Assistance Benefits Research Articles

Food Insecurity Is a Common Problem Affecting Dietary Quality in a Clinic-Based Pediatric Sickle Cell Disease Sample

Background: Understanding the effect of food insecurity on diet of children with sickle cell disease (SCD) is necessary to improve child dietary quality and optimize overall health. Objective: To characterize the association between food insecurity and dietary quality of children with SCD. Methods: A cross-sectional study of 100 youth aged 1-20 years with SCD and their parents was conducted from January-June 2018 at a pediatric SCD center at an academic medical center in New York City (NYC). Participating SCD patients were recruited from a convenient clinic-based sample. Food insecurity over the prior year, defined as a disruption in eating patterns due to lack of resources, was reported by adults ≥ 18 years using the validated 18-item U.S. Department of Agriculture Food Security Survey. Dietary quality in the prior 30 days was parent-reported for children <11 years and self-reported for children ≥11 years using a 15-item food frequency questionnaire adapted from the validated Dietary Screener Questionnaire (DSQ).1 Good dietary quality was defined as higher daily intake frequency of fruit, vegetable, protein and dairy and a lower frequency of pizza. Patient characteristics measured included SCD type, transfusion history, emergency room visits, housing hardship (defined as ≥2 moves in the prior year), and enrollment in federal food assistance programs (Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and the National School Lunch program). Multiple regression models adjusted for a priori covariates associated with food insecurity and nutrition: age, sex, and housing hardship. Results: Of the sample, 55% were male and 50% Caribbean Hispanic (Table). Overall, 85% of children had HbSS, 13% HbSC, and 3% HbSβ0. Mean hemoglobin level was 9.0 ± 1.7 mg/dL, including 11% on chronic transfusion therapy. Participants had a median of 2.2 emergency room visits (interquartile range (IQR): 3) over the prior year. Among families, 80% lived in lower-income neighborhoods in northern Manhattan and the Bronx, 22% had housing hardship and 80% received at least one federal food assistance benefit. Among all families, 30% reported food insecurity. Children with and without food insecurity were not significantly different by age (median (IQR): 14 (7) vs. 10 (10) years, p=0.6), male sex (53% vs. 55%, p=0.9), and housing hardship (13% vs. 24%, p=0.2). Food-insecure children had significantly lower mean daily frequency of fruit (0.5 ±0.2 vs. 0.7 ±0.6, p=0.04) and vegetable intake (0.3 ±0.2 vs. 0.5 ±0.5, p=0.04) compared to those without food insecurity (Figure). Similarly, among the 80% of children receiving federal food assistance, those with food insecurity had lower mean daily frequency of vegetable intake compared to children without food insecurity (0.3 ±0.4 vs. 0.5 ±0.3 respectively, p=0.02). Food insecurity was significantly associated with increased frequency of pizza intake among all children (β=0.2 ±0.1, 95% confidence interval 0.01-0.29). Conclusions: In this clinic-based urban sample of children with SCD, 30% experienced food insecurity and 1 in 5 experienced housing hardship. This was higher than reported NYC-wide food insecurity rate of 13% and the Bronx rate of 26% in 2018.2 Food insecurity was significantly associated with a poorer diet quality - lower mean daily frequency of fruit and vegetable intake, even among those receiving a federal food assistance benefit, and increased frequency of pizza intake. Screening for food insecurity and other health-related social needs in pediatric SCD clinic may identify many families needing assistance for basic food and housing needs, and may inform efforts to improve dietary quality and overall health in these children. This research was conducted due to support from a NIH Loan Repayment Program for Health Disparities Research Award (NIMHD), Dr. Fernández, PI.

Doula assistance on anxiety and duration of giving birth in normal mother giving birth

Normal childbirth has a high risk of causing excessive anxiety during the delivery process which can adversely affect the mother and the fetus. Besides, the long labor duration makes women even more anxious and afraid to go through the normal labor phase. However, anxiety and the duration of labor can be minimized and reduced with support and the presence of a doula during normal labor. The benefits of doula assistance during the normal delivery process are also not widely known because it is not commonly implemented in Indonesia. This study aims to prove the effect of doula assistance on anxiety and normal delivery duration. This study is a true experimental design with a Posttest Only with Control Group Design with a total sample size of 62 normal maternal mothers in the delivery room of the TK II Udayana Hospital Denpasar Bali which is divided into two. group, namely the intervention group as many as 31 people given doula assistance and a comparison group of 31 people who only provided support from their husbands. Observations and interviews were carried out immediately after delivery.

