State Policy Context Research Articles

Online Medication Abortion Direct-to-Patient Fulfillment Before and After the Dobbs v Jackson Decision

Online pharmacies have emerged as stakeholders in abortion care since the US Food and Drug Administration (FDA) relaxed in-person dispensing requirements in 2020. The role of online pharmacies in dispensing abortion medications following the Dobbs v Jackson Women's Health Organization decision on June 24, 2022, is understudied. To describe medication abortion prescription fulfillment patterns for 1 online pharmacy 1 year before and after the Dobbs v Jackson decision, considering patient, prescriber, and state policy characteristics. This cross-sectional study assesses deidentified medication abortion prescription fulfilment data from 1 online pharmacy. Prescribers sent prescription requests to the online pharmacy, which dispensed abortion medications to patients by mail. The study sample included prescription requests fulfilled by the online pharmacy between June 20, 2021, and June 24, 2023, for patients aged at least 18 years who received the combined medication abortion regimen. Data were analyzed from July 2023 to July 2024. The US Supreme Court Dobbs v Jackson decision on June 24, 2022. Patient and prescriber characteristics are described, including patient age, state to which the prescription was sent, medications prescribed, and prescribing prescriber's clinic care modality (in-person only, hybrid [in-person and virtual], and virtual only). States were grouped according to the Guttmacher Institute classification of policy support for abortion (most or very supportive, somewhat supportive, and somewhat restrictive). Fulfillment trends were disaggregated by prescriber modality and state policy environment; 2 states with similar telehealth but differing coverage policies (Illinois and Colorado) were compared. The dataset included 87 942 observations. Most prescriptions were sent to individuals younger than 30 years (57.1%), with a mean (SD) age of 28.7 (6.4) years. Throughout the study period, the greatest volume of prescription requests came from states with most or very supportive policies and from prescribers at virtual-only platforms. More prescriptions were sent in the year after Dobbs v Jackson (daily mean [SD], 88.5 [47.2] prescriptions in March 2022 vs 201.5 [97.5] prescriptions in March 2023) with fulfillment spikes following the Dobbs v Jackson leak on May 2, 2022, and decision on June 24, 2022. State policy contexts mirrored the overall trends, while prescriber modality trends were unique, with a big spike in fulfillment at 12 weeks after the Dobbs v Jackson decision for hybrid clinics compared with in-person-only clinics and telehealth-only platforms, which saw their largest spikes in mean daily prescription fulfillment the week immediately after Dobbs v Jackson. Illinois and Colorado had similar fulfillment trends, with spikes immediately following the Dobbs v Jackson decision and overall higher fulfillment after Dobbs v Jackson, with a daily mean (SD) of 10.5 (7.0) prescriptions in Illinois and 8.8 (5.7) prescriptions in Colorado in March 2022 versus 26.6 (13.6) prescriptions in Illinois and 16.7 (10.1) prescriptions in Colorado in March 2023. These findings illustrate the increasingly critical role online pharmacies play in direct-to-patient abortion care provision in the US and the strong linkages between virtual-only prescribers and online pharmacies. These findings suggest that barriers to accessing online pharmacies for abortion care should be removed.

Abstract B168: A qualitative examination of how state policy and sociopolitical environmental influence experiences of cancer care for minoritized sexual and gender populations who have experienced breast cancer

