Factors affecting the Affordable Care Act Marketplace stand-alone pediatric dental plan premiums.

BACKGROUND: Children from lower income families have inadequate dental insurance coverage and poorer dental health in the United States. The Affordable Care Act (ACA) created Health Insurance Exchange Marketplaces to increase competition among health insurers and to provide low-income families with less costly health plans. The study examined Marketplace pediatric stand-alone dental plans (SADPs) and factors that affect their premiums. METHODS: The data used were 2016 Federal-Facilitated and State-Partnership Marketplace pediatric SADP data. Ordinary least squares regressions were applied to estimate contributing factors' effects on SADP premiums. RESULTS: Great premium variation was found among low and high coverage level SADPs, respectively. Premiums of Health Maintenance Organization (HMO) SADPs were significantly less expensive than Preferred Provider Organization (PPO) SADPs. SADPs charged significantly higher premiums for more types of services covered. SADPs also charged higher premiums in states where there are larger proportions of low-income people who report poor dental health, more dentists per capita, or higher dentists' wages. The number of insurance companies offering pediatric SADPs in a Marketplace was negatively associated with premiums. CONCLUSION: The current Marketplace pediatric SADPs may have limited effects on increasing economically disadvantaged children's access to quality dental care. Marketplaces can promote competition among its pediatric dental insurers on providing lower-cost pediatric SADPs.

The effectiveness of introducing detection cameras on compliance with mobile phone and seatbelt laws: a before-after study among drivers in Riyadh, Saudi Arabia.

BACKGROUND: Because Saudi Arabia (SA) has struggled with the burden of Road Traffic Injuries (RTIs) for decades, a new automated citations system was implemented in 2018 to improve compliance with seatbelt and mobile phone laws. Therefore, the purpose of this study is to evaluate the impact of the system on the prevalence of seatbelt and mobile phone use among drivers in Riyadh. This is an observational study conducted between 2017 and 2018. A Pre-Post evaluation was employed to determine the impact of a camera detection system on seatbelt and mobile phone use. Two research coordinators collected the observations at several highways and inner intersections around Riyadh (n = 3400). We evaluated differences in the prevalence of seatbelt and mobile phone use across the two time periods using a chi-2 test. In addition, we evaluated the association between the new intervention and traffic violation using a logistic regression model. RESULTS: The overall seatbelt compliance increased significantly from 33.9% (95% CI = 31.7-36.2) to 75.8% (95% CI = 73.7-77.8; P < 0.01). In addition, mobile phone use declined significantly from 13.8% (95% CI = 12.2-15.5) to 9.8 (95% CI = 8.8-9.1; P < 0.01). We found the detection system to be associated with a significant increase in seatbelt use and also a significant decline in mobile phone use while driving. After implementing the intervention, drivers were 6.1 times (OR = 6.1, 95% CI = 5.2-7.0) more likely to wear seatbelts than before the technology went into effect. Similarly, drivers observed after implementing the cameras were 32% (OR = 0.68, 95% CI = 0.55,0.84) less likely to use mobile phones while driving than those seen prior to the intervention. CONCLUSIONS: This study found a significant reduction in traffic violations following the implementation of a camera detection system in Riyadh. This positive impact is evidence for the role preventative structural strategies play to improve traffic safety and reduce RTI in SA. Therefore, these findings may facilitate further support for policymakers that public health interventions play a significant role to improve traffic safety. Seatbelt and mobile phone use while driving should continue to be monitored, and traffic police may evaluate whether increasing the fine is associated with a significant reduction in traffic violations and associated crashes.

Indigenous Adolescents' Suicidal Behaviors and Risk Factors: Evidence from the National Youth Risk Behavior Survey.

The study sought to examine indigenous adolescents' suicidal behaviors and risk factors in a nationally representative sample and explore potential causes of disparities. The study analyzed the 1991-2013 Youth Risk Behavior Survey National Combined Datasets. Suicidal behavior outcomes included suicide consideration, planning, and attempts during the past 12 months. Logit regressions were used to estimate the effects of potential suicide risk factors on these suicidal behaviors. The results showed that a high percentage of indigenous adolescents exhibited suicidal behaviors (consideration: 24.6 %; planning: 20.7 %; attempts: 16.2 %). After adjusting for risk factors, indigenous adolescents were no more likely than other adolescents to consider or plan for suicide (consideration: OR 1.18, CI 0.96-1.45, p = 0.125; planning: OR 1.16, CI 0.95-1.42, p = 0.156); however, they remained significantly more likely to have made suicide attempts (OR 1.73, CI 1.32-2.26, p < 0.001). Disparities in adolescent suicidal behaviors could be explained by the heterogeneous prevalence of suicidal risk factors across different races/ethnicities.

Infectious complications in obese patients after trauma.

BACKGROUND: Obesity is a public health concern in the United States due to its increasing prevalence, especially in younger age groups. Trauma is the most common cause of death for people under aged 40 y. The purpose of this study is to determine the association between obesity and specific infectious complications after traumatic injury. MATERIALS AND METHODS: A retrospective analysis was conducted using data from the 2012 National Trauma Data Bank. The National Trauma Data Bank defined obesity as having a body mass index of 30 or greater. Descriptive statistics were calculated and stratified by obesity status. A hierarchical regression model was used to determine the odds of experiencing an infectious complication in patients with obesity while controlling for age, gender, diabetes, number of comorbidities, injury severity, injury mechanism, head injury, and surgical procedure. RESULTS: Patients with a body mass index of 30 or greater compared with nonobese patients had increased odds of having an infectious complication (Odds Ratio, 1.59; 1.49-1.69). In addition to obesity, injury severity score greater than 29, age 40 y or older, diabetes, comorbid conditions, and having a surgical procedure were also predictive of an infectious complication. CONCLUSIONS: Our results indicate that trauma patients with obesity are nearly 60% more likely to develop an infectious complication in the hospital. Infection prevention and control measures should be implemented soon after hospital arrival for patients with obesity, particularly those with operative trauma.

State all-driver distracted driving laws and high school students' texting while driving behavior.

OBJECTIVE: Texting while driving is highly prevalent among adolescents and young adults in the United States. Texting while driving can significantly increase the risk of road crashes and is associated with other risky driving behaviors. Most states have enacted distracted driving laws to prohibit texting while driving. This study examines effects of different all-driver distracted driving laws on texting while driving among high school students. METHODS: High school student data were extracted from the 2013 National Youth Risk Behavior Survey. Distracted driving law information was collected from the National Conference of State Legislatures. The final sample included 6,168 high school students above the restricted driving age in their states and with access to a vehicle. Logistic regression was applied to estimate odds ratios of laws on texting while driving. RESULTS: All-driver text messaging bans with primary enforcement were associated with a significant reduction in odds of texting while driving among high school students (odds ratio = 0.703; 95% confidence interval, 0.513-0.964), whereas all-driver phone use bans with primary enforcement did not have a significant association with texting while driving (odds ratio = 0.846; 95% confidence interval, 0.501-1.429). CONCLUSIONS: The findings indicate that all-driver distracted driving laws that specifically target texting while driving as opposed to all types of phone use are effective in reducing the behavior among high school students.