Recent ucb_sph items

The Past and Future of Fungal Diagnoses in Health Records: A Comparative Analysis and Harmonization of Mycoses ICD Codes

Thu, 22 Oct 2026 00:00:00 +0000

Background: International Classification of Diseases (ICD) codes are used in healthcare for documenting disease and billing, but also for research in epidemiological and translational studies for cohort identification and specimen selection. Periodic code revisions, while necessary, significantly differ in structure and descriptive content, preventing direct cross–version mapping while also complicating use in longitudinal research and coding accuracy during the transition to newer versions. Methods: Mycoses codes within ICD–9, ICD–10, and ICD–11 were manually identified within fungal and non–fungal disease sections using systematic searches for fungal–associated text and eponymous diseases with confirmed fungal etiology. Code descriptions were analyzed to classify etiologic and clinical characteristics for harmonized match scoring. Code similarity was assessed using a heuristically weighted match–score algorithm incorporating classification variables with description–based text...

Perception of Having Enough Information to Make Contraceptive Decisions: A Novel Metric of Person-Centered Contraceptive Access

Thu, 8 Oct 2026 00:00:00 +0000

INTRODUCTION: Information is a critical component of contraceptive access. This study presents a new person-centered metric of contraceptive access: perception of having sufficient information to choose a contraceptive method. METHODS: Between January and March 2022, we fielded a nationally representative online survey among 15- to 44-year-olds assigned female sex at birth using NORC's AmeriSpeak panel. We describe whether respondents felt they had enough information for contraceptive decision making and types of information needed. We investigate bivariate associations between perception of having enough information and key respondent characteristics. We use logistic regression to investigate whether past experiences of sexual and reproductive health (SRH) care and contraceptive self-efficacy are associated with feeling one has enough information. RESULTS: Of the analytic sample (unweighted n = 3,037), 73.5% felt they had enough information to decide about contraception, 11.8%...

No strings attached: a mixed methods evaluation of the acceptability of the San Francisco Abundant Birth Project, a perinatal guaranteed income program

Thu, 8 Oct 2026 00:00:00 +0000

BackgroundEconomic insecurity during pregnancy is a critical social determinant of maternal and infant health. Traditional public assistance programs often fail to meet the needs of marginalized communities, particularly Black and Pacific Islander (Pasifika) pregnant women and people. Guaranteed income (GI)–unconditional cash transfers for specific populations–has emerged as a potential solution, but little is known about the experiences of participants accessing perinatal GI programs. The current study describes the implementation and acceptability of the San Francisco Abundant Birth Project (ABP), the first perinatal GI pilot program in the U.S. ABP provided $1,000 per month for up to 14 months to 151 Black and Pasifika pregnant individuals in San Francisco, CA, between 2021 and 2024. MethodsWe conducted a mixed-methods participatory evaluation with a subset of program participants (116 survey and 21 interview participants), and asked about program satisfaction, trust, and experience....

Parental feeding practices and child weight status in Mexican American families: A longitudinal analysis

Tue, 6 Oct 2026 00:00:00 +0000

Background: Parental feeding practices are thought to influence children's weight status, through children's eating behavior and nutritional intake. However, because most studies have been cross-sectional, the direction of influence is unclear. Moreover, although obesity rates are high among Latino children, few studies of parental feeding practices have focused on this population. Methods: This 2-year longitudinal study examined mutual influences over time between parental feeding practices and children's weight status, in Mexican American families with children 18 years old at baseline. Mothers (n = 322) and fathers (n = 182) reported on their feeding practices at baseline, 1-year follow-up, and 2-year follow-up. Weight status, defined by waist-height ratio (WHtR) and body mass index (BMI), was ascertained at all assessments. Cross-lagged panel models were used to examine the mutual influences of parental feeding practices and child weight status over time, controlling for covariates....

The integration of water, sanitation and hygiene services into the US President's Emergency Plan for AIDS Relief: A qualitative study

Mon, 5 Oct 2026 00:00:00 +0000

Water, sanitation and hygiene (WASH) interventions have been associated with improving the health of people living with HIV/AIDS (PLHIV). WASH is increasingly integrated into the HIV sector and is now considered a key component of the transition from an emergency response to a better incorporated and coordinated AIDS response. However, limited research exists on integration efforts. This qualitative research study aims to address the limited body of research on WASH integration into HIV programmes through examining the US President's Emergency Plan for AIDS Relief (PEPFAR). PEPFAR is the US government's initiative to combat AIDS in the most afflicted countries. This study analyses the perceptions of people who have worked or are working on WASH integration into PEPFAR, highlighting their views on accomplishments, challenges and areas for improvement. It concludes with recommendations for moving forward.

A study of water and sanitation access trends in Peru: where do inequities persist?

Mon, 5 Oct 2026 00:00:00 +0000

Peru has made significant progress in increasing access to water supply and sanitation (WS&S). It is unclear, however, if improvements have been equitable and whether certain sub-populations are making equivalent progress. This study explored trends in access to WS&S throughout Peru using data from Demographic and Health Surveys. The study focused on the worst forms of household-level WS&S access, including use of untreated surface water and the practice of open defecation (OD). The prevalence of access and the average annual percentage point change in access were analyzed by quintiles of wealth, urban and rural residence, political regions of Peru, and language for the years 2000, 2004, and 2008. The findings indicate that significant progress in access to WS&S has been made in Peru, but that several sub-populations remain underserved. Regions experiencing high levels of OD made dramatic improvements between 2000 and 2008. The poorest urban populations showed...

Pandemic-related financial hardship and disparities in sugar-sweetened beverage consumption and purchasing among San Francisco Bay Area residents during COVID-19

Tue, 29 Sep 2026 00:00:00 +0000

Some reports suggest that the COVID-19 pandemic resulted in shifts to unhealthier diets. These unhealthier diets may include sugar-sweetened beverages (SSBs), which strongly contribute to diabetes and other chronic diseases. Using cross-sectional surveys in the San Francisco Bay Area, California, USA we sought to assess self-reported SSB consumption during the pandemic's shelter-in-place and self-reported changes in SSB purchasing from before to during the pandemic's shelter-in-place, stratifying by indices of pandemic-related financial hardship. Nearly 60% of our diverse sample (N = 943) reported that it was harder to pay for basics (like food and utilities) during shelter-in-place. Among those who found it harder to pay for basics and received financial assistance during shelter-in-place, we found a ten-fold higher frequency of daily SSB consumption compared to those not facing new financial hardship (2.76 [95% CI: 1.78, 3.74] versus 0.30 [95% CI: 0.23, 0.37] times/day)....

