American Journal of Preventive Medicine

BackgroundSince the 2025 Presidential Inauguration, the Trump Administration has terminated billions of dollars in federal funding for science; however, the impacts of these grant terminations on the mental health and substance use fields have not yet been examined. We thus aimed to quantify and map the costs associated with federally funded mental health- and substance use-related grants that have been prematurely terminated. MethodsWe used a comprehensive dataset of grants terminated by the National Institutes of Health (NIH), National Science Foundation (NSF), and Substance Abuse and Mental Health Services Administration (SAMHSA) compiled from multiple sources. After identifying terminated mental health- and substance use-related grants from this database via a two-step screening process, we quantified their number and associated lost funding for each congressional district, which we visualized using a series of maps to examine trends and regional variations. OutcomesWe identified 474 mental health- and/or substance use-related grants that were terminated by the NIH, NSF, or SAMHSA from February 28, 2025, through April 11, 2025, totaling $2,098,731,548 in lost funds. Congressional districts corresponding to urban centers with large academic and research institutions (e.g., New York City, Boston) experienced the most pronounced losses from NIH and NSF grants, whereas districts located throughout the Mid-Atlantic, Midwest, Southeast, and Southwest were the hardest hit by the termination of SAMHSA block grants (i.e., those used to pay for community mental health and substance use services). InterpretationAgainst a backdrop of ongoing and intersecting mental health and substance use crises, the Trump Administration has slashed research dollars on these topics, creating a chilling effect on the field. Such cuts are likely to destabilize existing mental health and substance use services and exacerbate inequities between and within U.S. states, ultimately intensifying the challenges faced by local communities. FundingNone to report.

ImportanceCannabinoid Hyperemesis Syndrome (CHS) is an emerging condition among those with heavy cannabis use characterized by persistent and severe nausea and vomiting. However, very little is known about the national prevalence of CHS, outside of healthcare settings, and among those who use cannabis frequently. ObjectiveTo determine the national prevalence of CHS symptoms, diagnosis, and associated characteristics. DesignA cross-sectional, nationally representative survey of US adults. SettingThe National Firearms, Alcohol, Cannabis, and Suicide survey was conducted in 2025. Participants7,034 US adults over 18 years old provided survey data. ExposuresNot applicable. Main Outcome and MeasuresItems were included that assess symptoms of CHS, along with multiple measures of cannabis use and problem use. ResultsThe prevalence of those reporting daily cannabis use in the past 5 years was 15.2%, corresponding to an estimated over 40 million US adults. Among those who used cannabis daily, 17.8% reported CHS-like symptoms (i.e., severe nausea, vomiting, or abdominal pain), which translates to an estimated 7.2 million US adults, or a 2.7% national prevalence rate. Only 11.5% of those with a symptom prolife consistent with CHS reported receiving a CHS diagnosis from a medical provider. Respondents reporting CHS symptoms were younger, more likely to be female and non-White race, lower income, less educated, and endorsed more cannabis use problems relative to those who used cannabis daily or less frequently. Conclusions and RelevanceA small but significant number of US adults with daily cannabis use reported symptoms consistent with CHS. Beyond patterns of cannabis use, those with CHS symptoms had fewer economic resources and endorsed more cannabis-related problems, even when compared to others with daily cannabis use. Most people reporting CHS symptoms were not diagnosed by a medical provider, suggesting that there may be a substantial cohort who is experiencing CHS symptoms but is not seeking medical treatment or having their condition recognized by medical providers. As cannabis use increases, it is likely that CHS will also become more common, underscoring the importance of expanded research on this condition. KEY POINTSO_ST_ABSQuestionC_ST_ABSHow frequently do people who use cannabis daily experience symptoms of Cannabinoid Hyperemesis Syndrome (CHS)? FindingsIn this nationally representative survey, 17.8% of those with daily cannabis use reported CHS-like symptoms (severe nausea, vomiting, or abdominal pain), which translates to over 7 million US adults. Those reporting CHS symptoms were younger, more likely to be female and non-White race, lower income, less educated, and endorsed more cannabis use problems relative to those who used cannabis daily and those who used less frequently. MeaningA significant proportion of those who use cannabis daily report symptoms consistent with CHS.

