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

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

Civil Rights, Firearm Safety, and Environmental Protection Policies Predict Better Health among U.S. Midlife Adults

Americans suffer worse health and shorter lives than do people in most other high-income countries. The poor health and early death of many Americans are pronounced in certain states. One explanation may be the dramatic changes in the policy environment in recent decades, particularly the polarization in state policies. This research brief examines the association between several state policies and self-rated health among adults ages 45-64 from 1993 to 2016. Findings show that more liberal versions of certain state policies, namely civil rights, firearm safety, and environmental protection are associated with better health

Democratic Erosion Predicts Rising Deaths from Drug Poisoning and Infectious Disease

Strong democratic functioning is good for population health. However, democratic functioning eroded in many U.S. states in recent decades. The erosion was especially pronounced for one aspect of democratic functioning—electoral democracy, which refers to free and fair elections. This brief summarizes findings from a study examining how changes in electoral democracy in the 50 states predicted changes in the risk of death among adults ages 25-64 during 2000-2019. Findings demonstrate that democratic erosion strongly predicts rising deaths from drug poisoning, infectious disease, suicide, and homicide

Validation of a survey to examine drinking-water access, practices and policies in schools

ObjectiveEnsuring ready access to free drinking-water in schools is an important strategy for prevention of obesity and dental caries, and for improving student learning. Yet to date, there are no validated instruments to examine water access in schools. The present study aimed to develop and validate a survey of school administrators to examine school access to beverages, including water and sports drinks, and school and district-level water-related policies and practices.DesignSurvey validity was measured by comparing results of telephone surveys of school administrators with on-site observations of beverage access and reviews of school policy documents for any references to beverages. The semi-structured telephone survey included items about free drinking-water access (sixty-four items), commonly available competitive beverages (twenty-nine items) and water-related policies and practices (twenty-eight items). Agreement between administrator surveys and observation/document review was calculated using kappa statistics for categorical variables, and Pearson correlation coefficients and t tests for continuous variables.SettingPublic schools in the San Francisco Bay Area, California, USA.SubjectsSchool administrators (n 24).ResultsEighty-one per cent of questions related to school beverage access yielded κ values indicating substantial or almost perfect agreement (κ>0·60). However, only one of twenty-eight questions related to drinking-water practices and policies yielded a κ value representing substantial or almost perfect agreement.ConclusionsThis school administrator survey appears reasonably valid for questions related to beverage access, but less valid for questions on water-related practices and policies. This tool provides policy makers, researchers and advocates with a low-cost, efficient method to gather national data on school-level beverage access

Polarized Federalism: Activists, Voters, and the Resurgence of State Policy in the U.S.

This dissertation investigates the causes and consequences of policy variation and policy polarization in the U.S. states. Chapter 2 describes policy change over time. Since the 1970s, state governments have implemented important policies while national policymaking has slowed, such that Americans' relationships to government are increasingly determined by their states of residence. This policy variation is increasingly associated with party control of state government, and carries major consequences for the lives of residents. Chapter 3 further investigates the measurement of policy outcomes, suggesting that prior measures may understate policy polarization in recent years. Chapter 4 estimates the relationship between public opinion and policy outcomes. Results suggest that this relationship varies widely by policy issue area, with marijuana and LGBT rights policy showing strong responsiveness. While public opinion may play an inconsistent role in state policy change, Chapter 5 suggests that changes in activist group behavior may influence legislative behavior and policy outcomes in the states. The implications of this dissertation challenge traditional theories of federalism and state politics, suggesting that organized and well-resourced political actors, not ordinary voters, have collapsed American politics into a single national arena of contestation over the direction of public policy

Polarized Federalism: Activists, Voters, and the Resurgence of State Policy in the U.S.

This dissertation investigates the causes and consequences of policy variation and policy polarization in the U.S. states. Chapter 2 describes policy change over time. Since the 1970s, state governments have implemented important policies while national policymaking has slowed, such that Americans' relationships to government are increasingly determined by their states of residence. This policy variation is increasingly associated with party control of state government, and carries major consequences for the lives of residents. Chapter 3 further investigates the measurement of policy outcomes, suggesting that prior measures may understate policy polarization in recent years. Chapter 4 estimates the relationship between public opinion and policy outcomes. Results suggest that this relationship varies widely by policy issue area, with marijuana and LGBT rights policy showing strong responsiveness. While public opinion may play an inconsistent role in state policy change, Chapter 5 suggests that changes in activist group behavior may influence legislative behavior and policy outcomes in the states. The implications of this dissertation challenge traditional theories of federalism and state politics, suggesting that organized and well-resourced political actors, not ordinary voters, have collapsed American politics into a single national arena of contestation over the direction of public policy