The effectiveness of isoniazid preventive treatment among contacts of multidrug-resistant tuberculosis: a systematic review and individual-participant meta-analysis

Tue, 29 Sep 2026 00:00:00 +0000

RATIONALE: Recent empirical research suggests that isoniazid may lead to a risk reduction of incident tuberculosis (TB) among close TB contacts of someone with multidrug-resistant TB (MDR-TB). OBJECTIVES: To evaluate the association between isoniazid TB preventive treatment (TPT), compared to no treatment, upon incident TB in household contacts of MDR-TB cases using a large global consortium of TB contact tracing studies. METHODS: We conducted a systematic review and individual-participant meta-analysis among observational studies of household contact tracing studies. Participants were included if they were exposed to someone with MDR-TB and were given either 6 months of isoniazid TPT or no TPT. Our primary outcome was incident TB in contacts exposed to TB. We derived adjusted hazard ratios (aHRs) using mixed-effects, multivariable survival regression models with study-level random effects. The effectiveness of isoniazid TPT against incident TB was estimated through propensity...

Bayesian methods provide a posterior probability by day for possible dates of HIV acquisition which is useful in clinical trials

Tue, 22 Sep 2026 00:00:00 +0000

Bayesian methods provide a posterior probability by day for possible dates of HIV acquisition which is useful in clinical trials

Estimation of the counterfactual HIV incidence in the PURPOSE trials

Tue, 22 Sep 2026 00:00:00 +0000

Estimation of the counterfactual HIV incidence in the PURPOSE trials

Comparison of HIV incidence as determined by two different recency assays in Ugandan women

Tue, 22 Sep 2026 00:00:00 +0000

Comparison of HIV incidence as determined by two different recency assays in Ugandan women

Tracer Dyes and Microbial Indicators Suggest Mobilization of Fecal Waste Flows from Latrines Following Rainfall in Kibera, Kenya

Sun, 13 Sep 2026 00:00:00 +0000

Malfunctioning sanitation systems can increase fecal contamination and exposure risks during rainfall, yet rapid methods for assessing system performance remain limited. This study evaluated sanitation system performance in low-income urban areas of Nairobi, Kenya, using Escherichia coli as a fecal indicator and fluorescent tracer dye to assess excreta flow. We collected 144 soil and 48 open drain water samples before and after rainfall and tested them for E. coli A fluorescent dye was introduced into sanitation systems to track leakage into surrounding environments. E. coli was detected in 75% of samples, with mean concentrations of 47 Most Probable Number per gram (MPN/g) in facility entrance soil, 45 MPN/g at household entryways, 44 MPN/g in compound soil, and 90 MPN/100 mL in open drains. Concentrations were lower immediately after rainfall, although the difference was not statistically significant (p = 0.097). Dye was detected outside sanitation systems in 56% of cases, rising...

Classification of early tuberculosis states to guide research for improved care and prevention: an international Delphi consensus exercise.

Fri, 11 Sep 2026 00:00:00 +0000

The current active-latent paradigm of tuberculosis largely neglects the documented spectrum of disease. Inconsistency with regard to definitions, terminology, and diagnostic criteria for different tuberculosis states has limited the progress in research and product development that are needed to achieve tuberculosis elimination. We aimed to develop a new framework of classification for tuberculosis that accommodates key disease states but is sufficiently simple to support pragmatic research and implementation. Through an international Delphi exercise that involved 71 participants representing a wide range of disciplines, sectors, income settings, and geographies, consensus was reached on a set of conceptual states, related terminology, and research gaps. The International Consensus for Early TB (ICE-TB) framework distinguishes disease from infection by the presence of macroscopic pathology and defines two subclinical and two clinical tuberculosis states on the basis of reported...

Lean management of crisis response and post-pandemic outcomes in US primary care practices.

Fri, 11 Sep 2026 00:00:00 +0000

Background

Primary care forms the basis for valued outcomes in health systems, including population health, high quality care, and reduced health expenditures. However, the primary care system in the United States (US) faces many difficulties, including financial pressures and clinician burnout that accelerated following the Covid-19 pandemic. This study examines the ability of primary care practices to adapt to post-pandemic challenges using a lean management system for quality and process improvement.

Methods

We used data from the National Survey of Healthcare Organizations and Systems II, a nationally representative sample of 1,245 physician practices located across the US. We first described the status of lean implementation among these primary care practices. We then conducted bivariate analyses followed by multivariate logistic regressions to examine relationships between lean implementation and outcomes of interest, including pandemic response activities,...

Health and Health Care Access Among Afghan Refugee Women in the United States

Fri, 11 Sep 2026 00:00:00 +0000

Importance: Afghans are one of the world's largest refugee populations. Afghan women face compounded health risks due to sociocultural restrictions, low literacy, forced displacement, and limited health care access, yet little is known about their experiences with health care after resettlement in the US. Objective: To explore health and health care access issues of Afghan refugee women in the US. Design, Setting, and Participants: This qualitative study was part of an ongoing community-based participatory research project started in July 2020. Bilingual investigators conducted semistructured interviews with Afghan refugee women in Dari or English. Dari interviews were interpreted to English by a fluent bilingual investigator, validated by a separate bilingual investigator, and then reviewed with an Afghan immigrant community member for accuracy. Transcribed interviews were analyzed using grounded theory from July 2023 to July 2024. Participants who self-identified as Afghan,...

A tuberculosis school outbreak in China, 2018: reaching an often overlooked adolescent population.

Fri, 11 Sep 2026 00:00:00 +0000

Adolescents have been largely neglected from tuberculosis control efforts. In low- to medium burden settings much of the tuberculosis burden in this age group occurs from school outbreaks. We report on a large tuberculosis outbreak in adolescents from a boarding high school in Jiangsu Province, China. From March to June 2018, a tuberculosis outbreak occurred in a boarding high school. We conducted an outbreak investigation involving clinical diagnostic tests and molecular analysis to determine the outbreak origin. Cases were detected through symptom screening, tuberculin skin testing (TST), chest radiography, sputum smear, solid sputum culture and GeneXpert MTB/RIF. Mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) genotyping and spoligotyping methods were performed on Mycobacterium tuberculosis (M. tuberculosis) isolates to identify the outbreak origin. A total of 845 students and 131 teachers/staff attended a TST screening for tuberculosis...

Tuberculosis incidence in foreign-born people residing in European countries in 2020.

