National Conference Of State Legislatures Research Articles

Youth MH among key topics in 2025 legislative sessions

The National Conference of State Legislatures (NCSL) last week released a new report citing such legislative concerns for the new year as the health workforce and youth mental health, Medicaid, artificial intelligence and prescription drugs. All are key topics NCSL's policy experts anticipate will occupy state lawmakers' time in 2025 legislative sessions.

Analysis of Legal Verbiage in State Legislation for Insurer Coverage of Early Eyedrop Refills in the United States

State laws on early eyedrop refills, implemented to help patients obtain their medications when they run out early, have many inconsistencies possibly impacting their efficacy and functionality. This study sought to examine different state laws and elucidate unique features and commonalities that may influence their effectiveness. A review of all state legislation to date regarding early eyedrop refills was performed. All 50 states were included, with an in-depth review of the 33 states that had early eyedrop refill legislation. The law database Nexis Uni (formerly LexisNexis) and each state's individual law code site were used to identify relevant laws (or proposed legislation) using keywords such as "eyedrop," "eye," "refill," and "early." Political data based on the year these laws were passed was obtained from the National Governor's Association and National Conference of State Legislatures. This data was aggregated and analyzed using descriptive statistics. State law wording was analyzed for percentage of dosage period passed, days passed, and other requirements. Of the 33 states with early eyedrop refill laws, 14 were only days based, 8 were only percentage based, 4 had both, 4 had neither percentage nor days criteria, and 3 had neither but cited CMS guidelines. These laws were passed between 2009-2023, with a notable increase from 2014-2018, rising from 10 to 29 states. Regionally, the Northeast had the highest adoption rate (88%), followed by the West (77%), the South (56%), and the Midwest (50%). Political climates varied: 14 states had Republican control, 2 had Democratic control, and 17 had mixed party control. Of the 17 states without an early eyedrop refill law 4 attempted passage but were not put into law for various reasons with the other 13 not appearing to have had any attempts at law passage. State laws providing coverage for early eyedrop refills vary in terms of verbiage and requirements necessary to obtain a covered early eyedrop refill. Region, political climate, and year appear to play minor roles in early eyedrop refill verbiage and passage.

Variability in youth coach concussion education requirements across states.

Youth sports coaches play a critical role in proper concussion recognition and management, reinforcing the need for coach concussion education. As of 2021, most states have statutory and policy measures mandating concussion education for coaches. In practice, these mandates have been enacted through state legislatures and their respective youth sport governing bodies. Prior studies have found significant variations in the contents of state-level concussion risk reduction policies and have raised questions about their specificity. To expand on previous analyses to provide an overview of youth sports coach concussion education, highlighting variations in state policies and discrepancies between state mandates and youth sport governing bodies. This report utilized qualitative content analysis to characterize and compare U.S. state and governing body concussion education requirements for youth sport coaches. State concussion statutes were identified via the National Conference of State Legislatures and Open States databases, and governing body handbooks/bylaws were obtained via their websites. Two researchers independently coded the policies, and discrepancies were resolved through consensus meetings with additional youth traumatic brain injury experts. We found significant variability in educational requirements and their implementation. A majority (68%; n = 34) of states require the completion of concussion education training for coaches. Notably, many states designate responsibility for enforcement and implementation of provisions to another party but just four state statutes delineate explicit consequences for noncompliance. Additionally, only 12 state statutes extend mandates to noninterscholastic sports, limiting their reach. In most cases, independent sanctioning authorities implement more stringent policies than the minimum acceptable standard established by state law. Our findings provide a coded data set of youth coach concussion laws and independent sanctioning authority guidelines that can be used in future research efforts. Further research investigating a relationship between the strength of coach concussion education policies and relevant youth and adolescent concussion-related metrics is required.

Oral cancer drug repositories: Challenges and solutions.

