The Alcohol Policy Information System (APIS) and Policy Research At NIAAA

Public policies have the potential to prevent the adverse consequences of alcohol consumption on a larger scale than any other category of interventions. However, measuring the effects of specific policies on alcohol-related behaviors and health outcomes is difficult and presents a variety of daunting challenges. One important challenge stems from the nonexperimental nature of most policy research, which makes it difficult to distinguish between causal relationships and noncausal associations. Another key challenge arises from the complexity of alcohol-related behaviors and outcomes and the wide range of potential effects that specific policy interventions may have on different groups and actors in various contexts. A third important challenge involves the difficulty in accurately characterizing the policies to be studied, which can be attributed largely to the arcane legal framework of statutes and regulations in which policies are created. This challenge is magnified by the enormous variety of alcohol-related public policies that have been adopted at all levels of government and the myriad variations in specific provisions that are embedded in the laws and regulations. Valid analysis of policy effects depends on surmounting all of these challenges and accurately characterizing policies and discerning the true causal effects of those policies on well-specified outcomes of interest.     

Imagining Gender Research: Violence,Masculinity, and the Shop Floor

This paper starts by arguing that visual data enriches gender research in management and organizations. Through an analysis of drawings by factory shop‐floor workers, we show that organizational climate is interwoven with gender dynamics, that shop‐floor masculinity is not necessarily heterosexual, and that masculinity in the shop‐floor context includes oppression as an element of man's symbolic violence against man. We discuss the usefulness of this type of data in gender research in organizational analysis and explore the ways in which gender violence is expressed in organizations. Moreover, the drawings gathered at a newspaper printing site located in the North of England provide a means of showing the relationship between gender violence and the exercise of masculinities, sexuality and oppression. We conclude that the exercise of hegemonic masculinity is associated not only with sexuality but also with the oppression of subaltern enactments of masculinity.     

Outcomes Measurement

SUMMARY

Outcomes measurement in health and mental health should be of vital concern to social workers since public support and financing will follow evidence of effectiveness. Social work in health and mental health requires a framework for conceptualizing outcomes measurement so that the profession can focus clearly on the work to be done in outcomes measurement. This framework should distinguish among the various ways that outcomes measurement can be used to advance policy, program and practice. This article discusses two applications of outcomes measurement, namely for improving policies and programs, and, second, for conducting outcomes research. Other dimensions that could be included in an outcomes measurement framework for social work in health and mental health are identified but not elaborated. The author's objective is to make a strong case for the role that outcomes measurement can play in both the improvement of social work policies and programs in health care, through performance measurement, as well as in advancing the healthcare knowledge base, through outcomes research.     

Youth tobacco sales-to-minors and possession-use-purchase laws: a public health controversy

Tobacco use among youth remains one of our nation's most significant public health problems, and yet available evidence from prevention and cessation person-centered approaches has been mixed. Given these disappointing outcomes, some have recommended more public health approaches, and these include tobacco sales-to-minors and possession-use-purchase laws. While community members and police officials have endorsed these types of public health initiatives, many within the public health community have been either guarded or even oppositional to such approaches. The primary reasons for this controversy are reviewed in this article. Outcome studies indicate that sales-to-minors laws can be an effective step toward the reduction of youth access to commercial sources of tobacco. However, even with these laws in place, many youth indicate that they continue to have easy access to tobacco, often by means of social sources. Advocates of these approaches have argued that more comprehensive public health interventions are needed, such as programs that combine youth access and possession-use-purchase laws. This article reviews the ongoing debate behind these types of public health efforts, and examines the evidence of such programs to reduce youth tobacco use.     