We use geospatial data to examine the unprecedented national program currently underway in the United States to distribute and administer vaccines against COVID-19. We quantify the impact of the proposed federal partnership with the company Dollar General to serve as vaccination sites and compare vaccine access with Dollar General to the current Federal Retail Pharmacy Partnership Program. Although dollar stores have been viewed with skepticism and controversy in the policy sector, we show that, relative to the locations of the current federal program, Dollar General stores are disproportionately likely to be located in Census tracts with high social vulnerability; using these stores as vaccination sites would greatly decrease the distance to vaccines for both low-income and minority households. We consider a hypothetical alternative partnership with Dollar Tree and show that adding these stores to the vaccination program would be similarly valuable, but impact different geographic areas than the Dollar General partnership. Adding Dollar General to the current pharmacy partners greatly surpasses the goal set by the Biden administration of having 90% of the population within 5 miles of a vaccine site. We discuss the potential benefits of leveraging these partnerships for other vaccinations, including against influenza.

BackgroundIn the United States, pharyngeal cancer has become the most common type of head and neck cancer, with 80% of cases found in males. Although disparities in treatment delays have been observed in pharyngeal patients, less is known about how policies facilitate timely care. This study aimed to estimate the association between Medicaid expansion and delaying initiation of pharyngeal cancer treatment. MethodologyWe extracted Surveillance, Epidemiological, End Results (SEER) case data to analyze pharyngeal cancers diagnosed between 2000-2018. The outcome of interest was a binary variable indicating if the patient initiated treatment two or more months after diagnosis. We conducted subgroup analyses by sex, marital status, and type of treatment received (surgery, radiation, chemotherapy, post-operative radiation, systemic therapy). We implement the Matrix Completion algorithm to account for staggered rollout of Medicaid expansion within our difference-in-differences design. ResultsOur sample included 79,433 patients diagnosed with pharynx cancer. Delayed treatment was lowest among married females receiving systemic therapy (5%), and highest among married males and females not recommended to receive surgery (43%). Generally, there was no association between Medicaid expansion and changes in delayed treatment. Subgroup analyses show that Medicaid expansion was associated with reduced treatment delays in unmarried females receiving systemic therapy (-4.5%-points), and married males receiving chemotherapy (Est. = -2.6%-points), radiotherapy (Est. = -3.1%-points), and married males not recommended to receive surgery (Est. = -4.6%-points). ConclusionsGiven the importance of timely pharyngeal cancer treatment, health systems must identify and address the drivers of treatment delays to advance cancer equity.

ImportanceStudies report disproportionate increases in cannabis use among middle-aged (50-64) and older (65+) U.S. adults, groups particularly vulnerable to its adverse effects. However, national data on attitudes towards cannabis use and legalization, as well as prevalences of key cannabis-related behaviors are lacking for these groups. ObjectiveTo present national prevalences of past-year any cannabis use, medical use, consumption methods, and other important use-related behaviors, and attitudes toward use, as well as associations of such behaviors and attitudes to cannabis use among U.S. adults ages 50 and older. DesignCross-sectional data from the Health and Retirement Study (HRS) were used to calculate weighted prevalences for all cannabis measures by primary age groups (50-64, [≥]65) as well as two specified older age groups (65-74, [≥]75) and sex. Associations between sociodemographics and cannabis use were evaluated using multivariable logistic regression. Main Outcomes and MeasuresSelf-reported past-year cannabis use (outcome), consumption methods, medical use and health conditions for which cannabis was used, prescriptions by healthcare providers, current and past perception of acceptability, perceptions of risk, and attitudes toward legalization (exposures). Covariates included sex, race/ethnicity, household income, and employment status. Setting and ParticipantsHRS participants who completed the 2018 cannabis use experimental module (n=1,324). ResultsPast year cannabis use was reported by 18.5% (SE=2.17) and 5.9% (SE=1.19) of middle-age and older adults, respectively in the U.S. In both groups, a majority of individuals consumed cannabis exclusively by smoking. Approximately 25% of middle-aged adults and 20% of older adults used cannabis for medical purposes, with [~]20% in both groups receiving a prescription or recommendation for medical use from a healthcare provider. Over 75% of individuals in both age groups viewed medical use of cannabis as acceptable, and older adults were more likely to view cannabis as a gateway drug and to support restrictions of cannabis laws. Conclusions and RelevanceCannabis use among both middle-aged and older U.S. adults is higher than previously reported in state- and national-level studies, with many engaging in cannabis behaviors associated with increased harm. Greater public health and clinical efforts are needed for tailored prevention and intervention strategies.

