Diana R Silver
Diana R Silver
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Vice Dean of Faculty Affairs
Professor of Public Health Policy and Management
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Professional overview
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Dr. Diana Silver's research explores the impact of variation in the implementation, adoption and repeal of state and local public health policies on health outcomes, particularly alcohol consumption, motor vehicle crashes, tobacco use, and food safety. Some of her other work has examined variation in access to publicly funded services such as clinics, after-school programs, parks and playgrounds. Her work has been funded by the National Institutes of Health, the Robert Wood Johnson Foundation, the New York City Department of Health and Mental Hygiene, and several other funders.
Dr. Silver's work has been published in a variety of prominent journals, including the American Journal of Public Health, the American Journal of Health Promotion, Public Health, Tobacco Control, Journal of Safety Research, Social Science and Medicine, the American Journal of Evaluation, PLoS One, Journal of Community Health, Journal of Immigrant and Minority Health, International Journal of Equity in Health, Globalization and Health, Youth and Society, Public Administration Review and Policy Studies Journal. She is an associate editor for the American Journal of Health Promotion, and serves on the New York City Department of Health’s Health Advisory Committee. She began her career focused on the developing policies and programs that could address the epidemics of AIDS, substance abuse and violence in New York City, in such settings as schools, workplaces, jails, and homeless shelters.
Dr. Silver teaches undergraduate and master’s level courses at the School of Global Health, and trains doctoral students. In 2015, Dr. Silver received NYU’s Distinguished Teaching Award, the university’s highest honor for teaching excellence.
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Education
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BA, History, Bates College, Lewiston, MEMPH, Health Education, Hunter College, New York City, NYPhD, Public Administration, New York University, New York City, NY
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Honors and awards
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Distinguished Teaching Award, New York University (2015)Steinhardt Goddard Award (2011)Annual Award for Outstanding Evaluation, American Evaluation Association (2010)Public Affairs Resident Scholar, The Rockefeller Foundation (2007)
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Areas of research and study
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Access to HealthcareAlcohol, Tobacco and Driving PoliciesFood Safety PoliciesImplementation and Impact of Public Health RegulationsInjury PreventionNew York Department of Health and Mental HygienePublic Health LawPublic Health Policy
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Publications
Publications
Assessing the Deterrent Effects of Ignition Interlock Devices
AbstractZeithammer, R., Macinko, J., & Silver, D. (n.d.).Publication year
2025Journal title
American journal of preventive medicineVolume
68Issue
1Page(s)
137-144AbstractIntroduction: Ignition interlock devices installed after conviction for driving under the influence of alcohol (DUI) have been shown to reduce subsequent DUI arrests (specific deterrence). However, there is little evidence on how interlock-device penalties might affect general deterrence, that is, deterring people from driving after consuming alcohol prior to a DUI conviction. Methods: A discrete choice experiment was conducted and data were analyzed in 2023 with 583 U.S.-based adults who consume alcohol at least once in the past week to assess the deterrent effects of five different penalties (fine, jail time, interlock device, license suspension, alcohol treatment) for alcohol-impaired driving under randomized sequential scenarios of high (20% chance of being caught) and low (1%) police enforcement. Participants resided in 46 states. Results: Deterrent effects of an interlock penalty, operationalized as having to install an interlock device for 1 year, are large and on par with a 20-fold increase in police enforcement activity (from 1% chance of being caught to 20%), or a $2,000 increase in the DUI fine under the status quo enforcement regime. On average, a 1-year interlock penalty had the same deterrent effect as a 10-day increase in jail time. Conclusions: Wider use of interlock devices as a DUI penalty could have large deterrent effects, independent of their ability to physically prevent the motor vehicle of an intoxicated driver from starting. The deterrent effect documented here adds to evidence on interlock devices’ overall effectiveness as well as their potential to shift DUI penalties away from criminalization (jail time) and toward immobilization and rehabilitation.Beyond social determinants: Fiscal determinants of overdose death in U.S counties, 2017–2020
AbstractLindenfeld, Z., Silver, D., Mauri, A. I., & Rothbart, M. W. (n.d.).Publication year
2025Journal title
Social Science and MedicineVolume
364AbstractA large body of research has been dedicated to understanding the relationship between social determinants of health (SDOH) and overdose death across counties in the United States (U.S). However, this literature has so far focused on demographic and socioeconomic characteristics of counties and has largely overlooked the ways in which county fiscal constraints may be associated with responses to the opioid epidemic. To address this gap, this longitudinal study uses data from the U.S Census of Governments to examine the associations between county governments’ revenues and expenditures, commonly used measures of SDOH, and overdose deaths in U.S counties from 2017 to 2020. We find that along with SDOH, higher per capita police spending, but not health expenditures, was associated with overdose deaths in U.S counties. Furthermore, we find that the link between police spending and overdose mortality depends on the amount of revenue generated through fines and forfeitures, suggesting it is a particular form of expenditures on policing – those linked to extractive practices– that is associated with overdose. This study heightens understanding on how the strategies counties undertake in generating and utilizing public resources impact overdose outcomes. Future studies should focus on measuring the causal impact of policies that significantly alter local revenue sources and expenditures on overdose deaths at the county level.Determinants of When Community Behavioral Health Clinics Partner With Emergency Response Systems: The Role of Capacity in 911 Referral and Co-response Models
