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Learn more about the Division of Juvenile Justice and Youth Services (JJYS). JJYS provides continuum of intervention, supervision, and rehabilitation programs to youth offenders while assuring public safety.

Learn more about the Office of Recovery Services.

Learn more about DHHS Finance and Administration .

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BackgroundDuring the COVID-19 pandemic, federal and state governments removed the scope of practice restrictions on nurse practitioners (NPs), allowing them to deliver care to patients without restrictions.PurposeTo support policy makers' efforts to grant full practice authority to NPs beyond the COVID-19 pandemic, this manuscript summarizes the existing evidence on the benefits of permanently removing state-level scope of practice barriers and outline recommendations for policy, practice, and research.MethodsWe have conducted a thorough review of the existing literature.FindingsNP full scope of practice improves access and quality of care and leads to better patient outcomes. It also has the potential to reduce health care cost.DiscussionThe changes to support full practice authority enacted to address COVID-19 are temporary. NP full practice authority could be part of a longer-term plan to address healthcare inequities and deficiencies rather than merely a crisis measure.

BackgroundTo determine if requiring Dual Eligible Special Need Plans (D-SNPs) to receive approval from the National Committee of Quality Assurance and contract with state Medicaid agencies impacts healthcare utilization.MethodsWe use a Multiple Interrupted Time Series to examine the association of D-SNP regulations with dichotomized measures of emergency room (ER) and hospital utilization. Our treatment group is elderly D-SNP enrollees. Our comparison group is near-elderly (ages 60-64) beneficiaries enrolled in Medicaid Managed Care plans (N = 360,405). We use segmented regression models to estimate changes in the time-trend and slope of the outcomes associated with D-SNP regulations, during the post-implementation (2012-2015) period, relative to the pre-implementation (2010-2011) period. Models include a treatment-status indicator, a monthly time-trend, indicators and splines for the post-period and the interactions between these variables. We conduct the following sensitivity analyses: (1) Re-estimating models stratified by state (2) Estimating models including interactions of D-SNP implementation variables with comorbidity count to assess for differential D-SNP regulation effects across comorbidity level. (3) Re-estimating the models stratifying by race/ethnicity and (4) Including a transition period (2012-2013) in the model.ResultsWe do not find any statistically significant changes in ER or hospital utilization associated with D-SNP regulation implementation in the broad D-SNP population or among specific racial/ethnic groups; however, we do find a reduction in hospitalizations associated with D-SNP regulations in New Jersey (DD level = - 3.37%; p = 0.02)/(DD slope = - 0.23%; p = 0.01) and among individuals with higher, relative to lower levels of co-morbidity (DDD slope = - 0.06%; p = 0.01).ConclusionsThese findings suggest that the impact of D-SNP regulations varies by state. Additionally, D-SNP regulations may be particularly effective in reducing hospital u

BackgroundTo determine if requiring Dual Eligible Special Need Plans (D-SNPs) to receive approval from the National Committee of Quality Assurance and contract with state Medicaid agencies impacts healthcare utilization.MethodsWe use a Multiple Interrupted Time Series to examine the association of D-SNP regulations with dichotomized measures of emergency room (ER) and hospital utilization. Our treatment group is elderly D-SNP enrollees. Our comparison group is near-elderly (ages 60-64) beneficiaries enrolled in Medicaid Managed Care plans (N = 360,405). We use segmented regression models to estimate changes in the time-trend and slope of the outcomes associated with D-SNP regulations, during the post-implementation (2012-2015) period, relative to the pre-implementation (2010-2011) period. Models include a treatment-status indicator, a monthly time-trend, indicators and splines for the post-period and the interactions between these variables. We conduct the following sensitivity analyses: (1) Re-estimating models stratified by state (2) Estimating models including interactions of D-SNP implementation variables with comorbidity count to assess for differential D-SNP regulation effects across comorbidity level. (3) Re-estimating the models stratifying by race/ethnicity and (4) Including a transition period (2012-2013) in the model.ResultsWe do not find any statistically significant changes in ER or hospital utilization associated with D-SNP regulation implementation in the broad D-SNP population or among specific racial/ethnic groups; however, we do find a reduction in hospitalizations associated with D-SNP regulations in New Jersey (DD level = - 3.37%; p = 0.02)/(DD slope = - 0.23%; p = 0.01) and among individuals with higher, relative to lower levels of co-morbidity (DDD slope = - 0.06%; p = 0.01).ConclusionsThese findings suggest that the impact of D-SNP regulations varies by state. Additionally, D-SNP regulations may be particularly effective in reducing hospital u

