Jose Pagan
Jose Pagan
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Chair and Professor of the Department of Public Health Policy and Management
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Professional overview
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Dr. Pagán received his PhD in economics from the University of New Mexico and is a former Robert Wood Johnson Foundation Health & Society Scholar with expertise in health economics and population health. He has led research, implementation, and evaluation projects on the redesign of health care delivery and payment systems. He is interested in population health management, health care payment and delivery system reform, and the social determinants of health. Over the years his research has been funded through grants and contracts from the Department of Defense, the Agency for Healthcare Research and Quality, the National Institutes of Health, the Centers for Medicare & Medicaid Services, the European Commission, and the Robert Wood Johnson Foundation, among others.
Dr. Pagán is Chair of the Board of Directors of NYC Health + Hospitals, the largest public healthcare system in the United States. He also served as Chair of the National Advisory Committee of the Robert Wood Johnson Foundation’s Health Policy Research Scholars and was a member of the Board of Directors of the Interdisciplinary Association for Population Health Science and the American Society of Health Economists.
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Areas of research and study
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Applied EconomicsHealth EconomicsPopulation HealthPublic Health Policy
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Publications
Publications
Association between subway iron particulate matter exposure and respiratory disease in New York City
AbstractPagan, J., Melicharová, S., Strobel, S., Zhang, Y., Pagán, J. A., Hu, A., Weiner, M., & Ghandehari, M. (n.d.).Publication year
2026Journal title
PLOS global public healthVolume
6Issue
1Page(s)
e0005335AbstractParticulate matter exposure is linked to increased morbidity and mortality. Iron-rich particulate matter (PM2.5), common in rapid transit systems, is a potential but understudied contributor to respiratory illness. Using electronic health records (EHR) from 452,272 patients in the INSIGHT Clinical Research Network in New York City (2020-2023), we examined whether local iron exposure is associated with asthma, chronic obstructive pulmonary disease (COPD), breathing difficulties, or respiratory inhaler use. Iron exposure was estimated using particulate matter measurements from New York City (NYC) subway stations, linked to each patients residential census block group. To account for potential non-linear relationships, we applied linear probability models and an adjacent block group estimator with paired fixed effects to assess respiratory outcomes across deciles of iron exposure. We found that the relative risk of developing asthma, COPD, or breathing difficulties increased by 6-15% between the lowest two exposure deciles. Beyond this range, there was no significant association between iron exposure and respiratory disease. This suggests that iron exposure from rapid transit is associated with respiratory disease primarily at lower exposure levels, with limited health benefits from marginal reductions in iron exposure at already high exposure levels.Association of childhood maltreatment with hypertension outcomes in adulthood: A systematic review and meta-analysis
AbstractPagan, J., Niu, L., Liu, S., Chen, R., Wang, Y., Zhang, J., Lin, S., Li, Y., Pagán, J. A., Moran, A. E., & Diaz, A. (n.d.).Publication year
2026Journal title
Child abuse & neglectVolume
172Page(s)
107840AbstractChildhood maltreatment has been associated with chronic stress, systemic inflammation, immune deregulation, and behavioral risk factors, all of which may increase long-term risk for high blood pressure. Prior to this study, no meta-analysis has systematically quantified the relationship between childhood maltreatment and high blood pressure in adulthood.Cost-Effectiveness of Expanding Home Cook Interventions for Salt Reduction in China
AbstractPagan, J., Li, X., Lv, Y., Gao, X., Fan, B., He, Y., Zhao, S., Liu, F., Li, N., Wu, Q., Li, W., Zhang, D., Marklund, M., Pagán, J. A., Yan, L. L., Moran, A. E., Wu, J., & Li, Y. (n.d.).Publication year
2026Journal title
American journal of preventive medicineVolume
