State Policy Environment Research Articles

Effects of Statewide Coronavirus Public Health Measures and State Gun Laws on American Gun Violence

The coronavirus (COVID-19) pandemic dramatically shifted American public life, and with it patterns of gun violence. In this paper, we show that states’ efforts to contain COVID-19 infections through statewide emergency declarations, Stay at Home orders, and phased reopening have significantly altered prevailing patterns of firearm injuries and deaths. We provide a systematic analysis of how state policy responses to COVID-19 affected overall levels of gun violence and specific kinds of shootings, including multiple victim and mass shootings. While emergency declarations and Stay at Home orders had a dampening effect on many forms of gun violence, we find that the number of people injured or killed by a firearm per day increased more than 15% following state reopening, on average. Over the first 30 days of reopening, we estimate that the average state had an additional 5 mass shootings than would be predicted absent the epidemic in the first 30 days of reopening. Additionally, we examine how COVID-related public health measures affect the composition of gun violence. We find that gun violence has followed workers and children home; even though workplaces and schools have closed, gun violence has likely reappeared in Americans’ lives as domestic violence related shootings and child involved shootings during Stay at Home and school closure periods. Finally, we show that state gun laws worked together with COVID-related emergency declarations and Stay at Home orders to further decrease gun violence in some states. Conversely, in states with decreased criminal liability for firearm use, as in states with Stand Your Ground laws, we observe an exacerbating effect on firearm injuries and deaths during the emergency declaration and Stay at Home order periods. Only one policy, waiting periods for handgun purchases, significantly dampened reopening surges in gun violence. These findings suggest that state policy environments can substantially reduce the impacts of exogenous shocks like COVID-19 on American gun violence and provides guidance on which policies can be helpful and which can be harmful.

Women's knowledge of their state's abortion regulations. A national survey

ObjectivesStates vary significantly in their regulation of abortion. Misinformation about abortion is pervasive and propagated by state-mandated scripts that contain abortion myths. We sought to investigate women’s knowledge of abortion laws in their state. Our secondary objective was to describe women’s ability to discern myths about abortion from facts about abortion. Study designThis was a cross-sectional study of English- and Spanish-speaking women aged 18–49 in the United States. We enrolled members of the GfK KnowledgePanel, a probability-based, nationally-representative online sample. Our primary outcome was the proportion of correct answers to 12 questions about laws regulating abortion in a respondent’s state. We asked five questions about common abortion myths. We used descriptive statistics to characterize performance on these measures and bivariate and multivariate modeling to identify risk factors for poor knowledge of state abortion laws. ResultsOf 2223 women contacted, 1057 (48%) completed the survey. The mean proportion of correct answers to 12 law questions was 18% (95% CI 17–20%). For three of five assessed myths, women endorsed myths about abortion over facts. Those who believe abortion should be illegal (aOR 2.18, CI 1.40–3.37), and those living in states with neutral or hostile state policies toward abortion (neutral aOR 1.99, CI 1.34–2.97; hostile aOR 1.6, CI 1.07–2.36) were at increased odds of poor law knowledge. ConclusionsWomen had low levels of knowledge about state abortion laws and commonly endorse abortion myths. Women’s knowledge of their state’s abortion laws was associated with personal views about abortion and their state policy environment. ImplicationsSupporters of reproductive rights can use these results to show policy makers that their constituents are unlikely to know about laws being passed that may profoundly affect them. These findings underscore the potential benefit in correcting widely-held, medically-inaccurate beliefs about abortion so opinions about laws can be based on fact.

US State Policies, Politics, and Life Expectancy.