AbstractMauri, A. I., Lindenfeld, Z., Willison, C., Todd, T. L., Purtle, J., & Silver, D. (n.d.).Publication year
2025Journal title
Milbank QuarterlyAbstractPolicy Points Certified community behavioral health clinics (CCBHCs) commonly partner with emergency response systems in mobile crisis response through 911 referral arrangements, wherein behavioral health practitioner–only teams respond to 911 calls, and co-response partnerships, wherein a CCBHC clinician joins a police or emergency medical services team. Both the internal staff capacity of the CCBHC and external police capacity are associated with when CCBHCs partner with emergency response systems in mobile crisis response, although their effects differ by partnership: Co-response is more likely when CCBHCs have greater internal capacity, whereas 911 referral is more common in communities with lower police capacity. Stakeholders seeking to increase CCBHC–emergency response system partnerships may need to apply different strategies depending on the type of arrangement they aim to expand. Context: Individuals with behavioral health disorders are more likely to experience substantial harm from a police encounter, prompting reforms to minimize encounters between police and people experiencing a behavioral health crisis. One strategy involves expanding partnerships between certified community behavioral health clinic (CCBHC) mobile crisis teams and emergency response systems, often through two models: 911 referral, wherein a CCBHC's behavioral health practitioner–only team responds to 911 calls, and co-response, wherein a CCBHC clinician joins a police or emergency medical services (EMS) team. We examine whether the internal capacity of the CCBHC and external police capacity influence when CCBHCs engage in these partnerships. Methods: Using data from the only national survey of CCBHCs, this study applies multivariable logistic regression to assess whether CCBHC staff capacity and police capacity are associated with CCBHC–emergency response system partnerships in mobile crisis, controlling for organizational characteristics of the CCBHC and demographic and socioeconomic features of its service area. Findings: One-third (33.0%, 95% confidence interval [CI], 26.0-40.0) of CCBHCs report a 911 referral partnership, and nearly half (48.5%, 95% CI 41.1-55.9) report a co-response arrangement. While police capacity is not significantly associated with co-response, a one standard deviation increase in police capacity corresponds to an 11.0-percentage-point (95% CI −19.5 to −2.5) decrease in the predicted probability of a 911 referral partnership. CCBHC capacity is not associated with 911 referral arrangements, but CCBHCs in the top tertile of CCBHC capacity are 19.2 (95% CI 4.3-34.2) percentage points more likely to report a co-response partnership. Conclusions: The internal capacity of CCBHCs and external police capacity are associated with when CCBHCs partner with emergency response systems in mobile crisis. Because a robust behavioral health crisis system likely requires multiple response models with varying police involvement, stakeholders may need different strategies depending on the type of partnership they aim to expand.Experiences of patient-provider concordance in healthcare among All of Us participants, 2017–2023
AbstractHolm, J., Cuevas, A., Wang, V. H. C., Pagán, J. A., & Silver, D. (n.d.).Publication year
2025Journal title
Patient Education and CounselingVolume
139AbstractObjective: To examine differences in care experiences and preferences related to patient-provider relationships across both cultural and personal patient identities. Methods: Logistic regression was used to test the associations between patient characteristics and patient survey responses using 2017–2023 data from the All of Us dataset. Results: Nearly two thirds of the All of Us participants considered it important that their providers were like them (63.2 %) and could often see them (66.3 %). The odds of reporting that it was important that their providers were like them were higher among all groups compared to non-Hispanic White participants (non-Hispanic Black: aOR 2.59 95% Confidence Interval (CI) [2.41–2.78]; Hispanic: aOR 1.42 95% CI [1.33–1.51]; non-Hispanic Asian: aOR 1.45 95% CI [1.33–1.59]; non-Hispanic Other: aOR 1.16 95% CI [1.08–1.25]). Female participants (aOR 1.29 95% CI [1.25–1.33]), those that spoke a language other than English at home (aOR 1.45 95% CI [1.38–1.53]), those with Medicaid (aOR 1.23 95% CI [1.15–1.32]) or no insurance (aOR 1.17 95% CI [1.10–1.25]) compared to those privately insured, and those with a disability (aOR 1.15 95% CI [1.11–1.20]) were more likely to report that it was very/somewhat important their provider be similar to them. Conclusions: The results of this study suggest that the dimensions of patient identity contribute to inequities in receiving culturally concordant care. Practice implications: The significant subgroup differences across all survey questions suggest that previous interventions addressing cultural competence in providers may not reach all the patient populations. Instead of a one-size-fits-all approach to improving the care experiences of different patient populations, adopting the key behaviors derived from both patient-centered and culturally competent care and by using the guiding principles of cultural humility would enable providers to tailor care that is centered on patient needs and preferences.Population, demographic and socioeconomic characteristics associated with state preemption laws in the United States, 2009-2018
AbstractPagán, J. A., Silver, D., Akiya, K., & Pomeranz, J. L. (n.d.).Publication year
