Across the U.S., states have adopted Complete Streets legislative statutes—state laws that direct transportation agencies to routinely design and operate roadways to provide safe access for all users, including pedestrians, bicyclists, motorists, and public transit users. To date, there has not been a systematic and comprehensive analysis of the content and provisions of these laws. In this study, Complete Streets state statutes were identified using legal research databases. Using established legal mapping methods, a qualitative analysis was conducted of state laws that were effective through December 2018. A codebook and open-source data set were developed to support the public use of the data. Eighteen states and Washington, DC, have adopted Complete Streets legislative statutes. A total of 21 have been adopted, with 76% (n=16) of laws adopted since 2007. While the laws vary in content, detail, and specificity, several common provisions were identified across statutes. Complete Streets legislative statutes may be essential to ensure that road networks throughout states are safe, connected, and accessible for all users. This study provides key insights into the legislative landscape of Complete Streets state laws and makes available a new data set that can support future evaluations of these laws.

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IntroductionApproximately 20 million new sexually transmitted infections (STIs) are diagnosed yearly in the United States costing the healthcare system an estimated $16 billion in direct medical expenses. The presence of other STIs increases the risk of HIV transmission. The Centers for Disease Control and Prevention (CDC) has long recommended routine HIV screening for individuals with a diagnosed STI. Unfortunately, HIV screening prevalence among STI diagnosed patients are still sub-optimal in many healthcare settings.ObjectiveTo determine the proportion of STI-diagnosed persons in the Medicaid population who are screened for HIV, examine correlates of HIV screening, and to suggest critical intervention points to increase HIV screening in this population.MethodsA retrospective database analysis was conducted to examine the prevalence and correlates of HIV screening among participants. Participant eligibility was restricted to Medicaid enrollees in 29 states with a primary STI diagnosis (chlamydia, gonorrhea, and syphilis) or pelvic inflammatory disease claim in 2009. HIV-positive persons were excluded from the study. Frequencies and descriptive statistics were conducted to characterize the sample in general and by STI diagnosis. Univariate and multivariate logistic regression were performed to estimate unadjusted odds ratios and adjusted odds ratio respectively and the 95% confidence intervals. Multivariate logistic regression models that included the independent variables (race, STI diagnosis, and healthcare setting) and covariates (gender, residential status, age, and state) were analyzed to examine independent associations with HIV screening.ResultsAbout 43% of all STI-diagnosed study participants were screened for HIV. STI-diagnosed persons that were between 20–24 years, female, residing in a large metropolitan area and with a syphilis diagnosis were more likely to be screened for HIV. Participants who received their STI diagnosis in the emergency department were less likely to be screened for HIV than those diagnosed in a physician’s office.ConclusionThis study showed that HIV screening prevalence among persons diagnosed with an STI are lower than expected based on the CDC’s recommendations. These suboptimal HIV screening prevalence present “missed opportunities” for HIV screening in at-risk populations. Measures and incentives to increase HIV screening among all STI-diagnosed persons are vital to the timely identification of HIV infection, linkage to HIV care, and mitigating further HIV transmission.