Health Behavior & Communication

Incentives and communication strategies that influence behaviors affecting health. LDI Senior Fellows study financial and non-financial incentives that promote healthy behaviors, and how individuals and communities receive and exchange health information.

Responding to the Trauma of COVID-19

Jul. 2, 2020

As the country looks to reopen and epidemiologists anticipate future waves of coronavirus (COVID-19) cases, we must address an equally important “pandemic:” the virus’ far-reaching mental health and trauma-related consequences. Whether balancing activities of essential work with exposure risk, bearing witness to suffering or loss, or feeling anguish or guilt for not “doing more” during this time, our society is facing great adversity with potentially devastating consequences.

Healthier Food And Beverage Interventions In Schools: Four Community Guide Systematic Reviews

Jul. 1, 2020

Holly R. Wethington, Ramona K. C. Finnie, Leigh Ramsey Buchanan, Devon L. Okasako-Schmucker, Shawna L. Mercer, Caitlin Merlo, Youfa Wang, Charlotte A. Pratt, Emmeline Ochiai, Karen Glanz, Community Preventive Services Task Force

Abstract [from journal]

Context: Healthy eating during childhood is important for optimal growth and helps reduce the risk of obesity, which has potentially serious health consequences. Changing the school food environment may offer one way to improve students' dietary intake. This manuscript reports 4 Community Guide systematic reviews examining the effectiveness of interventions in schools promoting healthy eating and weight.

Evidence acquisition: School obesity prevention programs aiming to improve diet were


What Do We Know About Health Insurance Choice?

Issue Brief
Jun. 30, 2020

From choosing a doctor to selecting an insurance plan, choices pervade nearly all aspects of our health care system. However, there is little agreement among policymakers and the public about what constitutes “choice,” which choices are important, and how and whether patients should be asked to make various health care choices. Although Americans claim to value having health insurance choices, research shows that when presented with options, people do not actually like to choose. Other studies suggest that people frequently make health insurance decisions that leave them worse off, or not much better than before. At Penn LDI’s Medicare for All and Beyond conference, a panel of researchers and policy experts discussed the current evidence around health insurance choice and implications for future health care reform efforts. This brief summarizes the panel’s key takeaways.

Male Partner Testing And Sexual Behaviour Following Provision Of Multiple HIV Self-Tests To Kenyan Women At Higher Risk Of HIV Infection In A Cluster Randomized Trial

Jun. 26, 2020

Sue Napierala, Elizabeth F. Bair, Noora Marcus, Perez Ochwal, Suzanne Maman, Kawango Agot, Harsha Thirumurthy

Abstract [from journal]

Introduction: Without significant increases in uptake of HIV testing among men, it will be difficult to reduce HIV incidence to disease elimination levels. Secondary distribution of HIV self-tests by women to their male partners is a promising approach for increasing male testing that is being implemented in several countries. Here, we examine male partner and couples testing outcomes and sexual decision making associated with this approach in a cluster randomized trial.

Methods: We examined


Association Of Suicide Prevention Interventions With Subsequent Suicide Attempts, Linkage To Follow-Up Care, And Depression Symptoms For Acute Care Settings: A Systematic Review And Meta-Analysis

Jun. 17, 2020

Stephanie K. Doupnik, Brittany Rudd, Timothy Schmutte, Diana Worsley, Cadence F. Bowden, Erin McCarthy, Elliott Eggan, Jeffrey A. Bridge, Steven C. Marcus

Abstract [from journal]

Importance: To prevent suicide deaths, acute care settings need tools to ensure individuals at risk of suicide access mental health care and remain safe until they do so.

Objective: To examine the association of brief acute care suicide prevention interventions with patients' subsequent suicide attempts, linkage to follow-up care, and depression symptoms at follow-up.

Data sources: Ovid MEDLINE, Scopus, CINAHL, PsychINFO, Embase, and references of included studies using


Association Of A Novel Index Of Hospital Capacity Strain With Admission To Intensive Care Units

Jun. 10, 2020

George L. Anesi, Marzana Chowdhury, Dylan S Small, M. Kit Delgado, Rachel Kohn, Brian Bayes, Wei Wang, Erich Dress, Gabriel J. Escobar, Scott D. Halpern, Vincent X Liu

Abstract [from journal]

Rationale: Prior approaches to measuring healthcare capacity strain have been constrained by using individual care units, limited metrics of strain, or general, rather than disease-specific, populations.

Objectives: We sought to develop a novel composite strain index and measure its association with ICU admission decisions and hospital outcomes.

Methods: Using more than 9.2 million acute care encounters from 27 Kaiser Permanente Northern California and Penn Medicine


A Qualitative Assessment Of Factors That Children, Parents, And Clinicians Prioritize In The Setting Of Elective Anesthesia And Surgery

Jun. 3, 2020

Wallis T Muhly, Brittany Wohler, Maria N Nelson, Jonathan M Tan, Frances K Barg, William England, Carolyn Fazzini, Luis Sequera-Ramos, Paul A Stricker

Abstract [from journal]

Background: Assessing the postoperative recovery of pediatric patients is challenging as there is no validated comprehensive patient-centered recovery assessment tool for this population. A qualitative investigative approach with in-depth stakeholder interviews can provide insight into the recovery process and inform the development of a comprehensive patient-centered postoperative assessment tool for children.

