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      Assessing provider and racial/ethnic variation in response to the FDA antidepressant box warning

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          Abstract

          Introduction

          After the 2004 FDA box warning raised concerns about increased suicidal ideation among youth taking antidepressants, antidepressant use decreased for White youth but slightly increased for Black and Latino youth. Better understanding of patient and provider factors contributing to these differences is needed to improve future risk warning dissemination.

          Methods

          We analyzed antidepressant prescriptions for youth aged 5‐17 in 2002‐2006 Medicaid claims data from four states ( CA, FL, NC, and NY). In multilevel models, we assessed provider‐ and patient‐level contributions to changes in antidepressant use by race/ethnicity and compared responses to the box warning between providers with large (>2/3) and small (<1/3) proportions of minority patients.

          Results

          A significant amount of variance in overall prescribing patterns (calculated by the ICC) was explained at the provider level. Significant provider‐level variation was also identified in the differential effect of the box warning by racial/ethnic group. In a test of the influence of provider panel mix, we found that providers with large proportions of minority patients reduced antidepressant prescribing more slowly after the box warning than other providers.

          Discussion

          This study is the first to assess provider‐ and patient‐level variation in the impact of a health care policy change on treatment disparities. Black and Latino youth Medicaid beneficiaries were seen by largely different providers than their White counterparts, and these distinct providers were influential in driving antidepressant prescription patterns following the box warning. Concerted outreach to providers of minority beneficiaries is needed to ensure that risk warnings and clinical innovations diffuse swiftly across racial/ethnic minority groups.

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          Most cited references31

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          Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey.

          The context in which patients consume health information has changed dramatically with diffusion of the Internet, advances in telemedicine, and changes in media health coverage. The objective of this study was to provide nationally representative estimates for health-related uses of the Internet, level of trust in health information sources, and preferences for cancer information sources. Data from the Health Information National Trends Survey were used. A total of 6369 persons 18 years or older were studied. The main outcome measures were online health activities, levels of trust, and source preference. Analyses indicated that 63.0% (95% confidence interval [CI], 61.7%-64.3%) of the US adult population in 2003 reported ever going online, with 63.7% (95% CI, 61.7%-65.8%) of the online population having looked for health information for themselves or others at least once in the previous 12 months. Despite newly available communication channels, physicians remained the most highly trusted information source to patients, with 62.4% (95% CI, 60.8%-64.0%) of adults expressing a lot of trust in their physicians. When asked where they preferred going for specific health information, 49.5% (95% CI, 48.1%-50.8%) reported wanting to go to their physicians first. When asked where they actually went, 48.6% (95% CI, 46.1%-51.0%) reported going online first, with only 10.9% (95% CI, 9.5%-12.3%) going to their physicians first. The Health Information National Trends Survey data portray a tectonic shift in the ways in which patients consume health and medical information, with more patients looking for information online before talking with their physicians.
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            Trends in mental health care among children and adolescents.

            Increasing mental health treatment of young people and broadening conceptualizations of psychopathology have triggered concerns about a disproportionate increase in the treatment of youths with low levels of mental health impairment.
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              Sex hormones, hormonal interventions, and gastric cancer risk: a meta-analysis.

              Estrogens may influence gastric cancer risk, but published studies are inconclusive. We therefore carried out a meta-analysis addressing the associations of gastric cancer in women with menstrual and reproductive factors and with use of estrogen- and antiestrogen-related therapies. Searches of PubMed up to June, 2011 and review of citations yielded a total of 28 independent studies, including at least one exposure of interest. Random effects pooled estimates of relative risk (RR) and corresponding 95% CIs were calculated for eight exposures reported in at least five studies, including: age at menarche, age at menopause, years of fertility, parity, age at first birth, oral contraceptive use, hormone replacement therapy (HRT), and tamoxifen treatment. Longer years of fertility (RR = 0.74, 95% CI: 0.63-0.86) and HRT (RR = 0.77; 95% CI: 0.64-0.92) were each associated with decreased gastric cancer risk. Conversely, tamoxifen treatment was associated with increased risk (RR = 1.82; 95% CI: 1.39-2.38). The other five exposures were not significantly associated. Our analysis supports the hypothesis that longer exposure to estrogen effects of either ovarian or exogenous origin may decrease risk of gastric cancer. Additional studies are warranted to extend this finding and to identify the underlying mechanisms.
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                Author and article information

                Contributors
                bcook@cha.harvard.edu
                Journal
                Health Serv Res
                Health Serv Res
                10.1111/(ISSN)1475-6773
                HESR
                Health Services Research
                John Wiley and Sons Inc. (Hoboken )
                0017-9124
                1475-6773
                21 January 2019
                February 2019
                : 54
                : Suppl 1 , Putting Patients First: Today's Disparities Research Leading to Health Equity Tomorrow ( doiID: 10.1111/hesr.2019.54.issue-S1 )
                : 255-262
                Affiliations
                [ 1 ] Health Equity Research Lab Cambridge Health Alliance Harvard Medical School Cambridge Massachusetts
                [ 2 ] Disparities Research Unit Massachusetts General Hospital Boston Massachusetts
                [ 3 ] Tucker‐Seeley Research Lab Leonard Davis School of Gerontology University of Southern California Los Angeles California
                [ 4 ] Yale School of Public Health New Haven Connecticut
                [ 5 ] Department of Health Care Policy Harvard Medical School Boston Massachusetts
                Author notes
                [*] [* ] Correspondence

                Benjamin L. Cook, Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA.

                Email: bcook@ 123456cha.harvard.edu

                Article
                HESR13104
                10.1111/1475-6773.13104
                6341210
                30666633
                23018ee2-a5c6-45e8-add3-231ef3b77b60
                © 2019 The Authors. Health Services Research published by Wiley Periodicals, Inc. on behalf of Health Research and Educational Trust

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Figures: 0, Tables: 3, Pages: 8, Words: 6540
                Funding
                Funded by: Patient‐Centered Outcomes Research Institute , open-funder-registry 10.13039/100006093;
                Award ID: ME‐1507‐31469
                Award ID: R01HS021486
                Funded by: Agency for Healthcare Research and Quality , open-funder-registry 10.13039/100000133;
                Categories
                Special Issue: Health Equity
                Health Equity
                Custom metadata
                2.0
                February 2019
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.2 mode:remove_FC converted:05.12.2019

                Health & Social care
                racial/ethnic differences in health and health care,modeling: multi‐level,psychiatry

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