Diana R Silver

Diana Silver
Diana R Silver

Associate Professor of Public Health Policy and Management

Professional overview

Dr. Diana Silver's research explores the impact of variation in the implementation, adoption and repeal of state and local public health policies on health outcomes, particularly alcohol consumption, motor vehicle crashes, tobacco use, and food safety. Some of her other work has examined variation in access to publicly funded services such as clinics, after-school programs, parks and playgrounds. Her work has been funded by the National Institutes of Health, the Robert Wood Johnson Foundation, the New York City Department of Health and Mental Hygiene, and several other funders.

Dr. Silver's work has been published in a variety of prominent journals, including the American Journal of Public Health, the American Journal of Health Promotion, Public Health, Tobacco Control, Journal of Safety Research, Social Science and Medicine, the American Journal of Evaluation, PLoS One, Journal of Community Health, Journal of Immigrant and Minority Health,  International Journal of Equity in Health, Globalization and Health, Youth and Society, Public Administration Review and Policy Studies Journal. She is an associate editor for the American Journal of Health Promotion, and serves on the New York City Department of Health’s Health Advisory Committee. She began her career focused on the developing policies and programs that could address the epidemics of AIDS, substance abuse and violence in New York City, in such settings as schools, workplaces, jails, and homeless shelters.

Dr. Silver teaches undergraduate and master’s level courses at the School of Global Health, and trains doctoral students. In 2015, Dr. Silver received NYU’s Distinguished Teaching Award, the university’s highest honor for teaching excellence.

Education

BA, History, Bates College, Lewiston, ME
MPH, Health Education, Hunter College, New York City, NY
PhD, Public Administration, New York University, New York City, NY

Honors and awards

Distinguished Teaching Award, New York University (2015)
Steinhardt Goddard Award (2011)
Annual Award for Outstanding Evaluation, American Evaluation Association (2010)
Public Affairs Resident Scholar, The Rockefeller Foundation (2007)

Areas of research and study

Access to Healthcare
Alcohol, Tobacco and Driving Policies
Food Safety Policies
Implementation and Impact of Public Health Regulations
Injury Prevention
New York Department of Health and Mental Hygiene
Public Health Law
Public Health Policy

Publications

Publications

Generational differences in beliefs about COVID-19 vaccines

Wang, V. H. C., Silver, D., & Pagán, J. A.

Publication year

2022

Journal title

Preventive Medicine

Volume

157
Abstract
Abstract
Vaccine uptake variation across demographic groups remains a public health barrier to overcome the coronavirus pandemic despite substantial evidence demonstrating the effectiveness of COVID-19 vaccines against severe illness and death. Generational cohorts differ in their experience with historical and public health events, which may contribute to variation in beliefs about COVID-19 vaccines. Nationally representative longitudinal data (December 20, 2020 to July 23, 2021) from the Understanding America Study (UAS) COVID-19 tracking survey (N = 7279) and multilevel logistic regression were used to investigate whether generational cohorts differ in COVID-19 vaccine beliefs. Regression models adjusted for wave, socioeconomic and demographic characteristics, political affiliation, and trusted source of information about COVID-19. Birth-year cutoffs define the generational cohorts: Silent (1945 and earlier), Boomer (1946–1964), Gen X (1965–1980), Millennial (1981–1996), and Gen Z (1997–2012). Compared to Boomers, Silents had a lower likelihood of believing that COVID-19 vaccines have many known harmful side effects (OR = 0.52, 95%CI = 0.35–0.74) and that they may lead to illness and death (OR = 0.53, 95%CI = 0.37–0.77). Compared to Boomers, Silents had a higher likelihood of believing that the vaccines provide important benefits to society (OR = 2.27, 95%CI = 1.34–3.86) and that they are useful and effective (OR = 1.97, 95%CI = 1.17–3.30). Results for Gen Z are similar to those reported for Silents. Beliefs about COVID-19 vaccines markedly differ across generations. This is consistent with the idea of generational imprinting—the idea that some beliefs may be resistant to change through adulthood. Policy strategies other than vaccine education may be needed to overcome this pandemic and future public health challenges.