70Issue
4Page(s)
108203AbstractExcessive salt intake is a major risk factor for cardiovascular disease and premature mortality in China and globally. A recent cluster RCT demonstrated the effectiveness of home cook interventions in reducing salt intake and blood pressure among participants from 6 provinces in China. Yet, it remains unclear whether expanding these interventions across China would be cost-effective.Ghost gun recovery and firearm deaths in California, 2014-2023
AbstractPagan, J., Bather, J. R., Mauri, A. I., Lindenfeld, Z., Rouhani, S., Chen, R., Fang, J., Pagán, J. A., Silver, D., & Goodman, M. S. (n.d.).Publication year
2026Journal title
Journal of epidemiology and community healthAbstractWe investigated whether ghost gun recovery rates are significantly associated with firearm mortality rates in the following year across California's 58 counties from 2014 to 2023.Implementation Strategies to Enhance Safety-Net Hospitals' Adoption of Screening, Brief Intervention, and Referral to Treatment for Opioid Use Disorder
AbstractPagan, J., Lindenfeld, Z., Franz, B., Fenstemaker, C., Lai, A. Y. Y., Pagan, J. A., Cronin, C. E., & Chang, J. E. E. (n.d.).Publication year
2026Journal title
Journal of general internal medicineVolume
41Issue
1Page(s)
26-34AbstractTo support adoption of Screening, Brief Intervention, and Referral to Treatment (SBIRT) for opioid use disorder (OUD), hospitals are likely to benefit from implementation strategies that are responsive to their unique environments. Yet there remains a gap in knowledge regarding which implementation strategies are needed to support SBIRT implementation and sustainment for OUD within safety-net hospitals.Overall and Avoidable Healthcare Utilization among Heterogeneous Hispanic/Latino Ethnic Groups with Cognitive Impairment in the Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA)
AbstractPagan, J., Fernandez Cajavilca, M., Finik, J., Ðoàn, L. N., Pagán, J. A., Wu, B., Fletcher, J., & Sadarangani, T. (n.d.).Publication year
2026Journal title
Journal of racial and ethnic health disparitiesAbstractLatino individuals represent one of the fastest-growing demographic groups in the United States, and the impact of dementia is rising within this population. Despite this growth, most research on healthcare utilization has predominantly focused on non-Hispanic White populations. The limited body of literature that does include Latino populations often treats them as a monolithic racial/ethnic category, which overlooks intra-group heterogeneity. As a result, little is known about how healthcare utilization patterns relate to cognitive impairment status across specific Latino ethnic groups.Proportion of Fentanyl Reports in Illicit Drug Seizures and Opioid Mortality
AbstractPagan, J., Dahlen, A., Lei, F., Agyabeng, K., Chen, R., Johnson, C. E., Amaro, G., Spinnler, J., Khezri, M., Pagán, J. A., Healton, C., & Farhat, T. M. (n.d.).Publication year
2026Journal title
JAMA health forumVolume
7Issue
1Page(s)
e256286AbstractThe monthly opioid overdose death rate in the US has declined by 50% from its peak in the summer of 2023 through fall of 2024, and the factors associated with this decline are not fully understood.Remote work and loneliness: Evidence from a nationally representative sample of employed U.S. adults
AbstractPagan, J., He, T., Wei, L., Goodman, M. S., Pagán, J. A., Cuevas, A. G., & Bather, J. R. (n.d.).Publication year
2026Journal title
Journal of affective disordersVolume
393Issue
Pt BPage(s)
120456AbstractTo examine whether remote workdays are associated with loneliness among employed adults in the United States.Strategies to Support Care Transitions for Patients With Opioid Use Disorder: Pathways and Partnerships for Success
AbstractPagan, J., Lindenfeld, Z., Chang, J. E. E., Fenstemaker, C., Lai, A. Y. Y., Pagán, J. A., Cronin, C. E., Shelley, D. R., & Franz, B. (n.d.).Publication year
2026Journal title
Journal of primary care & community healthVolume
17Page(s)
21501319251387820AbstractThe Screening, Brief Intervention, and Referral to Treatment (SBIRT) model has been adapted for hospitals to address opioid use disorder (OUD). While most hospitals conduct screening and brief interventions, many do not offer referrals to further treatment, often due to limited external partnerships. There is limited evidence on which types of partnerships hospitals should prioritize to support care transitions.A quasi-experimental study of New York City's sodium warning regulation and hypertension prevalence, 2005-2020
