"Hearing from all sides" How legislative testimony influences state level policy-makers in the United States

Roadblocks at every turn: What reproductive health experts say about barriers to legislative abortion advocacy

OBJECTIVES

Advocacy is an important part of the reproductive health care profession, but barriers to participating in the legislative process are not well understood. This study examines the barriers experts in reproductive health experience to testifying at state legislative committee hearings regarding abortion.

STUDY DESIGN

We conducted in-depth semistructured interviews with 40 experts in reproductive health, including obstetrician gynecologists (OBGYNs), midwives, pediatricians, nurses, primary care providers, and professional advocates. We analyzed the interview transcripts using an inductive coding process.

RESULTS

We identified four barriers to testifying at state legislative committee hearings regarding abortion. First, our interviewees described a tension between claiming expertise and stigma: those without direct experience in abortion care often felt too unqualified to testify, but representing oneself as an abortion provider came with stigma that made communicating with legislators difficult. Second, issues of power and identity informed interactions in committee chambers, as well as the structure of advocacy work more broadly. Third, institutional constraints shaped what experts could say and whether they could rely on their professional affiliations for support. Finally, fear of harassment and violence kept many of our interviewees from testifying, especially those who were active abortion providers.

CONCLUSIONS

These barriers appear unique to testifying on abortion and represent a complex web of hurdles that experts in reproductive health must navigate to participate in this part of the policymaking process.

IMPLICATIONS

Our findings suggest multiple strategies for improving the state of expert involvement in abortion policymaking, including expanding the pool of testifiers to include nonabortion providers and experts with a range of backgrounds, as well as supporting organizations that link experts to training and advocacy networks.

Opportunities to improve policy dissemination by tailoring communication materials to the research priorities of legislators

BACKGROUND

Communicating research to policymakers is a complex and difficult process. Ensuring that communication materials have information or design aspects that appeal to groups of policymakers with different priorities could be a substantive improvement over current dissemination approaches. To facilitate a more nuanced design of policy communication materials and message framing, we identified and characterized groups of state legislators based on how they prioritize different characteristics of research.

METHODS

We used deidentified data collected in 2012 on 862 state legislators belonging to the US liberal-moderate-conservative ideological spectrum and from all 50 US states. Legislators were grouped using latent class analysis based on how they prioritized 12 different characteristics of research (e.g., research is unbiased, presents data on cost-effectiveness, policy options are feasible). We fit initial models using 1-6 group solutions and chose the final model based on identification, information criteria, and substantive interpretation.

RESULTS

Most legislators placed a high priority on research that was understandable (61%), unbiased (61%), available at the time that decisions are made (58%), and brief and concise (55%). The best model identified four groups of state legislators. Pragmatic consumers (36%) prioritized research that was brief and concise, provided cost-effectiveness analyses, and was understandably written. Uninterested skeptics (30%) generally did not place a high priority on any of the research characteristics. Conversely, one-quarter of legislators (25%) belonged to the Highly Informed Supporters group that placed a high priority on most characteristics of research. Finally, Constituent-Oriented Decision Makers (9%) prioritized research that was relevant to their constituents, delivered by someone they knew or trusted, available at the time decisions were made, and dealt with an issue that they felt was a priority for state legislative action.

CONCLUSIONS

To maximize the impact of dissemination efforts, researchers should consider how to communicate with legislators who have distinct preferences, values, and priorities. The groups identified in this study could be used to develop communication materials that appeal to a wide range of legislators with distinct needs and preferences, potentially improving the uptake of research into the policymaking process. Future work should investigate how to engage skeptical legislators.

Analysis of Public Testimony About Philadelphia's Sweetened Beverage Tax

INTRODUCTION

Although interest in beverage taxes has increased in recent years, industry opposition and other challenges have limited their spread in the U.S. Because beverage tax proposals are often unsuccessful, there is limited empirical evidence to inform advocacy efforts. Philadelphia's 1.5 cent-per-ounce tax on sweetened beverages provides an opportunity to understand how public testimony for and against the tax was framed in a city that ultimately passed the policy.

