Journal Watch
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* Mark Barna

## ER visits jump with prison privatization

Hospital emergency department visits by incarcerated people have risen dramatically in Florida, a study in the May issue of APHA’s *American Journal of Public Health* finds.

Researchers examined 2011-2018 records from the state’s Agency for Health Care Administration, which tracks health care provided to the approximately 100,000 people who are incarcerated in Florida. They found that between 2015 and 2018, the rate of imprisoned people sent to external emergency departments rose 400%, and hospital stays rose 100%.

During the period, Florida contracted with outside companies to manage prison health care. The companies were reimbursed to cover all care whether it was on-site or off-site, the researchers found.

“They had a financial disincentive to providing costly services, such as outside hospitalization,” the researchers said.

A 2019 study by the Florida prison system also found a “decline in quantity and quality of care” during the period.

“Hospitals and government agencies should transparently report on health care utilization and outcomes among incarcerated people to ensure better oversight of services for a highly vulnerable population,” the researchers said.

## Marijuana may aid users of opioids

Marijuana may hold promise as a harm-reduction strategy among people using opioids or other drugs and stimulants, a study in the May issue of *AJPH* finds.

Researchers examined studies on marijuana as a harm reduction tool that were conducted in Vancouver, British Columbia, between 2016 and 2018.

Nearly 1,300 marijuana users were followed for months in the studies, with about a third using marijuana as self-medication for harm reduction.

“Further research may allow for a better understanding of circumstances under which individuals choose this harm-reduction strategy,” researchers wrote. “These insights may contribute to public health-based strategies to address drug-related harms or regulate licit medical and recreational cannabis systems.”

## Public health plan benefits Brazilians

A federal program in Brazil has helped older adults in underrepresented communities receive better health care, according to a study in May’s *AJPH*.

Since 1994, Brazil’s Family Health Strategy has used community health workers to bring primary health care to people with limited health care options. In 2017, researchers examined mortality and health coverage for over 1,300 people who had signed up in 2008 for a medical study. At the time of sign-up, all were at least 60 years of age.

People on the Family Health Strategy showed reduced social inequalities and lived longer when compared to people with similar socioeconomic status that were not part of the plan.

“The FHS is a powerful tool for reducing social inequalities in all-cause and avoidable mortality among older adults,” the researchers wrote. “It is an effective approach to organizing (primary health care) and may accelerate the achievement of the goal of health for all.”

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/51/5/4.2/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/51/5/4.2/F1)

After coal-fired plant closures, emergency room visits for children with asthma declined in nearby neighborhoods, a study says.

Photo by Monkeybusinessimages, courtesy iStockphoto

## Asthma falls when coal plants shutter

Kids who live near coal-fired power plants are less likely to visit emergency departments for asthma after plants are shut down, according to a May *AJPH* study.

Researchers analyzed data on wind, population, fine particulate air pollution and asthma-related emergency department visits by ZIP code in Chicago. The 2009-2017 study focused on children ages 0 to 4 in neighborhoods near three coal-fired power plants before and after their 2012 closures.

The study found that asthma-related emergency department visits among young children decreased by 12% in ZIP codes near the three power plants after closures, compared to ZIP codes farther away from the shuttered plants. Emergency department visits dropped by over 35 visits per 10,000 children.

“Young children, especially low-income and minority children living near operational power plants, are particularly susceptible and vulnerable to the consequences of exposure to air pollution,” the study stated. “Thus, public health may have much to gain from coal-fired power plant closures.”

*To access studies and podcasts from AJPH, visit [ajph.org](http://www.ajph.org).*

*   Copyright The Nation’s Health, American Public Health Association