2025Journal title
PloS oneVolume
20Issue
4AbstractObjective In the United States, preemption laws enacted by state governments can remove local government authority to enact policy and undermine community self-determination and local democracy. No study to date has evaluated the population, demographic, and socioeconomic characteristics associated with state preemption of public health policies. Our study identifies state characteristics associated with preemption of local paid sick leave, food and nutrition, tobacco control, and firearm safety policies. Methods We conducted a Classification and Regression Tree (CART) analysis using state-level demographic, socioeconomic, and population health indicators from 2009 to 2018 to predict state ceiling preemption of local paid sick leave, food and nutrition, tobacco control, and firearm safety policies. Results Several demographic, economic, political, and health factors best distinguish states with and without preemption in each of the four domains. Total state population was an important characteristic in all four trees and the non-Hispanic Black population was important in three trees. All other age- and race/ethnicity-related demographic variables included were important characteristics in at least one tree. Additionally, adult obesity and flu vaccination were relevant in the paid sick leave tree and firearm-deaths, suicide-deaths, and the unemployment rate were relevant in the firearm safety tree. The relationship between specific factors and preemption in each of the four domains varied depending on the location of the factor within the trees. Conclusions and relevance Specific population, demographic and economic characteristics in a state are associated with the adoption of ceiling preemption of paid sick, food and nutrition, tobacco, and firearm safety laws, but these characteristics vary by domain. Our study identified which populations within groups of states may be affected by preemption. The findings can inform whether preemption laws considered or adopted in a state may also require protective measures for population groups that could be adversely affected by these laws.Sociodemographic variation in experiences with medication shortages among US adults
AbstractFang, J., Goodman, M. S., Kaphingst, K. A., Parikh, N. S., Bae, J. Y., Silver, D., & Bather, J. R. (n.d.).Publication year
2025Journal title
Preventive Medicine ReportsVolume
51AbstractObjective: To investigate sociodemographic factors associated with prescribed and over-the-counter medication shortage experiences. Methods: We analyzed repeated cross-sectional data from the 2023 US Census Household Pulse Survey, a nationwide survey of US adults. Outcomes were based on the following question: “In the past month, have you or a member of your household been directly affected by the following?” We created binary indicators based on the following response options: (1) “Shortage of prescription medications, which includes any medicine required or provided by a healthcare provider, pharmacist, or hospital” and (2) “Shortage of over-the-counter medications, encompassing any medication available without a prescription.” Sociodemographic factors included age, gender identity, race/ethnicity, marital status, educational attainment, household income, number of children, employment status, health insurance coverage, at risk for depression/anxiety, disability status, and region. Weighted multivariable models accounted for the complex survey design and estimated adjusted odds ratios with 95 % confidence intervals. Results: We found that more experiences with prescribed and over-the-counter medication shortages were associated with middle age, transgender/other gender identity, non-Hispanic Other race/ethnicity, higher educational attainment, having at least one child, at risk for depression or anxiety, and being disabled. In contrast, fewer experiences with prescribed and over-the-counter medication shortages were associated with higher household income. Conclusions: Sociodemographic variation exist in experiences with medication shortages among US adults. These findings underscore the need to bolster the pharmaceutical supply chain to mitigate inequities in medication access.What substance use services are advertised by local governments? An analysis of data from county websites in New York state
AbstractLindenfeld, Z., Mauri, A. I., & Silver, D. (n.d.).Publication year
2025Journal title
Public HealthVolume
239Page(s)
133-135AbstractObjective: To assess the substance use disorder (SUD) prevention and response activities that county governments in New York advertise. Study design: Cross-sectional study. Methods: We coded websites of county public health, mental health, emergency, and social service departments to identify whether any government agency provided information about ten evidence-based SUD services. We calculated the number and percentage of counties advertising each service, overall and by county size (medium/large and small). Results: The most common services advertised on county websites were Resource Lists (91.4 %), Naloxone Training, Education, or Distribution (74.1 %), and Addiction/Overdose Education (62.1 %), and the least common were Syringe Exchange (31.0 %) and Anti-Stigma Training or Resources (13.8 %). When counties were assessed by population size, each service was advertised by a higher percentage of medium/large counties than small counties. Conclusions: Despite public health researchers recommending that government responses to the overdose crisis include the SUD services examined here, many counties do not provide information to their constituents about several important services. Thus, even if these services are available, they may be unknown to residents.An assessment of court fees, surcharges, and penalties for alcohol-impaired driving in five midwestern U.S. states: implications for exacerbating poverty and health inequalities
AbstractSilver, D., Bae, J. Y., Furuya, E., & Macinko, J. (n.d.).Publication year
2024Journal title
Journal of Public Health PolicyVolume
45Issue
1Page(s)