Abstract Introduction: A growing body of literature is investigating how structural barriers, including policies, impact cancer outcomes among marginalized populations, including the 2SLGBTQ+ (two spirit, lesbian, gay, bisexual, transgender, queer, asexual, intersex, and gender non- conforming or gender non-binary)(sexual and gender minoritized (SGM)) communities. An underresearched area is how the state-level policy and sociopolitical environment shape the experiences and outcomes of SGM people who have experienced breast cancer. Using data from the Elsie Study, this research examines how SGM people who have experienced breast cancer are impacted by their state’s policies and sociopolitical context. To the authors' knowledge, this study is the first of its kind to examine these experiences of breast cancer care for SGM people. Methods: The Elsie Study is the largest qualitative survey of SGM people who have experienced cancer conducted within the U.S. To date the Elsie Study at the University of Minnesota has conducted 60-90 minute semi-structured interviews with thirteen sexally and gender minoritized people who have experienced breast cancer. Our participants were recruited from advertising campaigns on social dating applications, including HER, and community organizations. Interviews were conducted nationwide over Zoom and phone beginning in June 2023 and continuing through June 2024. Summary of data: Our participants who have experienced breast cancer have diverse sexual orientations, gender identities, and racial and ethnic backgrounds. Among the thirteen sexually and gender minoritized participants who experienced breast cancer, their sexual orientations encompass those who identify as lesbian, gay, bisexual, queer, or some of these interchangeably. Participants’ gender identities include identifying as cisgender woman, genderqueer, non-binary, transgender man, and transgender woman. Participants’ racial and ethnic backgrounds are white, Black or African American, Latino/a/x, and Asian. Participants at the intersections of marginalized identities noted substantial difficulties in receiving culturally competent care during breast cancer treatment. A majority of SM and GM women and non-binary participants mentioned the importance of living in a “queer and trans friendly state,” liberal cities, or states with marriage equality for aspects such as accessing culturally competent cancer care and participating in cancer research. Conclusions: Narratives such as those expressed by our SGM participants who experienced cancer are important for understanding how state policy and sociopolitical contexts shape access to healthcare and even cancer research. Our study has wide implications for how affirming state policy and sociopolitical climates may afford more equity in cancer care for SGM people. Citation Format: Courtney Sarkin, Alexandra M. Ecklund, Ben Weideman, Rhea Alley, B.R. Simon Rosser, G. Nic Rider. A qualitative examination of how state policy and sociopolitical environmental influence experiences of cancer care for minoritized sexual and gender populations who have experienced breast cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B168.

Comprehensive vaping bans are associated with lower odds of initiation into electronic nicotine delivery systems use among young people.

E-cigarette and other electronic nicotine delivery systems (ENDS) use has grown considerably over the past decade, with notable increases among young people. US state policy contexts for ENDS and tobacco may shape initiation into ENDS use among adolescents as they age into early adulthood. We aimed to determine whether state-level comprehensive vaping ban policies reduce the odds of youth initiation into ENDS use, net of additional state-level ENDS and tobacco policies, as well as the youth's cigarette smoking status. Longitudinal data from the Population Assessment of Tobacco and Health study were merged with a state-year database on tobacco and ENDS policies. Multivariable discrete-time event history models of ENDS initiation were estimated. United States. Twenty thousand twelve youth assessed over six waves from 2013 to 2019 (n = 53 974 observations). We examined comprehensive indoor vaping bans (i.e. 100% vape-free workplaces, restaurants and bars) as a key factor in initiation into ENDS use (i.e. first instance of vaping) from age 13 to 22. Among young people, residing in a state with a comprehensive vaping ban was associated with 18% lower odds of ENDS initiation (odds ratio = 0.82; 95% confidence interval =[0.71, 0.94]), even after controlling for other state ENDS and tobacco policies, the youth's cigarette smoking and socio-demographic background and state-level covariates. In the United States, state-level vaping bans (i.e. 100% vape-free workplaces, restaurants and bars) are associated with reduced odds of youth initiation into electronic nicotine delivery systems use.

The Shifting Stress of Working Parents: An Examination of Dual Pandemic Disruptions—Remote Work and Remote Schooling

Working remotely at least some of the time has long been seen as promoting a better integration of work and care obligations, even though prepandemic research is mixed as to the extent to which parents benefit emotionally from remote work. We exploit dual social experiments in schooling and work spawned by the COVID-19 pandemic to understand any stress-reducing effects of working from home under different school-closing state policy contexts. The pandemic led to an unprecedented shift to (and subsequent away from) remote and hybrid work but also to the implementation of various containment policies, most notably school closures driving a shift to remote learning that were put into effect to different degrees across U.S. states. Drawing on parents’ data from a U.S. nationally representative panel survey of workers who spent at least some time working from home since the pandemic onset, we use mixed-effects models to examine whether and in what ways cross-state and over-time variations in school closure policies shape any stress-reducing impacts of remote/hybrid work. Results show that when schools were not mandated to close, remote/hybrid work largely reduces parents’—especially mothers’—stress. However, an opposite pattern emerges in the face of closing mandates. These patterns are especially pronounced among white mothers and are not observed among nonparents.

