Research in Brief: Understanding policy implications; using advanced methods to discern weight change in common medications, and more
Institute researchers estimate the potential fallout of new federal student loan caps on the medical field; take a closer look at understudied ACA provisions that have big potential impact on maternal health; use novel methods to estimate weight change effects of common medications, and more.
With the U.S. leading the world in medical school costs, students increasingly depend on federal loans to finance their education. Under the 2025 One Big Beautiful Bill Act (OBBBA), federal student loans would be capped at $50,000 per year, with a lifetime maximum of $200,000. A team led by Tarun Ramesh under the mentorship of Hao Yu conducted the first national estimate of how many medical students would be affected by these new restrictions. Their findings suggest the reforms are likely to place substantial financial barriers on aspiring physicians, potentially reducing workforce diversity and worsening existing physician shortages – especially in already underserved areas.
About Tarun Ramesh
Tarun Ramesh is an internal medicine resident at Massachusetts General Hospital and research fellow in the Division of Health Policy and Insurance Research (HPI). He studies provider workforce, rural health, global health workforce migration, and healthcare consolidation. His research has been published in The New England Journal of Medicine, JAMA, and The Lancet. Dr. Ramesh has worked as a research assistant for Hao Yu since 2022.
Federal loan restrictions could leave many medical students, especially those from low-income backgrounds, without affordable options to complete their training.
Debby Lin led the first study using a target trial approach to examine the association between the start of and continued use of common hypertensives and weight change. Dr. Lin and team looked at six varieties of common hypertensive medications compared to lisinopril, at 6, 12, and 24 months after initiation. The target trial would enroll adults aged 20 – 80 years planning to start one of the seven common hypertensives for the first time. To emulate the trial, they created a study cohort of 141,260 patients prescribed one of seven antihypertensives between 2010 and 2019 across 8 US health systems in PCORnet. The team found that hydrochlorothiazide, losartan, metoprolol, and propranolol were associated with greater weight gain compared to lisinopril.
About Debby Lin
Pi-I Debby Lin is a research scientist in the Division of Chronic Disease Research Across the Lifecourse (CoRAL) with a research focus on environmental and nutritional epidemiology. She is interested in investigating how environmental and dietary factors affect health across the lifecourse. She utilizes epidemiological study designs and statistical modeling to evaluate the relationship between environmental exposure and chronic disease outcomes. Particularly, she focuses on heavy metals, per- and polyfluoroalkyl substances (PFAS), air pollution, and greenspace.
A study led by former research fellow Han Yu under the mentorship of senior author Jason Block leveraged electronic health record (EHR) data to estimate comparative effects of beginning and continually taking six commonly prescribed antiseizure medications (topimirate, levetiracetam, lamotrigine, valproate, carbamazepine, and oxcarbazepine) on population average weight change at 6 and 12 months after starting. While topiramate's effect on weight has been well studied, data on other ASMs are more limited. The team found that use of all other ASMs was associated with higher weight change than topiramate, mostly driven by the weight loss from initiating and adhering to topiramate.
Read the study in Obesity
About Jason Block
Jason Block is a general internal medicine physician whose primary research interests are neighborhood-level determinants of weight gain and obesity, the evaluation of governmental and institutional policies and other novel interventions to improve diet and leveraging electronic health record data for observational research and public health surveillance.
Continuity of health care and insurance before, during, and after pregnancy helps both moms and babies stay healthier. A provision within the Affordable Care Act (ACA)—the Basic Health Program (BHP)—allows states to provide low-income people with earnings above the Medicaid income threshold and lawfully present noncitizens in the five-year waiting period for Medicaid with insurance coverage that is more affordable than Marketplace plans. Only three states have implemented such programs.
A team led by Julia Eddelbuettel evaluated the impact of New York’s BHP, known as the Essential Plan, on preconception coverage and continuous publicly subsidized coverage from preconception to the postpartum period. Results suggest that BHPs could be an important state-level policy to improve coverage affordability and stability from preconception through postpartum.