Fri, 11 Sep 2026 00:00:00 +0000

BackgroundEuropean-specific policies for tuberculosis (TB) elimination require identification of key populations that benefit from TB screening.AimWe aimed to identify groups of foreign-born individuals residing in European countries that benefit most from targeted TB prevention screening.MethodsThe Tuberculosis Network European Trials group collected, by cross-sectional survey, numbers of foreign-born TB patients residing in European Union (EU) countries, Iceland, Norway, Switzerland and the United Kingdom (UK) in 2020 from the 10 highest ranked countries of origin in terms of TB cases in each country of residence. Tuberculosis incidence rates (IRs) in countries of residence were compared with countries of origin.ResultsData on 9,116 foreign-born TB patients in 30 countries of residence were collected. Main countries of origin were Eritrea, India, Pakistan, Morocco, Romania and Somalia. Tuberculosis IRs were highest in patients of Eritrean and Somali origin in Greece and Malta...

Oil and gas well development and coccidioidomycosis risk in Kern County, CA, USA: a case-crossover study

Thu, 10 Sep 2026 00:00:00 +0000

BACKGROUND: Coccidioidomycosis is an emerging fungal disease caused by inhaling Coccidioides spp spores. As spores reside in soil, activities that disturb soil and generate dust can aerosolise and transport the pathogen. The oil and gas industry has been extensively developed in some regions that are endemic for Coccidioides spp and has been associated with dust emissions. Although several adverse health outcomes have previously been associated with oil and gas development, its impact on coccidioidomycosis risk has not been investigated. We aimed to estimate the association between exposure to oil and gas well development (ie, wells in preproduction) and risk of coccidioidomycosis among residents living near new wells. METHODS: In this case-crossover study, we obtained information on reported coccidioidomycosis cases and oil and gas well development between 2007 and 2022 in Kern County, CA, USA. We then compared exposure to preproduction wells within 5 km of each individual's...

Spatial close-kin mark-recapture methods to estimate dispersal parameters and barrier strength for mosquitoes

Wed, 9 Sep 2026 00:00:00 +0000

Close-kin mark-recapture (CKMR) methods have recently been used to infer demographic parameters for several aquatic and terrestrial species. For mosquitoes, the spatial distribution of close-kin pairs has been used to estimate mean dispersal distance, of relevance to vector-borne disease transmission and genetic biocontrol strategies. Close-kin methods have advantages over traditional mark-release-recapture (MRR) methods as the mark is genetic, removing the need for physical marking and recapturing that may interfere with movement behavior. Here, we extend CKMR methods to accommodate spatial structure alongside life history for mosquitoes and comparable insects. We derive kinship probabilities for parent-offspring and full-sibling pairs in a spatial context, where an individual in each pair may be a larva or adult. Using the dengue vector Aedes aegypti as a case study, we use an individual-based model of mosquito life history to test the effectiveness of this approach at estimating...

Repeated sampling of different individuals within the same clusters to improve precision of longitudinal estimators: the DISC design

Mon, 31 Aug 2026 00:00:00 +0000

BACKGROUND: Longitudinal studies often involve repeated cluster sampling of a population at multiple time points, such as in difference-in-differences (DID) studies. Although cohort designs typically lead to more efficient estimators relative to repeated cross-sectional (RCS) designs, they are often impractical. METHODS: We describe the DISC (Different Individuals, Same Clusters) design, a sampling scheme that improves the precision of estimators in these settings. The DISC design represents a hybrid between a cohort and an RCS design, in which the researcher takes a single sample of clusters at baseline, but takes different cross-sectional samples of individuals within clusters at each time point. RESULTS: We show analytically that the DISC design yields DID estimators with much higher precision relative to an RCS design, particularly if cluster effects are present. For example, for a design with two surveys, 40 clusters, and 25 individuals per cluster, the variance of a commonly...

Impacts of land use and fallowing on coccidioidomycosis incidence in California: A population-based longitudinal study

Fri, 28 Aug 2026 00:00:00 +0000

Coccidioidomycosis (Valley fever) is a growing public health concern in the western U.S., with California reporting more than an eightfold rise in cases over the past two decades. As climate change, groundwater regulation, and prolonged drought drive major agricultural land-use shifts in the state, including widespread retirement of cultivated lands (i.e., fallowing), understanding their effects on this soil-borne fungal infection is critical. We linked 65,657 confirmed, geolocated cases (2008-2021) to high-resolution maps distinguishing natural vegetation, crop types, and fallowed fields to quantify how land use and land cover were associated with disease rates. Flexible statistical models showed that natural land covers, shrubland, barren ground, and grassland, were associated with higher incidence. Some agricultural uses (grain/hay, field crops, corn, and cotton) were associated with higher incidence, whereas others (orchards, rice, and truck crops/berries) were associated...

Reconstructing pathogen-specific antibody binding epitopes and age-dependent immune signatures from proteomic-scale peptide libraries.

Thu, 27 Aug 2026 00:00:00 +0000

High-density peptide arrays are useful for mapping linear antibody epitopes and resolution of antibody specificity in a single-assay platform. Here, we used peptide library screening to evaluate magnitude and breadth of humoral responses to enteric pathogens in the context of public health interventions. We characterized the epitope landscape to known immunogenic proteins to several viruses, bacteria, and parasites and used that to infer immunological profiles at age 3, 14, and 28 months. The peptide libraries detected immune signatures better for viruses compared with bacteria and parasites and captured distinct dynamics of protein-level variation in immune signatures over time. We found limited sensitivity for bacterial and protozoan pathogens whose humoral responses may depend more on conformational or natively modified epitopes than linear-peptide binding. Unbiased peptide libraries have potential utility for broad analysis of antibody responses in integrated serosurveillance,...

Challenges and opportunities for scaling up infection prevention and control programmes in rural district hospitals of Tamil Nadu, India

Wed, 26 Aug 2026 00:00:00 +0000

Introduction: The aim of this study was to explore the barriers to implementing an infection prevention and control (IPC) programme in three public district hospitals in Tamil Nadu by interviewing key stakeholders involved in the roll-out of the programme. Materials and methods: Investigators conducted interviews (n = 17) with chief medical officers (CMOs), physicians, and IPC nurses at three secondary public district hospitals and their affiliated primary health centres (PHCs). Results: Six major themes emerged from the interviews: (1) prevalent IPC practices before the programme began; (2) barriers to implementation; (3) perceptions of the effectiveness of the IPC programme; (4) suggestions for future expansion of the programme; (5) the role of healthcare sanitation workers, and (6) water, sanitation and hygiene (WaSH) infrastructure. Stakeholders noted improvements in IPC knowledge, infection control related behaviour, and overall healthcare quality in...

