Issue: To off-set smoking among college students, a growing number of colleges and universities have implemented campus smoke- or tobacco-free policies over the course of the past decade. These policies have demonstrated positive effects and are associated with numerous benefits, such as reductions in smoking behaviors and intentions to smoke among students, shifting social norms with regard to tobacco use, reducing secondhand smoke exposure, and facilitating a more supportive environment for smoking cessation. Moreover, these efforts offer valuable opportunities to educate university populations, such as students, staff and faculty, on tobacco-related issues.

Description: With the emergence and popularity of noncombustible electronic cigarettes – particularly with adolescents and young adults - college and universities are having to adapt their campus tobacco-free policies. This presentation characterizes the tobacco-free campus policies of universities and colleges across the United States. Specifically, approximately 2,469 distinct 100% tobacco-free college campus policies were analyzed to determine whether use of e-cigarettes, vaping, and vaping marijuana were explicitly addressed. Data are presented visually by state.

Lessons Learned: Among included 100% smoke-free policies, 2,044 including non-combustibles/smokeless tobacco, 2,074 prohibited electronic cigarette use/vaping, and 477 prohibit smoking/vaping marijuana. Thus, of all smokefree campuses, the vast majority (83%) specifically prohibit e-cigarettes.

Recommendations: Given almost 2 million American middle- and high-school students initiated e-cigarette use in the past year, further refinement and enforcement of campus policies to prevent e-cigarette use among youth is a worthwhile public health goal.

Background: In 2019, Tennessee’s smoking prevalence was 20.7% compared to 16.1% nationally. Annually, more than 11,000 premature deaths occur, costing Tennesseans $5billion. Policies to address this public health issue have had little impact. Because 99% of smokers start by age 26, and over a third of youth attend colleges/universities, the role of HEIs is vital. Recently, many HEIs have begun to implement nicotine use-limiting policies, but no best practice instrument exists to guide HEIs policy development. Therefore, this study aimed to develop such an instrument. Method:Between August 2017 and October 2018, a Tobacco-Free Generation Campus Initiative (TFGCI) project to develop a TN policy-rating instrument for HEIs was undertaken. Focus group discussions were held at six HEIs across Tennessee to discuss perceptions of existing policies and effective policy components. These discussions were analyzed for components that should be included on the policy-rating instrument specific to Tennessee HEIs. Results: Nicotine product-free environment, enforcement of tobacco-free policies, prevention and treatment services, and policy organization emerged as themes. A subtheme of communication of the current policy to students and the entire public emerged under policy organization. These themes culminated in the creation of Nicotine Products Policy Index (NPPI) for assessing policies of HEIs in Tennessee. Conclusion: This study suggests that HEI policies should target nicotine products, not just tobacco/smoking products. Implementation of the NPPI will help in the development of comprehensive HEI policies to reduce the uptake of nicotine products among students and accelerate the decline in nicotine product use prevalence in the state

• Background: The 2017 National Immunization Survey (NIS) for Teenagers indicates only 66% of adolescents in the USA between 13-17 years have initiated the HPV vaccine series. The ACA mandates the vaccine to be covered in full, and the Vaccines for Children program fully covers uninsured/underinsured adolescents. Thus, it would be expected to see similar rates of vaccination irrespective of insurance status.

• Methods: Data was used from the 2017 NIS (n = 19,093) to compare continuous, interrupted (which was separated into having coverage and losing it, or not having coverage and gaining it), or never insured insurance statuses to receiving any amount of HPV vaccines (1 = yes, 0 = no). A binary outcome model using logistic regression including marginal effects was used to analyze the results.

• Results: Compared to those with consistent insurance, adolescents with inconsistent or no insurance were 6.2% less likely to vaccinate compared to their consistently insured peers (P-value: <0.000). Male adolescents were 8.6% less likely to vaccinate compared to female adolescents (P-value: <0.000). However, for each year (in terms of age) increase, teens were 2.2% more likely to vaccinate (P-value: <0.000).

• Conclusions: Based on the results, HPV vaccination is correlated with insurance continuity status, and those with inconsistent or no insurance are less likely to vaccinate. This is consistent with information suggesting that primary care services are avoided when individuals do not have consistent or any coverage. Insurance status should be considered when seeking to increase HPV vaccination rates.

