Expand and extend postpartum Medicaid to support maternal and child health.

Most early maternal deaths are preventable, with many occurring within the first year postpartum (we use the terms "maternal" and "mother" broadly to include all individuals who experience pregnancy or postpartum and frame our recognition of need and policy recommendations in gender-neutral terms. To acknowledge limitations inherent in existing policy and the composition of samples in prior research, we use the term "women" when applicable). Black, Hispanic, and Native American individuals are at the most significant risk of pregnancy-related death. They are more commonly covered by Medicaid, highlighting likely contributions of structural racism and consequent social inequities. State-level length and eligibility requirements for postpartum Medicaid vary considerably. Federal policy requires 60 days of Medicaid continuation postpartum, risking healthcare coverage loss during a critical period of heightened morbidity and mortality risk. This policy position paper aims to outline urgent risks to maternal health, detail existing federal and state-level efforts, summarize proposed legislation addressing the issue, and offer policy recommendations for legislative consideration and future study. A team of maternal health researchers and clinicians reviewed and summarized recent research and current policy pertaining to postpartum Medicaid continuation coverage, proposing policy solutions to address this critical issue. Multiple legislative avenues currently exist to support and advance relevant policy to improve and sustain maternal health for those receiving Medicaid during pregnancy, including legislation aligned with the Biden-Harris Maternal Health Blueprint, state-focused options via the American Rescue Plan of 2021 (Public Law 117-2), and recently proposed acts (HR3407, S1542) which were last reintroduced in 2021. Recommendations include (i) reintroducing previously considered legislation requiring states to provide 12 months of continuous postpartum coverage, regardless of pregnancy outcome, and (ii) enacting a revised, permanent federal mandate equalizing Medicaid eligibility across states to ensure consistent access to postpartum healthcare offerings nationwide.

Many maternal deaths happen within the first year postpartum and can be prevented. Black, Hispanic, and Native American mothers are at more risk for many reasons, including unfair systems and insufficient healthcare coverage from government insurance (Medicaid). Rules for getting Medicaid can be very different across states and in postpartum compared to pregnancy. The US government only requires states to continue providing Medicaid for 60 days postpartum, after which it is up to each state. If mothers are required to re-qualify for Medicaid shortly after giving birth, they could lose healthcare when they are at more risk of dying or getting sick. In this policy position paper, a team of maternal health researchers and clinicians reviewed and summarized recent research and current laws related to postpartum Medicaid to propose future laws that could address these issues. Some proposed laws would expand Medicaid coverage during postpartum, but lawmakers have not recently discussed them. This position paper recommends that lawmakers (i) consider laws that require states to provide 12 months of postpartum healthcare coverage and (ii) have the US government make the same rules to qualify for postpartum Medicaid across all states.

The role of anhedonia in the relationship between adverse childhood experiences (ACEs), alcohol use disorder symptoms, and food addiction symptoms in a sample of emerging adults with histories of heavy drinking.

Previous research has shown that (ACEs) are associated with negative health outcomes, including depression, problematic alcohol use, and disordered patterns of overeating, including food addiction (FA). Moreover, anhedonia, or an inability to feel pleasure, has been also shown to increase risk for problematic alcohol use, as well as FA. It is possible that anhedonia may be implicated in health risk behaviors as individuals with anhedonia may seek out highly hedonic activities. The purpose of the present study was to explore the direct and indirect relationship between ACEs and alcohol use disorder (AUD) and FA symptoms via anhedonia in a diverse sample of emerging adults with histories of heavy drinking. A cross-sectional, quantitative design was used. The sample was 42.6% male, 45.5% White, and 39.9% Black, and the average age of participants was 22.64 (SD = 1.01). A confirmatory factor analysis was used to specify the model, and structural equation modeling was used to test the hypotheses. The initial measurement model was overidentified and demonstrated acceptable to favorable fit. Standardized results from a bootstrap analysis of the structural regression model showed significant direct effects of ACEs on FA and AUD symptoms. Results also found a significant indirect effect of ACEs on AUD symptoms through anhedonia, though this indirect effect was not significant for FA. Anhedonia could be a key target for the prevention and treatment of problematic alcohol use. Future research should examine the role of anhedonia in the maintenance of FA in nonheavy drinking samples. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

High School Student and Caregiver Preferred Communication Method Regarding School Meals: A Qualitative Approach.

