State Level Research Articles

State-level racial and ethnic disparities in buprenorphine treatment duration in the United States.

National trends reveal a concerning escalation in racial and ethnic disparities in buprenorphine treatment duration for opioid use disorder. However, the extent of such disparities at the state level remains largely unexplored. This study aims to examine such disparities at the state level. We analyzed 9,040,620 buprenorphine prescriptions dispensed between January 2011 and December 2020 from IQVIA Longitudinal Prescription data. The primary outcome was the difference in median treatment duration between White people and racial and ethnic minorities. We also included a second outcome measurement to quantify the difference in median treatment duration among episodes lasting ≥180 days. Using quantile regressions, we examined racial and ethnic disparities in treatment duration, adjusting for the patient's age, sex, payment type, and calendar year of the treatment episode. All analyses were conducted at the state level. Our study revealed substantial statewide variations in racial and ethnic disparities. Specifically, 21 states showed longer treatment durations for White people across all episodes, and eight states displayed similar trends among episodes lasting ≥180 days. Five states exhibited longer treatment durations for White people in both overall and long-term episodes. Fifteen states showed no racial and ethnic disparities. These results are among the first to indicate substantial statewide variations in racial and ethnic disparities in buprenorphine treatment episode duration, providing a critical foundation for targeted interventions to enhance buprenorphine treatment, especially in states confronting such pronounced racial and ethnic disparities.

Cannabis policy bundles and traffic fatalities in the American States over time.

Since 1996, 38 US states have legalized access to cannabis (medical and/or adult-use recreational). We aimed to estimate the effect of three dimensions of state cannabis policy design - pharmaceutical, permissive and fiscal - on levels of overall, alcohol-impaired, occupant, light truck and pedestrian fatality rates. Observational study of US states' overall, alcohol-impaired, occupant, light truck and pedestrian fatalities between 1994 and 2020. The unit of analysis was at the state level, consisting of 50 states and 27 years of time series data, resulting in a total of 1350 state-year observations. Fatality rates associated with alcohol-impaired, pedestrian, total occupant, passenger car and light truck fatality rates were obtained from the Fatality Analysis Reporting System of the National Highway Traffic Safety Administration and normalized per 10 billion vehicle miles traveled. State cannabis policies are measured in three bundles (scales): pharmaceutical, permissive and fiscal. The pharmaceutical bundle was associated with increases in all fatality rates [β = 0.145; 95% confidence interval (CI) = 0.116-0.173; P < 0.000]. The permissive bundle was associated with lower overall fatality rates (β = -0.319; 95% CI = -0.361 to -0.277; P < 0.000). The fiscal bundle was generally associated with higher fatality rates (β = 0.062; 95% CI = 0.043-0.081; P < 0.000), occupant (β = 0.070; 95% CI = 0.042-0.098; P < 0.000), light trucks (β = 0.049; 95% CI = 0.026-0.072; P < 0.000). US state cannabis regulations influence traffic safety. Greater permissiveness in US state cannabis regulations does not appear to correlate with traffic fatality rate increases, but greater medicalization and fiscal operation does.

Budgets and the timing, intensity, and composition of interest group lobbying in the U.S. states

This paper examines state level lobbying data to determine how budgeting affects the timing, intensity and composition of lobbying expenditures. Using a database of all available lobbying expenditures in the U.S. states ranging up to 25 years, the paper shows interest group lobbying increases substantially during the budgeting process, and the budgeting process is unlike other issues lobbyists face. Spikes in lobbying during budgeting are driven primarily by business groups, and these business groups account for most of the changes on the margin in lobbying activity. Moreover, even groups relatively unaffected by budgets lobby more intensely during legislative budgeting, consistent with the “Christmas tree” effect of appropriations and budget bills.