State Paid Sick Leave and Paid Sick-Leave Preemption Laws Across 50 U.S. States, 2009–2020

Pomeranz, J. L., Silver, D., Lieff, S. A., & Pagán, J. A.

Publication year

2022

Journal title

American journal of preventive medicine

Volume

62

Issue

5

Page(s)

688-695
Abstract
Abstract
Introduction: Paid sick leave is associated with lower mortality risks and increased use of health services. Yet, the U.S. lacks a national law, and not all employers offer paid leave, especially to low-wage workers. States have enacted paid sick-leave laws or preemption laws that prohibit local governments from enacting paid sick-leave requirements. Methods: In 2019 and 2021, state paid sick-leave laws and preemption laws in effect in 2009–2020 were retrieved from Lexis+, coded, and analyzed for coverage and other features. Data from the U.S. Bureau of Economic Analysis were used to estimate the jobs covered by state paid sick-leave laws in 2009–2019. Results: In 2009, no state had a paid sick-leave law, and 1 state had preemption. By 2020, a total of 12 states had paid sick-leave laws, with a form of preemption (n=9) or no preemption (n=3), and 18 additional states solely preempted local laws without requiring coverage, creating a regulatory vacuum in those states. Although all state paid sick-leave laws covered private employers and required care for children and spouses, some laws exempted small or public employers or did not cover additional family members. The percentage of U.S. jobs covered by state-required paid sick leave grew from 0% in 2009 to 27.6% in 2019. Conclusions: Variation in state paid sick-leave laws, preemption, and lack of employer provision of paid sick leave to low-wage workers creates substantial inequities nationally. The federal government should enact a national paid sick-leave law.

By the Letter of Law? The Effects of Administrative Adjudication for Resolving Disputes in NYC’s Restaurant Grading Initiative

How Patient-Centered Medical Homes Integrate Dental Services Into Primary Care: A Scoping Review

Gupta, A., Akiya, K., Glickman, R., Silver, D., & Pagán, J. A.

Publication year

2021

Journal title

Medical Care Research and Review
Abstract
Abstract
Integrated care delivery is at the core of patient-centered medical homes (PCMHs). The extent of integration of dental services in PCMHs for adults is largely unknown. We first identified dental–medical integrating processes from the literature and then conducted a scoping review using PRISMA guidelines to evaluate their implementation among PCMHs. Processes were categorized into workforce, information-sharing, evidence-based care, and measuring and monitoring. After screening, 16 articles describing 21 PCMHs fulfilled the inclusion criteria. Overall, the implementation of integrating processes was limited. Less than half of the PCMHs reported processes for information exchange across medical and dental teams, referral tracking, and standardized protocols for oral health assessments by medical providers. Results highlight significant gaps in current implementation of adult dental integration in PCMHs, despite an increasing policy-level recognition of and support for dental-medical integration in primary care. Understanding and addressing associated barriers is important to achieve comprehensive patient-centered primary care.

State Gun-Control, Gun-Rights, and Preemptive Firearm-Related Laws Across 50 US States for 2009–2018

Pomeranz, J. L., Silver, D., & Lieff, S. A.

Publication year

2021

Journal title

American journal of public health

Volume

111

Issue

7

Page(s)

1273-1280
Abstract
Abstract
Objectives. To assess state policy environments and the relationship between state gun-control, gun-rights, and preemptive firearm-related laws in the United States. Methods. In 2019 through 2020, we evaluated substantive firearm laws and preemptive firearm laws across 50 US states for 2009 through 2018. For each state, we compared substantive measures with preemptive measures on the same policy topic for 2018. Results. The presence of state firearm-related laws varied across states, but with the exception of “punitive preemption” the number of gun-control, gun-rights, and preemptive measures remained unchanged in most states from 2009 through 2018. As of 2018, a majority of states had preemptive measures on almost all gun-control policy topics without enacting substantive gun-control measures. Several states had a combination of gun-control and preemptive measures. Only a small number of states had gun-control measures with few to no preemptive measures. Conclusions. Even where state legislators were unable to pass statewide gun-rights measures, they succeeded in passing preemption, preserving state authority over a wide range of gun-control and gun-rights policy topics. The majority of states used preemption as a tool to support policy frameworks favoring gun rights.