AbstractPagan, J., Maxey, N. J., Pagán, J. A., Rhodes-Bratton, B., Phalke, A., Wizentier, M. M. M., Kaphingst, K. A., Goodman, M. S., & Bather, J. R. (n.d.).Publication year
2025Journal title
Preventive medicine reportsVolume
56Page(s)
103152AbstractTo quantify temporal trends in age-adjusted hypertension prevalence in New York City before and after implementation of a menu labeling regulation requiring sodium warning icons at chain restaurants.A quasi-experimental study of New York City's sodium warning regulation and hypertension prevalence, 2005–2020
AbstractPagan, J., Maxey, N. J., Pagán, J. A., Rhodes-Bratton, B., Phalke, A., Wizentier, M. M., Kaphingst, K. A., Goodman, M., & Bather, J. R. (n.d.).Publication year
2025Journal title
Preventive Medicine ReportsVolume
56AbstractObjective: To quantify temporal trends in age-adjusted hypertension prevalence in New York City before and after implementation of a menu labeling regulation requiring sodium warning icons at chain restaurants. Methods: Using data from the New York City Community Health Survey, segmented regression models assessed: (1) the average annual percent change (AAPC) of age-adjusted hypertension prevalence during the pre-regulation period (2005–2015), (2) the annual percent change (APC) from 2015 to 2016 (regulation onset association), (3) the AAPC of age-adjusted hypertension prevalence during the regulation period (2016–2020), and (4) the percentage-point difference between the AAPCs of the pre-regulation and regulation periods. Results: We found a statistically significant average annual percent increase in the age-adjusted hypertension prevalence among the Hispanic population during the pre-regulation period (2005–2015 AAPC: 1.3 %, 95 % CI: 0.3 % to 2.3 %). The regulation's onset was significantly associated with a 4.2 % (95 % CI: 0.4 % to 8.0 %) increase in the age-adjusted hypertension prevalence among females from 2015 to 2016. During the regulation era, we observed statistically significant average annual percent decreases in age-adjusted hypertension prevalence among Black (2016–2020 AAPC: −1.9 %; 95 % CI: −2.5 % to −1.3 %) and female (2016–2020 AAPC: −3.5 %; 95 % CI: −5.0 % to −2.1 %) subgroups. Conclusions: Findings suggest a potential positive impact of the sodium warning regulation on hypertension prevalence. The decreasing trends in hypertension prevalence among female and Black populations suggest that sodium reduction policies may have differential impacts across subgroups. These empirical insights underscore the importance of sustained sodium reduction policies.Adolescent utilization of school based mental health services in the United States
AbstractPagan, J., Grunin, L., Pagán, J. A., Yu, G., Squires, A., & Cohen, S. S. (n.d.).Publication year
2025Journal title
International journal of mental health systemsVolume
19Issue
1Page(s)
27AbstractOver 14 million adolescents have a diagnosable mental, behavioral, or emotional disorder yet only 20% receive adequate mental health services. There is a critical need to identify accessible and effective pathways to treatment. School based mental health services (SBMHS) are an optimal setting for timely identification, effective management, and convenient delivery of evidence-based mental health care.Cost-effectiveness of population-based screening for chronic kidney disease among the general population and adults with diabetes in China : a modelling study
AbstractPagan, J., Wen, F., Wang, J., Yang, C., Wang, F., Li, Y., Zhang, L., & Pagán, J. A. (n.d.).Publication year
2025Journal title
The Lancet Regional Health - Western PacificVolume
56AbstractBackground: Despite the majority of patients with chronic kidney disease (CKD) live in low- and middle-income countries, most evidence on screening strategies is derived from high-income countries, where the contexts differ significantly. This study aims to assess the cost-effectiveness of population-based CKD screening strategies in both the general population and adults with diabetes in China. Methods: A validated microsimulation model of CKD was developed to evaluate the costs and health consequences of population-based CKD screening strategies from a societal perspective. A cohort of the population aged 45 years in China was simulated over their lifetime. Model parameters were estimated based on the existing literature and various data sources in China. Main outcomes included the averted number of cases