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Purpose: We assessed how COVID-19-related alcohol sales policies influenced alcohol use behaviors during the pandemic for U.S. adults of diverse sexual (lesbian, gay, bisexual, queer, questioning [LGBQ]) and gender identities (transgender, nonbinary, genderqueer, and gender questioning [T/NB/GQ]). Methods: Time-specific, state-level, restaurant, bar, and off-premise alcohol policy data were collected from the National Institute on Alcohol Abuse and Alcoholism-sponsored Alcohol Policy Information System and merged with the 2020 Behavioral Risk Factor Surveillance System survey data. Treatments included bar, restaurant, and delivery alcohol sales policies. Outcomes included past 30-day drinking frequency, quantity, and heavy episodic drinking (HED). We fitted negative binomial regression models for all outcomes, clustered standard errors by state and used sample weights. We also controlled for seasonality, state Alcohol Policy Scale scores, pre-/postpandemic time period, and included demographic control variables in our cross-sectional analyses. Results: The sample included 10,505 adults identifying as LGBQ and 809 as T/NB/GQ from 32 states. Restaurant and bar closures were associated with less alcohol use for LGBQ respondents. Outdoor-only policies at bars were also associated with significantly less quantity of use and HED for T/NB/GQ adults in the sample. Off-premise home delivery was associated with greater quantity of use for LGBQ respondents and less frequency for T/NB/GQ respondents. Conclusion: The COVID-19-related alcohol sales policy changes offer an opportunity to better understand alcohol policy and availability's influence on drinking behaviors among sexual and gender-diverse populations in the United States.

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INTRODUCTION: Shelter-in-place orders altered facilitators and barriers to tobacco use (e.g., outlet closures, restricted social gatherings). This study examined whether the duration of time in shelter in place and compliance with different shelter-in-place orders influenced adolescent cigarette and E-cigarette use and how the use may differ by demographic characteristics. METHODS: Shelter-in-place policy data obtained from government websites were merged with cross-sectional 2020 survey data on adolescents in California. Treatment variables included the proportion of time in shelter in place and self-reported compliance with shelter-in-place orders (for essential businesses and retail spaces and social and outdoor contexts). Multilevel logit models for dichotomous past 6-month cigarette and E-cigarette use and multilevel negative binomial regression models for past 6-month frequency of use were used. Moderation analyses were conducted on demographic measures. The sample included 1,196 adolescents (mean age=15.8 years, age range=13-19 years, 49.2% female, 50.0% White). Analyses were conducted in 2022. RESULTS: No associations were found between the proportion of time in shelter in place and outcomes. Shelter-in-place compliance with essential business and retail space orders was associated with lower odds of using cigarettes and E-cigarettes in the past 6 months. Compliance with social and outdoor context-related orders were associated with lower odds of using E-cigarettes and fewer days using cigarettes and E-cigarettes. Being aged ≥18 years moderated the associations between essential business/retail space and social/outdoor context-related shelter-in-place compliance orders and past 6-month frequency of cigarette smoking. CONCLUSIONS: Findings support tailored interventions for less compliant and older adolescents for future pandemic mitigation measures.

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CONTEXT: Public health accreditation is an ongoing national movement to improve the quality of public health departments and the public health system in the United States; however, calls have been made for more evidence regarding best practices in the accreditation process. OBJECTIVE: The purpose of this work is to provide evidence about best practices in the accreditation process, specifically within the workforce development domain. It is the first in-depth investigation into workforce development using data collected by Public Health Accreditation Board (PHAB). DESIGN: Using deidentified accreditation application data from PHAB, this study employs a mixed-methods approach to examining practices, lessons learned, challenges, and strategies pertaining to workforce development planning for Domain 8. SETTING: United States. PARTICIPANTS: US state (n = 19) and local health departments (n = 115). MAIN OUTCOME MEASURES: Public Health Accreditation Board assessment scores for the workforce measures and the relationship between the health department's approach to meeting a PHAB measure criteria and the PHAB assessment score. RESULTS: Of the 9 different approaches identified as ways of encouraging the development of a sufficient number of qualified public health workers (version 1, measure 8.1.1), only 1 approach (local health department internship programs with schools of public health; B = 0.25, P < .03) was significantly related to higher scores. An opportunity for improvement identified for measure 8.2.1 was that plans missing a clear identification of the gap between current staff competencies and staff needs were associated with a 0.88-point decrease in the 4-point score (P < .001). CONCLUSIONS: Findings suggest that there are approaches adopted for meeting PHAB domain 8 measures that will impact the overall conformance assessment and score of a health department pursuing accreditation. There are several opportunities for improvement that health departments might consider when planning for accreditation or assessing their activities.

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The burden of illness related to diabetes and its complications is exceedingly high and growing globally. Systematic approaches to managing chronic care are needed to address the complex nature of the disease, taking into account health system structures. This study presents data collected from interviews with physicians, health system administrators, and other healthcare staff about chronic care management for elderly people with diabetes co-morbid with other chronic conditions in light of new programs intended to reduce barriers by incentivizing care encounters that take place through telephone and electronic communications (non-face-to-face care). Results indicate that health system personnel view non-face-to-face care as potentially providing value for patients and addressing systemic needs, yet challenging to implement in practice. Barriers and facilitators to this approach for managing diabetes and chronic care management for its complications are presented, with consideration to different types of health systems, and recommendations are provided for implementation.

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OBJECTIVES: Federally qualified health centers (FQHCs) are essential to underinsured populations in the safety net by offering them several means of access to reduced cost medications. This study employed a 2-pronged approach to evaluate FQHCs' role, estimating both the need for patient assistance and the impact of the safety net. STUDY DESIGN: A multiyear panel data study for post-Affordable Care Act (ACA) years 2012 to 2016 and a 2016 cross-sectional analysis design were utilized to analyze FQHCs, their patient populations, and prescription assistance programs. METHODS: Publicly available Health Resources and Services Administration (HRSA) Uniform Data System data were merged with HRSA Office of Pharmacy Affairs Information System data on 340B programs. Descriptive statistics were produced to evaluate the need for patient assistance, costs, and conditions treated at FQHCs. RESULTS: There were 1337 FQHCs serving more than 2.5 million patients, nearly 29% of whom were uninsured. FQHCs utilized 2 programs to provide affordable, reduced-cost prescriptions for patients without insurance: 1) the HRSA 340B Drug Pricing Program and 2) prescription assistance programs, which rely on pharmaceutical manufacturer donations of reduced-cost medications or coupons. Although these programs were effective at providing affordable prescriptions, program accessibility varied widely by state and FQHC resources. CONCLUSIONS: Despite changes in the healthcare access landscape due to the ACA, underinsured populations remain prevalent and the need for financial assistance with medications persists. FQHCs are uniquely situated to provide access to these essential services. Further policy and funding efforts, such as expansion of 340B programs, could assist FQHCs in fulfilling the role of prescription safety-net providers.

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