Policy Points Changes in US state policies since the 1970s, particularly after 2010, have played an important role in the stagnation and recent decline in US life expectancy.Some US state policies appear to be key levers for improving life expectancy, such as policies on tobacco, labor, immigration, civil rights, and the environment.US life expectancy is estimated to be 2.8 years longer among women and 2.1 years longer among men if all US states enjoyed the health advantages of states with more liberal policies, which would put US life expectancy on par with other high‐income countries. ContextLife expectancy in the United States has increased little in previous decades, declined in recent years, and become more unequal across US states. Those trends were accompanied by substantial changes in the US policy environment, particularly at the state level. State policies affect nearly every aspect of people's lives, including economic well‐being, social relationships, education, housing, lifestyles, and access to medical care. This study examines the extent to which the state policy environment may have contributed to the troubling trends in US life expectancy.MethodsWe merged annual data on life expectancy for US states from 1970 to 2014 with annual data on 18 state‐level policy domains such as tobacco, environment, tax, and labor. Using the 45 years of data and controlling for differences in the characteristics of states and their populations, we modeled the association between state policies and life expectancy, and assessed how changes in those policies may have contributed to trends in US life expectancy from 1970 through 2014.FindingsResults show that changes in life expectancy during 1970‐2014 were associated with changes in state policies on a conservative‐liberal continuum, where more liberal policies expand economic regulations and protect marginalized groups. States that implemented more conservative policies were more likely to experience a reduction in life expectancy. We estimated that the shallow upward trend in US life expectancy from 2010 to 2014 would have been 25% steeper for women and 13% steeper for men had state policies not changed as they did. We also estimated that US life expectancy would be 2.8 years longer among women and 2.1 years longer among men if all states enjoyed the health advantages of states with more liberal policies.ConclusionsUnderstanding and reversing the troubling trends and growing inequalities in US life expectancy requires attention to US state policy contexts, their dynamic changes in recent decades, and the forces behind those changes. Changes in US political and policy contexts since the 1970s may undergird the deterioration of Americans’ health and longevity.

What does the future hold for utility electricity efficiency programs?

This study develops projections of future spending and savings from electricity efficiency programs funded by electric utility customers in the United States through 2030 based on three scenarios. Our analysis relies on detailed bottom-up modeling of current state energy efficiency policies, demand-side management and integrated resource plans, and regulatory decisions. The three scenarios represent a range of potential outcomes given the policy environment at the time of the study and uncertainties in the broader economic and state policy environment in each state. We project spending to increase to $8.6 billion in 2030 in the medium scenario, about a 45 percent increase relative to 2016 spending. In the high case, annual spending increases to $11.1 billion in 2030 and remains relatively flat in the low case ($6.8 billion in 2030). Our analysis suggests that electricity efficiency programs funded by utility customers will continue to impact load growth significantly at least through 2030, as savings as a percent of retail sales are forecast at 0.7 percent in the medium scenario and 0.98 percent in the high scenario.

Alcohol policies and alcohol-attributable cancer mortality in U.S. States

BackgroundAlthough more restrictive alcohol control policies (e.g., higher alcohol taxes) are related to lower levels of alcohol consumption, little is known about the relationship between alcohol policies and rates of alcohol-attributable cancer. MethodsState alcohol policy restrictiveness, as measured by a validated policy scale, were related to state rates of six alcohol attributable cancers in the U.S. from 2006 to 2010 in a lagged, cross-sectional linear regression that controlled for a variety of state-level factors. Cancer mortality rates were from the Center for Disease Control and Prevention's Alcohol-Related Disease Impact application, which uses population-attributable fraction methodology to calculate mortality from cancers of the esophagus, larynx, liver, oropharynx, prostate (male only) and breast (female only). ResultsMore restrictive state alcohol policies were associated with lower cancer mortality rates for the six cancer types overall (beta [β] −0.33; 95% confidence interval [CI] −0.59, −0.07), and among men (β −0.45; 95% CI -0.81, −0.10) and women (β −0.21; 95% CI -0.40, −0.02). A 10% increase in the restrictiveness of alcohol policies (based on the mean APS among states) was associated with an 8.5% decrease in rates of combined alcohol-attributable cancers. In all analyses stratified by cancer subtype and sex, the associations were in the hypothesized direction (i.e., more restrictive state policy environments were associated with lower rates of alcohol-attributable cancers), with the exception of laryngeal cancer among women. ConclusionStrengthening alcohol policies is a promising prevention strategy for alcohol-related cancer.

289EMF Are State Telemedicine Parity Laws Associated With Greater Uptake of Telemedicine in the Emergency Department?

