctuations (market risk) and energy policy changes (policy risk) using Geometric Brownian Motion (GBM). A case study in France demonstrates the framework's application, revealing that the discount rate is the most influential factor in solar PV valuation, followed by system lifespan and policy-driven Feed-in Tariff (FiT) rates. Sensitivity analyses further highlight how these variables interact to influence investment outcomes under various market scenarios. Key findings include (1) the identification of critical thresholds for solar PV investments, ensuring financial viability even under fluctuating conditions; (2) the validation of GBM as an effective tool for capturing long-term market and policy dynamics; and (3) actionable policy recommendations emphasizing market efficiency, policy stability, and end-of-life management. These insights contribute to advancing both household investment decision-making and policy design, addressing a significant gap in understanding the economic dynamics of residential renewable energy adoption. By bridging theoretical valuation models with empirical evidence, this research provides practical guidance for promoting decentralized renewable energy systems globally.

The experiences and roles of infection prevention and control professionals working in residential care facilities during global outbreaks: An integrative review.

The escalating threat of global infectious disease outbreaks has underscored the imperative for robust infection prevention and control (IPC) measures, particularly within the high-risk context of residential care facilities. This research aimed to investigate the experiences and roles of IPC professionals (IPCPs) in such settings during global outbreaks. Utilising an integrative review methodology, four electronic databases - Medline, CINAHL, Embase, and Scopus - were searched from 2003 onwards for relevant papers. A two-tiered independent screening approach was employed to select eligible articles, followed by a consensus-based appraisal and thematic analysis of included studies. The final review encompassed eight articles. IPCPs faced systemic organisational and ground-level operational hurdles, including inequitable access to resources, and lack of training and outbreak preparedness. External and internal variables impacted the effectiveness ofoutbreak responses, affecting resident and occupational health, and perceptions of IPC overtime. The review identified systemic challenges IPCPs face in residential care during outbreaks, including resource inequity and lack of standardised training. Centralised resources and standardised educational benchmarks may help to mitigate these issues. Policy changes are required to enhance healthcare readiness, quality, and research in residential care settings.

Disparities in clinical trial enrollment among LGBTQ+ individuals and its impact on cancer treatment and management: A systematic review.

805 Background: There is a significant gap in oncologic research, which arises from the exclusion of LGBTQ+ individuals from cancer clinical trials, compromising the development of personalized cancer therapies and limiting the generalizability of findings. Despite known health disparities in this population, including higher cancer risk factors and unique psychosocial stressors, data on clinical trial participation remains sparse. This study aims to elucidate the extent of underrepresentation of LGBTQ+ individuals in cancer clinical trials and examine its impact on treatment efficacy, safety, and overall management. Methods: We conducted a systematic review of literature and clinical trial databases, including PubMed, ClinicalTrials.gov, and other registries, focusing on cancer trials from 2010 to 2024. We extracted data on LGBTQ+ enrollment, analyzed demographic inclusivity criteria, and identified barriers to participation. Subgroup analyses evaluated the correlation between LGBTQ+ representation and treatment outcomes, considering variables such as trial design, recruitment strategies, and data collection on sexual orientation and gender identity. The review also examined policy changes and inclusivity initiatives aimed at improving trial access for this community. Results: The review identified a significant underrepresentation of LGBTQ+ individuals in cancer trials, with sexual orientation and gender identity data reported in only 6.2% of trials. Structural and sociocultural barriers, including heteronormative trial designs, lack of inclusive recruitment strategies, and pervasive discrimination, were frequently cited as impediments. Trials that included LGBTQ+ participants rarely conducted stratified analyses to assess differential treatment responses, leading to a paucity of data on drug safety, efficacy, and toxicity profiles specific to this population. The absence of these data may contribute to suboptimal therapeutic decision-making and potential adverse outcomes in clinical practice. Conclusions: The substantial underrepresentation of LGBTQ+ individuals in cancer clinical trials impairs the ability to develop inclusive, evidence-based oncology care. Addressing this gap requires systematic changes, including the integration of sexual and gender minority data collection, implementation of LGBTQ+-specific recruitment frameworks, and stratified analyses of treatment outcomes. Enhancing trial inclusivity will not only improve the external validity of oncologic research but also support the development of tailored therapeutic approaches that address the unique needs of LGBTQ+ cancer patients, ultimately advancing health equity in cancer care.

Exploring the acceptability of a risk prediction tool for cardiometabolic risk (gestational diabetes and hypertensive disorders of pregnancy) for use in early pregnancy: A qualitative study.

