Use Of Federal Funds Research Articles

Commentary: Which Principles Should Apply for a National Strategy on Rare Diseases?

Lexchin and Sirrs (2024) proposed five relevant principles to guide the use of federal funding for expensive drugs for rare diseases, including funding of outcomes-based risk-sharing agreements (OBRSAs) and proactive commitment and participation in the generation of high-quality evidence in a transparent way. This rejoinder, however, questions whether the federal funding should be used only to buy new drugs or whether it could be used to develop new drugs as well. It also examines what OBRSAs would require in terms of institutional capacities to allow the collection of real-world evidence.

Evidence-based practice criteria’s effect on the implementation of the Family First Prevention Services Act in Nebraska and Colorado

Child abuse, particularly neglect, is often preventable because many causes of harm stem from poverty, lack of social connections, substance use disorders, mental illness, lack of childcare, and other family support shortages. Prevention of child abuse and neglect starts with family support in these areas. The federal government recognized this need for prevention, and through considerable bipartisan support, passed the Family First Prevention Services Act on February 9, 2018. The Family First Prevention Services Act was designed to divert investment away from long-term foster care and toward programs that prevent unnecessary placement and child protective services interventions. The Family First Prevention Services Act restricts the state’s use of federal funds for institutional foster care placements and uses those savings to fund reimbursements for evidence-based family preservation. The requirement for evidence-based prevention is a first in child-welfare federal law, and compliance with this requirement requires public-private partnership with agencies implementing the models, infrastructure, and evaluation standards that most states must build to be eligible for the new funding. This evaluation research analyzed how the stringent guidelines for prevention funding and the requirement of federally approved evidence-based practice programming affect the implementation of the Family First Prevention Services Act in Nebraska and Colorado.

Conducting a Comprehensive Assessment of the Public Health Workforce: Lessons Learned and Opportunities for the Future.

Indiana was one of the earliest states to conduct a comprehensive public health workforce assessment in preparation for the use of federal funds for infrastructure strengthening. Experiences from this assessment provide insights that may be useful to other public health agencies and partners. This brief summarizes key lessons and highlights opportunities for improved workforce assessments. For example, the lack of standardized job titles within local health departments (LHDs) can be mitigated by collecting the top 3 job tasks employees engage in daily and reassigning standardized titles based on nationally collected workforce data. This facilitates comparisons across LHD employees nationally. In addition, many employees felt their job tasks did not align well with the Foundational Public Health Services (FPHS) areas and capabilities, which contributed to the likely overestimation of effort. Further consideration of how to better align and/or integrate FPHS assessment within current practice is needed in addition to improved ways of assessing efforts toward FPHS.

The urgent need for contingency management among Tribal communities in the United States: Considerations for implementation, policy, and sovereignty

In two randomized controlled trials, culturally adapted contingency management (i.e., incentives provided for substance-negative urine samples) was associated with reduced alcohol and drug use among geographically diverse American Indian and Alaska Native (AI/AN) adults. In response to interest in contingency management from other Tribal and AI/AN communities, our research team in collaboration with AI/AN behavioral health experts, translated the research into practice with new AI/AN community partners. Tenets of community-based participatory research were applied to develop, pilot, and refine contingency management training and implementation tools, and identify implementation challenges. In partnership with the AI/AN communities, four members of the university team developed tools and identified implementation and policy strategies to increase the successful uptake of contingency management in each location. Through our collaborative work, we identified policy barriers including inadequate federal funding of contingency management incentives and a need for further clarity regarding federal anti-kickback regulations. Adoption of contingency management is feasible and can strengthen Tribal communities' capacity to deliver evidence-based substance use disorder treatments to AI/AN people. Unfortunately, non-evidence-based limits to the use of federal funding for contingency management incentives discriminate against AI/AN communities. We recommend specific federal policy reforms, as well as other practical solutions for Tribal communities interested in contingency management.

Revisiting the History of Abortion in the Wake of the Dobbs Decision.

