BACKGROUND: Adherence with medications to prevent fractures is suboptimal. Patients' perceived need for medication is an important predictor of medication-use behavior. OBJECTIVE: Estimate the associations of patients' perceived need of medication for fracture prevention with objective indicators of fracture risk, patients' concerns about medications, and the quality of the patient-physician relationship. RESEARCH DESIGN: Cross-sectional medical record review and mailed survey. A multivariate path model was used to estimate the associations of predictor variables with perceived need for fracture prevention medication. SUBJECTS: A total of 1155 individuals were prescribed an oral bisphosphonate medication between January 1, 2006 and March 31, 2007 at a large urban multispecialty clinic in the United States. RESULTS: Trust in the prescribing physician, prevalent vertebral fracture on spine imaging, patients' self-reported susceptibility to and perceived severity of fractures, and medication concerns were independently associated with perceived need for medication. Bone mineral density and fracture history were only weakly associated with perceived need for medication. Trust in the physician was associated with perceived severity of fractures but not with self-reported susceptibility to fractures. Patients' perceptions that their physician communicates openly with them and their satisfaction with their physician's decision-making style are strongly associated with their trust in that physician. CONCLUSIONS: Documenting prevalent vertebral fracture may influence patients' perceived need for fracture prevention medication. Patients' trust in their physicians influences perceived need for fracture prevention medication. Patients' perceptions of open physician communication and their satisfaction with their physician's decision-making style are indirectly associated with perceived need for fracture prevention medication.

This study analyzes the experiences of youth placed out-of-home for behavioral reasons by human services and juvenile corrections departments in a large Midwestern metropolitan county. The study goals are to determine whether youth placed by each department have similar characteristics and analyze the factors associated with length of stay in placement. Many local human services and corrections departments are attempting to coordinate their services in an effort to improve the outcomes for youth and their families. The study findings suggest that the youth placed by the two departments are similar in many ways, yet there are some important differences. Factors associated with length of stay differ between the two departments, suggesting that youth experiences differ once placed. Out-of-home placements of youth for behavioral reasons are costly, and policymakers continually question the effectiveness of placements in providing treatment to youth with behavioral problems. Our study identifies key factors associated with long placement stays for youth placed by both human services and corrections departments. By targeting intensive intervention and treatment towards these youth and their families, local governments may be able to reduce the length of stay in out-of-home placement and effectively address the youths' behavioral problems.

More than half of all Americans receive health insurance coverage through an employer. The rising costs and escalating complexity of health insurance has led many employers to embark on extensive employee education campaigns. In 2002, 1,365 randomly selected employees from 16 Buyers Health Care Action Group firms in the Minneapolis region were surveyed to evaluate their awareness of employer-provided health plan quality information and the extent to which this information influences their enrollment decisions. The study found mixed evidence with respect to the value of employer communication. On one hand, employer communication does not significantly increase the probability that an employee responded correctly to the pharmacy benefit question posed in the survey. However, employer communication has a large effect on the awareness of quality information. How well those campaigns work, and by extension how well employees are informed about the health benefits decisions they make, is a key issue in health care today.

Antiracist health policy research requires methodological innovation that creates equity-centered and antiracist solutions to health inequities by centering the complexities and insidiousness of structural racism. The development of effective health policy and health equity interventions requires sound empirical characterization of the nature of structural racism and its impact on public health. However, there is a disconnect between the conceptualization and measurement of structural racism in the public health literature. Given that structural racism is a system of interconnected institutions that operates with a set of racialized rules that maintain White supremacy, how can anyone accurately measure its insidiousness? This article highlights methodological approaches that will move the field forward in its ability to validly measure structural racism for the purposes of achieving health equity. We identify three key areas that require scholarly attention to advance antiracist health policy research: historical context, geographical context, and theory-based novel quantitative and qualitative methods that capture the multifaceted and systemic properties of structural racism as well as other systems of oppression.