58-73AbstractDriving under the influence (DUI) remains an important threat to public health in the United States, and a substantial literature has evaluated the effectiveness of state-mandated penalties. Researchers have overlooked accelerated use of obscured fees and surcharges levied by local and state court systems added to penalties in the past 15 years. We present data regarding DUI penalties for offenders with a blood alcohol content (BAC of 0.08) and the fees and surcharges attached to them in Minnesota, Illinois, Wisconsin, Michigan, and Iowa, and variation in these within Wisconsin at four BAC levels. In all states, surcharges and fees exceed penalty fines substantially. Variation within Wisconsin is also meaningful. Our data suggest that opaque costs in state court systems add a substantial financial burden to DUI penalties, particularly for those with lower incomes. An appraisal of the deterrent role of these added costs is warranted.Beyond Laws: Governors’ Roles in Shaping State Firearm Environments, 2020–2022
Silver, D., Pomeranz, J. L., Holm, J., & Doki, M. (n.d.).Publication year
2024Journal title
American journal of preventive medicineVolume
66Issue
4Page(s)
744-749Cost-Associated Unmet Dental, Vision, And Hearing Needs Among Low-Income Medicare Advantage Beneficiaries
AbstractGupta, A., Johnston, K. J., Silver, D., Meyers, D. J., Glied, S. A., & Pagán, J. A. (n.d.).Publication year
2024Journal title
Health AffairsVolume
43Issue
10Page(s)
1392-1399AbstractMedicare Advantage (MA) supplemental benefits offered at no or low premiums are a key value proposition for low-income beneficiaries. Despite nearly $20 billion in rebate payments to MA plans for funding supplemental benefits, their quality or enrollee access is not monitored. Using 2018–19 Medicare Current Beneficiary Survey data linked to MA plan data, we found that regardless of plan benefit generosity, low-income beneficiaries were more likely to report dental, vision, and hearing unmet needs because of cost. Enrollment in plans with higher corresponding-year (that is, the same year as unmet need measurement) star ratings was associated with lower dental unmet need. Income-related disparities in dental unmet needs were lower in the highest-rated plans. However, prior-year star ratings that determined plan payments were not associated with unmet needs or disparities in those needs. Policy makers should consider monitoring supplemental benefits for equity and access, and they should assess the value added by quality bonus payments to high-rated plans for beneficiaries’ access.COVID-19 Vaccine Information Seeking Patterns and Vaccine Hesitancy: A Latent Class Analysis to Inform Practice
AbstractPiltch-Loeb, R., Silver, D., Kim, Y., & Abramson, D. (n.d.).Publication year
2024Journal title
Journal of Public Health Management and PracticeVolume
30Issue
2Page(s)
183-194AbstractContext: Throughout the COVID-19 pandemic, state and local health departments served as risk communicators to the public; however, public health practitioners have limited resources at their disposal when trying to communicate information, especially when guidance is rapidly changing. Identifying how the population gathers information across channels and which subsets of the population utilize which channels can help practitioners make the best use of these limited resources. Objective: To identify how individuals utilized different information channels to get COVID-19–related information and determine its effect on one COVID-19–related action: vaccine intentions. Design: This study applies latent class analysis to utilization of information channels to characterize information consumption patterns during the COVID-19 infodemic and then explores the relationship between these patterns and vaccine hesitancy. Setting: The data were collected from the COVID-19 Vaccine Hesitancy Survey, which is a nationally representative sample of US adults 18 years and older recruited from Social Science Research Solutions (SSRS)’s Opinion Panel. Participants: The online survey was conducted between April 7 and April 11, 2021, after the COVID-19 vaccine was available to all adults and enrolled more than 3000 respondents (n = 3014). Main Outcome Measure(s): Respondents were asked about their frequency of information seeking related to the COVID-19 vaccine, sociodemographics, and vaccine perceptions. Results: Based on fit statistics and prior research, we identified 6 latent classes that characterize information seeking: Nonseekers, Legacy, Legacy + Facebook/Instagram, Traditional Omnivore, Omnivore + Broad Social Media, and Twitter. Sociodemographics, political, economic, and COVID-19 exposure variables are associated with different patterns of seeking information about COVID-19. Membership in 3 of these classes was associated with higher rates of vaccine refusal and vaccine hesitancy. Discussion: The study has implications for public health officials and policymakers who use media channels to share news and health information with the public. Information should be tailored to the sociodemographic profiles of those users who are likely consuming information across multiple different channels.Enrollment Patterns of Medicare Advantage Beneficiaries by Dental, Vision, and Hearing Benefits
AbstractGupta, A., Silver, D., Meyers, D. J., Murray, G., Glied, S., & Pagán, J. A. (n.d.).Publication year
2024Journal title
JAMA Health ForumVolume
5Issue
1Page(s)
E234936AbstractImportance: Most Medicare beneficiaries now choose to enroll in Medicare Advantage (MA) plans. Racial and ethnic minority group and low-income beneficiaries are increasingly enrolling in MA plans. Objective: To examine whether dental, vision, and hearing supplemental benefits offered in MA plans are associated with the plan choices of traditionally underserved Medicare beneficiaries. Design, Setting, and Participants: This exploratory observational cross-sectional study used data from the 2018 to 2020 Medicare Current Beneficiary Survey linked to MA plan benefits. The nationally representative sample comprised primarily community-dwelling MA beneficiaries enrolled in general enrollment MA plans. Data analysis was performed between April and October 2023. Exposures: Beneficiary self-identified race and ethnicity and combined individual and spouse income and educational attainment. Main Outcomes and Measures: Binary indicators were developed to