Social and Behavioral Sciences Commons^™

Social Determinants Of Health, Center For Business And Economic Research, Gatton College Of Business And Economics, University Of Kentucky

CBER Infographic Posters

What is health? How do we measure the health of a society? Is it merely the clinical outputs of each individual patient or are these numbers impacted by environmental and social factors such as access to healthcare facilities? The answer is yes. Research surrounding health and social services shows a correlation between health outcomes and the environment, calling this junction the Social Determinants of Health (Bradley, et al., 2011; Bradley, et al., 2016; Woolf, et al., 2015). This includes a combination of factors that impact the health of an individual such as: access to food, income, education, physical activity, and …

How Did The Aca Affect Health Insurance Coverage In Kentucky?, Aaron Yelowitz

Institute for the Study of Free Enterprise Working Papers

The major components of the Affordable Care Act (ACA) were implemented in 2014, including the rollout of the Health Insurance Marketplace, Medicaid expansions, and the individual mandate. Kentucky stands out as one of the few southern states to expand Medicaid, and earlier work has demonstrated that Kentucky experienced some of the largest gains in health insurance coverage. The goal of the current study is to further explore the sources that individuals used to gain coverage in Kentucky using a large, publicly available dataset, the American Community Survey (ACS). Several findings emerge. First, overall health insurance coverage increased by 5.7 percentage …

Welfare Reform And The Intergenerational Transmission Of Dependence, Robert Paul Hartley, Carlos Lamarche, James P. Ziliak

University of Kentucky Center for Poverty Research Discussion Paper Series

We estimate the effect of welfare reform on the intergenerational transmission of welfare participation using a long panel of mother-daughter pairs over the survey period 1968-2013 in the Panel Study of Income Dynamics. Because states implemented welfare reform at different times starting in 1992, the cross-state variation over time permits us to quasi-experimentally separate out the effect of mothers’ participation on daughters’ welfare choice in the pre- and post-welfare reform periods. Our empirical framework also addresses potential issues in identifying a causal pathway from parent to child that arise from correlated unobservables in welfare decisions, misclassification error in survey reports, …

Public Health Spending And Its Contributions To The Total Spend On Health, Glen P. Mays

Health Management and Policy Presentations

This presentation provides an overview of recent research on governmental public health expenditures and their interaction with medical spending, carried out through the Robert Wood Johnson Foundation supported initiatives on Public Health Services and Systems Research (PHSSR) and the new Systems for Action research program. This work illustrates the value of tracking resource use across multiple sectors that influence health and well-being in American communities. As such, this work can inform the ongoing dialogue about methodologies for summarizing total health spending for the U.S. and for state and local areas.

Labor Market Returns To The Ged Using Regression Discontinuity Analysis, Christopher Jepsen, Peter Mueser, Kenneth R. Troske

Economics Faculty Publications

We evaluate returns to General Educational Development (GED) certification for high school dropouts using state administrative data. We apply a fuzzy regression discontinuity method to account for test takers retaking the test. For women we find that GED certification has no statistically significant effect on either employment or earnings. For men we find a significant increase in earnings in the second year after taking the test but no impact in subsequent years. GED certification increases postsecondary school enrollment by 4–8 percentage points. Our results differ from regression discontinuity approaches that fail to account for test retaking.

Measuring Progress To Comprehensive Public Health Systems, National Preparedness, And A Culture Of Health, Glen P. Mays

Health Management and Policy Presentations

This update describes recent progress on two national health measurement initiatives: The National Health Security Preparedness Index and the National Longitudinal Survey of Public Health Systems. These longitudinal data sources offer valuable perspectives on how health security practices and public health delivery systems are changing across the U.S.

Understanding The Value Of Multi-Sector Partnerships To Improve Population Health, Glen P. Mays

Health Management and Policy Presentations

We review recent research concerning multi-sectoral partnerships aimed at improving health status on a population-wide basis, with a particular focus on implementation strategies and on health and economic impact. While still preliminary and emerging, research indicates that large health benefits are possible through collective actions that engage the medical, public health, and social sectors. Mechanisms for aligning incentives, dividing responsibilities equitably, and measuring progress regularly appear critical to success.