Dismantling the United States Agency for International Development Costs Lives and Threatens Global Stability.

Wed, 26 Aug 2026 00:00:00 +0000

Dismantling the United States Agency for International Development Costs Lives and Threatens Global Stability.

Antimicrobial Resistance Gene Profiles in Integron-Positive and Integron-Negative Third-Generation Cephalosporin-Resistant E. coli from Human and Animal Sources

Wed, 26 Aug 2026 00:00:00 +0000

Background/Objectives: Integrons are genetic platforms that allow bacteria to acquire antimicrobial resistance (AMR) genes, making them a focal point for many AMR studies and surveillance programs. This study investigated how the prevalence of integrons (intI and attI genes) in third-generation cephalosporin-resistant E. coli (3GCR-Ec) varied across three different sources (i.e., healthy children, domestic animals and urinary tract infections). The study aimed to determine how different classes of AMR genes vary among 3GCR-Ec with integrons present versus those where integrons are absent. Methods: We analyzed 3GCR-Ec isolates collected from semirural parishes of Eastern Quito, Ecuador, that included: (1) 3GCR-Ec from healthy children (n = 946), (2) 3GCR-Ec from domestic animal species (n = 673), and 3GCR-Ec from patients with urinary tract infections (UTIs) (n = 138). Genomic analyses were performed for all 1757 sequences...

Cancer Screening and Citizenship Status in the US.

Wed, 26 Aug 2026 00:00:00 +0000

Importance: Immigrants without US citizenship, or noncitizens, disproportionately endure poverty, labor exclusions, and inadequate health care access-structural drivers of adverse cancer outcomes. While screening is critical for preventing cancer deaths, and cancer is the leading cause of death among noncitizens, little is known about citizenship status and its potential influence on cancer screening. Objectives: To examine cancer screening inequities associated with citizenship status, evaluate whether these inequities vary across states, and determine whether structural factors mediate these inequities. Design, Setting, and Participants: This cross-sectional study used nationally representative data from the National Health Interview Survey (2010-2023). Eligibility for cancer screening and the timing and types of tests considered appropriate were determined using US Preventive Services Task Force guidelines. Data were analyzed from May to August 2025. Exposure: Citizenship status:...

Oral and parenteral treatment with a third-generation cephalosporin promotes the proliferation of diverse ESBL-producing Escherichia coli in the chicken intestinal tract

Wed, 26 Aug 2026 00:00:00 +0000

The global rise of antimicrobial resistance is a major public health threat, with Escherichia coli facilitating the spread of extended-spectrum beta-lactamase (ESBL) genes like bla_CTX-M, which confer resistance to third-generation cephalosporins (3GCs). This study examines the impact of 3GC treatment on resistant E. coli clones and horizontal gene transfer (HGT) of ESBL genes in broiler chickens in Quito, Ecuador. Fifteen-day-old Ross broilers were divided into three groups: oral ceftriaxone (100 mg/kg), parenteral ceftriaxone (100 mg/kg intramuscular), and control (no treatment). The study included three phases: baseline, antimicrobial administration (5 days), and recovery (15 days). Fecal cultures on McConkey agar, with and without ceftriaxone (2 µg/mL), measured the ratio of 3GC-resistant lactose fermenters. Regardless of the administration route, ceftriaxone significantly increased resistant coliforms (>80%). Five E. coli colonies...

Extensive Overlap in Avian and Extraintestinal Pathogenic Escherichia coli Strains Between Backyard Poultry, Humans, and Dogs in Ecuador

Wed, 26 Aug 2026 00:00:00 +0000

Escherichia coli is a ubiquitous organism that colonizes a variety of animal hosts and has the ability to persist within the environment. As such, it is not surprising that animals frequently share E. coli strains and contribute to environmental E. coli ecology. It has been well documented that poultry meat can serve as a reservoir of avian pathogenic E. coli (APEC) with the potential to cause human disease. However, the impact of backyard poultry rearing on household and community APEC sharing is less clear. In this study, we examined 1348 E. coli isolates from children, dogs, and chickens in 222 households in peri-urban communities of Quito, Ecuador, sampled across five timepoints. Extensive overlap between isolates from all three host sources were identified using Clermont phylotyping and multilocus sequence typing. Human and dog isolates also had a high rate of carriage (37% and 49%, respectively) of genes indicative of APEC. Phylogenetic...

Tracking blaCTX-M transmission through transposable elements in uropathogenic and commensal E. coli

Wed, 26 Aug 2026 00:00:00 +0000

AIM: To investigate the nucleotide sequences associated with transposable elements carrying bla_CTX-M allelic variants as potential markers for the transmission of antimicrobial resistance genes between domestic animals, humans and the environment. MATERIALS & METHODS: We conducted whole-genome sequencing and analyzed the nucleotide sequences of most abundant bla_CTX-M allelic variants (bla_CTX-M-27, bla_CTX-M-55, and bla_CTX-M-65) in commensal Escherichia coli (n = 20) from household members in Quito and uropathogenic E. coli (UPEC) (n = 149) isolated from nine clinics in Quito, Ecuador. RESULTS: The Ecuadorian commensal E. coli and UPEC displayed identical nucleotide sequences surrounding the bla_CTX-M gene and the synteny was similar to those found in other parts of the world; however phylogenetic analysis indicated that the genetic environments in Ecuadorian isolates were unique. CONCLUSION:...

Field Evaluation of Do-It-Yourself Air Filtration Solutions for Evaporative Coolers to Reduce Ambient Particle Infiltration in Homes in Wildfire-Affected Communities

Wed, 19 Aug 2026 00:00:00 +0000

Evaporative coolers (ECs) introduce outdoor air pollutants indoors when operating. This study evaluates the potential of do-it-yourself (DIY) air filtration solutions for ECs to cost-effectively reduce the infiltration of ambient fine particulate matter (PM_2.5) in homes with ECs using measurements in 48 homes in wildfire-affected agricultural communities in California. All homes received one portable air cleaner (PAC); 25 homes also received DIY filters (mostly MERV 13) attached to their ECs. PurpleAir monitors measured indoor and outdoor PM_2.5 concentrations. PAC operation was monitored in all of the homes. EC usage was monitored in some homes and predicted using relative humidity dynamics in all homes. Conditional analyses between EC likely on and off conditions were used to evaluate the impacts of DIY EC filters on ambient PM_2.5 infiltration, including during several wildfire-affected days. Median levels of ambient PM_2.5 infiltration...