METHODS

A content analysis of all public testimony about the beverage tax presented to the Philadelphia City Council in 2016 was conducted. Testimonies were coded for policy stance (protax or antitax), speaker type, and specific protax or antitax arguments. Quantitative data were analyzed in 2018-2019 using chi-square tests.

RESULTS

A total of 177 unique testimonies were identified, which included 40 protax arguments (grouped into 11 themes) and 31 antitax arguments (grouped into 10 themes). Most testimonies were delivered orally, and most speakers argued in favor of the tax (58%). Among tax supporters, funding early childhood education was the most common argument (71%), whereas tax opponents most frequently argued that sugar-sweetened beverages were the wrong target for the tax (50%).

CONCLUSIONS

This analysis of public testimony revealed that protax advocacy efforts highlighted the revenue benefits for early childhood education and community infrastructure rather than the tax's potential to reduce sweetened beverage consumption and improve health. By contrast, antitax arguments centered on the unfairness of targeting a single industry, potential negative economic impacts, and the perceived lack of evidence that the tax would influence consumer behavior.

Expert participation in 25 years of Wisconsin abortion policymaking

OBJECTIVE

State-level abortion restrictions grew considerably in number over the last two decades. This study examines the scope of expert testimony given in legislative committee hearings at which these laws are first debated.

STUDY DESIGN

We gathered 265 testimonies given by experts at Wisconsin legislative committee hearings on 34 abortion bills from 1995-2019. We coded testimonies to identify testifiers' ideological leaning and source of expertise. We conducted descriptive analyses of testifiers' participation.

RESULTS

Experts with anti-abortion rights views testified more often than experts with pro-abortion rights views (2.1 vs 1.4 testimonies per expert). Experts with an activism background testified more often than experts in medicine (2.5 vs 1.3 testimonies per expert). Anti-abortion activist experts represented the largest proportion of testimonies (32%) but the smallest proportion of testifiers (16%). Pro-abortion rights medical experts gave the fewest testimonies (24%) relative to their proportion of testifiers (31%). The number of testimonies given by pro-abortion rights activist experts remained stable over the study period. Testimonies given by all other kinds of experts were more numerous in recent years.

CONCLUSIONS

The experts who testify most frequently tend to espouse anti-abortion views and have backgrounds in activism rather than healthcare. These repeat testifiers may have more opportunities to build relationships with legislators and thus influence policy. Anti-abortion rights activist experts' outsized role in legislative hearings, especially in recent years, should concern advocates of evidence-based reproductive health policy. Medical experts may be deterred from giving testimony by logistical or other structural barriers in the legislative process.

IMPLICATIONS

The family planning field should conduct more research on the role of experts in abortion policymaking. Future studies should examine testifiers in other states and identify barriers pro-abortion medical experts may face to testifying, as these experts are key for creating evidence-based abortion policy.

Linking Data on Constituent Health with Elected Officials' Opinions: Associations Between Urban Health Disparities and Mayoral Officials' Beliefs About Health Disparities in Their Cities

Policy Points Mayoral officials' opinions about the existence and fairness of health disparities in their city are positively associated with the magnitude of income-based life expectancy disparity in their city. Associations between mayoral officials' opinions about health disparities in their city and the magnitude of life expectancy disparity in their city are not moderated by the social or fiscal ideology of mayoral officials or the ideology of their constituents. Highly visible and publicized information about mortality disparities, such as that related to COVID-19 disparities, has potential to elevate elected officials' perceptions of the severity of health disparities and influence their opinions about the issue.

CONTEXT

A substantive body of research has explored what factors influence elected officials' opinions about health issues. However, no studies have assessed the potential influence of the health of an elected official's constituents. We assessed whether the magnitude of income-based life expectancy disparity within a city was associated with the opinions of that city's mayoral official (i.e., mayor or deputy mayor) about health disparities in their city.

METHODS

The independent variable was the magnitude of income-based life expectancy disparity in US cities. The magnitude was determined by linking 2010-2015 estimates of life expectancy and median household income for 8,434 census tracts in 224 cities. The dependent variables were mayoral officials' opinions from a 2016 survey about the existence and fairness of health disparities in their city (n = 224, response rate 30.3%). Multivariable logistic regression was used to adjust for characteristics of mayoral officials (e.g., ideology) and city characteristics.