BACKGROUND: This study examined student and caregiver preference for school communication and explored the feasibility and acceptability of a digital tool to assist with communication about school meal program between schools and families. METHODS: The study used qualitative methodology through youth focus groups and caregiver semi-structured phone interviews. The study was conducted in 4 high schools in a large, urban city. The phenomenon of interest included the exploration of preferences regarding communication around school meal programs and feasibility and acceptability of a digital tool for communication and promoting the ordering of healthful foods in the school environment. Interviews were transcribed, coded, and analyzed through NVivo qualitative software using thematic analysis approach to examine themes. RESULTS: Forty-seven students (ages 14-21, grades 9-12) participated in 7 focus groups and 24 caregivers participated in semi-structured phone interviews. Three themes emerged around (1) communication preferences, (2) accessibility, and (3) extrinsic motivational factors for engagement in healthy eating behaviors. CONCLUSION: Results indicated that communication methods could potentially influence motivation and engagement in youth school meal participation.

Advocacy efforts of the Society of Behavioral Medicine: a 6-year update.

Six years ago, we published a paper describing the Society of Behavioral Medicine's (SBM) health policy organizational leadership structure and policy initiatives. The purpose of the current paper is to provide an update on changes in the infrastructure and new policy initiatives that have been developed since 2017. We review each of the policy leadership arms of SBM including details of the work of each and goals for the future. The SBM engages in several health policy advocacy efforts through their Advocacy Council and Position Statements Committee. The Advocacy Council launched the Health Policy Ambassador Program in 2020. The Ambassador Program serves to train members to develop longer-term relationships with legislative staff around key policy priority areas. The Position Statements Committee is responsible for overseeing the development and dissemination of health policy position statements. Both groups work together and with partner organizations to increase the impact of our science. Over the last 6 years, developing a stronger infrastructure and implementing metrics for progress such as tracking social media engagement has helped to move SBM's policy agenda forward. The work of the policy-related leadership teams can serve as a model for other organizations who are interested in further developing their policy advocacy efforts.

The Society of Behavioral Medicine (SBM) engages in several health policy advocacy efforts through their Advocacy Council and Position Statements Committee. The Advocacy Council launch the Health Policy Ambassador Program in 2020. The Ambassador Program serves to train members to develop longer-term relationships with legislative staff around key policy priority areas. The Position Statements Committee is responsible for overseeing the development and dissemination of health policy position statements. Both groups work together and with partner organizations to increase the impact of our science. Over the last 6 years, developing a stronger infrastructure and implementing metrics for progress has helped to move SBM's policy agenda forward. The work of the policy-related leadership teams can serve as a model for other organizations who are interested in further developing their policy advocacy efforts.

Free Healthy School Meals for All as a Means to Advance Child Health Equity.

This Viewpoint discusses how providing free, healthy meals to all schoolchildren can advance health equity.

A Spatial Analysis of Food Insecurity and Body Mass Index with Income and Grocery Store Density in a Diverse Sample of Adolescents and Young Adults.

Food insecurity occurs when a household lacks consistent access to food and is more prevalent in ethnic and racial minority populations. While there has been a proliferation of research linking food insecurity to obesity, these findings are mixed. It may be helpful to consider some additional geographic factors that may be associated with both factors including socioeconomic status and grocery store density. The purpose of the current study aimed to examine spatial relationships between food insecurity and SES/store density and BMI and SES/store density in a diverse sample of adolescents and young adults across two studies in a large, urban city. GIS analysis revealed that participants with the highest food insecurity tend to live in the zip codes with the lowest median income. There did not appear to be clear a relationship between food insecurity and store density. Participants with the highest BMI tend to live in zip codes with lower median income and participants with higher BMI tended to live in the south and west sides of Chicago, which have a relatively lower concentration of grocery stores in the city. Our findings may help to inform future interventions and policy approaches to addressing both obesity and food insecurity in areas of higher prevalence.

Exploring food environment interventions for diet-related outcomes using a food sovereignty framework: a systematic review.