Methods: We conducted open-ended, semistructured interviews with children 6-12 years


Racial/Ethnic Disparities Among Extremely Preterm Infants In The United States From 2002 To 2016

Jun. 1, 2020

Colm P. Travers, Waldemar A. Carlo, Scott A. McDonald, Abhik Das , Namasivayam Ambalavanan, Edward F. Bell, Pablo J. Sánchez, Barbara J. Stoll, Myra H. Wyckoff, Abbot R. Laptook, Krisa P. Van Meurs, Ronald N. Goldberg, Carl T. D'Angio, Seetha Shankaran, Sara B. DeMauro, Michele C. Walsh, Myriam...

Abstract [from journal]

Importance: Racial/ethnic disparities in quality of care among extremely preterm infants are associated with adverse outcomes.

Objective: To assess whether racial/ethnic disparities in major outcomes and key care practices were changing over time among extremely preterm infants.

Design, setting, and participants: This observational cohort study used prospectively collected data from 25 US academic medical centers. Participants included 20 092 infants of 22 to 27 weeks'


Assessment Of Beliefs And Attitudes About Statins Posted On Twitter: A Qualitative Study

Robert Gross, MD, MSCE
Jun. 1, 2020

Su Golder, Karen O'Connor, Sean HennessyRobert Gross, Graciela Gonzalez-Hernandez 

Abstract [from journal]

Importance: Statins are prescribed to help lower cholesterol levels but have poor adherence rates. Attitudes or beliefs toward medications are important to ascertain because they may be associated with patient behavior.

Objective: To identify health-related discussion in Twitter posts mentioning a statin and analyze the content within these posts.

Design, setting, and participants: This qualitative study included 11 852 posts related to 1 of 8 statins (7 licensed for use


Assessment Of Physician Prescribing Of Muscle Relaxants In The United States, 2005-2016

Sean Hennessy
Jun. 1, 2020

Samantha E. Soprano, Sean Hennessy, Warren B. Bilker, Charles E. Leonard

Abstract [from journal]

Importance: Little is known to date about national trends in the prescribing of skeletal muscle relaxants (SMRs), the use of which is associated with important safety concerns, especially in older adults and in those who use concomitant opioids.

Objective: To measure national trends in SMR prescribing over a 12-year period.

Design, setting, and participants: This cross-sectional study used data from the National Ambulatory Medical Care Survey from January 2005 to


Obesity And Hypoalbuminaemia Are Independent Risk Factors For Readmission And Reoperation Following Primary Total Knee Arthroplasty

Neil Sheth, MD
May. 31, 2020

Matthew Sloan, Neil P. Sheth, Charles L Nelson

Abstract [from journal]

Aims: Rates of readmission and reoperation following primary total knee arthroplasty (TKA) are under scrutiny due to new payment models, which penalize these negative outcomes. Some risk factors are more modifiable than others, and some conditions considered modifiable such as obesity may not be as modifiable in the setting of advanced arthritis as many propose. We sought to determine whether controlling for hypoalbuminaemia would mitigate the effect that prior authors had identified in patients with obesity.


Maximum Daily Temperature, Precipitation, Ultra-Violet Light And Rates Of Transmission Of SARS-Cov-2 In The United States

May. 30, 2020

Shiv T. Sehra, Justin D. Salciccioli, Douglas J. Wiebe, Shelby Fundin, Joshua F. Baker

Abstract [from journal]

Background: Previous reports have suggested that transmission of SARS-CoV-2 is reduced by higher temperatures and higher humidity. We analyzed case-data from the United States to investigate effects of temperature, precipitation, and UV Light on community transmission of SARS-CoV-2.

Methods: Daily reported cases of SARS-CoV-2 across the United States from 01/22/2020 to 04/03/2020 were analyzed. We used negative binomial regression modelling to investigate whether daily maximum


A Global Survey On The Impact Of COVID-19 On Urological Services

May. 26, 2020

Jeremy Yuen-Chun Teoh, William Lay Keat Ong, Daniel Gonzalez-Padilla, Daniele Castellani, Justin M Dubin, Francesco Esperto, Riccardo Campi, Kalyan Gudaru, Ruchika Talwar, Zhamshid Okhunov, Chi-Fai Ng, Nitesh Jain, Vineet Gauhar, Martin Chi-Sang Wong, Marcelo Langer Wroclawski, ...

Abstract [from journal]

Background: The World Health Organization (WHO) declared coronavirus disease-19 (COVID-19) as a pandemic on March 11, 2020. The impact of COVID-19 on urological services in different geographical areas is unknown.

Objective: To investigate the global impact of COVID-19 on urological providers and the provision of urological patient care.

Design, setting, and participants: A cross-sectional, web-based survey was conducted from March 30, 2020 to April 7, 2020. A 55-item