Framing the Transfer Experience for Community College Students: Connection, Preparation, Support, Advocacy, and Resilience

Objective/Research Question: This practitioner-scholar study investigated perceptions and experiences of community college students who transferred upon completion of their associate degree programs in Colorado, a state with multiple state-level transfer policies. Each student participated in a cohort-based transfer support program offered at their community college. The research questions were: 1. Do community college students who participated in transfer programing while earning their associate degree perceive that it helped prepare them for successful transfer? 2. Do community college students perceive that their courses prepared them to be successful at a university? 3. What are the perceptions and experiences of community college students who transferred upon completion of their associate degree programs within a context of a state with multiple transfer policy initiatives? Methods: This study used a phenomenological approach and qualitative data collection methods. Results: While students believed their community colleges prepared them academically, and their transfer preparation programing was beneficial, their reflections highlight that regardless of support provided, academic preparation, or policy context, transfer from community college to university is challenging, problematic, and bureaucratic. Often community college students are viewed with a deficit lens by university staff. Conclusions/Contributions: Regardless of state policy context, transfer preparation, and support, obstacles encountered in the transfer process from community college to university must be negotiated through relationships and advocacy both on the part of college staff and the students themselves. However, students who transfer from a college with dedicated transfer support and preparation demonstrate resilience to complete the process successfully.

Linking Response to Intervention and Identification of a Specific Learning Disability

We investigated state and national trends in the enrollment of students ages 6 to 21 under the specific learning disability (SLD) category across 15 consecutive school years (2005–2006 to 2019–2020). We used multi-level modeling to estimate the effects of state and time on SLD enrollment and conducted a policy analysis of three states (Rhode Island, Kansas, and New Mexico) to examine changes in SLD policy (including Response to Intervention) in conjunction with trends in enrollment. Results indicate significant differences in SLD enrollment between states in the initial year and significant decreases in SLD enrollment over time, but no significant differences in the change in SLD enrollment between states. Results from the policy analysis suggest that the state policy context (including legal requirements in the SLD evaluation process), type of RTI model, and method of SLD evaluation can affect SLD enrollment. We discuss these results within the context of increased variability in RTI models.

TO THE QUESTION OF THE PROBLEM OF DEFINING THE CONCEPT OF “PLANETARISM” AS A NEW RELIGIOUS MOVEMENT WITHIN THE FRAMEWORK OF THE INTERNAL IDEOLOGICAL POLICY OF THE STATE

The purpose of the research. The article deals with the problems of defining the concept of «planetarism» as a new religious phenomenon within the framework of the internal ideological policy of the state, influencing the internal political processes of state administration and the nature of international interaction in the foreign policy arena. The change in the content of the concept of “planetarism” in its historical retrospective is analyzed, demonstrating the process of gradual separation of the concept of “planetarism” from the concept of “globalization” into an independent definition. The aim of the study is to formulate our own definition of the concept of “planetarism” as a new religious movement in the ideological context of state policy. This is necessary to determine the main directions of public administration in the context of value confrontation in the international arena, as well as for more effective legislative support for the implementation of the Decree of the President of the Russian Federation dated November 09, 2022 No. 809 “On Approval of the Fundamentals of State Policy for the Preservation and Strengthening of Traditional Russian Spiritual and Moral Values”. The laws of nature, within the framework of the concept of “planetarism”, began to act as a kind of absolute, which became a kind of scale for the ethical assessment of certain social processes and phenomena, which makes it possible to consider “planetarism” as a new form of religious movement. Conclusions. As a result of the study, the author comes to the conclusion that the ongoing socio-political processes reflect changes in the ideological basis of interstate cooperation. The basis of the new ideological orientation, called “planetarism”, is the idea of the planet Earth as a common “home” for all mankind. Within the framework of the “planetarism” concept, the planet acts not just as a common place of residence for all people, but also as an independent superorganism that has its own consciousness and rights along with the rights of the people themselves. The author, emphasizing the dualistic structure of “planetarism”, which includes, on the one hand, cognitive ideas about the unconditional value of the planet and natural laws, and on the other hand, faith in these values and ideas by analogy with religious faith, proposes to consider “planetarism” as a group of non-theistic beliefs, philosophical and ideological ideas that have arisen around the idea of our Planet as a kind of independent superorganism that gave life to all living things, has the ability of reasonable self-regulation in order to maintain life in all its diversity in accordance with the laws established by it.

Anticipatory stress, state policy contexts, and mental health during the COVID-19 pandemic

Substantial economic disruptions during the COVID-19 pandemic upended daily life and contributed to a widespread symptom of psychological distress during this period. Disruptions also led to more concerns about future stressful events related to financial hardship, or economic-related anticipatory stress, with the potential to undermine mental health. Although prior research provides ample evidence that state policies can impact mental and physical health, it has not considered how state policy contexts reduce adverse psychological outcomes stemming from economic-related anticipatory stress. The present study uses national survey data from the Census Bureau's Household Pulse Survey (April 2020–October 2020) to examine the extent to which state policy contexts moderate the association between economic-related anticipatory stress and depression/anxiety. We find that states with stronger social safety nets weakened the impact of anticipatory stress on depression/anxiety. This finding held for different types of anticipated economic hardships (i.e., reduced income, difficulty paying rent, difficulty affording food), as well as for policies that existed prior to COVID-19 and policies enacted in response to COVID-19. Findings provide strong evidence that state policies may buffer against poor mental outcomes for people who even anticipate facing economic uncertainty during the COVID-19 pandemic. We provide insight into how state policy contexts can shape individual experiences in ways that impact the mental health outcomes of the United States population.

