Diana R Silver

Diana Silver
Diana R Silver
Scroll

Vice Dean of Faculty Affairs

Professor of Public Health Policy and Management

Professional overview

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.

Education

BA, History, Bates College, Lewiston, ME
MPH, Health Education, Hunter College, New York City, NY
PhD, Public Administration, New York University, New York City, NY

Honors and awards

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)

Areas of research and study

Access to Healthcare
Alcohol, Tobacco and Driving Policies
Food Safety Policies
Implementation and Impact of Public Health Regulations
Injury Prevention
New York Department of Health and Mental Hygiene
Public Health Law
Public Health Policy

Publications

Publications

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

Silver, D., Bae, J. Y., Furuya, E., & Macinko, J. (n.d.).

Publication year

2024

Journal title

Journal of Public Health Policy

Volume

45

Issue

1

Page(s)

58-73
Abstract
Abstract
Driving 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

2024

Journal title

American journal of preventive medicine

Volume

66

Issue

4

Page(s)

744-749

COVID-19 Vaccine Information Seeking Patterns and Vaccine Hesitancy: A Latent Class Analysis to Inform Practice

Piltch-Loeb, R., Silver, D., Kim, Y., & Abramson, D. (n.d.).

Publication year

2024

Journal title

Journal of Public Health Management and Practice

Volume

30

Issue

2

Page(s)

183-194
Abstract
Abstract
Context: 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

Gupta, A., Silver, D., Meyers, D. J., Murray, G., Glied, S., & Pagán, J. A. (n.d.).

Publication year

2024

Journal title

JAMA Health Forum

Volume

5

Issue

1

Page(s)

E234936
Abstract
Abstract
Importance: 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..

Impacts of the Affordable Care Act Medicaid Expansion on Mental Health Treatment Among Low-income Adults Across Racial/Ethnic Subgroups, 2010–2017

Lieff, S. A., Mijanovich, T., Yang, L., & Silver, D. (n.d.).

Publication year

2024

Journal title

Journal of Behavioral Health Services and Research

Volume

51

Issue

1

Page(s)

57-73
Abstract
Abstract
This 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.

Mental Health Referrals Among Medicare Advantage Enrollees Receiving Home-Based Annual Wellness Visits in Puerto Rico During the COVID-19 Pandemic

Akiya, K., Palacios, S., & Silver, D. (n.d.).

Publication year

2024

Journal title

Journal of Applied Gerontology

Volume

43

Issue

3

Page(s)

287-292
Abstract
Abstract
Annual 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?

Silver, D., Kim, Y., Piltch-Loeb, R., & Abramson, D. (n.d.).

Publication year

2024

Journal title

Preventive Medicine Reports

Volume

38
Abstract
Abstract
Physicians 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.

Firearm Laws Enacted by Municipalities in 6 States With Diverse Policy Frameworks

Pomeranz, J. L., Silver, D., Lieff, S. A., & McNeill, E. (n.d.).

Publication year

2023

Journal title

American journal of preventive medicine

Volume

64

Issue

5

Page(s)

642-649
Abstract
Abstract
Introduction: 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?

Greene, J., Silver, D., Verrier, E., & Long, S. K. (n.d.).

Publication year

2023

Journal title

Patient Education and Counseling

Volume

112
Abstract
Abstract
Objective: 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

Gonçalves, 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

2023

Journal title

International Journal of Drug Policy

Volume

118
Abstract
Abstract
Background: 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

Lindenfeld, Z., Pagán, J. A., Silver, D., McNeill, E., Mostafa, L., Zein, D., & Chang, J. E. (n.d.).

Publication year

2023

Journal title

AJPM Focus

Volume

2

Issue

3
Abstract
Abstract
Introduction: 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

Macinko, J., Silver, D., Clark, D. A., & Pomeranz, J. L. (n.d.).