ContextPrevious research finds that some state policies regarding alcohol use during pregnancy (alcohol/pregnancy policies) increase low birth weight (LBW) and preterm birth (PTB), decrease prenatal care utilization, and have inconclusive relationships with alcohol use during pregnancy.ObjectiveThis research examines whether effects of 8 alcohol/pregnancy policies vary by education status, hypothesizing that health benefits of policies will be concentrated among women with more education and health harms will be concentrated among women with less education.MethodsThis study uses 1972-2015 Vital Statistics data, 1985-2016 Behavioral Risk Factor Surveillance System data, policy data from National Institute on Alcohol Abuse and Alcoholism's Alcohol Policy Information System and original legal research, and state-level control variables. Analyses include multivariable logistic regressions with education-policy interaction terms as main predictors.ResultsThe impact of alcohol/pregnancy policies varied by education status for PTB and LBW for all policies, for prenatal care use for some policies, and generally did not vary for alcohol use for any policy. Hypotheses were not supported. Five policies had adverse effects on PTB and LBW for high school graduates. Six policies had adverse effects on PTB and LBW for women with more than high school education. In contrast, 2 policies had beneficial effects on PTB and/or LBW for women with less than high school education. For prenatal care, patterns were generally similar, with adverse effects concentrated among women with more education and beneficial effects among women with less education. Although associations between policies and alcohol use during pregnancy varied by education, there was no clear pattern.ConclusionsEffects of alcohol/pregnancy policies on birth outcomes and prenatal care use vary by education status, with women with more education typically experiencing health harms and women with less education either not e

As part of the State Targeted Response to the opioid epidemic, California has adopted the Hub and Spoke model to expand access to medications for opioid use disorder, particularly buprenorphine, throughout the state. By aligning opioid treatment programs as hubs with primary care, office-based practitioners, and other health care settings as spokes, a broader treatment model can reach more people with opioid use disorder, improve access to medications for opioid use disorders, and decrease overdose deaths. Expanding access requires expanding knowledge and intensive implementation support of new practices. This paper describes the rationale, specific activities and anticipated impact of the implementation plan in California's Hub and Spoke system. Training and technical assistance are designed to: increase the number and capacity of waivered prescribers; enhance skills of prescribers and multidisciplinary teams; and create systems change. Activities include buprenorphine waiver trainings and provider support, a practice facilitator program, Project ECHO sessions, webinars, clinical skills trainings, and regional learning collaboratives. This overview highlights the steps California is taking to build treatment capacity to address the opioid epidemic.

We have performed the procedures agreed to by the Utah STEM Foundation. We have applied the agreed-upon procedures as listed below that were specified and agreed to by the Foundation pursuant to Utah Code 51-2a for the period from July 1, 2019 through June 30, 2020 to meet their intended purpose. This report may not be suitable for any other purpose.

Objectives. To estimate the combined effect of California's Tobacco 21 law (enacted June 2016) and $2-per-pack cigarette excise tax increase (enacted April 2017) on cigarette prices and sales, compared with matched comparator states.Methods. We used synthetic control methods to compare cigarette prices and sales after the policies were enacted, relative to what we would have expected without the policy reforms. To estimate the counterfactual, we matched pre-reform covariate and outcome trends between California and control states to construct a "synthetic" California.Results. Compared with the synthetic control in 2018, cigarette prices in California were $1.89 higher ($7.86 vs $5.97; P < .001), and cigarette sales were 16.6% lower (19.9 vs 16.6 packs per capita; P < .001). This reduction in sales equates to 153.9 million fewer packs being sold between 2017 and 2018.Conclusions. California's new cigarette tax was largely passed on to consumers. The new cigarette tax, combined with the Tobacco 21 law, have contributed to a rapid and substantial reduction in cigarette consumption in California.