IntroductionThe US continued to record all-cause excess mortality after the rollout of vaccines. We sought to quantify excess mortality by state and compare these rates to primary series vaccination completion levels. MethodsObservational cohort, US and state-level data. Expected monthly deaths were modeled using pre-pandemic US and state-level data (2015-2020). Mortality data was accessed from CDC public reporting. ResultsWe find that in a two-year period since the rollout of vaccines, the US recorded >874,000 excess deaths. Vaccination rates and excess mortality were most strongly correlated in first two periods before the Omicron variant. ConclusionThe association between vaccination and lower excess mortality rates was strongest in 2021 and early 2022, prior to high population rates of infection-acquired immunity. The findings underscore the benefits of the rapid vaccination rollout campaign and the continued need to boost at-risk populations.

Background and AimThe impact of health reforms such as affordable care act (ACA) and Medicaid expansion program on health insurance coverage among acute pancreatitis (AP) patients in the United States (US) is unknown. We report the trends and forecasts for the uninsured rates among acute pancreatitis (AP) patients in the US. MethodsWe included non-elderly adult patients (aged 18 -64 years), hospitalized with AP in the nationwide inpatient sample database years 2004-2019. We calculated the percentage of uninsured and Medicaid patients for each year and applied joinpoint (JP) regression model to study the trends. ResultsThe uninsured rates among patients hospitalized with AP were almost twice compared to the national average rates for all hospitalized patients. Uninsured rates were higher among Hispanic and African American races, rural location, lower income quartiles and in the southern US regions. A statistically significant decline was observed during 2013-2016 with an APC of - 12.23 (-20--4); p<0/01). The decline was apparent among all racial groups, locations and income groups but not in the southern region where gap in the uninsured rates worsened compared to other geographical regions. The trends reversed more recently, and the uninsured rates surged in 2018 for the first time after 2010. In 2019, 12.5% AP patients were uninsured compared to 11.6% in 2017. The forecasts after taking unemployment rates into account showed that uninsured rates would peak in 2020 followed by a gentle decline in the following years but overall uninsured rates would remain higher compared to 2017. ConclusionsThe ACA and Medicaid expansion programs resulted in overall decrease in the uninsured rates, particularly among racial minorities, rural location and in the lowest income group. However, there was a surge in uninsured rate in the most recent years (2017-2019) which will continue during the next four years

Background and AimsAlcohol use disorder (AUD) remains a major public health concern, with persistent disparities in access to evidence-based treatment. This study aimed to examine associations between perceived discrimination in healthcare settings (PDHS), patient-clinician communication (PCC), and receipt of treatment for AUD, and compared these with sociodemographic and insurance-related factors. DesignCross-sectional analysis using structural equation modeling (SEM), logistic and multinomial logistic regression, and machine learning approaches including SHapley Additive exPlanations (SHAP). SettingUnited States, using data from the National Institutes of Health All of Us Research Program. ParticipantsA total of 5,287 adults with AUD (mean age 61 years; 57% men), including 71.6% non-Hispanic White, 12.2% Black, and 8.6% Hispanic participants. Insurance coverage included 52% government (Medicaid/Medicare), 37% private, and 21% military with 19% reporting more than one type. MeasurementsPrimary outcomes were receipt of Food and Drug Administration-approved pharmacotherapy and/or psychotherapy for AUD, examined as binary and multinomial outcomes. The primary exposure was PDHS, measured using a 7-item scale (range 7-35), with higher scores indicating more frequent discrimination. PCC, assessed using a 2-item scale (range 2-8) with higher scores indicating poorer communication, was examined as a potential mediator. Models were adjusted for age group, sex at birth, race/ethnicity, insurance type (government, private, military), household income, and Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) scores (range 0-12). FindingsPDHS was associated with poorer PCC ({beta} = 0.209, p < 0.001), although communication was not independently associated with treatment receipt. The indirect pathway from discrimination to treatment via communication was not supported. Military insurance was the strongest predictor of treatment receipt, with 6-7 times higher odds compared with other insurance types. Higher AUDIT-C scores and greater PDHS were also associated with increased likelihood of treatment. In analyses restricted to civilian participants, PDHS showed a stronger association with treatment receipt, while PCC demonstrated more modest effects. Machine learning models identified PDHS, AUDIT-C, and PCC as strong contributors, with the impact of poor communication most pronounced among individuals with lower income. ConclusionsAccess to treatment for alcohol use disorder is most strongly associated with insurance coverage, particularly military insurance. PDHS and PCC also contribute to treatment engagement, with differential effects across socioeconomic groups. These findings highlight the importance of addressing structural and interpersonal barriers to improve equitable access to evidence-based AUD treatment.

