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RAND researchers present findings from the qualitative arm of the America's Military and Veteran Caregivers: Hidden Heroes Emerging from the Shadows research project, sharing insights from interviews with U.S. military and veteran caregivers. Thirty-eight qualitative interviews were conducted between December 2023 and February 2024. In the interviewed caregivers' own words, they provided rich descriptions of their experiences, complementing the main study's survey findings with illustrative anecdotes that deepen our understanding of the challenges and joys of caregiving and elucidate opportunities to improve supportive services. Caregivers highlighted aiding care recipients with a broad array of activities of daily living and instrumental activities of daily living, often leveraging a variety of informal and formal supports. They often faced challenges, such as balancing caregiving with other priorities and commitments; managing care recipients' health-related conditions and needs; financial, emotional, and physical struggles; and difficulty accessing respite and navigating health care systems. Caregivers reflected on their identities, highlighting ways in which they are similar to and different from other caregivers; they generally said that they found caregiving to be rewarding. They also discussed the economic impacts of caregiving and pointed to opportunities for organizations to improve outreach and provision of services.

The devastating impact of the coronavirus disease 2019 (COVID-19) pandemic has led governments, health care institutions, and researchers to intensify their focus on developing improved means to detect, contain, and manage potential future outbreaks. As part of these efforts, policymakers and other nontechnical personnel need to understand available biosurveillance technologies. In this study, the authors summarize how current and emerging nucleic acid biosurveillance techniques work, describe their capabilities and limitations, and discuss the promise of emerging technologies. Biosurveillance systems are used to detect, monitor, and characterize health threats, or pathogens, in human and animal populations, food, wastewater, and the environment. Nucleic acid testing assesses nucleic acids, comprising deoxyribonucleic acid (DNA) and ribonucleic acid (RNA), to determine the biologic agents present in clinical samples (i.e., a sample collected by a medical laboratory from a symptomatic human) or environmental samples (e.g., wastewater). The authors describe a scenario of testing for pathogens in wastewater that uses detection technology within a comprehensive and pathogen-agnostic biosurveillance system. Wastewater testing offers a method for collecting samples without needing symptomatic individuals to present at clinics for care. Such testing can, therefore, offer data prior to symptoms and from those who have less access to clinical care. The case study demonstrates the advancements needed to develop a truly pathogen-agnostic, cost-effective wastewater biosurveillance system. The authors conclude that policymakers interested in establishing a biosurveillance program should carefully evaluate their specific research questions and their resource limitations to determine which technology is best suited to their needs.

The authors produced new estimates of the number of adults caregiving in the United States today; investigated how those caring for wounded, ill, and injured service members and veterans compare with those caring for civilians and with non-caregivers; and share insights on the potential consequences of caregiving on caregiversapos health, their economic security, and their families' well-being. They also propose recommendations to strengthen caregiver support. The information in this study is derived from two sources. RAND researchers administered the 2023 RAND Caregiving Survey. The final analytic sample size was 2,946 respondents, including 513 military and veteran caregivers, and, for comparison, 1,205 civilian caregivers and 1,228 non-caregivers. RAND researchers also administered the 2022 RAND Veterans Survey, a survey of 1,100 veterans residing in the United States. There are 14.3 million military and veteran caregivers, representing 5.5 percent of the U.S. adult population. There are an additional 91.3 million civilian caregivers (35.0 percent of U.S. adults) caring for wounded, ill, or injured civilian adults. Across all caregivers, most (78 to 81 percent) spend between one and 30 hours per week providing care. Under 10 percent spend less than one hour per week, and 11 to 16 percent spend 31 hours or more per week caregiving. The estimated aggregate economic value generated by military/veteran caregiving activities, which are largely uncompensated, ranges from $119 billion to $485 billion per year. Military/veteran caregivers incur an estimated $8,583 in annual out-of-pocket costs associated with their caregiving responsibilities. Military/veteran caregivers forgo an estimated $4,522 in annual household income.