Background: Although Arlington has been identified as one of the healthiest counties in Virginia, substantial disparities rooted in social determinants of health (SDOH) exist among residents. In 2018, academic, clinical, and community organizations collaborated to examine and address SDOH affecting underserved residents in Arlington.

Methods: In October 2019, following a six-month fielding of a SDOH questionnaire to underserved Arlington residents, we convened a community meeting with 69 residents, which involved 17 concurrent focus groups in English, Spanish, Mongolian, Arabic, and Aramaic. Semi-structured interview questions focused on: 1) challenges with access to adequate food, housing, and transportation; and 2) solutions to overcome barriers to meeting these needs. Qualitative data analysis consisted of a multi-organizational team approach to identify common challenges and feasible solutions.

Results: Overall, 12 themes emerged that identified challenges related to: 1) affordability; 2) use of safety-net services; and 3) tradeoffs due to inadequate access to food, housing, and transportation. For example, public assistance doesn’t always result in self-sufficiency. Participants expressed that affordable housing subsidies comes with tradeoffs to economic mobility. Inadequate housing and transportation were also associated with public safety concerns. Numerous solutions emerged that were practical and feasible. Examples include: 1) improve communication about eligibility requirements and application processes for community resources, and 2) increase use of ride share services.

Conclusion: Addressing barriers to community needs will require health and non-health organizations to recognize their shared responsibility to protect the well-being of residents. Multi-sector collaboration and community engagement will be instrumental to promote health equity throughout Arlington.

Background: Policymakers have long debated the evolving concept of community benefits and the extent to which nonprofit hospitals are providing sufficient benefits to the community in exchange for the tax benefits they receive. Legislation passed in 2007 increased transparency and accountability for nonprofit hospitals to demonstrate their spending justifies forgone government tax revenues. The Affordable Care Act included additional community benefits provisions.

Objectives: This study compares community benefits spending by U.S. nonprofit hospitals in 2011, 2013, 2015, and 2017.

Methods: State-level community benefits expenditure data were taken from Community Benefit Insight and were consolidated into direct patient care (DPC), community health improvement initiatives (CHII), and health professions education and research (HPER).

Results: Most community benefits expenditures were allocated to DPC, but in nearly all U.S. states, the share allocated to CHII increased from 2011 to 2017. Community benefits spending is highly heterogeneous across states, with some spending a quarter (26%) of their total community benefits spending on CHII in 2017 -- more than five times more than their lowest performing counterparts. There appears to be no association between share of spending allocated to CHII and region, rurality, proportion of critical access hospitals, or Medicaid expansion.

Conclusion(s): These trends may suggest that hospitals are slowly shifting investments to initiatives and programs with broader community-wide benefits, though the lack of homogeneity across states is striking. Even modest shifts from DPC to other categories can represent dramatic investments in community health, especially when tied to priorities enumerated in a hospital’s community health needs assessment.

Background:

Mental health is increasingly being recognized as a major issue being faced by people throughout the United States. According to the Substance Abuse & Mental Health Services Administration (SAHMSA) 4.7% of Missouri adults have a “serious mental illness” and 11.5% of adolescents have experienced a major depressive episode in the past year. Hospitals play a key role in addressing mental illness in the community. This qualitative study evaluates how nonprofit hospitals in Missouri recognize and address mental health in their communities by analyzing the information in the required Community Health Needs Assessments (CHNAs).

Methods:

A content analysis of all available Missouri nonprofit hospital Community Health Needs Assessments (N=85) was conducted. CHNAs from three timepoints (2013, 2016, and 2019) were analyzed for specific search terms related to mental health. The data was coded, and statistical analysis was conducted.

Results:

The analysis showed an increase in the number of hospitals that view mental health as a priority in their community from 2013 to 2019. There was diversity in how mental health was identified and in the description of the plans to address it.

Conclusions:

The results of this study provide an understanding of how nonprofit hospitals across Missouri increasingly prioritize and address mental health in their communities. This study suggests increased awareness of mental health issues by communities and hospitals, confirms that increases in awareness are manifesting as priorities, and as more mental health services are provided by hospitals, encourages more collaboration with other public health related agencies.