11063 Background: Frequent drug shortages and high out-of-pocket costs due to inadequate and unaffordable insurance coverage hinder access to oral chemotherapy. Amidst this, oral cancer drugs estimated a mean of $4290/patient are wasted due to dose modification, discontinuation or death[Lam M. et al, JAMA Oncol. 2023;9(9):1238-1244]. To combat this discrepancy, multiple states have passed laws establishing drug repositories that collect unused oral cancer medications and redistribute them to patients in need. ASCO has also endorsed these programs, even advocating for open distribution systems allowing donations from individuals. Methods: We analysed statewise cancer drug repositories(source:National Conference of State Legislatures) and communicated with representatives from programs including SIRUM, RemediChain and I-DROP Coalition. We used a mixed methods approach to examine the breadth and functioning of these programs. Results: 28 out of the 44 states with laws establishing prescription drug repositories operate state-run drug recycling programs (Updated September 2023). However, only 14 states (California, Florida, Iowa, Michigan, Minnesota, Montana, Nebraska, Nevada, Ohio, Pennsylvania, Tennessee, Utah, Washington and Wisconsin) have provisions for donation of cancer medications, or for creation of separate cancer drug repositories. Other nonprofits like RemediChain and SIRUM function at a national level, covering 47 states and Washington D.C. between them. Conversations with 3 such programs revealed multiple obstacles that limit the effectiveness of drug recycling. All 3 programs reported inadequate donations, ranging from 2-3 donations/month in a state level program (I-DROP) to 1-10 donations/day in a larger national level program (RemediChain). 3/3 programs received more donations of unused pills from patients or their families than from pharmacies/health facilities. All 3 surveyed programs reported limited and inconsistent supply of donated drugs; expiration of drugs before redistribution; lack of demand for specialty drugs and unavailability of common oncology drugs that patients request since these drugs are less likely to go unused. All surveyed programs mentioned struggling with funding and staffing. Notably, all 3 repositories stressed that informing patients about recycling options right at the beginning of treatment was crucial to improve donation rates; and that expanding repository donor and recipient coverage could increase the chances of successfully redistributing drugs. Conclusions: Improving awareness amongst providers and patients, campaigning for federal funding and increasing the scale of coverage by expanding repository programs to all states and allowing interstate transfer of drugs could address current challenges to drug recycling. This would limit wastage of expensive medication while reducing financial burden on patients and improving access to life saving treatment.

Association Between Partisan Affiliation of State Governments and State Mortality Rates Before and During the COVID-19 Pandemic.

Increasing polarization of states reached a high point during the COVID-19 pandemic, when the party affiliation of elected officials often predicted their policy response. The health consequences of these divisions are unclear. Prior studies compared mortality rates based on presidential voting patterns, but few considered the partisan orientation of state officials. This study examined whether the partisan orientation of governors or legislatures was associated with mortality outcomes during the COVID-19 pandemic. Data on deaths and the partisan orientation of governors and legislators were obtained from the Centers for Disease Control and Prevention and the National Conference of State Legislatures, respectively. Linear regression was used to measure the association between Republican representation (percentage of seats held) in legislatures and (1) age-adjusted, all-cause mortality rates (AAMRs) in 2015-2021 and (2) excess death rates during three phases of the COVID-19 pandemic, controlling for median household income, the prevalence of four risk factors (obesity, chronic obstructive pulmonary disease, heart attack, stroke), and state policy orientation. Associations between excess death rates and the governor's party were also examined. States with Republican governors or greater Republican representation in legislatures experienced higher AAMRs during 2015-2021, lower excess death rates during Phase 1 of the COVID-19 pandemic (weeks ending March 28, 2020, through June 13, 2020), and higher excess death rates in Phases 2 and 3 (weeks ending June 20, 2020, through April 30, 2022; p < 0.05). Most associations lost statistical significance after adjustment for control variables. Mortality was higher in states with Republican governors and greater Republican legislative representation before and during much of the pandemic. Observed associations could be explained by the adverse effects of policy choices, reverse causality (e.g., popularity of Republican candidates in states with lower socioeconomic and health status), or unmeasured factors that predominate in states with Republican leaders.