Outcomes of primary versus revisional robotically assisted laparoscopic Roux-en-Y gastric bypass: a multicenter analysis of ten-year experience

BackgroundPostoperative morbidity after laparoscopic bariatric surgery is considered higher for patients undergoing revisional versus primary procedures. The objective of this retrospective cohort study was to compare outcomes between patients undergoing primary versus revisional robotically assisted laparoscopic (RAL) Roux-en-Y gastric bypass (RYGB).MethodsData of all patients who underwent RAL primary and revisional RYGB between 2009 and 2019 at two accredited, high-volume bariatric surgery centers—the Memorial Hermann – Texas Medical Center, Houston, TX, and the Tower Health, Reading Hospital, Reading, PA, were analyzed. Primary outcomes were early (< 30 days) and overall postoperative complications. Secondary outcomes included intraoperative complications, operative times, conversions to laparotomy, length of hospital stay, early (< 30 days) postoperative readmissions and deaths.ResultsData of 1072 patients were analyzed, including 806 primary and 266 revisional RAL RYGB procedures. Longer operative times (203 versus 154 min, P < 0.001), increased number of readmissions for oral intolerance (10.5% versus 6.7%, P = 0.046) and higher rate of gastrojejunal stricture (6.4% versus 2.7%, P = 0.013) were found in the revisional group. Gastrointestinal leak rates were 0.2% for the primary versus 1.1% for the revisional group (P = 0.101). Early (< 30 days) reoperations rates were 2.2% for the primary versus 1.1% for the revisional group (P = 0.318). There were no statistically significant differences between groups in overall and severe complication rates.ConclusionPatients undergoing RAL primary and revisional RYGB had comparable overall outcomes, with a non-significant higher early complication rate in the revisional group. Despite the study being underpowered to detect differences in specific complication rates, the morbidity seen in the revisional RYGB group remains markedly below literature reports of revisional laparoscopic RYGB and might suggest a benefit of robotic assistance. Further prospective studies are needed to confirm these results.

Effects of Residential Instability of Renters on Their Perceived Health Status: Findings from the Korean Welfare Panel Study.

Identifying the impact of housing instability on the health status of renters with relatively high economic difficulties is important for the improvement of renters’ quality of life and their social security. Accordingly, this study adopted a panel data regression approach to examine the associations between residential instability and perceived health status—including physical and mental health—using 14 waves (2006–2019) of longitudinal data collected by the Korean Welfare Panel Study. The results showed that residential instability significantly affected perceived health status, and renters who experienced residential instability perceived worse health status and had more severe depression than those who did not experience residential instability. Moreover, failure to meet the minimum housing standard worsened depression in renters. Despite assistance benefits from the government, permanent rental housing and the national basic living security were also factors that worsened depression. Dissatisfaction with one’s residential environment and social relationships were also associated with increased depression. We recommend that the overall quality of housing welfare services, including a focus on the mental health of low-income renters, be improved by expanding the range of services, increasing the number of professional housing welfare workers, and supplying community facilities for increasing residential and social relationship satisfactions.

Determinants of social assistance caseloads for employable single adults without dependants in Canada

AbstractGovernment officials like the idea of just a small number of households in their respective jurisdiction receiving social assistance. A large number is seen as costly to the public treasury, and declining caseloads are generally viewed as a mark of success for both the economy and the government of the day. But what factors account for the size of a Canadian province's social assistance caseload? This article aims to shed light on this question, with a focus on single adults without dependants (and without serious disabilities) during the 1989–2017 period. One important finding is that when the value of social assistance benefit levels for this group increases by 1% in a province, the social assistance caseload for this demographic rises by 0.457%. Put differently, there is indeed an important behavior response associated with higher benefit levels. In response, we propose that provincial officials budget for higher take up levels when they increase benefit levels for this household group.