The first key message in the landmark Future of Nursing report is that "Nurses should practice to the full extent of their education and training" (Institute of Medicine, 2011). Although there has been significant progress across states to remove or diminish barriers to the exercise of full scope of practice by advanced practice registered nurses (APRN), state regulations continue to unnecessarily restrict APRN practice in most of the United States. This article integrates data from studies that examine how state and local regulation affects psychiatric mental health APRN practice with the literature on how state scope of practice regulation affects the size and distribution of the broader APRN workforce, access to care, health care costs and prices, and innovation in health care service delivery. Common themes include confusion about regulatory requirements and mixed experiences of mandated physician supervision.

Preemption-when a higher level of government limits the authority of a lower level to enact new policies-has been devastating to tobacco control. We developed a preemption framework based on this experience for anticipating and responding to the possibility of preemption in other public health areas. We analyzed peer-reviewed literature, reports, and government documents pertaining to tobacco control preemption. We triangulated data and thematically analyzed them.Since the 1980s, tobacco companies have attempted to secure state preemption through front groups, lobbying key policymakers, inserting preemption into other legislation, and issuing legal threats and challenges. The tobacco control community responded by creating awareness of preemption through media advocacy, educating policymakers, mobilizing national collaborations, and expanding networks with the legal community. Ten of the 25 state smoke-free preemption laws have been fully repealed. Repeal, however, took an average of 11 years.State preemption has been detrimental to tobacco control by dividing the health community, weakening local authority, chilling public education and debate, and slowing local policy diffusion. Health scholars, advocates, and policymakers should use the framework to anticipate and prevent industry use of preemption in other public health areas.

We herein investigate the report entitled “O Sistema Educacional Fluminense” (The Fluminense Educational System) as a printed educational document. The book resulted from the Campaign for High and Elementary School Surveys and Inquiries (CILEME), which was launched in 1953, during Anísio Teixeira’s administration at the National Institute of Pedagogical Studies (INEP). The main aim of the Campaign was to collect data about the educational system in different Brazilian regions. The research was coordinated by Jayme Abreu in Rio de Janeiro State and gathered statistical, legislative and historical information about the organization of primary and secondary education, over eight months. The aims of the current study are to identify the theoretical and methodological perspectives of the report and to investigate how the produced knowledge helped improving the debate about public education policies and about the rights and duties of the State and private initiatives, based on the printed document and on the historiography of education. The report approaches the duality of the education system in Rio de Janeiro State, besides differences between educational opportunities and school access/permanence conditions, by suggesting “an attempt of interpretation and criticism” and by presenting the ways local, state and federal governments, and the private sector, provide primary and secondary education. Thus, the performance of intellectuals such as Jayme Abreu in state agencies helped institutionalizing the research on education in Brazil and the use of such knowledge as political positioning instrument in debates about the democratization of the Brazilian Society., Investigamos o relatório “O Sistema Educacional Fluminense” como um impresso educacional. O livro é um produto da Campanha de Inquéritos e Levantamentos do Ensino Médio e Elementar (CILEME) criada em 1953, durante a gestão de Anísio Teixeira no Instituto Nacional de Estudos Pedagógicos (INEP), com o objetivo principal de reunir dados sobre o sistema de ensino em diferentes regiões do país. Jayme Abreu foi o coordenador da pesquisa no estado do Rio de Janeiro, que, ao longo de oito meses, reuniu informações estatísticas, legislativas e históricas sobre a organização do ensino primário e do ensino médio. Temos como objetivos identificar as perspectivas teórico-metodológicas de tessitura do relatório e analisar, a partir do próprio impresso e à luz da historiografia da educação, como o conhecimento produzido colaborava para o debate sobre as políticas públicas de educação e sobre os direitos e deveres do Estado e da iniciativa particular. Ao propor “uma tentativa de interpretação e crítica” e apresentar as formas de participação das prefeituras, do governo estadual, da União e da iniciativa privada na oferta do ensino primário e do ensino médio, o relatório prospecta a dualidade do sistema escolar fluminense, as diferenças entre as oportunidades educativas e as condições de acesso e permanência na escola. Nessa perspectiva, a atuação de intelectuais como Jayme Abreu junto às agências estatais foi importante para a institucionalização da pesquisa em educação no Brasil e de seu uso como ferramenta de posicionamento político no debate sobre a democratização da sociedade brasileira., Investigamos el informe “El Sistema Educacional Fluminense” como un documento educativo. El texto es producto de la Campanha de Inquéritos e Levantamentos do Ensino Médio e Elementar (CILEME) creada en 1953, durante la gestión de Anísio Teixeira en el Instituto Nacional de Estudos Pedagógicos (INEP), con el objetivo principal de reunir datos sobre el sistema educativo en diferentes regiones del país. Jayme Abreu fue el coordinador de la investigación en Río de Janeiro, que, durante ocho meses, reunió informaciones estadísticas, legislativas e históricas sobre el sistema educativo primario y secundario. En consecuencia, tenemos como objetivos identificar las perspectivas teórico-metodológicas de la composición del informe, y analizar, a partir del texto y apoyados en la historiografía de la educación, como el conocimiento producido aportaba al debate sobre las políticas públicas de educación y sobre los derechos y deberes del Estado y de la iniciativa privada. Al proponer “una tentativa de interpretación y crítica” y presentar las formas de participación de las prefecturas, del gobierno estadual, de la Unión y de la iniciativa privada en la oferta de la educación primaria y secundaria; el informe examina la dualidad del sistema escolar fluminense, las diferencias entre las oportunidades educativas y las condiciones de acceso y permanencia en la escuela. La actuación de intelectuales como Jayme Abreu junto a las agencias estatales fue importante para la institucionalización de la investigación en educación en Brasil y de su uso como herramienta de posicionamiento político en el debate sobre la democratización de la sociedad brasileña.