Outcomes for children's health and well‐being

Health outcomes are implicit in the government's major policies on reducing poverty, unemployment and social exclusion, and in environmental regeneration, as well as in explicitly targeted policies for modernising the National Health Service. The impact of policies in childhood are regarded as a key feature in determining socioeconomic outcomes in many domains, among which mental health plays a particularly important part. But although early intervention is recognised as crucial in the achievement of socioeconomic and health policy aims, outcomes in children and for children have only recently received full recognition. This article outlines the impact that government policies may have on health outcomes for children. However, the assessment of changes in health status is difficult and mostly relies on proxy measures. The evidence that any changes can be related to policy is extremely limited and mostly based on small‐scale and locally specific projects. What can be learnt from these and from collective analysis of linked projects, such as those funded through the CAMHS Innovation Grant, is discussed. Because of the attention paid by the government to evidence‐based policy, outcomes in all domains will become known before long for major national children's policy initiatives such as the Sure Start programme, highlighting the crucial and continuing need for evaluation of the ways in which policies are implemented. Copyright © 2003 John Wiley & Sons, Ltd.     

Racist Nativism in the 21st Century

Since the 1960s, academia and the public have frequently used racism as the catch‐all phrase to explain any racial or ethnic injustice identified in America. However, are the disparities domestic minorities face the same as those faced by immigrant minorities? For example, journalists have suggested that the various state immigration policies targeting Hispanic immigrants in the United States recently are as racist as the Jim Crow laws enacted decades ago. In this essay, I contend that while nativism and racism are kissing cousins, distinguishing and using these concepts may lend to more precise explanations of the issues many racial and ethnic minorities face who exist outside of the Black–White dichotomy that has traditionally characterized United States. To untangle these terms, I review recent scholarship to provide up‐to‐date definitions, as well as reintroduce the concept of ‘racist nativism’ to better explain the variability that characterizes racial or ethnic prejudice and discrimination in 21st century America.     

WHAT DO BICYCLE HELMET LAWS DO? EVIDENCE FROM CANADA

Twenty‐one states and the District of Columbia require youths to wear helmets when riding a bicycle, and there has been a push to extend such laws to adults. We provide new evidence on helmet laws by studying Canada using difference‐in‐differences models and restricted area‐identified public health survey data with information on cycling and helmet use for nearly 800,000 individuals from 1994 to 2014. We first confirm prior patterns from the United States that laws requiring youths to wear helmets significantly increased youth helmet use. We then provide the literature's first comprehensive evidence that “all‐age” bicycle helmet laws significantly increased both adult and youth helmet use by 50%–190% relative to pre‐reform levels, with larger effects for younger adults and less‐educated adults. All‐age helmet laws had modest effects at reducing cycling and increasing in‐home exercise during winter months among adults but did not meaningfully affect weight. Overall, our findings confirm that all‐age helmet laws can be effective at increasing population helmet use without significant unintended adverse health consequences. (JEL I18, I12, K32)     

Black feminist theory in maternal health research: A review of concepts and future directions

Black maternal health and well-being has become a necessary focal point for health researchers due to higher rates of maternal mortality and morbidity for Black women. However, what is often absent from this scholarship within medical sociology is Black Feminist Theory as a framework for understanding Black women's health and well-being. Drawing on Black feminist and maternal health scholarship, I argue that integrating Black feminist approaches in maternal health research expands our understandings of what processes and mechanisms are impacting the health and well-being of Black mothers, while also highlighting the importance of maternal health research that solely centers Black women. Specifically, I focus on three concepts of Black Feminist Theory as it relates to Black maternal health research: (1) examining Black women's standpoint as credible, (2) acknowledging the historical context of multiple systems of oppression against Black women, and (3) incorporating a perspective that acknowledges both disadvantages, as well as empowerment, in the lives of Black women. I end this review with a discussion of future directions for sociological research in maternal health, including the importance of acknowledging how Black mothers are both impacted by, and resisting, social structures that may add nuance to our current understandings of Black maternal health and well-being.     

Workers, Unions, and Takeovers

How do takeovers affect workers?? wages and job security in the short-run? What role does the labor union play in mitigating these effects? I answer these two questions by analyzing wage and employment outcomes of over 4,000 public firms that were acquired between 1981 and 2002, using establishment-level data from the U.S. Census Bureau. I find that target establishments exhibit a net contraction in wages and employment, relative to comparable establishments after takeovers. Targets?? establishments in more unionized industries experience worse wage and employment outcomes after takeovers. These adverse effects are exacerbated when the establishment is located in a state with Right-to-work laws where unions face a less favorable bargaining environment. These findings indicate that target firms?? employees are negatively affected by takeovers and that their labor unions do not mitigate these negative effects.     