Field Testing of an Affordable Zero-Liquid-Discharge Arsenic-Removal Technology for a Small-Community Drinking Water System in Rural California

Wed, 19 Aug 2026 00:00:00 +0000

Arsenic contamination in groundwater threatens public health, particularly in small, low-income communities lacking affordable treatment solutions. This study investigated the field implementation of novel air cathode assisted iron electrocoagulation (ACAIE) technology for arsenic removal in Allensworth, California, where groundwater arsenic concentrations exceeded 250 µg/L. Over four months, a pilot-scale ACAIE system, operating at 600 L/h, consistently reduced arsenic levels to below the EPA’s maximum contaminant level of 10 µg/L. Laboratory experiments informed the optimization of charge dosage and flow rates, which were validated during field testing of the ACAIE 600 L/h system. The in-situ generation of hydrogen peroxide at the cathode speeded up the reaction kinetics, ensuring high arsenic removal efficiency while allowing high throughput, even with a compact reactor size. An economic analysis demonstrated a treatment cost of USD 0.02/L excluding labor, highlighting the...

Fathers’ Presence Makes a Difference During Children’s Evening Meals

Tue, 4 Aug 2026 00:00:00 +0000

This observational study used descriptive analysis to improve understanding of the relationship between fathers' presence or absence, the occurrence of mothers' feeding practices, and child eating behaviors at evening meals. Participants were 141 Mexican-origin families with children aged 8 to 10 years. We coded behavioral observations of video-recorded meals. Three parental feeding practices were established a priori: (1) pressure to eat, (2) restriction of amount of food, and (3) positive involvement in child's meals. Additionally, we identified child eating behaviors and food eaten. Fewer mothers engaged in certain types of positive involvement in child's meals when fathers were present at the meals, compared to when fathers were absent. Regarding child eating behaviors, when fathers were present, more children engaged in positive talk about food, compared to when fathers were absent. Additionally, when fathers were present, more children ate grains and fewer ate fruit,...

A Randomized, Controlled Study of a Rural Sanitation Behavior Change Program in Madhya Pradesh, India

Mon, 3 Aug 2026 00:00:00 +0000

Poor sanitation and open defecation are thought to be a major cause of diarrhea and intestinal parasite infections among young children. In 1999, India launched the Total Sanitation Campaign with the goal of achieving universal toilet coverage in rural India by 2012. This paper reports on a cluster-randomized, controlled trial that was conducted in 80 rural villages in Madhya Pradesh to measure the effect of the program on toilet access, sanitation behavior, and child health outcomes. The study analyzed a random sample of 3,039 households and 5,206 children under five years of age. Field staff collected baseline measures of sanitation conditions, behavior, and child health, and re-visited households 21 months later. The analysis finds that implementation of the program activities was slower than the original timeline (only 35 percent of villages were triggered more than six months before the follow-up survey). Nevertheless, the Total Sanitation Campaign successfully increased...

Wealthy, healthy and wise: does money compensate for being born into difficult conditions?

Mon, 3 Aug 2026 00:00:00 +0000

Recent studies have linked transfers from Mexican conditional cash transfer programme Oportunidades (formerly PROGRESA) to improvements in child development (Fernald et al., 2008, 2009), but this work has been criticized as failing to account for endogeneity of the transfers. We create an exogenous instrument for the amount of transfers and use it to test programme and transfer effects. Applying the new instrument confirms that improvements in child development are more linked to the transfers themselves than to other portions of the programme, which involve medical check-ups as well as educational sessions for mothers.

Economic costs of TB and HIV in high-TB-burden countries

Thu, 30 Jul 2026 00:00:00 +0000

INTRODUCTION: Tuberculosis (TB) remains a significant health burden in 25 low- and middle-income countries. Despite TB being more cost-effective to prevent and treat its funding is disproportionately lower than that of HIV. This study aims to assess the economic costs of TB versus HIV and evaluate the returns on investment in TB prevention compared to HIV. METHODS: The study uses a microfoundations behavioural model to estimate the economic costs of TB and HIV on households and the economy. We combine data from the WHO Global Tuberculosis Report, the Institute for Health Metrics and Evaluation's Global Burden of Disease dataset and Demographic Household Surveys among others. The analysis accounts for lost earnings and healthcare expenses in the short and long term. RESULTS: The findings indicate that active TB cases result in significant economic losses, with US$13.7 billion in current annual losses, US$17.2 billion in future losses and US$5.7 billion in medical expenses, for...

A systematic review and meta-analysis of studies testing effects of cash transfers on child cognitive, language, and socio-emotional development in low- or middle income countries

Thu, 30 Jul 2026 00:00:00 +0000

Cash transfers alleviate financial hardship as either conditional programs, requiring behavioral compliance, or unconditional programs. We undertook a systematic review, quality appraisal, and meta-analysis of 16 RCTs following PRISMA guidelines, examining effects of cash transfers on child development among children (n = 29,887, <8 years old) in low- or middle-income countries; papers were excluded if they used quasi-experimental or simulation methods, or did not have a control group without cash. To examine risk of bias in the studies, we used the revised Cochrane risk-of-bias tools for individually randomized trials (RoB 2) and cluster randomized trials (RoB 2 CRT). After 3.6 years, cash transfers had a small but significant positive effect on cognitive (Cohen’s d = 0.08, 95% CI 0.04, 0.13), language (d = 0.09, 95% CI 0.04, 0.13), and gross motor outcomes (d = 0.07, 95% CI 0.03, 0.11); only conditional cash transfers showed significant effects on socio-emotional...

Effects of a liquefied petroleum gas stove and fuel intervention and air pollution exposure on early childhood development: Findings from the household air pollution intervention network trial

Thu, 30 Jul 2026 00:00:00 +0000

BACKGROUND: Early Child Development (ECD) encompasses physical, cognitive, social, and emotional changes during childhood. Air pollution exposure has been associated with ECD delays. The Household Air Pollution Intervention Network (HAPIN) randomized controlled trial evaluated the health effects of a liquefied petroleum gas cookstove and fuel intervention during pregnancy and infancy. Here we present the intervention effect and exposure-response relationship between fine particulate matter (PM_2.5) and ECD. METHODS: The HAPIN trial enrolled 3195 pregnant women in rural Guatemala, Peru, India, and Rwanda. ECD was assessed at 12 months of infant age using the Caregiver Reported Early Development Instruments (CREDI). Personal 24-hr PM_2.5 exposure was measured from baseline through 12 months. Linear regression analyses were conducted to evaluate intervention effects on overall and domain-specific CREDI scores and exposure-response relationships between...

