Search

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent, persistent, and costly mental health condition. The internet is an increasingly popular source for information related to ADHD. With a nationally representative sample (2018 NSCH), we aimed to separate individual- and state-level effects to examine inequities in ADHD diagnoses. We extracted state-level relative search volumes using "ADHD," "ADHD treatment," "ADHD medication," and "ADHD therapy" from Google Trends, and sociodemographic and clinical variables from the 2018 National Survey of Children's Health (N = 26,835). We examined state variation in ADHD-related information-seeking and applied multilevel modeling to examine associations among individual-level race/ethnicity, state-level information-seeking patterns, and ADHD diagnoses. Online information seeking related to ADHD varies by state and search term. Individual-level racial/ethnic background and state-level information-seeking patterns were associated with ADHD diagnoses; however, their cross-level interaction was not significant. This study adds to the strong body of evidence documenting geographical variation and diagnostic disparity in mental health and the growing literature on the impact of the digital divide on population health, indicating an urgent need for addressing inequities in mental health care. Increasing public interest in and access to empirically supported online information may increase access to care, especially among people of color. [ABSTRACT FROM AUTHOR]

The trend toward continuous expansion of U.S. post-secondary enrollments was reversed in the 2010s. Using pooled state-level data in between-within models, we examine public higher education enrollment trends during the 2009–2019 period. We emphasize variation in the net associations of covariates by tiers. State economic conditions showed stronger net associations with regional comprehensive and community college enrollments than with research university enrollments. The proportion of 19–25 year-olds in the state population showed stronger net associations on research university enrollments than on enrollments in other sectors. The effects of state-level inequality, under-represented group populations, and Republican-controlled states also varied by tier in ways that align with the dominant orientations among conservative elites. Inequality and Republican Party preferences showed net negative associations with community college enrollments, while the proportion of under-represented groups in the 19–25 population showed net negative associations with research university enrollments. [ABSTRACT FROM AUTHOR]

This article explores the relationship between supervisory approaches to governance, punishment, and poverty among people with drug convictions. Tying government assistance to supervision could improve employment and economic outcomes. However, if experienced as punishment, recipients may forgo financial assistance and be more likely to experience poverty. Using information on policies that restrict access to welfare for people with drug felony convictions in the Temporary Assistance to Needy Families (TANF) and the Supplementary Nutrition Assistance Programs (SNAP), this paper makes two contributions. First, it documents state variation in the balance between supervision and punishment in these bans. Second, using data from NLSY97, it estimates how individuals' likelihood of being in poverty is related to state SNAP drug ban policies. States have shifted away from overtly punitive policies denying access to welfare toward policies that increase supervisory requirements, especially for SNAP. This shows that punitiveness extends beyond work activation programs like TANF. Additionally, poverty among people with drug convictions is almost half in no ban states compared to those in full ban states. While poverty is lower in states that include supervisory requirements than in those for which a drug conviction fully blocks access to welfare, this difference was not statistically significant. [ABSTRACT FROM AUTHOR]

Background and Aims: Responses to the 2019 US outbreak of 'e‐cigarette or vaping product use‐associated lung injury' (EVALI) ranged from temporary restrictions on nicotine e‐cigarette sales to critiques of state cannabis policies. However, if either mass‐marketed nicotine e‐cigarettes or cannabis use per se drove this outbreak, as opposed to an additive in regionally available black‐market e‐liquids, states' rates of vaping and/or cannabis use should predict their EVALI prevalence. This study tests that relationship. Design Observational study of EVALI data from US states' health departments Setting: United States. Participants: All US states (n = 50). Measurements The outcome of interest was each state's total EVALI cases per 12–64‐year‐old resident—an age group covering most EVALI patients—as reported in the second week of January 2020. Predictors are 2017–18 rates of adult e‐cigarette use and past‐month cannabis use by state. Findings The average state EVALI prevalence was 1.4 cases per 100 000 12–64‐year‐olds. Maps suggest a high‐prevalence cluster comprising seven contiguous states in the northern Midwest. EVALI cases per capita were negatively associated with rates of vaping and past‐month cannabis use, with the preferred specification's coefficients at −0.239 [95% confidence interval (CI) = −0.441, −0.037; P = 0.02] and −0.086 (95% CI = −0.141, −0.031; P = 0.003), respectively. Robustness checks supported this finding. Conclusions: In the United States, states with higher rates of e‐cigarette and cannabis use prior to the 2019 'e‐cigarette or vaping product use‐associated lung injury' (EVALI) outbreak had lower EVALI prevalence. These results suggest that EVALI cases did not arise from e‐cigarette or cannabis use per se, but rather from locally distributed e‐liquids or additives most prevalent in the affected areas. [ABSTRACT FROM AUTHOR]