Building local food systems through a food sovereignty lens, harnessing the right of people to control their own food systems, may enhance healthy food access and increase the consumption of fruits and vegetables in local communities. While research to date has described the outcomes of various multilevel, multicomponent food systems interventions, no known literature reviews to date have systematically examined food system interventions and dietary and health outcomes through the context of a food sovereignty lens. Utilization of a food sovereignty framework allows for the incorporation of key food systems and community-based concepts in the food environment literature. The purpose of this systematic review was to describe and summarize the efficacy of community-based local food system interventions, using the food sovereignty framework, for both pediatric and adult populations and their impact on health behaviors and physiological outcomes. We searched for peer-reviewed articles using Scopus, PubMed, PsychInfo and CINAHL databases and identified 11 articles that met the inclusion criteria for this study. Seven studies found that food systems interventions had a significant positive effect on improving health outcomes, three had null findings and one had null or negative results. Two studies utilized a community-based participatory approach. The most successful interventions involved community-based engagement involving multiple aspects of the food system and involving both children and adults for maximum impact. Our results inform how community-based food systems interventions can be guided by food sovereignty principles to improve health outcomes, such as body weight and fruit and vegetable intake, for both pediatric and adult populations.

Addictive behavior as molar behavioral allocation: Distinguishing efficient and final causes in translational research and practice.

OBJECTIVE: Translational research on addictive behaviors viewed as molar behavioral allocation is critically reviewed. This work relates rates of behavior to rates of reinforcement over time and has been fruitfully applied to addictive behaviors, which involve excessive allocation to short-term rewards with longer term costs. METHOD: Narrative critical review. RESULTS: This approach distinguishes between final and efficient causes of discrete behaviors. The former refers to temporally extended behavior patterns into which the act fits. The latter refers to environmental stimuli or internal psychological mechanisms immediately preceding the act. Final causes are most clear when addictive behaviors are studied over time as a function of changing environmental circumstances. Discrete acts of addictive behavior are part of an extended/molar behavior pattern when immediate constraints on engagement are low and few rewarding alternatives are available. Research framed by efficient causes often use behavioral economic simulation tasks as individual difference variables that precede discrete acts. Such measures show higher demand for addictive commodities and steeper discounting in various risk groups, but whether they predict molar addictive behavior patterning is understudied. CONCLUSIONS: Although efficient cause analysis has dominated translational research, research supports viewing addictive behavior as molar behavioral allocation. Increasing concern with rate variables underpinning final cause analysis and considering how study methods and temporal units of analysis inform an efficient or final cause analysis may advance understanding of addictive behaviors that occur over time in dynamic environmental contexts. This approach provides linkages between behavioral science and disciplines that study social determinants of health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Factors associated with COVID-19 vaccination uptake in community health center patients.

OBJECTIVES: Previous research on COVID-19 vaccination hesitancy has found that sociodemographic factors including sex, age, education, and occupation were associated with vaccination acceptance, along with other variables like trust in authorities, risk perception of COVID-19 and perception of vaccine efficacy and safety. However, this research has been limited by the use of nonvalidated measures for vaccination hesitancy and utilizing general samples that did not focus on minoritized groups. The purpose of the current study was to use validated methodology to determine factors associated with vaccination uptake in a community sample of predominantly Black and Latinx adults. METHOD: One-hundred and 9 participants (70% female, 40% Black, 40% Latinx) completed a survey assessing sociodemographic variables, vaccination uptake, medical mistrust, and vaccination attitudes. RESULTS: Multivariate logistic regression revealed that higher scores on the mistrust of the vaccine benefit subscale were associated with lower vaccination uptake (OR = .45, p < .001) and higher levels of education were associated with higher levels of vaccination uptake (OR = 1.56; p = .048). No other demographic variables, nor other aspects of vaccination hesitancy, were associated with vaccination uptake. CONCLUSIONS: Taken together, our findings speak to the importance of dispelling misinformation and building community trust in public health efforts. Specifically, vaccine mistrust may be an especially important focus of community-based education efforts. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Salivary cortisol levels and appraisals of daily hassles across dimensions of the tripartite model of anxiety and depression in emerging adults.

The objective of this study was to investigate how cortisol levels and appraisals of daily hassles differ across tripartite dimensions of depression and anxiety in emerging adults. Data collected from a sample of undergraduate students at a large Midwestern university was used to investigate these aims. This included salivary cortisol data collected over four days, scores on a measure of the tripartite model of anxiety and depression, and scores on a measure of daily hassles administered everyday for two weeks. Generalized estimating equations and multilevel modeling techniques were used to analyze data. Elevated cortisol levels during the awakening period and the evening period, lower total levels across the day, steeper diurnal slopes, and elevated levels of negative affect and physiological hyperarousal predicted experiences of daily hassles. Tripartite dimensions were unrelated to cortisol indices. The present study demonstrates the utility of modeling multiple cortisol indices and provides evidence of differential associations between physiological and phenomenological indices of stress.