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Purtle J, Stadnick NA, Wynecoop M, Walker SC, Bruns EJ, Aarons GA. A Tale of Two Taxes: Implementation of Earmarked Taxes for Behavioral Health Services in California and Washington State. Psychiatr Serv 2024; 75:410-418. [PMID: 37933132 PMCID: PMC11139541 DOI: 10.1176/appi.ps.20230257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
OBJECTIVE The authors sought to characterize perceptions of the impacts, attributes, and support for taxes earmarked for behavioral health services and to compare perceptions of the taxes among professionals in California and Washington, two states differing in earmarked tax designs. METHODS Surveys were completed by 155 public agency and community organization professionals involved in tax implementation in California (N=87) and Washington State (N=68) during 2022-2023 (29% response rate). Respondents indicated their perceptions of the taxes' impacts, attributes, and support. Responses were summed as aggregate scores and were also analyzed as individual items. Bivariate analyses were used to compare responses of professionals in California versus Washington State. RESULTS Earmarked taxes were generally regarded positively. Of the respondents, >80% strongly agreed that the taxes increased funding for services and were helpful, and only 10% strongly agreed that the taxes decreased behavioral health funding from other sources. Substantially more respondents in California than in Washington State strongly agreed that taxes' reporting requirements were complicated (45% vs. 5%, p<0.001) and that the taxes increased unjustified scrutiny of services or systems (33% vs. 2%, p<0.001). However, more respondents in California than in Washington State also strongly agreed that the taxes increased public awareness about behavioral health (56% vs. 15%, p<0.001) and decreased behavioral health stigma (47% vs. 14%, p<0.001). CONCLUSIONS Perceptions of the strengths and weaknesses of taxes earmarked for behavioral health services may vary by design features of the tax. Such features include stigma-reduction initiatives and tax spending and reporting requirements.
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Affiliation(s)
- Jonathan Purtle
- Global Center for Implementation Science, Department of Public Health Policy and Management, New York University School of Global Public Health, New York City (Purtle, Wynecoop); Dissemination and Implementation Science Center, Department of Psychiatry, Altman Clinical and Translational Research Institute, University of California, San Diego, La Jolla (Stadnick, Aarons); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Walker, Bruns)
| | - Nicole A Stadnick
- Global Center for Implementation Science, Department of Public Health Policy and Management, New York University School of Global Public Health, New York City (Purtle, Wynecoop); Dissemination and Implementation Science Center, Department of Psychiatry, Altman Clinical and Translational Research Institute, University of California, San Diego, La Jolla (Stadnick, Aarons); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Walker, Bruns)
| | - Megan Wynecoop
- Global Center for Implementation Science, Department of Public Health Policy and Management, New York University School of Global Public Health, New York City (Purtle, Wynecoop); Dissemination and Implementation Science Center, Department of Psychiatry, Altman Clinical and Translational Research Institute, University of California, San Diego, La Jolla (Stadnick, Aarons); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Walker, Bruns)
| | - Sarah C Walker
- Global Center for Implementation Science, Department of Public Health Policy and Management, New York University School of Global Public Health, New York City (Purtle, Wynecoop); Dissemination and Implementation Science Center, Department of Psychiatry, Altman Clinical and Translational Research Institute, University of California, San Diego, La Jolla (Stadnick, Aarons); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Walker, Bruns)
| | - Eric J Bruns
- Global Center for Implementation Science, Department of Public Health Policy and Management, New York University School of Global Public Health, New York City (Purtle, Wynecoop); Dissemination and Implementation Science Center, Department of Psychiatry, Altman Clinical and Translational Research Institute, University of California, San Diego, La Jolla (Stadnick, Aarons); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Walker, Bruns)
| | - Gregory A Aarons
- Global Center for Implementation Science, Department of Public Health Policy and Management, New York University School of Global Public Health, New York City (Purtle, Wynecoop); Dissemination and Implementation Science Center, Department of Psychiatry, Altman Clinical and Translational Research Institute, University of California, San Diego, La Jolla (Stadnick, Aarons); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Walker, Bruns)