24-Year trends in educational inequalities in adult smoking prevalence in the context of a national tobacco control program: The case of Brazil

Bandi, P., Chang, V. W., Sherman, S. E., & Silver, D.

Publication year

2020

Journal title

Preventive Medicine

Volume

131
Abstract
Abstract
Brazil was a low and middle-income country (LMIC) in the late-1980s when it implemented a robust national tobacco-control program (NTCP) amidst rapid gains in national incomes and gender equality. We assessed changes in smoking prevalence between 1989 and 2013 by education level and related these changes to trends in educational inequalities in smoking. Data were from four nationally representative cross-sectional surveys (1989, n = 25,298; 2003 n = 3845; 2008 n = 28,938; 2013 n = 47,440, ages 25–69 years). We estimated absolute (slope index of inequality, SII) and relative (relative index of inequality, RII) educational inequalities in smoking prevalence, separately for males and females. Additional analyses stratified by birth-cohort to assess generational differences. Smoking declined significantly between 1989 and 2013 in all education groups but declines among females were steeper in higher-educated groups. Consequently, both absolute and relative educational inequalities in female smoking widened threefold between 1989 and 2013 (RII: 1.31 to 3.60, SII: 5.3 to 15.0), but absolute inequalities in female smoking widened mainly until 2003 (SII: 15.8). Conversely, among males, declines were steeper in higher-educated groups only in relative terms. Thus, relative educational inequalities in male smoking widened between 1989 and 2013 (RII: 1.58 to 3.19) but mainly until 2008 (3.22), whereas absolute equalities in male smoking were unchanged over the 24-year period (1989: 21.1 vs. 2013: 23.2). Younger-cohorts (born ≥1965) had wider relative inequalities in smoking vs. older-cohorts at comparable ages, particularly in the youngest female-cohorts (born 1979–1988). Our results suggest that younger lower-SES groups, especially females, may be particularly vulnerable to differentially higher smoking uptake in LMICs that implement population tobacco-control efforts amidst rapid societal gains.

Dental radiographs for age estimation in us asylum seekers: Methodological, ethical, and health issues

Kapadia, F., Stevens, J., & Silver, D.

Publication year

2020

Journal title

American journal of public health

Volume

110

Issue

12

Page(s)

1786-1789
Abstract
Abstract
Unaccompanied migrant children seeking asylum status in the United States are often forced to undergo dental radiographs, or x-rays, to verify that they are younger than 18 years. The application of third molar dental radiographs is methodologically flawed and should not be employed as a determinant of chronological age. Furthermore, the use of such tests without obtaining informed consent from either the youth or an objective advocate is unethical. Finally, the legal and health consequences of these inappropriately applied tests are severe and jeopardize the safety and security of these vulnerable minors.

Have Health Reforms in Brazil Reduced Inequities in Access to Cancer Screenings for Women?

Mullachery, P., MacInko, J., & Silver, D.

Publication year

2020

Journal title

Journal of Ambulatory Care Management

Volume

43

Issue

3

Page(s)

257-266
Abstract
Abstract
We measured asset-based and education-based inequity in utilization of 2 cancer screening tests, Pap tests and mammograms, using nationally representative surveys conducted in 2003, 2008, and 2013. Utilization of Pap tests (ages 25-59 years) and mammograms (ages 50-69 years) increased over time. Asset-based and education-based inequities declined significantly for both screening tests, particularly among women who reported a doctor visit in the previous year. This decline coincided with increases in the coverage of primary health care in Brazil. However, barriers persisted; in 2013, college-educated women were still 2.27 times more likely to have a mammogram than those who were illiterate.

State Legislative Strategies to Pass, Enhance, and Obscure Preemption of Local Public Health Policy-Making

Pomeranz, J. L., & Silver, D.