Measuring Comprehensive Public Health Delivery Systems And Their Contributions To Population Health, Glen P. Mays, Rick Ingram

Health Management and Policy Presentations

We review methods for measuring the structure of public health delivery systems using data from the National Longitudinal Survey of Public Health Systems. A growing body of research using these measures demonstrates how multiple sectors contribute to core public health functions, and how these functions influence community health status over time. We end with a summary of how the Comprehensive Public Health System measure will be used in monitoring the impact of the 21st Century Public Health System initiative.

Aligning Delivery & Financing Systems To Advance A Culture Of Health, Glen P. Mays

Health Management and Policy Presentations

The Robert Wood Johnson Foundation's Systems for Action Research Program supports research on how best to organize, finance, and deliver the constellation of services and supports that promote health and well-being in American communities, including but extending beyond the medical care and public health sectors. This session describes work underway through the S4A program and future research priorities, building on a strong scientific foundation in the fields of health services research (HSR) and public health services & systems research (PHSSR).

Integrating Health Services & Systems: What We Know, Think We Know, And Need To Learn, Glen P. Mays

Health Management and Policy Presentations

The delivery and financing systems for medical care, public health, and social and community services pursue many common goals and serve overlapping groups of families and communities. Unfortunately, in most American communities these systems interact in complex and often poorly understood ways through fragmented funding vehicles, information flows, governance and decision-making structures, institutional relationships, implementation rules and strategies, and professional and interpersonal connections. New research approaches are required to untangle these interactions and expose novel pathways of influence that can support equitable improvements in service delivery, resource use, health impact, and wellbeing. This presentation will summarize evidence from recent studies …

Measuring Multi-Sector Contributions To Public Health Delivery Systems & Population Health, Glen P. Mays

Health Management and Policy Presentations

The National Longitudinal Survey of Public Health Systems has followed a nationally-representative cohort of U.S. communities since 1998 to measure the scope of public health activities implemented in each community and the range of organizations and sectors that contribute to each activity. With 16 years of follow-up observations, this survey allows us to study the effects of demographic, economic, and policy shocks on public health delivery systems, and estimate the health effects attributable to delivery system change.

Measuring Comprehensive Public Health Delivery Systems And Their Contributions To Population Health, Glen P. Mays

Health Management and Policy Presentations

Delivery and financing systems for public health services vary widely across U.S. communities, raising questions about the comparative effectiveness and efficiency of alternative structures. We summarize recent approaches for measuring alternative system configurations and estimating their health and economic effects.

Food Store Choice Of Poor Households: A Discrete Choice Analysis Of The National Household Food Acquisition And Purchase Survey, Sofia B. Villas-Boas, Rebecca Taylor

University of Kentucky Center for Poverty Research Discussion Paper Series

Policymakers are pursing initiatives to increase food access for low-income households. However, due in part to previous data deficiencies, there is still little evidence supporting the assumption that improved food store access will alter dietary habits, especially for the poorest of U.S. households. This article uses the new National Household Food Acquisition and Purchase Survey (FoodAPS) to estimate consumer food outlet choices as a function of outlet type and household attributes in a multinomial mixed logit. In particular, we allow for the composition of the local retail food environment to play a role in explaining household store choice decisions and …

The Effect Of Food Price On Food Insecurity And Diet Quality: Exploring Potential Moderating Roles Of Snap And Consumer Competency, Yunhee Chang, Jinhee Kim, Swarn Chatterjee

University of Kentucky Center for Poverty Research Discussion Paper Series

Higher food prices may aggravate household food insecurity and hurt diet quality. Using a sample of low-income households from the National Household Food Acquisition and Purchase Survey (FoodAPS), this study examines whether local food prices affect food insecurity and nutritional quality of foods acquired, and how households use competent consumer behaviors to mitigate any adverse effects of price. Financial management practices, nutrition literacy, and conscientious food shopping practices were considered for consumer competency. Our findings indicate that low-income households in higher-cost areas, regardless of whether they participate in SNAP or not, are more likely to adopt loyalty or other store …