UN‐SDGs framework for child development in India: Evidence from a decentralized analysis

AbstractThis article develops a framework to analyze and to assess the United Nations Sustainable Development Goals (UN‐SDGs) related progress in child development in India, and to provide improved policy recommendations for sub‐national (state and district level) governments. District level analysis is based on a case study of Karnataka State (India). Status of India's children is described in global, national and sub‐national contexts. Child development is measured by 26 multi‐dimensional indicators comprising child health, nutrition, education, and protection and participation. Using the NITI Aayog's methodology of SDG India Index 2020–21, components' scores and composite index of child development are calculated and level of child development at national, state and district level is categorized by performer, front runner, achiever, and aspirant. Main results show that, both vertically and horizontally, low child development are related to poor performance of nutrition and education indicators in aspirational districts. However, focus on improving all 26 child development indicators is essential to reach the targets. The speed of convergence will be critical to reduce the time distance from now to 2030. Policy recommendations are focused to prioritize the public expenditure strategies in child budget for attainment of UN‐SDGs goals and targets by 2030, and to extend child budgeting to urban and rural local bodies. The empirical approach and policy recommendations are of relevance for other states in India, and applicable for countries elsewhere in the world.

Managing the transformation of foreign economic activity in an unstable macroeconomic environment

In modern conditions of chaoticization of the system of international economic relations and foreign economic activity of business entities, the tasks of improving the management of foreign economic activity of enterprises by the state and the formation of its embedded mechanisms to ensure the protection of state security in the world market are actualized. The purpose of the article is to analyze the topical issues of foreign economic activity transformation in the context of global instability. According to the author, in the system of state regulation of foreign economic activity of an enterprise, the implementation of an integrated foreign economic activity management system will be timely, which will significantly offset the problems existing in subjects of foreign economic activity related to external factors. However, it is impossible to quickly adjust to dynamically changing conditions and ensure management consistency, increase the efficiency of foreign economic activity of domestic enterprises and protect state economic security. The main goal of the transformation, according to the author, is to provide the necessary transparency and flexibility in the management system of foreign economic activity both at the state level and at the level of a specific subject of foreign economic activity, which is very important in the context of growing instability of the macroeconomic environment. Priorities in the context of growing global instability are to increase the efficiency of foreign economic activity, the competitiveness of the economy and the protection of economic security.

Implementation of the policy of technological sovereignty in China

The article analyzes the current policy of ensuring technological sovereignty in China in the context of growing global turbulence. For half a century, China has traditionally paid significant attention both to the country's innovative technological development and national independence at the state and public levels in this area. For that the state provides financing for leading breakthrough innovative and technological areas, contributes to the growth of demand for innovations in the national economy among legal entities and individuals, forms a self- developing institutional structure of the innovation ecosystem, creates conditions for personnel growth. Due to international cooperation and China's desire to enter the global innovation system for effective interaction at the global level, the country has significantly advanced in the world innovation rankings and achieved substantial results in a number of key technologies. At the same time, the Chinese leadership sets new long-term goals and forms appropriate plans for the development of the innovation sector in order to achieve new results implying the challenges that China faces in the technological sphere against the background of the trade war unleashed against the PRC by the United States and a number of other Western countries. The purpose of the article is to analyze the stages of China's innovative and technological development, as well as the results that the country has managed to achieve over a number of decades. The article shows that China has sufficient potential to ensure technological sovereignty in key technological areas based on a common high and dynamically developing economic situation, a capacious domestic market, significant financial opportunities – national and attracted – and international cooperation.

Act of Grace Payments and the Constitution

This article focuses on a hitherto underexplored but increasingly important area of public expenditure: act of grace payments. Act of grace payments are voluntary, highly discretionary gifts of money made by the executive in the absence of any legal duty to do so. The expenditure on such payments in Australia has been significant, and a lack of transparency creates serious risks to integrity. Further, the cases of Pape v Federal Commissioner of Taxation, Williams v Commonwealth and Williams v Commonwealth [No 2] have transformed the constitutional framework for public expenditure. Accordingly, this article conducts a fine-grained analysis of the constitutional legality of act of grace payments at the Commonwealth, state and territory levels. The authors argue that there are significant constitutional issues with act of grace payments at the Commonwealth level, and that many state-based act of grace payments are likely to be illegal. To address these issues, and to reduce the risk that payments will be made illegally, the authors recommend several legislative and soft law changes.

