State Policymakers Research Articles

Overcoming barriers to HIV prevention: population health considerations on optimizing PrEP access.

The HIV epidemic remains a critical public health priority in the United States. The Ending the HIV Epidemic (EHE) initiative seeks to reduce HIV diagnoses by 75% by 2025 and by 90% by 2030. Certain demographic groups-including transgender women, cisgender Black women, and Black/African American and Hispanic/Latino men who have sex with men-are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) has proven effective in reducing HIV transmission. Real-world data indicate that the states with higher PrEP coverage have experienced steeper declines in new HIV diagnoses; however, several barriers hinder equitable PrEP access and uptake. Challenges such as stigma, discrimination, lack of education, and insurance barriers contribute to disparities in PrEP uptake and access to care, particularly in underserved communities. Population health decision-makers, including managed care organizations and federal and state policy makers, can play a vital role in expanding PrEP coverage and uptake by addressing these barriers and ensuring zero out-of-pocket costs for individuals who need PrEP. Enhancing health care provider education and person-centered HIV prevention strategies (eg, same-day PrEP services, telePrEP programs) also can increase PrEP uptake and adherence and patient satisfaction. A continuous focus on improving PrEP access can substantially contribute to achieving the EHE initiative's goal to end the HIV epidemic.

Next Generation of US Policies for Industrial Innovation

Forecasts project that industry will be the highest emitting sector in the United States by 2030. While recent legislation and programs have boosted efforts to decarbonize and bolster the competitiveness of the U.S. industrial sector, the programs must continue and additional action is needed. This note provides an overview of many industrial policy tools federal and state policymakers can use to secure the future of U.S. industries, ranging from continuation and expansion of existing tax credits, procurement policies, and grant programs to new policies, including demand-side and market-based policies.

Creating a robust coordinated data and policy framework for addressing substance use issues in the United States

The ongoing opioid epidemic has been met with the inadequate use of data-informed approaches to respond to the crisis. Although data relevant to opioid and substance use do exist and have been utilized for research in the literature and practice, they have not been prepared for cross-sector coordination and for providing practical intelligence to inform policy planning directly. In this article, we share our views on how data can better serve the purposes of informing policy and planning to maximize population health and safety benefits. Based on our experience in advising state policymakers on developing settlement allocation strategies based on empirical data, we discuss several issues in the data, including coverage, specificity in drug types, time relevance, geographic units, and access, which may hinder data-informed policymaking. Following these discussions, we envision a coordinated data and policy framework as an ideal case to ensure access to meaningful and timely data and harness the full potential of the data to inform policy to combat the continuing epidemic.

National Academies of Sciences, Engineering, and Medicine Standing Committee on Primary Care: An Objective Venue to Inform Policy.

The 2021 National Academies of Sciences, Engineering, and Medicine (NASEM) report Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care outlined an implementation framework with recommendations for federal, state, and local policy makers, health systems, educational institutions, the interprofessional workforce, and others across the health care ecosystem to ensure that high-quality primary care is available for everyone in the United States. Based on 1 of the report's recommendations, the Department of Health and Human Services, in collaboration with the Department of Veterans Affairs and the Department of Agriculture, launched the Initiative to Strengthen Primary Health Care in 2021 to coordinate and prioritize primary care activities across the federal government. Formation of this federal coordinating body is a critical step for improving primary care in the US, but it is equally important to enable external primary care policy experts, researchers, and working clinicians to provide input on urgent primary care needs and priorities as primary care policy evolves. The newly launched NASEM Standing Committee on Primary Care will provide a venue for input that is independent, objective, and evidence-based to inform policy, spark progress and innovation, and confront challenging issues facing primary care today and in the future.

Beyond Electric Vehicles: Recommendations for State and Municipal Policymakers to Ensure a Sustainable Transportation Future

Electric vehicles have rapidly become a primary component of the US’s strategy to reduce greenhouse gas emissions and mitigate the severity of climate change. While it will surely serve an important role, EV technological advancement alone is far from a silver bullet to solve all transportation-related climate woes. On the contrary, the formidable degree of electrification necessary to meet climate goals, paired with the rapid development of clean power grids and the immense quantity of critical minerals such as lithium and cobalt needed to power this transition, is a cause for concern over the feasibility of a strategy relying fundamentally on electric vehicles. A more comprehensive, impactful, and sustainable strategy would target the car-centric foundations of US culture to make electrification more attainable while also reducing the per-vehicle resource burden and promoting more sustainable battery alternatives.