determine whether beneficiaries were enrolled in a plan offering any dental, comprehensive dental, any vision, eyewear, any hearing, or hearing aid benefit. Mixed-effects logistic regression models were estimated to report average marginal effects adjusted for beneficiary-level demographic and health characteristics, plan attributes, and plan availability. Results: This study included 8139 (weighted N = 31 million) eligible MA beneficiaries, with a mean (SD) age of 77.7 (7.5) years. More than half of beneficiaries (54.9%) were women; 9.8% self-identified as Black, 2.0% as Hispanic, 83.9% as White, and 4.2% as other or multiple races or ethnicities. Plan choices by dental benefits were examined among 7516 beneficiaries who were not enrolled in any dental standalone plan, by vision benefits for 8026 beneficiaries not enrolled in any vision standalone plan, and by hearing benefits for 8131 beneficiaries not enrolled in any hearing standalone plan. Black beneficiaries were more likely to enroll in plans with any dental benefit (9.0 percentage points [95% CI, 3.4-14.4]; P <.001), any comprehensive dental benefit (11.2 percentage points [95% CI, 5.7-16.7]; P <.001), any eye benefit (3.0 percentage points [95% CI, 1.0 to 5.0]; P =.004), or any eyewear benefit (6.0 percentage points [95% CI, 0.6-11.5]; P =.03) compared with White beneficiaries. Lower-income individuals (earning ≤200% of the federal poverty level) were more likely to enroll in a plan with a comprehensive dental benefit (4.4 percentage-point difference [95% CI, 0.1-7.9]; P =.01) compared with higher-income beneficiaries. Beneficiaries without a college degree were more likely to enroll in a plan with a comprehensive dental benefit (4.7 percentage-point difference [95% CI, 1.4-8.0]; P =.005) compared with those with higher educational attainment. Conclusions and Relevance: The results of this study suggest that racial and ethnic minority individuals and those with lower income or educational attainment are more likely to choose MA plans with dental or vision benefits. As the federal government prepares to adjust MA plan star ratings for health equity, implements MA payment cuts, and allows increasing flexibility in supplemental benefit offerings, these findings may inform benefit monitoring for MA..Examining the relationship between social determinants of health, measures of structural racism and county-level overdose deaths from 2017–2020
AbstractLindenfeld, Z., Silver, D., Pagán, J. A., Zhang, D. S., & Chang, J. E. (n.d.).Publication year
2024Journal title
PloS oneVolume
19Issue
5AbstractIntroduction Despite being an important determinant of health outcomes, measures of structural racism are lacking in studies examining the relationship between the social determinants of health (SDOH) and overdose deaths. The aim of this study is to examine the association between per capita revenue generated from fines and forfeitures, a novel measure of structural racism, and other SDOH with county-level overdose deaths from 2017–2020. Methods This longitudinal analysis of 2,846 counties from 2017–2020 used bivariate and multivariate Generalized Estimating Equations models to estimate associations between county overdose mortality rates and SDOH characteristics, including the fines and forfeitures measure. Results In our multivariate model, higher per capita fine and forfeiture revenue (5.76; CI: 4.76, 6.78), households receiving food stamps (1.15; CI: 0.77, 1.53), residents that are veterans (1.07; CI: 0.52, 1.63), substance use treatment availability (4.69; CI: 3.03, 6.33) and lower population density (-0.002; CI: -0.004, -0.001) and percent of Black residents (-0.7‘; CI: -1.01, -0.42) were significantly associated with higher overdose death rates. There was a significant additive interaction between the fines and forfeitures measure (0.10; CI: 0.03, 0.17) and the percent of Black residents. Conclusions Our findings suggest that structural racism, along with other SDOH, is associated with overdose deaths. Future research should focus on connecting individual-level data on fines and forfeitures to overdose deaths and other health outcomes, include measures of justice-related fines, such as court fees, and assess whether interventions aimed at increasing economic vitality in disadvantaged communities impact overdose deaths in a meaningful way.Impacts of the Affordable Care Act Medicaid Expansion on Mental Health Treatment Among Low-income Adults Across Racial/Ethnic Subgroups, 2010–2017
AbstractLieff, S. A., Mijanovich, T., Yang, L., & Silver, D. (n.d.).Publication year
2024Journal title
Journal of Behavioral Health Services and ResearchVolume
51Issue
1Page(s)
57-73AbstractThis study examines whether the Affordable Care Act (ACA) Medicaid expansion (ME) was associated with changes in racial/ethnic disparities in insurance coverage, utilization, and quality of mental health care among low-income adults with probable mental illness using the National Survey on Drug Use and Health with state identifiers. This study employed difference-in-difference models to compare ME states to non-expansion states before (2010–2013) and after (2014–2017) expansion and triple difference models to examine these changes across non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic/Latino racial/ethnic subgroups. Insurance coverage increased significantly for all racial/ethnic groups in expansion states relative to non-expansion states (DD: 9.69; 95% CI: 5.17, 14.21). The proportion low-income adults that received treatment but still had unmet need decreased (DD: −3.06; 95% CI: −5.92, −0.21) and the proportion with unmet need and no mental health treatment increased (DD: 2.38; 95% CI: 0.03, 4.73). ME was not associated with reduced disparities.Lower social vulnerability is associated with a higher prevalence of social media-involved violent crimes in Prince George’s County, Maryland, 2018–2023
AbstractBather, J. R., Silver, D., Gill, B. P., Harris, A., Bae, J. Y., Parikh, N. S., & Goodman, M. S. (n.d.).Publication year
2024Journal title
Injury EpidemiologyVolume
11Issue