Impacts of home-care subsidies: Evidence from quasi-random assignment

Wed, 29 Jul 2026 00:00:00 +0000

We study the impact of subsidizing home-based long-term care on recipients’ health and the labor supply of their working-age children. We use administrative data from Israel on the universe of welfare benefit applications linked with tax records of applicants and their adult children. To address the endogeneity of benefit recipients’ health status, we instrument for benefit receipt using the leniency of randomly assigned evaluators who assess the applicant’s functional status and determine benefit eligibility. We find that for compliers—applicants who receive subsidies only from more lenient evaluators—subsidizing home-based care has large adverse effects on recipient health ( + 5.2 p.p. one-year mortality, 95 % CI: 1.5 to 8.9 p.p.) but no detectable effects on their children’s labor market outcomes (child labor market participation: − 0.5 p.p., 95 % CI: − 5.2 to + 4.2 p.p.; child income: − 5.5 log points, 95 % CI: − 46 to + 35 log points). The results are consistent with the...

Epidemiology of Intimate Partner Violence

Thu, 16 Jul 2026 00:00:00 +0000

Abstract Measurement and surveillance of intimate partner violence (IPV) are challenging, and they are critical for understanding IPV as a public health problem, with epidemiological patterns of risk and population-level opportunities for prevention. In the past 2 decades, population-based survey surveillance of IPV has greatly improved in the US and globally. Survey-based surveillance of IPV is complemented by record-based surveillance through criminal justice, health care, and vital statistics systems. In the US, about 45% of adults and 14% of adolescents report experiencing IPV in the Centers for Disease Prevention and Control population-based surveillance surveys, and prevalence varies by race and ethnicity and gender and type of IPV. Epidemiological studies of IPV have also identified risk and protective factors for IPV victimization and perpetration at the individual, interpersonal, community, and societal levels, providing opportunity for prevention. Many policy, practice,...

Medicaid expansion increased income among newly eligible adults.

Thu, 18 Jun 2026 00:00:00 +0000

The Affordable Care Acts Medicaid expansion improved health care access for low-income Americans; however, its impact on economic outcomes-particularly income-is less clear. We used US Census administrative income data that tracked 6120 cohorts covering 84% of working-age adults from 2005 to 2019. Using difference-in-differences, we compared changes in income among low-income adults living in expansion states, before and after expansion, with changes in income in low-income adults living in non-expansion states. Low-income adults living in Medicaid-expansion states experienced an average 9.5% relative increase in income in the 5 years after expansion. This impact was concentrated among adults who were likely newly eligible for Medicaid after the expansion. These adults experienced a 9.6% relative increase in income, as well as a 2.1 percentage point (7.3%) relative higher likelihood of having income in the 40th income percentile or higher. We found suggestive evidence that a reduction...

Early-life Exposure to Punitive School Discipline and Midlife Cognitive Outcomes

Thu, 18 Jun 2026 00:00:00 +0000

INTRODUCTION: Suspension and expulsion are common in US schools and disproportionately target structurally marginalized children. No research has examined whether these punitive practices may have long-term cognitive-aging implications. METHODS: In the prospective National Longitudinal Survey of Youth 1979 data (N=8021), we used confounder-adjusted linear models to investigate associations between early-life suspension or expulsion and global cognition, memory, and attention z -scores at age 50. Using interaction terms, we tested for additive scale effect modification by race, gender, and at their intersections. RESULTS: In all, 21.5% of participants had been suspended and 4.4% expelled, with Black men and women overrepresented among these early-life experiences. Punitive school discipline was associated with lower midlife global cognition, memory, and attention z -scores (eg, global cognition, suspension: : -0.21; 95% CI: -0.26, -0.15; expulsion: :-0.27; 95% CI: -0.38, -0.16)....

Evaluating the impact of a low-cost food storage intervention on complementary food contamination and diarrheal disease in low-income urban households: A randomized controlled trial in Dhaka, Bangladesh.

Wed, 17 Jun 2026 00:00:00 +0000

Diarrheal diseases remain a leading cause of under-five mortality globally, yet large-scale water, sanitation, and hygiene (WASH) interventions have shown limited effects on childhood diarrhea and growth, partly because foodborne transmission has been overlooked. In low-income urban settings, complementary foods for young children are often stored for several hours under unsafe conditions, increasing the risk of fecal contamination. This randomized controlled trial evaluated whether a low-cost wire-mesh food cabinet (meatsafe), paired with one-time behavior-change communication (BCC), could reduce microbial contamination and diarrhea among children aged 6-24 months in the Korail informal settlement of Dhaka, Bangladesh. A total of 290 households were randomly assigned 1:1 to receive a meatsafe plus food-hygiene handouts or no intervention. Over five biweekly post-intervention visits, we collected stored complementary food samples (≥4 h) for Escherichia coli testing and recorded...

Hepatitis C and risk of tuberculosis amongst United States veterans: a national cohort study.

Fri, 5 Jun 2026 00:00:00 +0000

Background

Tuberculosis (TB) and hepatitis C virus (HCV) infections share many risk factors and settings. We sought to determine and compare the incidence of TB amongst HCV-positive and negative individuals in a large national cohort of United States veterans, controlling for multiple confounders.

Methods

We conducted a retrospective-cohort study using data from The Electronically Retrieved Cohort of HCV-Infected Veterans (ERCHIVES) between 2001 and 2024 among United States veterans in care in the Veterans Affairs (VA) healthcare system. HCV-positive veterans were matched to HCV-negative veterans by age, sex, race/ethnicity, and VA enrollment year; veterans with TB diagnosed before the index HCV test, solid organ transplant history, and missing liver fibrosis score (FIB-4) or income data were excluded.

Findings

The primary outcomes were incident TB, defined as a new diagnosis recorded in the electronic health record after the index HCV antibody test date....

The Long-Term Impact of Early-Life Tuberculosis Disease on Child Health: A Prospective Birth Cohort Study.

Fri, 5 Jun 2026 00:00:00 +0000

Rationale: There is growing concern that post-tuberculosis disease (TB) sequelae and morbidity are substantial, but no studies have controlled for preexisting factors before disease. Whether children have post-TB morbidity is not well characterized. Objectives: To assess the effect of a TB diagnosis on wheezing episodes, lung function, and anthropometric measurements among children enrolled in a prospective birth cohort study in South Africa. Methods: We prospectively followed children from birth through 5 years for TB using diagnostic tests including chest radiography and repeated induced sputum sample testing with Xpert MTB/RIF and liquid culture. We longitudinally measured health outcomes including growth, wheezing, and lung function up to 5 years. Mixed-effects linear regression models were used to assess growth and lung function after TB. Poisson regression was used to assess risk of subsequent wheezing. Measurements and Main Results: Among 1,068...

