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PubMed1997

Question 1 tobacco education expenditures in Massachusetts, USA.

BACKGROUND: In 1992, voters in Massachusetts (United States) approved Question 1, a state ballot initiative, which raised the state excise tax to provide funds for tobacco education. OBJECTIVE: To examine Question 1 expenditures for tobacco-specific programmes in the 1994, 1995, 1996, and 1997 fiscal years. DESIGN: This study examined trends in Question 1 expenditures. Data were collected from the Massachusetts Department of Public Health and the Massachusetts Department of Revenue for the 1994, 1995, 1996, and 1997 fiscal years. MAIN OUTCOME MEASURES: The amount of spending on tobacco-specific programmes. RESULTS: Excluding the 1994 fiscal year because the state allocated 18 months of new revenues, from the 1995 fiscal year to the projected 1997 fiscal year, the state will have spent 22% of Question 1 funds for tobacco-specific programmes. Question 1 expenditures for tobacco-specific programmes have declined by 15%, whereas Question 1 expenditures for the other programmes decreased only 0.4%. CONCLUSIONS: The legislature has established a trend that has produced real reductions in Question 1 funding for tobacco education, which appears contrary to the mandate of the voters when they enacted Question 1 in 1992. These reductions undermine the effectiveness of tobacco-specific programmes that are an integral part of the Massachusetts Tobacco Control Programme. These results also highlight the fact that the initial compromises made after initiatives such as Question 1 are adopted have important long-term consequences for funding of tobacco control initiatives.

Female↗
PubMed1998

Patterns of smoking, risk factors for smoking, and smoking cessation among Vietnamese men in Massachusetts (United States).

OBJECTIVES: To measure the prevalence and patterns of, and risk factors for, smoking and other tobacco use among Vietnamese men in Massachusetts (United States). METHODS: Data were obtained via a telephone interview of 774 Vietnamese men in 1994. DESIGN: Cross-sectional survey administered via telephone in 1994. SETTING: Massachusetts, United States. SUBJECTS: Randomly selected Vietnamese men (n = 774). MAIN OUTCOME MEASURES: Present and past use of tobacco products, knowledge and attitudes regarding tobacco, and risk factors for tobacco use. Results were compared with data from the Massachusetts general population. RESULTS: Vietnamese men smoked at a rate 1.9 times that of the Massachusetts general men's rate (43% vs 24%). The smoking rate did not decrease with increasing length of residence in the United States. In a logistic regression, risk factors for current smoking were: age in the thirties; history of parental smoking; lower educational level; higher depression score; low level of exercise; lack of health insurance; and geographical origin from the south coast of Vietnam. Smoking cessation declined with increasing depression score. Most smokers (76%) had no plans to quit smoking. CONCLUSIONS: Vietnamese men smoke at much higher rates than the general population, and are much less likely to be planning cessation. High rates of depression and sociocultural barriers to smoking cessation must be addressed in efforts to reduce tobacco use among this high-risk population.

Acculturation↗
PubMed2000

Evolution of a comprehensive tobacco control programme: building system capacity and strategic partnerships--lessons from Massachusetts.

BACKGROUND: Since the passage of a voter approved state referendum in 1992 to establish a 25 cent increase on the excise tax on cigarettes and smokeless tobacco, Massachusetts has received an average of $40 million annually for its tobacco control programme. This funding allowed Massachusetts to expand and develop its tobacco control programme to become one of the most comprehensive in the world. OBJECTIVES: The development of the Massachusetts Tobacco Control Program is outlined, focusing on three stages of development: formation, strategic partnership building, and shared leadership. METHODS: The development of management structures, programmatic infrastructure, communication and partnership networks, and advisory structures are tracked throughout the three phases. RESULTS: The use of pre-existing public health resources, implementation of a strong training component, a geographical management structure, the creation of public and private partnerships, and the development of a shared leadership model contributed to building consensus and provided the foundation for coordinated approaches to tobacco control. CONCLUSION: Other states and countries can use lessons learned from Massachusetts about the organisational development of a comprehensive tobacco control programme as they embark upon similar efforts.

Humans↗
PubMedDate not supplied

What will become of the medical mecca? Health care spending in Massachusetts.

Massachusetts has been called a "medical mecca." It has also been called the world's most expensive health care market. This paper concludes that claims of excess costs in Massachusetts are overstated. Massachusetts hospitals have lower inpatient costs than peer institutions in other states, yet the state's concentration of academic hospitals tilts the system toward higher spending. In markets like Massachusetts, there is growing pressure to demonstrate tangible benefits to justify the additional costs of academic health centers (AHCs). Applying new information technologies to proactively manage patients with expensive chronic illnesses is a critical area for future collaboration between payers and AHCs.