We herein investigate the report entitled “O Sistema Educacional Fluminense” (The Fluminense Educational System) as a printed educational document. The book resulted from the Campaign for High and Elementary School Surveys and Inquiries (CILEME), which was launched in 1953, during Anísio Teixeira’s administration at the National Institute of Pedagogical Studies (INEP). The main aim of the Campaign was to collect data about the educational system in different Brazilian regions. The research was coordinated by Jayme Abreu in Rio de Janeiro State and gathered statistical, legislative and historical information about the organization of primary and secondary education, over eight months. The aims of the current study are to identify the theoretical and methodological perspectives of the report and to investigate how the produced knowledge helped improving the debate about public education policies and about the rights and duties of the State and private initiatives, based on the printed document and on the historiography of education. The report approaches the duality of the education system in Rio de Janeiro State, besides differences between educational opportunities and school access/permanence conditions, by suggesting “an attempt of interpretation and criticism” and by presenting the ways local, state and federal governments, and the private sector, provide primary and secondary education. Thus, the performance of intellectuals such as Jayme Abreu in state agencies helped institutionalizing the research on education in Brazil and the use of such knowledge as political positioning instrument in debates about the democratization of the Brazilian Society., Investigamos o relatório “O Sistema Educacional Fluminense” como um impresso educacional. O livro é um produto da Campanha de Inquéritos e Levantamentos do Ensino Médio e Elementar (CILEME) criada em 1953, durante a gestão de Anísio Teixeira no Instituto Nacional de Estudos Pedagógicos (INEP), com o objetivo principal de reunir dados sobre o sistema de ensino em diferentes regiões do país. Jayme Abreu foi o coordenador da pesquisa no estado do Rio de Janeiro, que, ao longo de oito meses, reuniu informações estatísticas, legislativas e históricas sobre a organização do ensino primário e do ensino médio. Temos como objetivos identificar as perspectivas teórico-metodológicas de tessitura do relatório e analisar, a partir do próprio impresso e à luz da historiografia da educação, como o conhecimento produzido colaborava para o debate sobre as políticas públicas de educação e sobre os direitos e deveres do Estado e da iniciativa particular. Ao propor “uma tentativa de interpretação e crítica” e apresentar as formas de participação das prefeituras, do governo estadual, da União e da iniciativa privada na oferta do ensino primário e do ensino médio, o relatório prospecta a dualidade do sistema escolar fluminense, as diferenças entre as oportunidades educativas e as condições de acesso e permanência na escola. Nessa perspectiva, a atuação de intelectuais como Jayme Abreu junto às agências estatais foi importante para a institucionalização da pesquisa em educação no Brasil e de seu uso como ferramenta de posicionamento político no debate sobre a democratização da sociedade brasileira., Investigamos el informe “El Sistema Educacional Fluminense” como un documento educativo. El texto es producto de la Campanha de Inquéritos e Levantamentos do Ensino Médio e Elementar (CILEME) creada en 1953, durante la gestión de Anísio Teixeira en el Instituto Nacional de Estudos Pedagógicos (INEP), con el objetivo principal de reunir datos sobre el sistema educativo en diferentes regiones del país. Jayme Abreu fue el coordinador de la investigación en Río de Janeiro, que, durante ocho meses, reunió informaciones estadísticas, legislativas e históricas sobre el sistema educativo primario y secundario. En consecuencia, tenemos como objetivos identificar las perspectivas teórico-metodológicas de la composición del informe, y analizar, a partir del texto y apoyados en la historiografía de la educación, como el conocimiento producido aportaba al debate sobre las políticas públicas de educación y sobre los derechos y deberes del Estado y de la iniciativa privada. Al proponer “una tentativa de interpretación y crítica” y presentar las formas de participación de las prefecturas, del gobierno estadual, de la Unión y de la iniciativa privada en la oferta de la educación primaria y secundaria; el informe examina la dualidad del sistema escolar fluminense, las diferencias entre las oportunidades educativas y las condiciones de acceso y permanencia en la escuela. La actuación de intelectuales como Jayme Abreu junto a las agencias estatales fue importante para la institucionalización de la investigación en educación en Brasil y de su uso como herramienta de posicionamiento político en el debate sobre la democratización de la sociedad brasileña.

