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When and why does the public support redistributive policies that seek to provide social risk protection through universal health financing? One central political dilemma in establishing systems of universal health coverage (UHC) in low- and middle-income countries is the small tax base available to contribute to pooled financing of healthcare. Middle-class workers in the formal sector (labor market insiders) may already get health coverage through the state or private insurers, leaving them little incentive to contribute to UHC that will primarily benefit indigent workers in the informal sector (labor market outsiders). Applying the insider–outsider politics framework, we explore attitudes toward UHC using recent data from Afrobarometer surveys in 36 countries in Sub-Saharan and North Africa. We find that, in spite of growing attention to universal coverage among policymakers, support from the average citizen is low, though variable, across countries. Further, in contrast with expectation, economically secure labor market insiders are more willing than labor market outsiders to pay more in taxes to finance health coverage. However, support for more tax financing of health services was dependent on trust in government and perceptions of government efficacy. Trust in the government’s capacity to use tax financing effectively may be a more important determinant of support for UHC than rational self-interest.

Has political polarization undermined the media’ informational role during the COVID-19 pandemic? Recent studies show that politicized reporting from conservative media discouraged compliance with COVID-19 guidelines in the U.S. However, greater attention to the 24-hour news cycle may make high-consumption viewers better factually informed regardless of the source. We examine how the extent of media consumption affects people’s emotions, attitudes, and behaviors toward the pandemic. With an online survey of 1128 respondents, we found a strong convergence in anxiety and health-protective behaviors in more avid media viewers regardless of media outlet while finding a divergence in attitudes toward specific mitigation strategies.

Calorie labeling on menus became a federal law in 2010 but was not implemented until 2018, 8 years after adoption. This study reconstructs the history of the federal menu-labeling mandate using a process-tracing approach and finds that the delays in implementation resulted not from direct agency capture by the regulated industry, but rather from a system of indirect influence whereby lawmakers continue to influence policy-making even after adoption. Excessive legislative control can contribute to substantial implementation delays that undermine legislative intent. However, administrative agencies can serve as trustees to hold elected officials accountable to their own policy commitments.

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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

Recent literature has focused on the impact of the differential adoption by states of the Affordable Care Act's Medicaid expansion. However, additional Medicaid policy dimensions exist where state-level trends in coverage have varied, including eligibility, benefits, and administrative burden, both before and after implementation of the Affordable Care Act.

This study examines the sources of COVID-19 vaccine hesitancy and refusal in Americans by decomposing different forms of government trust/mistrust including trust in Trump and mistrust in public health institutions.Using linear panel regression models with data from 5,446 US adults (37,761 responses) from the Understanding America Survey, the likelihoods of vaccine hesitancy, uptake, and trust in various information sources were examined.We find that the likelihoods of hesitancy and having negative perceptions of COVID-19 vaccines were consistently much higher among PHI mistrusters, showing even a stronger hesitancy than Trump trusters. This tendency has persisted over time, resulting in only 49% of PHI mistrusters having been vaccinated in the most recent survey wave. However, a large portion of PHI mistrusters still trusted physicians, family, and friends. These findings suggest that mistrust in PHIs is a salient predictor of vaccine hesitancy and reduced uptake on its own, which is compounded by trust in Trump.

Although the excess male mortality from COVID-19 is well-known, the variations in sex gaps in incidence and mortality across countries and the sources of such variations are not well understood. This study explored the patterns and the sources of variation in the sex gap in COVID-19 incidence and mortality rates across 100 countries where sex-disaggregated cases and deaths were available as of September 2020. Our results show that there is generally a male disadvantage in both incidence and mortality; however, COVID-19 incidence exhibited a lower male disadvantage (1.2 times higher risk for males) than COVID-19 mortality (1.5 times higher risk for males). The extent of male disadvantages in COVID-19 outcomes across countries varied by societal gender inequalities and behavioural factors. Greater gender equality, both socially and behaviourally, was associated with more equal COVID-19 incidence and mortality between men and women. The findings imply that male disadvantages in COVID-19 outcomes, particularly incidence, are socially determined, whereas further investigation is needed to understand behavioural and biological elements yielding a male disadvantage in mortality.