Academic Medical Centers↗
PubMed1984

Legislation raising the legal drinking age in Massachusetts from 18 to 20: effect on 16 and 17 year-olds.

The 1979 Massachusetts law raising the legal drinking age from 18 to 20 is examined--the effects on the drinking, drinking and driving, and nonfatal and fatal crash involvement of 16-17 yr-olds, teenagers immediately younger than those targeted by the law. Data from Massachusetts are compared with those from New York State, where the drinking age remained at 18. A total of 3 yr of survey data from the two states and 6 yr of data from the Department of Transportation's Fatal Accident Reporting System provide for pre- and postlaw comparisons. The findings suggest that raising the drinking age had minimal effects on the drinking behavior of Massachusetts teenagers. Although there was a significant reduction in nonfatal crashes in Massachusetts compared with New York, no decline in single-vehicle nighttime fatal crashes or in overall fatal crashes was observed. It is suggested that changes in the drinking age may offer some reduction in teenage driving after drinking and traffic crash involvement, but that teenage drinking and driving after drinking remain serious problems even in states that raise their drinking ages.

Accidents, Traffic↗
PubMed1993

Reorganization of craniofacial/cleft care delivery: the Massachusetts experience.

Until 1989, the Commonwealth of Massachusetts operated a mandated care program known as Services for Handicapped Children (SHC) for children with cleft lip/palate or craniofacial anomalies. During the mid 1980s, the federal government reduced its block grant funds and encouraged the Commonwealth of Massachusetts to develop Project SERVE to address this changing fiscal reality. The principal outcome of Project SERVE was the recommendation that the SHC direct care programs, including all craniofacial and cleft palate clinics, should be dismantled over a number of years. However, due to the economic recession, all government funding was suddenly withdrawn from cleft palate teams and the state-run SHC clinics were abruptly dissolved. To treat patients left without coordinated care, former team members reassembled and began a new craniofacial team based at the University of Massachusetts Medical Center. Difficulties with the transition of the clinic included recruiting and retaining team members; remuneration procedures for team members; maintenance of patient records previously kept by the state; coordination of clinical/clerical responsibilities; identifying a physical locale to hold the clinics; and solicitation of referring health care provider referrals and follow-up. All these issues required specific interventions that are presented in this paper. Project SERVE, begun under federal auspices, in the Commonwealth of Massachusetts, has recently been promoted as a model for a new and improved approach to the management of cleft palate and craniofacial care delivery nationwide. Awareness of the potential for abrupt, radical change in funding for federally mandated cleft/craniofacial care is essential, and a successful transition to a medical center-based model is possible using the procedures established at our center.

Child↗
PubMed1997

Strategies to improve the reporting of legal blindness in Massachusetts.

OBJECTIVES: Registration practices were evaluated as the initial phase of a validation study of the Register of the Massachusetts Commission for the Blind. METHODS: Massachusetts eye care providers were surveyed to determine factors associated with nonreporting of legal blindness to the commission. RESULTS: Among ophthalmologists, factors associated with nonreporting were small practice size and practicing for 5 years or less in Massachusetts. Among optometrists, factors included small practice size and unawareness of the Massachusetts reporting law. CONCLUSIONS: Information should be disseminated to eye care providers, legally blind patients, and the public to ensure registration and sustain it.

Analysis of Variance↗
PubMed2001

Strange bedfellows: the history of collaboration between the Massachusetts Restaurant Association and the tobacco industry.

OBJECTIVES: This article examines the historical relationship between the tobacco industry and the Massachusetts Restaurant Association, a nonprofit trade association aligned with the food and beverage industry. METHODS: The study analyzed data from Web-based tobacco industry documents, public relations materials, news articles, testimony from public hearings, requests for injunctions, court decisions, economic impact studies, handbooks, and private correspondence. RESULTS: Tobacco industry documents that became public after various state lawsuits reveal that a long history of collaboration exists between the Massachusetts Restaurant Association and the tobacco industry. For more than 20 years, their joint efforts have focused primarily on the battle to defeat state and local laws that would restrict smoking in public places, particularly in beverage and food service establishments. The resources of the tobacco industry, combined with the association's grassroots mobilization of its membership, have fueled their opposition to many state and local smoke-free restaurant, bar, and workplace laws in Massachusetts. CONCLUSIONS: The universal opposition of the Massachusetts Restaurant Association to smoking bans in food and beverage establishments is a reflection of its historic relationship with the tobacco industry.

