State Policies Matter: The Case of Outpatient Drug Treatment Program Practices

This study examined relationships between state policy requirements governing outpatient substance abuse treatment services and reported outpatient treatment program practices. State policies effective as of February 1, 2003, and February 1, 2004, were collected and analyzed via primary legal research; data were validated by state officials (88% response rate; \u3e 90% validation rate). Treatment practice data were obtained from the National Survey of Substance Abuse Treatment Services for the years 2003 and 2004. Multivariate analyses clustered by state were conducted, controlling for state, program, and state-aggregated client admission characteristics. Results indicated that treatment programs located in states with requirements for comprehensive substance abuse assessment, family counseling, substance abuse and infectious disease/sexually transmitted disease testing services, HIV/AIDS education, and aftercare services had significantly higher odds of offering such services (p values ranging from \u3c .05 to \u3c .001). This study presents new information regarding the potential role that state policy context may play in understanding treatment program practices

Drug Treatment Program Ownership, Medicaid Acceptance, and Service Provision.

The Institute of Medicine noted that effective substance abuse treatment (SAT) programs integrate individual therapeutic approaches with transitional/ancillary services. In addition, research suggests that type of ownership impacts SAT services offered and that Medicaid plays a key role in SAT access. Data from the National Survey of Substance Abuse Treatment Services for the years 2000 and 2002–2006 were used to examine relationships among SAT program Medicaid acceptance, program ownership, and transitional/ancillary service accessibility. Multivariate logistic regression models controlling for state- and program-level contextual factors were used to analyze the data. Nonprofit SAT programs were significantly more likely to offer transitional/ancillary services than for-profit programs. However, programs that accepted Medicaid, regardless of ownership, were significantly more likely to offer most transitional/ancillary services. The data suggest that Medicaid may play a significant role in offering key transitional/ancillary services related to successful treatment outcome, regardless of program ownership type

Will web-based research suffice when collecting U.S. school district policies? The case of physical education and school-based nutrition policies

<p>Abstract</p> <p>Background</p> <p>Recognizing the growing childhood overweight problem, a number of school-based strategies, including policy approaches, have been proposed and are being implemented to address the problem considering the amount of time children spend in schools. This paper describes the results of a pilot study that tested approaches to collecting U.S. school district policy information regarding physical education and nutrition requirements that can inform efforts by policy makers, researchers, advocates and others interested in collecting school district-level obesity-related policies that are typically not systematically available from a "one stop" source.</p> <p>Methods</p> <p>Sixty local school districts representing six states were selected for conducting the district policy research, with larger, urban school districts over-sampled to facilitate collection of policies from districts representing a larger proportion of the public school population in each study state. The six states within which the pilot districts were located were chosen based on the variability in their physical education and school-based nutrition policy and geographic and demographic diversity. Web research and a mail canvass of the study districts was conducted between January and May 2006 to obtain all relevant policies. An additional field collection effort was conducted in a sample of districts located in three study states to test the extent to which field collection would yield additional information.</p> <p>Results</p> <p>Policies were obtained from 40 (67%) of the 60 districts, with policies retrieved via both Web and mail canvass methods in 16 (27%) of the districts, and were confirmed to not exist in 10 (17%) of the districts. Policies were more likely to be retrieved from larger, urban districts, whereas the smallest districts had no policies available on the Web. In no instances were exactly the same policies retrieved from the two sources. Physical education policies were slightly more prevalent than nutrition policies.</p> <p>Conclusion</p> <p>Collection of U.S. local school district policies requires a multi-pronged approach. Web research and mail canvasses will likely yield different types of policy information. Given the variance in district-level Web site presence, researchers and others interested in obtaining district physical education and nutrition-related policies should consider supplementing Web research with more direct methods.</p

Does State Certification or Licensure Influence Outpatient Substance Abuse Treatment Program Practices?

In the United States, state governments legally authorize outpatient substance abuse treatment programs. In some states, programs are certified or accredited (ideal standards). Other states license programs (minimal standards). Additionally, some states authorize programs through deemed status , which is afforded to programs attaining accreditation from a national accrediting body. Primary legal research and the National Survey of Substance Abuse Treatment Services\u27 (N-SSATS) data were used to examine the relationships between state authorization type (certification/accreditation vs licensure with and without deemed status) and outpatient treatment program practices. Programs in certification/accreditation (vs licensure) states had significantly higher odds of offering wrap-around and continuing care/after care services associated with better long-term treatment outcome. Programs in states that allowed for certification/accreditation with deemed status had significantly lower odds of infectious disease testing, but higher odds of providing group and family counseling. Results suggest that state authorization type may impact services offered by outpatient treatment programs

State Methamphetamine Precursor Policies and Changes in Small Toxic Lab Methamphetamine Production

Domestic production of methamphetamine in small toxic labs (STLs) results in significant community safety and health consequences. This paper examines the effects of state-level policies implemented in the middle of the last decade in reaction to a rapid increase in STL labs. These policies focused on controlling access to the methamphetamine precursor chemicals ephedrine and pseudoephedrine and the relationship of such policies with actual STL seizure rates. Data include (a) primary legal research on state laws/regulations in all 50 states in effect as of October 1, 2005; and (b) STL seizure counts for 2004–2006. Results from random effects cross-sectional time-series regression models showed that states with the greatest reduction in STL seizures had comprehensive policies involving quantity limits on methamphetamine precursor purchases, clerk intervention requirements (such as requiring buyer identification) and regulatory agency specification for monitoring compliance and tracking multiple purchases. Criminalizing purchasing violations was not related to STL reductions

