Director's Note
Over the past 18 months, the COVID-19 pandemic has been the focus of most of our collective attention. But, over this same period, the opioid epidemic has worsened and there are rising rates of alcohol misuse. Cannabis legalization continues to advance state-by-state, with little information about the regulatory strategies that best protect children and prevent illicit teen use. And, the emergence of e-cigarettes and vaping devices has spurred a new wave of nicotine addiction. This month, we highlight the research led by Institute faculty that considers patterns of substance use and the policies and strategies that can successfully address it. Our work is local, statewide, national, and global, and has generated both foundational and applied knowledge that is shaping evidence-based policies to address these persistent problems.

Joanne Spetz
PRL-IHPS Focus On:
Tobacco and Substance Use
Many PRL-IHPS faculty are working on policy related to tobacco and substance use. Justin White, PhD, Joseph Guydish, PhD, Dorie Apollonio, PhD, Laura Schmidt, PhD, MPH and Leslie Suen, MD are some of our faculty and fellows working in this area. Learn more about their current research.

Upcoming Events
PRL-IHPS Health Policy Grand Rounds
“If you don’t enforce, COVID enforces”:
Public Health Leadership for CA School Reopening in COVID-19

Dec 15, 12 - 1 pm PT

Naomi Bardach, MD
Professor of Pediatrics and Policy,
UCSF Department of Pediatrics
Philip R. Lee Institute for Health Policy Studies Vice Chair of Health Services Research,
UCSF Department of Pediatrics

Research Highlights
Changes in older adults' life space during lung cancer treatment: A mixed methods cohort study

Older adults with non-small cell lung cancer (NSCLC) have low pretreatment life space mobility (LSM), the ability to move within one’s environment and community, with many patients developing restricted LSM during treatment. In a recent Journal of the American Geriatrics Society article Louise Walter, MD, her mentee, Melisa Wong, MD and colleagues, including IHPS affiliated faculty John Boscardin, PhD, share their findings from a mixed method study. They found that incorporating life-space assessments into clinical cancer care may help older adults concretely visualize how treatment might impact their daily function to allow for informed decision making and identify early changes in mobility to implement supportive interventions.

Enhanced recovery pathways (ERPs) have emerged as one of the most effective strategies to improve clinical outcomes and reduce health care utilization in elective colorectal surgery. Elizabeth Wick, MD, and colleagues, in a recent JAMA Surgery article, shared their findings that in a collaborative of hospitals with diverse settings and geographic spread low postoperative outcome occurrence is achievable regardless of hospital environment, and full ERP adherence may be an equalizing factor across diverse environments. 
It Is Time to Inform Patients of Medical Imaging Risks

In a recent JAMA Network Open perspective, Rebecca Smith-Bindman, MD, along with co-author Carly Stewart, MHA call for a systemic shift in educating physicians and patients about medical imaging with computed tomography (CT) risks, particularly long-term risks, so patients clearly understand the tradeoffs. Smith-Bindman and Stewart advocate that this approach will improve the safety of medical imaging, while reducing the physical, social, and economic toll of overuse and disease.

Perceptions of specialty palliative care and its role in pediatric stem cell transplant:
A multidisciplinary qualitative study

Consultation of specialty palliative care remains uncommon in pediatric stem cell transplant (SCT) despite growing evidence that early integration of palliative care improves outcomes in patients with advanced cancers or undergoing SCT. In a recent Pediatric Blood Cancer article, Elizabeth Dzeng, MD, MPH, PhD, and colleagues share their findings that multidisciplinary pediatric SCT teams may hold a more favorable perception and desire greater integration of palliative care than is suggested by low integration of specialist provided palliative care commonly seen in SCT. 

PRL-IHPS faculty are responding to policy challenges raised by the COVID-19 pandemic with rapid-cycle research and technical assistance. A compilation of their work to date is available on a regularly updated webpage. One recent publication is by Margot Kushel, MD and colleagues, "COVID-19 Testing and Vaccine Acceptability Among Homeless-Experienced Adults: Qualitative Data from Two Samples", published in Journal of General Internal Medicine.  Read more about our work to address the COVID pandemic here.
IHPS Faculty Spotlight
Sanket Dhruva, MD, MHS is Assistant Professor in the School of Medicine (Department of Medicine / Division of Cardiology) and affiliate faculty at PRL-IHPS. Dhruva studies the evidence base supporting medical device and pharmaceutical regulation. His research focuses on strengthening the evidence base for the safe, effective, and high-value use of medical devices in clinical care, with the goal of improving the quality of care and clinical outcomes for patients.
Media Mentions
Julia Adler-Milstein:
(Daily Californian)

Renee Hsia:
(Kaiser Health News)

Tracey Woodruff:
(International Federation of Gynecology and Obstetrics)