Cooperative Behavior↗
PubMedDate not supplied

The prevention of venous thromboembolism: a statewide evaluation of practices in Massachusetts.

The objective of this study was to determine the proportion of Massachusetts Medicare patients who received prophylaxis for venous thromboembolism following colectomy, hysterectomy or total hip arthroplasty. The sample frame was all 90 Massachusetts acute care hospitals, and the time frame was 1 April to 30 September 1994. The patients discharged with an International Classification of Disease (ICD-9-CM) discharge diagnostic code (recorded in the Massachusetts Medicare Claims Database) for colectomy, hysterectomy or total hip arthroplasty were used to identify the target patient population. The sample population comprised 1397 patients randomly selected from the target population, including 467 total hip arthroplasties, 474 colectomies, and 456 hysterectomies. Medical records were reviewed by trained nurse abstractors who collected information on the use of prophylaxis for venous thromboembolism. Prophylaxis for venous thromboembolism was employed by surgeons practicing in Massachusetts hospitals in 93 per cent of total hip arthroplasty cases (regional variation 85-98 per cent), 84 per cent of colectomies (regional variation 57-93 per cent), 66 per cent of hysterectomies (regional variation 35-71 per cent), and in 87 per cent of the subset of 111 hysterectomies with malignancy (regional variation 25-100 per cent). The results of this statewide study demonstrated significant regional and hospital-to-hospital variation in use of prophylaxis for venous thromboembolism following major surgery. A lower rate of prophylaxis use was observed in hospitals with fewer than 200 beds and in hospitals that did not have teaching programmes. Hospitals with below-average rates of prophylaxis were targeted for intensive quality improvement interventions.

Anticoagulants↗
PubMed2003

Managed care, networks and trends in hospital care for mental health and substance abuse treatment in Massachusetts: 1994-1999.

BACKGROUND: Rates of inpatient care for mental health and substance abuse treatment have been reported to fall after the introduction of managed care, but the actual decline may be overstated. Almost all managed care impact studies are based on pre-post comparisons, which have two drawbacks: secular downward trends may be attributed to a managed care effect and self-selection may exaggerate the impact of managed care. Therefore it is useful to examine long-term population-based trends in use associated with the growth of managed care. AIMS OF STUDY: This paper examines trends in inpatient care for mental health and substance abuse treatment in Massachusetts between 1994 and 1999 by service provider and payer. We analyze how managed care impacts the trends in mental health and substance abuse care. METHODS: We provide an overview of the health market in Massachusetts and compare trends in mental health and substance abuse services with all inpatient services. To analyze the impact of managed care, we compare the per discharge cost of managed care and fee for service plans in Medicare and Medicaid. Finally, we examine the role played by hospital networks in managed care. RESULTS: The reduction in service costs for mental health and substance abuse, about 25% in six years, is mostly due to the decline in the average cost per inpatient episode. This is only slightly greater than the decline in costs for all inpatient care. Managed care has reduced both the quantity (average length of stay) and intensity of health care (expenditure per day). Simulations suggest that the creation of hospital networks by managed care accounts for around 50% of the differential between the average costs of the HMO and FFS sectors. DISCUSSION: We find that the cost reductions in mental health and substance abuse services are larger than for physical health, but not by much. The average length of stay and average day cost is lower for managed care plans than for FFS plans, and much of this difference is attributable to the hospitals managed care plans select to participate in their networks. The data are limited to inpatient discharges from Massachusetts and therefore our conclusions may not be readily extended to other places. Furthermore, our analysis is based on the estimated cost rather than the actual payments to hospitals. IMPLICATION FOR HEALTH CARE PROVISION AND USE: The analysis highlights the importance of hospital selection and networks in affecting the cost of care. IMPLICATIONS FOR HEALTH POLICIES: Contrary to popular belief, the analysis shows that the experience of mental health and substance abuse and non-mental health and substance abuse services is similar. Creation of networks is an important strategy in managed care. IMPLICATIONS FOR FURTHER RESEARCH: This paper provides the groundwork for extending the analysis to areas with market characteristics different to those of Massachusetts. Further research should focus on the long-term trends in health outcomes between managed care and fee for service patients.

Community Mental Health Services↗
PubMed2005

Reporting of chlamydial infection--Massachusetts, January-June 2003.