Preventing impaired driving opportunities and problems

Impaired driving remains a significant public health problem in the United States. Although impressive reductions in alcohol-related fatalities occurred between 1982 and 1997, during which all 50 States enacted the basic impaired-driving laws, progress has stagnated over the last decade. Substantial changes in the laws and policies or funding for the enforcement of the criminal offense of driving while intoxicated (DWI) are needed for further substantial progress in reducing alcohol-related crash injuries. However, research indicates that evidence-based laws in the 50 States and current best practices in DWI enforcement are not being fully adopted or used. It seems, however, that effective operations, such as the low-staff check points that are routinely applied in many communities, could be extended to many more police departments. In addition, several enforcement methods have been proposed but never fully tested.     

Law,campus policy,social movements,and sexual violence: Where do we stand in the #MeToo movement?

In the last 8 years, activist pressure has increased attention to sexual violence at universities. Most recently, the #MeToo movement has widened the conversation about sexual violence. This increased public attention has coincided with changes in federal guidelines, state laws, and campus policies on sexual violence as well as social movement activity by survivor‐activists and emerging counter‐movements. I argue that sociologists—specifically researchers who study gender and/or law and society—are uniquely situated to contribute to the study of sexual violence on campus. I synthesize a growing sociological and interdisciplinary literature on sexual violence—legal changes, policy effects, and social movement struggles—in order to advocate that sociologists study laws, campus policies, and social movements simultaneously.     

Epistemic authority and the gender lens

Researching ‘hidden’ forms of social inequality such as gender often poses particular challenges. Not least of these is how to uncover such dimensions of social life whilst preserving the perspectives of research participants, who may not consider such matters relevant to their lives, particularly if other forms of identity or oppression are more prominent for them. Here, I reflect on these issues in the context of researching user involvement in mental health services from a feminist perspective. I show how ‘uncovering’ gender and other forms of social inequality in the field was aided through adopting a wide analytical lens focusing on power, along with reflexivity and openness in discussing my own political analysis and commitments in relation to the study area with the researched. I also describe how I attempted to resolve the epistemological‐ethical issues involved through conceptualising these in terms of ‘situatedness’ and gender salience and adopting a feminist standpoint which emphasised what researchers can, and indeed should, bring to the research enterprise. Related issues of power and empowerment in the research process are discussed.     

Public health,research and rights: the perspectives of deliberation panels with politically and socially active disabled people

Public health research purports to provide the evidence base for policies, programmes and interventions to improve the health of a population. However, there is increasing awareness that the experiences of disabled people have played little part in informing this evidence base. This paper discusses one aspect of a study commissioned by England’s National Institute for Health Research (NIHR) to review the implications for public health of theories and models of disability. This part of the study focused on the development of a tool or decision aid to promote ethical inclusion of disabled people in public health randomised controlled trials (RCTs) and evaluative research. The tool was introduced at four regional ‘deliberating panels’ involving politically and socially active disabled people. In addition, we held a panel with public health professionals. The deliberation panels debated how the focus of public health was narrowing, why disability was excluded and positive and negative issues with using rights to guide research and evaluative practice. Politically active disabled people argued for a social model of human rights to guide any rights based tools or decision aids in public health and disability research.     

Profiles of Risk: Maternal Health,Socioeconomic Status,and Child Health

Child health is fundamental to well‐being and achievement throughout the life course. Prior research has demonstrated strong associations between familial socioeconomic resources and children's health outcomes, with especially poor health outcomes among disadvantaged youth who experience a concentration of risks, yet little is known about the influence of maternal health as a dimension of risk for children. This research used nationally representative U.S. data from the National Health Interview Surveys in 2007 and 2008 (N = 7,361) to evaluate the joint implications of maternal health and socioeconomic disadvantage for youth. Analyses revealed that maternal health problems were present in a substantial minority of families, clustered meaningfully with other risk factors, and had serious implications for children's health. These findings support the development of health policies and interventions aimed at families.     