ImportanceSARS-CoV-2 containment is estimated to require attainment of high (>80%) post-infection and post-vaccination population immunity. ObjectiveTo assess COVID-19 vaccine intentions among US adults and their children, and reasons for vaccine hesitancy among potential refusers. DesignInternet-based surveys were administered cross-sectionally to US adults during December 2020 and February to March 2021 (March-2021). SettingSurveys were administered through Qualtrics using demographic quota sampling. ParticipantsA large, demographically diverse sample of 10,444 US adults (response rate, 63.9%). Main Outcomes and MeasuresCOVID-19 vaccine uptake, intentions, and reasons for potential refusal. Adults living with or caring for children aged 2 to 18 years were asked about their intent to have their children vaccinated. Multivariable weighted logistic regression models were used to estimate adjusted odds ratios for vaccine refusal. ResultsOf 5256 March-2021 respondents, 3467 (66.0%) reported they would definitely or most likely obtain a COVID-19 vaccine as soon as possible (ASAP Obtainers), and an additional 478 (9.1%) reported they were waiting for more safety and efficacy data before obtaining the vaccine. Intentions for children and willingness to receive a booster shot largely matched personal COVID-19 vaccination intentions. Vaccine refusal (ie, neither ASAP Obtainers nor waiting for more safety and efficacy data) was most strongly associated with not having obtained an influenza vaccine in 2020 (adjusted odds ratio, 4.11 [95% CI, 3.05-5.54]), less frequent mask usage (eg, rarely or never versus always or often, 3.92 [2.52-6.10]) or social gathering avoidance (eg, rarely or never versus always or often, 2.65 [1.95-3.60]), younger age (eg, aged 18-24 versus over 65 years, 3.88 [2.02-7.46]), and more conservative political ideology (eg, very conservative versus very liberal, 3.58 [2.16-5.94]); all P<.001. Conclusions and RelevanceThree-quarters of March-2021 respondents in our large, demographically diverse sample of US adults reported they would likely obtain a COVID-19 vaccine, and 60% of adults living with or caring for children plan to have them vaccinated as soon as possible. With an estimated 27% of the US population having been infected with SARS-CoV-2, once vaccines are available to children and they have been vaccinated, combined post-infection and post-vaccination immunity will approach 80% of the US population in 2021, even without further infections. Key PointsO_ST_ABSQuestionC_ST_ABSWhat are COVID-19 vaccines intentions, for adults and for children under their care? FindingsTwo-thirds of 5256 US adults surveyed in early 2021 indicated they would obtain a COVID-19 vaccine as soon as possible. Intentions for children and booster vaccines largely matched personal vaccine intentions. Refusal was more common among adults who were younger, female, Black, very politically conservative, less educated, less adherent with COVID-19 prevention behaviors (eg, wearing masks), had more medical mistrust, or had not received influenza vaccines in 2020. MeaningTailored vaccine promotion efforts and vaccine programs may improve vaccine uptake and contribute to US immunity against COVID-19.

ObjectiveAs cannabis use has increased in the United States, so has cannabinoid hyperemesis syndrome (CHS), a disorder characterized by severe nausea, vomiting, and abdominal pain among heavy cannabis users. We previously showed that CHS symptoms are associated with several behavioral and psychological characteristics linked to psychosocial impairment. We examined links between CHS symptoms and suicidal thoughts, behaviors, and proximal suicide risk factors. MethodsWe used data from the National Firearms, Alcohol, Cannabis, and Suicide survey, a nationally representative survey of 7,034 US adults. Items assessed symptoms of CHS and suicidal thoughts and behaviors. Comparisons focused on: those with daily cannabis use and CHS symptoms (n = 191), those with daily cannabis use without CHS symptoms (n = 882), those with past year cannabis use but not daily use (n = 1288), and those without past year cannabis use (n = 4673). ResultsThose with CHS symptoms reported the highest prevalence of suicidal thoughts and behaviors with most lifetime rates being significantly higher than those with daily cannabis use without CHS symptoms. Those with CHS symptoms also reported higher mean-levels of thoughts and feelings associated with suicide (i.e., perceived burdensomeness, thwarted belongingness, defeat, entrapment) than all the other groups. ConclusionsThose with CHS symptoms reported especially high rates of suicidal thoughts, behaviors, and attempts even when compared to others with daily cannabis use. People with CHS symptoms appear to be at high risk of suicide, possibly related to distress from their gastrointestinal symptoms and psychiatric, substance use, and medical comorbidities.

