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Chin HB, Howards PP, Kramer MR, Johnson CY. Understanding the roles of state demographics and state policies in epidemiologic studies of maternal-child health disparities. Am J Epidemiol 2024; 193:819-826. [PMID: 38055631 DOI: 10.1093/aje/kwad240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 11/20/2023] [Accepted: 12/04/2023] [Indexed: 12/08/2023] Open
Abstract
Disparities in maternal-child health outcomes by race and ethnicity highlight structural differences in the opportunity for optimal health in the United States. Examples of these differences include access to state-level social policies that promote maternal-child health. States vary in their racial and ethnic composition as a result of the complex history of policies and laws related to slavery, Indigenous genocide and relocation, segregation, immigration, and settlement in the United States. States also vary in the social policies they enact. As a result, correlations exist between the demographic makeup of a state's population and the presence or absence of social policies in that state. These correlations become a mechanism by which racial and ethnic disparities in maternal-child health outcomes can operate. In this commentary, we use the example of 3 labor-related policies actively under consideration at state and federal levels (paid parental leave, paid sick leave, and reasonable accommodations during pregnancy) to demonstrate how correlations between state demographics and presence of these state policies could cause or exacerbate racial and ethnic disparities in maternal-child health outcomes. We conclude with a call for researchers to consider how the geographic distribution of racialized populations and state policies could contribute to maternal-child health disparities.
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Affiliation(s)
- Helen B Chin
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, VA 22030, United States
| | - Penelope P Howards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, United States
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, United States
| | - Candice Y Johnson
- Department of Family Medicine and Community Health, School of Medicine, Duke University, Durham, NC 27705, United States
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Mojtabai R, Susukida R, Nejat K, Amin-Esmaeili M. Association of cigarette excise taxes and clean indoor air laws with change in smoking behavior in the United States: a Markov modeling analysis. J Public Health Policy 2024; 45:100-113. [PMID: 38155242 DOI: 10.1057/s41271-023-00458-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/30/2023]
Abstract
The rates of cigarette smoking in the United States have declined over the past few decades in parallel with increases in cigarette taxes and introduction of more stringent clean indoor air laws. Few longitudinal studies have examined association of taxes and clean indoor air policies with change in smoking nationally. This study examined the association of state and local cigarette taxes and clean indoor laws with change in smoking status of 18,499 adult participants of the longitudinal 2010-2011 Tobacco Use Supplement of the Current Population Survey over a period of 1 year. Every $1 increase in cigarette excise taxes was associated with 36% higher likelihood of stopping smoking among regular smokers. We found no association between clean indoor air laws and smoking cessation nor between taxes and clean indoor air laws with lower risk of smoking initiation. Cigarette taxes appear to be effective anti-smoking policies. Some state and local governments do not take full advantage of this effective policy measure.
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Affiliation(s)
- Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 624 North Broadway, Room 797, Baltimore, MD, 21205, USA
| | - Ryoko Susukida
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 624 North Broadway, Room 797, Baltimore, MD, 21205, USA
| | | | - Masoumeh Amin-Esmaeili
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 624 North Broadway, Room 797, Baltimore, MD, 21205, USA.
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Bultema S, Piper K, Salas E, Forberg P, Grinnell S. Exploring how health equity is addressed in accountable communities of/for health (ACHs). Health Serv Res 2024; 59 Suppl 1:e14258. [PMID: 37963440 PMCID: PMC10796284 DOI: 10.1111/1475-6773.14258] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE To explore how Accountable Communities of/for Health (ACHs), a type of health-focused multisector collaborative, are developing strategies to address health equity with diverse partners. DATA SOURCES AND STUDY SETTING Interview and focus group participants were recruited from a purposive sample of 22 ACH participant organizations in Washington (n = 9 ACHs) and California (n = 13 ACH). STUDY DESIGN Interview and focus group data were thematized using constant comparison analysis. DATA COLLECTION Interviews were conducted to learn how each ACH's system context, collaboration processes, and goals influence its progress toward health equity. Focus groups were conducted to gain a deeper understanding of how local context and power dynamics influence an ACH's ability to make progress toward health equity. There were 22 focus group participants and 65 interview participants. PRINCIPAL FINDINGS Results indicate that ACHs advance health equity across the social-ecological spectrum of health with approaches targeting the individual, community, and societal levels. Specific approaches used by ACHs to collaboratively address health equity include providing equity education to participating organizations and community groups; including diverse community voices in collaborative decision-making; changing practices in their participant's daily operations; improving existing services and developing new services; and actively promoting a culture of keeping equity at the center of ACH efforts. CONCLUSIONS This study identifies strategies for advancing health equity in multisector collaboratives. ACHs in Washington and California are devoting resources to ensure health equity is central to their work. The numerous approaches ACHs use to advance health equity are important to ensure everyone can reach their full health potential. While current literature argues that multisector health initiatives are integral for advancing health equity, there is a lack of research on how these initiatives advance equity in practice. Thus, this paper provides generalizable strategies that can be further investigated to optimize progress toward health equity.