Testing behavioral interventions designed to improve on-time SNAP recertification

We report results from a series of randomized controlled trials (RCTs) run between January 2019 and February 2020 testing behavioral interventions designed to increase the likelihood that SNAP recipients recertify on-time in Hennepin County, the most populous county in Minnesota. Given the different levels of governance and the abundance of qualifying rules and processes that low-income households must negotiate to obtain and retain SNAP food assistance benefits, many households may fail to recertify for SNAP. Administrative burden includes the difficulties created by having to learn deadlines and which forms constitute the proper paperwork necessary to recertify. In our main intervention, we test a three-armed study (n=23,756), comparing the efficacy of the Hennepin County SNAP recertification auto-dialer communication, a behaviorally-informed text message, and a third arm with both the Hennepin county autodialer and our text message, against a control group that did not receive any reminder at the beginning of the recertification month but did receive other standard written communications. Results from this trial show that the autodialer is not an effective reminder. However, the interventions with text messages are effective in improving recertification rates around five percent (p&lt;0.01) over no additional message and around two percentage points (p&lt;0.05) over the Hennepin County autodialer message currently being used. Text messaging appears to be particularly effective for SNAP recipients under the age of 60 with low to moderate levels of education.

Die Gew\xe4hrleistung von Krankheitshilfen bei asylsuchenden Menschen: Zweiklassenmedizin in Deutschland?

ZusammenfassungHintergrundEs gibt im Bereich des Asylbewerberleistungsgesetzes (AsylbLG) zwei Möglichkeiten der Leistungsgewährung mit praktischer Relevanz für die Gesundheitsversorgung (abhängig von der Voraufenthaltszeit): die Grundleistungen und die Leistungen in besonderen Fällen analog zum Sozialgesetzbuch (SGB) XII.MethodikDie Sekundärdatenanalyse untersucht das Leistungsgeschehen im Krankheitsfall bei den Leistungsempfängern nach dem AsylbLG beim Forschungsdatenzentrum der Statistischen Ämter des Bundes und der Länder. Dem untersuchten Personenkreis wurde noch keine Flüchtlingseigenschaft bzw. Asylberechtigung zuerkannt.ErgebnisseZum Stichtag 31.12.2018 bezogen 423.201 Personen in Deutschland Leistungen nach dem AsylbLG. Davon war gut ein Drittel Frauen. Das Durchschnittsalter betrug 24 Jahre. Über die Hälfte stammte aus Asien. Über ein Drittel aller Leistungsempfänger befand sich in ambulanter (33,5 %) oder stationärer Behandlung (1,3 %). Zwischen den Bundesländern variierten die Leistungen zur Hilfe bei Krankheit sowie die gesundheitsbezogenen Pro-Kopf-Bruttoausgaben sehr stark. Die Gewährung von Leistungen bei Krankheit war in Aufnahmeeinrichtungen relativ gering. Mit Gesundheitskarte war die Inanspruchnahme stationärer Behandlung generell höher.Die gesundheitsbezogene Regelversorgung mit Hilfen in besonderen Fällen (§2 AsylbLG analog SGB XII) erreichte einen größeren Anteil an leistungsberechtigten Menschen mit 42,7 % am Jahresende als die Minimalversorgung nach §3 AsylbLG mit 29,0 %. Sie verursachte trotzdem im Vergleich weniger Bruttoausgaben.SchlussfolgerungEs wird empfohlen, §2 AsylbLG schon bei einer Voraufenthaltszeit ab 3 Monaten anzuwenden, um frühzeitiger die Hilfen analog Kap. 5–9 SGB XII gewähren zu können. Eine flächendeckende Einführung der Gesundheitskarte würde den Zugang verbessern.

Household economic instability: Constructs, measurement, and implications

A growing body of research demonstrates the multiple dimensions and dynamism of family income and employment. The metrics of household economic instability and their associations with household characteristics and hardship require further examination in order to compare across studies, subgroups, and historical periods. This paper empirically examines and compares commonly used measures of income and employment instability, how these measures inter-relate, vary by household characteristics, and how they predict household hardship. Using longitudinal data from the 2008 panel of the Survey of Income and Program Participation (SIPP), and focusing on households with children, this study examined a range of descriptive measures of economic instability, including in income, earnings, public assistance benefits, and employment status, and how these measures related to each other. Results indicate that overall rates of income and employment instability were high, particularly among less-educated families, those with young children, and those who did not own a home. Economic instability, particularly decreases in employment, was associated with increased household hardship three months later. Findings also show that the source of income included in the instability measure affects the patterns identified and conclusions drawn, whereas the specific type of measure used matters less. Results highlight the instability of public assistance benefits and suggest that safety net programs must take economic instability into account when designing programs and benefits.