1AbstractBackground: Social vulnerability may play a role in social media-involved crime, but few studies have investigated this issue. We investigated associations between social vulnerability and social media-involved violent crimes. Methods: We analyzed 22,801 violent crimes occurring between 2018 and 2023 in Prince George’s County, Maryland. Social media involvement was obtained from crime reports at the Prince George’s County Police Department. Social media application types included social networking, advertising/selling, ridesharing, dating, image/video hosting, mobile payment, instant messaging/Voice over Internet Protocol, and other. We used the Centers for Disease Control and Prevention’s Social Vulnerability Index to assess socioeconomic status (SES), household characteristics, racial and ethnic minority status, housing type and transportation, and overall vulnerability. Modified Poisson models estimated adjusted prevalence ratios (aPRs) among the overall sample and stratified by crime type (assault and homicide, robbery, and sexual offense). Covariates included year and crime type. Results: Relative to high tertile areas, we observed a higher prevalence of social media-involved violent crimes in areas with low SES vulnerability (aPR: 1.82, 95% CI: 1.37-2.43), low housing type and transportation vulnerability (aPR: 1.53, 95% CI: 1.17-2.02), and low overall vulnerability (aPR: 1.63, 95% CI: 1.23-2.17). Low SES vulnerability areas were significantly associated with higher prevalences of social media-involved assaults and homicides (aPR: 1.64, 95% CI: 1.02-2.62), robberies (aPR: 2.00, 95% CI: 1.28-3.12), and sexual offenses (aPR: 2.07, 95% CI: 1.02-4.19) compared to high SES vulnerability areas. Low housing type and transportation vulnerability (vs. high) was significantly associated with a higher prevalence of social media-involved robberies (aPR: 1.54, 95% CI:1.01-2.37). Modified Poisson models also indicated that low overall vulnerability areas had higher prevalences of social media-involved robberies (aPR: 1.71, 95% CI: 1.10-2.67) and sexual offenses (aPR: 2.14, 95% CI: 1.05-4.39) than high overall vulnerability areas. Conclusions: We quantified the prevalence of social media-involved violent crimes across social vulnerability levels. These insights underscore the need for collecting incident-based social media involvement in crime reports among law enforcement agencies across the United States and internationally. Comprehensive data collection at the national and international levels provides the capacity to elucidate the relationships between neighborhoods, social media, and population health.Medicare Advantage Plan Star Ratings and County Social Vulnerability
AbstractGupta, A., Silver, D., Meyers, D. J., Glied, S., & Pagán, J. A. (n.d.).Publication year
2024Journal title
JAMA network openVolume
7Issue
7AbstractIMPORTANCE The star rating of a Medicare Advantage (MA) plan is meant to represent plan performance, and it determines the size of quality bonuses. Consumer access to MA plans with a high star rating may vary by the extent of social vulnerability in geographic regions. OBJECTIVE To examine the association between a county’s Social Vulnerability Index (SVI) and the star rating of a county’s MA plans. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used 2023 Centers for Medicare & Medicaid Services data for all MA plans linked to 2020 county-level SVI data from the Centers for Disease Control and Prevention. Data were analyzed from March to October 2023. EXPOSURE Quintile rank of county based on composite and theme-specific SVI scores, with quartile 1 (Q1) representing the least vulnerable counties and Q5, the most vulnerable counties. The SVI is a multidimensional measure of a county’s social vulnerability across 4 themes: socioeconomic status, household characteristics (such as disability, age, and language), racial and ethnic minority status, and housing type and transportation. MAIN OUTCOMES AND MEASURES County-level mean star rating and the number of MA plans with low-rated (<3.5 stars), high-rated (3.5 or 4.0 stars), and highest-rated (≥4.5 stars) plans. RESULTS Across 3075 counties, the median county-level star rating was 4.1 (IQR, 3.9-4.3) in Q1 counties and 3.8 (IQR, 3.6-4.0) in Q5 counties (P < .001). The mean star rating of MA plans was lower (difference, −0.24 points; 95% CI, −0.28 to −0.21 points; P < .001), the number of low-rated plans was higher (incidence rate ratio, 1.81; 95% CI, 1.61-2.06; P < .001), and the number of highest-rated plans was lower (incidence rate ratio, 0.75; 95% CI, 0.70-0.81; P < .001) in Q5 counties compared with Q1 counties. Similar patterns were found across theme-specific SVI score quintiles and for 2022 star ratings. CONCLUSIONS AND RELEVANCE In this cross-sectional study, the most socially vulnerable counties were found to have the fewest highest-rated plans for MA beneficiaries. As MA enrollment grows in socially vulnerable regions, this may exacerbate regional differences in health outcomes for Medicare beneficiaries.Mental Health Referrals Among Medicare Advantage Enrollees Receiving Home-Based Annual Wellness Visits in Puerto Rico During the COVID-19 Pandemic
AbstractAkiya, K., Palacios, S., & Silver, D. (n.d.).Publication year
2024Journal title
Journal of Applied GerontologyVolume
43Issue
3Page(s)
287-292AbstractAnnual Wellness Visits (AWV) promote preventive care for older adults, yet uptake remains low. To increase AWVs, a Medicare Advantage (MA) plan in Puerto Rico contracted a medical group to provide home-based AWVs during the last quarter of 2020. Using data from 464 visits, we conducted descriptive and multivariable analysis to profile patient characteristics and identify predictors of mental health referrals. We found that 87% of patients had multiple chronic conditions, 75% were taking more than 5 medications, and the odds of a mental health referral were higher for those who also had a nutrition-related condition (AOR = 5.05, CI95: 1.76–11.88), diabetes (AOR = 3.34, CI95: 1.18–7.58), or an additional reported uncontrolled health issue (AOR = 28.18, CI95: 8.96–70.59). This strategy helped one MA plan reach high-need patients, but coordination of follow-up care is needed to ensure patients receive recommended services.One year later: What role did trust in public officials and the medical profession play in decisions to get a booster and to overcome vaccine hesitancy?