Development assistance for health (DAH) has increased dramatically over the past two decades, and this increase has led to a debate on the benefits and perverse effects of scaling-up vs scaling back DAH, and the type of interventions DAH should support. Nutrition remains a contested category viewed as essential to achieving primary healthcare objectives but as falling outside of the direct ambit of the health system. Thus, despite the increase in DAH, it continues to remain an underfunded area and little is known about the relationship between aid for nutrition-specific and nutrition-sensitive interventions and the proportion of stunted children across low- and middle-income countries. We hypothesize that as nutrition-specific aid targets local needs of countries and is less fungible than nutrition-sensitive aid, it will contribute more to a reduction in the proportion of stunted children, with the steepest gains among countries that have the highest burden of malnutrition. We use fixed-effects regressions to examine the relationship between the proportion of stunted children and aid for nutrition interventions (specific and sensitive) to 116 low- and middle-income countries (2002–16). We construct our panel using the Creditor Reporting System, Institute of Health Metrics and Evaluation, Food and Agriculture Organization, World Health Organization and World Development indicators databases. We find a one-dollar increase in per capita nutrition-specific aid is associated with a reduction in the proportion of stunted children by 0.004 (P

CONTEXT: The United States is the only high-income country that relies on employer-sponsored health coverage to insure a majority of its population, and millions of Americans lost employer-sponsored health insurance during the COVID-19-induced economic downturn. We examine public opinion toward universal health coverage policies in this context. METHODS: Through a survey of 1,211 Americans in June 2020, we examine the influence of health insurance loss on support for Medicare for All (M4A) in two ways. First, we examine associations between pandemic-related health insurance loss and M4A support. Second, we experimentally prime some respondents with a vignette of a sympathetic victim losing employer-sponsored coverage during COVID-19. As a secondary outcome, we examine the effect of these exposures on support for the Affordable Care Act. FINDINGS: We find that directly experiencing recent health insurance loss is strongly associated (10 pp, p

Background: Young women and girls in Eastern and Southern Africa are at elevated risk of acquiring human immunodeficiency virus (HIV) compared with men, largely due to power dynamics within heterosexual relationships that contribute to HIV risk behaviors. Few studies employ a comprehensive framework to examine divisions between men and women and HIV risk behaviors in an African context. Thus, we examined associations between levels of women's empowerment and HIV risk behaviors applying the Theory of Gender and Power. Methods: We used logistic regression (adjusted odds ratios or AORs) to assess associations between women's empowerment indicators and HIV risk behaviors (multiple sexual partners) and self-efficacy (ability to negotiate sex/sex refusal) with couples data (n = 12,670) from Malawi, Namibia, Zambia, and Zimbabwe. Results: Specifically, key drivers of high levels of empowerment among women were household decision-making involvement, female economic independence, and rejecting all reasons for wife-beating. Furthermore, higher levels of women's empowerment in coupled relationships was associated with safer sex negotiation in Malawi (AOR = 1.57, p

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

Background The Supplementary Nutrition Assistance Program (SNAP) is a critical lifeline for millions of low-income US families, but some studies suggests that it may inadvertently increase obesity risk. Building on research contesting the SNAP-obesity link, we examine the effect of SNAP participation on BMI among multiyear participants at varying levels of SNAP benefit levels to provide some of the first evidence on the relationship between SNAP participation, state-level SNAP resources, and body weight. We focus on children given the strong links between early-life obesity and later-life health. Methods Linking state-level data on SNAP benefit levels with three waves of longitudinal individual-level data from the Child Development Supplement of the Panel Study of Income Dynamics, we use child- and state-level fixed effects to examine whether exogenous differences in SNAP benefit allotments influence the relationship between SNAP participation and weight gain. Results Lower SNAP benefit levels were associated with only modest increases in BMI among children; higher benefit levels showed no association with BMI. Conclusions Although concerns that more food assistance promotes obesity have spurred calls for cuts in the SNAP program, we find the opposite — that SNAP participation is associated with an increase in childhood BMI only when benefit levels are low. This study adds to the mounting evidence suggesting that SNAP does not cause obesity. It also contributes to the literature on the political economy of health, especially that pertaining to social policy variation across US states., Highlights • Observational studies link SNAP participation and higher bodyweight. • SNAP-obesity link has spurred calls for retrenchment of the SNAP program. • Meager benefits may help to explain the SNAP-obesity link. • SNAP participation positively associated with child BMI only when benefits are small. • Recently proposed SNAP budget cuts may inadvertently increase risk of obesity.

