RESUMO
This letter responds to the article "Beneath the Sword of Damocles: Moral Obligations of Physicians in a Post-Dobbs Landscape," by Anne Drapkin Lyerly, Ruth R. Faden, and Michelle M. Mello, in the May-June 2024 issue of the Hastings Center Report.
Assuntos
Aborto Induzido , Humanos , Feminino , Gravidez , Estados Unidos , Aborto Induzido/ética , Aborto Induzido/legislação & jurisprudência , Obrigações Morais , Médicos/ética , Médicos/legislação & jurisprudência , Aborto Legal/ética , Aborto Legal/legislação & jurisprudência , Risco , Governo EstadualRESUMO
During the past five years, many states have imposed out-of-pocket spending caps on insulin. In most cases, these reforms have had limited impact, in part because of the limits of state authority. Meanwhile, changes at the federal level and actions by manufacturers and commercial plans have made some of the caps nonbinding. It is not surprising that efforts to measure the impact of these caps yield conflicting results.
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Insulina , Insulina/economia , Humanos , Estados Unidos , Gastos em Saúde , Governo Estadual , Custos de Medicamentos , Hipoglicemiantes/economia , Hipoglicemiantes/uso terapêuticoRESUMO
Legislative agendas aimed at regulating nurse staffing in US hospitals have intensified after acute workforce disruptions triggered by COVID-19. Emerging evidence consistently demonstrates the benefits of higher nurse staffing levels, although uncertainty remains regarding whether and which legislative approaches can achieve this outcome. The purpose of this study was to provide a comprehensive updated review of hospital nurse staffing requirements across all fifty states. As of January 2024, seven states had laws pertaining to staffing ratios for at least one hospital unit, including California and Oregon, which had ratios pertaining to multiple units. Eight states required nurse staffing committees, of which six specified a percentage of committee members who must be registered nurses. Eleven states required nurse staffing plans. Five states had pending legislation, and one state, Idaho, had passed legislation banning minimum nurse staffing requirements. The variety of state regulations provides an opportunity for comparative evaluations of efficacy and feasibility to inform new legislation on the horizon.
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COVID-19 , Recursos Humanos de Enfermagem Hospitalar , Admissão e Escalonamento de Pessoal , Humanos , Admissão e Escalonamento de Pessoal/legislação & jurisprudência , Estados Unidos , Recursos Humanos de Enfermagem Hospitalar/legislação & jurisprudência , SARS-CoV-2 , Governo EstadualRESUMO
This Viewpoint discusses the limitations of state prescription drug spending targets for lowering medication costs.
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Medicamentos sob Prescrição , Humanos , Medicamentos sob Prescrição/economia , Estados Unidos , Gastos em Saúde , Governo Estadual , Custos de Medicamentos/tendênciasRESUMO
Importance: Despite high social and public health costs of firearm violence in the United States, the effects of many policies designed to reduce firearm mortality remain uncertain. Objective: To estimate the individual and joint effect sizes of state firearm policies on firearm-related mortality. Design, Setting, and Participants: In this comparative effectiveness study, bayesian methods were used to model panel data of annual, state-level mortality rates (1979-2019) for all US firearm decedents, with analyses conducted in October 2023. Exposures: Six classes of firearms policies: background checks, minimum age, waiting periods, child access, concealed carry, and stand-your-ground laws. Main Outcome and Measures: Primary outcomes (total firearm deaths, firearm homicide deaths, and firearm suicide deaths) were assessed using the National Vital Statistics System. Bayesian estimation was used to estimate the partial association of changes in firearms policies with subsequent changes in firearm mortality. Results: The estimated effect sizes of individual policies 5 or more years after implementation were generally small in magnitude and had considerable uncertainty. The policy class with the highest probability of reducing firearm deaths was child-access prevention laws, estimated to reduce overall firearm mortality by 6% (80% credible interval [CrI], -2% to -9%). The policy class with the highest probability of increasing firearm deaths was stand-your-ground laws, estimated to increase firearm homicides by 6% (80% CrI, 0% to 13% increase). Estimates of association of implementing multiple firearm restrictions with subsequent changes in firearm mortality yielded larger effect sizes. Moving from the most permissive to most restrictive set of firearm policies was associated with an estimated 20% reduction in firearm deaths (80% CrI, 10% to 28% reduction), with a 0.99 probability of any reductions in firearm death rates. Conclusions and Relevance: In this comparative effectiveness study of state firearm policies, the joint effect estimates of combinations of firearm laws were calculated, showing that restrictive firearm policies were associated with substantial reductions in firearm mortality. Although policymakers would benefit from knowing the effects of individual policies, the estimated changes in firearm mortality following implementation of individual policies were often small and uncertain.
