Marijuana Policy Bundles in the American States Over Time and Their Impact on the Use of Marijuana and Other Drugs.

American states have used different approaches in adoption of cannabis policies and continue to modify those policies after approval. States also differ in how long it takes to implement such policies, and this influences the availability of legal marijuana. Such policy differences and implementation timelines could influence usage of marijuana and other illicit drugs by adolescents, young adults, and older adults. We develop an original coding scheme for marijuana legalization policies by classifying policy bundles characterized by three views of marijuana: as a pharmaceutical; as a permissive drug, or as a state fiscal revenue source. We test the impact of state legal marijuana policy characteristics on age group rates of marijuana use with panel regression models including control variables and fixed effects for 2000-2019. This design moves beyond a dichotomous construct of marijuana legalization and accounts for the dynamic adaptation of policies beyond their initial adoption. States with a higher pharmaceutical score experienced lower marijuana usage rates for adolescents and young adults while states with a permissive approach or fiscal approach experienced higher rates of marijuana use for all age groups. We find no consistent spillover effect of the pharmaceutical or permissive marijuana policy bundles on other illicit drug use for any age group, but fiscal bundles show some association with greater illicit drug use for adults. These more nuanced measures better reflect state policies as implemented and provide more clarity of the policy impact on target populations' marijuana usage.

Learning From Waiver States: Coverage Effects Under Indiana's HIP Medicaid Expansion.

In 2015, Indiana expanded eligibility for Medicaid under the Affordable Care Act (ACA) through a unique waiver, Healthy Indiana Plan 2.0, which requires enrollees to make monthly contributions to an account that is similar to a health savings account to receive full benefits. Enrollees who fail to make these contributions receive less generous benefits if their income is below the federal poverty level, and if it is 100-138 percent of poverty, they are locked out of coverage for six months. We estimated the impact of this expansion on coverage rates and compared the effects to results from other states that expanded Medicaid after 2014. We found that Indiana's coverage gains (relative to pre-ACA uninsurance rates) were smaller than gains in neighboring expansion states, but larger than those in other states. These results imply that while one potential reason for Indiana's lower gains relative to neighboring states was its cost-sharing requirements, expansion led to unquestionable coverage gains in the state.

Personal and collective evaluations of the 2010 health care reform.

The 2010 health care reform law has been as controversial as any piece of American legislation in recent memory. Although numerous polls have been conducted on the public's views of the reform, we do not know much about how citizens evaluated the policy alternatives. Are citizens more focused on how policy affects them personally or how it affects the nation as a whole? Further, are these evaluations made more on the basis of past experience or assessments of how the policy will affect the future? Using an original survey of public opinion administered during the 2009 congressional debate, we examine how these evaluative dimensions (and several other factors) shaped public support for overall reform, for associated policy goals, and for available policy tools. We find evidence that retrospective and prospective collective evaluations mattered most, as did personal prospective assessments, but evidence on personal retrospective factors is somewhat mixed.

The effect of state regulations on truck-crash fatalities.

To improve traffic safety, states limit truck length and weight, and some set lower speed limits for trucks than for other vehicles. We examined the impact of truck-specific restrictions and general traffic-safety policies on fatality rates from crashes involving large trucks. We used state-level data from 1991 to 2005 with a cross-sectional time-series model that controlled for several policy measures. We found that higher speed limits for cars and trucks contributed to higher fatality rates, but differential speed limits by vehicle type had no significant impact. Truck-length limitations reduced fatalities in crashes involving large trucks. Our model estimates suggested that if all states had adopted a speed limit of 55 miles per hour for all vehicles in 2005, an additional 561 fatalities would have been averted.

Motorcyclist fatality rates and mandatory helmet-use laws.

Using cross-sectional time series data for the 50 states and Washington, DC, covering the period 1975-2004, we estimate fixed effects regression models that examine the effects of universal and partial helmet laws on three different motorcyclist fatality rates, while controlling for other state policies and characteristics. Depending on the particular measure that is employed, states with universal helmet laws have motorcyclist fatality rates that are on average 22-33% lower in comparison to the experience with no helmet law. Additionally, partial coverage helmet laws are associated with reductions in motorcyclist fatality rates of 7-10%, on average.

Motorcycle safety and the repeal of universal helmet laws.

OBJECTIVES: We assessed the implications for motorcyclist safety of recent repeals of universal helmet laws in 6 US states. METHODS: We examined cross-sectional time-series data from the 50 states and the District of Columbia for the period 1975 through 2004. RESULTS: On average, when compared to state experience with no helmet mandate, universal helmet laws were associated with an 11.1% reduction in motorcyclist fatality rates, whereas rates in states with partial coverage statutes were not statistically different from those with no helmet law. Furthermore, in the states in which recent repeals of universal coverage have been instituted, the motorcyclist fatality rate increased by an average of 12.2% over what would have been expected had universal coverage been maintained. Since 1997, an additional 615 motorcyclist fatalities have occurred in these states as a result of these changes in motorcycle helmet laws. CONCLUSIONS: Motorcyclist safety has been compromised in the states that have repealed universal coverage and is likely to be compromised in other states that abandon these statutes.

Measuring the propensity to drink and drive.

Laws such as .08 blood alcohol content, open container, and license revocation provide a policy framework for reducing drinking and driving. Drinking and driving behavior is difficult to assess; unlike property and violent crimes, where incidence statistics can approximate behavior, most drink-driving trips go undetected. The authors develop a novel measure of drink-driving propensity by estimating an item response model using national survey data. The authors illustrate their measures in the aggregate and as they relate to law enforcement efforts in the American states.

Safety belt use and the switch to primary enforcement, 1991-2003.

State seat belt laws have increased use rates and have reduced traffic fatalities, but tremendous variation exists in the laws. New Hampshire does not have a law, and 30 states have only secondary enforcement laws. Whereas primary enforcement allows an officer to issue a citation for any infraction, secondary enforcement permits a citation only if a motorist is stopped for another infraction first. We performed a cross-sectional time-series analysis of the impact of upgrading to primary enforcement on belt use rates for 47 states and the District of Columbia from 1991 to 2003. Our results suggest that states with secondary enforcement laws could increase belt use by 10 percentage points and improve public safety considerably by upgrading to primary enforcement.

Getting Americans to buckle up: the efficacy of state seat belt laws.

Annual state observed safety belt use rates over the period 1991-2001 are examined using time-series cross-section regression analysis. It was found that seat belt laws are associated with higher use rates and that the enforcement provision matters. Primary states experience belt use rates that on average are 9.1 percentage points higher than their secondary counterparts. In addition, the level of the fine imposed by statute has an effect on safety belt use apart from that attributable to the enforcement provision. The current median fine of 25 US dollars is associated with an additional 3.8 percentage points increase in belt use. To further increase safety belt use, it is recommended that states adopt primary enforcement and impose fines of at least $50 for violating a seat belt law.

Traffic safety and the switch to a primary seat belt law: the California experience.

This study explores whether the change of an existing seat belt law from secondary to primary enforcement enhances traffic safety. In particular, we examine traffic fatalities and injuries in California from 1988 to 1997. During the first half of this period, California law provided for secondary enforcement of its mandatory seat belt law, but in 1993 it upgraded the law to primary enforcement. Controlling for the number of motor vehicle collisions, a Box-Tiao intervention analysis of the time series is used to compare the monthly fatalities and injuries before and after the change in the enforcement provision. The results show that California experienced an improvement in traffic safety in terms of a significant reduction in injuries, but the change in enforcement provision had no statistically significant impact on fatalities.