AbstractSilver, D., Kim, Y., Piltch-Loeb, R., & Abramson, D. (n.d.).Publication year
2024Journal title
Preventive Medicine ReportsVolume
38AbstractPhysicians may have an important role to play in promoting boosters as well as reducing COVID-19 vaccine hesitancy, but the relationship between hesitancy and trust in the medical profession and these behaviors has been underexplored. A representative online panel of 1,967 US adults that included oversamples of minoritized and rural populations were surveyed in April 2021 and June 2022 regarding their booster and vaccine status and intentions, their views of the medical profession, and their levels of trust in their own doctors, and national and state/local officials. Eighty percent of those vaccinated in 2021 had received a booster by 2022, while fewer than half of those initially reluctant to get a vaccine had gotten one by Wave 2 of the survey. Mean factor scores were calculated for response to a validated scale measuring trust in the medical profession. Linear and logistic regression models estimated the relationship between these factors scores and trust in other officials for those vaccinated as well initial hesitaters/refusers in Wave 1, controlling for population factors. Trust in one's own physician was associated with those vaccinated/eager to be vaccinated getting a booster, while trust in the medical profession was associated with getting a vaccine among those who had previously refused or were hesitant. Trust in other experts was not significantly associated with these behaviors, but wide confidence intervals suggest a need for future research. Innovative strategies, including mobilizing the medical community is needed to address reluctance, uncertainty, and distrust of therapeutic agents in pandemic response.Policy dissemination and implementation research
Purtle, J., Crable, E. L., Cruden, G., Lee, M., Lengnick-Hall, R., Silver, D., & Raghavan, R. (n.d.). In Dissemination and Implementation Research in Health.Publication year
2024Page(s)
511-533Protocol for creating a dataset of U.S. state alcohol-related firearm laws 2000–2022
AbstractSilver, D., Bae, J. Y., & Macinko, J. (n.d.).Publication year
2024Journal title
PloS oneVolume
19Issue
3AbstractFirearms are a major source of preventable morbidity and mortality in the United States, contributing to over 48,000 deaths in 2022 and generating societal costs in excess of $500 billion. A body of work has examined the relationship between US state level firearm laws and health outcomes, generally finding that some firearm regulations are associated with lower firearm-related mortality. Alcohol has been identified as an additional risk factor for both homicides and suicide and stronger state alcohol laws have been associated with lower rates of suicide. To date, there are no empirical studies that have investigated the impact of laws over a long period of time that target the intersection of alcohol and firearm. One reason for this may be because there is no existing dataset that includes the range of these state laws over time. This study describes the protocol for collecting, coding and operationalizing these legal data.The Impact of Medicaid Accountable Care Organizations on Health Care Utilization, Quality Measures, Health Outcomes and Costs from 2012 to 2023: A Scoping Review
AbstractHolm, J., Pagán, J. A., & Silver, D. (n.d.).Publication year
2024Journal title
Medical Care Research and ReviewVolume
81Issue
5Page(s)
355-369AbstractMost of the evidence regarding the success of ACOs is from the Medicare program. This review evaluates the impacts of ACOs within the Medicaid population. We identified 32 relevant studies published between 2012 and 2023 which analyzed the association of Medicaid ACOs and health care utilization (n = 21), quality measures (n = 18), health outcomes (n = 10), and cost reduction (n = 3). The results of our review regarding the effectiveness of Medicaid ACOs are mixed. Significant improvements included increased primary care visits, reduced admissions, and reduced inpatient stays. Cost reductions were reported in a few studies, and savings were largely dependent on length of attribution and years elapsed after ACO implementation. Adopting the ACO model for the Medicaid population brings some different challenges from those with the Medicare population, which may limit its success, particularly given differences in state Medicaid programs.Documenting the Impact Potential of a Menthol Cigarette Ban at Point-of-Sale: A Photograph-Based Analysis of the Presence and Placement of Menthol Versus Regular Cigarette Packs on the Shelves of Tobacco Retail Outlets in New York City
AbstractKirchner, T. R., Guttentag, A., Vantu, A., & Silver, D. (n.d.).Publication year
2023Journal title
Nicotine and Tobacco ResearchVolume
25Issue
1Page(s)
28-35AbstractIntroduction: To investigate the absolute and proportionate number of menthol versus regular cigarette packs displayed on the shelves inside tobacco retail outlets (TROs) across New York City (NYC). Aims and Methods: Photographic surveillance methods were used to capture the presence and proportionate amount of all visible cigarette packs on the shelves inside N = 160 TROs. Statistical analyses examined the absolute and proportionate number of menthol packs in each TRO as a function of NYC borough, the local TRO environment, population smoking rates derived from the NYC Community Health Survey, and other demographic indicators from the American Community Survey. Results: The total number of cigarette packs on the shelves of each TRO and the proportion of menthol packs varied significantly across TROs, averaging about one-quarter of all packs displayed (M = 0.274; SD =. 15). Modeling results indicate that the proportion of menthol packs displayed was significantly greater in areas with elevated population smoking rates (odds ratio [OR] = 1.03, CI: 1.01-1.06) and density of TROs per 1000 residents (OR = 1.23; CI: 1.01-1.49), although these associations varied in complex ways with the proportion living under the federal poverty level and the proportion under age 18 years residing within each zip-code. Conclusions: Results of this study demonstrate the utility of photograph-based TRO audit methods for objective, reliable documentation of the presence and proportionate amount of menthol versus other cigarette pack types on TRO shelves and highlight the need to account for sources of variation between small areas when examining the TRO product landscape and evaluating the effectiveness of regulatory actions against menthol. Implications: This study describes use of a "hands-free"surveillance technique that offers valuable advantages over traditional retailer surveillance techniques. Comprehensive photographic surveillance data collection allows for more objective measurements of, in this case, the retail outlet's tobacco power wall, as multiple coders can review the same images and interrater reliability can be empirically tested.Firearm Laws Enacted by Municipalities in 6 States With Diverse Policy Frameworks