Assuntos
Teorema de Bayes , Armas de Fogo , Homicídio , Armas de Fogo/legislação & jurisprudência , Armas de Fogo/estatística & dados numéricos , Humanos , Estados Unidos/epidemiologia , Homicídio/estatística & dados numéricos , Masculino , Suicídio/estatística & dados numéricos , Ferimentos por Arma de Fogo/mortalidade , Ferimentos por Arma de Fogo/prevenção & controle , Feminino , Governo Estadual , Adulto , Política Pública/legislação & jurisprudênciaRESUMO
In recent years, the Minnesota Attorney General's Office and the Minnesota Department of Health have cultivated a productive partnership to strengthen the state's multidisciplinary response to overlapping health equity and social justice issues. This article describes shared efforts in three areas: post-conviction justice, drug overdose, and human trafficking/exploitation.
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Overdose de Drogas , Minnesota , Humanos , Overdose de Drogas/prevenção & controle , Governo Estadual , Advogados , Justiça Social , Equidade em SaúdeRESUMO
The COVID-19 pandemic spurred legal and policy attacks against foundational public health authorities. Act for Public Health - a partnership of public health law organizations - has tracked legislative activity since January 2021. This article describes that activity, highlighting 2023 bills primarily related to vaccine requirements and policy innovations undertaken in the wake of the pandemic. Finally, we preview a legal framework for more equitable and effective public health authority.
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COVID-19 , Pandemias , Saúde Pública , Governo Estadual , Humanos , COVID-19/prevenção & controle , COVID-19/epidemiologia , Estados Unidos , Saúde Pública/legislação & jurisprudência , Pandemias/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Vacinas contra COVID-19 , SARS-CoV-2RESUMO
Little research has explored relationships between prenatal substance use policies and rates of maternal mortality across all 50 states, despite evidence that prenatal substance use elevates risk of maternal death. This study, utilizing publicly available data, revealed that state-level mandated testing laws predicted maternal mortality after controlling for population characteristics.
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Mortalidade Materna , Transtornos Relacionados ao Uso de Substâncias , Humanos , Feminino , Estados Unidos/epidemiologia , Gravidez , Mortalidade Materna/tendências , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Governo Estadual , Epidemiologia Legal , Adulto , Política de Saúde/legislação & jurisprudência , Cuidado Pré-Natal/legislação & jurisprudência , Detecção do Abuso de Substâncias/legislação & jurisprudênciaRESUMO
Drug-impaired driving is a growing problem in the U.S. States regulate drug-impaired driving in different ways. Some do not name specific drugs or amounts. Others do identify specific drugs and may regulate cannabis separately. We provide up-to-date information about these state laws.
