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Congress is considering enactment of comprehensive parity legislation. The intent of parity is to equalize private coverage of behavioral and general medical care, thereby improving efficiency and fairness in insurance markets. One issue is whether to extend parity to substance abuse (SA) benefits. In the past, inclusion of substance abuse has been a hurdle to passage of parity. We examine the politics of SA parity, compare coverage trends for substance abuse and mental health, and assess the rationale for equalizing benefits. We conclude that the justification for SA parity is as compelling as it is for mental health parity.

Context: This article chronicles the political history of efforts by the U.S. Congress to enact a law requiring "parity" for mental health and addiction benefits and medical/surgical benefits in private health insurance. The goal of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity (MHPAE) Act of 2008 is to eliminate differences in insurance coverage for behavioral health. Mental health and addiction treatment advocates have long viewed parity as a means of increasing fairness in the insurance market, whereas employers and insurers have opposed it because of concerns about its cost. The passage of this law is viewed as a legislative success by both consumer and provider advocates and the employer and insurance groups that fought against it for decades.

Political actors recognize the power of framing problems using personalized examples and causal stories to shape public opinion. Yet little is known about how these frames interact. This research presents the results of three studies designed to investigate the effect of "individualizing" the problem of childhood obesity, in combination with information about causes of obesity, on public support for obesity prevention policies (Studies 1 and 2) and to examine how frequently the news media rely on individual depictions of obese children to portray the problem in actual news coverage (Study 3). Results from two experiments consistently demonstrated that, regardless of how the cause of childhood obesity was framed, when a news report identified an individual obese child, participants were less likely to support prevention policies than when the report described the problem in more general terms. A content analysis indicated that news articles relatively infrequently frame the problem using individualized depictions of a specific child. When specific overweight or obese children were mentioned, news coverage emphasized internal (behavioral and genetic) causes rather than factors external to the child such as neighborhood, economic, or food‐industry factors. Findings underscore the importance of considering attitudes toward a policy's target population when assessing how individual depictions of a policy problem influence public sentiment.

Policy PointsThe American public—both men and women and those with and without children in the household—holds parents highly responsible and largely to blame for childhood obesity.High attributions of responsibility to parents for reducing childhood obesity did not universally undermine support for broader policy action. School-based obesity prevention policies were strongly supported, even among those viewing parents as mostly to blame for childhood obesity.Americans who viewed sectors outside the family (such as the food and beverage industry, schools, and the government) as helping address childhood obesity were more willing to support a wider range of population-based obesity prevention policies.

Steep declines in pediatric antidepressant use were documented following the 2004 release of new safety information associating antidepressants with a risk of suicidality. The authors examine whether declines in pediatric antidepressant use were steeper among individuals with certain clinical or family characteristics. The authors find that declines in antidepressant use were associated with new (as compared with ongoing) treatment episodes. Although rates of antidepressant use were higher among children of college-educated parents prior to risk disclosures, these children were more likely to forgo antidepressant medication than children of less educated parents after risk disclosures. The authors find that both children with and without psychiatric impairment experienced declines in antidepressant medication use following the risk warnings, although the decline occurred more quickly in the latter group. The authors' findings highlight the need for additional data to assess the effects of risk disclosures on treatment patterns and health outcomes.

Context: Relatively little is known about the factors shaping public attitudes toward obesity as a policy concern. This study examines whether individuals' beliefs about the causes of obesity affect their support for policies aimed at stemming obesity rates. This article identifies a unique role of metaphor-based beliefs, as distinct from conventional political attitudes, in explaining support for obesity policies.

BACKGROUND: To examine the relationship between civic association participation and psychological distress during the COVID-19 pandemic, particularly whether different forms of engagement mitigate the increased rates of psychological distress throughout 2020. METHODS: Panel survey data collected from a nationally representative cohort of 1222 U.S. adults. Data was collected in three waves in April, July, and November 2020. Psychological distress was measured using the validated Kessler-6 instrument in November 2020. RESULTS: Respondents belonging to political associations were more likely to experience psychological distress (difference in predicted level of psychological distress on a 0-1 scale: 0.098, p ≤ .05) relative to those in unknown associations. However, individuals in political associations who more frequently interacted with others had lower levels of psychological distress (−.065, p ≤ .05) compared to those in political associations with less frequent interactions. CONCLUSIONS: Civic engagement that facilitates interpersonal interactions may protect against psychological distress. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-022-13289-4.

Objectives. To examine the public health and policy-relevant messages conveyed through local television news during the first stage of Affordable Care Act (ACA) implementation, when about 10 million Americans gained insurance. Methods. We conducted a content analysis of 1569 ACA-related local evening television news stories, obtained from sampling local news aired between October 1, 2013, and April 19, 2014. Coders systematically collected data using a coding instrument tracking major messages and information sources cited in the news. Results. Overall, only half of all ACA-related news coverage focused on health insurance products, whereas the remainder discussed political disagreements over the law. Major policy tools of the ACA—the Medicaid expansion and subsidies available—were cited in less than 10% of news stories. Number of enrollees (27%) and Web site glitches (33%) were more common features of coverage. Sources with a political affiliation were by far the most common source of information (> 40%), whereas research was cited in less than 4% of stories. Conclusions. The most common source of news for Americans provided little public health–relevant substance about the ACA during its early implementation, favoring political strategy in coverage.

Objectives. To examine gun storage practices and factors influencing those practices among gun owners. Methods. We conducted a nationally representative online survey of US gun owners (n = 1444) in 2016 to assess gun storage practices and attitudes, factors influencing storage practices, and groups that might effectively communicate regarding safe storage. We generated descriptive statistics by using cross-tabulations and used logistic regression to estimate characteristics that influenced safe storage practices. Results. Forty-six percent of gun owners reported safely storing all of their guns. Factors associated with higher odds of reporting safe storage were having a child in the home (adjusted odds ratio [AOR] = 1.44; 95% confidence interval [CI] = 1.03, 2.03), only owning handguns (AOR = 1.84; 95% CI = 1.24, 2.73), and reporting that storage decisions were influenced by a gun safety course (AOR = 2.05; 95% CI = 1.54, 2.74) or discussions with family members (AOR = 1.39; 95% CI = 1.05, 1.86). Gun owners ranked law enforcement, hunting or outdoors groups, active-duty military, and the National Rifle Association as most effective in communicating safe storage practices. Conclusions. Public health campaigns to promote safe gun storage should consider partnering with groups that garner respect among gun owners for their experience with safe use of guns.

The government often uses the Federal Employees Health Benefits (FEHB) Program as a model for both public and private health policy choices. In 2001, the U.S. Office of Personnel Management (OPM) implemented full parity, requiring that FEHB carriers offer mental health and substance abuse benefits equal to general medical benefits. OPM instructed carriers to alter their benefit design but permitted them to determine whether they would manage care and what structures or processes they would use. This article reports on the experience of 156 carriers and the government-wide BlueCross and BlueShield Service Benefit Plan. Carriers dropped cost-restraining benefit limits. A smaller percentage also changed the management of the benefit, but these changes affected the care of many enrollees, making the overall parity effect noteworthy.