State-level Public Policy Research Articles

A Validation and Extension of State-Level Public Policy Mood: 1956–2020

AbstractTo fully understand state policy outcomes or elections in the US, we need valid over-time measures of state-level public opinion. We contribute to the research on measuring state public opinion in two ways. First, we respond to Berry, Fording, Hanson, and Crofoot’s (BFHC) critique of Enns and Koch’s measure of state policy mood. We show that when BFHC’s analysis is performed using the same states and examining annual change, it validates the Enns and Koch measure and raises questions about the Berry, Ringquist, Fording, and Hanson measure. Second, we generate a new measure of state policy mood building on Enns and Koch’s approach. The new measure has even better properties than the previous measure and relates to state presidential vote and state policy liberalism in similar ways to Caughey and Warshaw’s measure of state economic liberalism. We conclude with recommendations for using the various direct measures of state public opinion.

Comparative Analysis of State Level Health Policy Support for Opioid Abuse Mitigation in Rural America

In rural America, opioid use disorder (OUD) continues to adversely impacted familial, public, and economic systems, creating extraordinary societal and financial burden. This comparative analysis of state-level public health policy and practices in rural opioid use abatement promotes the development and implementation of contextualized evidence-based comprehensive policy initiatives. Policy analysis across select highly affected states (Indiana, Kansas, Kentucky, and West Virginia) and exemplar OUD policy response states (Colorado, Massachusetts, Ohio, and Vermont) was performed using a systematic review of literature, legislation, plans, and policies. Findings included close alignment between states’ OUD policies and public health best practice standards; minimized differences between exemplar and highly affected states policy responses; and resource driven gaps in opioid epidemic legislation, regulation, guidelines, strategic plans, and initiatives. Furthermore, it is advocated that public and private stakeholders committed to health equity must seek reductions in opioid related disease and mortality through increased resource allocation.

The Impact of State Level Public Policy, Prescriber Education, and Patient Factors on Opioid Prescribing in Elective Orthopedic Surgery: Findings From a Tertiary, Academic Setting

BackgroundThe United States is in the midst of an opioid misuse epidemic. There have been recent changes to North Carolina’s public policy leading to institutional education attempting to reduce high-risk opioid prescribing. This study investigated whether state-level and institutional efforts were associated with provider-level changes in opioid prescriptions after common orthopedic surgeries. Patients and MethodsSix-week post-operative opioid prescribing in patients 18 years or older undergoing high-volume elective surgeries were reviewed retrospectively. Three patient cohorts from equivalent calendar year periods were included in this analysis; preceding policy implementation (January 1, 2017, to March 31, 2017), immediately after policy implementation (January 1, 2018, to March 31, 2018), and 1 year after policy implementation (January 1, 2019, to March 31, 2019). Multivariable models were constructed to evaluate the effects of public policy and institutional education on postoperative opioid prescribing. ResultsThe mean (standard deviation) amount of oxycodone 5-mg equivalents prescribed at discharge decreased from 75.6 (53.2) in 2017 to 55.7 (36.2) in 2018 and then 45.6 (32.6) in 2019 (P < .05). Similarly, 6-week postoperative cumulative oxycodone 5-mg equivalents prescribed also significantly decreased from 123.3 (145.8) in 2017 to 84.1 (90.3) in 2018 and to 80.2 (150.1) in 2019. Other outcomes including prescription duration and rates of outlier prescribing showed similar trends. ConclusionIn a North Carolina tertiary academic hospital, opioid prescribing decreased after public policy implementation and an institutional response of education for prescribers within a national context of changing practices in opioid prescribing. State-level public policy and prescriber education could be important avenues for decreasing postoperative opioid prescription in orthopedic settings.

Labor market freedom and geographic differentials in the percentage unemployment rate in the U.S.

The present paper statistically examines whether it can be inferred that the greater the labor market freedom in an environment, the lower the unemployment rate in that environment, other things held the same. The hypothesis is predicated on the tenet that enhanced labor market freedom in a state leads to a more efficiently operating labor market and thereby diminishes the unemployment rate in the state. The empirical context is a panel dataset for all states in the U.S. The study period begins with the year 2008 and runs through the end of the year 2016. This nine-year time frame integrates the entirety of the Great Recession and more than 6 years thereafter. The study includes a number of control variables. The findings strongly support the hypothesis that the unemployment rate is a decreasing function of labor market freedom, whether expressed in the form of its three sub-indices or in the form of the arithmetic mean of those three sub-indices. Potential state-level public policy implications of the findings are also provided and discussed in this study.

Human Papillomavirus Vaccine Initiation for Adolescents Following Rhode Island's School-Entry Requirement, 2010-2016.