with cardiovascular disease (CVD) and kidney failure with replacement therapy (KFRT) under the population-based screening strategy compared with usual care, and the incremental cost-effectiveness ratios (ICERs). CKD screening with different frequencies and for different age groups in both the general population and adults with diabetes were considered. One-way sensitivity analyses were performed to assess the robustness of the results. Findings: The ICER of annual screening starting at 45 years of age was $10,588 per quality-adjusted life year (QALY) for the general population and $9184 per QALY for adults with diabetes. Other screening strategies were also cost-effective compared to usual care, with ICERs less than three times the per-capita gross domestic product of China ($35,501). The most prominent absolute decrease in lifetime incidence of KFRT and CVD were also observed with the annual screening strategy in both the general population and in adults with diabetes. Specifically, the decreases were 1.88 and 8.55 per 1000 individuals for KFRT, and 35.07 and 19.92 per 1000 individuals for CVD, respectively. Interpretation: CKD screening in both the general population and adults with diabetes is cost-effective and could avert substantial numbers of KFRT and CVD cases in China. Funding: This study was supported by grants from National Natural Science Foundation of China ( 72125009), National Key Research and Development Program of China ( 2022YFF1203001), National High Level Hospital Clinical Research Funding (State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, 24QZ007), Peking University Medicine Sailing Program for Young Scholars’ Scientific & Technological Innovation ( BMU2023YFJHMX014), Young Elite Scientists Sponsorship Program by CAST ( 2022QNRC001), and CAMS Innovation Fund for Medical Sciences ( 2019-I2M-5–046).Cost-effectiveness of population-based screening for chronic kidney disease among the general population and adults with diabetes in China: a modelling study
AbstractPagan, J., Wen, F., Wang, J., Yang, C., Wang, F., Li, Y., Zhang, L., & Pagán, J. A. (n.d.).Publication year
2025Journal title
The Lancet regional health. Western PacificVolume
56Page(s)
101493AbstractDespite the majority of patients with chronic kidney disease (CKD) live in low- and middle-income countries, most evidence on screening strategies is derived from high-income countries, where the contexts differ significantly. This study aims to assess the cost-effectiveness of population-based CKD screening strategies in both the general population and adults with diabetes in China.Diabetes Management Through Remote Patient Monitoring: A Mixed-Methods Evaluation of Program Enrollment and Attrition
AbstractPagan, J., Su, D., Michaud, T. L., Ern, J., Li, J., Chen, L., Li, Y., Shi, L., Zhang, D., Andersen, J., & Pagán, J. A. (n.d.).Publication year
2025Journal title
Healthcare (Basel, Switzerland)Volume
13Issue
7AbstractDespite the growing use of remote patient monitoring (RPM) in diabetes management, few studies have assessed program enrollment and attrition. This study adopted a mixed-methods approach to examining factors linked to program enrollment and attrition amongst a large sample of patients who went through RPM in diabetes management. Based on quantitative data from the Remote Interventions Improving Specialty Complex Care program conducted in Nebraska from 2014 to 2018, chi-squared or tests were used to compare three groups of patients with diabetes who had been contacted for program participation: those who completed the intervention, withdrew from the intervention, or declined to participate. Logistic regression was used to identify factors associated with program dropout. Inductive thematic analysis was conducted to assess patient feedback based on semi-structured interviews with patients from the three groups. Out of the 1993 patients with diabetes invited for participation, 13% (n = 256) declined to participate, 16% (n = 317) withdrew before completion, and 71% (n = 1420) completed the intervention. Being younger or having poorer health (as indicated by higher blood glucose or blood pressure) at the baseline was associated with higher odds of program withdrawal. The top reason patients cited for declining participation or withdrawal from RPM was not having enough time to complete the intervention. Patients who declined to participate mentioned that an offer of incentives or more information at the beginning of the intervention may increase their motivation for participation. Being younger or having poorer health at the baseline was associated with higher odds of withdrawing from the RPM program. Future RPM programs can increase program retention by becoming more responsive to the health needs of vulnerable patients who struggle with managing their diabetes or related comorbidities at the baseline.Experiences of patient-provider concordance in healthcare among All of Us participants, 2017-2023
