An Association Between State Laws Limiting Local Control and Community Smoke-Free Indoor Air in the United States.

This study examines the association between state laws limiting local control (preemption laws) and local smoke-free policies. We utilized policy data from the American Nonsmokers' Rights Foundation. The primary outcome variable is the presence of a "100% smoke-free policy," across any of 4 indoor settings: workplaces, restaurants, bars, and gaming venues. We employed generalized structural equation modeling to investigate the relationship between state laws pre-empting smoke-free indoor air regulation and local adoption of policies requiring smoke-free air in any public venues, or for specific venues, adjusting for sociodemographic characteristics. Our findings reveal a significant association between state preemption laws and the presence of a local 100% smoke-free indoor policy as of 2023. In states with preemption laws, cities were less likely to have a 100% smoke-free indoor policy at any venue than cities in states without preemption laws (OR = 0.07, 95% CI = 0.05-0.10). When considering specific smoke-free venues, cities in states with preemption laws were less likely to have a 100% smoke-free indoor policy covering workplaces (OR = 0.05, 95% CI = 0.03-0.09), restaurants (OR = 0.04, 95% CI = 0.02-0.07), bars (OR = 0.04, 95% CI = 0.03-0.08), and gaming venues (OR = 0.03, 95% CI = 0.01-0.09) compared to cities in states without preemption laws. Our study suggests that state preemption laws limit local decision-making and the implementation of public health policies focused on tobacco harms.

Post-Dobbs Abortion Restrictions and the Families They Leave Behind.

The June 24, 2022 US Supreme Court decision in Dobbs v Jackson Women's Health Organization resulted in an expansive restriction on abortion access that had been constitutionally guaranteed for nearly half a century. Currently, 14 states have implemented complete bans on abortion with very limited exceptions, and an additional 7 states have implemented abortion bans at 6 to 18 weeks' gestation. It has been well demonstrated that restrictive policies disproportionately limit abortion access for minoritized people and people of low socioeconomic status; the financial and geographic barriers of these post-Dobbs restrictions will only exacerbate this disparity. Proponents of abortion restrictions, who identify as pro-life, assert that these policies are essential to protect children, women, and families. We examine whether the protection of these groups extends past conception by evaluating the association between state abortion legislation and state-based policies and programs designed to provide medical and social support for children, women, and families. We found that states with the most restrictive post-Dobbs abortion policies in fact have the least comprehensive and inclusive public infrastructure to support these groups. We suggest further opportunities for advocacy. (Am J Public Health. 2024;114(10):1043-1050. https://doi.org/10.2105/AJPH.2024.307792).

Federal, State, and Local Mental Health Policy Interventions in Response to the Pediatric Mental Health Crisis following the COVID-19 Pandemic.

The state of pediatric mental health in the United States has been declining prior to the coronavirus disease 2019 pandemic and was also acutely exacerbated by it as well. Federal, state, and local governments have increasingly prioritized pediatric mental health by investing critical resources through the implementation of policies at all levels of government to reverse this disturbing trend. Despite these investments, there remains a need to improve access to critical pediatric mental health prevention and interventions. When all stakeholders are actively and authentically engaged in the creation and implementation of policy, there is the greatest potential for widespread impact.

Navigating the Labyrinth of Pregnancy-Related Coverage for Undocumented Immigrants: An Assessment of Current State and Federal Policies.

Insurance coverage for prenatal care, labor and delivery care, and postpartum care for undocumented immigrants consists of a patchwork of state and federal policies, which varies widely by state. According to federal law, states must provide coverage for labor and delivery through Emergency Medicaid. Various states have additional prenatal and postpartum coverage for undocumented immigrants through policy mechanisms such as the Children's Health Insurance Program's "unborn child" option, expansion of Medicaid, and independent state-level mechanisms. Using a search of state Medicaid and federal government websites, we found that 27 states and the District of Columbia provide additional coverage for prenatal care, postpartum care, or both, while 23 states do not. Twelve states include any postpartum coverage; 7 provide coverage for 12 months postpartum. Although information regarding coverage is available publicly online, there exist many barriers to access, such as lack of transparency, lack of availability of information in multiple languages, and incorrect information. More inclusive and easily accessible policies are needed as the first step toward improving maternal health among undocumented immigrants, a population trapped in a complicated web of immigration policy and a maternal health crisis. (Am J Public Health. 2024;114(10):1051-1060. https://doi.org/10.2105/AJPH.2024.307750).

State Mandates To Cap Out-Of-Pocket Insulin Costs Are No Longer Necessary.

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.

Hospital Nurse Staffing Legislation: Mixed Approaches In Some States, While Others Have No Requirements.

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.

State Medical Boards and Interstate Telemedicine in the Courtroom.

This Viewpoint examines physician licensure requirements administered by state medical boards and 2 lawsuits challenging the restrictions placed on interstate telemedicine.

Implementation of public health consortiums and regional polyclinics in Bahia state, Brazil. / Implantação de consórcios públicos de saúde e policlínicas regionais na Bahia, Brasil.