Are farmers’ minds really too elusive to capture? A novel evaluation framework for the knowledge transfer initiatives in agriculture

ABSTRACT Knowledge transfer initiatives aim to improve farmers’ knowledge and skills for tackling the growing economic, environmental and social challenges in agriculture. However, their evaluation is often inadequate due to institutional barriers and a lack of comprehensive methodology for assessing normative and behavioural shifts within this social group. To address this gap, we developed an extended evaluation framework for the knowledge transfer activities within the European Union's Common Agricultural Policy (CAP), including three indicators levels: output, result and impact. The indicators and survey instruments were based on the Theory of Planned Behaviour and piloted in a selected EU Member State for evaluating knowledge transfer measures in the programming period 2014–2022. The results indicate a promising potential of the proposed framework for capturing the multifaceted outcomes of knowledge transfer activities in agriculture. The usefulness and feasibility of the evaluation framework were further assessed through interviews with AKIS actors. They highlighted that evaluation activities at the Member State level may be hindered by inconsistent long-term data collection, insufficient response and involvement of farmers, deviations from the agreed protocols and a lack of dedicated resources. To ensure the uptake of the proposed evaluation framework, evaluation culture within the managing authorities and among stakeholders should be systematically fostered at the Member State level. This process can be enhanced by adopting a more elaborated CAP monitoring framework and methodology guidelines and by providing targeted training on evidence-driven policy-making.

Gender Stereotypes and Bias in Imagery Depiction of Textbooks prescribed by West Bengal Board of Primary Education, India

India is a diverse country. Ethnic, Linguistic, Racial, Gender, and Socio-Religious, etc. diversity is observed in India. Educational institutions play a vital role in socializing children and creating gender-friendly attitudes. Textbooks serve as a vehicle for social change. From childhood in school through textbooks and classroom experiences students embrace gender socialization, societal norms, and beliefs, gender roles, inequality, and bias. So, it is very important to make textbooks gender-neutral, to do this, textbook analysis is required. This study investigates the images used in textbooks of primary education in West Bengal, India, to examine gender stereotypes and bias. The study adopted qualitative and documentary research approaches through content analysis. The findings demonstrate that gender patriarchy and bias are reflected through visual imagery in textbooks. Images often lack representation of women and tend to portray them engaging in indoor tasks such as domestic and household work, or menial labor. Meanwhile, men are predominantly shown in outdoor, professional, and leadership roles, reinforcing gender disparities in identity and societal roles. There is a limited attempt to showcase gender neutrality, and there's minimal encouragement for gender reflection, hindering the development of sustainable perceptions of gender roles in Indian society. The findings of the study provide a foundation for policy changes at the state or national level to ensure the development and implementation of guidelines that promote gender-neutral content in educational materials and are useful for textbook development agencies, textbook writers, and teachers in developing a gender-sensitive curriculum, and textbooks.

Neuroendocrinology of bone.

The past decade has witnessed significant advances in our understanding of skeletal homeostasis and the mechanisms that mediate the loss of bone in primary and secondary osteoporosis. Recent breakthroughs have primarily emerged from identifying disease-causing mutations and phenocopying human bone disease in rodents. Notably, using genetically-modified rodent models, disrupting the reciprocal relationship with tropic pituitary hormone and effector hormones, we have learned that pituitary hormones have independent roles in skeletal physiology, beyond their effects exerted through target endocrine glands. The rise of follicle-stimulating hormone (FSH) in the late perimenopause may account, at least in part, for the rapid bone loss when estrogen is normal, while low thyroid-stimulating hormone (TSH) levels may contribute to the bone loss in thyrotoxicosis. Admittedly speculative, suppressed levels of adrenocorticotropic hormone (ACTH) may directly exacerbate bone loss in the setting of glucocorticoid-induced osteoporosis. Furthermore, beyond their established roles in reproduction and lactation, oxytocin and prolactin may affect intergenerational calcium transfer and therefore fetal skeletal mineralization, whereas elevated vasopressin levels in chronic hyponatremic states may increase the risk of bone loss.. Here, we discuss the interaction of each pituitary hormone in relation to its role in bone physiology and pathophysiology.

Finance and intergenerational mobility: Evidence from US banking reforms

We investigate the impact of US banking industry deregulation on intergenerational mobility. In order to do so, we use a quasi-natural experimental research design to investigate how a change in state level bank competition (following geographic deregulation) affects the intergenerational mobility of individuals born to (poorer) families at the lower end of the income distribution. We find that individuals born to poorer families who spend their first years as adults in an area with a more competitive banking system, experience higher mobility relative to counterparts located in areas characterised by lower levels of bank competition. Increased educational opportunities and entrepreneurship are important underlying factors driving the observed increases in intergenerational mobility.

