Characterization of time toxicity in older patients with metastatic breast cancer.

PURPOSE: Recognizing that receiving healthcare can be time intensive and burdensome, time toxicity has been conceptualized as the time spent by patients seeking healthcare. This study investigates the association between age at diagnosis and time toxicity for patients with Metastatic Breast Cancer (MBC) and identifies major components of care that confer the greatest time toxicity. METHODS: We conducted a retrospective cohort study among patients with MBC aged 67 or older using the SEER-Medicare database. We assessed time toxicity using the number of encounter days patients interacted with the healthcare system per 100 days, within the first year of starting cancer treatment. We used a Poisson model to analyze the association between age and encounter days, adjusting for clinical and sociodemographic factors. We stratified the mean encounter days for each age cohort by treatment types. FINDINGS: The final sample included 2949 patients; 51.4% were between 70 and 79 years old, and 81.3% were white. Although unadjusted analysis showed an association between older age and more encounter days (Rate Ratio (RR) 1.12; 95% CI 1.02, 1.22), there was no significant association after adjusting for comorbidities and treatment type. Patients with more than three comorbidities had significantly higher encounter days compared to those without comorbidities [RR 1.36 (95% CI 1.26, 1.46)]. Receipt of radiotherapy [RR: 1.45 95% CI (1.37, 1.54)] was associated with more encounter days compared to not receiving radiotherapy, while receipt of bone-modifying agents was associated with fewer encounter days compared to not using Bone modifying agents [RR 0.75 (95% CI 0.70, 0.79)]. CONCLUSION: Our study identified comorbidities and cancer treatment modality, including radiotherapy, as the factors affecting time toxicity in older patients with MBC. Assessment of an individual's comorbid medical conditions and types of treatment planned are crucial to understanding age-related impacts on encounter days and to support shared decision making in older patients.

Trends in new and persistent opioid use in older adults with and without cancer.

BACKGROUND: The impact of ongoing efforts to decrease opioid use on patients with cancer remains undefined. Our objective was to determine trends in new and additional opioid use in patients with and without cancer. METHODS: This retrospective cohort study used data from Surveillance, Epidemiology, and End Results program-Medicare for opioid-naive patients with solid tumor malignancies diagnosed from 2012 through 2017 and a random sample of patients without cancer. We identified 238 470 eligible patients with cancer and further focused on 4 clinical strata: patients without cancer, patients with metastatic cancer, patients with nonmetastatic cancer treated with surgery alone ("surgery alone"), and patients with nonmetastatic cancer treated with surgery plus chemotherapy or radiation therapy ("surgery+"). We identified new, early additional, and long-term additional opioid use and calculated the change in predicted probability of these outcomes from 2012 to 2017. RESULTS: New opioid use was higher in patients with cancer (46.4%) than in those without (6.9%) (P < .001). From 2012 to 2017, the predicted probability of new opioid use was more stable in the cancer strata (relative declines: 0.1% surgery alone; 2.4% surgery+; 8.8% metastatic cancer), than in the noncancer stratum (20.0%) (P < .001 for each cancer to noncancer comparison). Early additional use declined among surgery patients (‒14.9% and ‒17.5% for surgery alone and surgery+, respectively) but was stable among patients with metastatic disease (‒2.8%, P = .50). CONCLUSIONS: Opioid prescribing declined over time at a slower rate in patients with cancer than in patients without cancer. Our study suggests important but tempered effects of the changing opioid climate on patients with cancer.

Picturing the populations who could benefit from health insurance access expansions: An analysis of US health insurance television ads airing in 2018.

Efforts to expand access to health insurance in the United States are key to addressing health inequities and ensuring that all individuals have access to health care during the coronavirus disease 2019 pandemic. Yet, attempts to expand public insurance programs, including Medicaid, continue to face opposition in state and federal policymaking. Limited policy success raises questions about the health insurance information environment and the extent that available information signals both available resources and the need for policy reform. In this study, we explore one way that consumers and policymakers learn about health insurance-television advertisements-and analyze content in ads that could contribute to an understanding of who needs health insurance or who deserves to benefit from policies to expand insurance access. Specifically, we implement a content analysis of health insurance ads airing throughout 2018 on broadcast television or national cable, focusing on the depictions of people in those ads. Our findings indicate that individuals depicted in ads for Medicaid plans differ from those in ads for non-Medicaid plans. Groups that comprise large populations of current Medicaid enrollees, children and pregnant people, were more likely to appear in ads for non-Medicaid plans than in ads for Medicaid plans. This has implications for potential enrollees' understanding of who is eligible as well as the general public's and policymakers' perspectives on who should be targeted for current or future policies.