AbstractPomeranz, J. L., Silver, D., Lieff, S. A., & McNeill, E. (n.d.).Publication year
2023Journal title
American journal of preventive medicineVolume
64Issue
5Page(s)
642-649AbstractIntroduction: Firearm violence is a public health crisis. Municipalities are frequently prevented from adopting firearm-related laws because of state preemption―when the state limits local authority to enact laws on a specific topic. Yet, it is unknown the extent to which municipalities enact firearm-related laws under varying preemption regimes, the content of such laws, and how municipal laws relate to the state's firearm-policy framework. Methods: A purposeful sample of 6 states with diverse preemption laws were chosen; 3 with robust preemption: South Carolina, Maryland, and Arizona; 1 with moderate preemption: Nebraska; and 2 without preemption: Connecticut and New York. Using Lexis+, municipal codes as of December 31, 2020 were identified, and the policy topics were evaluated and compared with the state's policy framework. Counties representing the municipalities identified were characterized using public use data. Results: In total, 613 municipal policies were identified, covering 56 topics. The number of policy topics enacted by at least 1 municipality in the state included 18 for Arizona, 21 for Connecticut, 24 for Maryland, 25 for Nebraska, 40 for New York, and 28 for South Carolina. The most common policy identified was restricting public discharge in community-centered locations. Local laws in preemption states replicated state requirements or were consistent with savings clauses expressly allowing local action. New York City, a municipality in a state without preemption, enacted laws covering the most policy topics of the municipalities identified. Conclusions: When not constrained by state preemption, local lawmakers actively passed firearm-related legislation. Many such laws are specific to local contexts and may reflect local lawmakers’ responsiveness to constituent concerns.Is patients' trust in clinicians related to patient-clinician racial/ethnic or gender concordance?
AbstractGreene, J., Silver, D., Verrier, E., & Long, S. K. (n.d.).Publication year
2023Journal title
Patient Education and CounselingVolume
112AbstractObjective: To examine the relationship between patient-clinician concordance (racial/ethnic and gender) and patients’ trust in their regular clinician. Methods: This mixed methods study used the 2019 U.S. Health Reform Monitoring Survey to examine concordance and patient trust in clinicians, and semi-structured interviews with 24 participants to explore patients’ perceptions of how concordance relates to trust in their clinician. Results: Almost six in ten adults (59.8%) who had a regular clinician reported having trust in their clinician. White, Black, and Latino participants were similarly likely to report trust. Those with racial/ethnic concordant clinicians were 7.5 percentage points more likely to report trust than were those with non-concordant clinicians (62.4% vs 54.9%). This finding was consistent for men and women, and did not differ significantly across racial and ethnic groups. In interviews, while almost all participants described having trusted non-racial/ethnic concordant clinicians, several described immediately trusting concordant clinicians. In contrast, we did not observe a consistent relationship between patient-clinician gender concordance and trust. Conclusion: The findings underscore the importance of increasing the number of Black and Latino clinicians, and also highlight that all clinicians need to work hard to build trust with patients from different racial/ethnic backgrounds.Recreational cannabis legislation and binge drinking in U.S. adolescents and adults
AbstractGonçalves, P. D., Bruzelius, E., Levy, N. S., Segura, L. E., Livne, O., Gutkind, S., Boustead, A. E., Hasin, D. S., Mauro, P. M., Silver, D., Macinko, J., & Martins, S. S. (n.d.).Publication year
2023Journal title
International Journal of Drug PolicyVolume
118AbstractBackground: Recreational cannabis laws (RCLs) may have spillover effects on binge drinking. Our aims were to investigate binge drinking time trends and the association between RCLs and changes in binge drinking in the United States (U.S.). Methods: We used restricted National Survey on Drug Use and Health data (2008-2019). We examined trends in the prevalence of past-month binge drinking by age groups (12-20, 21-30, 31-40, 41-50, 51+). Then, we compared model-based prevalences of past-month binge drinking before and after RCL by age group, using multi-level logistic regression with state random intercepts, an RCL by age group interaction term, and controlling for state alcohol policies. Results: Binge drinking declined overall from 2008 to 2019 among people aged 12-20 (17.54% to 11.08%), and those aged 21-30 (43.66% to 40.22%). However, binge drinking increased among people aged 31+ (ages 31-40: 28.11% to 33.34%, ages 41-50: 25.48% to 28.32%, ages 51+: 13.28% to 16.75%). When investigating model-based prevalences after versus before RCL, binge drinking decreased among people aged 12-20 (prevalence difference=-4.8%; adjusted odds ratio (aOR)=0.77, [95% confidence interval (CI) 0.70-0.85]), and increased among participants aged 31-40 (+1.7%; 1.09[1.01-1.26]), 41-50 (+2.5; 1.15[1.05-1.26]) and 51+ (+1.8%; 1.17[1.06-1.30]). No RCL-related changes were noted in respondents ages 21-30. Conclusions: Implementation of RCLs was associated with increased past-month binge drinking in adults aged 31+ and decreased past-month binge drinking in those aged < 21. As the cannabis legislative landscape continues to change in the U.S., efforts to minimize harms related to binge drinking are critical.