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Tevendale HD, Garraza LG, Brooks MAM, Koumans EH, House LD, Sommerfeldt HM, Brittain A, Mueller T, Fuller TR, Romero L, Fasula A, Warner L. Effects of Community-Wide Teen Pregnancy Prevention Initiatives on Local Teen Birth Rates in the United States: A Synthetic Control Approach. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:545-565. [PMID: 38578374 DOI: 10.1007/s11121-024-01663-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/06/2024]
Abstract
The impact of community-wide teen pregnancy prevention initiatives (CWIs) on local U.S. birth rates among adolescents aged 15 to 19 years was examined using synthetic control methodology within a quasi-experimental design. CWIs were implemented in 10 U.S. communities from 2010 to 2015. Each initiative implemented evidence-based teen pregnancy prevention interventions at local organizations and enhanced best practices in adolescent reproductive health care at local health centers, while engaging diverse community sectors. The synthetic control method was used to estimate the impact of each CWI on overall and race- and ethnicity-specific teen births relative to rates in synthetic control communities. Additionally, we estimated the overall effect of CWIs across communities by pooling results from the 10 synthetic control case studies using the mean percentile rank. Pooled data across all 10 communities indicated an estimated average of 6.6 fewer births per 1000 teens per year overall during the initiative relative to each community's synthetic control (p = .001). By race and ethnicity, there were an estimated average of 6.4 fewer births per 1000 teens per year among Black teens (p = .03), 10.7 fewer births among Hispanic teens (p = .03), and 4.2 fewer births (p = .10) among White teens. Results from individual communities indicated an intervention effect on overall and/or race/ethnicity-specific teen birth rates in five communities. This study demonstrates the value of synthetic control methods in evaluating community-level outcomes of programmatic efforts. Findings indicate the CWIs had a positive impact on teen birth rates and have the potential to address racial and ethnic disparities in those rates.
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Affiliation(s)
- Heather D Tevendale
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, 30341, USA.
| | | | | | - Emilia H Koumans
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, 30341, USA
| | - L Duane House
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, 30341, USA
| | | | - Anna Brittain
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, 30341, USA
| | - Trisha Mueller
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, 30341, USA
| | - Taleria R Fuller
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, 30341, USA
| | - Lisa Romero
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, 30341, USA
| | - Amy Fasula
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, 30341, USA
| | - Lee Warner
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, 30341, USA
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Townsend TN, Hamilton LK, Rivera-Aguirre A, Davis CS, Pamplin JR, Kline D, Rudolph KE, Cerdá M. Use of an Inverted Synthetic Control Method to Estimate Effects of Recent Drug Overdose Good Samaritan Laws, Overall and by Black/White Race/Ethnicity. Am J Epidemiol 2022; 191:1783-1791. [PMID: 35872589 PMCID: PMC9989361 DOI: 10.1093/aje/kwac122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/03/2022] [Accepted: 07/07/2022] [Indexed: 01/29/2023] Open
Abstract
Overdose Good Samaritan laws (GSLs) aim to reduce mortality by providing limited legal protections when a bystander to a possible drug overdose summons help. Most research into the impact of these laws is dated or potentially confounded by coenacted naloxone access laws. Lack of awareness and trust in GSL protections, as well as fear of police involvement and legal repercussions, remain key deterrents to help-seeking. These barriers may be unequally distributed by race/ethnicity due to racist policing and drug policies, potentially producing racial/ethnic disparities in the effectiveness of GSLs for reducing overdose mortality. We used 2015-2019 vital statistics data to estimate the effect of recent GSLs on overdose mortality, overall (8 states) and by Black/White race/ethnicity (4 states). Given GSLs' near ubiquity, few unexposed states were available for comparison. Therefore, we generated an "inverted" synthetic control method (SCM) to compare overdose mortality in new-GSL states with that in states that had GSLs throughout the analytical period. The estimated relationships between GSLs and overdose mortality, both overall and stratified by Black/White race/ethnicity, were consistent with chance. An absence of effect could result from insufficient protection provided by the laws, insufficient awareness of them, and/or reticence to summon help not addressable by legal protections. The inverted SCM may be useful for evaluating other widespread policies.
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Affiliation(s)
| | | | | | | | | | | | | | - Magdalena Cerdá
- Correspondence to Dr. Magdalena Cerdá, Department of Population Health, Center for Opioid Epidemiology and Policy, 180 Madison Avenue, New York, NY 10016 (e-mail: )
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