Human trafficking: What the pediatric nurse needs to know

Healthcare providers are in a unique position to recognize children who are at risk for human trafficking. Research shows that most trafficking victims have seen a healthcare professional at some point during their exploitation. This places healthcare providers in the position to recognize that something is wrong and take steps to provide support ( Administration for Strategic Preparedness and Response, 2023 Administration for Strategic Preparedness and Response Human trafficking and health professionals: Questions and answers. Public Health Emergency, 2023https://www.phe.gov/Preparedness/planning/abc/Pages/human-trafficking-faqs.aspx Google Scholar ; National Human Trafficking Resource Center, 2023 National Human Trafficking Resource Center Recognizing and responding to human trafficking in a healthcare context. https://humantraffickinghotline.org/sites/default/files/Recognizing%20and%20Responding%20to%20Human%20Trafficking%20in%20a%20Healthcare%20Context_pdf.pdfDate: 2023 Google Scholar ; Waugh, 2018 Waugh L. Human trafficking and the healthcare system. National Conference of State Legislatures, 2018, Aprilhttps://www.ncsl.org/research/health/human-trafficking-and-the-health-care-system.aspx Google Scholar ). Pediatric nurses in healthcare and community settings should have the knowledge necessary to recognize and report potential trafficking victims. This includes a general understanding of human trafficking, awareness of risk factors, assessment skills to recognize, resources to report, and education to help prevent trafficking.

Restrictions during the Intermediate Licensing Phase: A Content Analysis

Introduction: This study analyzed the content of intermediate licensing restrictions of all 50 US states and examined the variation in strictness and language of four restriction categories: minimum age, nighttime driving restrictions, passenger restrictions, and traffic violation penalties.&#x0D; Methods: We analyzed state intermediate licensing restrictions using data from four online sources (AAA Guide to Teen Driver Safety, National Conference of State Legislatures, Teen Driving Laws, and Insurance Institute for Highway Safety). Two trained coders independently coded the content of the restrictions, identified four restricted categories and subthemes for each category, and scored each subtheme from 0 to 2, with a higher score indicating a stricter restriction. Direct quotes from state laws were identified to support each subtheme.&#x0D; Results: All 50 states included a minimum age for obtaining an intermediate license. Of 50 states, 49 (98.0%) contained nighttime driving restrictions, 46 (92.0%) contained passenger restrictions, and 43 (86.0%) included traffic violation penalties. Variations existed in the minimum age for an intermediate license and length required in the learner permit phase, the starting time and length of the nighttime driving restrictions, the number and age of passengers in passenger restrictions, the minimum time the driver needs to be violation-free before obtaining a full license, and the type and severity of traffic violation penalties.&#x0D; Conclusions: Although all states have intermediate licensing restrictions, variations exist in the strictness and language of these restrictions. Future research should assess how these variations impact driving safety among teens when they first start driving unsupervised.

Digital Literacy Skill Levels of Teacher Candidates

Aşıcı, M. (2009). Literacy as a personal and social value. Journal of Values Education, 7(17), 9-26.Akgün, İ. H., Akgün, M. (2020). Analysis of digital literacy levels of social studies candidates. Journal of Ahi Evran University Kirsehir Education Faculty, 21(2), 1-19.Aksoy, N.C., Karabay, E. Aksoy, E. (2021). Analysis of digital literacy levels of classroom teachers. Selcuk University Journal of Communication, 14(2), 859-894. doi: 10.18094/JOSC.871290Altun, N., Alpan, G. B. (2021). Digital literacy in basic education programs. Journal of Education and Social Studies, 8(2), 280-294. DOI: 10.51725/etad.971177Arslan, S. (2019). Analysis of Digital Literacy Levels of Primary School and Middle-School Teachers in terms of Various Variables. Published master’s thesis. Sakarya University, Educational Sciences Institution.Aydemir, Z., Sakız, G., Doğan, M.C. (2019). Development of digital literacy skills rubric at the primary school level. National Education, 48(1), 617-638.Balay, R. (2004). Globalization, information society and education, Journal of Ankara University Faculty of Educational Sciences, 37(2), 61-82.Bay, D. N. (2021). Digital literacy levels of pre-school teacher candidates. Journal of Mustafa Kemal University Faculty of Education, 5(7), 72-187.Büyüköztürk, Ş. (2016). Scientific Research Techniques. Pegem Akademi Publications.Büyüköztürk, Ş., Çakmak, K. E., Akgün, E. Ö., Karadeniz, Ş., Demirel, F. (2010). Scientific Research Techniques. Pegem Publications.Deye, S. (2015). Promoting digital literacy among students and educators. National Conference Of State Legislatures. Retrieved from https://www.ncsl.org/Portals/1/Documents/educ/digLiteracy_final.pdfDirekçi, B., Akbulut, S., Şimşek, S. (2019). Analysis of Turkish lesson curriculum (2018) and middle-school Turkish textbooks in terms of digital literacy skills. Eurasian Journal of International Studies, 7(16), 797-813.Doğan, D. (2020). The perceptions of university students of their own digital literacy. Journal of Technology Applications in Education, 1(1), 26-35. https://doi.org/10.29329/jtae.2020.283.2.Duggan, F. (2013). Why Universities Should Acquire And Teach Digital Literacy. The Guardian. https://www.theguardian.com/education/2013/apr/23/universities-should-teach-digital-literacy. Access date: 14/04/2022Duran, E., Ertan Özen N. (2018). Digital literacy in Turkish lessons. Turkish Journal of Education, 3(2), 31-46.Eshet, Y. (2004). Digital literacy: A conceptual frame work for survival skills in the Digital era. Journal of Educational Multimedia and Hypermedia, 13(1), 93-106.Fraenkel, J. R., Wallen, N.E. (2006). How to design and evaluate research in education. McGraw-Hill International Edition.Göldağ, B. (2021). Analysis of the relationship between university students’ digital literacy levels and awareness levels of digital data security. E-international journal of educational research, 12(3), 82-100.Hamutoğlu, N. B., Canan Güngören, Ö., Kaya Uyanık, G., Gür Erdoğan, D. (2017). Digital literacy scale: Study on its adaptation to Turkish. Aegean Journal of Education, 18(1), 408- 429.Karabacak, Z. İ., Sezgin, A. A. (2019). Digital transformation and digital literacy in Turkey. Turkish Journal of Administration, 488, 319-343.Karasar, N. (2011). Scientific research methods. Nobel Publications.Kazu, İ. Y., Erten, P. (2014). Digital competency levels of teacher candidates. Bartın University Journal of Education Faculty, 3(2), 132-152.Korkmaz, M. (2020). Identification of the digital literacy levels of classroom teachers [Published master’s thesis]. Eskişehir Osmangazi University, Educational Sciences Institute.