The Department of Defense (DoD) requires both current and projected estimates of the size of its workforce population with specific categories of disabilities. These estimates support the requirements under the Rehabilitation Act of 1973 as well as the goals outlined in multiple executive orders, including Executive Order 14035, directing DoD to hire employees with disabilities and provide them with reasonable accommodations. These estimates are necessary to determine the assistive technology (AT) required and its anticipated costs through 2031. AT also furthers DoD's goals in aiding the recovery and retention of injured service members, as well as the broader DoD and U.S. Department of Veteran Affairs (VA) community in aiding in the post-service employment of service members who are medically separating. Thus, the authors seek to estimate the potential demand for AT from these groups. The authors give projections of the DoD civilian employee population-and of injured and wounded service members-with specific disabilities categorized by DoD's centralized AT procurer (hearing, vision, cognitive, and dexterity disabilities), as well as the potential anticipated requests for AT by these populations and their costs between 2021 and 2031.

Emerging research suggests that Parkinson's disease (PD) and dementia with Lewy bodies (DLB) share underlying pathology and may represent a single, biologically defined disease spectrum. Cognitive changes are among the most worrisome symptoms for patients with PD, and are the core feature of DLB. While the cognitive changes experienced by individuals with PD and mild cognitive impairment share some clinical characteristics with patients who have undiagnosed or prodromal DLB, these changes are distinct from other types of dementias, such as Alzheimer's disease. To spur the adaptation of existing cognition-focused measures and the development of new ones to underlie clinical trial endpoints in PD and DLB, the PD/DLB Cognition Roundtable was held on January 10 and 11, 2024, in Washington, D.C. The roundtable brought together representatives from academia and industry, as well as with representatives of regulatory agencies, community partners, patient advocates, and research funders, to build consensus and collaborate on the outcome assessment and trial design methods that will support the development of new treatments for early or mild cognitive changes in disorders on the PD/DLB spectrum. The authors of this document summarize the roundtable, discussing the state of the field for clinical trial design and cognition measures in PD and DLB, promising avenues of research, and perspectives of regulatory agencies.

Twenty years ago, the United States was divided by heated debates over legalizing marriage for same-sex couples. Those in favor argued that granting same-sex couples access to marriage would strengthen commitment for same-sex couples, extend the financial benefits of marriage to same-sex households, and improve outcomes for children raised by same-sex parents. Those who were opposed argued that granting legal status to marriages between same-sex partners would alter the foundation of marriage and diminish its value for different-sex couples, ultimately harming children by making them less likely to be raised in stable, two-parent families. It has now been 20 years since Massachusetts became the first state to issue marriage licenses to same-sex couples in May 2004. The consequences of extending legal recognition to same-sex couples need no longer be a topic of speculation and debate; researchers have had two decades to study the consequences of legalizing marriage for same-sex couples on lesbian, gay, bisexual, and transgender (LGBT) individuals; their children; and the general public. The broad goal of this study is to document those consequences. The authors pursued this goal in two ways. First, they conducted a comprehensive review of the existing research literature on the effects of legalizing marriage for same-sex couples. Second, they conducted new analyses to evaluate the prediction that rates of marriage, cohabitation, and divorce and attitudes toward marriage would be adversely affected by granting same-sex couples access to legal marriage.

RAND is supporting the Robert Wood Johnson Foundation in advancing understanding of U.S. public mindsets and attitudes toward health and well-being. This study describes the design and fielding of the 2023 National Survey of Health Attitudes, the third iteration of this survey, on how people in the United States think about, value, and prioritize health and consider issues of health equity.

The implementation and enforcement of state and local abortion policy can vary significantly between medical clinics and depend on the context and the individual decisionmakers involved. Research conducted prior to the U.S. Supreme Court decision in Dobbs v. Jackson Women's Health Organization showed that, when providers are unclear about potentially conflicting or changing local and state policies (formal and informal) or enforcement, many err on the side of caution and become more restrictive in their practices. However, it is unknown whether and to what extent state and local policies and practices adapted in the wake of Dobbs have influenced providers' practices. The authors conducted an initial study of laws and policies post-Dobbs in one state, North Carolina, to better understand the policy landscape and gather perspectives from staff in facilities or organizations that provide or support abortion care. This study served as a unique opportunity to explore laws and policies, as well as implementation experiences, given North Carolina's Senate Bill 20, which instituted a gestational limit of 12 weeks and 6 days, as well as other provisions, including a 72-hour in-person consent requirement. The findings highlight the reported impacts of Senate Bill 20 on facilities, providers, and patients, as well as other local and institutional policies on abortion care access. This work highlights the importance of understanding legislation and its underlying provisions to ensure a complete picture of implementation factors and potential impacts.