Resuming the Decline in Cardiovascular Deaths: Urgent Federal Policy Actions.

Methods to reduce carbon monoxide levels at the workplace

Problem: Local public housing authorities (PHAs) in the United States face a different set of mandates and opportunities today than they did before 1980; PHA financing and program authority are more flexible, while federal funding has shrunk, and new obligations have arisen. Taken together, these changes in federal policy have so diversified PHAs' responsibilities that they risk organizational incoherence and ineffectiveness in trying to fulfill all their obligations. Purpose: To understand the future prospects for public and assisted housing in the United States, we trace the influence of the last two decades of federal policy on the obligations and discretion of public housing authorities. Methods: We coded the federal policy actions that have affected affordable housing policy since 1980 to identify their likely implications for PHAs' organizational strategies. Our coding distinguished initiatives likely to prompt strategic innovation by PHAs from those likely to prompt a reactive posture or defense of existing arrangements. Results and conclusions: In combination, the most prominent and binding federal initiatives push PHAs toward reactive and defensive organizational strategies. More federal initiatives foster changes in PHAs' services, revenues, and internal capacities than in their markets and external partnerships. The federal initiatives with the most dramatic and far-reaching impacts on PHAs' strategies are the Quality Housing and Work Responsibility Act, voucher expansion, voucher funding formulas, and cuts in public housing funding. By comparison, other federal initiatives have had a more limited and diffuse impact on PHAs' statefies. Takeaway for practice: Reports from individual cities suggest that PHAs have responded to these federal policy changes by choosing to focus their organizational strategies on achieving specific aims for narrow subpopulations. These choices about organizational strategy matter because federal housing policy outcomes now depend both on what PHAs choose to do and on what they are capable of doing. PHAs that strive for organizational coherence may choose both to diversify funding streams and to serve fewer poor clients, while those attempting to fulfill all their federal policy obligations risk excelling at none. In the future, PHAs struggling to survive may reduce services to the poorest households to an even greater extent than federal policy now dictates. Research support: None.

BackgroundContraceptive access is influenced by policy decisions, which can expand and constrict the contraceptive options available. This study explored the impact of recent US federal policy on contraceptive access.MethodsFederal policy changes impacting contraceptive access over the past decade were identified in grey literature. These policy changes were organized into a timeline and analyzed according to Levesque et al.'s (2013) five dimensions of healthcare access (approachability, acceptability, availability/accommodation, affordability, and appropriateness), noting the most salient healthcare dimension impacted by the policy change and analyzing whether, according to this framework, the policy created a theoretical increase or decrease in contraceptive access.ResultsOf those policy changes coded as increasing (n = 42) and decreasing (n = 28) contraceptive access, most were related to the affordability (increasing n = 13; decreasing n = 12), physical availability (increasing n = 10; decreasing n = 7), and appropriateness (increasing n = 12; decreasing n = 4) of contraceptive care. Policy changes largely followed partisan divides, with contraceptive access increasing in years with a Democratic president and decreasing when a Republican president was in office. Many policy changes were related to the Affordable Care Act (ACA) and Title X of the Public Health Services Act. The implementation of the ACA and subsequent updates to it have increased the affordability of contraception, whereas changes to Title X have decreased the availability and appropriateness of contraceptive care.ConclusionsThis study highlights recent policy changes impacting contraceptive access, organizing them according to the five dimensions of healthcare access. It outlines specific policy barriers to contraceptive access and provides suggestions for policy and practice action that will improve contraceptive access and reproductive autonomy. Opportunities to ensure contraceptive access for all Americans include promoting comprehensive sex education, extending the Community Health Center Fund, increasing contraceptive care options for people with employers who are exempted from the ACA contraceptive mandate, addressing discrimination and building trust in contraceptive care, and amplifying outreach efforts to combat misinformation and confusion created by continuous changes to key family planning policies. Continued research on the role of policy in determining reproductive autonomy is warranted, and practice and policy action is needed to improve contraceptive access.

Digital Redlining and Cardiovascular Innovation.

Scholars and journalists have devoted considerable attention to understanding the circumstances in which Americans receive surprise medical bills. Previous research on this issue has focused on the scope of the problem, including the conditions that are most likely to lead to surprise bills. However, the existing literature has almost exclusively relied on claims data, limiting our understanding of consumer experiences and attitudes toward policy changes to address surprise billing. Using a survey administered to a nationally representative sample of 4998 Americans, we analyze consumer experiences with surprise billing, knowledge of the issue, how concerned Americans are about receiving surprise bills and how past experiences influence policy preferences toward federal action on surprise billing. Our analysis demonstrates that knowledge and concern about surprise billing are the highest among the educated and those who have previously received a surprise bill. These factors also predict support for federal policy action, with high levels of support for federal policy action across the population, including among both liberals and conservatives. However, more detailed federal policy proposals receive significantly less support among Americans, suggesting that stand-alone policy action may not be viable. Our results show bipartisan support among American consumers for federal action on surprise billing in the abstract but no consistent views on specific policy proposals.