Confronting implicit bias toward patients: a scoping review of post-graduate physician curricula

BackgroundPhysicians’ behavior may unknowingly be impacted by prejudice and thereby contribute to healthcare inequities. Despite increasingly robust data demonstrating physician implicit bias (The Office of Minority Health. Minority Population Profiles, 2021; COVID-19 Shines Light on Health Disparities, National Conference of State Legislatures 2021), the evidence behind how to change this with training programs remains unclear. This scoping review therefore reports on the implementation, outcomes, and characteristics of post-graduate physician implicit bias curricula.MethodsThe authors conducted a literature review using scoping review methodology. They searched 7 databases in February and November 2020 for English-language academic and gray literature on implicit bias curricula for physicians at all levels of post-graduate training. Ten reviewers screened studies for eligibility independently, then extracted data from these studies and compiled it into a chart and analytical summary.ResultsOf the 4,599 articles screened, this review identified 90 articles on implicit bias interventions for post-graduate physicians. Inductive data analysis revealed a spectrum of educational approaches, which were categorized int o 4 educational models called Competence, Skills-Based, Social Contact, and Critical Models. The most commonly reported strength was the interactive nature of the curricula (26%), and the most frequently identified challenges were related to time and resources available (53%). Half of the interventions discussed facilitator preparation, and the majority (62%) evaluated outcomes using pre and post self-assessments.ConclusionsThis review provides a comprehensive synthesis of the literature on physician implicit bias curricula. It is our goal that this supports medical educators in applying and improving aspects of these interventions in their own programs.

The Explosive Growth of Telehealth Throughout the COVID-19 Pandemic and Beyond

The Explosive Growth of Telehealth Throughout the COVID-19 Pandemic and Beyond

The Gender Wage Gap as it Relates to State Partisan Control and Pay Equity Policy

This study offers an explanation to the interstate variation of the gender wage gap in the United States. Looking at political explanations as an answer for the wage gap’s persistence, I hypothesize that Democratically controlled state government positively impacts the state having pay equity policies, and that having these pay equity policies positively impacts the state’s gender wage gap. Using U.S. Census Bureau, National Conference of State Legislatures, and American Association of University Women with U.S. Department of Labor Women’s Bureau data, I find that while there is a correlation between Democratically controlled state legislatures and pay equity policy and a correlation between Democratic majority legislatures and a narrower gender wage gap, there does not appear to be a direct association between pay equity policy and the state’s gender wage gap. The findings suggest that partisanship of the state legislature plays a key role in the wage equity policy of a state, as well as the reasoning that longstanding Democratic majorities have already passed policy to combat the apparent causes of the gap, and that more in depth policy is thus necessary to completely close it.

