RAND Corporation

Patient portals have become widespread since the passage of the American 21st Century Cures Act. However, little is known about how people are using these portals, especially for accessing telemedicine. We investigated patterns patient portal usage among a nationally representative sample of United States adults, focusing on the demographic factors influencing access and engagement. Using the RAND American Life Panel, we surveyed 1,672 people to assess their experiences with various portal functions, including viewing test results, messaging providers, and scheduling appointments. Our findings reveal that about three-quarters of respondents had used portals to view test results and to access health records, about half have used to message a provider, schedule an appointment, or pay a bill. However, we found significant differences in portal usage with women, non-Hispanic white people, people with college degrees, and those with higher self-reported technological proficiency all more likely to use portals. These results highlight the need for targeted interventions to enhance accessibility and usability of patient portals, ensuring access to health care resources for all individuals, particularly those from underrepresented populations.

Maternal and perinatal quality collaboratives (M/PQCs) across nearly all U.S. states focus on improving health care and outcomes for birth parents and their infants. In the context of increases in maternal morbidity (MM) and severe maternal mortality (SMM) in the USA, M/PQCs increasingly focus on addressing maternal care and disparities in care that are partly driving observed increases in SMM and MM. To date, quality care or safety bundles and other programming from state-based M/PQCs have been implemented by hospitals and other collaborating partners, while various studies have assessed their impact. However, no extant reviews synthesize the findings of this literature. The aim of this review is to synthesize the current evidence on implementation approaches of M/PQCs at the health system level in the USA and their impact on maternal health outcomes. We will conduct a scoping review of the literature of studies or reports that qualitatively and/or quantitatively assess the implementation of "toolkits" or "bundles" through state M/PQCs. We will include studies and reports on the implementation of state M/PQC initiatives in health systems/birth facilities or the impact of these on births, maternal and infant health outcomes and clinical care in the USA published after January 1, 2000. We will exclude studies that examine single-site quality improvement initiatives or initiatives outside of state M/PQCs, or studies that do not report on implementation, births, maternal and infant health, nor care outcomes. The information sources will include MEDLINE, Embase, CINAHL, and the Maternity and Infant Care Database, as well as a targeted search using Google Advanced for grey literature to capture information produced outside of academic publishing channels such as government and academics. Each record will be assessed independently by two reviewers at the title/abstract level and then at the full-text level. Included records will be subject to single reviewer data abstraction. We will assess study quality using the Mixed Methods Appraisal Tool (MMAT). Findings will be reported in the form of a narrative review and mapping outcomes in tabular form. This review will identify where additional evidence is needed to understand the relationship between M/PQCs and maternal health care and outcomes, as well as understanding key implementation processes. We will note key limitations of the included studies and general implications for the broader findings. Open Science Framework-Embargoed/anonymized until August 30, 2025 https://osf.io/bnmpk/?view_only=9e1f754cc2d947cba6ea889e5ae58f19 .

Cities in Central Asia remain underrepresented in global urban and climate studies, despite significant climate impacts in the region. At the same time, rapid urban expansion in Central Asia is changing both the horizontal and vertical dimensions of the cities, creating complex thermal environments. Urban morphology, including both two-dimensional (2D) and three-dimensional (3D) structural characteristics, plays a crucial role in shaping surface urban heat island (sUHI) intensity. While most previous research has mainly focused on 2D indicators such as building density and land use, the influence of 3D urban features on land surface temperature (LST) remains underexplored.To provide a regional-scale perspective, we first analyze urban growth and LST changes using Landsat and MODIS satellite time series in nine Central Asian cities. Next, we examine how urban morphology impacts LST across our cities, linking the findings to the observed urban growth trends.We find significant urban growth, particularly in Kazakhstan and Uzbekistan. The LST trend analysis reveals rising temperatures in urban areas, exacerbating heat stress, particularly in rapidly expanding cities. However, the temperature changes are uneven with some cities showing significant warming, while others show daytime cooling particularly in newly developed dense urban areas. By integrating 3D urban morphology indicators with contemporary LST data and information on urban vegetation, we demonstrate that significant urban temperature deviations are driven not only by 2D factors but also by vertical urban structures. Our findings highlight the need to incorporate 3D urban metrics into climate adaptation and urban planning strategies to better manage urban heat and promote resilient cities in Central Asia.

The indoor residential environment is a critical yet underexamined determinant of public health, particularly during extreme heat events. People in the U.S. spend roughly 90% of their time indoors, making indoor thermal exposure a key yet often overlooked, component of heat vulnerability. The level of residential protection against climate hazards depends on socioeconomic factors, but in the U.S., decades of systemic housing discrimination mean that housing quality issues disproportionately fall on racialized minority and low-income populations.The New Orleans Home, Environment, and Ambient Temperature: Measurements and Analysis for Preparedness (NOLA HEAT-MAP) Study assessed indoor thermal vulnerability to inform equitable resilience strategies. We enrolled 114 participants from high-urban-heat neighborhoods in New Orleans, LA, collecting demographic and housing data, continuous indoor temperature and humidity measurements over two- or four-week periods, and daily self-reported physical and mental health surveys.Modeling results show that outdoor temperature, air conditioning type and use, and homeownership status are key predictors of indoor heat exposure. Notably, homeowners were twice as likely as renters to experience the highest overnight indoor temperatures (62% vs. 38%). Across tenure types, homes relying on window units struggled to maintain 80°F (26.6°C) once outdoor temperatures exceeded 90°F (32.2°C)—an important threshold given New Orleans’ residential cooling standard requiring rental units to maintain temperatures of 80°F (26.6°C) or below.To understand how these challenges may change over time, we estimated the number of days exceeding 90°F in New Orleans using LOCA2 downscaled CMIP6 climate projections. We found that days exceeding 90°F (32.2°C) may rise by 50% by 2075, reaching approximately 150 days annually under SSP5-8.5. In this presentation, we will discuss how these findings suggest escalating cooling needs that could exacerbate existing inequities in thermal safety, and highlight the need for interdisciplinary, climate-informed research to support adaptive public health and resilience.

E-cigarette use (i.e., vaping) among young adults increases the risk for significant health consequences and combustible cigarette uptake. Although there are a growing number of vaping cessation interventions for young adults, there are no known evidence-based e-cigarette use treatments that include smoking uptake prevention. The Live Free From E-Cigarettes (LIFFE) digital program was developed to help young adults stop or reduce their use of e-cigarettes and reduce their cigarette smoking susceptibility. Twenty young adults (ages 18-24) who vape but do not smoke combustible cigarettes were recruited via social media. They completed an initial survey and the single-session, 30-min intervention on their mobile devices, followed by quantitative measures of intervention feasibility and acceptability. One week later, participants completed an interview to provide feedback about the program and a follow-up survey. All participants completed all seven intervention modules. Participants rated LIFFE as feasible in terms of delivery, usability, and logistics. Participants were satisfied with the content, design, and potential to help them and other young adults who vape to stop or reduce use. Some participants reported reductions in their susceptibility to smoke and vaping behaviors, including via quitting, 1 week after the intervention. Quantitative and qualitative results indicate that LIFFE is a feasible and acceptable program for engaging young adults in cessation efforts. Participants also included suggestions for potential changes to enhance the LIFFE program. Next steps will include building upon these suggestions for intervention refinement and testing the refined version in a randomized controlled trial. (PsycInfo Database Record (c) 2026 APA, all rights reserved).