AbstractPagan, J., Holm, J., Cuevas, A., Wang, V. H.-C. H., Pagán, J. A., & Silver, D. (n.d.).Publication year
2025Journal title
Patient education and counselingVolume
139Page(s)
109258AbstractTo examine differences in care experiences and preferences related to patient-provider relationships across both cultural and personal patient identities.Experiences of patient-provider concordance in healthcare among All of Us participants, 2017–2023
AbstractPagan, J., Holm, J., Cuevas, A., Wang, V. H., Pagán, J. A., & Silver, D. R. (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.Forging hospital and community partnerships to enable care coordination for opioid use disorder
AbstractPagan, J., Lindenfeld, Z., Franz, B., Lai, A. Y. Y., Pagán, J. A., Fenstemaker, C., Cronin, C. E., & Chang, J. E. E. (n.d.).Publication year
2025Journal title
Addiction science & clinical practiceVolume
20Issue
1Page(s)
37AbstractPrograms that aim to increase access to substance use disorder (SUD) treatment in hospital-based settings have proliferated in recent years. These efforts include transitional opioid programs (TOPs), which navigate patients to community-based SUD treatment programs post-discharge. Successful navigation from TOPs to outpatient treatment hinges on effective coordination between hospitals and post-discharge endpoints, yet it is unclear how hospitals can best develop effective partnerships with outpatient treatment organizations. The objective of this study is to synthesize the common themes underpinning the development of partnerships to facilitate care transitions between TOPs and ongoing SUD treatment.Forging hospital and community partnerships to enable care coordination for opioid use disorder
AbstractPagan, J., Lindenfeld, Z., Franz, B., Lai, A., Pagán, J. A., Fenstemaker, C., Cronin, C. E., & Chang, J. E. (n.d.).Publication year
2025Journal title
Addiction Science and Clinical PracticeVolume
20Issue
1AbstractBackground: Programs that aim to increase access to substance use disorder (SUD) treatment in hospital-based settings have proliferated in recent years. These efforts include transitional opioid programs (TOPs), which navigate patients to community-based SUD treatment programs post-discharge. Successful navigation from TOPs to outpatient treatment hinges on effective coordination between hospitals and post-discharge endpoints, yet it is unclear how hospitals can best develop effective partnerships with outpatient treatment organizations. The objective of this study is to synthesize the common themes underpinning the development of partnerships to facilitate care transitions between TOPs and ongoing SUD treatment. Methods: Qualitative study with staff and providers from hospitals affiliated with four safety-net health systems (n = 21) and leaders from community-based organizations (CBOs) and treatment facilities that had established referral partnerships with one of the four health systems in our study (n = 4). Results: Analysis of interview transcripts revealed seven common themes that underpinned the development of care transitions partnerships: (1) Active, intentional outreach; (2) Responding to a community need; (3) External Enabling Factors; (4) Leveraging reputations and community connections; (5) Focusing on operations; (6) Reciprocal relationships; and (7) Building Infrastructure and Processes to Ensure Collaboration. The seven identified themes were categorized into three groups corresponding to different partnership development stages. The first group revolves around the initial stage of meeting and developing a relationship (themes #1–4). The second set focuses on navigating and resolving challenges that arise in the partnership (themes #5–6). Lastly, the third group pertains to sustaining a partnership long-term (theme #7). Conclusions: This study identifies seven core themes underlying the development of care transition partnerships for SUD patients within four safety net health systems and their CBO partners. These themes demonstrate how partner organizations can establish the trust, reciprocity, and commitment necessary to support patients through the critical transition period.Implementation Strategies to Enhance Safety-Net Hospitals’ Adoption of Screening, Brief Intervention, and Referral to Treatment for Opioid Use Disorder