Publication year

2023

Journal title

American journal of preventive medicine

Volume

65

Issue

4

Page(s)

649-656
Abstract
Abstract
Introduction: Firearm violence is a public health crisis. Most states prohibit local firearm laws, but some states have laws that allow for lawsuits and other penalties against local governments and lawmakers who pass firearm laws deemed preempted. These punitive firearm preemptive laws may reduce firearm policy innovation, discussion, and adoption beyond preemption alone. Yet, it is unknown how these laws spread from state to state. Methods: In 2022, using an event history analysis framework with state dyads, logistic regression models estimate the factors associated with adoption and diffusion of firearm punitive preemption laws, including state-level demographic, economic, legal, political, population, and state-neighbor factors. Results: As of 2021, 15 states had punitive firearm preemption laws. Higher numbers of background checks (AOR=1.50; 95% CI=1.15, 2.04), more conservative government ideology (AOR=7.79; 95% CI=2.05, 35.02), lower per capita income (AOR=0.16; 95% CI=0.05, 0.44), a higher number of permissive state firearm laws (AOR=2.75; 95% CI=1.57, 5.30), and neighboring state passage of the law (AOR=3.97; 95% CI=1.52, 11.51) were associated with law adoption. Conclusions: Both internal and external state factors predict the adoption of punitive firearm preemption. This study may provide insight into which states are susceptible to adoption in the future. Advocates, especially in neighboring states without such laws, may want to focus their firearm safety policy efforts on opposing the passage of punitive firearm preemption.

Uses of Social Determinants of Health Data to Address Cardiovascular Disease and Health Equity: A Scoping Review

McNeill, E., Lindenfeld, Z., Mostafa, L., Zein, D., Silver, D., Pagán, J., Weeks, W. B., Aerts, A., Rosiers, S. D., Boch, J., & Chang, J. E. (n.d.).

Publication year

2023

Journal title

Journal of the American Heart Association

Volume

12

Issue

21
Abstract
Abstract
BACKGROUND: Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Prior research suggests that social determinants of health have a compounding effect on health and are associated with cardiovascular disease. This scoping review explores what and how social determinants of health data are being used to address cardiovascular disease and improve health equity. METHODS AND RESULTS: After removing duplicate citations, the initial search yielded 4110 articles for screening, and 50 studies were identified for data extraction. Most studies relied on similar data sources for social determinants of health, including geo-coded electronic health record data, national survey responses, and census data, and largely focused on health care access and quality, and the neighborhood and built environment. Most focused on developing interventions to improve health care access and quality or characterizing neighborhood risk and individual risk. CONCLUSIONS: Given that few interventions addressed economic stability, education access and quality, or community context and social risk, the potential for harnessing social determinants of health data to reduce the burden of cardiovascular disease remains unrealized.

Variance of US Hospital Characteristics by Safety-Net Definition

Mcneill, E., Cronin, C., Puro, N., Franz, B., Silver, D., & Chang, J. (n.d.).

Publication year

2023

Journal title

JAMA network open

Volume

6

Issue

9

Page(s)

E2332392

Association between COVID-19 vaccine hesitancy and trust in the medical profession and public health officials

Silver, D., Kim, Y., McNeill, E., Piltch-Loeb, R., Wang, V., & Abramson, D. (n.d.).

Publication year

2022

Journal title

Preventive Medicine

Volume

164
Abstract
Abstract
One's personal physician, national and state or local public health officials, and the broader medical profession play important roles in encouraging vaccine uptake for COVID-19. However, the relationship between trust in these experts and vaccine hesitancy has been underexplored, particularly among racial/minority groups where historic medical mistrust may reduce uptake. Using an April 2021 online sample of US adults (n = 3041) that explored vaccine hesitancy, regression models estimate levels of trust in each of these types of experts and between trust in each of these experts and the odds of being COVID-19 vaccine takers vs refusers or hesitaters. Interaction terms assess how levels of trust in the medical profession by race/ethnicity are associated with vaccine hesitancy. Trust in each expert is positively associated with trust in other experts, except for trust in the medical profession. Only trust in one's own doctor was associated with trust in the medical profession, as measured by factor scores derived from a validated scale. Lower levels of trust in experts were significantly associated with being either a hesitater or a refuser compared to being a taker. Black respondents had higher odds of being either a hesitater or a refuser compared to white respondents but the interaction with trust was insignificant. For Hispanic respondents only, the odds of being a hesitater declined significantly when trust in the medical profession rose. Mistrust in the medical profession, one's doctor and national experts contributes to vaccine hesitancy. Mobilizing personal physicians to speak to their own patients may help.

Determinants of the COVID-19 vaccine hesitancy spectrum

Piltch-Loeb, R., Silver, D. R., Kim, Y., Norris, H., McNeill, E., & Abramson, D. M. (n.d.).

