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Critics of the modern American welfare state allege that safety net benefits discourage work by providing sufficient resources to replace earned income. Yet, research in social policy has long depicted the US safety net as parsimonious and inadequate relative to its European counterparts, even when considering benefits from programs that reward favorable work histories. Other theories predict variability across states and regional clustering even amid low overall spending. Moreover, the recent COVID-19 outbreak has exposed the insufficiency and lack of resilience of the major US safety nets in the face of unprecedented unemployment. This study examines the benefit expenditures on three safety net programs available to American families with recently unemployed breadwinners—Temporary Assistance for Needy Families, Supplemental Nutrition Assistance Program, and Unemployment Insurance—as a proportion of median annual income for a given state-year between 1997 and 2017. We examine the overall spending as well as variability and clustering across states. We find that the average benefit expenditure comprises only 42% of median income, and while there is substantial variability around this average, only one state is above 78%. We also find that spending levels appear to be regionally clustered. We conclude that safety nets for the recently unemployed and their families are weak relative to earned income and that the extent of this weakness varies by state, with some regional patterning. © 2021 Policy Studies Organization

Research Objective Studies on health communication have suggested that acknowledging past injustice is an important step in reducing hesitancy towards vaccination among African‐Americans. However, few studies have tested this messaging through experimental approaches. Furthermore, research on racial priming suggests that framing messages in terms of prioritization of one racial group over another could trigger resentment in the out‐group. As the vaccine roll‐out continues in the US, policymakers are looking for ways to increase vaccine confidence and uptake, particularly in more hesitant populations. Through a survey experiment, this study asks how popular representations of race‐ethnic disparities in Coronavirus cases and deaths impacts vaccine hesitancy in a racially diverse sample of New Yorkers. Study Design Using a survey experiment, respondents were randomized to receive a newspaper prime recommending minority prioritization for vaccination acknowledging historical racism versus a control article without a minority prioritization focus. Respondents were then asked a series of questions about their attitudes towards vaccines, racial justice and socio‐demographics. We compared responses of the experimental versus control condition overall and stratified by race‐ethnicity. Population Studied 1,353 New York State residents recruited through the survey firm Qualtrics between November 23‐December 8. Black and Hispanic respondents were oversampled producing a sample of 429 NH Whites; 443 NH Blacks and 481 Hispanics. Respondents were drawn from both Downstate (43%) from Upstate (57%). Principal Findings We find no effects of the prime on respondents' intention to vaccinate against Coronavirus altogether and interacted with race‐ethnicity. We explore correlates of vaccine hesitancy and find that while African‐Americans are more vaccine hesitant than other race‐ethnic groups, identifying politically as an independent, being female and watching alternative news media are each stronger predictors of hesitancy. Qualitatively examining reasons for hesitancy or confidence, we find that conspiracy beliefs do not figure prominently in people's vaccine hesitancy, but rather more quotidian (and legitimate) concerns about the speed of the development process and generalized lack of trust in the political and scientific institutions producing the vaccine contributing to a desire to “wait and see.” These themes cut across race‐ethnic groups. Conclusions We conclude that strong hesitancy views may be relatively fixed and difficult to change at least with simple messaging campaigns among a segment of the population that holds longstanding deep‐seated skepticism towards established institutions (justified or not). Nor, do simple messaging campaigns animate racial resentment in out‐groups in a way that will influence their behavior. Rather, weaker hesitancy views may give way to willingness relative quickly as more people take the vaccine. Implications for Policy or Practice While vaccine hesitancy is considered to be a major barrier to widespread uptake of the Coronavirus vaccine, especially among African‐Americans, our results suggest that it is a relatively small portion of the population that is hesitant, but that “more than messaging” will be required to influence behavioral intentions to vaccinate. Primary Funding Source State of New York