BackgroundBetween 1979 and 2016, US overdose death rates rose in a smooth fashion, described by Jalal and Burke using an exponential growth curve that fit observed data nearly perfectly. Fluctuations above this curve have subsequently been seen during shocks related to drug supply and the COVID-19 pandemic. However, large-magnitude dips below the curve have never been demonstrated. Given that overdose mortality began sharply falling during 2023-2024, we assess updated overdose trends against the Jalal-Burke curve. MethodsWe examined US overdose deaths from the National Vital Statistics System between January 1979-December 2024. We recreated the Jalal-Burke curve, fitting an exponential growth curve to overdose rates from 1979 to 2016, linearly projecting through 2024, with 95% confidence intervals. We also examined trends by specific substance involvement. ResultsAfter precipitously surpassing exponential growth predictions in 2020-2023, overdose deaths decreased sharply from approximately 32 per 100,000 in 2021-2023 to 23.7 in 2024, falling below the lower bound of Jalal-Burke curve (24.98 per 100,000) for the first time since 2001. These decreases reflected declining illicit fentanyl-involved deaths (with and without stimulants); however, deaths involving stimulants without fentanyl, and those involving xylazine, represent an increasing share of deaths in 2024. ConclusionsRather than simply representing a return to the Jalal-Burke exponential growth curve, recent decreases in overdose deaths represent the first significant, large-magnitude deviation below exponential growth projections. These trends represent a very positive development. However, challenges in the US drug crisis are shifting, requiring a tailored public health response.

BackgroundCannabinoid hyperemesis syndrome (CHS) is characterized by episodes of severe nausea, vomiting, and abdominal pain among those with heavy cannabis use. We estimated differences between those reporting CHS symptoms and other daily and less frequent cannabis users on drug use, psychiatric problems, other health problems, antisocial behavior, and personality. MethodsThe National Firearms, Alcohol, Cannabis, and Suicide survey was administered to 7034 US adults in 2025. Survey items assessed substance use, common psychiatric symptoms, personality traits, and symptoms of CHS. ResultsThose with CHS symptoms reported the highest rates and greatest variety of drug use compared to others who used cannabis. Those with CHS symptoms reported higher rates of other drug use than those who used cannabis daily without CHS symptoms across a variety of drug classes, including opioids, hallucinogens, and sedatives, higher rates of drug overdoses, and greater use of all drug classes than those with less-than-daily cannabis use. Those with CHS symptoms also reported more depression, anxiety, sleep problems, chronic pain, antisocial behavior, intimate partner violence, and disinhibited personality traits than those who used daily (mean d = 0.58) and less frequently (mean d = 0.69) and those with no cannabis use in the past 12 months (mean d = 0.99). ConclusionsThose with CHS symptoms exhibit a variety of psychological and behavioral problems including higher rates of other drug use, psychiatric symptoms, antisocial behavior, and dysfunctional personality traits. Results highlight the importance of understanding and addressing the broader psychosocial challenges faced by people experiencing CHS symptoms. Highlights O_LICHS symptoms are linked to greater polysubstance use and overdose risk C_LIO_LICHS symptoms are associated with depression, anxiety, sleep, and pain problems C_LIO_LICHS tied to antisocial behavior and intimate partner violence C_LIO_LICHS shows disinhibited personality traits and low well-being C_LIO_LINational survey identifies high-risk psychosocial CHS profile C_LI