AbstractLindenfeld, Z., Franz, B., Fenstemaker, C., Lai, A., Pagan, J., Cronin, C. E., & Chang, J. E. (n.d.).Publication year
2025Journal title
Journal of general internal medicineAbstractBackground: To support adoption of Screening, Brief Intervention, and Referral to Treatment (SBIRT) for opioid use disorder (OUD), hospitals are likely to benefit from implementation strategies that are responsive to their unique environments. Yet there remains a gap in knowledge regarding which implementation strategies are needed to support SBIRT implementation and sustainment for OUD within safety-net hospitals. Objectives: To obtain expert consensus on the most effective implementation strategies to enhance the adoption of SBIRT for OUD in safety-net hospitals. Design and Setting: A modified Delphi study, with two rounds of online surveys. Participants: Eighteen US-based experts from within the fields of OUD-focused health services research, addiction medicine, and emergency medicine. Main Measures: The primary outcome was consensus on 35 potential SBIRT implementation strategies, ranked on a 5-point Likert scale across three domains: Effectiveness, Feasibility, Impact on Equity. Consensus across respondents within both rounds was evaluated using the interquartile range. If the IQR was 1 or below on the 0 to 5 Likert scale, consensus was considered obtained. Items with a median value of 4 or higher were considered high priority. Results: Following two rounds of ranking, consensus was achieved for all survey items. In total, 62.85% strategies (n = 22) were rated as High in Effectiveness, 20.0% (n = 7) were rated as High in Feasibility, and 11.42% (n = 4) were rated High in Impact on Equity. Seven strategies ranked high in two areas, with three—Identify and Prepare Champions, Identify Early Adopters, and Conduct Educational Meetings—ranked as highly effective and feasible. Conclusions: This consensus process provides strong support for implementation strategies that can be used to guide future practice and study. This work can encourage implementation of SBIRT for OUD within safety-net hospitals, and set the stage for future studies to evaluate the impact of different implementation strategies on patient outcomes following SBIRT.Need of the hour : A service failure recovery reorientation for U.S. hospitals
AbstractPagan, J., Chakraborty, S., & Pagán, J. A. (n.d.).Publication year
2025Journal title
Health Care Management ReviewAbstractIssue Many hospitals in the United States are facing significant postpandemic operational challenges largely as a result of increasing demand for health care services. Operational issues increase the risk of service failures. Improving the patient experience after service failures may lead to better outcomes for both patients and hospitals. Critical Theoretical Analysis Drawing support from service failure recovery and quality management paradigms, we suggest that hospitals could periodically obtain deidentified patient feedback data drawn from multiple sources - including social media - to build a comprehensive patient experience dashboard that can be used to improve health care quality. Insight/Advance We offer an overarching conceptual framework to support organizational learning and make hospitals more adaptive to patient feedback. Staff members and leaders could examine patient feedback data to identify service failures and take appropriate action to prevent their recurrence in hospitals. A patient experience dashboard can be developed to document and visualize remedial actions taken by hospitals against each past service failure and shared with all stakeholders. Practice Implications Reorienting health care as a service where hospitals immediately listen to patients and promptly address their questions and concerns may help to strengthen the continuity of health care services offered by hospitals as well as improve their financial position, quality of care, and the overall patient experience.Optimizing access to fruits and vegetables in rural communities: A decision-making model for the placement of produce markets
AbstractPagan, J., Pérez, E., Johnson, C. M., Li, Y., & Pagán, J. A. (n.d.).Publication year