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Affiliation(s)
- Stephanie Bultema
- Population Health Innovation LabPublic Health InstituteOaklandCaliforniaUSA
| | - Kendra Piper
- Population Health Innovation LabPublic Health InstituteOaklandCaliforniaUSA
| | - Esmeralda Salas
- Population Health Innovation LabPublic Health InstituteOaklandCaliforniaUSA
| | - Peter Forberg
- Population Health Innovation LabPublic Health InstituteOaklandCaliforniaUSA
| | - Sue Grinnell
- Population Health Innovation LabPublic Health InstituteOaklandCaliforniaUSA
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Jackson KE, Yeb J, Gosliner W, Fernald LCH, Hamad R. Characterizing the Landscape of Safety Net Programs and Policies in California during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2747. [PMID: 35270441 PMCID: PMC8910353 DOI: 10.3390/ijerph19052747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/19/2022] [Accepted: 02/24/2022] [Indexed: 11/24/2022]
Abstract
The COVID-19 pandemic prompted rapid and innovative policymaking around the world at the national, regional, and local levels. There has been limited work to systematically document and characterize new and expanded local U.S. pandemic-era policies, which is imperative to better understand the policy variation and resulting health impacts during this unprecedented time. California, the most populous U.S. state, provides a case example of a particularly active policy response. The aim of this Brief Report is to summarize the creation and potential areas of application of a newly created publicly available California- and US-based COVID-19 policy database. We generated an extensive list of California and US policies that were modified or created in response to the COVID-19 pandemic. From July-November 2021, we searched current and historical California and federal government websites, press releases, social media, and news sources and recorded detailed information on these policies, including coverage dates, eligibility criteria, and benefit amounts. This comprehensive dataset includes 39 public health, economic, housing, and safety net programs and policies implemented at both federal and state levels and provides details of the complex and multifaceted policy landscape in California from March 2020 to November 2021. Our database is publicly available. Future investigators can leverage the information systematically recorded in this database to rigorously assess the short- and long-term effects of these policies, which will in turn inform future preparedness response plans in California and beyond.
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Affiliation(s)
- Kaitlyn E. Jackson
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA 94158, USA; (J.Y.); (R.H.)
| | - Joseph Yeb
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA 94158, USA; (J.Y.); (R.H.)
| | - Wendi Gosliner
- Division of Agriculture and Natural Resources, Nutrition Policy Institute, University of California, Oakland, CA 94607, USA;
| | - Lia C. H. Fernald
- Division of Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, CA 94720, USA;
| | - Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA 94158, USA; (J.Y.); (R.H.)