An Investigation of Age-Differentiated Conversations About Electronic Nicotine Delivery Systems on Reddit.

Introduction: This study analyzes age-differentiated Reddit conversations about ENDS. Methods: This study combines 2 methods to (1) predict Reddit users' age into 2 categories (13-20 years [underage] and 21-54 years [of legal age]) using a machine learning algorithm and (2) qualitatively code ENDS-related Reddit posts within the 2 groups. The 25 posts with the highest karma score (number of upvotes minus number of downvotes) for each keyword search (i.e., query) and each predicted age group were qualitatively coded. Results: Of 9, the top 3 topics that emerged were flavor restriction policies, Tobacco 21 policies, and use. Opposition to flavor restriction policies was a prominent subcategory for both groups but was more common in the 21-54 group. The 13-20 group was more likely to discuss opposition to minimum age laws as well as access to flavored ENDS products. The 21-54 group commonly mentioned general vaping use behavior. Conclusions: Users predicted to be in the underage group posted about different ENDS-related topics on Reddit than users predicted to be in the of-legal-age group.

"Those Who Need It the Most": Equity Framing in 2021 U.S. Print News About Food Assistance.

Objective: To understand how equity appeared in news about food assistance from 2021. Methods: We assessed a national sample of news articles (N=298) for equity arguments and language about racial and health equity. Results: Only 28% of coverage argued that food assistance programs promote equity. Just 6% mentioned people of color or named racial disparities in food access. Discussion: Narratives that explain how food assistance programs reduce inequities could deepen their policy appeal and broaden public perceptions around recipients. Health Equity Implications: There are opportunities for news coverage to expand the discussion of how food assistance programs improve racial and health equity outcomes.

Advance care planning, serious illness communication, and conversations to facilitate coping for patients with gastrointestinal malignancies: a narrative review.

BACKGROUND AND OBJECTIVE: Patients with advanced gastrointestinal (GI) malignancies are at high-risk for disease-related complications, treatment-related toxicity, unplanned hospitalizations, poor psychological outcomes, and short life-expectancies. Advance care planning (ACP) and serious illness communication (SIC) are two forms of communication that can help patients with GI malignancies explore the future, especially in the event of worsening health. While there are some limitations to traditional ACP, SIC that focuses on what matters most to patients with GI malignancies in the future (future-focused SIC), has the potential to improve future medical decision-making, help patients cognitively and emotionally process and accept their illness over time, help them feel heard and understood, allow them to positively cope with their disease, and may also help their caregivers in a variety of ways. METHODS: Narrative review using PubMed and Google Scholar to search for relevant literature published between 2010-2022. KEY CONTENT AND FINDINGS: We present several key studies that highlight the complex, heterogenous nature of ACP and SIC research and its mixed outcomes for patients with GI malignancies. We also offer suggestions on how to optimize future-focused SIC research in this patient population. In the second half of this article, we suggest a practical approach to conducting future-focused SIC for patients with GI malignancies which includes a communication framework based on the literature and expert-opinion. We also provide practical tips on how to normalize these conversations and how to help patients use these conversations for future medical decision-making. CONCLUSIONS: Future-focused SIC has the potential to benefit patients with advanced GI malignancies in a variety of ways. Optimizing research outcome measures that highlight the patient experience with this communication is crucial to move this area of research forward.

News Media Coverage of Childcare: How U.S. Local TV News Framed the Problem Before and During the Early Stage of the COVID-19 Pandemic.

Early care and education (ECE), or the care young children receive before entering formal schooling, can take multiple forms and is delivered in different settings, such as a center, church, or public school. Federal and state governments regularly fund ECE programs and policies through the Child Care and Development Block Grant Act (CCDBG). Many families, however, face significant challenges in access, cost, and quality of ECE programs, and ECE professionals report substantial challenges in the workplace (e.g., inadequate training) and beyond (e.g., low wages). Policies addressing issues related to ECE were proposed in 2021, but stalled on the U.S. federal policy agenda. In this study, we examine the ECE content of local television news coverage both for its representations of and for its potential influences on ECE policy agendas. We use data from local stations affiliated with the major networks (ABC, NBC, CBS, and FOX) in media markets across the U.S., airing before and during the pandemic. We analyze elements of coverage that could affect public recognition of ECE-related issues, including how problems were framed (e.g., news coverage highlighting scandals or adverse events at ECE facilities) and solutions identified (e.g., public policy). We find that during 2018 and 2019, more coverage highlighted scandalous activity than public policy. The reverse was true, however, during the early period of the pandemic (from mid-March through June of 2020). Researchers and health professionals were seldom included in stories in either sample, and very few stories offered context about the benefits of ECE for health and well-being. These coverage patterns have implications for the public's understanding of ECE policy and the perceived need for reform. Policymakers, advocates, and researchers looking to advance support for ECE should consider ways to use local television news to present health and policy-relevant information to broad segments of the public.