Association of US state policy orientation with adverse birth outcomes: a longitudinal analysis

BackgroundThe current US context is marked by extreme right-left partisanship, which means that state policies tend to bundle together and are not experienced in isolation. While prior work has leveraged abrupt shifts in single policies to examine the effects of state policy on birth outcomes, we examined a holistic measure that captures political polarisation.MethodsData were drawn from national birth certificates for 2003-2017 (N=56 770 470). Outcomes included preterm birth, low birth weight, small-for-gestational age and other perinatal health measures. The primary exposure was a composite index of right-left state policy orientation, generated from historical data on 135 state policies. Multivariable regressions were used to estimate the association between state policy orientation and each outcome, adjusting for relevant covariates.ResultsCompared with infants born in states with right-leaning policy orientations, those born in left-leaning states had lower odds of adverse birth outcomes (eg, low birth weight: OR 0.95 (0.93, 0.97), preterm birth: OR 0.94 (0.92, 0.95)). Subgroup analyses revealed stronger associations for US-born and White mothers. With the inclusion of state fixed effects, left-leaning policy orientation was no longer associated with lower odds of adverse birth outcomes. Models were otherwise robust to alternative specifications.ConclusionWhile left-leaning state policy orientation has protective associations with a range of birth outcomes, the associations may be explained by stable characteristics of states, at least during the study period. Future studies should examine state policy orientation in association with other health outcomes and study periods

Integrated genetic and epigenetic prediction of coronary heart disease in the Framingham Heart Study

<div><p>An improved method for detecting coronary heart disease (CHD) could have substantial clinical impact. Building on the idea that systemic effects of CHD risk factors are a conglomeration of genetic and environmental factors, we use machine learning techniques and integrate genetic, epigenetic and phenotype data from the Framingham Heart Study to build and test a Random Forest classification model for symptomatic CHD. Our classifier was trained on n = 1,545 individuals and consisted of four DNA methylation sites, two SNPs, age and gender. The methylation sites and SNPs were selected during the training phase. The final trained model was then tested on n = 142 individuals. The test data comprised of individuals removed based on relatedness to those in the training dataset. This integrated classifier was capable of classifying symptomatic CHD status of those in the test set with an accuracy, sensitivity and specificity of 78%, 0.75 and 0.80, respectively. In contrast, a model using only conventional CHD risk factors as predictors had an accuracy and sensitivity of only 65% and 0.42, respectively, but with a specificity of 0.89 in the test set. Regression analyses of the methylation signatures illustrate our ability to map these signatures to known risk factors in CHD pathogenesis. These results demonstrate the capability of an integrated approach to effectively model symptomatic CHD status. These results also suggest that future studies of biomaterial collected from longitudinally informative cohorts that are specifically characterized for cardiac disease at follow-up could lead to the introduction of sensitive, readily employable integrated genetic-epigenetic algorithms for predicting onset of future symptomatic CHD.</p></div

Tapping into water: key considerations for achieving excellence in school drinking water access.

ObjectivesWe examined free drinking water access in schools.MethodsWe conducted cross-sectional interviews with administrators from 240 California public schools from May to November 2011 to examine the proportion of schools that met excellent water access criteria (i.e., location, density, type, maintenance, and appeal of water sources), school-level characteristics associated with excellent water access, and barriers to improvements.ResultsNo schools met all criteria for excellent water access. High schools and middle schools had lower fountain:student ratios than elementary schools (odds ratio [OR] = 0.06; 95% confidence interval [CI] = 0.02, 0.20; OR = 0.30, 95% CI = 0.12, 0.70). Rural schools were more likely to offer a nonfountain water source than city schools (OR = 5.0; 95% CI = 1.74, 14.70). Newer schools were more likely to maintain water sources than older schools (OR = 0.98; 95% CI = 0.97, 1.00). Schools that offered free water in food service areas increased from pre- to postimplementation of California's school water policy (72%-83%; P &lt; .048). Barriers to improving school water included cost of programs and other pressing concerns.ConclusionsAwareness of the benefits related to school drinking water provision and funding may help communities achieve excellence in drinking water access