Factors Associated With Knowledge and Experience of Self-managed Abortion Among Patients Seeking Care at 49 US Abortion Clinics

Patients attending US abortion clinics may consider or try self-managing their abortion before coming to the clinic, yet little is known about the factors associated with self-management behavior. To examine the prevalence and factors associated with considering or attempting a self-managed abortion before attending a clinic. This survey study included patients obtaining an abortion at 49 independent, Planned Parenthood, and academic-affiliated clinics chosen to maximize diversity in geographic, state policy, and demographic context in 29 states between December 2018 and May 2020. Data were analyzed from December 2020 to July 2021. Obtaining an abortion at a clinic. Knowledge of medications used to self-manage an abortion, having considered medication self-management before attending the clinic, having considered any method of self-management before attending the clinic, and having tried any method of self-management before attending the clinic. The study included 19 830 patients, of which 99.6.% (17 823 patients) identified as female; 60.9% (11 834 patients) were aged 20 to 29 years; 29.6% (5824 patients) identified as Black, 19.3% (3799 patients) as Hispanic, and 36.0% (7095 patients) as non-Hispanic White; 44.1% (8252 patients) received social services; and 78.3% (15 197 patients) were 10 weeks pregnant or less. Approximately 1 in 3 (34%) knew about self-managed medication abortion, and among this subsample of 6750 patients, 1 in 6 (1079 patients [16.1%]) had considered using medications to self-manage before attending the clinic. Among the full sample, 1 in 8 (11.7%) considered self-managing using any method before clinic attendance, and among this subsample of 2328 patients, almost 1 in 3 (670 patients [28.8%]) attempted to do so. Preference for at-home abortion care was associated with considering medication self-management (odds ratio [OR], 3.52; 95% CI, 2.94-4.21), considering any method of self-management (OR, 2.80; 95% CI, 2.50-3.13), and attempting any method of self-management (OR, 1.37; 95% CI, 1.10-1.69). Experiencing clinic access barriers was also associated with considering medication self-management (OR, 1.98; 95% CI, 1.69-2.32) and considering any method of self-management (OR, 2.09; 95% CI, 1.89-2.32). In this survey study, considering self-managed abortion was common before accessing in-clinic care, particularly among those on the margins of access or with a preference for at-home care. These findings suggest a need for expanded access to telemedicine and other decentralized abortion care models.

US State Policy Contexts and Population Health.

Policy Points This Perspective connects the dots between the polarization in US states' policy contexts and the divergence in population health across states. Key interlocking forces that fueled this polarization are the political investments of wealthy individuals and organizations and the nationalization of US political parties. Key policy priorities for the next decade include ensuring all Americans have opportunities for economic security, deterring behaviors that kill or injure hundreds of thousands of Americans each year, and protecting voting rights and democratic functioning.

Youth, Quechua and neoliberalism in contemporary Perú

AbstractFramed within a critical and ethnographic approach to language policy, my study addresses the phenomenon of language commodification and the construction of neoliberal subjectivities in contemporary Perú. Specifically, I address a project of Quechua teaching in the city of Lima called Quechua para Todos, or Quechua for All, promoted by young Quechua activists developing interventions to change historically established imaginaries. Taking this project as a starting point, I analyze what is behind the extremely high demand these Quechua courses are having among youth in the capital city, where Quechua has been historically silenced. My argument is that a significant group of the young students from the courses have begun to integrate the Quechua language to the figure of the entrepreneurial subject for whom both personal and national branding is central. While speaking Quechua has historically indexed ‘indianness’ linked to backwardness, rurality, ancestrality and ignorance, it is now being associated with other linguistic and non-linguistic signs (such as being a professional and knowing English) to enregister a multicultural citizenship within a context of neoliberal economic growth and state policies of cultural branding. Although the demand to study Quechua in Lima is shifting the meanings and values of Quechua, at least within a domain of speakers, it may also be erasing ongoing processes of racialization of indigenous peoples in Peruvian society and fundamental gaps in access to education and economic resources.