Publication year

2022

Journal title

PloS one

Volume

17

Issue

6
Abstract
Abstract
Vaccine hesitancy remains an issue in the United States. This study conducted an online survey [N = 3,013] using the Social Science Research Solution [SSRS] Opinion Panel web panelists, representative of U.S. adults age 18 and older who use the internet, with an over-sample of rural-dwelling and minority populations between April 8 and April 22, 2021- as vaccine eligibility opened to the country. We examined the relationship between COVID-19 exposure and socio-demographics with vaccine intentions [eager-to-take, wait-and-see, undecided, refuse] among the unvaccinated using multinomial logistic regressions [ref: fully/ partially vaccinated]. Results showed vaccine intentions varied by demographic characteristics and COVID-19 experience during the period that eligibility for the vaccine was extended to all adults. At the time of the survey approximately 40% of respondents were unvaccinated; 41% knew someone who had died of COVID-19, and 38% had experienced financial hardship as a result of the pandemic. The vaccinated were more likely to be highly educated, older adults, consistent with the United States initial eligibility criteria. Political affiliation and financial hardship experienced during the pandemic were the two most salient factors associated with being undecided or unwilling to take the vaccine.

Do alcohol policies affect everyone equally? An assessment of the effects of state policies on education-related patterns of alcohol use, 2011–2019

Silver, D., Bae, J. Y., McNeill, E., & Macinko, J. (n.d.).

Publication year

2022

Journal title

Drug and alcohol dependence

Volume

239
Abstract
Abstract
Background: Public policies are a powerful tool to change behaviors that may harm population health, but little is known about how state alcohol policies affect different population groups. This study assesses the effects of a comprehensive measure of the state alcohol regulatory environment (the State Alcohol Policy Score or SAPS) on heavy drinking—a risk factor for premature death—on different population groups, defined by levels of educational attainment, then by race/ethnicity, and sex. Methods: We pool each state's Behavioral Risk Factor Surveillance Survey (BRFSS) 2011–2019 and use robust Poisson regression analyses that control for individual-level factors, state-level factors (1 year lagged SAPS score for each state, state fixed effects), and year fixed effects to assess the relationship between SAPS and heavy drinking behaviors by education group. Interaction terms test whether education moderates the relationship by race/ethnicity and gender. Results: SAPS scores increased 2010–2018, but substantial gaps persist between states. A 10 % increase in a state's alcohol policy score is associated with a 2 % lower prevalence in current drinking (APR=0.97, 95 % CI=0.97–0.97, p < 0.0011) although not for those with a high school education or less. A 10 % increase in the SAPS was associated with a 3 % lower prevalence of heavy drinking; interaction terms in models reveal that a 10 % increase in the SAPS was associated with a lower prevalence of heavy drinking among those with less than a college education. Conclusion: Narrowing gaps in alcohol policies between states may reduce heavy drinking among those with lower educational attainment.

Federal Paid Sick Leave Is Needed to Support Prevention and Public Health and Address Inequities

Pomeranz, J. L., Pagán, J. A., & Silver, D. (n.d.). In American journal of preventive medicine (1–).

Publication year

2022

Volume

63

Issue

2

Page(s)

e75

Generational differences in beliefs about COVID-19 vaccines

Wang, V. H. C., Silver, D., & Pagán, J. A. (n.d.).

Publication year

2022

Journal title

Preventive Medicine

Volume

157
Abstract
Abstract
Vaccine uptake variation across demographic groups remains a public health barrier to overcome the coronavirus pandemic despite substantial evidence demonstrating the effectiveness of COVID-19 vaccines against severe illness and death. Generational cohorts differ in their experience with historical and public health events, which may contribute to variation in beliefs about COVID-19 vaccines. Nationally representative longitudinal data (December 20, 2020 to July 23, 2021) from the Understanding America Study (UAS) COVID-19 tracking survey (N = 7279) and multilevel logistic regression were used to investigate whether generational cohorts differ in COVID-19 vaccine beliefs. Regression models adjusted for wave, socioeconomic and demographic characteristics, political affiliation, and trusted source of information about COVID-19. Birth-year cutoffs define the generational cohorts: Silent (1945 and earlier), Boomer (1946–1964), Gen X (1965–1980), Millennial (1981–1996), and Gen Z (1997–2012). Compared to Boomers, Silents had a lower likelihood of believing that COVID-19 vaccines have many known harmful side effects (OR = 0.52, 95%CI = 0.35–0.74) and that they may lead to illness and death (OR = 0.53, 95%CI = 0.37–0.77). Compared to Boomers, Silents had a higher likelihood of believing that the vaccines provide important benefits to society (OR = 2.27, 95%CI = 1.34–3.86) and that they are useful and effective (OR = 1.97, 95%CI = 1.17–3.30). Results for Gen Z are similar to those reported for Silents. Beliefs about COVID-19 vaccines markedly differ across generations. This is consistent with the idea of generational imprinting—the idea that some beliefs may be resistant to change through adulthood. Policy strategies other than vaccine education may be needed to overcome this pandemic and future public health challenges.