Read the study in Health Affairs
About Julia Eddelbuettel
Julia Eddelbuettel is a PhD Candidate in Health Policy with a concentration in Methods for Policy Research at Harvard University and a research fellow in the Division of Health Policy and Insurance Research. Her research focuses on population health policy and health services research related to reproductive, maternal, and mental healthcare in the areas of social policy, population health, and health services research with an emphasis on reproductive/maternal health and mental health.
In the context of enrolling in an elective genomic testing (EGT) program, understanding whether and how the motivations of adults who were adopted (adoptees) may differ from the motivations of adults who were not adopted (nonadoptees) is important to ensure adoptees’ unique needs are considered during test enrollment and communication of results. In one of the first studies to examine data on adoptees who pursued EGT, a team led by Madison Hickingbotham under the mentorship of Kurt Christensen and Hadley Stevens Smith analyzed survey and electronic health record data from patients who enrolled in the Sanford Chip program, an EGT program at a large health system located in the upper midwestern U.S. Results showed notable differences between adoptees and nonadoptees who pursued EGT; most adoptees lacked information about their family health history, and this motivated them to pursue EGT to fill in those informational gaps that they recognized may have important implications for the health of themselves and their children. The team notes that the findings of this analysis can help inform how health providers approach genetics topics with adoptees, and that best practices for communicating genetic risk information with the adopted population are needed.
Read the paper in the American Journal of Medical Genetics Part A
About Madison Hickingbotham
Madison Hickingbotham is a Senior Research Assistant in the Division of Child Health Research and Policy (CHeRP) and PRecisiOn Medicine Translational Research Center (PRoMoTeR). She assists Kurt Christensen and Hadley Stevens Smith with genomics implementation and outcomes projects, including BabySeq, PreEMPT, and LIVING. Her research interests include social and behavioral epidemiology and epigenetics.
Approximately 1 in 5 American teens meet the criteria for prediabetes, making clear, timely guidance to help prevent type 2 diabetes in kids an urgent need. Drinks like soda and other sugary beverages (including 100% fruit juice) can lead to weight gain and increase the risk of diabetes. Because kids and teens drink these often, they are a common focus for intervention. A study led by Soren Harnois-Leblanc looked at what might happen if kids had no more than one sugary drink per week throughout childhood, following American Heart Association recommendations. They found that limiting sugary drinks alone isn’t enough to prevent prediabetes or type 2 diabetes, and that future efforts should look at combining healthy eating and lifestyle changes to reduce these risks in kids.
Read the study in American Journal of Epidemiology
About Soren Harnois-Leblanc
Soren Harnois-Leblanc is a postdoctoral fellow in the Division of Chronic Disease Research Across the Lifecourse (CoRAL). Dr. Harnois-Leblanc investigates the role of dietary habits on diabetes risk markers from early childhood to late adolescence in Project Viva Cohort using causal inference methods, under the supervision of Drs. Marie-France Hivert and Jessica Young. More broadly, her research focuses on the prevention of obesity, type 2 diabetes and cardiovascular disease in at-risk children and children from the general population.
A study senior authored by Hao Yu reported results from the first nationally representative survey that explores how often U.S. adolescents and young adults (ages 12 to 21) seek advice from generative AI, whether they find it useful, and how often they turn to it when feeling sad, angry, or anxious. The team found that about 1 in 8 U.S. youths used generative AI for mental health advice; this number rose to about 1 in 5 for youth aged 18 and older. Over half used AI at least monthly and most found the advice helpful. However, helpfulness varied, with Black youth reporting AI as less helpful.
They highlight that AI tools can be helpful especially for young people unlikely to receive traditional counseling as they’re often low cost and accessible and also caution that without proper oversight, AI carries risks, including the possibility of suggesting advice that isn’t safe or accurate.
Read the paper in JAMA Network Open
About Hao Yu
Dr. Yu has over 20 years of experience in studying health care financing and delivery reforms in both the U.S. and China, with an overarching goal of informing policies to promote health equity. His research has focused on how these reforms affect health care and health outcomes for vulnerable populations, such as children and women with special health care needs, people with mental disorders, and residents of medically underserved areas.