Telemedicine may improve access to specialists and clinical outcomes. In an effort to increase use of telemedicine, almost half of all states have passed telemedicine parity laws which require insurers to reimburse for telemedicine visits. Our objective was to determine if there is an association between such laws and use of telemedicine in the emergency department (ED). Building on prior research, we determined each states’ telemedicine policy environment as of January 2016. States were divided into those with any form of telemedicine parity law (conditional mandate, non-conditional mandate, or requirement for full parity in payment by private payers) and those without. As part of the 2016 National ED Inventory (NEDI)-USA survey, we surveyed the directors of all 5,381 EDs on the use of telemedicine with the question, “Does your ED receive telemedicine services for patient evaluation? Yes/No.” We assessed the association between a telemedicine parity law and use of telemedicine with a hierarchical logistic regression model controlling for a number of ED characteristics (annual total and pediatric visit volumes, academic status, freestanding ED, U.S. region, and rural/urban location); state was included as a random intercept. In 2016, among the 50 states and the District of Columbia (DC), 21 (41%) had a telemedicine parity law while 30 (59%) did not. Among the 4,419 respondents to the telemedicine question, (82% response rate), 2,125 (48%) used telemedicine. The proportion of EDs using telemedicine varied widely across the states and DC ranging from 13% in DC to 89% in Maine. In unadjusted analyses, there was no difference between the use of telemedicine in EDs in states with and without telemedicine parity laws (55% vs. 53%, p=0.17). After accounting for baseline ED characteristics, there was also no association between state policy environment and ED use of telemedicine, though telemedicine use did vary significantly by state (Table). Many states have adopted parity laws to encourage use of telemedicine. Surprisingly, we found no association between the presence of these laws and use of telemedicine in the ED. These results suggest that other factors are driving the wide variation in ED adoption of telemedicine across states.TableEmergency Department (ED) Characteristics Associated with Receipt of TelemedicineOdds Ratio95% Confidence IntervalAnnual ED volume(per 10,000patient increase)0.980.95-1.02Annual pediatric volume(reference: <3,000)Annual pediatric volume>3,0001.661.40-1.98Annual pediatric volume unknown1.461.18-1.81Academic0.360.25-0.53Freestanding ED0.480.38-0.61Region (Reference: Northeast)Region Midwest0.690.36-1.35Region South0.610.32-1.16Region West0.810.41-1.58Rural1.200.99-1.44Telemedicine parity law1.040.67-1.62Random intercept: state0.690.55-0.88 Open table in a new tab

ARCHETYPE OF THE PLACE IN ARCHITECTONIC OF THE ENVIRONMENT OF PUBLIC POLICY

The review of the concept of public policy environment in the modern public-management scientific discourse is actualized due to the lack of systematic and comprehensive studies on this problem. The results of consideration of the state policy environment as a place through the application of the archetypal paradigm are presented. The connection between archetypal ideas about the place and the modern course of state policy is also outlined and highlighted. The evaluation of the environment as a “place” is historically connected with the statement of the existence of a thing or phenomenon and lies in the plane of spatial terminology. The place, within the framework of the approach, is considered as a part of the space occupied by a person or an object, while the place is given the value of the minimum limit, and the space is given a maximum limit. Within the framework of the research, other approaches are highlighted that disclose the category of place in disciplinary and interdisciplinary contexts: sociological-behavioral, phenomenological, systemic, etc. Іt is noted that the spatial revolution in the structure of cognition determined the analysis of state policy in spatial categories, which substantiated modern interdisciplinary measurements of the environment of state policy. Аnd — the appearance in the thesaurus public policy topological and metric features reality: location periphery, a center, location and interaction “places”, theme composition state policy, etc. Therefore, the category “place” confers on the environment of state policy a social and cognitive entity, which, in particular, is defined in the concept of identity and leads to the emergence of new approaches to the analysis of identity: regional, local identities, identification with a place, environment or residence.

The Association between State Policy Environments and Self-Rated Health Disparities for Sexual Minorities in the United States.

A large body of research has documented disparities in health and access to care for lesbian, gay, and bisexual (LGB) people in the United States. Less research has examined how the level of legal protection afforded to LGB people (the state policy environment) affects health disparities for sexual minorities. This study used data on 14,687 sexual minority adults and 490,071 heterosexual adults from the 2014–2016 Behavioral Risk Factor Surveillance System to document differences in health. Unadjusted state-specific prevalence estimates and multivariable logistic regression models were used to compare poor/fair self-rated health by gender, sexual minority status, and state policy environments (comprehensive versus limited protections for LGB people). We found disparities in self-rated health between sexual minority adults and heterosexual adults in most states. On average, sexual minority men in states with limited protections and sexual minority women in states with either comprehensive or limited protections were more likely to report poor/fair self-rated health compared to their heterosexual counterparts. This study adds new findings on the association between state policy environments and self-rated health for sexual minorities and suggests differences in this relationship by gender. The associations and impacts of state-specific policies affecting LGB populations may vary by gender, as well as other intersectional identities.