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Dirigir sob a Influência , Governo Estadual , Humanos , Estados Unidos , Dirigir sob a Influência/legislação & jurisprudência , Controle de Medicamentos e Entorpecentes/legislação & jurisprudência , Condução de Veículo/legislação & jurisprudência , Legislação de MedicamentosRESUMO
Pre-exposure prophylaxis (PrEP) has the potential to prevent new HIV infections, but it is unclear how state policies governing sexual and reproductive health services (SRH) impact access for cisgender women. The objective of this review is to identify barriers to PrEP access for cisgender women in the United States. Using the CDC Atlas Program, 20 states with the highest HIV incidence among cisgender women were included in this analysis. Through a search conducted in May-July 2022 of CDC, PrEPWatch.org, and other State Department and Insurance websites, Medicaid expansion status, pharmacist PrEP prescribing laws, financial support programs, and Traditional Medicaid coverage of PrEP, HIV testing, and emergency contraception were reviewed. Of the included states, nearly half did not expand Medicaid at the state level. Emergency contraception and HIV testing was covered under Traditional Medicaid for almost all included states, but insurance stipulations and eligibility requirements remain. Although PrEP is covered under all Traditional Medicaid plans, six states require pre-authorization. Three states have HIV testing mandates, four allow pharmacists to prescribe PrEP and six have financial support programs to cover the cost of PrEP. Medicaid expansion, pre-authorization requirements for PrEP prescriptions and emergency contraception, and limitations on pharmacist prescribing abilities were identified as barriers to SRH access for cisgender women. Medicaid expansion should be prioritized as an approach to expanding access to HIV prevention services at the state level.
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Infecções por HIV , Acessibilidade aos Serviços de Saúde , Medicaid , Profilaxia Pré-Exposição , Humanos , Estados Unidos , Medicaid/estatística & dados numéricos , Profilaxia Pré-Exposição/estatística & dados numéricos , Profilaxia Pré-Exposição/economia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Feminino , Infecções por HIV/prevenção & controle , Política de Saúde , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Governo Estadual , Saúde Sexual/estatística & dados numéricosRESUMO
Government health messaging is significant to the containment of public health crises. Such communication may benefit from using fear appeal, a message strategy for promoting health and preventing diseases. Yet little scholarly attention has been paid to how fear appeal is employed in government messaging to promote social media engagement through online actions including likes, shares, and comments. These actions play a meaningful role in addressing communication exigencies within the context of health crises. In this study, quantitative content analysis and corpus linguistics methods were employed to analyze fear appeal-related elements in COVID-19 messages sent by a state-owned media outlet on social media. The results show that when compared to messages without threat, messages conveying threat elicited significantly more comments, in which emotions and perceptions to threat and efficacy were exhibited, while messages containing both threat and efficacy generated more engagement in comparison to messages with threat alone. Moreover, while subdimensions under efficacy were positive predictors of engagement, those under threat were primarily found to have exerted negative effects. The findings provide insights into how fear appeal elements can be employed in government health crisis communication to engage the public.
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COVID-19 , Medo , Comunicação em Saúde , Mídias Sociais , Humanos , COVID-19/prevenção & controle , Mídias Sociais/estatística & dados numéricos , Comunicação em Saúde/métodos , Governo Estadual , Comunicação Persuasiva , Estados UnidosRESUMO
We conducted a comprehensive review of state workers' compensation laws in the United States to evaluate the extent to which they support first responders with mental injury. Most state workers' compensation systems divide mental injuries into categories based on their presumed etiology: physical-mental, mental-physical, and mental-mental. Major differences exist among states as to which workers are eligible. Proving workplace causation can be difficult where no traumatic physical injuries exist. Latency periods, time limits, preexisting health conditions, restrictions as to types of condition covered, and complex chains of causation may make this burden, which falls on the claimant, even more challenging. Only nine (9) states enacted presumption of causation laws for mental health conditions to ease claimants' burden of proof. This contrasts starkly with presumption laws for chronic and infectious diseases. State decision-makers should create presumptions that mental health conditions in first responders are caused or significantly exacerbated by their stressful workplaces.
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Transtornos Mentais , Indenização aos Trabalhadores , Humanos , Estados Unidos , Indenização aos Trabalhadores/legislação & jurisprudência , Saúde Mental/legislação & jurisprudência , Governo EstadualRESUMO
Cross jurisdictional collaboration efforts and emergency vaccine plans that are consistent with Tribal sovereignty are essential to public health emergency preparedness. The widespread adoption of clearly written federal, state, and local vaccine plans that address fundamental assumptions in vaccine distribution to Tribal nations is imperative for future pandemic response.