In What Institutional Contexts Do Adult Community College Students Prosper?

Objective: Policymakers in many states are endeavoring to increase graduation rates among older community college students. However, we know little about how the factors that influence college completion among older students differ from their younger peers. We aim to identify features of institutional contexts in which adult community college students are more likely to prosper, as evidenced by an elevated likelihood of graduating. Methods: Using a multilevel statistical approach to analyze administrative data for Ohio’s community colleges, we examine how associations between students’ age and their likelihood of graduating differ as a function of dosage-weighted exposure to six contextual characteristics that align with the organizational, human aggregate, and socially constructed dimensions of Strange and Banning’s (2015) socioecological framework for campus environments. Results: Contrary to expectations, we find more similarities than differences between older and younger students in how exposure to particular institutional characteristics is related to the likelihood of graduating. Only one of the six characteristics has a relationship of meaningful magnitude with the likelihood of graduating among students of any age. Specifically, exposure to classmates taking heavier course credit loads is positively related to the likelihood of graduating for students 40 years of age and older. Conclusion: Our findings point to two potential levers for strengthening outcomes of older students as community colleges seek to become adult- serving not just adult- enrolling. First, incentivize a full-time course load across the student population. Second, create opportunities for adult students, many of whom attend part-time, to take classes with a range of classmates, including younger classmates and classmates who are attending full-time.

Empowering Salon Professionals: A Needs Assessment to Understand Training Preferences and Strategies for Addressing Sex Trafficking and Violence

ABSTRACT In some U.S. regions, laws mandate violence training for salon professionals, but Indiana has no current requirement. Our study surveyed 408 licensed salon professionals in Indiana to explore their experiences with violence and sex trafficking and their training preferences. Participants aged 18 to 70 came from all 92 counties, with most holding barber, cosmetologist, or massage therapist licenses. A significant majority (80.1%, n = 327) reported encounters with sex trafficking victims, and 88.0% (n = 359) noted interactions with intimate partner violence (IPV) victims. Barbers and instructors were more likely to encounter both IPV and sex trafficking victims compared to other professionals (χ2 = 7.45, p < .02; χ2 = 8.74, p < .01), while licensed estheticians and electrologists expressed significantly more uncertainty in responding to cases compared to non-licensed professionals (χ2 = 33.34, p < .001). Participants emphasized the need for mandatory violence prevention education covering intervention strategies, victim identification, resources, and safety plans. They also highlighted the importance of collaboration with state agencies, policymakers, and community partners. Longer-tenured professionals reported more frequent encounters with victims (F(2, 403) = 5.91, p < .01), reinforcing the need for ongoing, role-specific training to boost confidence in responding to suspected cases.

Government-Business Relations in Policymaking During the New Order Indonesia

Government–business relations have been central to general discussions on policymaking in democratic states. This study analyzes government–business relations in policymaking during economic booms and crises in New Order Indonesia (March 1966–May 1998). The analysis is based on pluralist, state autonomy, and capacity theories, and critical discourse analysis is applied to textual sources to reveal the historical dimensions of policymaking during the economic booms and downturns under the New Order Indonesia. The findings show that policymaking during these periods was characterized by complex, dialectical, and dynamic relations between the government and businesses.

On political interests and self-serving diversity: How state policymakers envision public service media

ABSTRACT Since 2012, diversity has been a declared pillar of Public Service Media (PSM) organizations worldwide – yet the term lacks conceptual clarity. This article offers an empirical analysis of how diversity is discussed and conceptualized in the process of legislating a new PSM law. Through reflexive thematic analysis of 160 transcripts of Israel’s parliament discussions during 2012–2018, we find that policymakers approach diversity as a crucial feature in PSM organizations, yet seem unable to produce an operationalizable definition of it. Our findings suggest diversity is easily manipulated for political interests – a phenomenon we coin as “self-serving diversity.” The Israeli case herein contributes a data-based approach to theorizing media diversity as a bendable ideology rather than a concrete embracive approach to society.