Background and aimsExtended release buprenorphine injection (INJ-BUP) has been available in the United States since 2018. INJ-BUP has the potential to positively impact OUD treatment outcomes by providing additional treatment options and patient choice. We aimed to describe the availability and prescribing of INJ-BUP for Medicaid beneficiaries since its availability, nationwide and by state. MethodsTo assess availability, we measured the number of substance use disorder (SUD) facilities that offered INJ-BUP and accepted Medicaid insurance in 2018-2021 and calculated the percentage of all facilities offering medications of OUD. To assess prescribing, we measured the number of prescriptions for INJ-BUP paid by Medicaid 2018-2022 and calculated the percentage of all buprenorphine prescriptions paid by Medicaid. Data sources were publicly available. ResultsThe number of facilities that offered INJ-BUP and accepted Medicaid insurance increased from 360 (2.5% of all SUD facilities offering medication) in 2018 to 2,257 (13.3%) in 2021. The number of prescriptions for INJ-BUP paid by Medicaid increased from 4,322 (0.1% of all buprenorphine prescriptions) in 2018 to 186,861 (2.0%) in 2022. There was notable variability in the number of facilities and prescriptions by state. ConclusionsThere has been exponential increase in the number of INJ-BUP prescriptions but uptake is much less than observed in other countries in shorter time periods. Limited availability at SUD treatment facilities that accept Medicaid may be one barrier to access.

ImportanceAll U.S. states provided Covid-19 vaccine access to frontline healthcare workers first, but after that, states varied in whether they gave earlier access to the elderly, versus the vulnerable with comorbidities, or school employees or essential workers, reflecting the underlying scientific and policy uncertainty. ObjectiveTo evaluate if risk-based or age-based prioritization is more effective at reducing reported Covid-19 cases and deaths. DesignA serial cross-sectional study Setting50 U.S. states and Washington D.C. Participants60+ years of age, high-risk individuals, K-12 school employees, and essential workers Main Outcomes and MeasuresHospitalizations and deaths ResultsSeven to nine weeks after 60-year-olds became eligible for a vaccine, there was a statistically significant 40-50% decline in Covid-19 hospitalizations in that state. In contrast, there was no statistically detectable change in hospitalizations in the 7-9 weeks after K-12 employees become eligible for vaccines. Vaccine eligibility of "high-risk adults" and "essential workers" produces effects somewhere in the middle, with reductions in hospitalization of about 25%. There was a large statistically significant decline in death rates (25-38%) 10 to 11 weeks after people aged over 60 became vaccine-eligible. These effects were generally statistically larger than high risk individuals, K-12 school employees, and essential workers. Conclusions and RelevancePanel data analysis of weekly variation in Covid-19 health outcomes reveals that prioritizing adults 60+ years of age is associated with the largest reduction in hospitalizations and Covid-19 cases, followed by vaccines for adults with high-risk comorbidities. Vaccinations extended to K-12 school employees and essential workers is associated with the smallest reductions in hospitalizations and deaths. Key PointsO_ST_ABSQuestionC_ST_ABSDid Risk-based or Age-based Vaccine Prioritization for Covid-19 Save More Lives? FindingsPanel data analysis of weekly variation in Covid-19 health outcomes reveals that prioritizing adults 60+ years of age is associated with the largest reduction in hospitalizations and Covid-19 cases, followed by vaccines for adults with high-risk comorbidities. Vaccinations extended to K-12 school employees and essential workers is associated with the smallest reductions in hospitalizations and deaths. MeaningPrioritizing adults 60+ years of age can lead to a higher estimated reduction in hospitalizations and deaths, followed by a strategy of prioritizing adults with high-risk comorbidities. Our findings add to the limited evidence for the roadmap for prioritizing use of Covid-19 vaccines, and help address uncertainties about the relative effectiveness of different vaccine strategies.