Dengue transmission risk in California under climate and land-use change: a semi-mechanistic modelling study

Thu, 4 Jun 2026 00:00:00 +0000

Background Dengue cases are increasing in non-endemic regions due to environmental change and increasing travel and trade. For these non-endemic regions, estimating dengue risk is challenging as transmission is driven by both local environmental conditions and the introduction of viremic travelers. In this study, we aimed to estimate current and future dengue risk in California, USA—a region that has recently experienced its first cases of locally-acquired dengue. Methods We modeled dengue risk as the product of three key components needed for local transmission—vector presence, temperature-suitability for pathogen transmission, and viral introductions via travel-associated cases—estimated using vector and case surveillance, sociodemographic, and environmental data. We estimated risk for locations and months where local transmission was reported in 2023–2024 to define a ‘threshold’ level of risk. We then projected monthly, census tract-level risk under both current conditions...

The Household Secondary Attack Rate of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): A Rapid Review.

Thu, 4 Jun 2026 00:00:00 +0000

Background

Although much of the public health effort to combat coronavirus disease 2019 (COVID-19) has focused on disease control strategies in public settings, transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within households remains an important problem. The nature and determinants of household transmission are poorly understood.

Methods

To address this gap, we gathered and analyzed data from 22 published and prepublished studies from 10 countries (20 291 household contacts) that were available through 2 September 2020. Our goal was to combine estimates of the SARS-CoV-2 household secondary attack rate (SAR) and to explore variation in estimates of the household SAR.

Results

The overall pooled random-effects estimate of the household SAR was 17.1% (95% confidence interval [CI], 13.7-21.2%). In study-level, random-effects meta-regressions stratified by testing frequency (1 test, 2 tests, >2 tests), SAR estimates were 9.2%...

A Cluster of Novel Coronavirus Disease 2019 Infections Indicating Person-to-Person Transmission Among Casual Contacts From Social Gatherings: An Outbreak Case-Contact Investigation.

Thu, 4 Jun 2026 00:00:00 +0000

Background

Severe acute respiratory syndrome coronavirus 2, the pathogen causing novel coronavirus disease of 2019 (COVID-19), efficiently spreads from person to person in close contact settings. Transmission among casual contacts in settings such as during social gatherings is not well understood.

Methods

We report several transmission events to both close and casual contacts from a cluster of 7 COVID-19 cases occurring from mid-January to early February 2020. A total of 539 social and family contacts of the index patients, including members of a 2-day wedding and a family party, were contacted and screened through epidemiologic surveys. The clinical progression of all cases is described.

Results

We estimate the secondary attack rate among close contacts to be 29% (2 of 7) and for the casual contacts to be 0.6% (3 of 473). The incubation period of our case cluster was 4-12 days (median, 7 days).

Conclusions

Transmission efficiency among close contacts...

Trends in medical debt in the United States by imputed borrower race and ethnicity, 2016-2022.

Thu, 4 Jun 2026 00:00:00 +0000

Introduction

Medical debt is a major financial consequence of healthcare in the United States, but there is limited evidence about whether medical debt in collections varies across racial and ethnic groups.

Methods

We analyzed credit report data from 2016 to 2022 for 23,093,888 adults to study medical debt in collections accrued within the past year (flow) and total outstanding medical debt in collections (stock).

Results

Black borrowers had the highest levels of annual flow of medical debt, with 11.2% of borrowers facing any annual flow of debt in 2022 (mean conditional on any flow: $1524). Similar trends existed for stock, with 24% of borrowers having any stock in 2022 (mean conditional on any stock: $2074). Hispanic and White borrowers had similar medical debt, and Asian and Pacific Islander borrowers had the least debt. Gaps between racial and ethnic groups were smaller in states that expanded Medicaid compared to those that did not, especially on the...

Revitalizing the US Youth Presidential Fitness Test: Are States Prepared to Support Implementation?

Mon, 1 Jun 2026 00:00:00 +0000

Our objective was to describe policy infrastructure of elementary school fitness testing at the state level and to assess states readiness for implementation of the recently reinstated Presidential Fitness Test. We conducted a cross-sectional policy analysis by using data from the State of the States Policy Report and used the Classification of Laws Associated with School Students to create a standardized readiness index. Only 5 states required recommended weekly minutes of physical education, 24 had no fitness testing requirements, 6 mandated testing results reporting, and most delegated compliance monitoring locally. State policies are not positioned to support large-scale standardized fitness testing, indicating a need for coordinated reform.

Increasing Divergence in Drug Prices Between the United States and Germany After Implementation of Comparative Effectiveness Analysis and Collective Price Negotiations.

Mon, 25 May 2026 00:00:00 +0000

BACKGROUND: Payers and purchasers in the United States seek to moderate drug prices and align them with the incremental clinical benefit offered by individual medications; some policymakers have proposed linking U.S. prices to an index of prices paid in other nations. The German health care system resembles that of the United States in featuring multiple private payers but differs in featuring a highly coordinated process of comparative clinical assessment and price negotiations for drugs. OBJECTIVES: To (a) measure trends in prices paid for physician-administered drugs in Germany before and after the mandate for comparative effectiveness assessment and price negotiations in 2011 and (b) compare them with price trends for the same drugs in the United States. METHODS: This study observed trends in the prices paid for 80 physician-administered drugs, which account for approximately half of Medicare Part B drug spending. Quarterly data covering 2004-2018 were obtained for Germany...

Association of Reference Pricing for Diagnostic Laboratory Testing With Changes in Patient Choices, Prices, and Total Spending for Diagnostic Tests

Mon, 25 May 2026 00:00:00 +0000

IMPORTANCE: Prices for laboratory and other clinical services vary widely. Employers and insurers increasingly are adopting "reference pricing" policies to create incentives for patients to select lower-priced facilities. OBJECTIVE: To measure the association between implementation of reference pricing and patient choice of laboratory, test prices, patient out-of-pocket spending, and insurer spending. DESIGN, SETTING, AND PARTICIPANTS: We conducted an observational study of changes in laboratory pricing and selection by employees of a large national grocery firm (n = 30 415) before and after the firm implemented a reference pricing policy for laboratory services and compared the findings with changes over the same period for policy holders of a large national insurer that did not implement reference pricing (n = 181 831). The grocery firm established a maximum payment limit at the 60th percentile of the distribution of prices for each laboratory test in each region. Employees...