The Effects of Policy-Interested Bureaucrats on State and Local Policymaking

From 1971 to 2023, 19 states, 24 counties, and 105 cities passed Source-of-Income Anti-Discrimination (SOI) laws, outlawing landlord discrimination against tenants receiving rental assistance. I present a theory of bureaucratic involvement in state and local policymaking, arguing that policy-interested local bureaucratic agencies—signaled by participation in a national membership organization—elevate mission-relevant policy problem definitions to the legislative agenda and motivate the passage of legislation. I present results from a Cox Proportional Hazards Model which demonstrates that SOI laws are significantly more likely to be enacted in cities, counties, and states associated with a public agency which is a member of the Council of Large Public Housing Authorities, even compared to jurisdictions associated with non-member Public Housing Authorities of similar sizes.

Penerapan Kaidah Fiqh dalam Hukum Media Sosial di Era Globalisasi Ilmu Pengetahuan dan Teknologi

The globalization of science and technology continues, especially on social media. On the one hand, the benefits of various conveniences are also clearly felt to cause harm. The research examines social media laws and the limitations of their use concerning fiqh rules. This research includes normative legal research methods with a conceptual approach in the form of Islamic law principles. The study concludes that the original law of social media is permissible (permissible) and will change to be recommended if it brings benefits and change to be forbidden if it causes damage. However, the potential for harm in social media exists, so there must be limits to its use and regulatory restrictions, especially restrictions that apply widely in society through state policymaking. The research results can be considered when responding to developments in technology and information, especially regarding social media, so that we can use social media more wisely. Keywords: Social Media Law, Fiqh Rules, Era of Globalization of Science and Technology

Building Public–Private Partnerships for Advanced Air Mobility Infrastructure Using Game Theory

To operationalize advanced air mobility (AAM) and realize its potential market value, AAM infrastructure development is needed. However, the investment required for this often exceeds the individual capacity of state governments. The challenge for state governments lies in deciding whether they can independently invest in the entire infrastructure or whether they should form public–private partnerships (PPP) with private entities. To aid state governments and policymakers in making informed decisions on AAM infrastructure investment, we have devised two models: one without PPP, identifying the optimal timing for the state governments to independently invest in AAM infrastructure in specific cities over a given analysis horizon, and the other with PPP, focusing on resolving a PPP game for AAM infrastructure investment involving state governments and private investors. The PPP model addresses uncertainties and risks in AAM operations and allows renegotiation between investors in case of unexpected situations. The equilibrium solutions generated from the PPP model reveal optimal strategies for state governments and private investors. Results highlight the required investment amounts, the optimal investment times, and the investment returns for both players. Additionally, parametric analysis is conducted by varying critical parameters to observe how these variations affect outcomes for both investors.

Charting the Ethical Frontier in Newborn Screening Research: Insights from the NBSTRN ELSI Researcher Needs Survey

From 2008 to 2024, the Newborn Screening Translational Research Network (NBSTRN), part of the National Institute of Child Health and Human Development (NICHD) Hunter Kelly Newborn Screening Program, served as a robust infrastructure to facilitate groundbreaking research in newborn screening (NBS), public health, rare disease, and genomics. Over its sixteen years, NBSTRN developed into a significant international network, supporting innovative research on novel technologies to screen, diagnose, treat, manage, and understand the natural history of more than 280 rare diseases. The NBSTRN tools and resources were used by a variety of stakeholders including researchers, clinicians, state NBS programs, parents, families, and policy makers. Resources and expertise for the newborn screening community in ethical, legal, and social issues (ELSI) has been an important area of focus for the NBSTRN and this includes efforts across the NBS system from pilot studies of candidate conditions to public health implementation of screening for new conditions, and the longitudinal follow-up of NBS-identified individuals to inform health outcomes and disease understanding. In 2023, the NBSTRN conducted a survey to explore ELSI issues in NBS research, specifically those encountered by the NBS community. Since NBS research involves collaboration among researchers, state NBS programs, clinicians, and families, the survey was broadly designed and disseminated to engage all key stakeholders. With responses from 88 members of the NBS community, including researchers and state NBS programs, the survey found that individuals rely most on institutional and collegial resources when they encounter ELSI questions. Most survey responses ranked privacy as extremely or very important in NBS research and identified the need for policies that address informed consent in NBS research. The survey results highlight the need for improved collaborative resources and educational programs focused on ELSI for the NBS community. The survey results inform future efforts in ELSI and NBS research in the United States (U.S.) and the rest of the world, including the development of policies and expanded ELSI initiatives and tools that address the needs of all NBS stakeholders.

