Suchergebnisse

Despite a robust literature applying the Multiple Streams Framework (MSF) to national government institutions, there remains a dearth of research examining the theory's explanatory power in US state legislative contexts. This omission is problematic given the critical role state legislatures play in driving policy change in a host of policy domains, including healthcare, emergency preparedness and voting rights policy, to name a few. To fill this gap in the research, this study applies the MSF to the case of climate adaptation policy making in the Massachusetts State Legislature. Using a mixed methods design, it assesses the effect of all three of the MSF's streams (the problem, politics and policy streams), as well as the concept of policy entrepreneurship on the climate adaptation policy agenda of the Massachusetts State Legislature between the years 2001 and 2020. The findings suggest that agenda activity was largely driven by changes within the political stream, namely the election of a Republican governor. In addition to advancing the MSF by providing one of the most comprehensive quantitative analyses of the framework to date, this article draws on new data from the State House News Service and other sources of state legislative floor debates to present a new methodological approach for measuring agenda change. In this way, the article makes a clear theoretical contribution to the MSF literature as well as providing new analysis of state-level climate adaptation policy adoption.

Abstract

Introduction
Managed Alcohol Programs (MAPs) are designed to improve health and housing outcomes for unstably housed people with an alcohol use disorder (AUD). The present study assesses the association of MAP participation with healthcare and mortality outcomes.


Methods
A retrospective cohort study assessed health outcomes for 205 MAP participants and 128 controls recruited from five Canadian cities in 2006–2017. Survival and negative binomial regression models were used to calculate hazard ratios (HR) of death and emergency room (ER) visits and hospital bed days (HBDs). Covariates included age, sex, AUD severity and housing stability score.


Results
In fully adjusted models, compared with times outside MAPs, participants had significantly reduced risk of mortality (HR = 0.37, P = 0.0001) and ER attendance (HR = 0.74, P = 0.0002), and fewer HBDs yearly (10.40 vs 20.08, P = 0.0184). Over the 12 years, people enrolled in a MAP at some point had significantly fewer HBDs per year than controls after MAP enrolment (12.78 vs 20.08, P = 0.0001) but not significantly different rates of death or ER presentation. MAP participants had significantly more alcohol-related but significantly fewer nonalcohol-related ER presentations than controls.


Conclusion
Attendance at a MAP was associated with reduced risk of mortality or morbidity and less hospital utilization for individuals with unstable housing and severe AUDs. MAPs are a promising approach to reduce mortality risk and time spent in hospital for people with an AUD and experiencing homelessness.