State Abortion Policy and Moral Distress Among Clinicians Providing Abortion After the Dobbs Decision

Moral distress occurs when individuals feel powerless to do what they think is right, including when clinicians are prevented from providing health care they deem necessary. The loss of federal protections for abortion following the Dobbs v Jackson Women's Health Organization Supreme Court decision may place clinicians providing abortion at risk of experiencing moral distress, as many could face new legal and civil penalties for providing care in line with professional standards and that they perceive as necessary. To assess self-reported moral distress scores among abortion-providing clinicians following the Dobbs decision overall and by state-level abortion policy. This survey study, conducted from May to December 2023, included US abortion-providing clinicians (physicians, advanced practice clinicians, and nurses). A purposive electronic survey was disseminated nationally through professional listservs and snowball sampling. Abortion policy in each respondent's state of practice (restrictive vs protective using classifications from the Guttmacher Institute). Using descriptive statistics and unadjusted and adjusted negative binomial regression models, the association between self-reported moral distress on the Moral Distress Thermometer (MDT), a validated psychometric tool that scores moral distress from 0 (none) to 10 (worst possible), and state abortion policy was examined. Overall, 310 clinicians (271 [87.7%] women; mean [SD] age, 41.4 [9.7] years) completed 352 MDTs, with 206 responses (58.5%) from protective states and 146 (41.5%) from restrictive states. Reported moral distress scores ranged from 0 to 10 (median, 5) and were more than double for clinicians in restrictive compared with protective states (median, 8 [IQR, 6-9] vs 3 [IQR, 1-6]; P < .001). Respondents with higher moral distress scores included physicians compared with advanced practice clinicians (median, 6 [IQR, 3-8] vs 4 [IQR, 2-7]; P = .005), those practicing in free-standing abortion clinics compared with those practicing in hospitals (median, 6 [IQR, 3-8] vs 4 [IQR, 2-7]; P < .001), those no longer providing abortion care compared with those still providing abortion care (median, 8 [IQR, 4-9] vs 5 [IQR, 2-8]; P = .004), those practicing in loss states (states with the greatest decline in abortion volume since the Dobbs decision) compared with those in stable states (unadjusted incidence rate [IRR], 1.72 [95% CI, 1.55-1.92]; P < .001; adjusted IRR, 1.59 [95% CI, 1.40-1.79]; P < .001), and those practicing in surge states (states with the greatest increase in abortion volume since the Dobbs decision) compared with those in stable states (unadjusted IRR, 1.27 [95% CI, 1.11-1.46]; P < .001; adjusted IRR, 1.24 [95% CI, 1.09-1.41]; P = .001). In this purposive national survey study of clinicians providing abortion, moral distress was elevated among all clinicians and more than twice as high among those practicing in states that restrict abortion compared with those in states that protect abortion. The findings suggest that structural changes addressing bans on necessary health care, such as federal protections for abortion, are needed at institutional, state, and federal policy levels to combat widespread moral distress.

A case study of inclusion of rural populations in research: Implications for science and health equity.

Prior research highlights that rural populations have been historically underrepresented/excluded from clinical research. The primary objective of this study was to describe the inclusion of rural populations within our research enterprise using Clinical Research Management System demographic information at a large academic medical center in the Southeast. This was a cross-sectional study using participant demographic information for all protocols entered into our Clinical Research Management System between May 2018 and March 2021. Descriptive statistics were used to analyze the representation of rural and non-rural participants and demographic breakdown by age, sex, race, and ethnicity for our entire enterprise and at the state level. We also compared Material Community Deprivation Index levels between urban and rural participants. Results indicated that 19% of the research population was classified as rural and 81% as non-rural for our entire sample, and 17.5% rural and 82.5% urban for our state-level sample. There were significant differences in race, sex, and age between rural and non-rural participants and Material Community Deprivation Indices between rural and non-rural participants. Lessons learned and recommendations for increasing the inclusion of rural populations in research are discussed.