Television airings of U.S. federal COVID-19 public service announcements in 2020 were associated with market-level political orientation, not COVID-19 rates.

Televised public service announcements were one of the ways that the U.S. federal government distributed health information about the COVID-19 pandemic to Americans in 2020. However, little is known about the reach of these campaigns or the populations who might have been exposed to the information these ads conveyed. We conducted a descriptive analysis of federally-affiliated public service announcement airings to assess where they were aired and the market-level social and demographic characteristics associated with the airings. We found no correspondence between airings and COVID-19 incidence rates from March to December 2020, but we found a positive association between airings and the Democratic vote share of the market, adjusting for other market demographic characteristics. Our results suggest that PSAs may have contributed to divergent exposure to health information among the U.S. public during the first year of the COVID-19 pandemic.

Evaluation of healthcare-associated infection rates in patients with hematologic malignancies and stem cell transplantation during the coronavirus disease 2019 (COVID-19) pandemic.

Objective: To evaluate whether rates of healthcare-associated infections (HAIs) changed during the coronavirus disease 2019 (COVID-19) pandemic in malignant hematology and stem cell transplant patients. Design: A retrospective, cohort study. Patients: The study included malignant hematology and stem cell transplant patients admitted between March 1, 2019, through July 31, 2019, and March 1, 2020, through July 31, 2020. Methods: Rates of catheter-associated urinary tract infections (CAUTIs), central-line-associated bloodstream infections (CLABSIs), central-line-associated mucosal barrier injury infections (CLAMBIs), and Clostridioides difficile infections (CDIs) during the pandemic were compared to those in a control cohort. Secondary outcomes included the rate of non-COVID-19 respiratory viruses. Results: The rate of CAUTIs per 1,000 hospital days was 0.435 before the pandemic and 0.532 during the pandemic (incidence rate ratio [IRR], 1.224; 95% confidence interval [CI], 0.0314-47.72; P = .899). The rate of CLABSIs was 0.435 before the pandemic and 1.064 during the pandemic (IRR, 2.447; 95% CI, 0.186-72.18; P = .516). The rate of CLAMBIs was 2.61 before the pandemic and 1.064 during the pandemic (IRR 0.408, 95% CI 0.057-1.927; P = .284). The rate of CDIs was 2.61 before the pandemic and 1.579 during the pandemic (IRR, 0.612; 95% CI, 0.125-2.457; P = .512). Non-COVID-19 respiratory virus cases decreased significantly from 12 (30.8%) to 2 cases (8.3%) (P = 0.014). Conclusions: There was no significant difference in HAIs among inpatient malignant hematology and stem cell transplant patients during the COVID-19 pandemic compared to those of a control cohort. Rates of infection were low among both cohorts. Rates of community-acquired respiratory viruses decreased significantly during the pandemic among this population.

Serving the public? A content analysis of COVID-19 public service announcements airing from March - December of 2020 in the U.S.

The objective of this research was to examine the health messages conveyed in public service announcements (PSAs) affiliated with the U.S. federal government response to the COVID-19 pandemic in 2020. To do so, we conducted a content analysis of 132 federally-affiliated PSAs that were aired 170,820 times between March 12 and December 16, 2020. Using a quantitative coding instrument, we analyzed health behavioral guidance, messages about groups, people depicted, and other PSA features. We calculated frequencies of exposure to messages at the airing-level to account for the varying number of times each PSA was aired. Far more PSAs aired between March and June than between July and December. The most common health guidance was to stay at home (80.7%), practice social distancing (61.9%), and wash hands (54.5%); 36.1% of airings included guidance to wear masks. Few PSAs referenced group differences in risk of infection or transmission, nor did they reference scientific evidence or the future availability of vaccines. PSAs aired in 2020 missed opportunities to convey important information to the public and to center health equity in public communication.