The Effects Of Benefit Timing And Income Fungibility On Food Purchasing Decisions Among Snap Households, Joshua P. Berning, Gregory Colson, Jeffery H. Dorfman, Travis A. Smith, Xiaosi Yang

University of Kentucky Center for Poverty Research Discussion Paper Series

The Supplemental Nutrition Assistance Program (SNAP) is the largest nutritional safety net in the United States. Prior research has found that participants have higher consumption shortly after receiving their benefits, followed by lower consumption towards the end of the benefit month. This “SNAP benefit cycle” has been found to have negative effects on beneficiaries. We examine two behavioral responses of SNAP participants that may work in tandem to drive much of the cycle: short-run impatience – a higher preference to consume today; and fungibility of income – the degree of substitutability between a SNAP dollar and a cash dollar. Using …

Variation In Food Prices And Snap Adequacy For Purchasing The Thrifty Food Plan, Erin Bronchetti, Garret Christensen, Benjamin Hansen

University of Kentucky Center for Poverty Research Discussion Paper Series

Whether Supplemental Nutrition Assistance Program (SNAP) benefits are adequate to provide food security for eligible households is an important and timely policy question. While the nominal value of SNAP benefits is fixed across states (except for Hawaii and Alaska), variation in food prices across geographic areas is dramatic, and the real value of SNAP benefits varies widely across the U.S. Our research provides new evidence on geographic variation in the adequacy of SNAP benefits to purchase the Thrifty Food Plan (TFP).

Using multiple methods to estimate the cost of the Thrifty Food Plan (TFP) faced by households across the nation, …

Cost Of Living, Healthy Food Acquisition, And The Supplemental Nutrition Assistance Program, Sanjay Basu, Christopher Wimer, Hilary K. Seligman

University of Kentucky Center for Poverty Research Discussion Paper Series

We tested the hypothesis that high costs of living, such as from high housing rents, reduce the healthfulness of food acquisitions. Using the National Household Food Acquisition and Purchase Survey (2012-13), we examined the relationships between cost of living and food acquisition patterns among both SNAP participants and non-participants (N = 5,414 individuals from households participating in SNAP, 3,863 individuals from non-participating households <185% of the federal poverty threshold, and 5,036 individuals from non-participating households >185% of the federal poverty threshold). Indices for cost of living included county-level Regional Price Parities for major classes of expenditures and the geographic adjustment to the Supplemental Poverty Measure, which is based on rent prices. We …

Kentucky Annual Economic Report 2016, Christopher R. Bollinger, William H. Hoyt, David Blackwell, Michael T. Childress

Kentucky Annual Economic Report

No abstract provided.

Food Security And Geographic Factors In Food Purchase And Acquisition Decisions: A Compilation Of Research Conducted Under Usda Cooperative Agreements 58-5000-1-0050 And 58-5000-3-0066, James P. Ziliak, Craig Gundersen

University of Kentucky Center for Poverty Research Discussion Paper Series

No abstract provided.

Supermarket Proximity And Price: Food Insecurity And Obesity In The United States, Janelle Downing, Barbara Laraia

University of Kentucky Center for Poverty Research Discussion Paper Series

Where we live matters for our health. The social, economic, and physical features of neighborhoods can play a powerful role in health and longevity. Neighborhood concentration of poverty and poor health have been shown to be linked. Residing in low-income neighborhoods has been associated with diet related chronic diseases such as obesity and diabetes.

Kentucky's Educational Performance & Points Of Leverage, Michael T. Childress

Issue Brief on Topics Affecting Kentucky’s Economy

This issue brief explores the links between obstacles students face and educational outcomes.