Aids and Brazilian social welfare: analysis of benefits granted in social security and social assistance, 2004-2016.

The study explores the distribution of AIDS through sociodemographic variables, within the scope of Brazilian social security and social assistance. Twenty-seven federal units were used for data spatialization and analysis. Data were stratified according to gender, age group, area of residence, social welfare membership, type of benefit received and grant method for the beneficiaries. Benefits were classified as social security (71,939, 72.4%), social assistance (26,302, 26.5%) and accident benefits (1,128, 1.1%), a large proportion of which were granted to males (64,654, 65.1%). The unemployed (50,404, 50.7%), who lived in urban areas (96,767, 97.4%), were aged between 20 and 39 years (49,508, 49.8%) and who received benefits based on article 27 of Decree Nº 3048/99 (51,985, 52.3%) were the most incident. The results show that more than half of the benefits granted were for unemployed individuals or those without job stability and, thus, did not contribute to social security for continuous periods. This fact reaffirms the segregation in the labor market to which these individuals are subjected. Also, it is noted that AIDS persists at high levels at the most productive stage of life.

Quality of Work Life of the Administrative Technical Servants in Education: Analysis of a Brazilian Federal University

The New Public Management has incorporating private business administration precepts that aim to optimize the public service provision. This model has done the stability of public office more flexible through performance evaluation. So the objective of this study was to know and to evaluate the Quality of Work Life perceptions of the administrative technical servants in education in a Brazilian Federal University. The target population was 540 activity administrative technical servants in education at the Federal University of São João del-Rei, Minas Gerais. Of the 176 respondents, 62.50% were married or in a stable relationship, 93.85% have at least completed Higher Education, totaling 168 individuals, what justify the health services, social assistance and extra benefits dissatisfied by the interviews because they need to support and afford personal and family health. Neutrality / dissatisfaction trends were found in the aspects like personal and professional development, task variety and growth opportunity. It happened because 92% of the respondents have a higher level of education than the job requirement. For the university, it is suggested to include measures to improve people management that involve working methods, autonomy in the execution of tasks, access to commissioned functions and greater participation in decisions regarding tasks.

Pelatihan Penyusunan Biaya Operasional Penyelenggaraan PAUD di Kelurahan Cisaranten Kidul Kecamatan Gedebage Kota Bandung

Early Childhood Education (PAUD) a kind of PAUD Unit (SPS) one of form of organization early which focuses on basic placement in the direction of physical growwth and development (fine and gross motor coordination), intelligence (power of thought, creativity, emotional intelligent, spiritual intelligent), socio emotional (attitudes and behavior and variety), language and communication, in accordance with the uniqueness and the stages of development that are traversed by the children. Meanwhile the high demans of teachers as a consequnce of the issueance of ministerial regulations empowering the state apparatus and bureaucratic reform (goverment regulations) number 16 year 2009 about funtional positions and creadit scoure. The approach method used to improve the quality of services provided by educators and education staff in carrying out early childhood education services is to provide training in the provision of PAUD in general. In addition to providing training the method used is mentoring, with this method after partners can feel the benefits of training assistance optimally, partners are also expected to carry out their duties proper. The target for the implementation of the paud organizer program is to provide assistance in preparing reports on government assistance through non-physical BOP grants (operational operational costs) for the paud can be optimally ranging from planning, preparation to management of PAUD management. Thus PAUD organizers can better understand and plan in managing early education institutions in their own environment so that ultimately it will improve the quality of education services.

The Effect of a Social License From the Community on Acceptance from the Community

The purpose of this study is to analyze the benefits of assistance to the communities around the mine and the negative influence that communities have received in influencing community trust in influencing their decision to accept the collection of mines that are operated in the middle of their homes. This research was conducted by direct interview with the interviewees. The research sample is 203 residents who live in the mine within a radius of 1 Km. The results of this study are the General Benefits of Mining, Infrastructure Benefits from Mining, Impacts on Other Industries, and Environmental Costs do not have a significant effect on Mining Revenues. In contrast, Labor and Community Benefits and Increased Living Costs are associated with the significance of Mining Revenues.