Publication year

2020

Journal title

American journal of preventive medicine

Volume

59

Issue

3

Page(s)

333-342
Abstract
Abstract
Introduction: Local governments are often innovators of public health policy-making, yet states are increasingly preempting or prohibiting local control over public health issues. Previous research identified examples of strategies used by state legislatures to pass preemption in ways that may obscure public discussion about preemption or the topics preempted or enhance the strength of a previously passed preemptive law. Methods: To systematically identify strategies to pass, obscure, or enhance preemption, in 2019, the authors conducted a content analysis of the full text of the bills from which preemptive laws in 5 policy areas (tobacco control, firearms, paid sick leave, food and nutrition, and civil rights) passed over a 5-year period (2014–2018) for preemptive laws that remained in effect as of January 2019. Results: This research identified 5 methods state legislators used during the 5-year period to pass and support preemption: (1) pass preemptive bills quickly (11 laws); (2) obscure preemption by adding it to pre-existing bills on nonrelevant substantive topics (4 bills), bundling preemption of multiple nonrelated topics (4 bills), or titling bills in a way that does not reflect the substance of the bill (1 bill); (3) repeal and replace preemption (2 laws); (4) preempt litigation (1 law); and (5) enact punitive preemption (7 laws). Conclusions: Strategies employed to pass preemption obscure public debate about preemption and the underlying public health and social justice issues at stake while minimizing the ability of local governments to protect their populations and the nation to learn from local policy successes.

Presence of Counterfeit Marlboro Gold Packs in Licensed Retail Stores in New York City: Evidence from Test Purchases

Kurti, M., He, Y., Silver, D., Giorgio, M., Von Lampe, K., MacInko, J., Ye, H., Tan, F., & Mei, V.

Publication year

2019

Journal title

Nicotine and Tobacco Research

Volume

21

Issue

8

Page(s)

1131-1134
Abstract
Abstract
Background: There are no independent studies measuring the availability of premium brand counterfeit cigarettes in New York City from licensed retailers. Methods: We forensically analyzed the cigarette packaging of Marlboro Gold (n = 1021) purchased from licensed tobacco retailers in New York City, using ultraviolet irradiation and light microscopy to determine whether they were counterfeit. Results: We find that while only 0.5% (n = 5) of our sample exhibits at least one characteristic synonymous with counterfeit packaging, none of our packs can be conclusively classified as counterfeit. Conclusions: We do not find any counterfeit Marlboro Gold packs purchased at full price from licensed cigarette retailers throughout New York City. Future research using test purchases should include other venues (eg, street and online) and specifically ask for discounts to ascertain the overall presence of counterfeit cigarettes. Implications: This is the first study to independently measure the availability of counterfeit cigarette packs purchased at full price from licensed retailers in New York City. We find that none of the Marlboro Gold packs purchased from licensed cigarette retailers are counterfeit.

What a Difference a Grade Makes: Evidence from New York City's Restaurant Grading Policy

Rothbart, M. W., Schwartz, A. E., Calabrese, T. D., Papper, Z., Mijanovich, T., Meltzer, R., & Silver, D.

Publication year

2019

Journal title

Public Administration Review

Volume

79

Issue

5

Page(s)

651-665
Abstract
Abstract
Can governments use grades to induce businesses to improve their compliance with regulations? Does public disclosure of compliance with food safety regulations matter for restaurants? Ultimately, this depends on whether grades matter for the bottom line. Based on 28 months of data on more than 15,000 restaurants in New York City, this article explores the impact of public restaurant grades on economic activity and public resources using rigorous panel data methods, including fixed-effects models with controls for underlying food safety compliance. Results show that A grades reduce the probability of restaurant closure and increase revenues while increasing sales taxes remitted and decreasing fines relative to B grades. Conversely, C grades increase the probability of restaurant closure and decrease revenues while decreasing sales taxes remitted relative to B grades. These findings suggest that policy makers can incorporate public information into regulations to more strongly incentivize compliance.

What Are the Financial Implications of Public Quality Disclosure? Evidence from New York City’s Restaurant Food Safety Grading Policy

Meltzer, R., Rothbart, M. W., Schwartz, A. E., Calabrese, T., Silver, D., Mijanovich, T., & Weinstein, M.