Nostalgia, Scapegoating, and Alterity Politics. An analysis of the Albatross Undercutting Zimbabwe’s Leverage of Bilateral Relations with China

The article explores the interplay of nostalgia, scapegoating, and alterity politics within the context of China–Zimbabwe relations. Grounded in postcolonial critique, constructivism, and psychology, the paper grapples with how identities, historical narratives, memory, and the legacy of colonialism shape state behavior and policymaking. Therefore, this study interrogates the contradictions, continuities, and discontinuities surrounding the ideological frameworks, histories, and power structures as they impact Zimbabwe’s postcolonial policy praxis and maneuvers with China. Pursuant, I foreground the agency of domestic political dynamics in shaping the nature, impact, success, or failure thereof, of China–Zimbabwe relations. Overarchingly, the study brings nuance to the broader salience of identity politics in shaping the Global South relations with emerging powers either as a source of leverage or hindrance.

EMI programs in Azerbaijani Higher Education: analysis of macro, meso, and micro level agents’ perceptions of language policy and planning implementation

ABSTRACT Within the last decade, Azerbaijani universities’ upward implementation of English-medium instruction (EMI) policy has spread among most of the country's universities, public and private . Studies show that EMI programs in many universities worldwide are positioned as a language-planning tool to promote students’ mastery of English, which would open up new horizons and facilitate globalization. Considering that language planning and policy is an understudied topic in the Azerbaijani context and that there are practically no or few studies in this vein, it is hard to appraise EMI programs as a language planning tool in terms of this country. The paper reveals the key tendencies of the increasing number of EMI programs in Higher Educational Institutions in Azerbaijan. It examines the nature of EMI-related language policy and investigates how it is enacted in practice. We analyze EMI-related language policies and listen to the voices of the stakeholders at three levels, illustrating how macro (state/national), meso (university), and micro (staff) levels translate into one another. For this, we refer to a qualitative method of data collection that includes (1) a content analysis that studies four state policy documents at the macro level, (2), interviews administered to ten state representatives and policymakers at meso levels, and sixteen university professors at micro levels. The paper is a relevant contribution to understanding the language policy and planning (LPP) tendencies in the country using EMI as a key tool for globalization and internationalization.

How Academic-Based Survey Research Organizations Inform and Influence the Development of Subnational Public Policy

This field note describes how public polling produced by academic-based survey research organizations provides state and local policymakers with information regarding public preferences. Utilizing a case study from Maryland, we describe how one such organization—the Goucher College Poll—informed the policy response to the COVID-19 pandemic in realtime. Although the American Political Science Association was founded with an eye toward applied research, academic-based survey research organizations are among the few institutions in the discipline that continue to carry out this mission in earnest.

Economic Costs Attributed to Diagnosed Diabetes in Each U.S. State and the District of Columbia: 2021.