- Department of Family & Community Medicine, University of California San Francisco, San Francisco, CA 94110, USA
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Pilar M, Jost E, Walsh-Bailey C, Powell BJ, Mazzucca S, Eyler A, Purtle J, Allen P, Brownson RC. Quantitative measures used in empirical evaluations of mental health policy implementation: A systematic review. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221141116. [PMID: 37091091 PMCID: PMC9924289 DOI: 10.1177/26334895221141116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Mental health is a critical component of wellness. Public policies present an opportunity for large-scale mental health impact, but policy implementation is complex and can vary significantly across contexts, making it crucial to evaluate implementation. The objective of this study was to (1) identify quantitative measurement tools used to evaluate the implementation of public mental health policies; (2) describe implementation determinants and outcomes assessed in the measures; and (3) assess the pragmatic and psychometric quality of identified measures. Method Guided by the Consolidated Framework for Implementation Research, Policy Implementation Determinants Framework, and Implementation Outcomes Framework, we conducted a systematic review of peer-reviewed journal articles published in 1995-2020. Data extracted included study characteristics, measure development and testing, implementation determinants and outcomes, and measure quality using the Psychometric and Pragmatic Evidence Rating Scale. Results We identified 34 tools from 25 articles, which were designed for mental health policies or used to evaluate constructs that impact implementation. Many measures lacked information regarding measurement development and testing. The most assessed implementation determinants were readiness for implementation, which encompassed training (n = 20, 57%) and other resources (n = 12, 34%), actor relationships/networks (n = 15, 43%), and organizational culture and climate (n = 11, 31%). Fidelity was the most prevalent implementation outcome (n = 9, 26%), followed by penetration (n = 8, 23%) and acceptability (n = 7, 20%). Apart from internal consistency and sample norms, psychometric properties were frequently unreported. Most measures were accessible and brief, though minimal information was provided regarding interpreting scores, handling missing data, or training needed to administer tools. Conclusions This work contributes to the nascent field of policy-focused implementation science by providing an overview of existing measurement tools used to evaluate mental health policy implementation and recommendations for measure development and refinement. To advance this field, more valid, reliable, and pragmatic measures are needed to evaluate policy implementation and close the policy-to-practice gap. Plain Language Summary Mental health is a critical component of wellness, and public policies present an opportunity to improve mental health on a large scale. Policy implementation is complex because it involves action by multiple entities at several levels of society. Policy implementation is also challenging because it can be impacted by many factors, such as political will, stakeholder relationships, and resources available for implementation. Because of these factors, implementation can vary between locations, such as states or countries. It is crucial to evaluate policy implementation, thus we conducted a systematic review to identify and evaluate the quality of measurement tools used in mental health policy implementation studies. Our search and screening procedures resulted in 34 measurement tools. We rated their quality to determine if these tools were practical to use and would yield consistent (i.e., reliable) and accurate (i.e., valid) data. These tools most frequently assessed whether implementing organizations complied with policy mandates and whether organizations had the training and other resources required to implement a policy. Though many were relatively brief and available at little-to-no cost, these findings highlight that more reliable, valid, and practical measurement tools are needed to assess and inform mental health policy implementation. Findings from this review can guide future efforts to select or develop policy implementation measures.
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Affiliation(s)
- Meagan Pilar
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
- Department of Infectious Diseases, Washington University School of Medicine,
Washington University in St. Louis, St. Louis, MO, USA
| | - Eliot Jost
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Callie Walsh-Bailey
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Byron J. Powell
- Center for Mental Health Services Research, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of
Medicine, Washington University School of Medicine, Washington University in St.
Louis, St. Louis, MO, USA
| | - Stephanie Mazzucca
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Amy Eyler
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Jonathan Purtle
- Department of Public Health Policy & Management, New York
University School of Global Public Health, Global Center for Implementation Science, New York University, New York, NY, USA
| | - Peg Allen
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Ross C. Brownson
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin
J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St.
Louis, St. Louis, MO, USA
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Oh A, Abazeed A, Chambers DA. Policy Implementation Science to Advance Population Health: The Potential for Learning Health Policy Systems. Front Public Health 2021; 9:681602. [PMID: 34222180 PMCID: PMC8247928 DOI: 10.3389/fpubh.2021.681602] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022] Open
Abstract
Many health policies are designed with the intention of improving health outcomes for all. Yet implementation of policies are variable across contexts, potentially limiting its impact on population health outcomes. The potential impact of a policy to advance health equity depends both on the design and its implementation, requiring ongoing evaluation and stakeholder engagement. Despite the importance of health policies in shaping public health, health care policy implementation science remains underrepresented in research. We argue that enhanced integration of policy questions within implementation science could reduce the time lag from policy to practice and improve population health outcomes to build a body of evidence on effective policy implementation. In this commentary, we argue that approaches to studying policy implementation science should reflect the dynamic and evolving policy context, analogous to the “learning healthcare system,” to better understand and respond to systematic and multilevel impacts of policy. Several example opportunities for a learning health policy system are posed in building a broader agenda toward research and practice in policy implementation science in public health.