Revisiting the History of Abortion in the Wake of the Dobbs Decision Kelly O’Donnell (bio) and Naomi Rogers (bio) In September 1977, Rosaura Jimenez, a twenty-seven-year-old Mexican American single mother in McAllen, Texas, went to the home of Maria Pineda for a surgical abortion. Pineda, a midwife, was licensed to deliver babies but not to perform abortions. After the procedure Jimenez developed sepsis; several days later she died of organ failure in the McAllen General Hospital. Her death would have been common and unremarkable a decade earlier, but since the Supreme Court’s 1973 Roe v. Wade decision, abortion had become legal and widely available in hospitals, clinics, and doctors’ offices across the United States. Jimenez had initially wanted a legal abortion and returned to a physician who had given her one eight months earlier, paid for by Medicaid. But in August the Hyde Amendment had gone into effect after the Supreme Court had judged it constitutional. Passed by Congress in the previous session, the amendment banned the use of federal funds for abortions and led states to restrict their funding of Medicaid as well. In McAllen Jimenez had been rebuffed by the physician, who said he would not be reimbursed, although she could find and pay for an abortion herself. Jimenez had a financial aid check in her purse to pay for her college classes (she was studying to become a special education teacher), but she chose access to education over access to legal reproductive care. After first traveling to Mexico where she received a cheaper but ineffective “hormone injection” from a pharmacy there, she sought Pineda’s aid.1 [End Page 1] Jimenez was quickly described as the first victim of the Hyde Amendment, a symbol that inspired rallies and candlelight vigils outside the state legislature in Texas and across the country. Eager to make this tragedy a potent lesson about the danger of antiabortion politics that could threaten the lives of every woman, feminist and Village Voice journalist Ellen Frankfort along with Frances Kissling, the director of the National Abortion Federation, came to McAllen in 1978. They believed that this death could become an issue that would unite feminists across class and race.2 Frankfort and Kissling, along with two of Jimenez’s friends, organized a sting operation to try to bring Pineda to justice. Setting up one woman with a wire and having Diana Rivera, another friend, pretend to need an abortion, the two white abortion activists waited in a station wagon with reporters from a Dallas television station. Pineda warned Rivera—as she had probably said to Jimenez—that if there were complications, she should say that her abortion was performed across the border in Mexico.3 The feminist visitors were then shocked to find that their race and status did not protect them from the arm of the law. Local police officers arrested not only Pineda but also Frankfurt, Kissling, and Rivera as potential “co-conspirators” in an illegal abortion.4 Texas’s weak medical practice law meant that although Pineda was found guilty of practicing medicine without a license, her misdemeanor offense resulted in three days in jail and a hundred-dollar fine. In 1979 Frankfort and Kissling published Rosie: The Investigation of a Wrongful Death and announced that 5 percent of the book’s royalties would be contributed to the new Rosie Jimenez Fund to provide financial assistance to poor women seeking abortions in Texas.5 [End Page 2] Jimenez remained a symbolic figure for American feminists seeking to protect access to abortion in the face of increasingly successful anti-abortion strategies that grew more creative and restrictive in the wake of the Hyde Amendment. As a poor Latina, Jimenez offered a way for white middle-class feminists to demonstrate cross-class, cross-racial support of reproductive health care in the face of the splintering of feminist organizations such as the Black Women’s Health Project and the National Latina Health Organization in the 1980s. A more holistic reframing of reproductive rights and reproductive justice was necessary to bring together disparate groups of feminists, especially around forced sterilization.6 Access to safe and legal abortion continued as a...

Barriers to abortion provision in primary care in New England, 2019–2020: A qualitative study

ObjectiveTo assess barriers to and facilitators of abortion provision among abortion-trained primary care providers. Study DesignWe conducted 21 qualitative in-depth interviews with 20 abortion-trained family physicians and one internal medicine physician in five New England states. We dual-coded interviews, using a consensus method to agree upon final coding schema. Through iterative dialogue, using an inductive content analysis approach, we synthesized the themes and identified patterns within each domain of inquiry. ResultsThe most commonly reported barriers were a lack of organizational support, the Hyde Amendment, which prevents the use of federal funds for most abortion care, and the mifepristone Risk Evaluation and Mitigation Strategy, a federal regulation which prohibits routine mifepristone pharmacy dispensing. The logistical barriers created by these policies require cooperation from additional stakeholders, creating more opportunities for abortion stigma and moral opposition to arise. Other salient barriers included inter-specialty tension (particularly with obstetrician-gynecologists), perceived need for pre-abortion ultrasound, absence of a clinician support network, and lack of knowledge of existing resources for establishing abortion care in primary care. ConclusionsIncreased abortion provision in primary care is one of many necessary responses to the human rights crisis produced by the Dobbs decision. Eliminating the Hyde Amendment and ending federal regulations restricting pharmacy dispensing of mifepristone are key interventions to address barriers to primary care abortion provision. Building interspecialty partnerships between family medicine and OB/GYN and spreading awareness of the evidence-based ultrasound-as-needed protocol and other educational resources are also likely to increase primary care abortion access. ImplicationsBy exploring barriers to and facilitators of primary care abortion provision, this study outlines a targeted approach to support increased access to abortions. In states with legal abortion post-Roe, it is important that motivated and trained primary care providers can offer abortions, rather than referring patients to overburdened specialty clinics.

