A Multilevel Test of Constrained Choices Theory

Abstract

According to Bird and Rieker's sociology of constrained choices, decisions and priorities concerning health are shaped by the contexts-including policy, community, and work/family-in which they are formulated. While each level received attention in the original and subsequent research, we contend their constrained choices theory provides a powerful multilevel framework for modeling health outcomes. We apply this framework to tobacco clean air restrictions, combining a comprehensive database of tobacco policies with the National Longitudinal Survey of Youth 1997 from ages 19 to 31. Using multilevel panel models, we find that clean air policies lower the odds of past 30 day smoking and dependence while controlling for other policy-, city-, and individual-level constraints. We also find unique between- and within-person effects, as well as gender effects, for the constraint levied by smoking bans. We argue for the theory's broad applicability beyond commonly cited findings regarding gender and biological influences.

Comprehensive vaping bans are associated with lower odds of initiation into electronic nicotine delivery systems use among young people

“…To assess how state comprehensive vaping bans have shaped age of initiation into ENDS use among contemporary youth (13)(14)(15)(16)(17)(18)(19)(20)(21)(22), we merged longitudinal data from the Population Assessment of Tobacco and Health (PATH) study with a state-year database on tobacco and ENDS policies, including clean indoor air policies. We used event history analyses to examine how state-level comprehensive vaping bans were associated with age of initiation into ENDS use.…”

“…Substance use policies are often implemented to reduce or constrain patterns of use, especially among adolescents. Long-term evidence demonstrates that tobacco control policies had considerable success in reducing tobacco use among young people [12][13][14][15][16]. Such policies made tobacco products less affordable, less accessible and less visible to youth, and in turn achieved a notable impact in reducing youth tobacco use [17,18].…”

“…Clean air laws for tobacco were effective in reducing smoking among young people [13,14], and many of these policies were eventually extended to cover ENDS products in some states. Such policies may not be fully effective for reducing adult vaping.…”

Improving Behavioral Health in Young People: It Is Time for Social Work to Adopt Prevention

“…Public health experts had long recognized the value of identifying the individual and environmental characteristics, conditions, and behaviors that predict illness and disease. National campaigns to inform the public of risks for and protective factors against cardiovascular disease-as well as new state and local policies and regulations-led to considerable reductions in cardiovascular risk factors such as smoking (Vuolo, Kadowaki, & Kelly, 2016). Identifying risks for and protective factors against health problems such as diabetes had helped countless individuals prevent, detect, or manage their diseases (Selvin, Parrinello, Sacks, & Coresh, 2014).…”

The impact of school-entry mandates on social inequalities in human papillomavirus vaccination

“…FCT conjectures health and social policy are closely linked to health inequalities, and the relationship between social position and health can be weakened by implementing policies that distribute health enhancing knowledge, resources, and/or interventions equally across populations ( Link, 2008 ; Phelan et al., 2010 ). Studies examining policies in relation to social inequalities in the United States have found: mandatory seatbelt laws lessened the socioeconomic gap in seatbelt use ( Harper et al., 2014 ); smoking bans reduced young adult smoking regardless of race or parental socioeconomic status (SES; Vuolo et al., 2016 ) and were especially effective for those with low individual and/or parental education ( Hernandez et al., 2019 ); and folic acid fortification decreased absolute disparities in low folate status by race-ethnicity and income—yet concentrated the prevalence of low folate status within the most disadvantaged groups ( Dowd & Aiello, 2008 ). Cross-nationally, a comparative study of the United States and Canada suggests social policy buffers the SES–health relationship for highly preventable disease ( Willson, 2009 ).…”