SNAP Schedules and Domestic Violence

AbstractThis paper exploits a policy change in Illinois that altered monthly nutritional assistance benefits dates to estimate the impact of in‐kind benefit receipt on domestic violence. We find that issuing SNAP benefits on days other than the first of the month increases domestic crimes. On average, we find the shifting benefit dates increases domestic abuse by 6.9 percent and child maltreatment by 30.0 percent. We posit that these effects are driven by increases in opportunities for conflict or changes in drug use.

Teoria racjonalnego tworzenia prawa a ustawodawstwo z zakresu pomocy społecznej. Uwagi na tle ustalania właściwości miejscowej gminy w sprawach przyznawania świadczeń z zakresu pomocy społecznej na rzecz osób bezdomnych

Przedmiot rozważań, prowadzonych w niniejszym artykule z punktu widzenia teorii ra-cjonalnego ustawodawcy, stanowi regulacja art. 101 ustawy z dnia 12 marca 2004 roku o pomocy społecznej odnosząca się do sposobów ustalania właściwości miejscowej gminy w sprawach doty-czących przyznawania świadczeń z tej ustawy na rzecz osób bezdomnych. O aktualności przyjętego tematu publikacji świadczy to, że problematyka nim objęta stanowi przedmiot zainteresowania przedstawicieli literatury i praktyki, organu administracji publicznej, jakim jest Rzecznik Praw Obywatelskich1, oraz jest przedmiotem licznych orzeczeń sądów administracyjnych. Regulacja ta zakłada pewnego rodzaju fikcję prawną mającą na celu zagwarantowanie osobom bezdomnym dostępu do świadczeń z zakresu pomocy społecznej2. Powoduje również pewne trudności na tle jej stosowania. Skutkują one między innymi powstawaniem sporów o właściwość między gmina-mi w sprawach dotyczących udzielania świadczeń osobom bezdomnym. Obowiązująca regulacja przekłada się na sytuację prawną osób bezdomnych ubiegających się o przyznanie im świadczenia z zakresu pomocy społecznej, gdy faktycznie przebywają one na terenie innej gminy niż gmina ich ostatniego miejsca zameldowania. W publikacji zastosowano metody teoretyczno-prawną oraz empiryczno-prawną.

Incarceration Exposure During Pregnancy and Infant Health: Moderation by Public Assistance

To assess the relationship between exposure to incarceration during pregnancy and adverse infant health outcomes: low birth weight (<2500g), very low birth weight (<1500g), preterm birth (<37weeks), and very preterm birth (≤33weeks), and to evaluate the moderating role of receiving public assistance benefits (Special Supplemental Nutrition Program for Women, Infants, and Children and Medicaid) during pregnancy in this process. The current study employs data from the Pregnancy Risk Assessment Monitoring System, 2009-2017. Logistic regression models were used to assess the association between incarceration of a woman or her partner in the year before birth, the receipt of public assistance during pregnancy, and postpartum infant health. Moderation analyses were conducted by interacting forms of public assistance and incarceration exposure. Exposure to incarceration either personally or vicariously through a partner increased all 4 adverse infant health outcomes. However, moderation analyses demonstrated that public assistance benefits and incarceration have a negative interaction, indicating that public assistance might buffer against the harmful effects of incarceration exposure during pregnancy on infant health. Incarceration exposure during pregnancy poses a significant risk for adverse infant health outcomes. However, the receipt of public assistance benefits including Special Supplemental Nutrition Program for Women, Infants, and Children and Medicaid may mitigate this risk. Expanded access to public assistance for women exposed to incarceration during pregnancy holds promise to improve infant health outcomes.

Studi Pendampingan Pengembangan Bahan Ajar Tematik Terintegrasi Literasi Baru dan Literasi Bencana Pada Guru IPA Kabupaten Agam