Policy Points: For more than 3 decades, international development agencies have advocated health system decentralization to improve health system performance in low- and middle-income countries. We found little rigorous evidence documenting the impact of decentralization processes on health system performance or outcomes in part due to challenges in measuring such far-reaching and multifaceted system-level changes. We propose a renewed research agenda that focuses on discrete definitions of decentralization and how institutional factors and mechanisms affect health system performance and outcomes within the general context of decentralized governance structures. Context Despite the widespread adoption of decentralization reforms as a means to improve public service delivery in developing countries since the 1980s, empirical evidence of the role of decentralization on health system improvement is still limited and inconclusive. This study reviewed studies published from 2000 to 2016 with adequate research designs to identify evidence on whether and how decentralization processes have impacted health systems. Methods We conducted a systematic review of peer-reviewed journal articles from the public health and social science literature. We searched for articles within 9 databases using predefined search terms reflecting decentralization and health system constructs. Inclusion criteria were original research articles, low- and middle-income country settings, quantifiable outcome measures, and study designs that use comparisons or statistical adjustments. We excluded studies in high-income country settings and/or published in a non-English language. Findings Sixteen studies met our prespecified inclusion and exclusion criteria and were grouped based on outcomes measured: health system inputs (n = 3), performance (n = 7), and health outcomes (n = 7). Numerous studies addressing conceptual issues related to decentralization but without any attempt at empirical estimation were excluded. Overall, we found mixed results regarding the effects of decentralization on health system indicators with seemingly beneficial effects on health system performance and health outcomes. Only 10 studies were considered to have relatively low risks of bias. Conclusions This study reveals the limited empirical knowledge of the impact of decentralization on health system performance. Mixed empirical findings on the role of decentralization on health system performance and outcomes highlight the complexity of decentralization processes and their systemwide effects. Thus, we propose a renewed research agenda that focuses on discrete definitions of decentralization and how institutional factors and mechanisms affect health system performance and outcomes within the general context of decentralized governance structures.

In spite of vast global improvements in living standards, health, and well-being, the persistence of absolute poverty and its attendant maladies remains an unsettling fact of life for billions around the world and constitutes the primary cause for the failure of developing states to improve the health of their peoples. While economic development in developing countries is necessary to provide for underlying determinants of health--most prominently, poverty reduction and the building of comprehensive primary health systems--inequalities in power within the international economic order and the spread of neoliberal development policy limit the ability of developing states to develop economically and realize public goods for health. With neoliberal development policies impacting entire societies, the collective right to development, as compared with an individual rights-based approach to development, offers a framework by which to restructure this system to realize social determinants of health. The right to development, working through a vector of rights, can address social determinants of health, obligating states and the international community to support public health systems while reducing inequities in health through poverty-reducing economic growth. At an international level, where the ability of states to develop economically and to realize public goods through public health systems is constrained by international financial institutions, the implementation of the right to development enables a restructuring of international institutions and foreign-aid programs, allowing states to enter development debates with a right to cooperation from other states, not simply a cry for charity.

A qualitative study was conducted with 28 women who are human immunodeficiency virus (HIV)–positive and have experienced childhood sexual abuse (CSA) in order to examine (1) the challenges generated by the experience of sexual abuse and related coping strategies, (2) the impact of the HIV diagnosis on their coping strategies, and (3) the links perceived by the women between their CSA and HIV infection. The interviews revealed that CSA raised challenges in four areas: disclosure of the abuse, sexual problems, relationship difficulties, and psychological distress. The women used two strategies to cope with their CSA: illicit substances to numb their emotional distress and sexual activity, and alienation to gain control in relationships. When diagnosed with HIV, the women initially coped with their illness by using these two strategies. The women reported that, over time, they were able to accept their HIV illness, seek social support, find alternative sources of significance, and use spirituality to sustain their growth. However, they continued to suffer psychological distress related to their sexual trauma. Further, most of the women did not perceive any connection between the two traumas. Implications of these findings for secondary prevention interventions with women who have HIV and experience of CSA are discussed. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 655–672, 2005.

A new approach is presented for the application of single-molecule imaging to membrane receptors through the use of vesicles derived from cells expressing fluorescently labeled receptors. During the isolation of vesicles, receptors remain embedded in the membrane of the resultant vesicles, thus allowing these vesicles to serve as nanocontainers for single-molecule measurements. Cell-derived vesicles maintain the structural integrity of transmembrane receptors by keeping them in their physiological membrane. It was demonstrated that receptors isolated in these vesicles can be studied with solution-based fluorescence correlation spectroscopy (FCS) and can be isolated on a solid substrate for single-molecule studies. This technique was applied to determine the stoichiometry of α3β4 nicotinic receptors. The method provides the capability to extend single-molecule studies to previously inaccessible classes of receptors.