Literature Collection

Though overall death from opioid overdose are increasing in the United States, the death rate in some states and population groups is stabilizing or even decreasing. Several states have enacted a Naloxone Accessibility Laws to increase naloxone availability as an opioid antidote. The extent to which these laws permit layperson distribution and possession varies. The aim of this study is to investigate differences in provisions of Naloxone Accessibility Laws by states mainly in the Northeast and West regions, and the impact of naloxone availability on the rates of drug overdose deaths.This cross-sectional study was based on the National Vital Statistics System multiple cause-of-death mortality files. The average changes in drug overdose death rates between 2013 and 2017 in relevant states of the Northeast and West regions were compared according to availability of naloxone to laypersons.Seven states in the Northeast region and 10 states in the Western region allowed layperson distribution of naloxone. Layperson possession of naloxone was allowed in 3 states each in the Northeast and the Western regions. The average drug overdose death rates increased in many states in the both regions regardless of legalization of layperson naloxone distribution. The average death rates of 3 states that legalized layperson possession in the West region decreased (-0.33 per 100,000 person); however, in states in the West region that did not allow layperson possession and states in the Northeast region regardless of layperson possession increased between 2013 and 2017.The provision to legalize layperson possession of naloxone was associated with decreased average opioid overdose death rates in 3 states of the West region.

Childbearing families in the United States, especially in rural communities, face inconsistent access to high-quality maternity care, with many experiencing sparse and fragmented services. In response to long-standing disparities in Alabama, we created the Women and Children Health Initiative (WACHI), a coordinated hub that advances midwifery workforce growth, expands practice partnerships, and catalyzes policy change to support collaborative, risk-appropriate care. Central to WACHI is integrating certified nurse-midwives (CNMs) within systems that have historically imposed practice barriers. Grounded in the belief that Alabama can do better, WACHI convenes academic fields, health systems, public health sectors, and community partners to codesign and implement evidence-informed interventions. Program pillars include (1) reopening and expanding the state's nurse-midwifery education pathway, (2) embedding Nurse-Family Partnership home visiting with integrated behavioral health, (3) launching the Moms and Kids Mobile Health Clinic to reach underserved rural areas, and (4) building durable CNM-physician collaborations and standardized protocols for team-based care. These coordinated strategies align workforce development, health care delivery, and policy to increase first-trimester prenatal entry, improve postpartum follow-up, and reduce preventable complications. Early results include growth in the CNM workforce, new rural practice partnerships, and health-system engagement with respectful, team-based models that prioritize patient preferences and cultural safety. In this article we describe the WACHI model and early outcomes to inform adaptation and support replication by diverse regional coalitions and systems nationwide.

As the aging population in the United States grows, the need for an integrated approach to support older adults has become increasingly urgent. The SUNSHINE framework, Seniors Uniting Nationwide to Support Health, INtegrated Care, and Evolution, offers a model for advancing resilience, defined as the capacity of individuals, families, systems, and communities to adapt and thrive in the face of adversity. SUNSHINE promotes this goal through the alignment of older and aging adults, families, healthcare systems, public health agencies, social services, and community resources. Using the Theory of Change modeling, SUNSHINE emphasizes whole-person health, interdisciplinary collaboration, and the strategic use of technology to address the evolving needs of aging populations. The framework promotes systems integration supported by research infrastructure and multi-sector collaboration to enhance the well-being of older adults and family caregivers. SUNSHINE places a strong emphasis on mental health, particularly depression, and highlights the importance of social connection and prevention in addressing health disparities and care gaps associated with aging. It conceptualizes resilience as both a desired outcome and a driver of transformation, guiding the redesign and evaluation of health and social systems. The framework also identifies opportunities to leverage artificial intelligence and machine learning (AI/ML) technologies, grounded in scientific evidence, to support personalized prevention, treatment, and care strategies. These technologies are critical for optimizing decision-making, improving care delivery, and enhancing system flexibility. Finally, SUNSHINE aspires to advance a future of aging that is healthy, resilient, and fair, guided by principles of equity, defined as fairness and impartiality in health opportunities and outcomes.