Literacy is required in the 4.0 industrial revolution and education in Indonesia. However, the real condition indicated that the integration of literacy in science learning of the science teachers was still limited. The solution of this problem is assisting the partner in writing science thematic learning material by integrating new literacy and disaster literacy. The objective of assisting is to improve competency of science teachers in writing thematic learning material. The target of the assisting activity was the teachers in science MGMP in Agam district. Methods in assisting include presentation and discussion, group work, independent task, and task presentation. Instruments to collect the data consist of knowledge test and questionnaire. Data analysis techniques were descriptive statistical analysis and paired comparison test. There are four results of the assistance, namely: 1). The average value of skills in integrating new literacy into thematic science worksheet is 70.5 and this average value can be classified into good category, 2). Teachers felt the benefits of assistance in aspects of learning material, thematic learning, integration of new literacy and disaster literacy in learning, and writing of thematic learning material, 3). The response of student from to the use of thematic science worksheet by integrating new literacy can be entered into very good category with an average value of 86.7, and 4). The implementation of assisting on the writing of thematic science learning material is effective to improve the new literacy and disaster literacy of science teachers.

Wybrane świadczenia w polskim systemie pomocy społecznej - próba analizy

Celem artykułu jest przedstawienie struktury wybranych świadczeń - pieniężnych lub niepieniężnych - w systemie pomocy społecznej oraz zidentyfikowanie kluczowych w Polsce trendów w tym obszarze w latach 2012-2018. Przeprowadzone na potrzeby artykułu analizy sygnalizują, że zapowiedź odejścia od transferów pieniężnych na rzecz świadczeń pozapieniężnych, aktywizacji społecznej czy zawodowej ma jedynie charakter deklaratywny.W analizowanym okresie wystąpił negatywny trend polegający na zwiększeniu się liczby odbiorców świadczeń realizowanych w formie pieniężnej przy spadku liczby osób objętych wsparciem w formie pozapieniężnej. Rosła także liczba świadczeń przyznawanych z powodu dysfunkcji zdrowotnych i niepełnosprawności, malała zaś liczba świadczeń z powodu bezrobocia i ubóstwa.Ponadto nastąpiło zwiększenie zatrudnienia w sektorze pomocy społecznej, ale przy jednoczesnym spadku zatrudnienia pracowników socjalnych.

Public Charge in the Time of Coronavirus

The United States government recently passed legislation and stabilization packages to respond to the COVID-19 (i.e., coronavirus disease 2019) outbreak by providing paid sick leave, tax credits, and free virus testing; expanding food assistance and unemployment benefits; and increasing Medicaid funding. However, the response to the global pandemic might be hindered by the lassitude of the state and the administration’s conception of social policy that leaves the most vulnerable unprotected. The administration’s “zero tolerance” immigration campaign poses public health challenges, especially in the prevention of communicable diseases. In addition to the systemic obstacles noncitizens face in their access to healthcare, recent changes to immigration law that penalize recipients of some social services on grounds that they are a public charge will further restrict their access to treatment and hinder the fight against the pandemic.

SOCIAL ASSISTANCE FOR THE ELDERLY

At the beginnings of the ’80 in Łódź voivodship number of persons receiving social assistance benefits doubled, and – as authors indicate – they were mostly elderly who do not receive any retirement pensions or receiving them at the minimal statutory level, what makes them extremely poor. Taking these facts as a starting point authors describe living conditions of the elderly from the age cohort 70–74

Is less more? Examining the relationship between food assistance benefit levels and childhood weight.

BackgroundThe Supplementary Nutrition Assistance Program (SNAP) is a critical lifeline for millions of low-income US families, but some studies suggests that it may inadvertently increase obesity risk. Building on research contesting the SNAP-obesity link, we examine the effect of SNAP participation on BMI among multiyear participants at varying levels of SNAP benefit levels to provide some of the first evidence on the relationship between SNAP participation, state-level SNAP resources, and body weight. We focus on children given the strong links between early-life obesity and later-life health.MethodsLinking state-level data on SNAP benefit levels with three waves of longitudinal individual-level data from the Child Development Supplement of the Panel Study of Income Dynamics, we use child- and state-level fixed effects to examine whether exogenous differences in SNAP benefit allotments influence the relationship between SNAP participation and weight gain.ResultsLower SNAP benefit levels were associated with only modest increases in BMI among children; higher benefit levels showed no association with BMI.ConclusionsAlthough concerns that more food assistance promotes obesity have spurred calls for cuts in the SNAP program, we find the opposite — that SNAP participation is associated with an increase in childhood BMI only when benefit levels are low. This study adds to the mounting evidence suggesting that SNAP does not cause obesity. It also contributes to the literature on the political economy of health, especially that pertaining to social policy variation across US states.