To assess changes in human papillomavirus (HPV) vaccine initiation for adolescent girls and boys in Rhode Island compared with all other states. We estimated the gender-specific effects of Rhode Island's school-entry HPV vaccination policy on self-reported HPV vaccination initiation by using a difference-in-differences design with the National Immunization Survey-Teen from 2010 through 2016. Compared with boys in other states, boys in Rhode Island increased their HPV vaccine initiation rate by 11% (b = 0.11; 95% confidence interval [CI] = 0.05, 0.18) after enactment of the requirement. No difference was seen in the probability of HPV vaccine initiation among girls in Rhode Island compared with girls in the multistate control (b = -0.01; 95% CI = -0.08, 0.05). Our analysis identified an 11% increase in HPV vaccine initiation rate among boys in Rhode Island after the school-entry requirement was enacted, whereas no significant change was observed for girls. Public Health Implications. Given suboptimal vaccine uptake rates in the United States, continued pursuit of state-level public policy to improve HPV vaccination is needed. School-entry requirements for HPV vaccination may be a strategy for closing the gap in HPV vaccine uptake for boys and girls.

How Courts Structure State-Level Representation

AbstractI examine how courts condition the relationship between state-level public opinion and policy. The system of federalism in the United States allows federal and state courts to establish the types of policies that states are constitutionally allowed to implement. In particular, federal courts can set “federal floors” for policy, below which no states can go. State courts, in turn, can raise the level of this floor. Thus, both federal and state courts shape whether state policy can match the preferences of the median voter in a given state. Analyzing data on public opinion, judicial decisions, and state-level policy on the issue of abortion, from 1973 to 2012, I show that changes in the set of allowable abortion restrictions, according to the combined decisions of state and federal courts, significantly affect whether states implement majority-preferred policies. I also show that ignoring the influence of courts on the policymaking environment significantly affects the estimated level of policy congruence and thus conclusions about the scope of representation. These results demonstrate the importance of placing courts in the larger study of state-level representation.

Trends and Factors Associated with Breastfeeding and Infant Sleep Practices in Georgia.

Breastfeeding benefits both infant and mother, including reducing the risk of Sudden Infant Death Syndrome (SIDS). To further reduce risk of SIDS, the American Academy of Pediatrics recommends infants sleep on their backs on a separate sleep surface. Our objective was to describe trends and factors associated with breastfeeding and infant sleep practices in Georgia. Pregnancy Risk Assessment Monitoring System 2004-2013 data were obtained from the Georgia Department of Public Health. Chi square tests for trends were utilized to determine whether there were significant linear trends in breastfeeding and infant sleep overtime and by survey phase. After exclusions, 4643 cases remained for analysis. From 2004 to 2013, there was a slight (insignificant) decrease in breastfeeding initiation, with the highest proportion in 2010 (79.9%) and the lowest in 2013 (66.9%). Rates of exclusive breastfeeding increased significantly from 2004 (31.3%) to 2013 (81.7%). During that time, the proportion of infants being placed back to sleep slightly decreased (though not significantly), from 59.7 to 48.9%. The proportion of mothers who reported never bed-sharing increased significantly from 26.7 to 45.1% over this period. The decreasing breastfeeding initiation rates in Georgia diverge from national upward trends, however, exclusive breastfeeding rates by survey phase were slightly higher than national trends. Our results suggest the need for targeted education and support for breastfeeding and safe sleep practices. State-level trends data on breastfeeding and infant sleep practices provide valuable information for state-level public health professionals and policy makers, health care providers, and breastfeeding and safe sleep advocates.

Reflections on a boom: Perceptions of energy development impacts in the Bakken oil patch inform environmental science & policy priorities

Ecosystems worldwide have been subject to new or intensified energy development facilitated by technologies such as horizontal drilling and hydraulic fracturing, activity that has generated concern for air, water, biotic, and social resources. Application of these technologies in the development of the Bakken oil patch has made it one of the most productive petroleum plays in North America, causing unprecedented landscape industrialization of otherwise rural, agricultural counties in western North Dakota. The region is isolated, and development impacts have not been well-studied. To identify concerns of citizens of the Bakken and determine how research and policy might support them, we conducted a two-part study: First, we held focus groups with resource management and community leaders in three major oil-producing counties. Second, we used an outline of the major concerns expressed by focus group members as a survey for landowners and farm/ranch operators. We found little relationship between survey respondents' reported categorization of energy impacts and actual land area impacted, suggesting factors such as attitude towards development, degree of compensation, and level of disturbance are relevant. Landowners agreed with focus groups on the nature of relationships between energy companies and locals and development impacts on infrastructure and communities; those reporting greater impacts tended to agree more strongly. But many specific problems described in focus groups were not widely reported in the survey, suggesting energy-community relationships can be improved through state-level public policy and respect from energy companies for locals and their way of life. Consideration of these concerns in future energy policy—both in the Bakken and worldwide—could reduce social tension, lessen environmental impact, and increase overall social, economic, and environmental efficiency in energy development.