ImportanceAs the population of older people with HIV (PWH) in the US is growing, costs to Medicare are expected to rise substantially. ObjectivesTo project the number of Medicare beneficiaries with HIV aged 65y+ on ART in the US from 2026-2035 and the budget impact on Medicare. Design, Setting, and ParticipantsWe developed the novel CHARMED simulation model and projected the number of Medicare beneficiaries with HIV aged 65y+ on ART and associated costs from 2026 to 2035; we populated the model with age and sex-stratified clinical data and costs derived from 2023 Traditional Medicare (TM) claims and accounted for enrollment in Medicare Advantage, as well as healthcare inflation. Main Outcomes and MeasuresNumbers of Medicare beneficiaries with HIV aged 65y+ on ART and undiscounted costs to Medicare from 2026-2035. ResultsWe projected that 111,600 PWH would be enrolled in Medicare and in care at the beginning of 2026 (65-69y: 57,370; 70-74y: 32,940; 75-79y: 14,670; 80y+: 6,610). By the end of 2035, this number would nearly double, to 193,560 (65-69y: 70,490; 70-74y: 62,820; 75-79y: 38,290; 80y+: 21,960). Annual costs to Medicare for PWH 65y+ on ART would increase 2.5-fold, from $11.4 billion at the end of 2026 to $28.6 billion at the end of 2035. Cumulative 10-year costs are projected to be $195.6 billion with 66.5% of cumulative costs due to ART. If ART costs are reduced by 60% as per the Inflation Reduction Act or generic ART, Medicare would save $78.0 billion over the next decade. Conclusions and RelevanceThe number of Medicare beneficiaries with HIV 65y+ on ART will more than double over the next decade, resulting in $195.6 billion in 10-year total costs to Medicare. Reducing ART costs through the IRA or generic oral ART could lead to 40% lower overall Medicare spending for older Medicare beneficiaries with HIV. KEY POINTSO_ST_ABSQuestionC_ST_ABSAs the population of people with HIV in the US grows older, what are the expected costs to Medicare and the impact of antiretroviral therapy (ART) costs? FindingsUsing microsimulation modeling, we find that the number of Medicare beneficiaries with HIV 65y+ on ART will more than double over the next decade. At current costs of ART and health care-associated inflation, total 10-year costs to Medicare are anticipated to be $196.5 billion; reducing ART costs through the Inflation Reduction Act or generic ART could lower Medicare spending by 40%. MeaningEfforts to reduce ART costs, while maintaining access to high-quality ART, are critical to reduce total Medicare costs as more people with HIV are anticipated to enroll in Medicare in the next 10 years.

ImportanceUS public health guidance has increasingly shifted responsibility for actions to minimize ongoing impacts of COVID-19 onto individuals. During September to October 2022, the World Health Organization continued to characterize COVID-19 as a pandemic. Yet, public perceptions of the pandemic status of COVID-19 and its associations with COVID-19-related behaviors were unknown. ObjectiveTo assess US public opinion on the characterization of COVID-19 as a pandemic. Design, Setting, and ParticipantsThe COVID-19 Outbreak Public Evaluation (COPE) Initiative internet-based surveys, administered to 4985 US adults during September to October 2022. Demographic quota sampling and survey weighting were employed to improve sample representativeness of the US population by age, sex, and combined race and ethnicity. ExposuresThe COVID-19 pandemic. Main Outcomes and MeasuresResponse to the statement, "The pandemic is over." Response options included Strongly agree, Somewhat agree, Neutral, Somewhat disagree, and Strongly disagree. ResultsOverall, 5015 US adults completed The COPE Initiative surveys (response rate, 56.2%), and 4985 (99.4%) provided complete information for all analyzed variables and were included in this analysis. Only 1657 (33.2%) respondents agreed with the statement "the pandemic is over," while 2141 (43.0%) disagreed and the remaining 1187 (23.8%) were neutral about the statement. Agreement that the pandemic was over was most strongly associated with having received fewer COVID-19 vaccines, lesser concern about SARS-CoV-2 variant viruses, and less frequent engagement in COVID- 19 preventive behaviors, such as mask usage in public spaces, as well as increasingly conservative political ideology, roles as unpaid caregivers of both children and adults, younger age, male sex, and significant disabilities. Conclusions and RelevanceAs of September to October 2022, US public opinion was mixed on the characterization of COVID-19 as a pandemic. Belief the pandemic was over was associated with less frequent engagement in COVID-19 preventive\behaviors, highlighting the important role of public health communication. Demographic groups to prioritize tailored public health messaging about the pandemic status were identified. Continued assessment of public perceptions about the state of the pandemic is warranted entering Year 4 of the COVID-19 pandemic. Key Points QuestionAs of September to October 2022, what was US public opinion as to whether COVID-19 remained a pandemic? FindingsIn this demographically representative survey study of 4985 US adults, only 1 in 3 respondents agreed with the statement "the pandemic is over;" 43% of adults disagreed. Agreement that the pandemic was over was associated with less engagement in COVID-19 preventive behaviors and more political conservatism. MeaningAs of September to October 2022, US public opinion was divided regarding the status of COVID-19 as a pandemic and is associated with COVID-19-related behaviors, underscoring important public health and policy implications of this designation.