Background The Joint United Nations Programme on HIV/AIDS (UNAIDS) has recently set the ambitious “90-90-90 target” of having 90% of people living with HIV (PLHIV) know their status, receive antiretroviral therapy (ART), and achieve viral suppression by 2020. This ambitious new goal is occurring in a context of global “scale-down” following nearly a decade of heightened investment in HIV prevention and treatment efforts. Arguably international goals spur action, however, setting unrealistic goals that do not take weak health systems and variations in the nature of the epidemic across countries into consideration may set them up for failure in unproductive ways that lead to a decline in confidence in global governance institutions. This study explores how policy actors tasked with implementing HIV programs navigate the competing demands placed upon them by development targets and national politics, particularly in the current context of waning international investments towards HIV. Methods To examine these questions, we interviewed 29 key informants comprising health experts in donor organizations and government employees in HIV programs in Pakistan, a country where HIV programs must compete with other issues for attention. Themes were identified inductively through an iterative process and findings were triangulated with various data sources and existing literature. Results We found both political and governance challenges to achieving the target, particularly in the context of the global HIV scale-down. Political challenges included, low and heterogeneous political commitment for HIV and a conservative legal environment that contributed towards a ban on opiate substitution therapy, creating low treatment coverage. Governance challenges includedstrained state and non-governmental organization (NGO) relations creating a hostile service delivery environment, weak bureaucratic and civil society capacity contributing to poor regulation of the health infrastructure, and resource mismanagement on both the part of the government and NGOs. Conclusion Our findings suggest that in a context of waning international attention to HIV, policy actors on the ground face a number of practical hurdles to achieving the ambitious targets set out by international agencies. Greater attention to the political and governance challenges of implementing HIV programs in low- and middle-income countries (LMICs) could help technical assistance agencies to develop more realistic implementation plans.

Menu calorie labeling aims to empower customers to make healthier food choices, but researchers have questioned whether labels will empower those with greater health literacy, literacy or numeracy more, possibly reinforcing race-ethnic or socioeconomic inequalities in obesity. The goal of this study was to investigate differences in seeing and using restaurant menu calorie labels and whether differences have compounded over time. Using data from three rounds of the National Health and Nutrition Examination Survey covering the period 2007-2014, we investigate race-ethnic and socio-economic differences in menu label usage over time adjusting for sex, age and body weight. While menu label usage increased over time, not all groups increased their use equally. While we find that Blacks and Hispanics use labels more than Whites in sit-down restaurants, more educated individuals, higher income groups and Whites each increased the degree to which they saw and/or used labels in certain settings compared with other groups. This study reinforces concerns that menu-calorie labeling may exacerbate socio-economic and certain race-ethnic obesity differences. As menu labeling policy moves forward to be implemented federally, more attention may need to be diverted to educational campaigns accompanying the implementation and improving the labels so the information is easier to use.

Described as “universal prepayment,” the national health insurance (or single-payer) model of universal health coverage is increasingly promoted by international actors as a means of raising revenue for health care and improving social risk protection in low- and middle-income countries. Likewise, in the United States, the recent failed efforts to repeal and replace the Affordable Care Act have renewed debate about where to go next with health reform and arguably opened the door for a single-payer, Medicare-for-All plan, an alternative once considered politically infeasible. Policy debates about single-payer or national health insurance in the United States and abroad have relied heavily on Canada’s system as an ideal-typical single-payer system but have not systematically examined health system performance indicators across different universal coverage models. Using available cross-national data, we categorize countries with universal coverage into those best exemplifying national health insurance (single-payer), national health service, and social health insurance models and compare them to the United States in terms of cost, access, and quality. Through this comparison, we find that many critiques of single-payer are based on misconceptions or are factually incorrect, but also that single-payer is not the only option for achieving universal coverage in the United States and internationally.