2025Journal title
PloS oneVolume
20Issue
9Page(s)
e0331545AbstractMany rural communities experience limited access to fruits and vegetables (FV) and may benefit from food environment interventions to increase the number of produce markets selling FV. Systems analysis is an innovative approach for informing policy, systems, and environmental (PSE) change interventions for the food retail environment. However, there has been little research. This study describes a new decision-making model that optimizes placement of new FV markets in a rural community in Texas based on combinations of three intervention factors: recommended driving distance to nearest produce market, service capacity of new and existing FV markets, and financial resources. Models estimated the potential effects of three intervention outcomes: the number of new FV markets, the ratio of fast food outlets to FV markets, and population coverage. Secondary sources of data were used in the models. The analysis tested 27 different interventions and compared effects to a benchmark. The smallest increase in population coverage or the local population's access to FV was 19% compared to benchmark, while other interventions increased access to 100%. Models showed that the largest relative gain in access to FV, 29% to 37% for the local population, was at a lower level of financial resource availability ($1516171819-20,000). Findings provide evidence for the potential effects of food environment changes for one rural Texas community. Stakeholders can generate insights to inform context-specific decisions about their communities. In addition, this new decision-making model can be adapted for other communities to support PSE change interventions for nutrition.Population, demographic and socioeconomic characteristics associated with state preemption laws in the United States, 2009-2018
AbstractPagan, J., Pagán, J. A., Silver, D. R., Akiya, K., & Pomeranz, J. L. (n.d.).Publication year
2025Journal title
PloS oneVolume
20Issue
4 APRILAbstractObjective 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.Population, demographic and socioeconomic characteristics associated with state preemption laws in the United States, 2009-2018
AbstractPagan, J., Pagán, J. A., Silver, D., Akiya, K., & Pomeranz, J. L. (n.d.).Publication year
2025Journal title
PloS oneVolume
20Issue
4Page(s)
e0321184AbstractIn 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.Projected Prevalence and Economic Burden of Alzheimer's Disease and Related Dementias in China: Regional Disparities and Policy Implications
AbstractPagan, J., Liu, X., Chen, S., Zhang, D., Gu, Y., Li, G., Wu, B., Pagán, J. A., Zhang, L., & Li, Y. (n.d.).Publication year
2025Journal title
Health data scienceVolume
5Page(s)
0377AbstractChina has the largest population with Alzheimer's disease and related dementias (ADRDs) globally, and rapid population aging is expected to drive a substantial increase in cases. This study projects ADRD prevalence and associated economic burdens across provinces in China from 2025 to 2060. Using data from the China Health and Retirement Longitudinal Study (CHARLS) supplemented by national demographic and provincial statistics, we projected the prevalence and care costs of ADRD for each of the 31 provinces in China from 2025 to 2060. Cost projections included formal care expenses and informal caregiving valued through replacement cost methods. We conducted uncertainty analysis to provide robust estimates for ADRD prevalence and costs. By 2060, ADRD cases in China are projected to reach approximately 49.89 million, with the highest prevalence and economic burden concentrated in provinces such as Shandong, Sichuan, Jiangsu, Henan, and Guangdong. Formal care costs alone are expected to exceed $1 trillion annually, while the total economic value-including informal caregiving-could surpass $5 trillion. Geographic disparities highlight that Eastern and Central regions, with a higher proportions of older adults, will bear disproportionate costs. Informal caregiving is projected to constitute 60% to 80% of total ADRD-related costs. China faces an unprecedented rise in ADRD-related economic burden over the next 4 decades, with substantial regional disparities. Strengthening long-term care infrastructure, expanding financial and social support for caregivers, and implementing regionally tailored healthy aging policies are essential to ensuring equitable and sustainable ADRD care across China.