Forty Years of State Alcohol and Pregnancy Policies in the USA: Best Practices for Public Health or Efforts to Restrict Women's Reproductive Rights?

Alcohol consumption during pregnancy remains a public health problem despite >40 years of attention. Little is known about how state policies have evolved and whether policies represent public health goals or efforts to restrict women's reproductive rights. Our data set includes US state policies from 1970 through 2013 obtained through original legal research and from the National Institute for Alcohol Abuse and Alcoholism's (NIAAA)'s Alcohol Policy Information System. Policies were classified as punitive to women or supportive of them. The association between numbers of punitive policies and supportive policies in 2013 with a measure of state restrictions on reproductive rights and Alcohol Policy Effectiveness Scores (APS) was estimated using a Pearson's correlation. The number of states with alcohol and pregnancy policies has increased from 1 in 1974 to 43 in 2013. Through the 1980s, state policy environments were either punitive or supportive. In the 1990s, mixed punitive and supportive policy environments began to be the norm, with punitive policies added to supportive ones. No association was found between the number of supportive policies in 2013 and a measure of reproductive rights policies or the APS, nor was there an association between the number of punitive policies and the APS. The number of punitive policies was positively associated, however, with restrictions on reproductive rights. Punitive alcohol and pregnancy policies are associated with efforts to restrict women's reproductive rights rather than effective efforts to curb public health harms due to alcohol use in the general population. Future research should explore the effects of alcohol and pregnancy policies. The number of states with alcohol and pregnancy policies has increased since 1970 (1 in 1974 and 43 in 2013). Alcohol and pregnancy policies are becoming increasingly punitive. These punitive policies are associated with efforts to restrict women's reproductive rights rather than policies that effectively curb alcohol-related public health harms.

Agriculture, health insurance, human capital and economic development at the rural-urban-interface

Human capital theory identifies investments in health and health care policy as critical components to building human capital, however, there has been little research critically examining how health insurance policy factors into broader workforce development initiatives in the farm sector. In the U.S., the Patient Protection and Affordable Care Act (ACA), signed into law in 2010, represents the first major attempt to restructure the U.S. health insurance system, yet there has been little research examining how the ACA will affect the farm sector. This article seeks to broaden approaches to agriculturally based economic development by qualitatively and quantitatively: 1) establishing health insurance as an issue directly tied to human capital in the food and agriculture sector; 2) benchmarking farmer health insurance knowledge, the link between health insurance and farm finances, individual and employer attitudes towards the ACA, and health insurance decision-making shortly after the implementation of the ACA, and; 3) contributing research findings that inform national and state efforts to develop human capital in the food and agriculture sector. Farmers in this national sample tended to be well-insured, largely due to off-farm employment. However, a meaningful numbers of farmers reported being uninsured or underinsured and explained how their own personal health is linked to the health of the farm operation. Farmer attitudes towards the ACA and anticipated impacts varied across gender, race and ethnicity; age groups; farm scale; farmers who employ non-family members and state policy environments. Overall attitudes towards the ACA are largely mixed and differences are shades of grey rather than outright extremes. Young and beginning farmers tended to have the most positive attitudes towards the ACA and were most vocal in connecting health insurance to the viability, growth and development of their farm.

Metropolitan Eco-Regimes and Differing State Policy Environments: Comparing Environmental Governance in the Portland–Vancouver Metropolitan Area

The Portland Metropolitan region, a single economic and ecological region with a bifurcated state and local governance structure, provides an opportunity to compare governance models and state policy environments in a single region. Using stakeholder interviews and secondary sources, we examine the role of state government policy in shaping and supporting different regimes. We find that Portland exhibits a stable, “smart-growth” regime that we characterized as a metropolitan eco-regime whereas Vancouver is in a period of fragmentation without a stable metropolitan regime. This is best explained by the differing state-level regulatory contexts and the different forms of polycentricity influenced by state action. Differences in regime and governance structure result in differently drawn and expanded urban growth boundaries with subsequent differences in land-use outcomes. We conclude with observations about state-level action and subsequent forms of polycentricity to support metropolitan eco-regimes.

Women's Pathways to Abortion Care in South Carolina: A Qualitative Study of Obstacles and Supports.