Lists online portals for state agencies in Virginia during the coronavirus pandemic

Preemption-when a higher level of government limits the authority of a lower level to enact new policies-has been devastating to tobacco control. We developed a preemption framework based on this experience for anticipating and responding to the possibility of preemption in other public health areas. We analyzed peer-reviewed literature, reports, and government documents pertaining to tobacco control preemption. We triangulated data and thematically analyzed them.Since the 1980s, tobacco companies have attempted to secure state preemption through front groups, lobbying key policymakers, inserting preemption into other legislation, and issuing legal threats and challenges. The tobacco control community responded by creating awareness of preemption through media advocacy, educating policymakers, mobilizing national collaborations, and expanding networks with the legal community. Ten of the 25 state smoke-free preemption laws have been fully repealed. Repeal, however, took an average of 11 years.State preemption has been detrimental to tobacco control by dividing the health community, weakening local authority, chilling public education and debate, and slowing local policy diffusion. Health scholars, advocates, and policymakers should use the framework to anticipate and prevent industry use of preemption in other public health areas.

BACKGROUND:Most states have at least one policy targeting alcohol use during pregnancy. The public health impact of these policies has not been examined. We sought to examine the relationship between state-level policies targeting alcohol use during pregnancy and alcohol use among pregnant women. METHODS:Data include state-level alcohol and pregnancy policy data and individual-level U.S. Behavioral Risk Factor Surveillance System data about pregnant women's alcohol use from 1985 to 2016 (N = 57,194). Supportive policies include mandatory warning signs, priority substance abuse treatment, reporting requirements for data and treatment purposes, and prohibitions on criminal prosecution. Punitive policies include civil commitment, Child Protective Services reporting requirements, and child abuse/neglect. Analyses include logistic regression models that adjust for individual- and state-level controls, include fixed effects for state and year, account for clustering by state, and weight by probability of selection. RESULTS:Relative to having no policies, supportive policy environments were associated with more any drinking, but not binge or heavy drinking. Of individual supportive policies, only the following relationships were statistically significant: mandatory warning signs was associated with lower odds of binge drinking, and priority treatment for pregnant women and women with children was associated with higher odds of any drinking. Relative to no policies, punitive policy environments were also associated with more drinking, but not with binge or heavy drinking. Of individual punitive policies, only child abuse/neglect was associated with lower odds of binge and heavy drinking. Mixed policy environments were not associated with any alcohol outcome. CONCLUSIONS:Most policies targeting alcohol use during pregnancy do not seem to be associated with less alcohol consumption during pregnancy.