How Patient-Centered Medical Homes Integrate Dental Services Into Primary Care: A Scoping Review

Gupta, A., Akiya, K., Glickman, R., Silver, D., & Pagán, J. A. (n.d.).

Publication year

2022

Journal title

Medical Care Research and Review

Volume

79

Issue

4

Page(s)

487-499
Abstract
Abstract
Integrated care delivery is at the core of patient-centered medical homes (PCMHs). The extent of integration of dental services in PCMHs for adults is largely unknown. We first identified dental–medical integrating processes from the literature and then conducted a scoping review using PRISMA guidelines to evaluate their implementation among PCMHs. Processes were categorized into workforce, information-sharing, evidence-based care, and measuring and monitoring. After screening, 16 articles describing 21 PCMHs fulfilled the inclusion criteria. Overall, the implementation of integrating processes was limited. Less than half of the PCMHs reported processes for information exchange across medical and dental teams, referral tracking, and standardized protocols for oral health assessments by medical providers. Results highlight significant gaps in current implementation of adult dental integration in PCMHs, despite an increasing policy-level recognition of and support for dental-medical integration in primary care. Understanding and addressing associated barriers is important to achieve comprehensive patient-centered primary care.

State Paid Sick Leave and Paid Sick-Leave Preemption Laws Across 50 U.S. States, 2009–2020

Pomeranz, J. L., Silver, D., Lieff, S. A., & Pagán, J. A. (n.d.).

Publication year

2022

Journal title

American journal of preventive medicine

Volume

62

Issue

5

Page(s)

688-695
Abstract
Abstract
Introduction: Paid sick leave is associated with lower mortality risks and increased use of health services. Yet, the U.S. lacks a national law, and not all employers offer paid leave, especially to low-wage workers. States have enacted paid sick-leave laws or preemption laws that prohibit local governments from enacting paid sick-leave requirements. Methods: In 2019 and 2021, state paid sick-leave laws and preemption laws in effect in 2009–2020 were retrieved from Lexis+, coded, and analyzed for coverage and other features. Data from the U.S. Bureau of Economic Analysis were used to estimate the jobs covered by state paid sick-leave laws in 2009–2019. Results: In 2009, no state had a paid sick-leave law, and 1 state had preemption. By 2020, a total of 12 states had paid sick-leave laws, with a form of preemption (n=9) or no preemption (n=3), and 18 additional states solely preempted local laws without requiring coverage, creating a regulatory vacuum in those states. Although all state paid sick-leave laws covered private employers and required care for children and spouses, some laws exempted small or public employers or did not cover additional family members. The percentage of U.S. jobs covered by state-required paid sick leave grew from 0% in 2009 to 27.6% in 2019. Conclusions: Variation in state paid sick-leave laws, preemption, and lack of employer provision of paid sick leave to low-wage workers creates substantial inequities nationally. The federal government should enact a national paid sick-leave law.

By the Letter of Law? The Effects of Administrative Adjudication for Resolving Disputes in NYC’s Restaurant Grading Initiative

Silver, D., Rothbart, M. W., & Bae, J. Y. (n.d.).

Publication year

2021

Journal title

American Review of Public Administration

Volume

51

Issue

8

Page(s)

619-635
Abstract
Abstract
Administrative adjudication can serve as a quasi-judicial forum for resolving disputes resulting from government regulations. New York City recently required restaurants to post letter grades reflecting their compliance with food safety regulations and incorporated an easily accessible administrative adjudication system into its policy design. This study examines the implementation of this feature of the policy by using a regression discontinuity framework to explore the effects of the grading policy on adjudication processes and regulatory outcomes. Quantitative data included 222,527 food safety inspection records (2007–2014); qualitative data included interviews, observations, and document review. Restaurants were more likely to have violations reduced and grades improved at adjudication when grades were at stake. Moreover, adjudication outcomes were highly sensitive to score differences near grade cut-points. Professional representatives helped restaurants to negotiate the interpretation of rules in the quasi-judicial proceedings, softening rigidity of regulations. Representatives’ expertise was consistent with being “repeat players,” which may distort the use of such forums to ensure justice and fairness. This study illuminates the ramifications of including alternative dispute resolution systems in the implementation of regulatory policies.