ASA Promotes Patient Safety at 2021 NCSL Legislative Summit

State Beat| February 2022 ASA Promotes Patient Safety at 2021 NCSL Legislative Summit Jason Hansen, MS, JD Jason Hansen, MS, JD Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor February 2022, Vol. 86, 29. https://doi.org/10.1097/01.ASM.0000820420.71787.6b Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share MailTo Twitter LinkedIn Cite Icon Cite Get Permissions Search Site Citation Jason Hansen; ASA Promotes Patient Safety at 2021 NCSL Legislative Summit. ASA Monitor 2022; 86:29 doi: https://doi.org/10.1097/01.ASM.0000820420.71787.6b Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search In early November 2021, ASA State Affairs represented the society at the National Conference of State Legislatures (NCSL) 46th annual Legislative Summit in Tampa, Florida. For more than 15 years, ASA has participated as an exhibitor at this important gathering of state lawmakers. Jay Epstein, MD, FASA, Chair of the ASA Task Force on State Advocacy, joined State Affairs staff in interacting with state legislators and legislative staff at the exhibit booth. ASA represented physician anesthesiologists as part of a larger joint physician booth called “Physicians Advocating for Patients.” This booth included representatives of the American Academy of Anesthesiologist Assistants, American Society for Dermatologic Surgery, American Academy of Dermatology, American College of Surgeons, and the Federation of State Medical Boards. NCSL has become one of the largest bipartisan organizations of state lawmakers in the country. It serves state lawmakers and legislative staff throughout the U.S. with policy research and... You do not currently have access to this content.

Popularity of Delta-8 THC on the Internet Across US States, 2021.

Objectives. To assess the popularity of an emergent drug, delta-8 tetrahydrocannabinol (THC), and compare interest levels between US states with or without legalized recreational cannabis. Methods. We used Google Trends to assess the growth of interest among delta-8 THC-related search terms from May 17, 2020, to May 9, 2021. We examined differences between states with or without legalized cannabis using state-level Google Trends data from February 13 to May 13, 2021, and policy data from the National Conference of State Legislatures. Results. Interest in delta-8 THC increased starting in mid-June 2020, with search volumes for delta-8 THC queries currently at 35% of the "marijuana" query. States where recreational cannabis is illegal had higher relative queries than did states with legalized recreational cannabis (52.3 vs 14.8; t = 40.9; P < .001). Conclusions. There has been rapid growth in interest in delta-8 THC. Findings between state policy contexts likely indicate delta-8 THC's role as a substitute good for delta-9 THC. Public Health Implications. Digital signals such as search volumes may point to an emergent use trend in the substance delta-8 THC. Further studies are needed to assess potential harms and correlates of delta-8 THC use. (Am J Public Health. 2022;112(2):296-299. https://doi.org/10.2105/AJPH.2021.306586).

Preliminary findings on TBI knowledge of professionals working with justice-involved youth

Professionals working with justice-involved youth (JIYs) play a critical role in identifying and providing supports and services related to traumatic brain injury (TBI). The aim of this study was to better understand the knowledge of TBI of professionals working with JIYs, a research priority identified by the National Conference of State Legislatures. Fifty employees of an urban juvenile court system completed an online survey about their TBI knowledge. Respondents scored an average of 77.31% correct, yet patterns emerged in item responses and based on participant characteristics that indicate opportunities for training and education on TBI. The results of this preliminary study provide foundational evidence on TBI knowledge of professionals working with JIYs, inform future TBI-related trainings and education provided to professionals working with JIYs, and inform other practices and policies related to JIYs with TBI.

Bang for the buck: The impact of political financial contributions on firearm law.