Cannabis, Communities, and Place: (Re)constructing Humboldt’s Post-Prohibition Present

Since 1990, many Cal Poly Humboldt faculty and students have made cannabis the focus of scholarship and learning. This work has been shaped by the political, economic, and cultural legacies of cannabis in Humboldt County. Scholarly interest spans multiple dimensions of cannabis cultivation, commerce, consumption, and related social issues. As a multidisciplinary team of scholars, Cal Poly Humboldt faculty affiliated with the Humboldt Institute for Interdisciplinary Marijuana Research (HIIMR) have also shaped the Bachelor of Arts in Cannabis Studies that will launch in Fall 2023. This is the first social science degree program in the United States with this orientation. In this article we trace the origins of cannabis scholarship and learning at Cal Poly Humboldt from a period of domestic cannabis prohibition to the recent period of industry legalization. We also provide an overview of the BA program links to local and state policy and other contexts. Finally, we discuss cultivation communities and strategies of resilience in the context of economic turmoil as a result of legalization.

U.S. state policy contexts and mortality of working-age adults.

The rise in working-age mortality rates in the United States in recent decades largely reflects stalled declines in cardiovascular disease (CVD) mortality alongside rising mortality from alcohol-induced causes, suicide, and drug poisoning; and it has been especially severe in some U.S. states. Building on recent work, this study examined whether U.S. state policy contexts may be a central explanation. We modeled the associations between working-age mortality rates and state policies during 1999 to 2019. We used annual data from the 1999–2019 National Vital Statistics System to calculate state-level age-adjusted mortality rates for deaths from all causes and from CVD, alcohol-induced causes, suicide, and drug poisoning among adults ages 25–64 years. We merged that data with annual state-level data on eight policy domains, such as labor and taxes, where each domain was scored on a 0–1 conservative-to-liberal continuum. Results show that the policy domains were associated with working-age mortality. More conservative marijuana policies and more liberal policies on the environment, gun safety, labor, economic taxes, and tobacco taxes in a state were associated with lower mortality in that state. Especially strong associations were observed between certain domains and specific causes of death: between the gun safety domain and suicide mortality among men, between the labor domain and alcohol-induced mortality, and between both the economic tax and tobacco tax domains and CVD mortality. Simulations indicate that changing all policy domains in all states to a fully liberal orientation might have saved 171,030 lives in 2019, while changing them to a fully conservative orientation might have cost 217,635 lives.

“From an ethic of care to queer resistance”: Texas administrator and teacher perspectives on supporting LGBTQ students in secondary schools

LGBTQ students often have a secondary school experience fraught with bullying, mental health struggles, and marginalization. In this qualitative study, we examined teacher and administrator perspectives on school supports for LGBTQ students using data collected for a larger project on early college high schools (ECHS) in Texas. Using an ethic of care in education as a conceptual frame, our findings revealed that participants perceived ECHSs as safe and accepting spaces for sizable populations of queer youth, even in a restrictive state policy context. We suggest that because ECHSs were not intentionally designed to serve LGBTQ students—yet staff perceived to be serving them well—the characteristics embodied by ECHS faculty and staff may serve as aspirational aims for educators in other school contexts.

Harm reduction implementation among HIV service organizations (HSOs) in the U.S. south: a policy context analysis and results from a survey of HSOs

BackgroundHIV service organizations are integral to serving communities disproportionately impacted by the HIV and opioid epidemics in the U.S. South. Addressing these intersecting epidemics requires implementation of evidence-based approaches, such as harm reduction. However, little is known about the extent to which Southern HIV service organizations implement harm reduction. This manuscript examines: 1) the implementation context of harm reduction in the South, 2) Southern HIV service organization implementation of harm reduction, and 3) the impact of different contexts within the South on HIV service organization implementation of harm reduction.MethodsTo examine implementation context, authors analyzed nation-wide harm reduction policy and drug-related mortality data. To examine HIV service organization implementation of harm reduction, authors performed frequency distributions on survey data (n = 207 organizations). Authors then constructed logistic regressions, using state mortality data and policy context as predictors, to determine what contextual factors predicted HIV service organization implementation of harm reduction.ResultsDrug-related mortality data revealed an increased need for harm reduction, and harm reduction policy data revealed an increased political openness to harm reduction. Frequency distributions revealed that approximately half of the HIV service organizations surveyed reported that their organizations reflect a harm reduction orientation, and only 26% reported providing harm reduction services. Despite low utilization rates, HIV service organizations indicated a strong interest in harm reduction. Logistic regressions revealed that while increased mortality rates do not predict HIV service organization implementation of harm reduction, a harm reduction-friendly policy context does.DiscussionThis study highlights how regions within a high-income country can face unique barriers to healthcare and therefore require a unique understanding of implementation context. Study findings indicate a rapidly changing implementation context where increased need meets increased political opportunity to implement harm reduction, however there is a lag in HIV service organization adoption of harm reduction. Financial resources, capacity building, and continued policy advocacy are required for increased HIV service organization adoption of harm reduction.

