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Forty states mandate that providers query their patients' prescription histories in the state's prescription drug monitoring program (PDMP) before prescribing controlled substances. However, little is known about providers' use of PDMPs, either with or without a mandate. We measured the share of opioid prescriptions with PDMP queries in Kentucky from 2010 to 2018, before and after the implementation of the first comprehensive PDMP mandate in the Us. Providers queried the PDMP for 12 percent of opioid prescriptions before the mandate; after the mandate, they queried for 56 percent of prescriptions. The share of prescriptions queried was lowest for patients without recent opioid use (3 percent before the mandate, 25 percent after) and highest for pain management specialists (31 percent before, 72 percent after). Over time, high-compliance providers reduced prescribing to the riskiest patients, whereas low-compliance providers continued to prescribe to them. Although the share of prescriptions queried greatly increased after the mandate, compliance remained incomplete, including for patients with high-risk patterns of opioid use.

The authors estimate the associations between community socioeconomic composition and changes in coronavirus disease 2019 (COVID-19) vaccination levels in eight large cities at three time points. In March, communities with high socioeconomic status (SES) had significantly higher vaccination rates than low-SES communities. Between March and April, low-SES communities had significantly lower changes in percentage vaccinated than high-SES communities. Between April and May, this difference was not significant. Thus, the large vaccination gap between communities during restricted vaccine eligibility did not narrow when eligibility opened up. The link between COVID-19 vaccination and community disadvantage may lead to a bifurcated recovery whereby advantaged communities move on from the pandemic more quickly while disadvantaged communities continue to suffer.

Some states have not adopted the Affordable Care Act (ACA) Medicaid expansions due to concerns that the expansions may impair access to care and utilization for those who are already insured. We investigate such negative spillovers using a large panel of Medicare beneficiaries. Across many subgroups and outcomes, we find no evidence that the expansions reduced utilization among Medicare beneficiaries and can rule out all but very small changes in utilization or spending. These results indicate that the expansions in Medicaid did not impair access to care or utilization for the Medicare population.

Rollouts of COVID-19 vaccines in the USA were opportunities to redress disparities that surfaced during the pandemic. Initial eligibility criteria, however, neglected geographic, racial/ethnic, and socioeconomic considerations. Marginalized populations may have faced barriers to then-scarce vaccines, reinforcing disparities. Inequalities may have subsided as eligibility expanded. Using spatial modeling, we investigate how strongly local vaccination levels were associated with socioeconomic and racial/ethnic composition as authorities first extended vaccine eligibility to all adults. We harmonize administrative, demographic, and geospatial data across postal codes in eight large US cities over 3 weeks in Spring 2021. We find that, although vaccines were free regardless of health insurance coverage, local vaccination levels in March and April were negatively associated with poverty, enrollment in means-tested public health insurance (e.g., Medicaid), and the uninsured population. By April, vaccination levels in Black and Hispanic communities were only beginning to reach those of Asian and White communities in March. Increases in vaccination were smaller in socioeconomically disadvantaged Black and Hispanic communities than in more affluent, Asian, and White communities. Our findings suggest vaccine rollouts contributed to cumulative disadvantage. Populations that were left most vulnerable to COVID-19 benefited least from early expansions in vaccine availability in large US cities.

Several recent studies focused on first date expectations and enactment. These studies indicate that men evaluate female-initiated first dates in more sexual ways than do females. Results from these studies indicate, however, that participants report less intimacy on such dates. This study uses expectancy violation theory to investigate these apparently conflicting results. Participants evaluated either a male or female target person following a date initiation. Evaluations of targets' specific sexual expectations for the date are consistent with the notion that males may enter female-initiated first dates with heightened sexual expectations. Results also indicate that participants evaluated date initiators as more sociable, more liberal, and less physically attractive than the person being asked.

Working Paper No. 25153 Some states that have not adopted the Affordable Care Act (ACA) Medicaid expansions have stated concerns that the expansions may impair access to care and utilization for those who are already insured. We investigate such negative spillovers using a large panel of Medicare beneficiaries. Across many subgroups and outcomes, we find no evidence that the expansions reduced utilization among Medicare beneficiaries, and can rule out all but very small changes in utilization or spending. These results suggest that the expansions in Medicaid did not impair access to care or utilization for the Medicare population.

Many opioid control policies target the prescribing behavior of health care providers. In this paper, we study the first comprehensive state-level policy requiring providers to access patients' opioid history before making prescribing decisions. We compare prescribers in Kentucky, which implemented this policy in 2012, to those in a control state, Indiana. Our main difference-in-differences analysis uses the universe of prescriptions filled in the two states to assess how the information provided affected prescribing behavior. As many as forty percent of low-volume opioid prescribers stopped prescribing opioids altogether after the policy was implemented. Among other providers, the major margin of response was to prescribe opioids to approximately sixteen percent fewer patients. While providers disproportionately discontinued treating patients whose opioid histories showed the use of multiple providers, there were also economically-meaningful reductions for patients without multiple providers and single-use acute patients.

Some states that have not adopted the Affordable Care Act (ACA) Medicaid expansions have stated concerns that the expansions may impair access to care and utilization for those who are already insured. We investigate such negative spillovers using a large panel of Medicare beneficiaries. Across many subgroups and outcomes, we find no evidence that the expansions reduced utilization among Medicare beneficiaries, and can rule out all but very small changes in utilization or spending. These results suggest that the expansions in Medicaid did not impair access to care or utilization for the Medicare population.