Browsing by Author "Silverman, Ross D."

Now showing 1 - 10 of 37
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    Achieving an Optimal Childhood Vaccine Policy
    (American Medical Association, 2017-09-01) Opel, Douglas J.; Schwartz, Jason L.; Omer, Saad B.; Silverman, Ross D.; Duchin, Jeff; Kodish, Eric; Diekema, Douglas S.; Marcuse, Edgar K.; Orenstein, Walt; Health Policy and Management, School of Public Health
    Policies to remove parents' ability to opt-out from school immunization requirements on the basis of religious or personal beliefs (ie, nonmedical exemptions) may be a useful strategy to increase immunization rates and prevent outbreaks of vaccine-preventable disease. However, there is uncertainty about the effectiveness of this strategy and the range of possible outcomes. We advocate for a more deliberative process through which a broad range of outcomes is scrutinized and the balance of values underlying the policy decision to eliminate nonmedical exemptions is clearly articulated. We identify 3 outcomes that require particular consideration before policies to eliminate nonmedical exemptions are implemented widely and outline a process for making the values underlying such policies more explicit.
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    Adolescent Consent for HPV Vaccine: Ethical, Legal, and Practical Considerations
    (Elsevier, 2021) Zimet, Gregory D.; Silverman, Ross D.; Bednarczyk, Robert A.; English, Abigail; Pediatrics, School of Medicine
    Healthy People 2020 set a goal of 80% series completion for HPV vaccine. 1 The 2019 National Immunization Survey-Teen shows that 54.2% of adolescents aged 13-17 years were up-to-date with the vaccine series. 2 Although this coverage level represents an incremental increase over 2018, it remains well-below the Healthy People goal. Furthermore, HPV vaccine ordering and administration have dropped dramatically during the COVID-19 pandemic.
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    The Challenges of Conducting Intrastate Policy Surveillance: A Methods Note on County and City Laws in Indiana
    (APHA, 2021-06) Sanner, Lindsey; Grant, Sean; Walter-McCabe, Heather; Silverman, Ross D.; Social and Behavioral Sciences, School of Public Health
    Policy surveillance is critical in examining the ways law functions as a structural and social determinant of health. To date, little policy surveillance research has focused on examining intrastate variations in the structure and health impact of laws. Intrastate policy surveillance poses unique methodological challenges because of the complex legal architecture within states and inefficient curation of local laws. We discuss our experience with these intrastate policy surveillance challenges in Indiana, a state with 92 counties and several populous cities, a complicated history of home rule, systemically underfunded local governments, and variations in demography, geography, and technology adoption. In our case study, we expended significant time and resources to obtain county and city ordinances through online code libraries, jurisdiction Web sites, and (most notably) visits to offices to scan documents ourselves. A concerted effort is needed to ensure that local laws of all kinds are stored online in organized, searchable, and open access systems. Such an effort is vital to achieve the aspirational goals of policy surveillance at the intrastate level.
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    Characterizing variability in state-level regulations governing opioid treatment programs
    (Journal of Substance Abuse Treatment, 2020-04-24) Jackson, Joanna R.; Harle, Christopher A.; Silverman, Ross D.; Simon, Kosali; Menachemi, Nir
    Abstract Introduction: The opioid use crisis has left nearly 1 million people in need of treatment. States have focused primarily on policies aimed at decreasing the prevalence of opioid use disorder. However, opioid treatment programs (OTPs), an evidence-based modality which can prevent and decrease opioid-related mortality and morbidity, remain highly complex with variation in treatment by state. A focus on evidence-based state-level regulation of OTPs may help improve the unmet need for treatment. This study characterized the variability in state laws that regulate OTPs and examines how this variability is associated with state characteristics. These data provides an opportunity for policymakers to consider regulations that increase access to care and retention in OTPs, which could improve population health. Materials and Methods: Utilizing legal mapping techniques, we identified all regulations governing OTPs in effect on January 1, 2017 and determined whether the most common regulations were consistent with best practices. We then examined how the number and type of regulations were associated with state characteristics. All legal mapping research was conducted between November 2017 and March 2019. Results: We identified 89 different regulations, the most common of which exists in fewer than half of all states; and most exist in less than 25% of states. Eighteen of the 30 most common regulations were inconsistent with best practice recommendations. Overall, variability in the number and type of OTP regulations was related to geographic location as opposed to state size or political leanings. Conclusions: Wide-ranging variability in the regulations of OTPs exists across the U.S. The majority of state OTP regulations are not congruent with best practices.
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    ‘Clustering of exemptions’ as a collective action threat to herd immunity
    (2003-03) May, Thomas; Silverman, Ross D.
    In this paper, we examine the phenomenon of ‘clustering of exemptions’ to childhood vaccination, and the dangers this poses both to those exempted as well as the general population. We examine how clusters of exemptions might form through collective action as described by Thomas Schelling, and how religious groups who live in close proximity to one another can “self-select” in a way that exacerbates this phenomenon. Given the growing number of exemptions and the increasing visibility of the anti-vaccine movement, policy makers must be vigilant for dangerous clustering in order to avoid loss of herd immunity.