Publication year

2019

Journal title

Public Finance Review

Volume

47

Issue

1

Page(s)

170-201
Abstract
Abstract
Grading schemes are an increasingly common method of quality disclosure for public services. Restaurant grading makes information about food safety practices more readily available and may reduce the prevalence of foodborne illnesses. However, it may also have meaningful financial repercussions. Using fine-grained administrative data that tracks food safety compliance and sales activity for the universe of graded restaurants in New York City and its bordering counties, we assess the aggregate financial effects from restaurant grading. Results indicate that the grading policy, after an initial period of adjustment, improves restaurants’ food safety compliance and reduces fines. While the average effect on revenues for graded restaurants across the municipality is null, the graded restaurants located geographically closer to an ungraded regime experience slower growth in revenues. There is also evidence of revenue convergence across graded and ungraded restaurants in the long term.

Evaluating the relationship between binge drinking rates and a replicable measure of U.S. State alcohol policy environments

Planned parenthood is health care, and health care must defend it: A call to action

Silver, D., & Kapadia, F.

Publication year

2017

Journal title

American journal of public health

Volume

107

Issue

7

Page(s)

1040-1041

Changes in health care inequity in Brazil between 2008 and 2013

Mullachery, P., Silver, D., & Macinko, J.

Publication year

2016

Journal title

International Journal for Equity in Health

Volume

15

Issue

1
Abstract
Abstract
Background: Brazil has made progress towards a more equitable distribution of health care, but gains may be threatened by economic instability resulting from the 2008 global financial crisis. This study measured predictors of health care utilization and changes in horizontal inequity between 2008 and 2013. Method: Data were from two nationally representative surveys that measured a variety of sociodemographic, health behaviors and health care indicators. We used Poisson regression models to estimate adjusted prevalence ratios and the Horizontal Equity Index (HEI) standardized by health needs to measure inequity in the utilization of doctor and dentist visits, hospitalizations and reporting of a usual source of care (USC) for those 18 and older. To estimate the HEI, we ranked the population from the poorest to the richest using a wealth index. We also decomposed the HEI into its different components and assessed changes from 2008 to 2013. Results: The population proportion with doctor and dentist visits in the past year and a USC increased between 2008 and 2013, while hospitalizations declined. In 2013, pro-rich inequity in doctor visits increased significantly while the distribution of hospitalizations shifted from pro-rich in 2008 to neutral in 2013. Dentist visits were highly pro-rich and USC was slightly pro-rich; the distribution of dentist visits and USC did not change over time. Health need was a strong predictor of health care utilization regardless of the type of coverage (public or private). Education, wealth, and private health plans were associated with the pro-rich orientation of doctor and dentist visits. Private health plans contributed to the pro-rich orientation of all outcomes, while the Family Health Strategy contributed to the pro-poor orientation of all outcomes. Conclusion: The results of this study support the claim that Brazil's population continued to see absolute gains in access to care despite recent economic crises. However, gains in equity have slowed and may even decline if investments are not maintained as the country enters deeper financial and political crises.

Compliance with minimum price and legal age for cigarette purchase laws: Evidence from NYC in advance of raising purchase age to 21

Silver, D., Bae, J. Y., Jimenez, G., & Macinko, J.

Publication year

2016

Journal title

Tobacco control

Volume

25

Issue

3

Page(s)

289-294
Abstract
Abstract
Background New York City (NYC) raised the minimum purchase age for cigarettes from 18 to 21 on 1 August 2014. The new law is intended to decrease current smoking rates and smoking initiation among the city’s youth. Assessment of compliance with existing cigarette sales and tax laws could aid in determining what may be needed for successful implementation of the city’s new law. Purpose To assess compliance with minimum sales price and purchase age laws in NYC, before change in law. Methods Ten trained field investigators purchased cigarettes from different types of retailers throughout all five NYC boroughs, resulting in 421 purchases. Investigators noted whether they were asked for identification and the price of their purchase. Multivariable logistic and Ordinary Least Squares regression techniques were used to assess predictors of retailer compliance with sales price and minimum purchase age laws. Results In 29% of purchases, investigators did not have to produce identification (p<0.05) to purchase cigarettes. Only 3.1% of sales were at prices lower than the minimum sales price. City borough was significantly associated with purchase without identification (p<0.001) and mean sales price (p<0.024). Vendor type (independent vs chain) was significantly related to investigators being able to purchase cigarettes without identification (p<0.001). Conclusions Variation in compliance with existing laws suggests that more active monitoring of compliance with the new minimum legal purchase age will be required in order to realise the new law’s public health potential.