Association of Funding Cuts to the Patient Protection and Affordable Care Act Navigator Program With Privately Sponsored Television Advertising.

Importance: Many individuals eligible for coverage in the Patient Protection and Affordable Care Act (ACA) marketplace remain unenrolled because of information barriers. Whether the private sector or the public sector should conduct outreach to address these barriers is a topic of active debate. Objective: To determine whether cuts to the funding of the ACA navigator program were associated with changes in the volume of private sector advertising. Design, Setting, and Participants: Using data from the 2015 to 2019 open enrollment periods, this economic evaluation analyzed the changes in advertising associated with 2017 to 2019 cuts to navigator program funding. A difference-in-difference analysis was used to compare outcomes before and after the cuts in counties with higher and lower exposure to the navigator program. Health insurance advertising was measured using data from Kantar/Campaign Media Analysis Group in collaboration with the Wesleyan Media Project, the most comprehensive data available on local broadcast and national cable advertising. The data set included all counties that met the eligibility criteria for the navigator program from 2015 through 2019. Data were analyzed from August 2021 to May 2022. Exposures: Counties were classified as having higher or lower exposure to the navigator program according to the intensity of program activity in 2016, before the funding cuts. Counties served only by statewide navigator programs were categorized as lower exposure, while those also served by local navigator programs were categorized as higher exposure. Main Outcomes and Measures: Number of privately sponsored television advertisement airings for the ACA individual health insurance marketplace during the 2015 to 2019 open enrollment periods in each county, adjusted for population. Results: All counties in 33 states that met the eligibility criteria for the navigator program from 2015 through 2019 were included in the analysis (2435 counties). Cuts to the navigator program were not associated with changes in the number of privately sponsored health insurance advertisements aired. Results were similar under several alternative approaches including an event study specification. Conclusions and Relevance: In this study of the association between television advertising and navigator funding in the ACA marketplaces, private sector entities did not increase their advertising to compensate for declines in government-sponsored navigator activity. This finding can inform policy debates about the extent to which the private sector adjusts in response to changes in government outreach, and thus improve the design of state waivers and federal funding allocations.

Health Insurance Ad Messages Targeted to English- and Spanish-Speaking Populations in a Period of Limited Federal Investment in Marketplace Outreach.

Federal funding cuts to enrollment outreach and marketing of the Affordable Care Act (ACA) marketplace options in 2017 has raised questions about the adequacy of the information the public has received, especially among populations vulnerable to uninsurance. Using health insurance ads aired from January 1, 2018, through December 21, 2018, we conducted a content analysis focused on (a) the messaging differences by ad language (English vs. Spanish) and (b) the messaging appeals used by nonfederally sponsored health insurance ads in 2018. The results reveal that privately sponsored ads focused on benefit appeals (e.g., prescription drugs), while publicly sponsored ads emphasized financial assistance subsidies. Few ads, regardless of language, referenced the ACA explicitly and privately sponsored Spanish-language ads emphasized benefits (e.g., choice of doctor) over enrollment-relevant details. This study emphasizes that private-sponsored television marketing may not provide specific and actionable health insurance information to the public, especially for the Spanish-speaking populations.

Posttraumatic stress symptoms and financial toxicity among adolescent and young adult oncology patients and their caregivers at cancer diagnosis.

BACKGROUND: Adolescent and young adult oncology (AYAO) patients and caregivers may experience significant psychosocial dysfunction and financial toxicity. Understanding early risk factors is critical to improving survivorship trajectories. METHODS: The authors conducted a cross-sectional study of baseline survey data from a prospective cohort of AYAO patient-caregiver dyads enrolled within 1 month of medical oncology treatment initiation. Posttraumatic stress symptoms (PTSS) were measured by the Impacts of Events Scale-Revised, and financial toxicity was measured with the Comprehensive Score (COst). The authors fit models of linear association between PTSS, financial toxicity, and other end points and pairwise associations of PTSS and financial toxicity within dyads. RESULTS: The analytic cohort contained 41 patients, 37 caregivers, and 34 complete dyads. Clinically-concerning PTSS were observed among patients (44%) and caregivers (52%). The median COst scores were 20.0 for patients (quartiles, 12.5-29.5) and 22.0 for caregivers (quartiles, 12.8-26.0), which were consistent with high financial toxicity (patients, 46%; caregivers, 44%). PTSS were positively associated with financial toxicity (P = .013 for patients, P = .039 for caregivers), subjective distress (P < .001 for all), depressive (P < .001 for all) and anxiety symptoms (P = .005 for patients, P = .024 for caregivers), and poorer quality of life (P < .001 for patients, P = .003 for caregivers). A significant paired association was not found in PTSS (Pearson correlation coefficient [PCC], 0.23; 95% confidence interval [CI], -0.15 to 0.56). Financial toxicity was positively associated within dyads (PCC, 0.65; 95% CI, 0.36-0.83). CONCLUSIONS: At diagnosis, AYAO patients and caregivers exhibit substantial PTSS, which are associated with greater financial toxicity and other psychosocial distress.