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Vacinas , Humanos , Planejamento em Desastres , Governo Federal , Indígenas Norte-Americanos , Governo Estadual , Estados Unidos , Vacinas/provisão & distribuiçãoRESUMO
This Viewpoint from AHRQ describes the plan to create a national health care extension service to disseminate actionable knowledge, with a goal to reduce the gap from evidence of clinical effectiveness to clinical practice.
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Melhoria de Qualidade , United States Agency for Healthcare Research and Quality , Estados Unidos , Humanos , Governo Estadual , Atenção à Saúde/organização & administraçãoRESUMO
OBJECTIVE: Governmental public health agencies have experienced longstanding challenges in recruiting individuals at the state and local level. Understanding civil service laws as they relate to the hiring processes is an important component of recruitment and increasing public health workforce capacity. This study presents state hiring laws and regulations governing the public health government workforce. METHODS: Legal mapping techniques were employed to collect and code data on current hiring laws governing governmental public health employees across all 50 states. The review of laws included constitutions, statutes and regulations, and searches of administrative code. RESULTS: In 12 states, the laws do not specify civil service exam criteria or they have no mention of civil service exams in the law. Almost a third of states have laws that establish civil service exam requirements without specifying conditions for when exams must be required, or which positions allow which types of exam/criteria. Similarly, almost all of the states that have civil service exams denoted in their laws have unspecified language about whether there are exam fees. Requirements for the maintenance/use of state hiring lists are in place in 36 states and 26 states have a non-public health agency managing this process. Nearly all states (n = 48, 96%) require hiring preferences for certain types of individuals, most commonly veterans (n = 48, 96%) and family members of veterans (n = 30, 60%). No state laws provide hiring preferences for individuals from public health fellowships or special training programs. CONCLUSION: Key findings suggest that the laws governing the merit system and civil service vary and often lack clarity, which may be difficult for public health agencies and for potential employees to understand, navigate, and successfully recruit key employees. The recruitment and hiring of new governmental public health staff are complicated by the management of hiring by other state agencies and the vague civil service exam requirements and process. Developing preferences for hiring individuals who have additional practical training in public health (eg, public health fellowships and AmeriCorps) should be considered.
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Seleção de Pessoal , Saúde Pública , Governo Estadual , Humanos , Seleção de Pessoal/legislação & jurisprudência , Seleção de Pessoal/métodos , Saúde Pública/legislação & jurisprudência , Saúde Pública/métodos , Estados Unidos , Empregados do Governo/legislação & jurisprudência , Empregados do Governo/estatística & dados numéricosRESUMO
OBJECTIVES: The Family First Prevention Services Act (FFPSA) allows states to use federal Title IV-E funds to provide time-limited, clinically appropriate use of congregate care, including Qualified Residential Treatment Programs (QRTPs), for youth in foster care. October 1, 2021 marked the deadline for states to begin implementing these FFPSA congregate care reforms. From June to September 2022, we conducted a mixed-methods study to obtain a baseline understanding of implementation barriers, successes, and recommendations to inform congregate care policy and practice. METHODS: We fielded a national survey with state child welfare agency directors and conducted focus groups with youth with QRTP experiences, child welfare agency administrators, and QRTP executive leaders. We integrated a descriptive analysis of survey data with focus group themes to summarize state implementation progress. RESULTS: A total of 47 states (90%) responded to the survey. Most states reported ongoing congregate care reforms aligned with FFPSA, reducing the use of congregate care and increasing kinship foster care. QRTPs have become the primary congregate care setting. Top implementation barriers concerned workforce resource and capacity constraints, funding, and access to therapeutic foster care models and foster families. Focus group themes converged on the lack of tailored treatment, quality staff, coordinated aftercare, and a need for QRTP outcome evidence. CONCLUSIONS: Early implementation lessons of FFPSA congregate care reforms call for additional funding and technical assistance, oversight of congregate care, professionalization and investment in QRTP staff, youth advisory boards to promote youth-driven treatment, and performance- and outcome-based monitoring of QRTPs.