The drug felony lifetime ban on Temporary Assistance for Needy Families (TANF) affects thousands of individuals with felony drug convictions in the United States. Federal law allows states to choose to opt out or modify the full ban. Prior research has treated the ban as a binary outcome, characterizing anything but a full ban as a sign of state reform of this harsh collateral consequence. We argue that modified versions of the ban, which simultaneously allow greater access to public aid while also monitoring and sanctioning recipient behavior, have been overlooked but pose important theoretical and empirical challenges to this narrative. To address this gap, we analyze state discretion in the implementation of the drug felony lifetime ban on TANF receipt between 1997 and 2010 utilizing a multilevel multinomial modeling strategy. Results reveal that distinct patterns of state-level factors are associated with each form of the ban, highlighting the need to treat modified bans as unique policy choices in their own right. Our study informs the understanding of state implementation of collateral consequences that straddle both the penal and welfare systems in the United States. [ABSTRACT FROM AUTHOR]

This study examined differences by race/ethnicity and state in poisoning deaths of undetermined intent (UnD) versus suicide classification and the potential impact of state variations on UnD rates for Blacks and Hispanics. We used data from the 2005-2015U.S. National Violent Death Reporting System (N=29,567 aged 15þ) and weighted coarsened exact matching. The odds of UnD classification were 7-10 times higher in the 5 highest UnD states (Kentucky, Maryland, Michigan, Utah, and Rhode Island) than in other states. Blacks in these 5 states had twice the odds of Whites of being classified as UnDs than suicides, but had lower odds in other states. Other significant UnD classification factors were opioid and cocaine positive toxicologies. [ABSTRACT FROM AUTHOR]

This study examined differences by race/ethnicity and state in poisoning deaths of undetermined intent (UnD) versus suicide classification and the potential impact of state variations on UnD rates for Blacks and Hispanics. We used data from the 2005-2015 U.S. National Violent Death Reporting System (N = 29,567 aged 15+) and weighted coarsened exact matching. The odds of UnD classification were 7-10 times higher in the 5 highest UnD states (Kentucky, Maryland, Michigan, Utah, and Rhode Island) than in other states. Blacks in these 5 states had twice the odds of Whites of being classified as UnDs than suicides, but had lower odds in other states. Other significant UnD classification factors were opioid and cocaine positive toxicologies. [ABSTRACT FROM AUTHOR]

Services offered through Part C of the Individuals With Disabilities Education Improvement Act improve cognitive, behavioral, and physical skills for children less than 3 years old at risk for or with a disability. However, there are low enrollment rates into services. Various Lead Agencies oversee services through Part C, and states determine which agency is in charge of administering these services. The objective of this study was to describe odds of enrollment into early intervention services based on the department administering services (Lead Agency). Each state’s Lead Agency (Education, Health, or Other), state population size, narrowness of eligibility criteria, and state-level screening rates were fit into a negative binomial regression model to predict odds of enrollment into Part C services. Results show that state’s reporting from “Health” and “Other” as a Lead Agency had significantly higher odds for Part C services compared with the state Lead Agency of Education (Health adjusted odds ratio [AOR] = 1.56, 95% confidence interval [CI] = [1.557, 1.561]; Other AOR = 2.40, 95% CI = [2.401, 2.405]). Further research should describe unique components of a Lead Agency’s administrative practices that contribute to the variation in enrollment. This study was an important step toward the investigation of low enrollment rates into Part C services. [ABSTRACT FROM AUTHOR]

Scholarship on the expansion of the U.S. carceral state has primarily focused on imprisonment rates. Yet the majority of adults under formal criminal justice control are on probation, an “alternative” form of supervision. This article develops the concept of mass probation and builds a typology of state control regimes that theorizes both the scale and type of punishment states employ. Drawing on Bureau of Justice Statistics data from 1980 and 2010, I analyze whether mass probation developed in the same places, affecting the same demographic groups and driven by the same criminal justice trends, as mass imprisonment. The results show that mass probation was a unique state development, expanding in unusual places like Minnesota and Washington. The conclusions argue for a reimagining of the causes and consequences of the carceral state to incorporate the expansion of probation. [ABSTRACT FROM AUTHOR]