BackgroundThe State Innovation Models (SIM) Initiative invested $254 million in 6 states in Round 1 to accelerate delivery system and payment reforms.ObjectiveThe objective of this study was to examine the association of early SIM implementation and diagnosed diabetes prevalence among adults and hospitalization rates among diagnosed adults.Research designQuasi-experimental design compares diagnosed diabetes prevalence and hospitalization rates before SIM (2010-2013) and during early implementation (2014) in 6 SIM states versus 6 comparison states. County-level, difference-in-differences regression models were estimated.SubjectsThe annual average of 4.5 million adults aged 20+ diagnosed with diabetes with 1.4 million hospitalizations in 583 counties across 12 states.MeasuresDiagnosed diabetes prevalence among adults and hospitalization rates per 1000 diagnosed adults.ResultsCompared with the pre-SIM period, diagnosed diabetes prevalence increased in SIM counties by 0.65 percentage points (from 10.22% to 10.87%) versus only 0.10 percentage points (from 9.64% to 9.74%) in comparison counties, a difference-in-differences of 0.55 percentage points. The difference-in-differences regression estimates ranged from 0.49 to 0.53 percentage points (P<0.01). Regression results for ambulatory care-sensitive condition and all-cause hospitalization rates were inconsistent across models with difference-in-differences estimates ranging from -5.34 to -0.37 and from -13.16 to 0.92, respectively.ConclusionsSIM Round 1 was associated with higher diagnosed diabetes prevalence among adults after a year of implementation, likely because of SIM's emphasis on detection and care management. SIM was not associated with lower hospitalization rates among adults diagnosed with diabetes, but the SIM's long-term impact on hospitalizations should be assessed.

The Utah Legislature faced two major budget and tax policy challenges leading into the 2018 General Legislative Session: federal tax reform and a citizen’s initiative to increase public school funding. Together, the two created a unique opportunity for legislators to re-balance the state tax system and generate additional revenue for public education. During the session, Legislators addressed these issues as well as homelessness, Medicaid expansion, transportation investments, and others. By the end of the 45-day session, the state had a $16.8 billion budget for FY19, which was a 3.8 percent increase over the budget passed by legislators for FY18. This report provides details about the FY19 budget, examines the budgeting process, provides highlights on key budgetary items, and discusses the economic and demographic factors that impacted the budget.

These reports summarize the 13 western state budgets for the 2018‒2019 fiscal year. The majority of the western states are financially sound, but several states continue to struggle nearly 10 years after the recession. In this regard, there are stark differences across the states in this region.

The Wyoming Legislature concluded its 2018 twenty-day budget session on March 15th, a few days beyond its normally allotted time. The Legislature was able to meet longer than four weeks this year without holding a special session because it had three days left over from last year. In large part, the extended session was the result of the House and Senate’s inability to agree over education and construction spending. The nearly $3 billion general fund biennial budget includes small increases for local governments ($105 million), strengthening cybersecurity ($2.2 million), senior centers ($200 thousand), an allotment to pay off the Capitol Square construction project, and additional funding for community colleges. According to Jim Magagna, executive vice president of the Wyoming Stock Growers Association, collegiality, something that has long been a hallmark of Wyoming’s Legislature, has significantly diminished this year with important divisiveness within the majority party (Rogers 3/23/18). A major sticking point, the state’s $850 million structural budget deficit, was never fully resolved. Here, the deficit is going to be paid mostly out of savings and unrealized capital gains from the state’s investments in the stock market. The state’s final budget keeps funding levels for most of state government generally stable, with increases in spending on social services that former Govenor Matt Mead argued were hit too hard by cuts passed during the previous legislative session (Rosenfeld 3/10/18). Cuts were felt in many agencies, with some program elimination, but seemingly little disruption to most state services.

The 2018 midterm elections strengthened the Democrats’ control of Oregon’s state government. Governor Kate Brown won re-election with 50percent of the vote defeating moderate Republican Knute Buehler with 46.6percent of the vote. Democrats also increased their seats in both the House and Senate, leading to super majorities in both houses. Governor Brown and the Democrats in Salem have taken fairly strong progressive policy stances in 2017 and 2018, particularly opposing President Trump’s immigration and marijuana policies, reinforcing the West Coast carbon-reduction pattern, and strongly supporting health care coverage expansion. With a booming economy and unemployment at record lows, the state seems to be able to deliver on its progressive agenda for the 2017-19 biennium, but funding progressive policies in the future will be a challenge for the governor for a variety of reasons. The fate of this progressive vision depends on five elements: (1) the continuation of the favorable economy and the corresponding revenue growth in the approaching budget cycle; (2) the ability to manage the ongoing taxing and spending structures that include major obligations for the Public Employees Retirement System (PERS); (3) the constraints of ongoing dependency on income taxes; (4) the vicissitudes of Trump era politics and policy with declining federal funds; and (5) continued public support for expansive public policies.