The acceptability of providing women with personalised cardiometabolic risk information using risk prediction tools early in pregnancy is not well understood. To explore women's and healthcare professionals' perspectives of the acceptability of a prognostic, composite risk prediction tool for cardiometabolic risk (gestational diabetes and/or hypertensive disorders of pregnancy) for use in early pregnancy. Semi-structured interviews were conducted to explore the acceptability of cardiometabolic risk prediction tools, preferences for risk communication and considerations for implementation into antenatal care. The Theoretical Framework of Acceptability informed interview questions. Transcripts were thematically analysed. Women ≤24 weeks' gestation (n = 13) and healthcare professionals (n = 8), including midwives (n = 2), general practitioners (n = 2), obstetricians (n = 2), an endocrinologist (n = 1) and cardiologist (n = 1) participated. Participants indicated that providing personalised risk information is only appropriate when preventative measures can be initiated to mitigate risks. Differentiating the risk for each condition (single risk outputs) was often preferred to composite risk outputs to enable targeted monitoring and management. Defining conditions and risks to mother/baby, visually depicting personalised risk scores, and providing clear, patient-centred clinical management plans were recommended. Supportive clinical policy changes, staff engagement/training, and integration into electronic health records were suggested to facilitate uptake into routine antenatal care. Women and healthcare professionals suggested that early pregnancy cardiometabolic risk prediction tools may be acceptable when preventative interventions are available to reduce risks. Risk prediction tools with integrated patient-centred education materials may promote timely access and engagement with preventative interventions to optimise women's current and future health.

The Social Security Fairness Act: Evaluating Potential Impact, Limitations, and Implications for Research, Policy, and Practice.

The impact of laws and policies that involve social determinants of health (SDOH), particularly among older, retired populations, needs to be considered as a public health intervention. The Social Security Fairness Act was signed into law in 2025, as a new amendment to the Social Security Act first introduced in 1935. The Social Security Fairness Act ends two provisions that have reduced benefits for spouses, widows, and widowers and for public service workers, which include teachers, fire fighters, police officers, nurses, and others who are receiving pensions from state or local government. Specifically, this new bill involves economic stability, which is considered an important SDOH for older adults. The purpose of the current article is to evaluate policy changes through the Social Security Fairness Act, including potential impact and benefits, limitations or unintended consequences, and implications and recommendations for future research, policy, and practice. Findings will help guide gerontological nurses and interprofessional researchers, clinicians, and educators promoting healthy aging. [Journal of Gerontological Nursing, 51(2), 7-12.].

Implementing Food as Medicine During COVID-19: Produce Prescriptions and Integrative Group Medical Visits in Federally Qualified Health Centers.

Food as Medicine is a rapidly developing area of health care in the United States, aimed at concurrently addressing nutrition-sensitive chronic conditions and food and nutrition insecurity. Recipe4Health (R4H) is a Food as Medicine program with an integrative health equity focus. It provides prescriptions for locally grown produce ('Food Farmacy') with or without integrative group medical visits, alongside training for clinic staff. To describe the initial implementation of R4H in four Federally Qualified Health Centers in Northern California, using a convergent mixed-methods approach. We used the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) implementation science framework to assess the first two years of R4H (2020-2022). We draw from 40 interviews (26 partner organization staff, 14 patients) and program data on reach and adoption. Qualitative data were analyzed using codebook thematic analysis. Reach: From January 2020 to August 2022, 3255 patients were referred to the program; 1997 of those referred (61%) enrolled in the Food Farmacy only (N = 1681) or Food Farmacy + integrative group medical visits (N = 316). Participating patients included a wide range of ages (mean age 41.4, [SD 20]; 18% < 18 years old) and racial and ethnic backgrounds (3% American Indian or Alaska Native, 6% Asian or Pacific Islander, 19% Black, 57% Hispanic/Latine, 7% white). 69% were female; 43% primarily spoke Spanish. Adoption: 84% of trained clinic staff referred two or more patients to R4H. Implementation: Elements of successful implementation included: (1) support from county government leadership, (2) centralized coordination of the multi-sector partnership, and (3) a flexible approach responsive to organizational and COVID-related shifts. R4H implementation informed statewide Medicaid policy changes. Maintenance: To date, all four clinics continue to participate in R4H. Centralized implementation, training, and administration of Food as Medicine programs can strengthen community health centers' capacities to concurrently address chronic conditions and food insecurity. Multi-sector partnerships can support Food as Medicine program sustainability.