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.

Though the adverse consequences of lead exposure in children have been well known for over a century, the recent Flint water crisis has drawn renewed attention to the impacts of lead exposure on human health and development. This study considers connections to educational outcomes, asking whether population-level lead exposure in early childhood influences later academic achievement and racial achievement gaps. It assesses the effectiveness of recent local- and state-level lead hazard control programs in mitigating exposure and uses this source of exogenous variation in early childhood exposure across birth cohorts to draw inferences about the long-term effects of lead on mean student test scores. Our findings indicate that lead hazard control grants reduced lead poisoning incidents by over 70% of the baseline prevalence. And each one percentage point reduction in lead poisoning in early childhood translated to a growth of 0.04 standard deviations in student math test scores and 0.08 standard deviations in student reading scores. This same reduction in lead poisoning narrowed both the white-Hispanic math achievement gap and white-Hispanic reading achievement gap by 0.06 standard deviations, implying important downstream consequences for economic inequality.

There is a need for diabetes prevention efforts targeting vulnerable populations. Our community–academic partnership, the East Harlem Partnership for Diabetes Prevention, conducted a randomized controlled trial to study the impact of peer led diabetes prevention workshops on weight and diabetes risk among an economically and racially diverse population in East Harlem, New York. We recruited overweight/obese adults from more than 50 community sites and conducted oral glucose tolerance testing and completed other clinical assessments and a health and lifestyle survey. We randomized prediabetic participants to intervention or delayed intervention groups. Intervention participants attended eight 90-minute peer-led workshop sessions at community sites. Participants in both groups returned for follow-up assessments 6 months after randomization. The main outcomes were the proportion of participants who achieved 5% weight loss, percentage weight loss, and change in the probability of developing diabetes over the next 7.5 years according to the San Antonio Diabetes Prediction Model. We enrolled 402 participants who were mainly female (85%), Latino (73%) or Black (23%), foreign born (64%), and non-English speaking (58%). At 6 months, the intervention group lost a greater percentage of their baseline weight, had significantly lower rise in HbA1c (glycated hemoglobin), decreased risk of diabetes, larger decreases in fat and fiber intake, improved confidence in nutrition label reading, and decrease in sedentary behavior as compared with the control group. Thus, in partnership with community stakeholders, we created an effective low-resource program that was less intensive than previously studied programs by incorporating strategies to engage and affect our priority population.

We developed an approach utilizing nanoscale vesicles extracted from brain regions combined with single molecule imaging to monitor how an animal’s physiological condition regulates the dynamics of protein distributions in different brain regions. This method was used to determine the effect of nicotine on the distribution of receptor stoichiometry in different mouse brain regions. Nicotine induced upregulation of α4β2 nicotinic acetylcholine receptors (nAChRs) is associated with changes in their expression, trafficking, and stoichiometry. The structural assembly of nAChRs has been quantified in cell culture based systems using single molecule techniques. However, these methods are not capable of quantifying biomolecule assembly that takes place in a live animal. Both nicotine induced upregulation and changes in nAChR stoichiometry differ across brain regions. Our single molecule approach revealed that nicotine acts differentially across brain regions to alter assembly in response to exposure and withdrawal.