Chlamydia trachomatis infection is the most commonly reported sexually transmitted disease (STD) in the United States. An estimated 2.8 million infections occur annually. In 2002, a total of 834,555 cases in the United States, including 10,914 cases in Massachusetts, were reported through the National Notifiable Disease Surveillance System (NNDSS). Chlamydial infection is most often reported in females, particularly those aged 15-24 years, reflecting a higher level of screening in females but also important risk factors. Although the majority of infections are asymptomatic, complications are potentially severe in women and include pelvic inflammatory disease, which can lead to tubal pregnancy, infertility, and chronic pelvic pain. Chlamydial infection during pregnancy can cause illness in the infant (e.g., conjunctivitis and pneumonia). Infection in men can manifest as urethritis and epididymitis. Timely, documented diagnosis and treatment of chlamydial infection are critical to prevent both complications and transmission. Since 1996, a progressive increase has occurred in the number of reported cases of chlamydial infection in Massachusetts, in part because of an increase in screening and use of more sensitive tests. This report summarizes an evaluation of chlamydial-infection reporting in Massachusetts during January-June 2003. The results underscore the need for improvement in both completeness and timeliness of reporting chlamydial infection in Massachusetts.

Chlamydia Infections↗
PubMed2006

Eastern equine encephalitis--New Hampshire and Massachusetts, August-September 2005.

During August-September 2005, the New Hampshire Department of Health and Human Services reported seven cases of human eastern equine encephalitis virus (EEEV) disease, the first laboratory-confirmed, locally acquired cases of human EEEV disease reported from New Hampshire in 41 years of national surveillance. Also during August--September 2005, the Massachusetts Department of Public Health reported four cases of human EEEV disease, five times the annual average of 0.8 cases reported from Massachusetts during the preceding 10 years. Four of the 11 patients from New Hampshire and Massachusetts died. EEEV is transmitted in marshes and swamps in an enzootic bird-mosquito-bird cycle primarily by the mosquito Culiseta melanura. Bridge mosquito vectors (e.g., Coquillettidia perturbans, Aedes vexans, or Aedes sollicitans) transmit EEEV to humans and other mammals. This report summarizes the investigations of cases in New Hampshire and Massachusetts conducted by the two state health departments and CDC. The findings underscore the importance of surveillance for, and diagnostic consideration of, arboviral encephalitis in the United States and promotion of preventive measures such as local mosquito control and use of insect repellent.

Adolescent↗
PubMed1992

The uninsured and the debate over the repeal of the Massachusetts universal health care law.

OBJECTIVES: The debate in Massachusetts over the repeal of the first state-based "pay or play" universal health plan is discussed using data from a survey of 1066 Massachusetts households. The survey attempted to measure the problems of the uninsured, to estimate the likelihood that they would buy insurance if offered, and to calculate the proportion of the uninsured who would be covered under an employer mandate. DESIGN: A survey conducted in person and by telephone in 1066 households, with an oversample of uninsured households, using stratification, clustering, disproportionate sampling, and poststatistical weighting. PARTICIPANTS: Adults aged 18 years and older who were knowledgeable about the insurance status of persons in their household. MAIN OUTCOME MEASURES: Insurance status, employment status, access to and use of health services, and willingness to purchase health insurance. RESULTS: First, the present system of hospital-based uncompensated care in Massachusetts is inadequate by itself to meet the needs of uninsured residents. Uninsured persons are less likely than insured ones to seek medical care for chronic health problems and serious symptoms requiring evaluation. Second, 83% of uninsured families and 24% of uninsured individual respondents would purchase one of several insurance options with 30% of the cost subsidized. Last, the employer mandate provisions of the legislation would cover 43% of the uninsured in Massachusetts. CONCLUSION: In the current economic climate, the political viability of the universal health care plan and similar national initiatives is uncertain given the intractable conflict between perceptions of the financial stability of small businesses that do not offer insurance and the health care needs of uninsured individuals.

Cluster Analysis↗
PubMed1977

The closure of maternity services in Massachusetts. The causes, process, and hospital impact.

There has been a decline in the number of maternity services in Massachusetts from 120 in 1960 to 65 in 1975. Further consolidation must be carefully thought out with all options and possible outcomes thoroughly explored. The Massachusetts Maternity and Newborn Regionalization Project and the Massachusetts Hospital Association conducted a preliminary survey of Massachusetts Maternity services that had closed to understand the causes, process,, and hospital impact. The findings of this preliminary investigation, in addition to identifying areas for more intensive future research, provide some observations that should be of assistance to those considering a maternity service closure.

Female↗
PubMed1998

The coming of age of the Delta Dental Plan of Massachusetts, 1966-1996.

