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Background: We determine trends in fatal pediatric drug overdose from 1999 to 2018 and describe the influence of contextual factors and policies on such overdoses., Methods: Combining restricted CDC mortality files with data from other sources, we conducted between-county multilevel models to examine associations of demographic and socioeconomic characteristics with pediatric overdose mortality and a fixed-effects analysis to identify how changes in contexts and policies over time shaped county-level fatal pediatric overdoses per 100,000 children under 12 years., Results: Pediatric overdose deaths rose from 0.08/100,000 children in 1999 to a peak of 0.19/100,000 children in 2016, with opioids accounting for an increasing proportion of deaths. Spatial patterns of pediatric overdose deaths are heterogenous. Socioeconomic characteristics are not associated with between-county differences in pediatric overdose mortality. Greater state expenditures on public welfare (B = -0.099; CI: [-0.193, -0.005]) and hospitals (B = -0.222; CI: [-.437, -.007]) were associated with lower pediatric overdose mortality. In years when a Good Samaritan law was in effect, the county-level pediatric overdose rate was lower (B = -0.095; CI: [-0.177, -0.013])., Conclusions: Pediatric overdose mortality increased since 1999, peaking in 2016. Good Samaritan laws and investment in hospitals and public welfare may temper pediatric overdoses. Multi-faceted approaches using policy and individual intervention is necessary to reduce pediatric overdose mortality., Impact: Pediatric fatalities from psychoactive substances have risen within the U.S. since 1999. Higher levels of state spending on public welfare and hospitals are significantly associated with lower pediatric overdose mortality rates. The implementation of Good Samaritan laws is significantly associated with lower pediatric overdose mortality rates. We identified no county-level sociodemographic factors associated with pediatric overdose mortality. The findings indicate that a multi-faceted approach to the reduction of pediatric overdose is necessary., (© 2021. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)

Education affords a range of direct and indirect benefits that promote longer and healthier lives and stratify health lifestyles. We use tobacco clean air policies to examine whether policies that apply universally-interventions that bypass individuals' unequal access and ability to employ flexible resources to avoid health hazards-have an effect on educational inequalities in health behaviors. We test theoretically informed but competing hypotheses that these policies either amplify or attenuate the association between education and smoking behavior. Our results provide evidence that interventions that move upstream to apply universally regardless of individual educational attainment-here, tobacco clean air policies-are particularly effective among young adults with the lowest levels of parental or individual educational attainment. These findings provide important evidence that upstream approaches may disrupt persistent educational inequalities in health behaviors. In doing so, they provide opportunities to intervene on behaviors in early adulthood that contribute to disparities in morbidity and mortality later in the life course. These findings also help assuage concerns that tobacco clean air policies increase educational inequalities in smoking by stigmatizing those with the fewest resources.

According to Bird and Rieker's sociology of constrained choices, decisions and priorities concerning health are shaped by the contexts-including policy, community, and work/family-in which they are formulated. While each level received attention in the original and subsequent research, we contend their constrained choices theory provides a powerful multilevel framework for modeling health outcomes. We apply this framework to tobacco clean air restrictions, combining a comprehensive database of tobacco policies with the National Longitudinal Survey of Youth 1997 from ages 19 to 31. Using multilevel panel models, we find that clean air policies lower the odds of past 30 day smoking and dependence while controlling for other policy-, city-, and individual-level constraints. We also find unique between- and within-person effects, as well as gender effects, for the constraint levied by smoking bans. We argue for the theory's broad applicability beyond commonly cited findings regarding gender and biological influences., (© American Sociological Association 2016.)

In this article, we present the results of a systematic review of state, county, and municipal restrictions on the use of electronic cigarettes (e-cigarettes) in public spaces within the United States, alongside an overview of the current legal landscape. The lack of federal guidance leaves lower-level jurisdictions to debate the merits of restrictions on use in public spaces without sufficient scientific research. As we show through a geographic assessment of restrictions, this has resulted in an inconsistent patchwork of e-cigarette use bans across the United States of varying degrees of coverage. Bans have emerged over time in a manner that suggests a "bottom up" diffusion of e-cigarette clean air policies. Ultimately, the lack of clinical and scientific knowledge on the risks and potential harm reduction benefits has led to precautionary policymaking, which often lacks grounding in empirical evidence and results in spatially uneven diffusion of policy., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Introduction: Recent research has called upon investigators to exploit cross-national differences to uncover the cultural and structural factors influencing drug use. While the individual-level correlates are well-established, little is known about the association between cross-national variation in drug policies and young people's substance use. This study examines, net of individual-level predictors, the association between national-level drug policy and use of an illicit drug other than cannabis., Methods: The study uses Eurobarometer repeated cross-sectional surveys in 2002 and 2004 of adolescents aged 15-24 drawn in multistage, random probability samples proportional to population size and density within regions of their country (N=15,191). Participants completed self-reported measures of last month drug use, attitudes toward drugs, school and work participation, and demographics. Gathered from several international bodies, national-level policy measures include drug offense levels, possession decriminalization, and presence and usage of harm reduction strategies., Results: Hierarchical logistic regression models demonstrate that, while controlling for important individual-level predictors, in countries where there is no restriction on possession of drugs for personal use, the odds of drug use in the last month are 79% lower (p<0.05). On the other hand, higher usage of treatment and drug substitution are associated with higher levels of drug use. These results are robust to several alternate specifications., Conclusions: Among the strongest and most consistent findings, eliminating punishments for possession for personal use is not associated with higher drug use. The results indicate that researchers should take national-level context into account in individual-level studies of drug use., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)