A comprehensive nutrition policy containing a broad package of cross-sector and synergistic policy actions is required to attenuate the systemic drivers of poor nutrition. The current study aims to critically analyse trends in the scope of federal nutrition policy actions in Australia between 2007 and 2018 by: (1) describing the changes in nutrition policy actions, benchmarked against an international best-practice policy framework and (2) investigating how and why the scope of these policy actions have changed over time by examining the decision-making processes that led to the establishment of Australia's Healthy Food Partnership (the Partnership). Qualitative case study involving documentary analysis and key-informant interviews. Australian federal government documents (n 10) were analysed against the NOURISHING framework. Key informants (n 6) were interviewed and asked about the Partnership's decision-making and establishment processes. Australia. Executive Committee (the Partnership's governing body) and working group members. From 2007 to 2018, the scope of Australian national nutrition policy has fluctuated from evidence-informed recommendations for a comprehensive policy to the mostly discrete policy actions of the Partnership. Themes of 'pragmatism and compromise', 'actor relationships and lobbying' and 'political context' were critical drivers for establishing the Partnership. The narrowing of Australian nutrition policy reflects a response to political expediency and compromise. This political dynamic highlights a dilemma facing nutrition policy advocates: should (and if so, how) a balance be sought between the aspirational but possibly unrealistic goals, and the limited but likely deliverable outcomes during policy-making processes? These findings have relevance for developing a future comprehensive national nutrition policy.

In the absence of partisan ownership of an issue, what factors shape public preferences for federal, state and local policy action? The Zika virus provides a unique context in which to examine this question, as it is a new threat to public health in the United States and lacks clear partisan ownership. We examine (1) which Zika policies do citizens support, (2) at which level(s) of government and (3) what factors explain citizen assignment of policy responsibility to different levels of government? Using nationally representative survey data, we find that the three most popular policy responses to Zika are travel warnings, research funding and public education, with the federal government being the preferred policy actor. In the absence of clear partisan issue ownership, we find that Republicans are significantly more likely to prefer state policy action, while partisanship has no impact on public preferences for federal or local policy action.

Tobacco 21 (T21) policies, which prohibit tobacco sales to individuals under 21, aim to reduce youth tobacco use by limiting youth access to these products. Little, however, is known about the longitudinal effect of T21 policies on youth tobacco use behaviors at the national level. Participants aged 15-21 years from a longitudinal study conducted between May 2014 and May 2019 (n = 13,990) were matched to geocoded T21 policies. Generalized linear mixed models examined the association of direct and bordering T21 policy exposure and cigarette and e-cigarette use and intention to use, accounting for individual characteristics. Controlling for sociodemographic and psychosocial covariates, there were statistically significant positive associations between T21 exposure and e-cigarette use (OR = 1.45 [1.03,2.06], p < .003) and intention to use e-cigarettes (OR = 1.54 [1.05,2.26], p < .027). We found no association between T21 policy exposure and cigarette use or intention to use cigarettes. Furthermore, exposure to T21 policies did not significantly modify the relationship between age and either cigarette outcome. This is the first longitudinal study to evaluate state and local T21 policies at the national level. Our analyses demonstrate that existing T21 policies are not sufficient to reduce youth tobacco use and intentions to use, and suggest that T21 policies need to be a part of a comprehensive tobacco policy landscape. Our findings suggest further research is warranted on state and local T21 policy enforcement and implementation, including how T21 may differentially impact cigarette and e-cigarette use, and may have implications for the federal T21 policy. This research evaluates state and local T21 policies in the United States longitudinally, finding that T21 policies are not sufficient to stem e-cigarette use among adolescents and young adults. These findings support further policy action and suggest that local and state T21 policies are not sufficient to reduce tobacco use and rather, need to be part of a broader, more comprehensive set of tobacco control policies. Further research on enforcement and implementation challenges of T21 policies and the impacts of the new federal T21 policy is warranted.