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Cuidados no Lar de Adoção , Humanos , Criança , Estados Unidos , Reforma dos Serviços de Saúde , Grupos Focais , Adolescente , Governo Estadual , Criança Acolhida , Proteção da CriançaRESUMO
CONTEXT: In 2021, the Centers for Disease Control and Prevention (CDC) launched CORE, an agency-wide strategy to embed health equity as a foundational component across all areas of the agency's work. The CDC established a definition of health equity science (HES) and principles to guide the development, implementation, dissemination, and use of the HES framework to move beyond documenting inequities to investigating root causes and promoting actionable approaches to eliminate health inequities. The HES framework may be used by state and local health departments to advance health equity efforts in their jurisdictions. OBJECTIVE: Identify implementation considerations and opportunities for providing technical assistance and support to state and local public health departments in advancing HES. DESIGN: A series of implementation consultations and multi-jurisdictional facilitated discussions were held with state and local health departments and community partners in 5 states to gather feedback on the current efforts, opportunities, and support needs to advance HES at the state and local levels. The information shared during these activities was analyzed using inductive and deductive methods, validated with partners, and summarized into themes and HES implementation considerations. RESULTS: Five themes emerged regarding current efforts, opportunities, and support needed to implement HES at state and local health departments. These themes included the following criteria: (1) enhancing the existing health equity evidence base; (2) addressing interdisciplinary public health practice and data needs; (3) recognizing the value of qualitative data; (4) evaluating health equity programs and policies; and (5) including impacted communities in the full life cycle of health equity efforts. Within these themes, we identified HES implementation considerations, which may be leveraged to inform future efforts to advance HES at the state and local levels. CONCLUSION: Health equity efforts at state and local health departments may be strengthened by leveraging the HES framework and implementation considerations.
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Equidade em Saúde , Governo Local , Equidade em Saúde/tendências , Equidade em Saúde/normas , Humanos , Estados Unidos , Centers for Disease Control and Prevention, U.S./organização & administração , Governo Estadual , Saúde Pública/métodosRESUMO
OBJECTIVES: Complementing the extensive research literature demonstrating that increased alcohol outlet density is associated with excessive alcohol consumption and related harms, this article synthesizes information on the types of alcohol outlet density restrictions in US state-level laws. DESIGN: Statutes and regulations related to alcohol outlet density in all 50 states and the District of Columbia in effect as of January 1, 2022, were collected using Westlaw. State-level density restrictions were coded according to 4 variables and overlaid with existing research on state-specific local authority to regulate outlet density. Alcohol outlet density laws in Michigan and Massachusetts were analyzed in detail as case studies. SETTING: United States. MAIN OUTCOME MEASURE: US state-level licensing laws restricting alcohol outlet density. RESULTS: Thirty-three states and the District of Columbia have state-level licensing laws that limit alcohol outlet density. Of those, 25 have population-based restrictions, 8 have distance-based restrictions, 7 have quotas, and 6 require the licensing agency to consider density-related factors. Within the same group of 34 jurisdictions, 22 apply restrictions to both on- and off-premises outlets, 5 apply them only to on-premises outlets, and 7 apply them only to off-premises outlets. Among the 32 states where localities lack authority to license alcohol outlets, two-thirds have state-level laws restricting outlet density. State-level density restrictions also exist in approximately two-thirds of the states where localities have licensing authority. Case studies of Michigan and Massachusetts highlight how state-level density restrictions operate in practice. CONCLUSIONS: Two-thirds of jurisdictions have state-level alcohol outlet density restrictions, with population-based restrictions being the most common. In addition, outlet density restrictions may exist regardless of limits on local control and whether localities with authority to enact density restrictions have done so. Policymakers and others can reference this assessment to identify examples and opportunities to strengthen the alcohol policy environment in any given state.