Medicaid is vastly more important than Medicare or private insurance in funding long-term care (LTC). However, states vary tremendously in their commitment to Medicaid LTC. This article advances knowledge of the origins, nature, and implications of this variation. After examining the degree of variation in state spending on Medicaid LTC, we show how federal policy has over the past fifty years steadily increased state discretion to shape these services. This decentralization largely reflects the potency of the intergovernmental lobby--governors and other state officials--in influencing federal policy. While fueling state variation, the intergovernmental lobby has also provided valuable political support that has helped Medicaid grow and resist retrenchment. After considering policy options that could mitigate Medicaid LTC inequities rooted in state differences, we assess how the catalytic forces that have fueled growth in Medicaid LTC may be insufficient to protect the program from future erosion. [ABSTRACT FROM AUTHOR]

Introduction Driving under the influence of drugs, including marijuana, has become more prevalent in recent years despite local, state, and federal efforts to prevent such increases. The Fatality Analysis Reporting System (FARS) is the primary source of drugged driving data for fatal crashes in the United States but lacks the completeness required to calculate unbiased estimates of drug use among drivers involved in fatal crashes. Methods This article uses the 2013 FARS dataset to present differences in state drug testing rates by driver type, driver fault type, and state-level factors; discusses limitations related to analysis and interpretation of drugged driving data; and offers suggestions for improvements that may enable appropriate use of FARS drug testing data in the future. Results Results showed that state drug testing rates were highest among drivers who died at the scene of the crash (median = 70.8%) and drivers who died and were at fault in the crash (median = 64.4%). The lowest testing rates were seen among surviving drivers who were not transported to a hospital (median = 14.0%) and surviving drivers who were not at fault in the crash (median = 10.0%). Drug testing rates differed by state blood alcohol content (BAC) testing rate across all driver types and driver fault types, and in general, states that tested a higher percentage of drivers for BAC had higher drug testing rates. Discussion Testing rates might be increased through standardization and mandatory testing policies. FARS data users should continue to be cautious about the limitations of using currently available data to quantify drugged driving. More efforts are needed to improve drug testing and reporting practices, and more research is warranted to establish drug concentration levels at which driving skills become impaired. [ABSTRACT FROM AUTHOR]

Objectives: To ascertain differences across states in children's oral health care access and oral health status and the factors that contribute to those differences. Study design: Observational study using cross-sectional surveys. Methods: Using the 2007 National Survey of Children's Health, we examined state variation in parents' report of children's oral health care access (absence of a preventive dental visit) and oral health status. We assessed the unadjusted prevalences of these outcomes, then adjusted with child-, family-, and neighbourhood-level variables using logistic regression; these results are presented directly and graphically. Using multilevel analysis, we then calculated the degree to which child-, family-, and community-level variables explained state variation. Finally, we quantified the influence of state-level variables on state variation. Results: Unadjusted rates of no preventive dental care ranged 9.0e26.8% (mean 17.5%), with little impact of adjusting (10.3-26.7%). Almost 9% of the population had fair/poor oral health; unadjusted range 4.1-14.5%. Adjusting analyses affected fair/poor oral health more than access (5.7-10.7%). Child, family and community factors explained ~1/4 of the state variation in no preventive visit and ~1/2 of fair/poor oral health. State-level factors further contributed to explaining up to a third of residual state variation. Conclusion: Geography matters: where a child lives has a large impact on his or her access to oral health care and oral health status, even after adjusting for child, family, community, and state variables. As state-level variation persists, other factors and richer data are needed to clarify the variation and drive changes for more egalitarian and overall improved oral health. [ABSTRACT FROM AUTHOR]

Individuals involved in the criminal legal system face unique challenges to accessing substance use disorder (SUD) treatment, yet state-level variation in referrals for treatment remains largely unknown. To address disparities in the overdose crisis among individuals with criminal legal involvement, it is important to understand variation in SUD treatment across states. We conducted a retrospective comparison of substance use treatment referrals from the criminal legal system and other sources across participating states. Using data from the 2018–2019 Treatment Episode Dataset-Admissions, we characterized treatment referral rates from the criminal legal system, the substances most commonly leading to treatment, and rates of treatment with medication for opioid use disorder (MOUD) across states. Across all states, criminal legal referral rates were higher than non-criminal legal rates. Criminal-legal referral rates, adjusted for state overdose deaths, were highest in the Northeast and Midwest. Methamphetamine use was the most common substance leading to treatment referral from the criminal legal system in 24 states while opioid use was the most common reason for non-criminal legal referrals in 34 states. In over half the states analyzed, fewer than 10% of opioid treatment referrals from the criminal legal system received MOUD. In almost all states, MOUD was more common in treatment referred from non-criminal legal settings. State-specific policies and practices shape drug policy and the SUD treatment landscape for people with criminal legal involvement. Standards and ongoing monitoring for substance use treatment referrals from the criminal-legal system should be considered by federal agencies charged with addressing the ongoing overdose crisis. • Little is known about state variation in SUD treatment among individuals with criminal legal involvement. • Methamphetamine use was the most common reason for criminal legal system referrals in 24 states. • Opioid use was the most common reason for non-criminal legal referrals in 34 states. • In almost all states, MOUD was more common in treatment referred from non-criminal legal settings. • Standards for SUD access within the criminal-legal system should be considered. [ABSTRACT FROM AUTHOR]