To update state-specific estimates of diabetes-attributable costs in the U.S. and assess changes in spending from 2013 to 2021. We used an attributable fraction approach to estimate direct medical costs of diagnosed diabetes using the 2021 State Health Expenditure Accounts, the 2021 Behavioral Risk Factor Surveillance System, and the Centers for Medicare and Medicaid Services 2018-2019 Minimum Data Set. We estimated diabetes-attributable productivity losses from morbidity and mortality using the 2016-2021 National Health Interview Survey and the 2021 mortality data from the Centers for Disease Control and Prevention. Costs were adjusted to 2021 U.S. dollars. Total diabetes-attributable cost in 2021 was $640 billion ($335 billion in direct medical costs and $305 billion in indirect costs). The median state-level total diabetes-attributable cost was $8.2 billion (range $842 million to $81 billion). The median state-level per-person cost was $21,082, ranging from $17,452 to $37,090. Total diabetes-attributable cost increased by a median of 33% between 2013 and 2021, ranging from 16 to 68% across states. Medical costs increased by 50% overall (range 33-79%) and by 27% (range 15-41%) for per person with diabetes. Costs paid by Medicaid experienced the highest increase between 2013 and 2021 (median 153%; range 41-483%). State economic costs of diagnosed diabetes are substantial and increased over the last decade. These costs and their growth vary considerably across states. These findings may help state policy makers in developing evidenced-based public health interventions in their respective states to prevent and control the prevalence of diabetes.

Mental Health Agency Officials' Perceived Priorities for Youth Mental Health and Factors That Influence Priorities.

This study aimed to characterize the perceived priorities of state and county policy makers for youth mental health services and the factors that influence those priorities. Mental health agency officials (N=338; N=221 state officials, N=117 county officials) representing 49 states completed a Web-based survey in 2019-2020. On 5-point scales, respondents rated the extent to which 15 issues were priorities for their agency in providing youth mental health services and the extent to which nine factors influenced those priorities. Suicide was identified as the highest priority (mean±SD rating=4.38±0.94), followed by adverse childhood experiences and childhood trauma and then increasing access to evidence-based treatments. Budget issues (mean=4.27±0.92) and state legislative priorities (mean=4.01±0.99) were perceived as having the greatest influence on setting priorities. These findings provide insights into youth mental health policy priorities and can be used to guide implementation and dissemination strategies for research and program development within state and county systems.

A Mixed Methods Approach to Understanding the Public Health Impact of a School-Based Citizen Science Program to Reduce Arsenic in Private Well Water.

Exposure to arsenic (As) in well water is a well-documented public health issue for Maine and New Hampshire, as well as for other states in the United States and abroad. Arsenic contamination of well water in these locations is primarily attributed to metasedimentary bedrock that leaches As into groundwater. However, As can also enter groundwater reserves from soils contaminated by the historical use of arsenical pesticides. Approximately half of the households in Maine and New Hampshire rely on private wells, many of which have elevated As. Arsenic exposure has been associated with an increased risk of cancer, cardiovascular disease, reduced infection resistance, and lower intelligence quotient in children. Despite these known health impacts, well water testing and treatment are not universal. We have approached the problem of low well water testing rates in Maine and New Hampshire communities by developing the All About Arsenic (AAA) project, which engages secondary school teachers and students as citizen scientists in collecting well water samples for analysis of As and other toxic metals and supports their outreach efforts to their communities. We assessed this project's public health impact by analyzing student data relative to existing well water quality datasets in both states. In addition, we surveyed private well owners who contributed well water samples to the project to determine the actions taken to mitigate As in well water. Students collected 3,070 drinking water samples for metals testing, and 752 exceeded New Hampshire's As standard of . The AAA data has more than doubled the amount of information available to public health agencies about well water quality in multiple municipalities across both states. Students also collected information about well types and treatment systems. Their data reveal that some homeowners did not know what type of wells they had or whether they had filtration systems. Those with filtration systems were often unaware of the type of system, what the system was filtering for, or whether the system was designed to remove As. Through interviews with pilot survey participants, we learned that some had begun mitigating their exposure to As and other toxic metals in response to test results from the AAA project. A school-based approach to collecting and analyzing private well water samples can successfully reach communities with low testing rates for toxic elements, such as As and other metals. Importantly, information generated through the program can impact household decision-making, and students can influence local and state policymaking by sharing information in their communities. https://doi.org/10.1289/EHP13421.

Assessing Contexts, Not Children: Working Towards Early Educational Equity by Prioritizing Agentic Learning Experiences Over Control

United States policymakers and education leaders continue to assess young children as if their learning contexts are neutral and harmless. This article draws upon examples from the multi-sited Civic Action and Young Children study to show why contexts that actively refuse deficit, racist thinking and support agency have the best chance of showing children’s diverse ranges of skills and knowledge and so should be the focus of assessment.