Analgesic use among US adults is extremely high, specifically of non-prescription analgesics. Given this, health care providers and consumers should be aware of potential adverse effects and monitor use closely.

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We estimate the effect of county-level e-cigarette indoor vaping restrictions on adult prenatal smoking and birth outcomes using United States birth record data for 7 million pregnant women living in places already comprehensively banning the indoor use of traditional cigarettes. We use both cross-sectional and panel data to estimate our difference-in-difference models. Our panel model results suggest that adoption of a comprehensive indoor vaping restriction increased prenatal smoking by 2.0 percentage points, which is double the estimate obtained from a cross-sectional model. We also document heterogeneity in effect sizes along lines of age, education, and type of insurance.

We estimate the effect of county-level e-cigarette indoor vaping restrictions on adult prenatal smoking and birth outcomes using United States birth record data for 7 million pregnant women living in places already comprehensively banning the indoor use of traditional cigarettes. We use both cross-sectional and panel data to estimate our difference-in-difference models. Our panel model results suggest that adoption of a comprehensive indoor vaping restriction increased prenatal smoking by 2.0 percentage points, which is double the estimate obtained from a crosssectional model. We also document heterogeneity in effect sizes along lines of age, education, and type of insurance.

Background: Provider ability to estimate caregiver health literacy (HL) in English-speaking caregivers has been shown to be poor, but estimation of HL in Spanish-speaking caregivers by physicians and staff has yet to be studied. Linguistic differences can further hinder communication in medical care. Objective: This study evaluated how well pediatric providers and staff predict caregiver HL as measured by two HL tools in a bilingual (English/Spanish) population. Method: For this study, we obtained a convenience sample of caregivers, evaluating one group with the Newest Vital Sign (NVS) and the second group with the Short Assessment of Health Literacy (SAHL). Physicians/nurse practitioners (NPs), and medical assistants (MAs) estimated caregiver scores for each tool. We dichotomized estimated and actual scores for each tool using published standards. We used McNemar's test and Cohen's Kappa to evaluate agreement between dichotomized predicted and actual scores. We used log binomial regression to examine how caregiver's language affected agreement between dichotomized caregiver scores and provider estimates. All physicians/NPs were native English speakers only and all MAs were native bilingual English/Spanish speakers. Physicians/NPs used interpretation services when appropriate. Key Results: Fifty caregivers were evaluated using the NVS and 50 using the SAHL. There was no overall association between dichotomized physician/NP or MA estimation and caregiver score for either tool. However, providers' estimates were less likely to match caregiver scores when the caregiver's language was Spanish (NVS: relative risk [RR] = 0.57 [95% CI 0.37, 0.87], SAHL: RR = 0.37 [95% CI 0.23,0.6]). Conclusion: Physician/NP and MA ability to estimate caregiver HL in English proficient and limited English proficiency caregivers is poor. The physician/NP group was less likely to estimate HL correctly if the caregivers spoke Spanish. Providers must use additional caution when providing cross-language care. [ HLRP: Health Literacy Research and Practice . 2018;2(2):e107–e114.] Plain Language Summary: This study examined estimation of health literacy of English- and Spanish-speaking caregivers by pediatric providers and medical assistants. We found that both providers and staff estimate caregiver health literacy poorly, and that primary language discordance may be a factor. The results support the institution of universal health literacy precautions for all caregivers of pediatric patients.