The increase of casualty events pushes attention to blood preparedness. Because blood availability is a national priority, the vulnerability of the US blood supply system does not benefit from deferrals and can harm the preparedness of health emergencies.

Methods. This experimental project evaluated the blood availability results when different blood deferrals take place for the MSM population. The aim is to find if there is any cause-effect relationship between deferral period and blood availability.

Results. The impact of blood donors' MSM time-based deferral on blood availability is absolute, excluding all MSM as a potential blood donor in case of mass casualty. The current policy of deferral for MSMs who have had sex in a 12-month period will only constitute four of the 93 donors rejected. Other reasons for deferrals than identifying as MSM rejected 59 from the 66 volunteers to donate, represented by a rejection to become a donor rate of 90 %. The difference between the groups compared with permanent deferral as the control did not show to be statistically significant (p > 0.05).

Conclusions. The discussion about the best time-based deferral for the MSM becomes unproductive since any time deferral equivalents absolute deferrals. Shorter time-based deferral than the current 12-month does not have a statistically significant gain of the number of eligible young adult blood donors, with no impact in blood availability in case of a mass casualty event. Unnecessary deferrals of blood donors are excessive, a civil rights issue and detrimental to public health.

background: Inability to access transition-related services (TRS) is associated with poor transgender health outcomes. New York State mandates insurance coverage of medically necessary TRS for patients experiencing gender dysphoria. Despite this affirmative legislative stance, little is known about why insurers continue to deny some TRS. This study identifies which TRS are commonly denied coverage by New York insurers, and common reasons for their denial.

methods: I first identified the frequency of all TRS listed in Marketplace insurers’ coverage guidelines for gender dysphoria treatment in New York by reason for affirmative or negative coverage. Next, I compiled rejected medical reimbursement claims and appeals for TRS and identified the frequency of denial of TRS by reason for denial.

results: Genital reconstructive surgeries, mastectomy, and hormones were deemed “medically necessary” in all 14 insurers’ coverage guidelines. All other TRS were commonly deemed “cosmetic.” I examined 104 records of individual TRS coverage denials. “Cosmetic” designation was common for facial gender confirmation surgery (77%; n = 44), breast augmentation (57%; n = 14), and breast reduction (42%; n = 14). Nipple/areolar reconstruction was frequently denied due to physicians’ procedural coding errors (67%; n = 12). Hormone denials (n = 14) occurred because of outdated or fragmentary formularies.

conclusion: Non-compliance with New York's health insurance regulations on TRS can be interpreted as gender-based discrimination. Moreover, these practices may violate mental health parity laws and exacerbate health inequities within the transgender community. Patients in states with fewer protections of transgender rights likely face additional barriers to TRS.

Voting is essential to the functioning of a democracy and has implications for public health. Although national voter turnout increased from 41.9% in 2014 to 53.4% in 2018 (U.S. Census Bureau), participation in U.S. elections remains low. Registered voters hospitalized on Election Day comprise one group of adults that may have difficulty exercising their civic right to vote.

In Pennsylvania, registered voters hospitalized and unable to make it to the polls on Election Day can apply for and cast an emergency absentee ballot. However, many of these voters do not utilize this mechanism because they are unaware of its existence or due to the complexity of the process.

In advance of the 2016 U.S. elections, we launched Presby Votes, a non-partisan, interdisciplinary initiative designed to facilitate voting among registered voters hospitalized at one of the hospitals in our health system on Election Day. Since then, we have expanded the initiative to include a second hospital and renamed the program the Penn Votes Project.

In this presentation, we will provide an overview of the steps that patients must take to obtain and cast an emergency absentee ballot in Pennsylvania. We will also highlight the roles of the volunteer physicians, lawyers, nurses, health system administrators, government relations officers, medical students, law students, and nursing students who are involved in raising awareness of the Penn Votes Project and assisting patients with securing emergency absentee ballots. Finally, we will present the lessons we have learned from helping 150 patients vote in 5 U.S. elections.