Islamist Government in Malaysia under PAS: Ideology, Policies, and Competition

ABSTRACT Dominant approaches to understanding Islamist politics tend to assume a uniform polity. Most notably, inclusion–moderation hypotheses presume Islamist parties are simply in or out: that the lure of office persuades radical Islamist groups to moderate their behaviour and ideologies to participate in elections. We suggest a different dynamic, in which an Islamist party adapts its mien and messaging to appeal simultaneously to heterogeneous audiences, without compromising its core positions. We find an exemplary case in Malaysia, where Parti Islam Se-Malaysia (Pan-Malaysian Islamic Party, PAS) contests both nationally and at the state level. At the federal level, PAS seeks support within a multi-ethnic, multi-religious polity, working in coalition with either secular, noncommunal parties, for whom an adamantly Islamist stance would be verboten, or Malay-ethnonationalist parties, for whom Islam is salient, but secondary. Meanwhile, PAS competes subnationally in its northeastern stronghold, where its confirmed Islamism confers strong advantage – but also in other states, with different approaches. Yet, across these stages, PAS sustains its underlying ideological consistency, especially on fraught social issues. We explore the extent to which electoral participation amid differing incentives reveals more a moderating effect on Islamist-party behaviour and ideology, or a capacity for strategic posturing.

Public health use and lessons learned from a statewide SARS-CoV-2 wastewater monitoring program (MiNET)

The global SARS-CoV-2 monitoring effort has been extensive, resulting in many states and countries establishing wastewater-based epidemiology programs to address the spread of the virus during the pandemic. Challenges for programs include concurrently optimizing methods, training new laboratories, and implementing successful surveillance programs that can rapidly translate results for public health, and policy making. Surveillance in Michigan early in the pandemic in 2020 highlights the importance of quality-controlled data and explores correlations with wastewater and clinical case data aggregated at the state level. The lessons learned and potential measures to improve public utilization of results are discussed.The Michigan Network for Environmental Health and Technology (MiNET) established a network of laboratories that partnered with local health departments, universities, wastewater treatment plants (WWTPs) and other stakeholders to monitor SARS-CoV-2 in wastewater at 214 sites in Michigan. MiNET consisted of nineteen laboratories, twenty-nine local health departments, 6 Native American tribes, and 60 WWTPs monitoring sites representing 45 % of Michigan's population from April 6 and December 29, 2020. Three result datasets were created based on quality control criteria. Wastewater results that met all quality assurance criteria (Dataset Mp) produced strongest correlations with reported clinical cases at 16 days lag (rho = 0.866, p < 0.05).The project demonstrated the ability to successfully track SARS-CoV-2 on a large, state-wide scale, particularly data that met the outlined quality criteria and provided an early warning of increasing COVID-19 cases. MiNET is currently poised to leverage its competency to complement public health surveillance networks through environmental monitoring for new and emerging pathogens of concern and provides a valuable resource to state and federal agencies to support future responses.

Regional ambassadors or state agents? Representing Welsh interests in the British Parliament and Cabinet

ABSTRACT Despite devolution, the United Kingdom possesses no mechanism to represent its four nations at the state level. Consequently, some peripheral actors use their state representative positions to ‘stand up’ for Wales, Scotland or Northern Ireland. This paper explores this paradox by focussing on the descriptive and substantive representation of Wales in the Commons and the Cabinet between 1945 and 2019. We demonstrate that only one-third of Welsh backbenchers still adopt a role of ‘regional ambassador’ and that Welsh ministers tend to adopt the role of ‘state agent’. This research ratifies the radical disconnection between central and sub-state politics since devolution.

Equitable Care for Children With a Tracheostomy: Addressing Challenges and Seeking Systemic Solutions.