Itʼs 3:00 p.m., do you know where your children are? New Yorkʼs inadequate use of federal funds that have led to the continuance of childcare deserts

AbstractIn New York, low‐income families, urban communities, and rural areas are suffering from a lack of childcare. This inadequacy leads to the formation of childcare deserts; areas where families do not have access to childcare. Because of the vague guidelines proposed by federal grants, New York has misused federal funds, which has led to the continuance of childcare deserts. This Note proposes specifying federal funding guidelines, which can better allocate funds to needy families, as well as creating a volunteer program for high school students to create before and aftercare programs in public schools.

1197. Development and Implementation of Innovative Syringe Service Programs for Veterans in Rural and Urban Settings

BackgroundSyringe Services Programs (SSPs) is one aspect of a comprehensive Harm Reduction approach necessary to reduce the transmission of blood borne infections including Hepatitis B, Hepatitis C, and HIV. Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that in 2019 that 595,000 veterans engage in opioid misuse with at least 57,000 veterans engaging in heroin. Stigmas to SSP are pervasive in the community and within the government system. Federal law prohibited the use of federal funds to purchase sterile needles or syringes for the purposes of illegal use of drugs by injection. It was officially clarified in May 24, 2021 that the prohibition to purchase syringes does not apply to Veterans Health Administration (VHA). While awaiting approximately 2 years to secure this clarification, syringes were obtained through a community donation. We aim to describe our process including difficulties encountered and data collected for SSP at two locations. Difficulties included developing an anonymous process to track quality, motivating providers to refer, educating highest risk veterans, providing face to face engagement during COVID-19 pandemic and ability to mail Harm Reduction kits containing sterile syringes.Illiana VA Program Information Sheet Orlando VA Program Information Sheet MethodsOf the 140 facilities within VHA, there are currently only two SSPs established, Illiana VA and Orlando VA. A retrospective analysis of Harm Reduction benefits was performed among veterans who engaged with the two SSPs between 2018 to 2021. Orlando VA SSP Intake Process Map Process that veteran undergo when they engage with Orlando VA SSPContents of Standard SSP Kit Distributed to Veterans at Orlando VA ResultsApproximately 3000 syringes were dispensed. Of the 17 veterans, 65% received syringes, 82% received naloxone, 100% engagement in mental health and 94% engagement in substance use disorder clinics. In total, 65% were screened for HIV, 82% for HCV and 29% for sexually transmitted infections. ConclusionThese numbers, while modest, are notable, especially given the financial and organizational barriers that were in place. Furthermore, the COVID-19 pandemic impacted full implementation and outreach. With the recent, official clarification on syringe purchase and support for SSPs, the number of SSPs in the VA will grow, along with opportunity for more robust data collection. The experience of both facilities is a model for programs currently in development and moves us closer to ending the HIV epidemic by 2030.Disclosures All Authors: No reported disclosures

A Policy Mapping Analysis of the U.S. Congressional Approach to Medical Aid-in-Dying.

This study examines the goals of medical aid-in-dying (MAID) legislation introduced to the US Congress from 1994-2020 using a policy mapping analysis approach. Using congress.gov, we identified 98 bills, 23 bills were analyzed in this study. Most of the bills aimed to restrict the use of federal funds, to regulate the drugs commonly used for MAID, to prohibit the development of policies or practices supporting MAID, and to regulate practitioners' roles in MAID. In practice, these bills would limit patient access to MAID by restricting drugs, funds, health care services, legal assistance, policy, and research. These findings suggest there lacks congressional support for MAID, even though polls of the public are divided yet favorable. Policymakers who support MAID should consider affirmative policies that 1) prevent MAID policies from discriminating against vulnerable groups, 2) support funding to study the use of MAID, and 3) build avenues to allow all qualified people to access MAID in places where it is legal.

Why Social Distance Demands Social Justice: Systemic Racism, COVID-19, and Health Security in the United States.

Why Social Distance Demands Social Justice: Systemic Racism, COVID-19, and Health Security in the United States.