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Affiliation(s)
- April Oh
- Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
| | - Ali Abazeed
- Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
| | - David A Chambers
- Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
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Grembowski D, Ingraham B, Wood S, Coe NB, Fishman P, Conrad DA. Statewide Evaluation of Washington's State Innovation Model Initiative: A Mixed-Methods Approach. Popul Health Manag 2021; 24:727-737. [PMID: 34010039 DOI: 10.1089/pop.2020.0374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Washington State Innovation Model (SIM) $65 million Test Award from the Center for Medicare and Medicaid Innovation is a statewide intervention expected to improve population health, quality of care, and cost growth through 4 initiatives in 2016-2018: (1) regional accountable communities of health linking health and social services to address local needs; (2) a practice transformation support hub; (3) four value-based payment reform pilot projects mainly in state employee and Medicaid populations; and (4) data and analytic infrastructure development to support system transformation with common measures. A mixed-methods study design and data from the 2013-2018 Behavioral Risk Factor Surveillance System Surveys are used to estimate whether SIM resulted in changes in access to care, health behaviors, and health status in Washington's adult population. Semi-structured qualitative interviews also were conducted to assess stakeholder perceptions of SIM performance. SIM may have reduced binge drinking, but no effects were detected for heavy drinking, physical activity, smoking, having a regular doctor checkup, unmet health care needs, and fair or poor health status. Complex interventions, such as SIM, may have unintended consequences. SIM was associated unexpectedly with increased unhealthy days, but whether the association was related to the Initiative or other factors is unclear. Over 3 years, stakeholders generally agreed that SIM was implemented successfully and increased Washington's readiness for system transformation but had not yet produced expected outcomes, partly because SIM had not spread statewide. Stakeholders perceived that scaling up SIM statewide takes time to achieve and remains challenging.
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Affiliation(s)
- David Grembowski
- Department of Health Services, Hans Rosling Center, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Bailey Ingraham
- Department of Health Services, Hans Rosling Center, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Suzanne Wood
- Department of Health Services, Hans Rosling Center, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Norma B Coe
- Health Policy Division, Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul Fishman
- Department of Health Services, Hans Rosling Center, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Douglas A Conrad
- Department of Health Services, Hans Rosling Center, School of Public Health, University of Washington, Seattle, Washington, USA
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Caspi CE, De Marco M, Durfee T, Oyenuga A, Chapman L, Wolfson J, Myers S, Harnack LJ. A Difference-in-Difference Study Evaluating the Effect of Minimum Wage Policy on Body Mass Index and Related Health Behaviors. OBSERVATIONAL STUDIES 2021; 7:https://obsstudies.org/wp-content/uploads/2021/02/caspi_obs_studies_published.pdf. [PMID: 33665650 PMCID: PMC7929481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Minimum wage laws are a promising policy lever to promote health equity, but few rigorous evaluations have tested whether and how minimum wage policy affects health outcomes. This paper describes an ongoing difference-in-difference study evaluating the health effects of the 2017 Minneapolis Minimum Wage Ordinance, which incrementally increases the minimum wage to $15/hr. We present: (1) the conceptual model guiding the study including mediating mechanisms, (2) the study design, and (3) baseline findings from the study, and (4) the analytic plan for the remainder of the study. This prospective study follows a cohort of 974 low-wage workers over four years to compare outcomes among low-wage workers in Minneapolis, Minnesota, and those in a comparison city (Raleigh, North Carolina). Measures include height/weight, employment paystubs, two weeks of food purchase receipts, and a survey capturing data on participant demographics, health behaviors, and household finances. Baseline findings offer a profile of individuals likely to be affected by minimum wage laws. While the study is ongoing, the movement to increase local and state minimum wage is currently high on the policy agenda; evidence is needed to determine what role, if any, such policies play in improving the health of those affected.
