Public Health and Politics

Positioned at the nexus of social science and health, the Journal's work is necessarily political. One of the many concerns in the U.S. as we approach the Fall of 2022 is the U.S. Supreme Court's June decision in Dobbs v. Jackson Women's Health Organization to overturn Roe v. Wade and with it the Constitutional guarantee of the right to abortion, abrogating women's moral autonomy over their reproductive health. In this issue, Frohwirth and colleagues consider another contested site in the reproductive health care landscape—contraception affected by abortion policy—as they assess the impact on women in Iowa of a 2017 reduction in Medicaid coverage of contraceptive care. Due to the new law, patients enrolled in the state family planning program could no longer access subsidized care at publicly funded clinics affiliated with abortion provision, and over 15,000 patients had to find to find a new family planning provider. The researchers learned in their qualitative study that high fees for visits and contraceptive methods, restrictive or inadequate insurance coverage, and access barriers such as long appointment wait times were the most common barriers to preferred contraceptive care, and these barriers compounded one another. Furthermore, barriers grew once the more restrictive Iowa Medicaid policy was in place. The authors conclude that policy changes supportive of contraceptive care would decrease vulnerability and increase reproductive autonomy.

Several papers in this issue bear on the construction of datasets or use datasets in new and sophisticated ways. We publish them aware of the fact that database construction is central to many highly political debates. Qato and colleagues introduce an intermediate-level variable—the nursing home—into an analysis of the distribution of COVID19 vaccination among nursing home residents. Looking at over 12,000 nursing homes in terms of the racial heterogeneity of the residents, the authors find that residents of the quantile of homes that were more predominantly non-Hispanic White were significantly more likely to be vaccinated (mean vaccinated 85.65%) than residents of the quantile that was least predominantly non-Hispanic White (mean vaccinated 72.74%). The authors of this short article conclude, "A higher proportion of White residents per facility was associated with higher resident COVID-19 vaccination rates reflecting continued disparities in quality of care during the pandemic."

While it is not construed formally as a variable, the construct of neighborhood in the paper by DiFiore and colleagues reveals significant patterns in the distribution of food insecurity. They assess food insecurity in relationship to perceived neighborhood safety, social cohesion, informal social control, and crime, adjusted for demographics, socioeconomic status, and neighborhood characteristics. The participants in the study were 300 mothers and female caregivers of Medicaid-enrolled two- to four-year old children in Philadelphia. Greater food security was associated with higher perceived neighborhood safety and social cohesion, and lower police-recorded violent crime rates. The evidence of this research suggests that the structural condition of living in a supportive neighborhood social environment may protect against food insecurity.

Kong and colleagues also conducted COVID19/food security research, using longitudinal data to assess the interrelationships among food insecurity, mental health, and the COVID19 pandemic. They found that food insecurity was associated with stress, depression, and anxiety. They also found that these conditions improved over time during the pandemic among food-secure participants but worsened among food-insecure participants. The pandemic appears to worsen the already vicious cycle connecting food insecurity and mental health.

Two papers based on the Youth Risk Behavior Survey (YRBS) argue for enriched variables for coding race and ethnicity. Jones and Satter analyze mental health outcomes based on race and ethnicity and, in doing so, they observe that over 80% of respondents to the YRBS who self-identified as American Indian/Alaska Native also self-identified as Hispanic. American Indians/Alaska Natives are often multi-racial and of Hispanic/Latino ethnicity, and therefore outcomes differ widely depending on whether one examines American Indian/Alaska Native alone or in combination with other racial/ethnic variables. Also using the YRBSS, Braun and colleagues assessed tobacco and alcohol use and adolescent sexual practices among...