Training needs of investigators and research team members to improve inclusivity in clinical and translational research participation.

Despite increasing attention to the importance of diverse research participants, success across the translational research spectrum remains limited. To assess investigator and research team training needs, we conducted a web-based survey exploring barriers in knowledge and practice. Respondents (n = 279) included those affiliated with the University of Wisconsin Institute for Clinical and Translational Research (ICTR). Although all respondents reported an abstract belief in the importance of diversity, factors associated with higher levels of best practices knowledge and implementation included: (1) use of federal funding; (2) having fewer years of experience; (3) recruiting healthy participants; and (4) having recruitment training.

Securing Election Infrastructure with Hand-Marked Paper Ballots

American democracy is critically threatened by the use of insecure voting systems. Many existing electronic voting machines have malfunctioned during recent elections, and many are also vulnerable to hacking (Appel et al. 2019, Blaze et al. 2019, Blaze 2020). Most states have switched to secure, hand-marked paper ballots, but roughly 30% of Americans will continue to vote using vulnerable voting machines in 2020 (Cordova et al. 2019, Bajak 2020). While Congress allocated $380 million in 2018 and $425 million in 2020 to improve election security, these funds were neither targeted at nor sufficient for replacing all electronic voting machines. We propose that Congress (1) allocate $110 million exclusively for transitioning away from electronic voting machines and (2) prohibit the use of federal funds for purchasing voting systems that do not primarily use hand-marked paper ballots. This one-time transition cost is much smaller than even annual expenditures on other critical infrastructure (Copeland 2010; Halderman 2019). Replacing electronic voting machines with hand-marked paper ballots is the most affordable and secure option.

The Excess Mortality Risk and Prevalence of Drinking-and-Driving in the United States: 1983–2017

Drinking-and-driving remains a leading cause of preventable mortality and morbidity in the United States, yet reliable estimates of its prevalence and the increased risk it imposes on other road users remain elusive. The tendency of respondents to under-report illicit and socially stigmatized behavior and the likelihood that they select out of random sample designs suggests survey-based prevalence estimates are biased downward, resulting in upward biased estimates of excess mortality risk. Moreover, in 2015 the House of Representatives voted to prohibit the use of federal funds to plan or administer the National Roadside Survey (NRS). Therefore, in this article, we apply a statistical approach to document how the excess mortality risk, prevalence, and externality of drinking-and-driving in the United States has evolved over the past four decades. We find that drinking-and-driving declined significantly between 1983 and 1992, but has since plateaued. We also find that the excess mortality risk of drinking drivers rose steadily between 1983 and 2012, but the associated external cost of drinking drivers decreased, suggesting that ‘sober-biased technical change’ may have made all driving less dangerous, but had a smaller impact on drivers influenced by alcohol. For the latest five-year period, however, we identify a sharp reversal in both these trends.

Do Party Ties Increase Transfer Receipts in Cooperative Federalism? - Evidence from Germany

Cooperative fiscal federalism needs a multi-level consent to decide on the allocation of intergovernmental transfers. We study how parliamentary representation of municipalities on the federal level influences the allocation of federal transfers to municipal governments under this type of federalism. Using a regression discontinuity design in close electoral races, we find that a directly elected member of the federal parliament, who belongs to the party that leads the federal government, induces higher infrastructure transfers from the federal government to a local jurisdiction. However, our results show that this effect only unfolds, if the parliamentarian’s party is simultaneously leading the state government. Moreover, we identify party competition on the local level as motive behind the strategic use of federal funds. Thus, while supporting the swing voter hypothesis, our results suggest that federalism inherently entails restrictions for misusing intergovernmental transfers for political reasons.

Impact of financial reimbursement on retention rates in military clinical trial research: A natural experiment within a multi-site randomized effectiveness trial with active duty service members.