Applying hybrid effectiveness-implementation studies in equity-centered policy implementation science

Policy implementation science (IS) is complex, dynamic, and fraught with unique study challenges that set it apart from biomedical or clinical research. One important consideration is the ways in which policy interacts with local contexts, such as power and social disadvantage (e.g., based on ability, race, class, sexual identity, geography). The complex nature of policy IS and the need for more intentional integration of equity principles into study approaches calls for creative adaptations to existing implementation science knowledge and guidance. Effectiveness-implementation hybrid studies were developed to enhance translation of clinical research by addressing research questions around the effectiveness of an intervention and its implementation in the same study. The original work on hybrid designs mainly focused on clinical experimental trials; however, over the last decade, researchers have applied it to a wide range of initiatives and contexts, including more widespread application in community-based studies. This perspectives article demonstrates how effectiveness-implementation hybrid studies can be adapted for and applied to equity-centered policy IS research. We draw upon principles of targeted universalism and Equity in Implementation Research frameworks to guide adaptations to hybrid study typologies, and suggest research and engagement activities to enhance equity considerations; for example, in the design and testing of implementing strategies. We also provide examples of equity-centered policy IS studies. As the field of policy IS rapidly evolves, these adapted hybrid type studies are offered to researchers as a starting guide

A comprehensive review of state laws governing Internet and other delivery sales of cigarettes in the United States

All U.S. states regulate face-to-face tobacco sales at retail outlets. However, the recent growth of delivery sales of tobacco products by Internet and mail order vendors has prompted new state regulations focused on preventing youth access and tax evasion. To date, there are no comprehensive and systematic analyses of these laws. The objectives of this study were to: (1) document the historical enactment of the laws; (2) assess the nature and extent of the laws; and (3) conduct preliminary analyses to examine the relationship between states with laws and other factors that might predict enactment of or be impacted by these laws. Between 1995 and 2006, thirty-four states (67%) enacted a relevant law, with 23 states’ laws (45%) enacted between 2003 and 2006. Four states banned direct-to-consumer shipment of cigarettes. The remaining 30 states’ laws included a combination of requirements addressing minimum age/ID, payment issues, shipping, vendor licensure and related issues, tax collection/remittance, and penalties/enforcement. States with delivery sales laws also have stronger state excise tax rates, youth access to tobacco policies, and state tobacco control environments as well as higher cigarette excise tax revenue, past month cigarette use rates, and perceptions of risk of use by adolescents. This paper provides the policy context for understanding Internet and other cigarette delivery sales laws in the U.S. It also provides a systematic framework for ongoing policy surveillance and will contribute to future analyses of the impact of these laws on successfully reducing youth access to cigarettes and preventing tax evasion

Driven to Support: Individual- and County-Level Factors Associated With Public Support for Active Transportation Policies

Purpose: To assess predictors of stated support for policies promoting physically active transportation. Design: Cross-sectional. Setting: US counties selected on county-level physical activity and obesity health status. Participants: Participants completing random-digit dialed telephone survey (n = 906). Measures: Survey measures assessed stated support for 5 policies to promote physically active transportation, access to active transportation facilities, and time spent in a car. County-level estimates included household car dependence and funding for bicycle–pedestrian projects. Analysis: Multivariable generalized linear mixed models using binary distribution and logit link, accounting for clustering within county. Results: Respondents supported policies for accommodating bicyclists and pedestrians through street improvements (89%), school active transportation programs (75%), employer-funded active commuting incentives (67%), and allocation of public funding (68%) and tax support (56%) for building and maintaining public transit. Residents spending >2 h/d (vs $1.6 million in bicycle and pedestrian improvements expressed greater support for funding (OR: 1.71; CI: 1.04-2.83) and tax increases (OR: 1.73; CI: 1.08-2.75) for transit improvements compared to those with lower prior investments ($1.6 M), public transit is nearby, and respondents drive >2 h/d

Policy, Systems, and Environmental Approaches for Obesity Prevention: A Framework to Inform Local and State Action

The public health literature has not fully explored the complexities of the policy process as they relate to public health practice and obesity prevention. We conducted a review of the literature across the policy science and public health fields, distilled key theories of policy making, and developed a framework to inform policy, systems, and environmental change efforts on obesity prevention. Beginning with a conceptual description, we focus on understanding three domains of the policy process: the problem domain, the policy domain, and the political domain. We identify key activities in the policy process including the following: (a) assessing the social and political environment; (b) engaging, educating and collaborating with key individuals and groups; (c) identifying and framing the problem; (d) utilizing available evidence; (e) identifying policy solutions; and (f) building public support and political will. The article provides policy change resources and case studies to guide and support local and state efforts around obesity prevention

Effects of countdown displays in public transport route choice under severe overcrowding

The paper presents a route choice model for dynamic assignment in congested, i.e. overcrowded, transit networks where it is assumed that passengers are supported with real-time information on carrier arrivals at stops. If the stop layout is such that passenger congestion results in First-In-First-Out (FIFO) queues, a new formulation is devised for calculating waiting times, total travel times and route splits. Numerical results for a simple example network show the effect of information on route choice when heavy congestion is observed. While the provision of information does not lead to a remarkable decrease in total travel time, with the exception of some particular instances, it changes the travel behaviour of passengers that seem to be more averse to queuing at later stages of their journey and, thus, prefer to interchange at less congested stations