Background: Individuals involved in the criminal legal system face unique challenges to accessing substance use disorder (SUD) treatment, yet state-level variation in referrals for treatment remains largely unknown. To address disparities in the overdose crisis among individuals with criminal legal involvement, it is important to understand variation in SUD treatment across states.Methods: We conducted a retrospective comparison of substance use treatment referrals from the criminal legal system and other sources across participating states. Using data from the 2018-2019 Treatment Episode Dataset-Admissions, we characterized treatment referral rates from the criminal legal system, the substances most commonly leading to treatment, and rates of treatment with medication for opioid use disorder (MOUD) across states.Results: Across all states, criminal legal referral rates were higher than non-criminal legal rates. Criminal-legal referral rates, adjusted for state overdose deaths, were highest in the Northeast and Midwest. Methamphetamine use was the most common substance leading to treatment referral from the criminal legal system in 24 states while opioid use was the most common reason for non-criminal legal referrals in 34 states. In over half the states analyzed, fewer than 10% of opioid treatment referrals from the criminal legal system received MOUD. In almost all states, MOUD was more common in treatment referred from non-criminal legal settings.Conclusion: State-specific policies and practices shape drug policy and the SUD treatment landscape for people with criminal legal involvement. Standards and ongoing monitoring for substance use treatment referrals from the criminal-legal system should be considered by federal agencies charged with addressing the ongoing overdose crisis. [ABSTRACT FROM AUTHOR]

State Medicaid programs have expanded home and community-based services (HCBS). This article compares trends and variations in state policies for Medicaid HCBS programs in 2005 and 2010. State limitations on financial eligibility criteria and service benefits have remained stable. Although the use of consumer direction, independent providers, and family care providers has increased, some states do not have these options. The increased adoption of state cost control policies have led to large increases in persons on waiver wait lists. Access could be improved by standardizing and liberalizing state HCBS policies, but state fiscal concerns are barriers to rebalancing between HCBS and institutional services. [ABSTRACT FROM AUTHOR]

Abstract: The focus of this paper is the spacecraft formation flying problem where the formation switches successively among multiple shapes, the number and the composition of spacecraft in the group may change among these shapes, and some spacecraft may be faulty. The whole flying process is modeled as a state-varying switched system. The formation stability and fault tolerability are analyzed by using new results on state-varying switched systems. [Copyright &y& Elsevier]

The cortisol awakening response (CAR) is a much studied but poorly understood aspect of the circadian pattern of cortisol secretion. A Scopus search of 'cortisol' and 'awakening' reveals 666 publications in this area since 1997 when it was first identified by Pruessner and colleagues as a 'reliable biomarker of adrenocortical activity'. The primary focus of the majority of these studies is centered on its utility as a biomarker associated with a range of psychosocial, physical and mental health variables. Such studies typically examine differences in the CAR (studied on 1 or 2 days) between healthy participants and other comparator groups of interest. Fewer studies (25 in our estimation) have examined correlates of day-to-day variation in the CAR in healthy participants, informing its role and regulation within the healthy circadian pattern of cortisol secretion. This is the first review to examine these studies which, although limited in number, offer a relatively coherent emerging story about state factors that influence the CAR and the impact of the CAR on daily functioning. Greater understanding of these issues helps illuminate the utility of the CAR as a promising biomarker in psychophysiological and epidemiological research. The review also highlights areas that require greater clarification and points to potentially fruitful areas of further research. [ABSTRACT FROM AUTHOR]