Detecting causality in policy diffusion processes

Over-the-counter sales of out-of-state and counterfeit tax stamp cigarettes in New York City

Silver, D., Giorgio, M. M., Bae, J. Y., Jimenez, G., & Macinko, J.

Publication year

2016

Journal title

Tobacco control

Volume

25

Issue

5

Page(s)

584-586
Abstract
Abstract
Background New York City (NYC) has strict minimum cigarette price and tax stamp laws, but evidence regarding the extent of evasion of such laws in over-thecounter sales is scarce. Methods 830 packs were purchased at licensed tobacco retailers at 92 randomly selected neighbourhoods in NYC in spring and fall 2014, following the establishment of NYC’s minimum price law. The χ2 analyses of illegal tax stamps on pack, by retailer type and data collection period, are presented. Results Over 15% of packs purchased had out-of-state (4.5%) or counterfeit tax stamps (10.6%). Purchases resulted in at least one illegal pack obtained in 70% of neighbourhoods, largely from independent stores. In 21.5% of sampled neighbourhoods, it was possible to purchase an illegal pack each collection period. Conclusions Enhanced enforcement of retail sales of cigarettes is needed to ensure the full benefit of existing tobacco control laws in NYC.

Retailer compliance with tobacco control laws in New York city before and after raising the minimum legal purchase age to 21

Silver, D., Macinko, J., Giorgio, M., Bae, J. Y., & Jimenez, G.

Publication year

2016

Journal title

Tobacco control

Volume

25

Issue

6

Page(s)

624-627
Abstract
Abstract
Objectives: New York City (NYC) is the first large city to increase the legal minimum age for possessing tobacco products from 18 to 21 (Tobacco 21) and establish a minimum price law to reduce smoking rates among youth. However, retailer compliance with these regulations is unknown. Methods: Youthful investigators purchased cigarettes pre and post-Tobacco 21 implementation in 92 NYC neighbourhoods. Investigators recorded whether their ID was checked, the pack’s purchase price, and observed compliance with additional regulations. Multivariable OLS and Poisson regression models assess pre and post Tobacco 21 compliance with ID checks and purchase prices, controlling for retailer type, location and compliance with other laws. Results: Retailer compliance with ID checks declined from 71% to 62% (p<0.004) between periods, and holding constant other factors, compliance with ID checks and sales at legal prices declined significantly after the laws changed. Compared to chain stores, independent retailers had significantly lower compliance rates (p<0.01). Conclusions: Several aspects of tobacco control appear to have deteriorated in NYC. Greater attention to monitoring retailer compliance with all tobacco regulations will be important for Tobacco 21 laws to be effective in reducing youth access to tobacco products.

That's not how the learning works - the paradox of Reverse Innovation: A qualitative study

Harris, M., Weisberger, E., Silver, D., Dadwal, V., & Macinko, J.

Publication year

2016

Journal title

Globalization and Health

Volume

12

Issue

1
Abstract
Abstract
Background: There are significant differences in the meaning and use of the term 'Reverse Innovation' between industry circles, where the term originated, and health policy circles where the term has gained traction. It is often conflated with other popularized terms such as Frugal Innovation, Co-development and Trickle-up Innovation. Compared to its use in the industrial sector, this conceptualization of Reverse Innovation describes a more complex, fragmented process, and one with no particular institution in charge. It follows that the way in which the term 'Reverse Innovation', specifically, is understood and used in the healthcare space is worthy of examination. Methods: Between September and December 2014, we conducted eleven in-depth face-to-face or telephone interviews with key informants from innovation, health and social policy circles, experts in international comparative policy research and leaders in the Reverse Innovation space in the United States. Interviews were open-ended with guiding probes into the barriers and enablers to Reverse Innovation in the US context, specifically also informants' experience and understanding of the term Reverse Innovation. Interviews were recorded, transcribed and analyzed thematically using the process of constant comparison. Results: We describe three main themes derived from the interviews. First, 'Reverse Innovation,' the term, has marketing currency to convince policy-makers that may be wary of learning from or adopting innovations from unexpected sources, in this case Low-Income Countries. Second, the term can have the opposite effect - by connoting frugality, or innovation arising from necessity as opposed to good leadership, the proposed innovation may be associated with poor quality, undermining potential translation into other contexts. Finally, the term 'Reverse Innovation' is a paradox - it breaks down preconceptions of the directionality of knowledge and learning, whilst simultaneously reinforcing it. Conclusions: We conclude that this term means different things to different people and should be used strategically, and with some caution, depending on the audience.