How Courts Structure State-Level Representation

I examine how and state courts influence the relationship between state-level public opinion and policy. The system of dual federalism, combined with the sweeping power of judicial review, allows state and courts to establish the types of policies that states are constitutionally allowed to implement. In particular, courts can set federal floors for policy, below which no state can go. State courts, in turn, can raise the level of this floor. As a result, both and state courts can shape the extent to which state policy can match the preferences of the median voter in a given state. I demonstrate this important role of courts by analyzing data on public opinion, judicial decisions, and state-level policy on the issue of abortion, from 1973 to 2012. I show that changes in the set of allowable abortion restrictions, according to the combined decisions of and state courts, significantly affect whether states implement majority-preferred policies. These results demonstrate the importance of placing courts in the larger study of state-level representation.

Injury-related infant deaths: a state analysis of a public health, health care, policy network

Introduction: This research examines a state-level public health, health care, and policy network focused on efforts to reduce unintentional childhood injuries. The network is composed of 12 organizations: four public health, four health care, and four policy. Methods: A 23-item survey was administered to the 12 organizations between January and June 2015. Analyses were conducted using HyperResearch and UCInet 6. Results: More organizations worked together on assessment and planning efforts that identify and quantify the nature of at-risk infants in the community and strategies for reducing injury-related infant deaths. The Injury Prevention Center, the most central organization, interacted most frequently with organizations in an effort to reduce unintentional childhood injuries. Implications: The identification of these relationships, central organization, and the level of importance viewed by the network organizations may help create an integrated network positioned to change and improve service and program delivery as well as policy.

Assessing the impacts of traditional school year calendar start dates

The importance of education is undeniable. With considerable investment by the public in education, effectiveness and mechanisms for delivery must continually be monitored and evaluated. Proposals to alter the school calendar year therefore merit serious consideration if this translates to better management of scarce resources. Among those facets of school level costs that offer an opportunity for significant savings are plant operations. Any savings that enable resources to be focused more centrally on delivery and support of the educational mission are clearly worthy of exploration. At issue is the variability of school beginning and ending dates across the United States. It is hypothesized that strategic planning of break periods can lead to decreases in energy costs, and usage. For example, in the southwest United States, hot summer conditions can lead to significant spikes in energy consumption at times of the year when energy prices are at their highest. An approach for evaluating energy usage patterns relative to school calendars is developed, where usage and climate conditions are sought to be better understood. An optimization model is structured, formulated and applied capable of identifying ideal school start/end dates with plant operation costs in mind. Application results for a school are presented, with findings discussed within the context of proposed state-level public policy.

The 2008 State New Economy Index: Benchmarking Economic Transformation in the States

In the midst of economic slowdowns, it's often hard to think beyond the near term. But, just as the most effective companies take advantage of slowdowns to better position themselves for subsequent periods of strong economic growth, so, too, should states. For the current slowdown, caused in large part by higher energy prices and excesses in the housing market that have spurred turmoil in the financial services industry, will not last forever. In fact, given the experiences of past New Economy slowdowns (the early 1990s and at the turn of this century), the slowdown could be less severe than many past slowdowns. As a result, the more important economic question states should be focused on is whether their economies are well positioned for robust growth and innovation over the next decade. Being well positioned means that state economies need to be firmly grounded in the New Economy. These New Economy factors have become a fundamental capacity that states need to have to find success and navigate the shoals of economic change. This report uses twenty-nine indicators to assess that capacity and, in particular, to measure the differences in the extent to which state economies are structured and operate according to the tenets of the New Economy. In other words, it examines the degree to which state economies are knowledge-based, globalized, entrepreneurial, IT-driven, and innovation-based. With these indicators as a frame of reference, the report then outlines a state-level public policy framework aimed at helping states master forthcoming challenges and take advantage of opportunities. The report builds off three earlier reports (The 1999 State New Economy Index, The 2002 State New Economy Index, and The 2007State New Economy Index).

Paradoxes of diaspora, global identity and human rights: the deportation of Nigerians in Ireland

This article examines the contemporary reversal and rupture of the Nigerian diasporic flow to Ireland through the circumstances of deportation; emphasizing the utility of deportations in the discursive context of national identity, global standing, human rights and racism. Through an examination of the unique relationship between the Nigerian and Irish diasporas, it is argued that the state-level discourse and public policy regarding the deportation of Nigerian migrants in Ireland highlight the presence of ‘parallel’ and ‘catalytic’ diasporas that form what can be considered paradoxes of diaspora. The article also maintains that deportations: 1) facilitate the proliferation of national racisms and human rights violations through the legitimating mechanisms of international law; 2) expose the attempt at insuring a national Irish identity that is racialized as White; 3) bring into sharp relief the simultaneous determination of Nigeria to secure a reputation as democratic and Ireland to preserve its standing as a philanthropic and benevolent nation in the global arena and; 4) highlight the post-national significance of diasporic belonging in a contemporary global context.