Background Worldwide obesity has more than doubled since 1980. Researchers have attributed rising obesity rates to factors related to globalization processes, which are believed to contribute to obesity by flooding low-income country markets with inexpensive but obesogenic foods and diffusing Western-style fast food outlets (dependency/world systems theory). However, alternative explanations include domestic factors such as increases in unhealthy food consumption in response to rising income and higher women’s labor force participation as countries develop economically (“modernization” theory). To what extent are processes of globalization driving rising global overweight/obesity rates versus domestic economic and social development processes? This study evaluates the influence of economic globalization versus economic development and associated processes on global weight gain. Results Using two-way fixed-effects OLS regression with a panel dataset of mean body weight for 190-countries over a 30-year period (1980–2008), we find that domestic factors associated with “modernization” including increasing GDP per capita, urbanization and women’s empowerment were associated with increases in mean BMI over time. There was also evidence of a curvilinear relationship between GDP per capita and BMI: among low income countries, economic growth predicted increases in BMI whereas among high-income countries, higher GDP predicted lower BMI. By contrast, economic globalization (dependency/world systems theory) did not significantly predict increases in mean BMI and cultural globalization had mixed effects. These results were robust to different model specifications, imputation approaches and variable transformations. Discussion Global increases in overweight/obesity appear to be driven more by domestic processes including economic development, urbanization and women’s empowerment, and are less clearly negatively impacted by external globalization processes suggesting that the harms to health from global trade regimes may be overstated. Electronic supplementary material The online version of this article (10.1186/s12992-019-0457-y) contains supplementary material, which is available to authorized users.

This cross-sectional study compares in-person school reopening decisions by student sociodemographic characteristics among elementary schools in New York State.

The purpose of this study was to explore potential mediators of the relationship between depression and obesity in a sample of low-income, minority women. Data were extracted from a sample of 535 women enrolled in a weight loss intervention for the prevention of type 2 diabetes. Using a non-parametric bootstrapping procedure, the potential mediation effects of stress eating and sleep disturbance on the relationship between depression and obesity were tested. Results of a single mediation model indicated that depressive symptomatology was significantly associated with obesity (β = 0.800, SE = 0.290, p = 0.006), and that stress eating (β = 0.166, 95% CI [0.046, 0.328]) and sleep disturbance (β = 1.032, 95% CI [0.612, 1.427]) were significant independent mediators of this relationship. Sleep disturbance remained a significant mediator in a combined mediation model (β = 1.009, 95% CI [0.653, 1.399]). Findings add to the growing literature on the psychosocial factors implicated in the link between depression and obesity, particularly among disadvantaged populations. Future longitudinal research should aim to establish causal pathways between obesity, stress eating, sleep disturbance, and depression.

Objectives. To examine the relationship between adolescent pregnancy–prevention and sexuality and abstinence-only education funding and adolescent birthrates over time. Also, to determine whether state ideology plays a moderating role on adolescent reproductive health, that is, whether the funding has its intended effect at reducing the number of adolescent births in conservative but not in liberal states. Methods. We modeled time-series data on federal abstinence-only and adolescent pregnancy–prevention and sexuality education block grants to US states and rates of adolescent births (1998–2016) and adjusted for state-level confounders using 2-way fixed-effects models. Results. Federal abstinence-only funding had no effect on adolescent birthrates overall but displayed a perverse effect, increasing adolescent birthrates in conservative states. Adolescent pregnancy–prevention and sexuality education funding eclipsed this effect, reducing adolescent birthrates in those states. Conclusions. The millions of dollars spent on abstinence-only education has had no effect on adolescent birthrates, although conservative states, which experience the greatest burden of adolescent births, are the most responsive to changes in sexuality education–funding streams.