In the early nineteen fifties prepaid dental health insurance came of age on the West Coast. Because of the hard work of members of the Massachusetts Dental Society, dental insurance became available in Massachusetts in 1966. During the early eighties the Massachusetts Dental Service Corporation completed its separation from the dental society, and in 1985 achieved its independence from their management company, Blue Cross. This paper highlights the creative growth strategies of the start up company, Delta Dental of Massachusetts, that over the past decade has become the number one dental insurance group statewide.

History, 20th Century↗
PubMed2002

Associations between health risk behaviors and opposite-, same-, and both-sex sexual partners in representative samples of vermont and massachusetts high school students.

OBJECTIVE: To examine associations between health risk behaviors and sexual experience with opposite-, same-, or both-sex partners in representative samples of high school students. DESIGN: We used 1995 and 1997 data from the Vermont and Massachusetts Youth Risk Behavior Surveys. Logistic regression and multiple regression analyses were used to compare health risk behaviors among students who reported sex with opposite-sex partners only (opposite-sex students), with same-sex partners only (same-sex students), and with both male and female sexual partners (both-sex students). SETTING: Public high schools in Vermont and Massachusetts. PARTICIPANTS: Representative, population-based samples of high school students. The combined samples had 14 623 Vermont students and 8141 Massachusetts students. MAIN OUTCOME MEASURE: Violence, harassment, suicidal behavior, alcohol and other drug use, and unhealthy weight control practices. RESULTS: In both states, both-sex students were significantly more likely to report health risk behaviors than were opposite-sex students. For example, both-sex students had odds 3 to 6 times greater than opposite-sex students of being threatened or injured with a weapon at school, making a suicide attempt requiring medical attention, using cocaine, or vomiting or using laxatives to control their weight. In both states, same-sex students were as likely as opposite-sex students to report most health risk behaviors. CONCLUSION: Relative to opposite- and same-sex students, both-sex students may be at elevated risk of injury, disease, and death by experiencing serious harassment and engaging in violence, suicidal behavior, alcohol and other drug use, and unhealthy weight control practices.

Adolescent↗
PubMed1996

Managing the care of schizophrenia. Lessons from a 4-year Massachusetts Medicaid study.

BACKGROUND: In 1992, Massachusetts launched a state-wide managed care plan for all Medicaid beneficiaries. METHODS: This retrospective, multi-year, cross-sectional study used administrative data from the Massachusetts Division of Medical Assistance and Department of Mental Health, consisting of claims for 16,400 disabled adult patients insured by Medicaid in Massachusetts between July 1, 1990, and June 30, 1994. The main outcome measures include annual rates of hospitalization, emergency department utilization, and follow-up care 30 days after discharge; length of inpatient stay; and per-person inpatient and outpatient expenditures. RESULTS: Between 1991 and 1994, the likelihood of an inpatient admission decreased from 29% to 24% and was accompanied by a slight reduction in length of stay (median number of bed-days per admission dropped by 3.3 days). There was a slight decrease in the number of patients who sought care in general hospital emergency department utilization. However, there was a small increase in the fraction of patients readmitted within 30 days of discharge. Medicaid and Department of Mental Health expenditures for mental health per treated beneficiary decreased slightly, from $11,060 to $10,640, during the 4-year study period. CONCLUSION: Although per-person expenditures dropped and most patient patterns of care remained the same, longer-term study is recommended to asses whether the trends can be maintained.

Adolescent↗
PubMed2000

Tobacco use among Massachusetts youth: is tobacco control working?

BACKGROUND: This paper examines whether the Massachusetts Tobacco Control Program is affecting the rates of smoking and smokeless tobacco use among Massachusetts' youth. METHODS: School survey data from the Massachusetts Prevalence Study were analyzed to estimate differences between 1993 and 1996 rates of youth cigarette and smokeless tobacco use, attitudes toward smoking, and awareness of cigarette ads and promotions of antismoking messages. RESULTS: Lifetime and Current Smoking rates declined significantly among middle school males, contrasting with stable national trends. Among girls in this age group, Lifetime and Current Smoking did not change significantly. Hispanic middle school students exhibited a significant decline in Lifetime Use. There were no significant changes in Lifetime or Current Smoking rates among high school students. Lifetime use of smokeless tobacco declined among middle school students while Current Use declined among both middle and high school students. Students reported declines in awareness of cigarette ads or promotions and increases in awareness of antismoking messages. CONCLUSIONS: These results provide evidence for cautious optimism regarding the impact of tobacco control, but indicate that these efforts should begin earlier and that additional research is needed to understand and address the problems of tobacco use by girls.

Adolescent↗