One hundred thousand Americans are shot annually, and 39,000 die. State laws restricting firearm sales and use have been shown to decrease firearm deaths, yet little is known about what impacts their passage or repeal. We hypothesized that spending by groups that favor firearm restrictive legislation would increase new state firearm restrictive laws (FRLs) and that states increasing these laws would endure fewer firearm deaths. We acquired 2013 to 2018 state data on spending by groups against firearm restrictive legislation and for firearm restrictive legislation regarding lobbying, campaign, and independent and total expenditures from the National Institute on Money in State Politics. State-level political party representation data were acquired from the National Conference of State Legislatures. Mass shooting data were obtained from the Mass Shooter Database of the Violence Project, and firearm death rates were obtained from Centers for Disease Control Wide-ranging Online Data for Epidemiologic Research and Federal Bureau of Investigation Uniform Crime Reporting databases. Firearm restrictive laws were obtained from the State Firearms Law Database. A univariate panel linear regression with fixed effect for state was performed with change in FRLs from baseline as the outcome. A final multivariable panel regression with fixed effect for state was then used. Firearm death rates were compared by whether states increased, decreased, or had no change in FRLs. Twenty-two states gained and 13 lost FRLs, while 15 states had no net change (44%, 26%, and 30%; p = 0.484). In multivariable regression accounting for partisan control of state government, for-firearm restrictive legislation groups outspending against-firearm restrictive legislation groups had the largest association with increased FRLs (β = 1.420; 95% confidence interval, 0.63-2.21; p < 0.001). States that gained FRLs had significantly lower firearm death rates (p < 0.001). Relative to states with no change in FRLs, states that lost FRLs had an increase in overall firearm death of 1 per 100,000 individuals. States that gained FRLs had a net decrease in median overall firearm death of 0.5 per 100,000 individuals. Higher political spending by groups in favor of restrictive firearm legislation has a powerful association with increasing and maintaining FRLs. States that increased their FRLs, in turn, showed lower firearm death rates. Epidemiological, level I.

State Vaccine Mandates for COVID-19 – An Emerging Disparity between Childcare Providers and School Teachers

INTRODUCTION: On December 22, 2020, the Advisory Committee on Immunization Practices (ACIP) issued guidelines for the allocation of the coronavirus disease-2019 (COVID-19) vaccine. Childcare providers and K-12 school teachers, as designated ‘frontline essential workers,’ were recommended for early vaccination. Despite ACIP recommendations, some states chose only to prioritize school teachers, sending the message that childcare providers’ occupational risk was less than that of school teachers and other frontline essential workers. More recently, on August 11, 2021, California became the first state to require COVID-19 vaccination of school teachers, but excluded childcare providers. To better understand this emerging disparity, we characterize state vaccine mandates for childcare providers versus school teachers.METHODS: To determine which states had issued legislative and/or regulatory directives requiring vaccination of childcare and/or school personnel (as of November 1, 2021), we reviewed official archives of executive orders for all 50 states and the District of Columbia (DC) and COVID-19 state databases maintained by the National Conference of State Legislatures and the National Academy for State Health Policy. For each state with legislative or regulatory directives, we collected information on issue date and compliance deadline, type (e.g., executive order, public health order), issuer (e.g., governor, public health officer), availability of vaccine exemptions and testing alternatives, and acceptable proofs of vaccination.RESULTS: Ten states (including DC) had issued executive-branch directives requiring either COVID-19 vaccination or routine testing for school teachers, of which only five included childcare providers (no states had issued directives for childcare providers alone). No states had passed legislation requiring COVID-19 vaccination. Three states required COVID-19 vaccination without a routine testing alternative; six states allowed for both vaccination and routine testing to fulfill the directive’s requirement; and one state (New York) required routine testing with opt out vaccination for those who objected. Five states did not specify any exemptions to vaccination, with the rest allowing medical and/or religious belief exemptions and none allowing personal belief exemptions. All states required formal proof of vaccination either in the form of an attestation from a healthcare provider, a signed CDC vaccination card, and/or a record from a state immunization registry; no states allowed for personal attestation to support receipt of vaccination. The results can be found summarized in the table. CONCLUSION: While ten states (including DC) have issued directives requiring either COVID-19 vaccination or routine testing among school teachers, only half include childcare providers. This emerging trend suggests an unwarranted disparity between childcare and school settings in states’ efforts to promote vaccination, as the argument in favor of vaccinating the former is at least as strong as that of the latter for several reasons. First, both staff and children in childcare programs may be at higher risk for contracting COVID-19 than those in schools, given the congregation of infants and young children who are both ineligible for vaccination and possibly less effectively adherent to nonpharmaceutical interventions (e.g., masking, social distancing, handwashing). Second, childcare providers have a lower COVID-19 vaccine uptake compared to school teachers (78% versus 90% as of late Spring 2021). Finally, childcare providers skew more heavily minority, and therefore may be at greater risk for COVID-19-related morbidity and mortality (17.3 and 19.3 percent of childcare personnel are Black and Hispanic versus 12.1 and 13.0 percent of school personnel, respectively). To ensure equitable consideration for the health and safety of childcare providers and school teachers alike, states should consider expanding directives to include childcare providers—as has been done by both New Jersey and Illinois—to bridge the COVID-19 vaccination gap between childcare providers and school teachers.