Public Health Consortiums (PHC) in Brazil represent a strategy to enhance regionalization in the Public Health Care System (SUS in Portuguese) and State/interstate/intermunicipal cooperation. The establishment of regional polyclinics aims to improve access to services with greater technological concentration and closer to users' homes. This study specifically aims to analyze the process of creating PHC and regional polyclinics in Bahia State, based on documental analysis, identifying aspects related to entering the political agenda that facilitate and hinder, the role of state administration, specificities of the composition of these PHC and regional polyclinics. A documental analysis was carried out of the minutes of the Comissão Intergestores Bipartite (CIB-BA) [Bipartite Administrative Commission] from 2015 to 2018 and of constitutive documents of the consortiums established in this state. The Ceará State experience inspired the creation of consortiums in Bahia, especially the structuring of polyclinics. Municipal administrators demonstrated a favorable position regarding the potential of consortiums with cooperation among municipalities. The role of the state government proved to be a facilitating condition, whereas the maintenance of the municipal counterpart in finance constituted a hindering element. The consortiums contributed to the regionalization of health in the state as well as expansion of access to specialized care.

Os consórcios públicos de saúde (CPS) representam uma estratégia para potencializar a regionalização no SUS e a cooperação interfederativa. A implantação de policlínicas regionais visa melhorar o acesso a serviços de maior densidade tecnológica, mais próximos ao município de origem dos usuários. Este estudo objetiva analisar o processo de implantação dos consórcios públicos de saúde e das policlínicas regionais na Bahia, com base em análise documental, identificando aspectos facilitadores e dificultadores relativos à entrada na agenda política, ao papel da gestão estadual e às especificidades da composição dos CPS e das policlínicas regionais no estado da Bahia. Realizou-se análise documental das atas da Comissão Intergestores Bipartite dos anos de 2015 a 2018 e de documentos constitutivos dos consórcios implantados na Bahia. A experiência do Ceará inspirou a criação dos consórcios na Bahia, sobretudo na estruturação das policlínicas. Verificou-se posicionamento favorável dos gestores municipais acerca da potencialidade do consórcio na cooperação entre municípios. A atuação do governo do estado revelou-se condição facilitadora, e a manutenção da contrapartida municipal no financiamento, como elemento dificultador. Os consórcios contribuíram para a regionalização da saúde no estado e a ampliação do acesso à atenção especializada.

A Risk Is Not a Harm: Abortion Exceptions in State Laws.

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.

Social Media Users' Engagement with Fear Appeal Elements in Government's Health Crisis Communication via State-Owned Media.

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.

Inventory of state workers' compensation laws in the United States: first responder mental health.

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.

The Relationship Between State-Level Earned Income Tax Credits and Violent Crime.

Policies that provide economic support, such as the earned income tax credit (EITC), improve peoples' ability to meet their basic needs and reduce stress, which can reduce violence perpetration. Refundable state-level EITCs have been associated with decreases in multiple forms of violence (e.g., child abuse and neglect); however, it is unknown whether there is an association between the EITC and violent crime as captured by Uniform Crime Reports. Crime and violence remain a pressing concern for many communities across the nation. Using a longitudinal data set, we conducted fixed-effects regression models with year and state specified as fixed effects, to determine whether variations in generosity of state-level EITCs are related to the rate of violent crime. After adjusting for demographic covariates, refundable state-level EITCs remained significantly associated with reductions in criminal homicide compared to states without an EITC. As many states attempt to combat crime and prevent violence in their communities, anti-poverty measures such as the EITC provide a promising strategy for reducing the social and economic costs associated with violence.

Upholding Tribal Sovereignty in Federal, State, and Local Emergency Vaccine Distribution Plans.

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.

Nurses as Petitioners: A Legal Mapping of State Extreme Risk Protection Order Laws.

Gun violence is a leading public health concern in the US; subsequently, firearm-related violence prevention is a top priority for policymakers. Extreme risk protection order (ERPO) laws are a state-level attempt to reduce gun-related injuries and deaths. These court-issued orders prohibit people found to be dangerous to themselves or others from temporarily purchasing or possessing a firearm. Six states (Colorado, Connecticut, Hawaii, Maryland, Michigan, New York) and the District of Columbia have passed or amended their laws to include nurses as ERPO petitioners. The study's purpose was to conduct a review of state ERPO laws that included nurses as petitioners. Using a legal mapping approach, information on nurse ERPO petitioning was extracted from the seven jurisdictions. ERPO laws with nurse petitioners were passed between 1999 and 2023. Nurse petitioners included advanced practice registered nurse (n = 3), clinical nurse specialists (n = 3), nurse practitioner (n = 3), professional nurse (n = 2), and register nurse (n = 1). Psychiatric/mental health (n = 2) and school nurses (n = 2) were specified. Statutes differed in the handling of disclosed health information as part of the ERPO petition, as well as how health information would be handled by the court (e.g. sealed by the court, confidential by the court, returned to provider/disposed of post-hearing/order.) Three statutes exempted petitioners from civil and/or criminal liability, if petitions were submitted in good faith. Two of these states extended protection from liability to all petitioners, while one only referenced petitioners who were healthcare providers. The study findings have important policy, clinical, and research implications.

Building Successful Partnerships Between State Health Departments and Attorney General Offices: The Minnesota Example.

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.

Recent State Legislative Attempts to Restructure Public Health Authority: The Good, The Bad, and The Way Forward.

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.

The Association Between State-Level Prenatal Substance Use Policies and Rates of Maternal Mortality in the United States: A Legal Epidemiology Study.

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.

State Driving Under the Influence of Drugs Laws.

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.

State Spending Targets for Prescription Drugs.

This Viewpoint discusses the limitations of state prescription drug spending targets for lowering medication costs.