Nevada is experiencing solid economic performance during 2018. The state budget is resting on a solid foundation in terms of satisfying revenue projections contained in the 2017-2019 biennial budget. Nevada successfully faced and responded to a state economic environment that was characterized for many years by recession, a budget crisis and political budget fights. The budget in Nevada is currently stable and Nevada has experienced steady economic improvement during fiscal year 2018–2019. The Nevada Legislature meets once every two years during odd-numbered years and 2018 represents an off year for the Nevada Legislature. The off legislative year consists of monitoring economic indicators and the preliminary construction of the new biennial budget. The 2018 General Election represented an election year of great success for Democrats in Nevada. The 2018 General Election produced unified state government with the Democrats looking forward to being solidly in control of Nevada government in 2019.

During the final year of Governor John Hickenlooper's second term as governor the General Assembly passed a state budget including $11.42 billion in General Fund spending that increased funding for nearly every state department. Governor Hickenlooper prioritized increased spending for education and the criminal justice system as Colorado residents also considered tax increases for education and transportation. Colorado’s economic trajectory remains generally positive, and recent budgetary reform has allowed policymakers to make greater investments in key issue areas.

In January 2018, the New Mexico State Legislature convened for its regular session, a thirty day budget session, per its constitutional mandate. Thirty days later the legislative session ended quietly and the state of New Mexico closed the book on the great recession and a decade of financial and political strife. The 2018 legislature passed a $6.38 billion dollar budget, re-supplied dangerously low general fund reserves, and provided small raises to teachers and state employees. Oil and gas revenues are up, unemployment is slowly coming down and legislative-executive political battles have muted. The balanced budget, signed by the governor in early March, brings the state back to where it began almost 10 years before, leading one observer to refer to the time as the “lost decade in New Mexico” (Cole 2018).

As a state that overwhelmingly relies on sales tax revenue, Washington benefitted from a strong economy in 2018. However, that revenue was necessary as the state faced a court ordered deadline to fully fund K-12 education, and a need to address transportation, mental health, and a capital budget held over from the 2017 session. This is all in addition to creating a new Department of Children, Youth and Families. The state government was under unified government for the first time since 2012 which may have contributed to the state completing its work in a supplemental budget year on time and adjourning by the March deadline.

Montana uses a biennium budget; there was not a legislative session in 2018.The 65th Montana Legislature ended its constitutionally mandated 90-day biennium session with a $10.3 billion, two-year all funds budget in April 2017. The Republican-controlled legislature returned to its contentious tradition. There were several big issues, but due to budget shortfalls, and few policy issues were resolved. Infrastructure bills generally failed, although the first gas tax in decades passed to help with infrastructure needs. Montana’s colleges and universities took significant cuts in their budgets and tuition increased roughly 13 percent. Except for K-12 programs, most state agencies’ budgets were cut. Overall, it was a grim legislative session that produced very few results and resolved few problems. The balanced budget lasted less than two months when revenue projections turned out to be wrong and the governor had to use his authority to further cut expenses, which included layoffs and additional cuts to state agencies and services. It was a session marked by lack of funds and budget cuts across most agencies. As the fall season began, the state budget appeared to be in shambles only months after the session adjourned. A special session was called in November 2017 to address Montana’s $227 million budget shortfall, largely a result of the most expensive state fire season in Montana’s history. Bills were passed to address the shortfall. Governor Steve Bullock allowed most of the bills to become law. Although some funding would later be partly restored after the special session for some agencies, most of the cuts remained.

Like Idaho’s population and economy in general, state budget appropriations have increased moderately each year. The 2018 legislative session focused upon tax changes and continued infrastructure investment. Ongoing challenges in the state include disparity between the regions in terms of economic and population growth and the disconnect between citizen preferences and legislative action in Medicaid gap funding.