Changes in Marketplace competition and television advertising by insurers.

OBJECTIVES: The Trump administration ended television advertising for the Health Insurance Marketplace prior to the 2018 open enrollment period, leaving insurers as the predominant source of health insurance advertising. Prior research findings are mixed on the effectiveness of private advertising on Marketplace enrollment, but no work to date has examined how competitive changes in health insurance markets are related to marketing patterns. This study provides the first evidence on how insurers are altering their marketing in response to changes in competition. STUDY DESIGN: This study links data capturing Marketplace participation (CMS Qualified Health Plan Landscape files) by county and health insurance advertising (Kantar Media/Campaign Media Analysis Group) by media market for the 2014 through 2018 open enrollment periods. METHODS: We used population-weighted county fixed effects models to estimate the relationship between year-over-year changes in Marketplace competition and changes in (1) total private advertising and (2) advertising per insurer. RESULTS: Going from multiple insurers to a single insurer resulted in 465 fewer private ads aired within a county during open enrollment (P < .01), a 17% to 38% reduction. Losing monopoly status is associated with a drop in advertising of 452 airings per insurer (P < .01), and becoming a monopolist is associated with 293 more airings per insurer (P < .01). CONCLUSIONS: Insurers are not replacing the decline in government-sponsored advertising. We find that insurers behave as if they are responding to strategic incentives, advertising more when they become a monopolist but not filling the hole left by their former competitor, which has implications for the volume of messages seen by consumers.

Paid family leave on local television news in the United States: Setting the agenda for policy reform.

Access to paid family and medical leave ("paid leave") has bipartisan support among lawmakers in the United States, but the issue remains stalled on the public policy agenda. The U.S. does not currently have a federal paid leave policy, and unpaid leave-guaranteed by the Family and Medical Leave Act of 1993-is all that is available to the majority of workers. In this study, we examine the content of local television news as representations of, and potential influence on, paid leave policy agendas. To do so, we analyze the extent to which local television news coverage describes the problem of lack of employment leave, and whether coverage highlights public policy as a solution. We use data from local television stations affiliated with the four major networks (ABC, NBC, CBS, and FOX) in all 210 media markets in the U.S. during a period pre-pandemic, from October 2018 until July 2019. We find that 64% of local television news coverage related to paid leave discussed the issue in the context of public policy. Coverage more often cited early-stage policy actions such as a policy idea - reflected in 40% of stories discussing stages of public policymaking - or the introduction of a bill - detailed in 22% of these stories. This coverage aligns with actual policy activity at the state-level during the same time period. News coverage infrequently included elements that could shape public understanding of paid leave as a population health issue, such as including health-related sources of providers or researchers. Policymakers, advocates, and researchers looking to advance public support for paid leave should consider efforts to use local television news as a vehicle to present health and policy-relevant information to broad segments of the public and set the agenda for policy reform.

Exposure to televised political campaign advertisements aired in the United States 2015-2016 election cycle and psychological distress.

CONTEXT: Prior research suggests the potential for political campaign advertisements to increase psychological distress among viewers. The current study tests relationships between estimated exposure to campaign advertising and the odds of respondents reporting that a doctor told them they have anxiety, depression, insomnia, or (as a negative control) cancer. METHODS: A secondary analysis of U.S. data on televised campaign ad airings from January 2015 to November 2016 (n = 4,659,038 airings) and five waves of a mail survey on television viewing patterns and self-reported medical conditions from November 2015 to March 2017 (n = 28,199 respondents from n = 16,204 unique households in the U.S.). FINDINGS: A 1 percent increase in the estimated volume of campaign advertising exposure was associated with a 0.06 [95% CI 0.03-0.09] percentage point increase in the odds of a respondent being told by a doctor that they have anxiety in the past 12 months. We observed this association regardless of the political party of the ad sponsor, the political party of the respondent, or their statistical interaction. We also observed this association for both Presidential campaign ads and non-Presidential (including local, state, and U.S. congressional election) campaign ads, providing evidence that these relationships were not driven by the unique divisiveness of the race between Donald Trump and Hilary Clinton. Some topic-specific models offered additional evidence of association between estimated volume of campaign advertising exposure and the odds of being told by a doctor that they have depression or insomnia, but these patterns were less consistent across models that utilized different categories of campaign exposure. Campaign ad exposure was not associated with cancer, which served as a negative control comparison. CONCLUSIONS: There was a consistent positive association between the volume of campaign advertising exposure and a reported diagnosis of anxiety among American adults.