IntroductionAchieving adequate retention rates in clinical trials is essential to ensuring meaningful results. Although financial reimbursement is an effective strategy to increase participant retention, current policies restrict the use of federal funds to reimburse U.S. active duty Service members for research participation. It is unknown whether permitting financial reimbursement among this population would improve trial retention rates. A recent randomized effectiveness trial received approval to provide reimbursement to Service member participants several months after recruitment began, creating a natural experiment to study the effects of financial reimbursement on retention.Materials and methodsActive duty Service members recruited from six U.S. military treatment facilities (N = 666) were enrolled in a collaborative care study and completed assessments at baseline, three-, six-, and 12-months. Data on study assessment completion rates at three- and six-months were analyzed using the mixed-effects binary logit model to determine the probabilities of completing assessments based on reimbursement status.ResultsParticipants who received reimbursement were significantly more likely to complete study assessments at both time-points than participants who did not receive reimbursement (p < 0.01). Survey completion was 5% and 4% greater among participants offered reimbursement at three- and six-month time-points, respectively.ConclusionResults suggest that providing Service members with reimbursement for research participation is associated with modest increases in retention rates in clinical trials. Findings provide useful insight for researchers, funding agencies, and policy-makers in considering retention strategies to maximize the value and impact of military research.

Service providers' experience of methamphetamine and the portrayal of the 'ice epidemic' in remote Australia.

To contrast service providers' perceptions about crystalline methamphetamine (henceforth, ice) use and harm with information communicated in media reports and politicians' statements. In-depth semi structured interviews with service providers about the nature and extent of ice use in the local community and its impact on individual services, clients and town life. Interviews were transcribed verbatim, manually analysed and coded around key themes, interpreted and independently cross-checked for context and accuracy. Two remote towns located in different states and territories operating as service hubs to very remote communities. Twenty-seven key service providers representing local organisations that engage with ice users and/or their families. First, compared with alcohol, ice use and ice-related harm were insignificant at the two sites. Ice users were primarily high-earning and -functioning non-Australian Aboriginal tradesmen, and to a lesser extent, professionals and secondary school students. There were few Australian Aboriginal users. Ice was used to 'party', keep alert, and escape psychological distress. Second, the 'Ice Destroys Lives' campaign and references to an 'ice epidemic' amplified public anxiety about ice and ice-related harm in the surveyed communities. Third, the attention on ice distracted from the more extensive harm arising from alcohol use in their communities. The respondents questioned the notion of an 'ice epidemic' and the use of federal funding for ice-related initiatives in remote communities, especially while general alcohol and other drug services were under-resourced.

Court Rules Individual Mandate, Entire ACA Unconstitutional.

The holiday season brought a potentially fatal blow to the Affordable Care Act, but enrollment remained steady, and the law remains in place.

Justice Dept. Threatens Action Against Planned Safe Injection Sites

Justice Dept. Threatens Action Against Planned Safe Injection Sites

Electoral incentives to combat mosquito-borne illnesses: Experimental evidence from Brazil.

Mosquito-borne illnesses present significant health challenges to the developing world. If citizens are informed about their government's efforts to combat these diseases, will they reward incumbents who have performed well and punish those who have done poorly at this task? Electoral sanctioning requires that combatting disease be a sufficiently salient concern, which, in turn, is likely to depend upon subjective perceptions of the risks posed by particular illnesses. Epidemics typically prompt stronger risk perceptions than endemic diseases, but where both types circulate jointly, the more familiar endemic disease may determine public reactions. The salience of health threats also varies among individuals; those with a self-interest in prevention or a personal connection to the effects of mosquito-borne illnesses may react more strongly. This study presents the results of a face-to-face survey experiment in Pernambuco, Brazil, informing subjects about their mayor's use of federal funds to combat mosquito-borne illnesses such as dengue (an endemic disease) and Zika and chikungunya (both epidemics). We examine the effect of this information on intended vote for the mayor's reelection. For the full sample, the treatment has no significant effect. However, we find a large and significant punishment effect among voters who know someone affected by microcephaly or the Zika virus. Drawing on survey and focus group evidence, we argue that most voters fail to act upon our treatment information because mosquito control is a low-salience concern primarily associated with endemic rather than epidemic diseases. Our study constitutes the first experimental evidence as to whether informing citizens about government public health efforts affects voting behavior. Our results suggests that, where similar epidemic and endemic diseases circulate together, informational campaigns aiming to induce electoral accountability should also seek to boost the salience of the information by educating the public about the difference between familiar and newer threats.

Popularity shocks and political selection

We observe that popularity shocks are crucial for electoral accountability beyond their effects on voters' behaviors. By focusing on Brazilian politics, we show that the disclosure of audit reports on the (mis)use of federal funds by local administrators affects the type of candidates who stand for election. When the audit finds low levels of corruption, the parties supporting the incumbent select less-educated candidates. On the contrary, parties pick more-educated candidates when the audit reveals a high level of corruption. These effects are stronger in municipalities that have easier access to local media.