California passed a 2018‒2019 budget with record budget surpluses as the state attention shifted to the upcoming 2018 election. This was Jerry Brown’s final budget after sixteen years as governor, a state record. Brown was concerned the state’s volatile income tax revenues might not hold up during a future recession and wanted to store as much of the surplus away in the state’s emergency “rainy-day” fund. Continuing the annual pattern, Democratic legislators wanted to spend some of the surplus on social services, including the increasing problems of homelessness and affordable housing. In addition, legislators began to address the long-ignored problem of sexual harassment in the capitol and was on the front line of the #MeToo movement, leading several legislators to resign. Democrats did well in the November elections, leading to an even bluer California.

Since the early 1980s, Alaska has relied on oil taxes for almost all of its state government revenue. Like many resource-based economies, including many of the Western states, the result is a boom and bust economy. With production declining and the price of Alaska’s North Slope crude around $75 per barrel, the state is in a bust cycle, with a large state government deficit. Although Alaska is experiencing a somewhat improved revenue outlook compared to 2017, the state’s executive and legislative branches continue to wrestle with unpopular political choices; do we implement a state income tax, tap the state’s Permanent Fund sovereign wealth fund (and thereby reduce or eliminate Alaska’s annual Permanent Fund Dividend payment to Alaskan residents), or some combination of those two approaches? In Spring 2018, the Alaska State Legislature—supported by Independent Governor Bill Walker—chose the first of these options, tapping Alaska’s Permanent Fund to fund state government operations for the first time. The result is a dramatically improved fiscal position for 2019, and although the state remains in deficit, chances of a balanced budget are much improved. Use of the Permanent Fund has not been popular, however; a number of incumbents who supported the use Permanent Fund earnings were defeated in November 2018 by opponents who campaigned on the issue. At the moment, Alaska’s fiscal future remains in doubt.

The FY2019 budget saw the country’s largest movement of teachers descend on the state capital and force Governor Doug Ducey to scramble to save his re-election prospects. Gradually growing through social media, the #RedforEd movement culminated with 50,000 teachers and supporters walking out of classrooms and descending onto the Capitol grounds. Gov. Ducey deftly rose to the occasion from his initial one percent raise to a 20 percent raise by FY2021 before the walkout commenced, moving the pressure to legislators to seal the deal, which they did on May 3, 2018. Stronger revenue growth than prior years enabled the governor and Legislature to find the necessary funds.

Hawaii adopted a state budget that authorizes $14.3 billion in spending for FY2019. The Aloha State’s economy continues to benefit from record-breaking tourist numbers and robust federal military spending. Although the state’s unemployment rate is among the lowest ever recorded for any state in the nation, the cost of housing has made it increasingly difficult for working families to purchase a home. Tax revenues are strong, but they remain very dependent on the tourism industry. Hawaii also faces huge liabilities for pension and health care payments that are promised to retired state employees.

OBJECTIVE:To explore the perspectives of key stakeholders regarding advancement of the tobacco endgame in California. DESIGN:Interviews and focus groups exploring participants' knowledge of the tobacco endgame concept, their reactions to 4 endgame policy proposals (banning tobacco sales, registering smokers, retailer reduction, and permanently prohibiting tobacco sales to all those born after a certain year ["tobacco-free generation"]), and policy priorities and obstacles. PARTICIPANTS:Interviews with 11 California legislators/legislative staff members, 6 leaders of national tobacco control organizations, and 5 leaders of California-based organizations or California subsidiaries of national organizations. Focus groups (7) with professional and volunteer tobacco control advocates in Northern, Southern, and Central California. RESULTS:Advocates were more familiar with the endgame concept than legislators or legislative staff. All proposed endgame policies received both support and opposition, but smoker registration and banning tobacco sales were the least popular, regarded as too stigmatizing or too extreme. The tobacco-free generation and retailer-reduction policies received the most support. Both were regarded as politically feasible, given their focus on protecting youth or regulating retailers and their gradual approach. Concerns raised about all the proposals included the creation of black markets and the potential for disparate impacts on disadvantaged communities. CONCLUSION:Participants' willingness to support novel tobacco control proposals suggests that they understand the magnitude of the tobacco problem and have some appetite for innovation despite concerns about specific endgame policies. A preference for more gradual approaches suggests that taking incremental steps toward an endgame policy goal may be the most effective strategy.