Correction: Predicting Age Groups of Reddit Users Based on Posting Behavior and Metadata: Classification Model Development and Validation.

[This corrects the article DOI: 10.2196/25807.].

Predicting Age Groups of Reddit Users Based on Posting Behavior and Metadata: Classification Model Development and Validation.

BACKGROUND: Social media are important for monitoring perceptions of public health issues and for educating target audiences about health; however, limited information about the demographics of social media users makes it challenging to identify conversations among target audiences and limits how well social media can be used for public health surveillance and education outreach efforts. Certain social media platforms provide demographic information on followers of a user account, if given, but they are not always disclosed, and researchers have developed machine learning algorithms to predict social media users' demographic characteristics, mainly for Twitter. To date, there has been limited research on predicting the demographic characteristics of Reddit users. OBJECTIVE: We aimed to develop a machine learning algorithm that predicts the age segment of Reddit users, as either adolescents or adults, based on publicly available data. METHODS: This study was conducted between January and September 2020 using publicly available Reddit posts as input data. We manually labeled Reddit users' age by identifying and reviewing public posts in which Reddit users self-reported their age. We then collected sample posts, comments, and metadata for the labeled user accounts and created variables to capture linguistic patterns, posting behavior, and account details that would distinguish the adolescent age group (aged 13 to 20 years) from the adult age group (aged 21 to 54 years). We split the data into training (n=1660) and test sets (n=415) and performed 5-fold cross validation on the training set to select hyperparameters and perform feature selection. We ran multiple classification algorithms and tested the performance of the models (precision, recall, F1 score) in predicting the age segments of the users in the labeled data. To evaluate associations between each feature and the outcome, we calculated means and confidence intervals and compared the two age groups, with 2-sample t tests, for each transformed model feature. RESULTS: The gradient boosted trees classifier performed the best, with an F1 score of 0.78. The test set precision and recall scores were 0.79 and 0.89, respectively, for the adolescent group (n=254) and 0.78 and 0.63, respectively, for the adult group (n=161). The most important feature in the model was the number of sentences per comment (permutation score: mean 0.100, SD 0.004). Members of the adolescent age group tended to have created accounts more recently, have higher proportions of submissions and comments in the r/teenagers subreddit, and post more in subreddits with higher subscriber counts than those in the adult group. CONCLUSIONS: We created a Reddit age prediction algorithm with competitive accuracy using publicly available data, suggesting machine learning methods can help public health agencies identify age-related target audiences on Reddit. Our results also suggest that there are characteristics of Reddit users' posting behavior, linguistic patterns, and account features that distinguish adolescents from adults.

Relationship between Drug Overdose Mortality and Coverage of Drug-Related Issues in US Television Political Campaign Advertising in the 2012 and 2016 Election Cycles.

CONTEXT: Understanding the role of drug-related issues in political campaign advertising can provide insight on the salience of this issue and the priorities of candidates for elected office. This study sought to quantify the share of campaign advertising mentioning drugs in the 2012 and 2016 election cycles and to estimate the association between local drug overdose mortality and drug mentions in campaign advertising across US media markets. METHODS: The analysis used descriptive and spatial statistics to examine geographic variation in campaign advertising mentions of drugs across all 210 US media markets, and it used multivariable regression to assess area-level factors associated with that variation. FINDINGS: The share of campaign ads mentioning drugs grew from 0.5% in the 2012 election cycle to 1.6% in the 2016 cycle. In the 2016 cycle, ads airing in media markets with overdose mortality rates in the 95th percentile were more than three times as likely to mention drugs as ads airing in areas with overdose mortality rates in the 5th percentile. CONCLUSIONS: A small proportion of campaign advertising mentioned drug-related issues. In the 2016 cycle, the issue was more prominent in advertising in areas hardest hit by the drug overdose crisis and in advertising for local races.