FINDINGS

In cities in the highest income-based life expectancy disparity quartile, 50.0% of mayoral officials "strongly agreed" that health disparities existed and 52.7% believed health disparities were "very unfair." In comparison, among mayoral officials in cities in the lowest disparity quartile 33.9% "strongly agreed" that health disparities existed and 22.2% believed the disparities were "very unfair." A 1-year-larger income-based life expectancy disparity in a city was associated with 25% higher odds that the city's mayoral official would "strongly agree" that health disparities existed (odds ratio [OR] = 1.25; P = .04) and twice the odds that the city's mayoral official would believe that such disparities were "very unfair" (OR = 2.24; P <.001).

CONCLUSIONS

Mayoral officials' opinions about health disparities in their jurisdictions are generally aligned with, and potentially influenced by, information about the magnitude of income-based life expectancy disparities among their constituents.

Key Drivers of State Preemption of Food, Nutrition, and Agriculture Policy: A Thematic Content Analysis of Public Testimony

PURPOSE

Local communities are often active public health policy makers, so state preemption-when the state withdraws authority from local governments-can hinder public health progress. Kansas enacted the most sweeping law in the nation preempting food, nutrition, and agricultural policy.

DESIGN

Qualitative thematic content analysis was used on public comments to identify and evaluate common and key arguments. A codebook was developed using an iterative process. Open coding was applied to all comments.

SETTING

All testimony and comments submitted by individuals and organizations to the Kansas State Legislature on the preemptive bill.

PARTICIPANTS

Eight types of commentators submitted 34 written and 12 oral comments.

MEASURES

The data were evaluated on a latent level to examine underlying drivers of preemption.

RESULTS

Comments addressed 18 themes, referenced 366 times; 68% in opposition. Common themes included local control, food labeling, public health, need for statewide standards, and debate over food regulation. Key themes included the need for state and federal uniformity to support businesses and consumers, debate over topics not in the bill, the value of local control, confusion over bill coverage, and outside influences.

CONCLUSION

Confusion about bill language and coverage, the combination of food and agricultural issues, and backing by multinational corporations helped propel preemption forward in Kansas. Food policy stakeholders nationally can anticipate similar arguments and strategies in their state.

Factors Influencing Georgia Legislators' Decision-Making on Nurse Practitioner Scope of Practice

The state of Georgia faces challenges in providing access to care, largely due to rural hospital closures and physician shortages. Although nurse practitioners (NPs) could help address Georgia's urgent health care needs, the state remains restrictive with respect to NP scope of practice (SOP). This study examined factors that influence Georgia legislators' decision-making on NP SOP. In June 2016, after the January through March legislative session, a questionnaire was e-mailed to 49 state legislators on the Committees on Health and Human Services in Georgia's House of Representatives and Senate. The questionnaire was adapted from a legislative questionnaire previously used in research on state educational policy. Nine of 49 (18%) Georgia legislators responded. The majority of nine respondents were Republicans having served less than 15 years in the legislature. The number of respondents was approximately equal between Senate and House of Representatives. The respondents rated expert testimony and hearing from constituents as most likely to influence their decision-making on NP SOP. They reported that media and concerns about reelection were least likely to influence their decision-making about NP SOP. Therefore, nurses who aim to influence state policy should consider legislator preferences, such as speaking personally with constituents and receiving expert testimony. In-person communication could enhance interactions with legislators, potentially improving policy outcomes. Future research is necessary and should be conducted by NPs to determine the forms of communication and content in testimony most effective in influencing state lawmakers about NP SOP and examine if results vary by state political or other contexts.

Comparison of Research Framing Preferences and Information Use of State Legislators and Advocates Involved in Cancer Control, United States, 2012-2013

Introduction

Evidence-based policy plays an important role in prevention of cancer and other chronic diseases. The needs of actors involved in policy decision-making should inform knowledge translation strategies. This study examines the differences between state legislators and advocates in how they seek and use information and what their preferences are for how research information is framed.

Methods

We conducted a cross-sectional comparison of survey responses by US advocates (n = 77) and state legislators (n = 265) working on issues related to cancer control.