Children with medical complexity (CMC) often face significant barriers to accessing care, obtaining appropriate insurance coverage for medical devices, technology, supplies, home nursingand social services. These challenges, when viewed through the lens of social determinants of health, highlight concerns about healthcare inequity. These inequities can impact CMC by limiting access to follow-up appointments, leading to disproportionate use of emergency department services, restricting support services, reducing the quality of medical productsand increasing the likelihood of adverse events. Addressing these concerns requires comprehensive policy changes at both state and federal levels. Achieving successful collaborations between states and federal agencies is particularly challenging and may take months or even years to accomplish. Through an exploratory qualitative approach, this study facilitates a nuanced inquiry into the experiences and systemic challenges encountered by medical professionals and primary caregivers managing CMC who require a paediatric tracheostomy. Qualitative interviews were conducted with 17 health professionals and primary caregivers residing in the United States. A thematic analysis was used to analyse the transcribed interview data. Using exploratory thematic analysis, we identified challenges and opportunities for improvement regarding (a) access to health insurance, (b) procurement of essential medical supplies, (c) logistical constraintsand (d) identifying interim solutions. Building on our findings, we discuss how socioecological factors impact health and quality of life of CMC and families. Additionally, we address the growing gap in quality of care through a comprehensive approach that considers patient needs, regulatory frameworksand affordability. Medical practitioners and healthcare professionals were actively involved in the development, productionand implementation of the research project. These individuals were given the opportunity to review their statements and review the manuscript before publishing. While caregivers did not engage in member checking, each provided their consent before data collection.

Climate change adaptation attributes across scales and inter-institutional networks: insights from national and state level water management institutions in India

Effective climate change adaptation requires cohesive inter-institutional networks across different scales, facilitating the sharing of data, information, knowledge, and practices. However, the impact of adaptation attributes across scales is poorly understood due to limited focus on these networks. Based on interviews with 26 institutions operating at the national level (ION) in India and 26 institutions operating within a state (Himachal Pradesh) (IOS), this study analysed adaptation attributes and the inter-institutional networks across the two scales to understand its implications at different scales. IONs have a greater capacity (compared to IOS) to frame guidelines, standards and regulations for practitioners along with better accessibility to resources and information. When coupled with bridging institutions, this can enhance adaptive capacities at other scales. Conversely, learnings from low regret adaptive measures being implemented by IOS are opportunities for informing national policy strategies. While national adaptation strategies and goals can inspire adaptation at lower scales, the currently fragmented inter-institutional network in India reduces the passage and accessibility of data and information, creating a bottleneck for the smooth devolution of adaptation attributes. Recruitment and deployment practices for water officials further entrench silo attitudes, impeding essential data accessibility. Adaptation needs comprehensive networks across vertical, horizontal, and diagonal institutional connections to improve climate risk perception and strategy implementation. Policy measures should consider socio-institutional factors beyond legislative prescriptions.

Survey of state animal health officials reveals lack of personnel and resources to manage equine infectious disease outbreaks.

The purpose of the study was to assess the challenges faced by state animal health officials (SAHOs) when managing equine disease outbreaks. A survey was conducted to assess SAHOs' collaboration with horse owners and practicing veterinarians to provide biosecurity and infection disease control. It was sent to 180 email addresses listed in the Equine Disease Communication Center website database. The responses in each category for each question were tabulated and reported as a percentage. There were 72 survey responses from 45 states. The number of states responding suggested that the results represent SAHOs' current opinions. Fifty percent of responders identified the lack of resources and training for equine health management and equine reportable disease prevention and control. There is a lack of owner compliance in managing disease outbreaks, and boarding stables, horse shows, and racing facilities require the most resources for outbreak management. The survey indicated on-site communication as the most effective for managing an outbreak, and the Equine Disease Communication Center is to be a valued resource for alerts and disease information. At the state level, there is a lack of needed personnel and resources to effectively manage an equine infectious disease outbreak. Furthermore, failure of veterinary and owner compliance in reporting and managing equine infectious diseases allows disease spread. Lack of sufficient resources for management of reportable diseases will potentially result in disease spread with a negative impact on horse health and the equine industry.

Advancing emigrants’ rights in India: strategies of civil society in spaces for engagement

ABSTRACT This article explores Indian civil society’s efforts to promote the rights of migrant Indian labourers working abroad in low-wage employment as a response to weakly institutionalized rights frameworks in the global and India's national governance of labour migration. Existing scholarship has explored civil societies’ advocacy in multi-national fora, at regional levels, and as forms of transnationally organized networks, but only marginally at the analytical level of migrant-origin states. The article examines their multi-level and multi-stakeholder strategies through the analytical lens of spaces for engagement. Drawing on original qualitative data, this article shows that civil society organizations play a leading role in (e)migration governance in India and are key to understanding the politics of migration of the world’s largest migrant-origin state. In particular, the local and subnational levels are important entry points to advance their agendas in the context of migrant-origin states.