EL Policy and Immigrant Politics: State and Federal Policy and Ever-EL Students’ Postsecondary Pathways

Although current and former English Learner (EL) or “ever-EL” students comprise one of the fastest-growing K-12 populations, we still know relatively little about the factors that influence their college-going. Using Perna’s seminal college-going model as a launching point, we propose a policy-driven empirical approach to explore how state and federal policy uniquely inform ever-EL students’ academic trajectories. This model considers how EL education policy is largely defined at the federal level but interpreted and implemented by state and local actors (i.e., the Lau and Castañeda cases). In addition, largely of immigrant origin, ever-EL students are directly affected by federal immigration policy as well as state immigrant policies. We suggest that the unique status of EL education in K-12 schools and the framing of immigrant-origin communities in federal and state policies make it necessary to consider both federal and state policy contexts in ever-EL college-going research.

The intersection of welfare stigma, state contexts and health among mothers receiving public assistance benefits

The stigmatizing nature of the US welfare system is of particular importance not only because it has shown to deter eligible applicants from participating in public assistance programs despite facing economic hardship, but also because stigma is an important fundamental cause of health inequities. Although scholars agree stigma is shaped by individual and contextual dimensions, the role of context is often overlooked. Given the heterogeneous nature of US state welfare environments, it may be critical to consider the ways in which state policy, social and economic contexts condition the relationship between welfare stigma and health. Using a multilevel lens, this study first examined the impact of experienced and perceived welfare stigma on self-reported health among female public assistance recipients with children. Second, we assessed the moderating effect of uneven state TANF policies, income inequality, and negative public welfare attitudes in shaping these associations. Using data from the Fragile Families and Child Wellbeing Study merged with state-level economic and social measures, we employed a series of multilevel logit models with random effects. Findings show experiences and perceptions of welfare stigma are significantly linked to poor health regardless of state contexts, and outcomes vary markedly by race, ethnicity and education. States with strong anti-welfare attitudes amplified the relationship between experienced welfare stigma and poor health for Black and Hispanic mothers, and state economic contexts modified the relationship between experienced welfare stigma and poor health for mothers with less than a high school education. TANF generosity had no moderating effect on health suggesting state policy environments have limited ability to protect welfare recipients against the stigmatizing effects of the US welfare system. Results have implications for explaining stigma related disparities in health within the context of U.S. welfare environments and informing policies that may be key levers for reducing health inequities.

Surveying Elementary Schools’ Summer Reading Interventions in a State Policy Context

This study sought to better understand how schools were addressing U.S. state policies targeting summer reading interventions for students not meeting accountability standards. Survey data were gathered from 580 public and private elementary schools in one state (67% response rate) regarding the barriers to offering summer programs, characteristics of the students served, amount of instructional and enrichment time provided, curricular materials used, means of monitoring students’ progress, and staff qualifications. Approximately 65% of respondents held summer reading programs, despite not being required or specially funded to do so. Because the programs usually were intended for students not reading proficiently and those in special education, we discuss the practical implications of common program features and the potential misalignment with the existing literature base guiding the design of summer programs.

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).

U.S. State Policy Contexts and Physical Health among Midlife Adults.

This study examines how state policy contexts may have contributed to unfavorable adult health in recent decades. It merges individual-level data from the 1993-2016 Behavioral Risk Factor Surveillance System (n=2,166,835) with 15 state-level policy domains measured annually on a conservative to liberal continuum. We examined associations between policy domains and health among adults ages 45-64 years and assess how much of the associations is accounted by adults' socioeconomic, behavioral/lifestyle, and family factors. A more liberal version of the civil rights domain was associated with better health. It was disproportionately important for less-educated adults and women, and its association with adult health was partly accounted by educational attainment, employment, and income. Environment, gun safety, and marijuana policy domains were, to a lesser degree, predictors of health in some model specifications. In sum, health improvements require a greater focus on macro-level factors that shape the conditions in which people live.