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Affiliation(s)
- Caitlin E Caspi
- Rudd Center for Food Policy and Obesity, University of Connecticut, 1 Constitution Plaza, Hartford, CT, 061032
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Dr., Storrs, CT 06269
- Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware St. SE, Minneapolis, MN 55445
| | - Molly De Marco
- Center for Health Promotion & Disease Prevention, University of North Carolina at Chapel Hill, 1700 M.L.K. Jr Blvd #7426, Chapel Hill, NC, 27514
- Department of Nutrition, Gillings School of Global Public Health, UNC-CH, 135 Dauer Dr, Chapel Hill, NC 27599
| | - Thomas Durfee
- The Roy Wilkins Center for Human Relations and Social Justice, Hubert H. Humphrey School of Public Affairs, University of Minnesota, 270 Humphrey Center, 301 19 Avenue South, Minneapolis, MN
- Department of Applied Economics, University of Minnesota, 231 Ruttan Hall, 1994 Buford Avenue, St. Paul, MN
| | - Abayomi Oyenuga
- Department of Applied Economics, University of Minnesota, 231 Ruttan Hall, 1994 Buford Avenue, St. Paul, MN
| | - Leah Chapman
- Center for Health Promotion & Disease Prevention, University of North Carolina at Chapel Hill, 1700 M.L.K. Jr Blvd #7426, Chapel Hill, NC, 27514
- Department of Nutrition, Gillings School of Global Public Health, UNC-CH, 135 Dauer Dr, Chapel Hill, NC 27599
| | - Julian Wolfson
- Division of Biostatistics, School of Public Health, University of Minnesota, A460 Mayo Building MMC 303, 425 Delaware St. SE, Minneapolis, MN
| | - Samuel Myers
- The Roy Wilkins Center for Human Relations and Social Justice, Hubert H. Humphrey School of Public Affairs, University of Minnesota, 270 Humphrey Center, 301 19 Avenue South, Minneapolis, MN
- Department of Applied Economics, University of Minnesota, 231 Ruttan Hall, 1994 Buford Avenue, St. Paul, MN
| | - Lisa J Harnack
- Division of Epidemiology and Community Health, Suite 300, University of Minnesota, 1300 South 2nd St, Minneapolis, MN
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Montez JK, Beckfield J, Cooney JK, Grumbach JM, Hayward MD, Koytak HZ, Woolf SH, Zajacova A. US State Policies, Politics, and Life Expectancy. Milbank Q 2020; 98:668-699. [PMID: 32748998 PMCID: PMC7482386 DOI: 10.1111/1468-0009.12469] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Policy Points Changes in US state policies since the 1970s, particularly after 2010, have played an important role in the stagnation and recent decline in US life expectancy. Some US state policies appear to be key levers for improving life expectancy, such as policies on tobacco, labor, immigration, civil rights, and the environment. US life expectancy is estimated to be 2.8 years longer among women and 2.1 years longer among men if all US states enjoyed the health advantages of states with more liberal policies, which would put US life expectancy on par with other high‐income countries.
Context Life expectancy in the United States has increased little in previous decades, declined in recent years, and become more unequal across US states. Those trends were accompanied by substantial changes in the US policy environment, particularly at the state level. State policies affect nearly every aspect of people's lives, including economic well‐being, social relationships, education, housing, lifestyles, and access to medical care. This study examines the extent to which the state policy environment may have contributed to the troubling trends in US life expectancy. Methods We merged annual data on life expectancy for US states from 1970 to 2014 with annual data on 18 state‐level policy domains such as tobacco, environment, tax, and labor. Using the 45 years of data and controlling for differences in the characteristics of states and their populations, we modeled the association between state policies and life expectancy, and assessed how changes in those policies may have contributed to trends in US life expectancy from 1970 through 2014. Findings Results show that changes in life expectancy during 1970‐2014 were associated with changes in state policies on a conservative‐liberal continuum, where more liberal policies expand economic regulations and protect marginalized groups. States that implemented more conservative policies were more likely to experience a reduction in life expectancy. We estimated that the shallow upward trend in US life expectancy from 2010 to 2014 would have been 25% steeper for women and 13% steeper for men had state policies not changed as they did. We also estimated that US life expectancy would be 2.8 years longer among women and 2.1 years longer among men if all states enjoyed the health advantages of states with more liberal policies. Conclusions Understanding and reversing the troubling trends and growing inequalities in US life expectancy requires attention to US state policy contexts, their dynamic changes in recent decades, and the forces behind those changes. Changes in US political and policy contexts since the 1970s may undergird the deterioration of Americans’ health and longevity.