Global Processes, Local Consequences: Gender Equity and Health Sector Reform in Peru

This article brings into relief the gendered tensions and contradictionsthat have resulted from Peru’s neoliberal health sectorreforms. Previous studies were clear that economic adjustmenthad a negative impact on women and gender relations. I showmore nuanced effects of neoliberal policies when applied tohealth sector reforms. To evaluate these policies, I utilizethe distinction between redistribution and recognition. I departfrom the supposition that policies serve either redistributiveor recognition ends and show that single policies can have bothtypes of effects. I conclude that policies based on neoliberalprinciples in some instances have a negative impact on women,in other instances reify existing unequal gender relations,while in still others open up spaces for positive change. Onthe whole, however, neoliberal health reforms have had a negativeimpact on gender equity.     

ACADEMIC PROBATION,STUDENT PERFORMANCE,AND STRATEGIC COURSE‐TAKING

We use a regression discontinuity design to study how academic probation affects outcomes and course‐taking behaviors at a large public university in the United States. Consistent with past work, students placed on probation improve their grade point average (GPA) in the subsequent semester. We document that part of this GPA improvement is attributable to strategic course‐taking, and there is significant heterogeneity in these behaviors across race. Non‐minority students placed on probation attempt fewer credits, easier courses, and are more likely to withdraw from courses in the following term. In contrast, underrepresented minorities exhibit few of these behaviors, consistent with past work that suggests black and Hispanic students are less likely to possess helpful institutional knowledge and use available support systems such as academic counseling. (JEL I20, I23)     

Governing transnational social problems: public health politics on the US–Mexico border

Governance research suggests that transnational networks are the key to developing and implementing cooperative public policy across borders. I examine this claim through analysing how the US–Mexico Border Health Commission, a policy instrument designed to enhance transnational public health cooperation, developed from idea to law in Mexico and the United States. Despite a long‐standing transnational network, the policy process took over ten years and was contentious, politicized by domestic policymaking in the United States. I show how transnational networked governance intersects with domestic politics and find that the structure of overlap between the two are places where actors promoting state and transnational interests struggle with each other to define public problems in an attempt to shape policy outcomes.     

Disabled People,Health Professionals and the Social Model of Disability: Can there be a research relationship?

The social model of disability is proposed as an alternative to models that have viewed disability as an individual, rather than a socio-political issue. The use of this model to guide both research theory and practice is proposed in order to equalise research power relationships, and involve and empower disabled people. Health professionals have traditionally reinforced the medical model of disability in both research and practice, and this has been seen as contributing to the oppression and marginalisation of disabled people. If the social model is to achieve wider dissemination, it would appear important to develop a dialogue between disabled people and health professionals. However, because of negative perceptions it can be difficult for health professionals to find an appropriate position in relation to disabled people, research and the social model of disability. While not denying the past, it appears essential to look at ways in which disabled people and health professionals can work together to overcome the oppression and marginalisation that has been linked to the provision of health services.     

The LGBQ Social Climate Matters: Policies,Protests, and Placards and Psychological Well-Being Among LGBQ Emerging Adults

Sexual minority youth, including emerging adults, are at risk for negative health outcomes. Minority stress theory posits that heterosexism can contribute to these outcomes among sexual minorities. Researchers have tested this theory with respect to interpersonal heterosexism; however, little attention has been given to macro-level and environmental forms of heterosexism, especially among lesbian, gay, bisexual, and queer (LGBQ) youth. In this study, we examine the role of objective social climate (LGB state-level policies) and experiential distal and proximal environmental microaggressions on the psychological well-being of LGBQ emerging adults. Furthermore, we examine the role of LGBQ identity salience as a moderating factor on the macro/environmental-heterosexism and well-being relationship. Multivariable linear regression results suggest that living in a state without same-sex marriage laws is associated with greater self-esteem, whereas both distal and proximal environmental microaggressions are risk factors for anxiety and perceived stress. Furthermore, identity salience can ameliorate the effects of distal microaggressions and intensify the effects of proximal microaggressions and same-sex marriage legislation. Implications for practice with sexual minority youth are discussed.