In February 2021, Oregon became the first US state to decriminalize possession of small amounts of all commonly used illicit drugs (Measure 110); twenty-four days later, Washington's Supreme Court Blake ruling produced a weaker, shorter-lived decriminalization. Evaluations of these policy periods have focused on overdose deaths, with contested results; their association with the mental health of the general population is unknown. Using surveillance data on 6.3 million adult interviews (2011-2024) and synthetic control methods with permutation inference, we find frequent mental distress an estimated 2.15 percentage points higher in Oregon than in its synthetic counterfactual (largest positive gap among 45 jurisdictions; two-sided rank 2/45, p = 0.044, though not significant under the alternative fit-normalized statistic), with directionally consistent estimates in Washington and a joint test on the pair at p = 0.015. The increase concentrates in self-reported distress, among women and young adults, and is not mirrored in diagnoses, police-recorded partner violence or suicide.

BackgroundCo-occurring substance use and mental health disorders (COD) represent a growing public health concern, yet healthcare utilization studies with a large sample size remain limited. This study examined healthcare utilization patterns and sociodemographic correlates among COD adults using data from the All of Us Research Program (2018-2023). MethodsElectronic health record data were analyzed for adults aged [&ge;]18 years with confirmed diagnoses of substance use and mental health disorders recorded on at least two occasions. Healthcare services were identified using the standardized Current Procedural Terminology and Healthcare Common Procedure Coding System codes and categorized into counseling and therapy, medication/somatic services, online or telehealth care, and other supportive modalities. Multivariable logistic regression was employed to assess sociodemographic and structural correlates of healthcare utilization. ResultsAmong 19,423 adults with COD, 57.1% received healthcare. Counseling and therapy accounted for the largest share of encounters, while online services surged in 2020 during the COVID-19 pandemic. Healthcare utilization was higher among older adults ([&ge;]65 years: aOR=1.52, 95%CI:1.29-1.78), males (aOR=1.19, 95%CI:1.12-1.26), individuals with disabilities (aOR=1.46, 95%CI:1.36-1.56), and those with employer-sponsored (aOR=1.22, 95%CI:1.10-1.36) or other private insurance (aOR=2.15, 95%CI:1.97-2.34). The level of healthcare utilization was lower among participants with lower income ([&le;]$25,000: aOR=0.75, 95%CI:0.69-0.81) or Medicaid coverage (aOR=0.83, 95%CI:0.77-0.89). ConclusionsDespite high clinical need, healthcare utilization among adults with COD remains suboptimal and is shaped by structural inequities across income and insurance lines. Findings highlight the need to expand integrated healthcare services, strengthen Medicaid coverage, and sustain telehealth infrastructure to promote equitable, long-term engagement in care. Highlights{o} Individuals with co-occurring disorders continue to face low healthcare utilization. {o} Counseling and therapy were the major mode of care, while telehealth peaked during COVID-19. {o} Lower income and Medicaid coverage were tied to lower healthcare utilization. {o} Older adults and people with disabilities were more likely to use healthcare services. {o} Findings highlight the needs to expand integrated, equitable behavioral care.

We estimate the associations between community socioeconomic composition and changes in COVID-19 vaccination levels in eight large cities at three time points. Between March and April, low SES communities had significantly lower change in percent vaccinated than high SES communities. Between April and May, this difference was not significant. Thus, the large vaccination gap between communities during restricted vaccine eligibility did not narrow when eligibility opened up. The link between COVID-19 vaccination and community disadvantage may lead to a bifurcated recovery where advantaged communities move on from the pandemic more quickly while disadvantaged communities continue to suffer.

BackgroundRecent evidence suggests that willingness to vaccinate against COVID-19 has been declining throughout the pandemic and is low among ethnic minority groups. MethodsObservational study using a nationally representative longitudinal sample (N =7,840) from the Understanding America Study (UAS). Changes in the percentage of respondents willing to vaccinate, undecided, or intending to refuse a COVID-19 vaccine were examined over 20 survey waves from April 1 2020 to February 15 2021. ResultsAfter a sharp decline in willingness to vaccinate against COVID-19 between April and October 2020 (from 74.0% to 52.7%), willingness to vaccinate increased by 8.1% (p <.001) to 60.8% between October 2020 and February 2021. A significant increase in willingness to vaccinate was observed across all demographic groups examined and Black (15.6% increase) and Hispanic participants (12.1% increase) showed particularly large changes. ConclusionsWillingness to vaccinate against COVID-19 increased in the US from October 2020 to February 2021. Funding statementN/A