Results

Advocates differed significantly from legislators on all demographic characteristics. Advocates reported seeking and using information more frequently than legislators, though legislators used legislative research bureaus more often (0.45 point difference, P = .004). Both legislators and advocates prioritized the presentation and timeliness of research information similarly but reported different preferences for source (information bias, information relevance, delivery of information by trusted person) of research information. Several differences between advocates and legislators were modified by participant age.

Conclusion

Our study provides insights for development of knowledge translation strategies to enhance evidence-based policy making for cancer control that are tailored to state-level legislators and advocates. Additional research efforts should evaluate the effectiveness of such knowledge translation strategies, particularly among advocates.

Uses of Research Evidence by State Legislators Who Prioritize Behavioral Health Issues

OBJECTIVE

Disseminating behavioral health (BH) research to elected policy makers is a priority, but little is known about how they use and seek research evidence. This exploratory study aimed to identify research dissemination preferences and research-seeking practices of legislators who prioritize BH issues and to describe the role of research in determining policy priorities. The study also assessed whether these legislators differ from those who do not prioritize BH issues.

METHODS

A telephone-based survey was conducted with 862 state legislators (response rate, 46%). A validated survey instrument assessed priorities and the factors that determined them, research dissemination preferences, and research-seeking practices. Bivariate analyses were used to characterize and compare the two groups.

RESULTS

Legislators who prioritized BH issues (N=125) were significantly more likely than those who did not to identify research evidence as a factor that determined policy priorities (odds ratio=1.91, 95% confidence interval=1.25-2.90, p=.002). Those who prioritized BH issues also attributed more importance to ten of 12 features of research, and the difference was significant for four features (unbiased, p=.014; presented in a concise way, p=.044; delivered by someone known or respected, p=.033; and tells a story, p=.030). Those who prioritized BH issues also engaged more often in eight of 11 research-seeking and utilization practices, and a significance difference was found for one (attending research presentations, p=.012).

CONCLUSIONS

Legislators who prioritized BH issues actively sought, had distinct preferences for, and were particularly influenced by research evidence. Testing legislator-focused BH research dissemination strategies is an area for future research.

Framing research for state policymakers who place a priority on cancer

PURPOSE

Despite the potential for reducing the cancer burden via state policy change, few data exist on how best to disseminate research information to influence state legislators' policy choices. We explored: (1) the relative importance of core framing issues (source, presentation, timeliness) among policymakers who prioritize cancer and those who do not prioritize cancer and (2) the predictors of use of research in policymaking.

METHODS

Cross-sectional data were collected from US state policymakers (i.e., legislators elected to state houses or senates) from January through October 2012 (n = 862). One-way analysis of variance was performed to investigate the association of the priority of cancer variable with outcome variables. Multivariate logistic regression models examined predictors of the influence of research information.

RESULTS

Legislators who prioritized cancer tended to rate characteristics that make research information useful higher than those who did not prioritize cancer. Among differences that were statistically significant were three items in the "source" domain (relevance, delivered by someone respected, supports one's own position), one item in the "presentation" domain (telling a story related to constituents) and two items in the "timeliness" domain (high current state priority, feasible when information is received). Participants who prioritized cancer risk factors were 80 % more likely to rate research information as one of their top reasons for choosing an issue on which to work.

CONCLUSIONS

Our results suggest the importance of narrative forms of communication and that research information needs to be relevant to the policymakers' constituents in a brief, concise format.

Is Twitter a forum for disseminating research to health policy makers?

Findings from scientific research largely remain inside the scientific community. Research scientists are being encouraged to use social media, and especially Twitter, for dissemination of evidence. The potential for Twitter to narrow the gap on evidence translated into policy presents new opportunities. We explored the innovative question of the feasibility of Twitter as a tool for the scientific community to disseminate to and engage with health policy makers for research impact. We created a list of federal "health policy makers." In December 2014, we identified members using several data sources, then collected and summarized their Twitter usage data. Nearly all health policy makers had Twitter accounts. Their communication volume varied broadly. Policy makers are more likely to push information via Twitter than engage with constituents, although usage varied broadly. Twitter has the potential to aid the scientific community in dissemination of health-related research to health policy makers, after understanding how to effectively (and selectively) use Twitter.