Nursing homes certified by the Medicare and/or Medicaid program are subject to federally mandated and state-enforced quality and safety standards. We examined the relationship between state quality enforcement and nursing home terminations from the two programs. Using data from a survey of state licensure and certification agencies and other secondary databases, we performed bivariate and multivariate analyses on the strength of state quality regulation in 2005, and nursing home voluntary terminations (decisions made by the facility) or involuntary terminations (imposed by the state) in 2006-2007. Involuntary terminations were rarely imposed by state regulators, while voluntary terminations were relatively more common (2.16 percent in 2006-2007) and varied considerably across states. After controlling for facility, market, and state covariates, nursing homes in states implementing stronger quality enforcement were more likely to voluntarily terminate from the Medicare and Medicaid programs (odds ratio=1.53, p=.018). Although involuntary nursing home terminations occurred rarely in most states, nursing homes in states with stronger quality regulations tend to voluntarily exit the publicly financed market. Because of the consequences of voluntary terminations on patient care and access, state regulators need to consider the effects of increased enforcement on both enhanced quality and the costs of termination. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine whether adoption of Medicaid case mix reimbursement is associated with greater prevalence of feeding tube use in nursing home (NH) residents. DESIGN: Secondary analysis of longitudinal administrative data about the prevalence of feeding tube insertion and surveys of states' adoption of case mix reimbursement. SETTING: NHs in the United States. PARTICIPANTS: NH residents at the time of NH inspection between 1993 and 2004. MEASUREMENTS: Facility prevalence of feeding tubes reported at the state inspection of NHs reported in the Online Survey, Certification and Reporting database and interviews with state policy makers regarding the adoption of case mix reimbursement. RESULTS: Between 1993 and 2004, 16 states adopted Resource Utilization Group case mix reimbursement. States varied in the prevalence of feeding tubes in their NHs. Although the use of feeding tube increased substantially over the years of the study, once temporal trends and facility fixed effects were accounted for, case mix reimbursement was not associated with greater prevalence of feeding tube use. CONCLUSION: The adoption of Medicaid case mix reimbursement was not associated with an increase in the prevalence of feeding tube use. [ABSTRACT FROM AUTHOR]

Purpose: States are increasingly using the Medicaid 191 5c waiver program to provide community-based long-term care. A substantially greater share of long- term-care dollars supports community-based care for individuals with intellectual and developmental dis- abilities, relative to older and working-age persons with primarily physical disabilities. Design and Methods: We used state-level data for the period from 1992 to 2001 to estimate fixed-effects panel models. We compared state predictors of waiver utilization and expenditures for waivers serving both older and working-age individuals (0/WAIs) relative to waivers serving individuals with intellectual and developmental disabilities (IDDs). Results: We found community-based-care capacity to predict use and expenditures for both target groups. Although regulation of institutional supply was positively re- lated to expenditure measures for lDDs, it was not related to use or expenditures for 0/WAIs. Demand variables (e.g., the size of a state's African American population) predicted use and expenditures for IDD waivers, but they were less consistent for O/WAI waivers. State resources were a robust predictor of use and expenditures for both groups., Implications: In- creased community-based-care capacity appears to be an important factor in efforts to expand the availability of Medicaid community-based care. Federal policies that address state resource issues may also spur growth in community-based long- term care. [ABSTRACT FROM AUTHOR]

Policies and regulations on opioid use have evolved from being primarily state-to federally based. We examined the trends and variation in chronic opioid use among states and nursing homes. Retrospective cohort study. We used the nursing home Minimum Data Set and Medicare claims from 2014 to 2018 and included long-term care nursing home residents from each year who had at least 120 days of consecutive stay. Chronic opioid use was defined as use for ≥90 days. Three-level hierarchical logistic regression models (resident, nursing home, state) were constructed to estimate intraclass correlation coefficient (ICC) at the state level and at the nursing home level. The ICC shows the proportion of variation in chronic opioid use that is attributable to states or nursing homes. All models were constructed separately for each calendar year and controlled for resident, nursing home, and state characteristics. We included 3,245,714 nursing home stays from 2014 to 2018, representing 1,502,131 unique residents. The stays ranged from 676,413 in 2014 to 594,874 in 2018, with residents contributing a maximum of 1 stay per year. Chronic opioid use among nursing home residents declined from 14.1% in 2014 to 11.4% in 2018. The variation (ICC) in chronic opioid use among states declined from 2.5% in 2014 to 1.7% in 2018. In contrast, the variation (ICC) among nursing homes increased from 5.6% in 2014 to 6.5% in 2018. Variation in chronic opioid use declined by one-third at the state level but not at the nursing home level. National guidelines on opioid use and federal policies on opioid use may have contributed to reducing state-level variation in chronic opioid use. [ABSTRACT FROM AUTHOR]