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Objectives. To quantify the number of people in the US who delay medical care annually because of lack of available transportation and to examine the differential prevalence of this barrier for adults across sociodemographic characteristics and patient populations.Methods. We used data from the National Health Interview Survey (1997-2017) to examine this barrier over time and across groups. We used joinpoint regression analysis to identify significant changes in trends and multivariate analysis to examine correlates of this barrier for the year 2017.Results. In 2017, 5.8 million persons in the United States (1.8%) delayed medical care because they did not have transportation. The proportion reporting transportation barriers increased between 2003 and 2009 with no significant trends before or after this window within our study period. We found that Hispanic people, those living below the poverty threshold, Medicaid recipients, and people with a functional limitation had greater odds of reporting a transportation barrier after we controlled for other sociodemographic and health characteristics.Conclusions. Transportation barriers to health care have a disproportionate impact on individuals who are poor and who have chronic conditions. Our study documents a significant problem in access to health care during a time of rapidly changing transportation technology. buy TLR2-IN-C29 (Am J Public Health. Published online ahead of print April 16, 2020 e1-e8. doi10.2105/AJPH.2020.305579).Objectives. To describe the evolution of flavored e-cigarette sales since the expansion of the JUUL brand, and to describe the effect of JUUL's November 2018 decision to self-regulate the flavors it sold in stores on flavored e-cigarette sales.Methods. We used Scantrack data on sales of e-cigarettes in the United States from January 2015 to October 2019 provided by The Nielsen Company. National sales values were aggregated monthly in 5 flavor categories (fruit, menthol/mint, sweet, tobacco, and other).Results. The expansion of JUUL sales coincided with an expansion in fruit-flavor sales through October 2018. Once JUUL withdrew fruit and sweet flavors from stores, menthol/mint came to dominate the e-cigarette market, but through 2019, a new surge in fruit-flavor sales by non-JUUL brands was observed.Conclusions. After a decline in sales following JUUL's decision to withdraw some flavored products from stores, JUUL sales recovered within weeks and surpassed their previous maximum in those same channels, as consumption shifted to the menthol/mint and tobacco flavors that remained on shelves.Public Health Implications. These trends suggest shortcomings of self-regulation and highlight the utility of government regulation. (Am J Public Health. Published online ahead of print April 16, 2020 e1-e3. doi10.2105/AJPH.2020.305667).Cannabis-infused "edibles" are a popular means of cannabis use, and the variety of edible food products available to consumers continues to grow. Although there has been much discussion on dose standardization, childproof packaging, and the prevention of overconsumption, the important topic of food safety has received less attention.We discuss potential food safety hazards associated with cannabis-infused edible food products, drawing on examples from Colorado, and describe edible-associated foodborne illness outbreaks and other contamination events.It is important for public health agencies, particularly environmental health and enteric disease programs, to be familiar with the cannabis industry, including regulatory partners, signs and symptoms of cannabis ingestion, the scope of edible products sold and consumed, and the food safety risks unique to cannabis products. (Am J Public Health. Published online ahead of print April 16, 2020 e1-e6. doi10.2105/AJPH.2020.305601).Objectives. To estimate the economic burden of untreated perinatal mood and anxiety disorders (PMADs) among 2017 births in the United States.Methods. We developed a mathematical model based on a cost-of-illness approach to estimate the impacts of exposure to untreated PMADs on mothers and children. Our model estimated the costs incurred by mothers and their babies born in 2017, projected from conception through the first 5 years of the birth cohort's lives. We determined model inputs from secondary data sources and a literature review.Results. We estimated PMADs to cost $14 billion for the 2017 birth cohort from conception to 5 years postpartum. The average cost per affected mother-child dyad was about $31 800. Mothers incurred 65% of the costs; children incurred 35%. The largest costs were attributable to reduced economic productivity among affected mothers, more preterm births, and increases in other maternal health expenditures.Conclusions. The US economic burden of PMADs is high. Efforts to lower the prevalence of untreated PMADs could lead to substantial economic savings for employers, insurers, the government, and society. (Am J Public Health. Published online ahead of print April 16, 2020 e1-e9. doi10.2105/AJPH.2020.305619).Stigma plays an important role in understanding successful interventions to control the opioid epidemic in the United States. Stigma has been described both as an agent to incentivize positive health behavior and as an agent of marginalization contributing to poorer health. Past scholarship has argued that stigma has positively motivated public health changes, for example, among tobacco users; it has also been associated with discrimination against vulnerable individuals, resulting in increasingly poorer health behaviors, for example in relation to HIV-prevention messaging.The discourse on stigma may conflate the denormalization of unhealthy behaviors with wholesale rejection of individual identities. More effective interventions would counter stigma against people who use opioids in general and specifically denormalize opioid misuse. These interventions might alter the effect of public health messaging and ultimately improve outcomes.We argue that public health educators and communication campaigns can contribute to positive social norm change and motivate healthy behaviors by incorporating strategies that attempt to disentangle unhealthy behaviors from identity. (Am J Public Health. Published online ahead of print April 16, 2020 e1-e4. doi10.2105/AJPH.2020.305628).
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