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
Beyond social determinants: Fiscal determinants of overdose death in U.S counties, 2017–2020
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
What substance use services are advertised by local governments? An analysis of data from county websites in New York state
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
Beyond Laws: Governors’ Roles in Shaping State Firearm Environments, 2020–2022
Cost-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
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
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
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 (1–).Publication year
2024Page(s)
511-533Protocol for creating a dataset of U.S. state alcohol-related firearm laws 2000–2022
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
Firearm Laws Enacted by Municipalities in 6 States With Diverse Policy Frameworks
Is patients' trust in clinicians related to patient-clinician racial/ethnic or gender concordance?
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.Stakeholder Perspectives on Data-Driven Solutions to Address Cardiovascular Disease and Health Equity in New York City
AbstractLindenfeld, Z., Pagán, J. A., Silver, D., McNeill, E., Mostafa, L., Zein, D., & Chang, J. E. (n.d.).Publication year
2023Journal title
AJPM FocusVolume
2Issue
3AbstractIntroduction: There is growing recognition of the importance of addressing the social determinants of health in efforts to improve health equity. In dense urban environments such as New York City, disparities in chronic health conditions (e.g., cardiovascular disease) closely mimic inequities in social factors such as income, education, and housing. Although there is a wealth of data on these social factors in New York City, little is known about how to rapidly use available data sources to address health disparities. Methods: Semistructured interviews were conducted with key stakeholders (N=11) from across the public health landscape in New York City (health departments, healthcare delivery systems, and community-based organizations) to assess perspectives on how social determinants of health data can be used to address cardiovascular disease and health equity, what data-driven tools would be useful, and challenges to using these data sources and developing tools. A matrix analysis approach was used to analyze the interview data. Results: Stakeholders were optimistic about using social determinants of health data to address health equity by delivering holistic care, connecting people with additional resources, and increasing investments in under-resourced communities. However, interviewees noted challenges related to the quality and timeliness of social determinants of health data, interoperability between data systems, and lack of consistent metrics related to cardiovascular disease and health equity. Conclusions: Future research on this topic should focus on mitigating the barriers to using social determinants of health data, which includes incorporating social determinants of health data from other sectors. There is also a need to assess how data-driven solutions can be implemented within and across communities and organizations.The Diffusion of Punitive Firearm Preemption Laws Across U.S. States