Background: Health guidelines help in ensuring uniformity in quality of care for clients, yet little attention has been giving to understanding if health facilities in the public or private sector are more likely to possess national health guidelines. We hypothesize that government health facilities in low and middle income countries are more likely to possess national guidelines as they are required to comply with public regulations, and are closer to organizations that communicate these guidelines. Methods: We use cross-sectional data from the DHS-SPA surveys to understand the relationship between the managing authority of a health facility (public versus private) and if the facility reports the presence of national health guidelines for maternal and child health (MNCH), communicable, and non-communicable diseases. We restrict our sample to several African and South Asian countries. Findings: We find that health facilities managed by a public authority are more likely to possess guidelines for MNCH, and communicable diseases, as compared to privately managed health facilities. In terms of MNCH healthcare guidelines, the odds of reporting the presence of national guidelines for family planning, IMPAC, CEmOC, and PMTCT, are 57%, 42.4%, 72.2%, and 60.2% higher respectively among public health facilities. For communicable disease guidelines, the odds of reporting the presence of national guidelines for malaria, tuberculosis, and STIs are 103%, 121%, and 81% higher respectively among public health facilities. Interpretation: Our findings suggest that inspite of criticisms, public health facilities have comparative strength in possessing guidelines. Our findings imply a need to improve health system regulation. Funding Statement: The authors stated that they did not receive funding for this work. Declaration of Interests: The authors have no conflicts of interest to declare. Ethics Approval Statement: The study uses publicly available, secondary data and so an IRB application was not filed.

Importance: Few studies examining the use of peers during interventions have been published, and no systematic review has been conducted to evaluate the available literature. Objective: To examine the effectiveness of social skills interventions incorporating peers for children with attention deficit hyperactivity disorder (ADHD) to improve social interactions. Data Sources: A search of five databases (CINAHL, PubMed, Web of Science, Google Scholar, and PsycINFO) produced 697 articles. Sixty-one were retrieved for full-text review, and 15 articles met inclusion criteria. Study Selection and Data Collection: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to abstract data. Inclusion criteria: Participants younger than age 18 yr with any ADHD pattern, social skills interventions with peer involvement, outcome measures within the domain of occupational therapy, written in English, and involved a peer as the sole or primary component at some point in the social skills intervention. Exclusion criteria: Studies older than 20 yr or that used participants with comorbidities or multiple conditions. Findings: Interventions incorporating both peer categories were effective for increasing play skills, reducing undesirable social behaviors (e.g., inappropriate verbalizations, dominant behaviors, aggression), and improving communication (e.g., pragmatic language, collaboration, joint participation) and social participation. Improvements were maintained over time, as evidenced by follow-up studies. Conclusions and Relevance: Outcomes of these studies demonstrate moderate evidence that supports the use of social skills interventions incorporating peers for children with ADHD to improve social interactions, supporting their use by occupational therapists and the need for more studies. What This Article Adds: This article provides guidance to occupational therapy practitioners on social skills intervention options for children with ADHD.

Senegal has a reputation for having one of the most effective and far-reaching nutritionservice delivery systems in Africa. Chronic malnutrition has dropped to less than 20 percent, oneof the lowest in Sub-Saharan Africa. The reduction in stunting in particular has been deemed a success in Senegal with the prevalence of child stunting one of the lowest in Sub-Saharan Africa in absolute terms (Nene 2017). This success has at least in part been attributed to broad-based government commitment to nutrition, which has grown from US$0.3 million per year in 2002 to US$5.7 million per year in 2015, increasing from approximately 0.02 percent to 0.12 percent of the national budget. Yet concerns remain regarding whether the level of government support for nutrition is sufficient and the degree to which nutrition has been as effectively “mainstreamed” across major line ministries, such as agriculture, education, water and sanitation, socialprotection and health, to support both nutrition-specific and nutrition-sensitive interventions. Moreover, the nutrition field as a whole is characterized by a myriad of actors (international donors, NGOs, and technical support agencies) whose interventions are not well coordinated, leading to duplications of effort and inefficiencies in the provision of services. A series ofexternal shocks, including food shortages stemming from drought, the global financial crisis, and the instability of prices for local foodstuffs since 2007, has revealed the continued need for additional investment in nutrition and better intersectoral coordination of activities to counter cyclical attention to nutrition and a predominant focus on food insufficiency rather than abroader focus on nutrition. To this end, the government of Senegal, through the CLM, is in the process of drafting the new PSMN to develop a reform agenda for the sector. The PSMN will lay out a framework and timeline for the development of a nutrition financing strategy that will requirespecific analysis of the sector spending and financial basis, linking it to the coverage and quality of nutrition services and assessing the contribution of different sectors and actors to the budget. As part of the Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal series, the World Bank commissioned this report to elaborate the specific political challenges to and opportunities for further raising the profile ofnutrition on the government’s agenda and secure a sustainable effort to reduce maternal and child malnutrition. The nutrition agenda is often prone to political economy challenges when it competes for government support, as the impact of nutritional intervention is neither immediate nor tangible. Though the benefits of proper nutrition are life-long and are foundational to proper growth and development, nutrition can fall by the wayside in policymakers’ inevitably shorter-termoutlook. With this in mind, the objective of this report was to identify the policy and political levers that can be used to foster government leadership and galvanize intersectoral coordination that mainstreams nutrition into government policies and programs and effectively, efficiently, and sustainably delivers nutrition interventions in Senegal.