The Relationship Between Neighborhood Food Environment And Food Store Choice On Purchasing Habits Among Snap And Lower Income Households, Usda Foodaps Data, Alison A. Gustafson, James E. Allen Iv, Nancy E. Schoenberg, Mark Swanson

University of Kentucky Center for Poverty Research Discussion Paper Series

The objective of the study was to determine relationship between neighborhood food store availability, store choice and food purchasing habits among Supplemental Nutrition Assistance Program (SNAP) participating households. The study sample consisted of SNAP households (n=1581) and low income households participating in the USDA's National Household Food Acquisition and Purchase Survey (FoodAPS) a nationally representative cross-sectional survey of American households with household food purchases and acquisitions data. Main Outcomes: 1) Food purchasing choices (sugar-sweetened beverages, fruits and vegetables, snacks, water, and milk) obtained from store receipts over a one-week period; 2) food shopping activities was obtained from a log book …

Influence Of Snap Participation And Food Environment On Nutritional Quality Of Food At Home Purchases, Amy Hillier, Benjamin Chrisinger, Tony E. Smith, Eliza Whiteman, Michael Kallan

University of Kentucky Center for Poverty Research Discussion Paper Series

A growing body of research describes how individuals make food shopping decisions in both time and space. The FoodAPS dataset provides a unique opportunity for understanding these patterns among a large sample across income, SNAP status, and settings. We addressed three questions in our research: (1) Where do participants shop for food at home (FAH) and how do individual characteristics interact with store characteristics and distance? (2) How does the nutritional content of foods purchased change as time from SNAP distribution increases? and (3) How does store choice influence the nutritional quality of FAH purchases? We used a conditional logit …

Do Snap Recipients Get The Best Prices?, Conrad Lyford, Raymond J. March, Carlos E. Carpio, Tullaya Boonsaeng

University of Kentucky Center for Poverty Research Discussion Paper Series

This paper examines the relationship between SNAP participation and prices paid for food items. To test this relationship, we develop an expensiveness index following the method of Aguiar and Hurst (2007) and use the FoodAPS data set. Using both the ordinary least squares method and controlling for endogeneity using an instrumental variables approach, we found SNAP participation did not hold a statistically significant relationship with the prices paid for food items when we controlled for consumer behavior and food market variables. This suggests that SNAP participants are not systematically disadvantaged in their food purchases. Additional efforts to further educate SNAP …

Causes And Consequences Of The Calorie Crunch, Michael A. Kuhn

University of Kentucky Center for Poverty Research Discussion Paper Series

Monthly welfare programs such as the Supplementary Nutrition Assistance Program (SNAP) produce consistent cycles of expenditure and consumption amongst recipients. Food insecurity and negative behavioral outcomes track these cycles. This paper leverages new data from the USDA, the FoodAPS survey, and to answer a variety of questions related to these phenomena: Are consumption and expenditure cycles correlated? Who bears the burden of food shortages at the end of each benefit month? Does diet quality track food expenditure? I find robust expenditure and consumption cycles in the FoodAPS data, but contrary to popular belief, they are only weakly correlated. The youngest …

Contextualizing Family Food Decisions: The Role Of Household Characteristics, Neighborhood Deprivation, And Local Food Environments, Sarah Bowen, Richelle Winkler, J. Dara Bloom, Lillian Macnell

University of Kentucky Center for Poverty Research Discussion Paper Series

We employ multilevel models with neighborhood and state effects (fixed effects and random effects) to analyze the associations between household characteristics, neighborhood characteristics, regional attributes and dietary quality. We use data from the USDA National Household Food Acquisition and Purchase Survey. Our dependent variable is a Healthy Eating Index that incorporates dollars spent and amount of food in several categories. Key explanatory variables at the household level include variables household financial condition, housing burden, home ownership, car access, household size. We include a variable for the number of large food stores in the neighborhood, a neighborhood deprivation index, and a …

An Overview Of Snap, Food Security, And Geographic Factors In Food Purchase And Acquisition Decisions, James P. Ziliak, Craig Gundersen

University of Kentucky Center for Poverty Research Discussion Paper Series

In April 2012 the Economic Research Service (ERS) and the Food and Nutrition Service (FNS) in the U.S. Department of Agriculture embarked on an ambitious new data collection enterprise known as the National Household Food Acquisition and Purchase Survey (FoodAPS). FoodAPS is innovative in that it is the first nationally representative household survey to collect comprehensive data on household food expenditures and acquisitions, including those obtained using benefits from food assistance programs. The survey includes data from 4,826 households, including Supplemental Nutrition Assistance Program (SNAP) households, low-income eligible households not participating in SNAP, and higher income households. FoodAPS is specifically …