Why Employment During and After COVID-19 Is a Critical Women's Health Issue.

Why Employment During and After COVID-19 Is a Critical Women's Health Issue.

Generosity of state insurance mandates and growth in the workforce for autism spectrum disorder.

To improve access to health services for children with autism spectrum disorder, US states have passed laws requiring health insurers to cover autism-related care, commonly known as state insurance mandates. However, the features of mandates differ across states, with some state laws containing very generous provisions and others containing very restrictive provisions such as whether the mandates include children aged above 12 years, whether there is a limit on spending, and whether there are restrictions on the types of services covered. This study examined the relationship between generosity of mandates and growth in the health workforce between 2003 and 2017, a period during which 44 states passed mandates. We found that states that enacted more generous mandates experienced significantly more growth in board-certified behavioral analysts who provide behavioral therapy as well as more growth in child psychiatrists. We did not find differences in the growth of pediatricians, which is a less specialized segment of the workforce. Our findings were consistent across eight different mandate features and suggest that the content of legislation may be as important as whether or not legislation has been passed in terms of encouraging growth in the supply of services for children with autism spectrum disorder.

Extending a Hand in Perilous Times: Beneficial Immigration Policy in the Fifty States, 2005–2012

ObjectiveThe passage of Arizona SB 1070 in 2010 focused national attention on punitive, state‐level immigration legislation. Largely ignored is the increasing number of beneficial, state‐level policies passed during the same period. We seek to understand whether beneficial immigration policy making amounts to reversing the factors underlying punitive immigration policy making, as is implied by current literature.MethodsWe utilize data from the National Conference of State Legislatures from 2005 to 2012 to uncover the puzzling enactment of beneficial state immigration laws during a period of high anti‐immigrant sentiment and budgetary declines in the 50 states.ResultsBeneficial immigration policy making is not a reversal of the process that underlines punitive immigration policy making and is particularly responsive to the need generated by immigrant population size, regardless of the documentation status of the beneficiary.ConclusionThe passage of beneficial immigration policies requires further analysis, as it is not as simple as reversing the process that produces punitive immigration policies.

State Insurance Mandates and the Workforce for Children With Autism.

State mandates have required insurance companies to provide coverage for autism-related child health care services; however, it has not been determined if insurance mandates have improved the supply of child health care providers. We investigate the effect of state insurance mandates on the supply of child psychiatrists, pediatricians, and board-certified behavioral analysts (BCBAs). We used data from the National Conference of State Legislatures and Health Resources and Services Administration's Area Health Resource Files to examine child psychiatrists, pediatricians, and BCBAs in all 50 states from 2003 to 2017. Fixed-effects regression models compared change in workforce density before versus one year after mandate implementation and the effect of mandate generosity across 44 US states implementing mandates between 2003 and 2017. From 2003 to 2017, child psychiatrists increased from 7.40 to 10.03 per 100 000 children, pediatricians from 62.35 to 68.86, and BCBAs from 1.34 to 29.88. Mandate introduction was associated with an additional increase of 0.77 BCBAs per 100 000 children (95% confidence interval [CI]: 0.18 to 1.42) one year after mandate enactment. Mandate introduction was also associated with a more modest increase among child psychiatrists (95% CI: 0.10 to 0.91) and was not associated with the prevalence of pediatricians (95% CI: -0.76 to 1.13). We also found evidence that more generous mandate benefits were associated with larger effects on workforce supply. State insurance mandates were associated with an ∼16% increase in BCBAs from 2003 to 2017, but the association with child psychiatrists was smaller and nonsignificant among pediatricians. In these findings, it is suggested that policies are needed that specifically address workforce constraints in the provision of services for children with autism spectrum disorder.