Three Essays on Determinants of Policy Change at the Federal and State Levels Open Access

Abstract

Abstract
Three Essays on Determinants of Policy Change at the Federal and State Levels

Understanding determinants of policy change provides a critical window into Federal and State-level decisionmaking. This dissertation comprises three articles examining determinants of policy change at the Federal and State levels to identify the effects of stakeholders, politics and economics on policy outcomes.

The first chapter aimed to identify barriers to influenza vaccination policy change and implementation, through interviews with 35 stakeholders from the medical, public health, educational, insurance and vaccine industry sectors. Over 97% of respondents supported the expansion of vaccination for all school-age children. Roughly 95% supported universal vaccination for all ages, but despite the level of support for this policy change, respondents raised reservations. The findings highlight the need for additional studies to examine issues related to policy implementation.

The second chapter examined the impact of political and economic determinants on state-level cancer control efforts. The shift to comprehensive cancer control represents a major policy change. Examining the variation in state spending on cancer control can provide a window into state activity and can be used as a tool to assist states in overcoming barriers to adoption, particularly related to the allocation of state investment. This study also models other state policy outcomes which have implications for cancer control. The results showed that measures of fiscal capacity appear to explain more of the variation in spending across all state outcomes examined, although political factors were also important.

The third chapter examined whether institutional factors related to women in state legislatures are predictive of policy outcomes. Results show that the incorporation of women in state legislatures is not associated with higher state appropriations for breast and cervical cancer screening. The percentage of women in state legislatures, the percentage of women in leadership roles and the percentage of women holding committee chairmanships were not significant predictors of cancer screening funding. Other political and economic factors, however, were found to be significantly associated with higher levels of state cancer screening funding. This study provides further evidence in the debate over the impact of women in legislatures on policy outcomes.

Table of Contents

Table of Contents

INTRODUCTION...1
CHAPTER 1...3

Abstract...3
Introduction...5
Methods...7

Study Population...7
Data Collection...8

Results...9
Discussion...16
Limitations...18
Conclusion...18
References...20

CHAPTER 2...27

Abstract...27
Introduction...28
Background...29
Objective...35
Conceptual Framework...37
Methods...42

Data...42
Independent Variables...43
Multivariable Analysis...45

Results...47
Discussion...51
Limitations...56
Implications...57
References...59

CHAPTER 3...81

Abstract...81
Background...83
Agenda Setting and Public Policy...85
Methods...89

Multivariable Analysis...91
Sensitivity Analysis...92

Results...93
Discussion...94
Limitations...96
Conclusion...97
References...98

List of Tables

CHAPTER 1

Table 1: Stakeholder Perceptions of Barriers to Current Influenza Recommendations...23

Table 2: Stakeholder Attitudes Towards Expansion of Current Influenza Recommendations...25

Table 3: Best Setting for the Administration of Influenza Vaccine For School-Age Children...26

Table 4: Financing School Administered Vaccination...26

CHAPTER 2

Table 1: Distribution of State Political, Economic and Funding Characteristics, 2004, 2006, 2008...67

Table 2: Distribution of State Political, Economic and Funding Characteristics, 2007-2009...69

Table 3:Bivariate Relationships between Independent Variables and Outcomes...71

Table 4: Multivariable Linear Regression Model Predicting State Public Health Funding...73

Table 5: Multivariable Linear Regression Model Predicting State Medicaid Spending...75

Table 6: Multivariable Linear Regression Model Predicting State Tobacco Control Spending...77

Table 7: Multivariable Linear Regression Model Predicting State Cancer Control Spending...79

CHAPTER 3

Table 1: Distribution of State Political, Economic and Funding Characteristics, 2008-2010...103

Table 2: Spearman Correlation Coefficients, Women's Legislative Incorporation...105

Table 3: Spearman Correlation Coefficients Between Funding for Breast and Cervical Cancer Screening and State Political and Economic Characteristics, 2008-2010...106

Table 4: State Appropriations for Breast and Cervical Cancer Screening Programs by Discrete Political Characteristics, 2008-2010...107

Table 5: Multivariable Linear Regression Model Predicting State Appropriations for Breast and Cervical Cancer Screening Programs...108

About this Dissertation

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School	Laney Graduate School
Department	Health Services and Research Health Policy
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Health Sciences, Public Health Political Science, General
Keyword	state legislatures public policy cancer control women legislators political determinants policy change
Committee Chair / Thesis Advisor	Lipscomb, Joseph, Emory University
Committee Members	Black, Bruce, Druss, Benjamin G, Emory University Reingold, Beth, Emory University

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