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Affiliation(s)
| | | | | | | | | | | | | | - Anna Zajacova
- University of Western Ontario.,Coauthors listed alphabetically
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10
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Andrea SB, Messer LC, Marino M, Goodman JM, Boone-Heinonen J. The tipping point: could increasing the subminimum wage reduce poverty-related antenatal stressors in U.S. women? Ann Epidemiol 2020; 45:47-53.e6. [PMID: 32336654 DOI: 10.1016/j.annepidem.2020.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 01/27/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Tipped workers, primarily women of reproductive-age, can be paid a "subminimum wage" 71% lower than the federal minimum wage, contributing to economic hardship. Poverty-related antenatal stress has deleterious health effects for women and their children. The purpose of this study was to investigate the effects of increasing the state-level subminimum wage (currently $2.13 per hour) on poverty-related antenatal stress for women in the United States. METHODS Utilizing a difference-in-differences approach comparing state wage policies over time, we estimated the impact of increases in the subminimum wage on poverty-related antenatal stress using data from 35 states participating in the Pregnancy Risk Assessment Monitoring System between 2004 and 2014, linked to state-level wage laws, census, and antipoverty policy data. RESULTS The effect of increasing the subminimum wage on poverty-related stress differed by year and sociodemographics. Wage increases in 2014 were associated with the largest decreases in stress for unmarried women of color with less than a college degree, a population that we estimated would have experienced a 19.7% reduction in stress from 2004 to 2014 if subminimum wage was equivalent to the federal minimum wage. CONCLUSIONS Increasing the subminimum wage can reduce poverty-related stress and may be a potential intervention for reducing poor health outcomes.
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Affiliation(s)
- Sarah B Andrea
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA.
| | | | - Miguel Marino
- OHSU-PSU School of Public Health, Portland, OR; Department of Family Medicine, Oregon Health & Science University, Portland, OR
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11
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Andrea SB, Messer LC, Marino M, Goodman JM, Boone-Heinonen J. A nationwide investigation of the impact of the tipped worker subminimum wage on infant size for gestational age. Prev Med 2020; 133:106016. [PMID: 32045614 DOI: 10.1016/j.ypmed.2020.106016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 02/03/2020] [Accepted: 02/07/2020] [Indexed: 10/25/2022]
Abstract
Tipped workers, primarily women of reproductive-age, can be paid a "subminimum wage" 71% lower than the federal minimum wage. We estimated the effects of increasing the state-level tipped worker subminimum wage (federally, $2.13 per hour) on infant size for gestational age in the US as infants born small or large are at risk for poor health across the lifecourse. Utilizing unconditional quantile regression and difference-in-differences analysis of data from 2004 to 2016 Vital Statistics Natality Files (N = 41,219,953 mother-infant dyads), linked to state-level wage laws, census, and antipoverty policy data, we estimated the effect of increasing the subminimum wage on birthweight standardized for gestational age (BWz). Smallest and largest infants are defined as those in the 5th and 95th BWz percentiles, respectively. Increases in the subminimum wage affected the BWz distribution. When compared to a static wage of $2.13 for the duration of the study period, wage set to 100% of the federal minimum ($5.15-$7.25) was associated with an increase in BWz of 0.024 (95% CI: 0.004, 0.045) for the smallest infants and a decrease by 0.041 (95% CI: -0.054, -0.029) for the largest infants. Increasing the subminimum wage may be one strategy to promote healthier birthweight in infants.
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Affiliation(s)
- Sarah B Andrea
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA.
| | - Lynne C Messer
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Miguel Marino
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA; Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Julia M Goodman
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Janne Boone-Heinonen
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
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Douglas MD, Josiah Willock R, Respress E, Rollins L, Tabor D, Heiman HJ, Hopkins J, Dawes DE, Holden KB. Applying a Health Equity Lens to Evaluate and Inform Policy. Ethn Dis 2019; 29:329-342. [PMID: 31308601 DOI: 10.18865/ed.29.s2.329] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Health disparities have persisted despite decades of efforts to eliminate them at the national, regional, state and local levels. Policies have been a driving force in creating and exacerbating health disparities, but they can also play a major role in eliminating disparities. Research evidence and input from affected community-level stakeholders are critical components of evidence-based health policy that will advance health equity. The Transdisciplinary Collaborative Center (TCC) for Health Disparities Research at Morehouse School of Medicine consists of five subprojects focused on studying and informing health equity policy related to maternal-child health, mental health, health information technology, diabetes, and leadership/workforce development. This article describes a "health equity lens" as defined, operationalized and applied by the TCC to inform health policy development, implementation, and analysis. Prioritizing health equity in laws and organizational policies provides an upstream foundation for ensuring that the laws are implemented at the midstream and downstream levels to advance health equity.
