Regulating Risk: State Policy and Health Outcomes Across Substance Use and Reproductive Care

Session Submission Type: Panel

Abstract

This panel examines how state-level regulatory and funding decisions shape population health outcomes in politically contested domains: opioid prescribing, substance use disorder treatment, prenatal substance exposure, and reproductive care access. Across four papers, we leverage natural experiments generated by staggered state policy adoption to identify causal effects on outcomes ranging from child educational attainment to overdose mortality to STI rates. Together, the papers offer a unified empirical account of how policy design choices propagate through households and communities, often with heterogeneous effects by socioeconomic status and demographic group. The first paper examines mandatory-access Prescription Drug Monitoring Programs, finding that while PDMPs reduce average caregiver distress, they widen academic and behavioral disparities among children in high-risk households, particularly those with tobacco exposure or caregiver substance problems. The second paper evaluates Vermont's hub-and-spoke opioid use disorder (OUD) treatment reform alongside Medicaid expansion, documenting sustained reductions in opioid overdose mortality concentrated among adults without a college degree, with effects attenuating after 2020 as polysubstance overdose patterns accelerated. The third paper traces national trends in prenatal substance use from 2015 to 2023, finding that cannabis has surpassed tobacco as the predominant substance used during pregnancy, with socioeconomic gradients shaping differential exposure across policy periods. The fourth paper investigates how closures of women's health clinics affect community STI rates, highlighting the downstream public health consequences of funding disruptions to safety-net reproductive care providers. Collectively, these papers contribute to a conversation about the spillovers generated by policies targeting substance use and reproductive health that extend well beyond their immediate targets. These spillovers are not randomly distributed, and effective regulation requires attending to treatment infrastructure, household risk environments, and the safety-net providers that serve the most vulnerable populations. The panel speaks directly to ongoing federal and state debates over Medicaid financing, substance use regulation, and reproductive health funding, offering rigorous causal evidence at a moment when the stakes of these policy decisions are especially high.

Policy Area

• Health Policy

Chair

• Joel E Segel, Pennsylvania State University

Discussant

• Lance Gui, University of Mannheim

Organizer

• Jennifer A Mangano, Indiana University

Individual Presentations

• The Effect of Women’s Health Clinic Closures on Community STI Rates - Presenting Author: Jennifer A Mangano, Indiana University

• Medicaid Expansion of Opioid Use Disorder Treatment and Overdose Mortality in Vermont - Presenting Author: Sabin Gaire, University of Pittsburgh

• Cannabis Surpasses Tobacco Among Pregnant Women: Trends and Predictors of Use in the U.S., 2015-2023 - Presenting Author: Joanne Constantin, State University of New York (SUNY) Downstate Health Sciences University

• Inheriting Risk: Theory and Evidence on Parental Substance Use, Child Outcomes, and PDMP Mandates - Presenting Author: Archi Arnob, University of Kansas