Women seeking timely and affordable abortion care may face myriad challenges, including high out-of-pocket costs, transportation demands, scheduling difficulties and stigma. State-level regulations may exacerbate these burdens and impede women's access to a full range of care. Women's reports of their experiences can inform efforts to improve pathways to abortion care. In 2014, semistructured qualitative interviews were conducted with 45 women obtaining abortions in South Carolina, which has a restrictive abortion environment. Interviews elicited information about women's pathways to abortion, including how they learned about and obtained care, whether they received professional referrals, and the supports and obstacles they experienced. Transcripts were examined using thematic analysis to identify key themes along the pathways, and a process map was constructed to depict women's experiences. Twenty participants reported having had contact with a health professional or crisis pregnancy center staff for pregnancy confirmation, and seven of them received an abortion referral. Women located abortion clinics through online searches, previous experience, and friends or family. Financial strain was the most frequently cited obstacle, followed by transportation challenges. Women reported experiencing emotional strain, stress and stigma, and described the value of receiving social support. Because of financial pressures, the regulation with the greatest impact was the one prohibiting most insurance plans from covering abortion care. Further research on experiences of women seeking abortion services, and how these individuals are affected by evolving state policy environments, will help shape initiatives to support timely, affordable and safe abortion care in a climate of increasing restrictions.

Opportunities and Challenges for Payment Reform: Observations from Massachusetts.

Policy makers and private health plans are expanding their efforts to implement new payment models that will encourage providers to improve quality and deliver health care more efficiently. Over the past five years, payment reforms have progressed faster in Massachusetts than in any other state. The reasons include a major effort by Blue Cross Blue Shield of Massachusetts to implement global payment, the presence of large integrated systems willing to take on financial risk, and a supportive state policy environment. By 2014, thirty-seven percent of Massachusetts's residents enrolled in health plans were covered under risk-based payment models tied to global budgets. But the expansion of payment reform in Massachusetts slowed between 2012 and 2015 because some commercial enrollment shifted from risk-based health maintenance organization products to fee-for-service preferred provider organization (PPO) plans, and the state Medicaid program fell short of its payment reform goals. Provider groups will not fully commit to population-based clinical models if they believe it will result in large reductions in fee-for-service revenue. The use of alternative payment models will accelerate in 2016 when Blue Cross begins implementing PPO payment reforms, but it is unknown how quickly other payers will follow. Massachusetts's experience illustrates the complexity of payment reform in pluralistic health care markets and the need for complementary efforts by public and private stakeholders.

State policy environment and the dental safety net: a case study of professional practice environments' effect on dental service availability in Federally Qualified Health Centers.

To determine whether and to what extent the state policy environment for the dental hygiene workforce affects the availability of dental services at Federally Qualified Health Centers (FQHCs). We examined data drawn from the Uniform Data System on 1,135 unique FQHC grantees receiving community health center funding from the U.S. Health Center program between 2004 and 2012. The Dental Hygiene Professional Practice Index was used to quantify variations in state policy environment. We then examined the influence of state policy environment on the availability of dental care through generalized linear mixed-effects models. Approximately 80% of FQHCs reported delivering dental services. We consistently observed that FQHCs with favorable levels of state support had the highest proportion of FQHCs that delivered dental services, even more so than FQHCs with extremely high support. FQHCs located in the most restrictive states had 0.28 the odds of delivering dental services as did those located in the most supportive states. The state policy environment for the dental hygiene workforce is likely associated with the availability of dental services at FQHCs. The greatest proportion of FQHCs delivering dental services was found in states with policy provisions supporting professional independence in public health settings. Nevertheless, additional research is needed to understand the specific mechanism by which these policies affect FQHCs.

A State-Level Analysis of Social and Structural Factors and HIV Outcomes Among Men Who Have Sex With Men in the United States.

We apply a social determinants of health model to examine the association of select social and structural influences on AIDS diagnosis rates among men who have sex with men (MSM) in the U.S. states. Secondary data for key social and structural variables were acquired and analyzed. Standard descriptive and inferential statistics were used to examine bivariate and multivariate associations of selected social and structural variables with estimated rate of Stage 3 HIV infection (AIDS) per 100,000 MSM in 2010. We found that living in states with a higher demographic density of lesbian, gay, bisexual, and transgender persons is independently associated with lower AIDS diagnosis rates among MSM. In addition, we found that greater income inequality and higher syphilis rates among men were associated with greater AIDS diagnosis rates among MSM, which may be attributable to state policy environments that underinvest in social goods that benefit population health, and to the fact that ulcerative sexually-transmitted infections increase biological risk of HIV transmission and acquisition. To end the epidemic in the U.S., it will be critical to identify and address state-level social and structural factors that may be associated with adverse HIV outcomes for MSM.