Exposure to nicotine alters the trafficking and assembly of nicotinic receptors (nAChRs), leading to their up-regulation on the plasma membrane. Although the mechanism is not fully understood, nicotine-induced up-regulation is believed to contribute to nicotine addiction. The effect of cotinine, the primary metabolite of nicotine, on nAChR trafficking and assembly has not been extensively investigated. We utilize a pH-sensitive variant of GFP, super ecliptic pHluorin, to differentiate between intracellular nAChRs and those expressed on the plasma membrane to quantify changes resulting from cotinine and nicotine exposure. Similar to nicotine, exposure to cotinine increases the number of α4β2 receptors on the plasma membrane and causes a redistribution of intracellular receptors. In contrast to this, cotinine exposure down-regulates α6β2β3 receptors. We also used single molecule fluorescence studies to show that cotinine and nicotine both alter the assembly of α4β2 receptors to favor the high sensitivity (α4)2(β2)3 stoichiometry.

Cell-derived vesicles facilitate the isolation of transmembrane proteins in their physiological membrane maintaining their structural and functional integrity. These vesicles can be generated from different cellular organelles producing, housing, or transporting the proteins. Combined with single-molecule imaging, isolated organelle specific vesicles can be employed to study the trafficking and assembly of the embedded proteins. Here we present a method for organelle specific single molecule imaging via isolation of ER and plasma membrane vesicles from HEK293T cells by employing OptiPrep gradients and nitrogen cavitation. The isolation was validated through Western blotting, and the isolated vesicles were used to perform single molecule studies of oligomeric receptor assembly.

Well-designed decentralization can deepen democracy and strengthen the state in five key ways. Decentralizing below the level of social cleavages should undermine secessionism by peeling away moderates from radical leaders. The “fragmentation of authority” critique is mistaken; decentralization transforms the state from a simpler, brittler command structure to one of multilevel complementarity more robust to local failure. Decentralizing services with low economies of scale, with devolved taxation and bail-outs prohibited, should increase accountability. Lastly, the small scale of local politics allows citizens to become political actors, promoting social learning-by-doing, strengthening political legitimacy and ‘democratic suppleness’ from the grass-roots upwards.

Understanding membrane protein trafficking, assembly, and expression requires an approach that differentiates between those residing in intracellular organelles and those localized on the plasma membrane. Traditional fluorescence-based measurements lack the capability to distinguish membrane proteins residing in different organelles. Cutting edge methodologies transcend traditional methods by coupling pH-sensitive fluorophores with total internal reflection fluorescence microscopy (TIRFM). TIRF illumination excites the sample up to approximately 150 nm from the glass-sample interface, thus decreasing background, increasing the signal to noise ratio, and enhancing resolution. The excitation volume in TIRFM encompasses the plasma membrane and nearby organelles such as the peripheral ER. Superecliptic pHluorin (SEP) is a pH sensitive version of GFP. Genetically encoding SEP into the extracellular domain of a membrane protein of interest positions the fluorophore on the luminal side of the ER and in the extracellular region of the cell. SEP is fluorescent when the pH is greater than 6, but remains in an off state at lower pH values. Therefore, receptors tagged with SEP fluoresce when residing in the endoplasmic reticulum (ER) or upon insertion in the plasma membrane (PM) but not when confined to a trafficking vesicle or other organelles such as the Golgi. The extracellular pH can be adjusted to dictate the fluorescence of receptors on the plasma membrane. The difference in fluorescence between TIRF images at neutral and acidic extracellular pH for the same cell corresponds to a relative number of receptors on the plasma membrane. This allows a simultaneous measurement of intracellular and plasma membrane resident receptors. Single vesicle insertion events can also be measured when the extracellular pH is neutral, corresponding to a low pH trafficking vesicle fusing with the plasma membrane and transitioning into a fluorescent state. This versatile technique can be exploited to study localization, expression, and trafficking of membrane proteins.