This paper studies the dynamics of detention, deportation, and the criminalization of immigrants. We ground our analyses and discussion around the Illegal Immigration Reform and Immigrant Responsibility Act of 1996's (IIRIRA's) detention mandate, the role of special interest groups and federal policies. We argue that these special interest groups and major federal policies have come together to fuel the expansion of immigrant detention to unprecedented levels. Moreover, we aim to incite discussion on what this rapid growth in detention means for human rights, legislative representation and democracy in the United States. This study analyzes two main questions: What is the role of special interests in the criminalization of immigrants? And does the rapid increase in detention pose challenges or risks to democracy in the United States? Our study is grounded within the limited, yet growing literature on immigrant detention, government data, and “gray” literature produced by nonprofits and organizations working on immigration-related issues. We construct a unique dataset using this literature and congressional reports to assess what factors are associated with the rise of immigrant detention. A series of correlations and a time series regression analysis reveal that major restrictive federal immigration policies such as IIRIRA, along with the increasing federal immigration enforcement budget, have had a significant impact on immigrant detention rates. Based on these findings, we recommend three central policy actions. First, the paper recommends increased transparency and accountability on behalf of the Department of omeland Security, Immigration and Customs Enforcement, and on lobbying expenditures from for-profit detention corporations. Second, it argues for the repeal of mandatory detention laws. These mandatory laws have led to the further criminalization and marginalization of undocumented immigrants. And lastly, it argues that repeal of the Congressional bed mandate would allow for the number of detainees to mirror actual detention needs, rather than providing an incentive to detain. However, we anticipate that the demand for beds will increase even more given the current administration's push for the criminalization and increased arrests of undocumented individuals. The rhetoric used by the present administration further criminalizes immigrants. 1

Since 11 March 2020 when officially declared a global pandemic, Covid‐19 (or SARS‐COV2) has turned out to be a multifaceted disease differently affecting countries and individuals. What makes certain countries more vulnerable than others has attracted the interest of scientists from various disciplines. This paper intends to compare the impact of demographic parameters, population health conditions and policy actions on prevalence and fatality levels of Covid‐19 during the first 3 months since its declaration of global pandemic. A country‐level exploratory analysis has been conducted in order to assess how demography, national health conditions and measures taken interact and condition the disease outcomes. Analysis relies on publicly available data on Covid‐19 reported cases, deaths and number of persons tested. Those data are combined with demographic parameters (sex ratio, mean age, population density and life expectancy), health data (cardiovascular death rate, diabetes prevalence, share of smokers among males and females and number of hospital beds) and information about relative national policies aiming the management of the pandemic (lockdown timing and duration). Our analysis confirms the diversity of factors and the complexity of their interaction in explaining the propagation and fatality of the disease across Europe. Our findings question some well‐established attitudes concerning the role of demographic variables and public health conditions in the spread of the disease.

The role of health policy in the prevention of venous thromboembolism in the UK National Health Service—Learning from the past, looking to the future

News and Views: A Roundup of some new developments in diabetes.

tation of stabilization policies that allow to take into account differences between the regions in response to the changes made in federal policy. The paper has substantiated the system of performance indicators that measures anti-inflationary policy and also takes into account the heterogeneity of economic space of the Russian Federation in the context of the “direct” and “conjugate” effects on the central regions. Theoretical position application and output indicators, which are outlined in this article allow building a system of co

Coastal ecosystems such as mangroves, salt marshes, and seagrasses provide important ecosystem services, including nursery habitat for fish, shoreline protection, and the recently recognized service of carbon sequestration and storage. When these wetland ecosystems are degraded or destroyed, the carbon can be released to the atmosphere, where it adds to the concentration of greenhouses gases (GHGs) that contribute to climate change. Many federal statutes and policies specifically require that impacts on ecosystem services be considered in policy implementation. Yet, no federal statute, regulation, or policy accounts directly for the carbon held in coastal habitats. There are a number of federal statutes and policies for which coastal carbon ecosystem services could reasonably be added to environmental and ecosystem considerations already implemented. We look at a subset of these statutes and policies to illustrate how coastal carbon ecosystem services and values might affect the implementation and outcomes of such statutes generally. We identify key steps for the inclusion of the ecosystem services of coastal habitats into the implementation of existing federal policies without statutory changes; doing so would increase the degree to which these policies consider the full economic and ecological impacts of policy actions.

First paragraphs: Producing social change and supporting social justice has always required multiscalar strategy and action. Federal policy actions can be transfor­mative, but are sensitive to extreme philosophical shifts and partisan conflict in federal leadership. When federal leadership is unstable, local and regional government action provides a critical space for maintaining movement forward and presenting opposition when federal policies are not supportive. These dynamics are evident in many spheres of policy, such as housing, transportation, economic development, education, health, and food systems. We can see this tension in food systems today, as federal policies regarding agricultural subsidies and proposals to tighten food assistance programs (e.g., SNAP) can be in opposition to local goals of sup­porting sustainable and just local food systems. Local activities and practitioners must be agile to work within an ever-changing federal policy landscape....