Understanding policy diffusion in the U.S.: An information-theoretical approach to unveil connectivity structures in slowly evolving complex systems

Anderson, R. P., Jimenez, G., Bae, J. Y., Silver, D., Macinko, J., & Porfiri, M.

Publication year

2016

Journal title

SIAM Journal on Applied Dynamical Systems

Volume

15

Issue

3

Page(s)

1384-1409
Abstract
Abstract
Detecting and explaining the relationships among interacting components has long been a focal point of dynamical systems research. In this paper, we extend these types of data-driven analyses to the realm of public policy, whereby individual legislative entities interact to produce changes in their legal and political environments. We focus on the U.S. public health policy landscape, whose complexity determines our capacity as a society to effectively tackle pressing health issues. It has long been thought that some U.S. states innovate and enact new policies, while others mimic successful or competing states. However, the extent to which states learn from others, and the state characteristics that lead two states to influence one another, are not fully understood. Here, we propose a model-free, information-theoretical method to measure the existence and direction of influence of one state's policy or legal activity on others. Specifically, we tailor a popular notion of causality to handle the slow time scale of policy adoption dynamics and unravel relationships among states from their recent law enactment histories. The method is validated using surrogate data generated from a new stochastic model of policy activity. Through the analysis of real data in alcohol, driving safety, and impaired driving policy, we provide evidence for the role of geography, political ideology, risk factors, and demographic and economic indicators on a state's tendency to learn from others when shaping its approach to public health regulation. Our method offers a new model-free approach to uncover interactions and establish cause and effect in slowly evolving complex dynamical systems.

'They hear "Africa" and they think that there can't be any good services' - perceived context in cross-national learning: A qualitative study of the barriers to Reverse Innovation

Harris, M., Weisberger, E., Silver, D., & Macinko, J.

Publication year

2015

Journal title

Globalization and Health

Volume

11

Issue

1
Abstract
Abstract
Background: Country-of-origin of a product can negatively influence its rating, particularly if the product is from a low-income country. It follows that how non-traditional sources of innovation, such as low-income countries, are perceived is likely to be an important part of a diffusion process, particularly given the strong social and cognitive boundaries associated with the healthcare professions. Methods: Between September and December 2014, we conducted eleven in-depth face-to-face or telephone interviews with key informants from innovation, health and social policy circles, experts in international comparative policy research and leaders in Reverse Innovation in the United States. Interviews were open-ended with guiding probes into the barriers and enablers to Reverse Innovation in the US context, specifically also to understand whether, in their experience translating or attempting to translate innovations from low-income contexts into the US, the source of the innovation matters in the adopter context. Interviews were recorded, transcribed and analyzed thematically using the process of constant comparison. Results: Our findings show that innovations from low-income countries tend to be discounted early on because of prior assumptions about the potential for these contexts to offer solutions to healthcare problems in the US. Judgments are made about the similarity of low-income contexts with the US, even though this is based oftentimes on flimsy perceptions only. Mixing levels of analysis, local and national, leads to country-level stereotyping and missed opportunities to learn from low-income countries. Conclusions: Our research highlights that prior expectations, invoked by the Low-income country cue, are interfering with a transparent and objective learning process. There may be merit in adopting some techniques from the cognitive psychology and marketing literatures to understand better the relative importance of source in healthcare research and innovation diffusion. Counter-stereotyping techniques and decision-making tools may be useful to help decision-makers evaluate the generalizability of research findings objectively and transparently. We suggest that those interested in Reverse Innovation should reflect carefully on the value of disclosing the source of the innovation that is being proposed, if doing so is likely to invoke negative stereotypes.