State Gun-Control, Gun-Rights, and Preemptive Firearm-Related Laws Across 50 US States for 2009–2018

Pomeranz, J. L., Silver, D., & Lieff, S. A. (n.d.).

Publication year

2021

Journal title

American journal of public health

Volume

111

Issue

7

Page(s)

1273-1280
Abstract
Abstract
Objectives. To assess state policy environments and the relationship between state gun-control, gun-rights, and preemptive firearm-related laws in the United States. Methods. In 2019 through 2020, we evaluated substantive firearm laws and preemptive firearm laws across 50 US states for 2009 through 2018. For each state, we compared substantive measures with preemptive measures on the same policy topic for 2018. Results. The presence of state firearm-related laws varied across states, but with the exception of “punitive preemption” the number of gun-control, gun-rights, and preemptive measures remained unchanged in most states from 2009 through 2018. As of 2018, a majority of states had preemptive measures on almost all gun-control policy topics without enacting substantive gun-control measures. Several states had a combination of gun-control and preemptive measures. Only a small number of states had gun-control measures with few to no preemptive measures. Conclusions. Even where state legislators were unable to pass statewide gun-rights measures, they succeeded in passing preemption, preserving state authority over a wide range of gun-control and gun-rights policy topics. The majority of states used preemption as a tool to support policy frameworks favoring gun rights.

24-Year trends in educational inequalities in adult smoking prevalence in the context of a national tobacco control program: The case of Brazil

Bandi, P., Chang, V. W., Sherman, S. E., & Silver, D. (n.d.).

Publication year

2020

Journal title

Preventive Medicine

Volume

131
Abstract
Abstract
Brazil was a low and middle-income country (LMIC) in the late-1980s when it implemented a robust national tobacco-control program (NTCP) amidst rapid gains in national incomes and gender equality. We assessed changes in smoking prevalence between 1989 and 2013 by education level and related these changes to trends in educational inequalities in smoking. Data were from four nationally representative cross-sectional surveys (1989, n = 25,298; 2003 n = 3845; 2008 n = 28,938; 2013 n = 47,440, ages 25–69 years). We estimated absolute (slope index of inequality, SII) and relative (relative index of inequality, RII) educational inequalities in smoking prevalence, separately for males and females. Additional analyses stratified by birth-cohort to assess generational differences. Smoking declined significantly between 1989 and 2013 in all education groups but declines among females were steeper in higher-educated groups. Consequently, both absolute and relative educational inequalities in female smoking widened threefold between 1989 and 2013 (RII: 1.31 to 3.60, SII: 5.3 to 15.0), but absolute inequalities in female smoking widened mainly until 2003 (SII: 15.8). Conversely, among males, declines were steeper in higher-educated groups only in relative terms. Thus, relative educational inequalities in male smoking widened between 1989 and 2013 (RII: 1.58 to 3.19) but mainly until 2008 (3.22), whereas absolute equalities in male smoking were unchanged over the 24-year period (1989: 21.1 vs. 2013: 23.2). Younger-cohorts (born ≥1965) had wider relative inequalities in smoking vs. older-cohorts at comparable ages, particularly in the youngest female-cohorts (born 1979–1988). Our results suggest that younger lower-SES groups, especially females, may be particularly vulnerable to differentially higher smoking uptake in LMICs that implement population tobacco-control efforts amidst rapid societal gains.

Dental radiographs for age estimation in us asylum seekers: Methodological, ethical, and health issues

Kapadia, F., Stevens, J., & Silver, D. (n.d.).

Publication year

2020

Journal title

American journal of public health

Volume

110

Issue

12

Page(s)

1786-1789
Abstract
Abstract
Unaccompanied migrant children seeking asylum status in the United States are often forced to undergo dental radiographs, or x-rays, to verify that they are younger than 18 years. The application of third molar dental radiographs is methodologically flawed and should not be employed as a determinant of chronological age. Furthermore, the use of such tests without obtaining informed consent from either the youth or an objective advocate is unethical. Finally, the legal and health consequences of these inappropriately applied tests are severe and jeopardize the safety and security of these vulnerable minors.

Contact

drs1@nyu.edu 708 Broadway New York, NY, 10003