Explaining Cross‐State Differences in Elderly Suicide Rates and Identifying State‐Level Public Policy Responses that Reduce Rates

Elderly Americans commit suicide at higher rates than other age groups. We contend that macro- and micro-social variables contribute distinct aspects to explanations of this tragic loss: the former focus on circumstances that affect overall rates, the latter reveal why certain individuals succumb to suicide. Our analysis focuses on the macro-social end of a causal sequence including variables at both levels. We describe how elderly suicide rates vary among states, show that macrosocial indicators of social integration contribute to cross-state variation in elderly suicide rates, and explain how selected aspects of state-level public policy contribute to reducing elderly suicide rates.

Informing State Policymakers: Opportunities for Social Workers

Colleagues, legislative staff, interest groups, administrative agencies, universities and think tanks, the media, and constituents are some of the more commonly recognized sources of information for state legislators. Results of a survey of 507 legislators in 12 U.S. states reveal that ethnic associations, grassroots organizations, the Internet, local branches of national or state organizations, and conferences are also sources of information for state legislators. The relative importance of the various sources is linked to characteristics of the legislators and the districts they represent. This suggests the need for targeted information dissemination strategies to influence state-level public policy.

Personal and location-specific characteristics and elderly interstate migration.

"The purpose of this paper is to investigate the impact of locational and individual characteristics upon interstate retiree migration, particularly in state-level public policy variables. Data regarding the characteristics of individual movers are drawn from the 1990 U.S. Census of Population and Housing 5% Public Use Microdata Sample. The household data are merged with location-specific attributes including both natural amenities and local fiscal variables." Three alternative models are developed, involving push factors, pull factors, and differences in site characteristics experienced by migrants. "The results indicate that both personal and locational characteristics are important factors determining the decision of elderly migrants to change their state of residence. While there is some limited support for the push and pull specifications, the difference model is found to provide the best overall fit."

State Level Public Policy Choices as Predictors of State Teen Birthrates

The findings of this study confirm that there is a relationship between US state level policy choices and teen birth rates. The predictors of state teen birth rates--high poverty rates low school completion rates low public welfare expenditures and high unemployment rates--are depictive of opportunity structures devoid of opportunities or reasons for hoping for a better future. This is compounded by low expenditures for both education and public welfare which are directly linked to the low school completion rates and high poverty rates that are so strongly predictive of high teen birth rates. These findings are consistent with those of other studies conducted throughout the world for 25 years or longer that also have shown an association between high birth rates low levels of educational attainment and high rates of poverty and unemployment. The role that state level policy choices play in this configuration is depicted statistically in the present analysis. All of this suggests that family professionals have a very strong advocacy role to play in their respective states and nationally as well in changing attitudes that underlie states spending choices and the federal governments too in terms of the costs that high teen birth rates entail. Counseling family life and sex education family planning services although important are insufficient for addressing the underlying conditions with which high teen birth rates are associated: poverty and low levels of education and aspirations for it. To address such conditions opportunity structures must be created in the states and communities in which poor teenagers live.

State-level public policy as a predictor of individual and family well-being.

This exploratory study examines the relationship between state-level public policy and individual and family well-being and factors that affect it. The inquiry, based on exchange and choice theories, assumes that state-level public policy reflects states' awareness of the needs of individuals and families, their ability to predict the future in failing to meet them, and the extent to which the norm of reciprocity prevails in the 50 states. Measures of states' collective choices were states' per capita expenditures for public welfare, education, and health, and per capita taxes in 1980; measures of states' individual and well- or ill-being, or social malaise, were states' teenage birthrates, infant death rates, and suicide rates. Taken into account as antecedent and intervening variables were age, gender, and racial composition, income distribution, marital, socioeconomic, and employment status of states' populations, and attitudes toward public spending. The findings show that higher state expenditures for public welfare and for education indeed contribute to individual and family well-being as measured by lower state rates of suicide and teenage births. States per capita spending for education, which together with state per capita spending for public welfare was a positive predictor of school completion rates and positively associated with states' income level, accounted for almost all of the variance in states' per capita taxes. State spending for public welfare was not a predictor of state per capita taxes. These findings are cause for considerable concern given the reduced role of the federal government in human affairs, particularly in states whose choices violate the assumptions underlying exchange and choice theories and the norm of reciprocity which says that people should help, not hurt, others.