July 2021 highlights from the American Journal of Public Health

Date: May 20 2021

To request a full copy of any of these studies or for information on scheduling interviews with an expert, contact APHA Media Relations.

American Journal of Public Health July issue highlights:

  • May 2020 the deadliest month on record for U.S. overdose deaths
  • Significant racial disparities in youth experiences with police
  • Study of digital health behavior highlights gaps in access, usage
  • Direct-access care models can expand access for uninsured

May 2020 the deadliest month on record for U.S. overdose deaths

The COVID-19 pandemic ushered in an unprecedented increase in U.S. overdose deaths, according to a new study in July’s AJPH.

Using provisional data from the Centers for Disease Control and Prevention, researchers estimated about 9,200 people died from a drug overdose in May 2020. That toll made it the deadliest month on record and marked a more than 57% increase over May 2019. Significant increases were seen across most states, with West Virginia, Kentucky and Tennessee reporting the highest.

Overdose mortality numbers remained elevated in June 2020, at nearly 36% higher than June 2019, and in July 2020, at more than 43% above July 2019 levels. Overall, according to the study, overdose deaths during the first seven months of 2020 went up by 35%, compared to the same time period in 2019.

“The drastic exacerbations of the U.S. overdose crisis described here warrant renewed investments in overdose surveillance and prevention during the pandemic response and post-pandemic recovery efforts,” researchers wrote. “Lowering logistical and financial barriers to accessing substance use treatment is paramount.”

[Author contact: Joseph Friedman, University of California-Los Angeles Center for Social Medicine and Humanities, Los Angeles, California. “COVID-19 and the Drug Overdose Crisis: Uncovering the Deadliest Months in the United States, January-July 2020”]

Significant racial disparities in youth experiences with police

Police encounters with young people of color are typically more aggressive — and potentially more traumatic — than those with white youth, finds a new study published in the July issue of AJPH.

An effort to examine police contact as a potentially adverse childhood experience, the study is based on data from the Fragile Families and Child Wellbeing Study, which follows nearly 5,000 children born in 20 large U.S. cities between 1998 and 2000. Overall, police exposure was common across race, with most Black, Hispanic and white youth reporting vicarious contact. However, when it came to personal experiences with police, disparities were significant.

Black boys and girls were each more likely than their white peers to report being stopped by police, with 39% of Black boys and 14% of Black girls reporting police contact, versus 23% and 10% of white boys and girls, respectively. About 12% of Black boys reported frisks, 14% reported searches, 10% reported harsh language and 12% reported being handcuffed — all of which were “extremely rare” among white boys.

“Findings suggest that urban adolescents face broad, potentially toxic exposure to police, beginning as early as childhood,” the study stated.

[Author contact: Amanda Geller, University of California-Irvine Department of Criminology, Law and Society, Irvine, California. “Youth-Police Contact: Burdens and Inequities in an Adverse Childhood Experience, 2014-2017”]

Study of digital health behavior highlights gaps in access, usage

Narrowing the digital divide will be a key factor in advancing health equity goals, researchers concluded in a new study published in July’s AJPH.

Using nationally representative data from the 2018 Health Information Trends Survey, researchers set out to characterize the prevalence and predictors of digital health engagement among U.S. residents. They found that digitally seeking health information was a relatively common activity, while using health apps or digital devices to track personal health metrics was much less common, at 39.5% and about 35%, respectively.

More than 35% reported digitally communicating with their health care providers, the study found, and about 17% reported digitally sharing health data with providers. Sharing health information on social media was fairly uncommon, with 14% of respondents doing so. Indicators that positively predicted a number of digital health engagement behaviors included being female, younger than 65, having a college degree and owning a smart device.

“This highlights potential digital divides, with greater barriers to engagement for older individuals, males, those with lower levels of education, and (for social media) rural residents,” researchers wrote. “Unsurprisingly, access to internet and digital devices predicted digital health engagement.”

[Author contact: Chelsea L. Ratcliff, University of Georgia Department of Communication Studies, Athens, Georgia. “Digital Health Engagement in the U.S. Population: Insights from the 2018 Health Information National Trends Survey”]

Direct-access care models can expand access for the uninsured

A direct-access health care model that offers transparent pricing and care coordinated through a primary care home — all done without the involvement of insurance companies — can successfully increase access for the uninsured, finds a new study in July’s AJPH.

The study examined the impacts of ActionHealthNYC, a one-year, direct-access demonstration program operating May 2016 to June 2017 with a goal of increasing access to care for New York City residents who did not qualify for Medicaid or health plans sold on the state’s health insurance marketplace. Researchers noted that being uninsured can have severe consequences for those with chronic health conditions and result in higher downstream costs for public health systems.

Nine to 12 months into the project, ActionHealthNYC participants were 1.2 times more likely to report having a primary care provider, 1.2 times more likely to have seen a doctor in the prior nine months, and had 1.5 times more health visits than participants not assigned to the direct-access intervention.

“As the COVID-19 pandemic continues to exacerbate inequities in health systems and disparities in health care access, direct-access programs can play a key role in facilitating access to care,” the study stated.

[Author contact: Rishi K. Sood, New York City Department of Health and Mental Hygiene, Queens, New York. “ActionHealthNYC: Effectiveness of a Health Care Access Program for the Uninsured, 2016-2017”]

Check out the full list of AJPH research papers that published online in our First Look area.

These articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. AJPH is published by the American Public Health Association and is available at ajph.org.

Complimentary online access to the Journal is available to credentialed members of the media. Address inquiries to APHA Media Relations. A single print issue of the Journal is available for $35 from the Journal’s Subscriptions Department. If you are not a member of the press, a member of APHA or a subscriber, online single-issue access is $30, and online single-article access is $22 at AJPH.org. For direct customer service, call 202-777-2516, or email us.

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