States compared to ten other countries.

We examined income gaps in the period 2011-13 in self-assessments of personal health and health care across thirty-two middle- and high-income countries. While high-income respondents were generally more positive about their health and health care in most countries, the gap between them and low-income respondents was much bigger in some than in others. The United States has among the largest income-related differences in each of the measures we studied, which assessed both respondents' past experiences and their confidence about accessing needed health care in the future. Relatively low levels of moral discomfort over income-based health care disparities despite broad awareness of unmet need indicate more public tolerance for health care inequalities in the United States than elsewhere. Nonetheless, over half of Americans felt that income-based health care inequalities are unfair, and these respondents were significantly more likely than their compatriots to support major health system reform-differences that reflect the country's political divisions. Given the many provisions in the Affordable Care Act that seek to reduce disparities, any replacement would also require attention to disparities or risk taking a step backward in an area where the United States is in sore need of improvement.

We used 2 population-representative surveys to evaluate the recommendation from recent clinical guidelines for prescribing opioid analgesics that physicians discuss the risk of long-term use disorders with patients. In nationally representative data we observed a 60% lower rate, after adjustment for covariates, in a self-reported saving of pills among respondents who say they talked with their physicians about the risks of prescription painkiller addiction (67% lower rate without adjustment). These findings suggest patient education efforts, as currently practiced in the United States, may have positive behavioral consequences that could lower the risks of prescription painkiller abuse. Future research should test these associations under controlled settings. 2016;14:575-577. doi: 10.1370/afm.1994. Ann Fam Med INTRODUCTIONI n its recently published guidelines for prescribing opioids for chronic pain, the Centers for Disease Control and Prevention (CDC) recommend that clinicians discuss the known risks and benefits of opioid therapy with their patients.1 Recommended topics of discussion include the risks of life-long use disorders and the risk posed to family members if prescription painkillers are intentionally or unintentionally shared. Although communication-based techniques have been shown to improve patient behaviors, 2 the CDC guidelines note that no evidence currently exists to evaluate the effectiveness of patient education or any other risk-mitigation strategies for prescription opioids. Given the increasing demands placed on physicians in primary care, evidence will be essential to helping physicians prioritize as they put these guidelines into practice. We evaluated 2 population-representative surveys conducted in 2015 and found preliminary evidence that suggests patient education efforts as currently practiced may be having positive behavioral consequences. METHODSWe analyzed the results of 2 random-digit-dial telephone surveys of adults aged 18 years and older conducted by the Harvard T. H. Chan School of Public Health and the Boston Globe: a national poll fielded April 15-19, 2015 (an 8% response rate yielded 1,033 completed interviews) and a Massachusetts poll fielded April 7-16, 2015 (a 15% response rate yielded 810 completed interviews). Both surveys included cellular and landline telephones and were poststratified to US Census benchmarks of age, sex, education, race, marital status, and geographic area to be representative of underlying populations (The United States and Massachusetts, respectively). Samples were restricted to respondents who reported that they had been prescribed strong prescription painkillers within the last 2 years, bringing final sample sizes to 216 in the national survey, and 169 in the Massachusetts sample. We provide the survey instrument in the Supplemental Appendix, available at http://www.annfammed.org/content/14/6/575/suppl/DC1. 576We fit multivariable logistic regressions to estimate the association between reporting having talked with a physician about t...

Joachim O Hero 1 [research fellow in health policy], Anna D. Sinaiko 2 [assistant professor of health economics and policy], Jon Kingsdale 3 [associate professor of the practice], Rachel S Gruver 4 [doctoral student in epidemiology], Alison A Galbraith 5 [associate professor of population medicine]