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BackgroundAdult smoking prevalence in Minnesota fell from 21.8% in 1997 to 15.2% in 2016. This reduction improved heart and lung health, prevented cancers, extended life and reduced healthcare costs, but quantifying these benefits is difficult.Methods1.3 million individuals were simulated in a tobacco policy model to estimate the gains to Minnesotans from 1998 to 2017 in health, medical spending reductions and productivity gains due to reduced cigarette smoking. A constant prevalence scenario was created to simulate the tobacco harms that would have occurred had smoking prevalence stayed at 1997 levels. Those harms were compared with tobacco harms from a scenario of actual smoking prevalence in Minnesota from 1998 to 2017.ResultsThe simulation model predicts that reducing cigarette smoking from 1998 to 2017 has prevented 4560 cancers, 31 691 hospitalisations for cardiovascular disease and diabetes, 12 881 respiratory disease hospitalisations and 4118 smoking-attributable deaths. Minnesotans spent an estimated $2.7 billion less in medical care and gained $2.4 billion in paid and unpaid productivity, inflation adjusted to 2017 US$. In sensitivity analysis, medical care savings ranged from $1.7 to $3.6 billion.ConclusionsMinnesota’s investment in comprehensive tobacco control measures has driven down smoking rates, saved billions in medical care and productivity costs and prevented tobacco related diseases of its residents. The simulation method employed in this study can be adapted to other geographies and time periods to bring to light the invisible gains of tobacco control.

Background Despite high morbidity and mortality among people who use drugs (PWUD) in rural America, most research is conducted within urban areas. Our objective was to describe influencing factors, motivations, and barriers to research participation and retention among rural PWUD. Methods We recruited 255 eligible participants from community outreach and community-based, epidemiologic research cohorts from April to July 2019 to participate in a cross-sectional survey. Eligible participants reported opioid or injection drug use to get high within 30 days and resided in high-needs rural counties in Oregon, Kentucky, and Ohio. We aggregated response rankings to identify salient influences, motivations, and barriers. We estimated prevalence ratios to assess for gender, preferred drug use, and geographic differences using log-binomial models. Results Most participants were male (55%) and preferred methamphetamine (36%) over heroin (35%). Participants reported confidentiality, amount of financial compensation, and time required as primary influential factors for research participation. Primary motivations for participation include financial compensation, free HIV/HCV testing, and contribution to research. Changed or false participant contact information and transportation are principal barriers to retention. Respondents who prefer methamphetamines over heroin reported being influenced by the purpose and use of their information (PR = 1.12; 95% CI: 1.00, 1.26). Females and Oregonians (versus Appalachians) reported knowing and wanting to help the research team as participation motivation (PR = 1.57; 95% CI: 1.09, 2.26 and PR = 2.12; 95% CI: 1.51, 2.99). Conclusions Beyond financial compensation, researchers should emphasize confidentiality, offer testing and linkage with care, use several contact methods, aid transportation, and accommodate demographic differences to improve research participation and retention among rural PWUD.

Community organizations and university researchers partnered to develop a model Family History Demonstration Project with input from community members. Evaluations of the project were positive. Future efforts should focus on sustainable dissemination of the educational programs and resulting health outcomes.

Accurately testing, treating, and tracking all malaria cases is critical to achieving elimination. Ensuring health providers are able and motivated to test, treat, and report cases is a necessary component of elimination programs, and particularly challenging in low endemic settings where providers may not encounter a large volume of cases. With funding from the Bill & Melinda Gates Foundation, this study aimed to identify and validate distinctive subtypes of motivation among private sector providers enrolled in the Greater Mekong Subregion Elimination of Malaria through Surveillance (GEMS) program, implemented by Population Services International. Quantitative questionnaires were administered electronically in person by trained enumerators to various provider groups in Myanmar, Lao PDR, and Vietnam. A three-stage confirmatory factor analysis was then conducted in STATA. Following this analysis, a two-factor solution that describes motivation in this population of providers was identified, and providers were scored on the two dimensions of motivation. Provider motivations were analyzed by provider characteristics, and associations with intentions and outcomes related to malaria service provision were explored. These providers, who are often assumed to only be financially motivated, engaged in malaria elimination activities because of both internal and external motivational factors that are independent of remuneration or financial gain. Motivation varied by provider characteristics and was associated with outcomes of importance to malaria elimination. Understanding components of provider motivation to test, treat, and report malaria cases in elimination settings will ensure that malaria programs can establish mechanisms to encourage lasting engagement by providers in pursuit of elimination goals.