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Affiliation(s)
- Megan D Douglas
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA.,Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Robina Josiah Willock
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Ebony Respress
- Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, GA
| | - Latrice Rollins
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA.,Prevention Research Center, Morehouse School of Medicine, Atlanta, GA
| | - Derrick Tabor
- National Institute on Minority Health and Health Disparities, Washington, DC
| | - Harry J Heiman
- School of Public Health, Georgia State University, Atlanta, GA
| | - Jammie Hopkins
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA.,Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, GA
| | - Daniel E Dawes
- H. Wayne Huizenga College of Business and Entrepreneurship, Nova Southeastern University, Fort Lauderdale, FL
| | - Kisha B Holden
- Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, GA.,Department of Psychiatry, Morehouse School of Medicine, Atlanta, GA
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Hall RL, Jacobson PD. Examining Whether The Health-In-All-Policies Approach Promotes Health Equity. Health Aff (Millwood) 2019; 37:364-370. [PMID: 29505382 DOI: 10.1377/hlthaff.2017.1292] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Scholars and public health advocates have expressed optimism about the potential for the health-in-all-policies approach to address social disparities in health, but little research has been done on whether it promotes health equity in practice. Based on sixty-five in-depth interviews with US officials in the public and private sectors conducted in five states in 2016-17, we found a relationship between the use of the approach and the prominence of health equity as a policy concern. In emphasizing the social determinants of health, the approach gives public officials and policy entrepreneurs a framework for promoting this goal. In some areas, we found a gradual transition in focus from health generally to health equity. Overall, we found that practitioners of the approach introduce equity selectively and strategically.
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Affiliation(s)
- Richard L Hall
- Richard L. Hall is a professor in the Department of Political Science and the Gerald R. Ford School of Public Policy, University of Michigan, in Ann Arbor
| | - Peter D Jacobson
- Peter D. Jacobson ( ) is a professor in the Department of Health Management and Policy, School of Public Health, University of Michigan
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14
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McConnell KJ, Charlesworth CJ, Meath THA, George RM, Kim H. Oregon's Emphasis On Equity Shows Signs Of Early Success For Black And American Indian Medicaid Enrollees. Health Aff (Millwood) 2018; 37:386-393. [PMID: 29505371 PMCID: PMC5899901 DOI: 10.1377/hlthaff.2017.1282] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In 2012 Oregon transformed its Medicaid program, providing coverage through sixteen coordinated care organizations (CCOs). The state identified the elimination of health disparities as a priority for the CCOs, implementing a multipronged approach that included strategic planning, community health workers, and Regional Health Equity Coalitions. We used claims-based measures of utilization, access, and quality to assess baseline disparities and test for changes over time. Prior to the CCO intervention there were significant white-black and white-American Indian/Alaska Native disparities in utilization measures and white-black disparities in quality measures. The CCOs' transformation and implementation of health equity policies was associated with reductions in disparities in primary care visits and white-black differences in access to care, but no change in emergency department use, with higher visit rates persisting among black and American Indian/Alaska Native enrollees, compared to whites. States that encourage payers and systems to prioritize health equity could reduce racial and ethnic disparities for some measures in their Medicaid populations.