Age, period, and cohort effects in motor vehicle mortality in the United States, 1980-2010: The role of sex, alcohol involvement, and position in vehicle

Macinko, J., Silver, D., & Bae, J. Y.

Publication year

2015

Journal title

Journal of Safety Research

Volume

52

Page(s)

47-57
Abstract
Abstract
Introduction Although substantive declines in motor vehicle fatalities in 1980-2010 have been observed, declines by position in the vehicle and alcohol involvement have not been well elucidated. Method Analyses of FARS data use the Intrinsic Estimator (IE) to produce estimates of all age, period, and cohort effects simultaneously by position in the car and by alcohol involvement. Results Declines in MVC deaths by position in the car vary for men and women by age and cohort over time. Cohorts born before 1970 had higher risks than those born later. Analyses using proxy indicators of alcohol involvement found the highest risks for those aged 16-24. By period, these risks declined more rapidly than non- alcohol related traffic fatalities. Conclusion Changes in risk patterns are consistent with evidence regarding the contributions of new technologies and public policy efforts to reduce fatalities, but gains have not been shared evenly by sex or position in the car. Practical applications Greater attention is needed in reducing deaths among older drivers and pedestrians. Gender differences should be addressed in prevention efforts aimed at reducing MVCs due to alcohol involvement.

Diffusion of impaired driving laws among US states

Macinko, J., & Silver, D.

Publication year

2015

Journal title

American journal of public health

Volume

105

Issue

9

Page(s)

1893-1900
Abstract
Abstract
Objectives. We examined internal and external determinants of state's adoption of impaired driving laws. Methods. Data included 7 state-level, evidence-based public health laws collected from 1980 to 2010. We used event history analyses to identify predictors of first-time law adoption and subsequent adoption between state pairs. The independent variables were internal state factors, including the political environment, legislative professionalism, government capacity, state resources, legislative history, and policy-specific risk factors. The external factors were neighboring states' history of law adoption and changes in federal law. Results. We found a strong secular trend toward an increased number of laws over time. The proportion of younger drivers and the presence of a neighboring state with similar laws were the strongest predictors of first-time law adoption. The predictors of subsequent law adoption included neighbor state adoption and previous legislative action. Alcohol laws were negatively associated with first-time adoption of impaired driving laws, suggesting substitution effects among policy choices. Conclusions. Organizations seeking to stimulate state policy changes may need to craft strategies that engage external actors, such as neighboring states, in addition to mobilizing within-state constituencies.

Patterns of alcohol consumption and related behaviors in Brazil: Evidence from the 2013 National Health Survey (PNS 2013)

Macinko, J., Mullachery, P., Silver, D., Jimenez, G., & Neto, O. L. M.

Publication year

2015

Journal title

PloS one

Volume

10

Issue

7
Abstract
Abstract
This study uses data from a nationally representative household survey (the 2013 National Health Survey, n = 62,986) to describe patterns of alcohol consumption and related behaviors among Brazilian adults. Analyses include descriptive and multivariable Poisson regression for self-reports in the past 30 days of: drinking any alcohol, binge drinking, binge drinking 4 or more times, and driving after drinking (DD); as well as age of alcohol consumption initiation. Results show that current drinking prevalence was 26%, with an average age of initiation of 18.7 years. Binge drinking was reported by 51% of drinkers, 43% of whom reported binge drinking 4 or more times. Drinking and driving was reported by nearly one quarter of those who drive a car/motorcycle. Current drinking was more likely among males, ages 25-34, single, urban, and those with more education. Binge drinking was more likely among males, older age groups, and people who started drinking before 18. Drinking and driving was higher among males, those with more education, and rural residents. Those who binge-drink were nearly 70% more likely to report DD. All behaviors varied significantly among Brazilian states. Given their potential health consequences, the levels of injurious alcohol behaviors observed here warrant increased attention from Brazilian policymakers and civil society.