Medicare Advantage Reimbursement to Physicians

Mon, 25 May 2026 00:00:00 +0000

Medicare Advantage Reimbursement to Physicians

Consumer Choice Between Hospital-Based and Freestanding Facilities for Arthroscopy

Mon, 25 May 2026 00:00:00 +0000

BACKGROUND: Hospital-based outpatient departments traditionally charge higher prices for ambulatory procedures, compared with freestanding surgery centers. Under emerging reference-based benefit designs, insurers establish a contribution limit that they will pay, requiring the patient to pay the difference between that contribution limit and the actual price charged by the facility. The purpose of this study was to evaluate the impact of reference-based benefits on consumer choices, facility prices, employer spending, and surgical outcomes for orthopaedic procedures performed at ambulatory surgery centers. METHODS: We obtained data on 3962 patients covered by the California Public Employees' Retirement System (CalPERS) who underwent arthroscopy of the knee or shoulder in the three years prior to the implementation of reference-based benefits in January 2012 and on 2505 patients covered by CalPERS who underwent arthroscopy in the two years after implementation. Control group data...

Value-Based Pricing and Patient Access for Specialty Drugs

Mon, 25 May 2026 00:00:00 +0000

Value-Based Pricing and Patient Access for Specialty Drugs

Reference Pricing, Consumer Cost-Sharing, and Insurer Spending for Advanced Imaging Tests

Mon, 25 May 2026 00:00:00 +0000

BACKGROUND: Fees charged for similar imaging tests often vary dramatically within the same market, leading to wide variation in insurer spending and consumer cost-sharing. Reference pricing is an insurance design that offers good coverage to patients up to a defined contribution limit but requires the patients who select high-priced facilities to pay the remainder out of pocket. OBJECTIVES: To measure the association between implementation of reference pricing and patient choice of facility, test prices, out-of-pocket spending, and insurer spending for advanced imaging (CT and MRI) procedures. RESEARCH DESIGN: Difference-in-differences multivariable analysis of insurance claims data. Study included 4751 employees of a national grocery chain (treatment group) and 23,428 enrollees in the nation's largest private insurance plan (comparison group) that used CT or MRI tests between 2010 and 2013. MEASURES: Patient choice of facility, price paid per test, patient out-of-pocket cost-sharing,...

Value‐Based Physician Payment in Oncology: Public and Private Insurer Initiatives

Mon, 25 May 2026 00:00:00 +0000

Policy Points: Public and private insurers are implementing payment mechanisms to improve coordination and reduce the cost of drug, hospital, and ancillary services for cancer patients. Some target unnecessary hospitalization, while others create incentives for prescribing lower‐cost chemotherapies and biologics. Physician payment methods in oncology require a balance between incentives for cost control and incentives for patient access to expensive specialty drugs. None of the initiatives adopt bundled methods out of concern for shifting excessive financial risk onto physicians in the context of rapid pharmaceutical innovation. Context High‐value oncology requires physicians to monitor and coordinate all aspects of care, educate and engage their patients, and adopt cost‐effective drug treatments. However, oncology practices in the United States traditionally have been reimbursed based on the number of office visits performed and through cost‐plus margins from prescription...

Value-based payment for oncology services in the United States and France

Mon, 25 May 2026 00:00:00 +0000

The pursuit of economic and clinical value in oncology goes “beyond the pill” to encompass improvements in the process of caring for patients suffering from cancer. The concept of value-based payment thus extends beyond the amounts reimbursed for drugs themselves to encompass the methods of payment used for the physicians and facilities where those drugs are prescribed and delivered. Oncology payment mechanisms vary widely across nations depending on the structure of their health care systems, but the challenges of appropriate drug selection and patient engagement are common to all. This paper describes contemporary efforts to create stronger payment incentives for appropriate drug selection, administration, monitoring, and management in the United States and France.

Association of Reference Pricing with Drug Selection and Spending

Mon, 25 May 2026 00:00:00 +0000

Background In the United States, prices for therapeutically similar drugs vary widely, which has prompted efforts by public and private insurers to steer patients toward the lower-priced options. Under reference pricing, the insurer or employer establishes a maximum contribution it will make toward the price of a drug or procedure, and the patient pays the remainder. Methods We used difference-in-differences multivariable regression methods to analyze changes in prescriptions and pricing for 1302 drugs in 78 therapeutic classes in the United States, before and after implementation of reference pricing by an alliance of private employers. We assessed trends for the study group relative to those for an employee group that was not subject to reference pricing. The study included 1,122,741 prescriptions that were reimbursed during the period from 2010 through 2014. Results Implementation of reference pricing was associated with a higher percentage of prescriptions that were filled...

Consumer Responses to Price Transparency Alone versus Price Transparency Combined with Reference Pricing

Mon, 25 May 2026 00:00:00 +0000

Efforts to spur patient price shopping by providing access to price transparency tools have been met with limited success. One potential reason is the absence of financial incentives. This paper uses data from a large employer that implemented a price transparency platform and subsequently implemented a reference pricing program for laboratory and diagnostic imaging tests. We find no price shopping effects when the price transparency tool is offered alone. However, combining price transparency with reference pricing leads to significant shifts in consumer choice of facility, resulting in a 27 percent reduction in the average price paid per laboratory test and a 13 percent reduction in price paid per imaging test. A variety of public and purchaser initiatives have sought to further the development and adoption of price transparency tools. Our results imply that these tools will capture the attention of consumers, and influence their behavior, only if patients have strong financial...

The Redesign of Consumer Cost Sharing for Specialty Drugs at the California Health Insurance Exchange

Mon, 25 May 2026 00:00:00 +0000

This paper describes the redesign of health benefits at Covered California-the nation's largest health insurance exchange, which covers 1.3 million individuals, and its benefit designs extending to hundreds of thousands more enrollees through insurance products sold outside the exchange-with respect to specialty drugs for the 2016 enrollment year. The catalyst for benefit redesign came from advocacy organizations representing patients suffering from HIV, multiple sclerosis, epilepsy, hepatitis C, and other chronic conditions. The first component of the benefit redesign creates a separate deductible for pharmaceutical expenditures, with a commensurate reduction in the deductible for other (medical) expenditures. The second component requires health plans to assign at least 1 specialty drug for each therapeutic class to a nonspecialty tier, offering patients a treatment option for which they are not exposed to coinsurance. The third component imposes a monthly payment limit of $250...

Quantifying The Economic Burden Of Drug Utilization Management On Payers, Manufacturers, Physicians, And Patients