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Affiliation(s)
- K John McConnell
- K. John McConnell ( ) is a professor in the Department of Emergency Medicine and director of the Center for Health Systems Effectiveness, both at Oregon Health & Science University, in Portland
| | - Christina J Charlesworth
- Christina J. Charlesworth is a research associate at the Center for Health Systems Effectiveness, Oregon Health & Science University
| | - Thomas H A Meath
- Thomas H. A. Meath is a research associate at the Center for Health Systems Effectiveness, Oregon Health & Science University
| | - Rani M George
- Rani M. George is a research project manager at the Center for Health Systems Effectiveness, Oregon Health & Science University
| | - Hyunjee Kim
- Hyunjee Kim is a research assistant professor at the Center for Health Systems Effectiveness and in the Department of Emergency Medicine, Oregon Health & Science University
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Furtado KS, Brownson C, Fershteyn Z, Macchi M, Eyler A, Valko C, Brownson RC. Health Departments With A Commitment To Health Equity: A More Skilled Workforce And Higher-Quality Collaborations. Health Aff (Millwood) 2018; 37:38-46. [PMID: 29309233 PMCID: PMC5975259 DOI: 10.1377/hlthaff.2017.1173] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Health equity is a public health priority, yet little is known about commitment to health equity in health departments, especially among practitioners whose work addresses chronic disease prevention. Their work places them at the forefront of battling the top contributors to disparities in morbidity and mortality. A random sample of 537 chronic disease practitioners working in state health departments was surveyed on health equity commitments, partnerships, and needed skills. A small percentage of respondents (2 percent) worked primarily on health equity, and a larger group (9 percent) included health equity as one of their multiple work areas. People who rated their work unit's commitment to health equity as high were more likely to engage with sectors outside of health and rate their leaders as high quality, and less likely to identify skills gaps in their work unit. Opportunities exist to more fully address health equity in state public health practice through organizational, institutional, and governmental policies, including those regarding resource allocation and staff training.
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Affiliation(s)
- Karishma S Furtado
- Karishma S. Furtado ( ) is a PhD student at the Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, in Missouri
| | - Carol Brownson
- Carol Brownson is a consultant at the National Association of Chronic Disease Directors, in Atlanta, Georgia, and at the Prevention Research Center in St. Louis
| | - Zarina Fershteyn
- Zarina Fershteyn is director of program evaluation at the National Association of Chronic Disease Directors
| | - Marti Macchi
- Marti Macchi is senior director of programs at the National Association of Chronic Disease Directors
| | - Amy Eyler
- Amy Eyler is an associate professor at the Prevention Research Center in St. Louis
| | - Cheryl Valko
- Cheryl Valko is center manager at the Prevention Research Center in St. Louis
| | - Ross C Brownson
- Ross C. Brownson is the Bernard Becker Professor of Public Health at the Prevention Research Center in St. Louis and the Department of Surgery (Division of Public Health Sciences) and the Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine
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Edward J, Mir N, Monti D, Shacham E, Politi MC. Exploring Characteristics and Health Care Utilization Trends Among Individuals Who Fall in the Health Insurance Assistance Gap in a Medicaid Nonexpansion State. Policy Polit Nurs Pract 2017; 18:206-214. [PMID: 29460689 PMCID: PMC5993619 DOI: 10.1177/1527154418759312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
States that did not expand Medicaid under the Affordable Care Act (ACA) in the United States have seen a growth in the number of individuals who fall in the assistance gap, defined as having incomes above the Medicaid eligibility limit (≥44% of the federal poverty level) but below the lower limit (<100%) to be eligible for tax credits for premium subsidies or cost-sharing reductions in the marketplace. The purpose of this article is to present findings from a secondary data analysis examining the characteristics of those who fell in the assistance gap ( n = 166) in Missouri, a Medicaid nonexpansion state, by comparing them with those who did not fall in the assistance gap ( n = 157). Participants completed online demographic questionnaires and self-reported measures of health and insurance status, health literacy, numeracy, and health insurance literacy. A select group completed a 1-year follow-up survey about health insurance enrollment and health care utilization. Compared with the nonassistance gap group, individuals in the assistance gap were more likely to have lower levels of education, have at least one chronic condition, be uninsured at baseline, and be seeking health care coverage for additional dependents. Individuals in the assistance gap had significantly lower annual incomes and higher annual premiums when compared with the nonassistance gap group and were less likely to be insured through the marketplace or other private insurance at the 1-year follow-up. Findings provide several practice and policy implications for expanding health insurance coverage, reducing costs, and improving access to care for underserved populations.
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Affiliation(s)
- Jean Edward
- 1 Center for Health Services Research, University of Kentucky, Lexington, KY, USA
| | - Nageen Mir
- 2 Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Denise Monti
- 2 Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Enbal Shacham
- 3 College for Public Health and Social Justice, Department of Behavioral Sciences and Health Education, Saint Louis University, MO, USA
| | - Mary C Politi
- 2 Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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