Lack of political commitment has been identified as a primary reason for the low priority that food and nutrition interventions receive from national governments relative to the high disease burden caused by malnutrition. Researchers have identified a number of factors that contribute to food and nutrition's 'low-priority cycle' on national policy agendas, but few tools exist to rapidly measure political commitment and identify opportunities to advance food and nutrition on the policy agenda. This article presents a theory-based rapid assessment approach to gauging countries' level of political commitment to food and nutrition security and identifying opportunities to advance food and nutrition on the policy agenda. The rapid assessment tool was piloted among food and nutrition policymakers and planners in 10 low- and middle-income countries in April to June 2013. Food and nutrition commitment and policy opportunity scores were calculated for each country and strategies to advance food and nutrition on policy agendas were designed for each country. The article finds that, in a majority of countries, political leaders had verbally and symbolically committed to addressing food and nutrition, but adequate financial resources were not allocated to implement specific programmes. In addition, whereas the low cohesion of the policy community has been viewed a major underlying cause of the low-priority status of food and nutrition, the analysis finds that policy community cohesion and having a well thought-out policy alternative were present in most countries. This tool may be useful to policymakers and planners providing information that can be used to benchmark and/or evaluate advocacy efforts to advance reforms in the food and nutrition sector; furthermore, the results can help identify specific strategies that can be employed to move the food and nutrition agenda forward. This tool complements others that have been recently developed to measure national commitment to advancing food and nutrition security.

Analysis of the politics of HIV programme scale-up requires critical attention to the role of the state, since the state formulates HIV policies, provides resources for the HIV response and negotiates donor involvement in HIV programmes. However, conceptual and methodological approaches to analysing states' responses to HIV remain underdeveloped. Research suggests that differences in states' successes in HIV programme scale-up reflect their levels of 'political commitment' to responding to HIV. Few empirical measures of political commitment exist, and those that do, notably the AIDS Program Effort Index (API), employ ad hoc scoring approaches to combine information from different variables into an index of commitment. The indices are thus difficult to interpret and may not have empirically useful meaning. In this paper, we apply exploratory factor analysis to examine whether, and how, selected variables that comprise the API score reflect previously theorised dimensions of political commitment. We investigate how variables associated with each of the factors identified in the analyses correspond to these theorised dimensions as well as to API categories. Finally, we discuss potential uses--such as political benchmarking and accountability--and challenges of factor analysis as a means to identify and measure states' political commitment to respond to HIV.

As a result of massive scale-up efforts in developing countries, millions of people living with HIV are now receiving antiretroviral therapy (ART). However, countries have been uneven in their scale-up efforts with ART coverage rates exceeding expectations in some places and lagging behind expectation in others. This paper develops a model that explains ART scale-up as a function of the responsiveness of political parties to their primary constituents. Specifically, the paper argues that, faced with a perilous 'threat to the nation', countries responded in one of two ways, both of which were designed to appeal to their primary constituents--either adopting a 'Geneva Consensus' response, or depicting the epidemic as a Western disease and adopting a 'pan-African' response. The article tests this theory using Afrobarometer data for eleven countries. The paper finds that HIV/AIDS is generally a non-partisan issue in most countries. However, the analysis does uncover some differences in partisan support for HIV/AIDS responses in both countries that have adopted Geneva Consensus and pan-African responses, though not in the direction hypothesised. The lack of congruence in policy preferences between the public and their governments suggests a democratic deficit in that these governments have acted independently of the preferences of core constituents.