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    Contact Tracing, Intrastate and Interstate Quarantine, and Isolation
    (Public Health Law Watch, 2020-08) Silverman, Ross D.
    Contact tracing, quarantine and isolation are core communicable disease control measures used by public health departments as part of a comprehensive case ascertainment and management strategy. These are practices with historic roots enabled by state laws and policies, and have been used by other countries to slow and stop the spread of COVID-19. To date, their implementation as part of U.S. response efforts at the national, state, and local levels has been confounded by the scale of the COVID-19 outbreak; lack of a systemic infectious disease response; insufficient and fragmented funding streams; low levels of public accountability; and concerns about the impact of such efforts on individual privacy, liberty, and travel rights, as well as the financial and personal costs that may arise out of a positive diagnosis. Recommendations have been offered by expert groups on both the scaling up of contact tracing and ensuring ethical implementation of such measures. One state has passed legislation establishing an oversight framework for state contact tracing and associated data collection and use. Legal challenges to interstate quarantine rules have, thus far, been unsuccessful. Recommendations include: appropriating federal funding adequate to mount and sustain rapid, comprehensive, culturally-appropriate state and local testing, treatment, contact tracing, and supported quarantine and isolation service efforts; building contact tracing systems that cover social as well as health care supports for those affected; and, to bolster trust and participation in public health efforts, implement contact tracing-related health communication efforts targeted to reach the diverse array of communities affected by the epidemic.
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    Controlling Measles through Politics and Policy
    (Hastings Center Report, 2019-04-22) Silverman, Ross D.
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    Coronavirus Disease 2019 and Vaccination of Children and Adolescents: Prospects and Challenges
    (Elsevier, 2021-04) Zimet, Gregory D.; Silverman, Ross D.; Fortenberry, J. Dennis; Pediatrics, School of Medicine
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    Court personnel attitudes towards medication-assisted treatment: A state-wide survey
    (Elsevier, 2019-09) Andraka-Christou, Barbara; Gabriel, Meghan; Madeira, Jody; Silverman, Ross D.; Health Policy and Management, School of Public Health
    Background Despite its efficacy, medication-assisted treatment (MAT) is rarely available in the criminal justice system in the United States, including in problem-solving courts or diversionary settings. Previous studies have demonstrated criminal justice administrators' hostility towards MAT, especially in prisons and jails. Yet, few studies have examined attitudes among court personnel or compared beliefs among different types of personnel. Also, few studies have explored the relationship between MAT education/training and attitudes. Finally, few studies have directly compared attitudes towards methadone, oral buprenorphine, and extended-release naltrexone in the criminal justice system. Methods We modified a survey by Matusow et al. (2013) to explore justice professionals' MAT attitudes, including associations with demographic variables, court role, and previous MAT education/training. After piloting the survey, we distributed it to a convenience sample of justice professionals registered for an educational summit held in Indiana in 2018. Data was analyzed using descriptive and inferential statistical methods. Results 231 Indiana court employees who had registered for a state MAT educational summit completed the survey prior to the summit, including judges, probation officers, law enforcement personnel, attorneys, probation officers, program directors, counselors, and case managers. Overall, participants had significantly more positive attitudes towards extended-release naltrexone than towards other medications ( p value <0.01). Court employee average attitudes towards methadone were significantly more negative than average attitudes towards oral buprenorphine; and average attitudes towards oral buprenorphine were significantly more negative than average attitudes towards extended-release naltrexone ( p value <0.01). Employment as a prosecutor or law enforcement officer was associated with more negative attitudes towards oral buprenorphine and methadone ( p value <0.05). Exposure to previous MAT training was associated with more positive attitudes for all medications ( p value <0.05). Compared to participants with graduate degrees, participants with less education had significantly more negative attitudes towards extended-release naltrexone ( p < 0.05). Gender, age, rurality, and personal/family recovery history were not associated with differences in attitudes. Conclusion As expected, court employees' attitudes significantly differ by medication, with average attitudes towards agonist medications being more negative than attitudes towards extended-release naltrexone. Despite a larger evidence base for the efficacy of methadone and oral buprenorphine, justice personnel may have more positive attitudes towards extended-release naltrexone due to targeted marketing by the pharmaceutical manufacturer, fears about diversion or misuse of agonist medications, and historic criminal justice hostility towards agonist medications. Importantly, previous education/training regarding MAT is associated with more positive attitudes, suggesting that more awareness-raising or capacity building educational interventions are needed, especially for prosecutors and law enforcement personnel.
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    Covid-19, equity, and inclusiveness
    (BMJ, 2021-06) Evans, Nicholas G.; Berger, Zackary D.; Phelan, Alexandra L.; Silverman, Ross D.; Health Policy and Management, School of Public Health