Variation in Practice of Expedited Partner Therapy for Adolescents by State Policy Environment

PurposeThe purpose of this study was to assess provider practice of expedited partner therapy (EPT) for adolescents with chlamydial infection across varying state policy environments and compare provider practice in a parallel treatment scenario for a nonsexually transmitted disease. MethodsAnonymous survey of randomly selected providers in one of three state EPT policy environments: EPT is (A) explicitly legal; (B) permissible, but not directly referenced in law; or (C) potentially allowable. ResultsOf 195 respondents, only 20% reported ever practicing EPT. Group A providers were more likely to have used EPT than Groups B and C. Commonly cited barriers included missed opportunity to counsel partners and ensuring medication delivery. In parallel hypothetical scenarios, providers were more likely to offer prophylactic antibiotics to a patient's mother for pertussis exposure without a face-to-face visit than the sexual partner of an adolescent with chlamydia. ConclusionsFurther investigation is needed to better understand provider and policy factors that may facilitate EPT provision to adolescents.

The Role of Federally Qualified Health Centers in Delivering Family Planning Services to Adolescents

PurposeThe purpose of this article was to examine the role of community health centers (CHCs) in providing comprehensive family planning services to adolescents, looking at the range of services offered and factors associated with provision of these services. MethodsThis study employed a mixed methods approach comprising a national survey of CHCs and six in-depth case studies of health centers to examine the organization and delivery of family planning services. We developed an adolescent family planning index comprising nine family planning services specifically tailored to adolescents. We analyzed the influence of state-level family planning policies, funding for adolescents, and organizational characteristics on the provision of these services in CHCs. The case studies identified barriers to the provision of family planning to adolescent patients. ResultsThe survey found substantial variation in the provision of family planning services at CHCs, with a mean of 6.33 out of a maximum score of 13 on the family planning adolescent services index. Title X funding and location within a favorable state policy environment were significantly associated with higher scores on the family planning adolescent services index (p value < .001 and .002, respectively). Case studies revealed barriers to adolescent family planning, including lack of funding, lack of knowledge, and limitations on school-based clinical services. ConclusionsCHCs have the opportunity to play a significant role in providing high-quality family planning to low-income, medically underserved adolescents. Additional funding, resources, and a favorable policy climate would further improve CHCs' ability to serve the family planning needs of this special patient population.

Provider Attitudes, Knowledge and Practice of Expedited Partner Therapy (EPT) for Adolescents Treated for Chlamydial Infection in Varying State Policy Environments

Provider Attitudes, Knowledge and Practice of Expedited Partner Therapy (EPT) for Adolescents Treated for Chlamydial Infection in Varying State Policy Environments

Variation in U.S. traffic safety policy environments and motor vehicle fatalities 1980–2010

ObjectiveTo examine the impact of variation in state laws governing traffic safety on motor vehicle fatalities. Study designRepeated cross sectional time series design. MethodsFixed effects regression models estimate the relationship between state motor vehicle fatality rates and the strength of the state law environment for 50 states, 1980–2010. The strength of the state policy environment is measured by calculating the proportion of a set of 27 evidence-based laws in place each year. The effect of alcohol consumption on motor vehicle fatalities is estimated using a subset of alcohol laws as instrumental variables. ResultsOnce other risk factors are controlled in statistical models, states with stronger regulation of safer driving and driver/passenger protections had significantly lower motor vehicle fatality rates for all ages. Alcohol consumption was strongly associated with higher MVC death rates, as were state unemployment rates. ConclusionsEncouraging laggard states to adopt the full range of available laws could significantly reduce preventable traffic-related deaths in the U.S. – especially those among younger individuals. Estimating the relationship between different policy environments and health outcomes can quantify the result of policy gaps.

State stem cell policy and the geographic preferences of scientists in a contentious emerging field

In the USA, stem cell research policy has been addressed at both federal and state levels. This paper focuses on the heterogeneous state policy environment and compares data from surveys of stem cell scientists and other biomedical researchers to evaluate the impact of supportive state policies on stem cell scientists’ geographic preferences. At least early in the development of the field, permissive state policies were a strong predictor of scientists’ geographic preferences. Combined with an analysis of scientists’ policy awareness and explanations of their preferences, these findings suggest that supportive state science policies have influenced scientists’ geographic preferences and, at least in the case of stem cell research where federal funding restrictions are prevalent, may help states to successfully recruit scientists.