Social and Behavioral Sciences Commons^™

Association Between Low Health Literacy And Adverse Health Behaviors In North Carolina, 2016, Manan Roy, Adam Hege, Erin D. Bouldin

Journal of Appalachian Health

Introduction: Health literacy (HL) is an urgent public health challenge facing the U.S. HL is a critical factor in health inequities and exacerbates underlying social determinants of health.

Purpose: This study assesses the association between low HL (LHL) and adverse health behaviors, which contribute to poor health.

Methods: Researchers used North Carolina’s 2016 Behavioral Risk Factor Surveillance System data, namely, the Health Literacy optional module which asks respondents to rate how difficult it is for them to get health-related advice or to understand medical information (verbal or written). Health behaviors analyzed were excessive alcohol consumption, lack of adequate exercise and …

Three Essays On Health, Food, And Agricultural Economics, Saber Feizy

Theses and Dissertations--Agricultural Economics

This dissertation comprises three distinct but interrelated projects that explore the intersection of agriculture, nutrition, and economics. The first project investigates the impact of Community Supported Agriculture (CSA) food programs on the health outcomes of its participants. Using fixed effects models and a matching algorithm, the study finds that while conventional fixed effects models indicate a significant effect of CSA participation on diet-related medical expenditures, our modified time-heterogenous fixed effects model did not find a meaningful effect. The results of the matching method are consistent with those of our modified model.

The second project examines racial disparities in the prevalence …

Association Of Diabetes Prevalence With Labor Force Participation Rates In Kentucky Counties, Ryan Montgomery

MPA/MPP/MPFM Capstone Projects

Compared to other states in the USA, Kentucky has one of the highest rates of diagnosed diabetes and one of the lowest levels of labor force participation. This project employs a multivariable linear regression model to estimate the correlation between county-level diabetes prevalence and county-level labor force participation rates in Kentucky counties from 2015-2019, using publicly available data from the Centers for Disease Control’s Behavioral Risk Factor Surveillance System (BRFSS) and the U.S. Census Bureau’s American Community Survey (ACS). Labor force participation rates serve as the dependent variable and diabetes prevalence rates serve as the primary independent variable, alongside nine …

The Impacts Of Public Policies On Health-Related Outcomes, Yaxiang Song

Theses and Dissertations--Economics

This dissertation consists of three chapters that study how public policies affect health-related outcomes in China. The first two papers examine the impacts of the country’s Critical Illness Insurance program on health-related outcomes. The third paper studies the effects of maternal education on children’s early childhood health outcomes and cognitive skills.

The first chapter evaluates the impact of a recent social health insurance benefits expansion program on middle-aged and elderly individuals. In 2012, China launched a Critical Illness Insurance (CII) program, which aimed to reduce out-of-pocket costs for individuals covered by the government’s health insurance programs. This chapter utilizes the …

Essays On Evaluating The Effects Of The Child Tax Credit, Hyein Kang

Theses and Dissertations--Economics

This dissertation consists of three essays understanding how the Child Tax Credit (CTC) affects maternal labor supply, maternal health, and children’s outcomes. The CTC was implemented in 1998 tax year and has been expanded multiple times throughout the past 20 years. Chapter 1 examines the effect of the CTC on the labor supply of single and married mothers using the numerous policy reforms in the credit generosity and eligibility criteria since its inception in 1997. I use variation in the simulated benefits for a nationally representative sample to estimate the labor supply response at the extensive and intensive margins. Using …

Essays On The Role Of Policies In Major Public Health Issues, Anh Le

Theses and Dissertations--Economics

This dissertation explores the role of policy on health outcomes and behaviors that relate to major public health concerns. Essay 1 and Essay 2 investigate the effects of Medicaid expansions on substance-use outcomes. Essay 3 examines the impacts of school reopenings in Texas on COVID-19 and mobility outcomes.

Essay 1 studies the effect of the Affordable Care Act Medicaid expansion. Using State Drug Utilization Data 2011-2017, I find that the Medicaid expansion is associated with an increase of 40-60 Medicaid-paid opioid prescriptions per 1,000 people aged 19–64. However, the results suggest that post-expansion prescriptions are, on average, shorter or prescribed …

Three Essays On Grocery Sales Taxes, Lingxiao Wang

Theses and Dissertations--Agricultural Economics

Grocery sales taxes represent a stable tax revenue stream for state and municipal government, but there is rare empirical evidence suggesting grocery taxes may adversely affect health. In addition, the how governments set grocery sales taxes is still unclear. Therefore, based on a novel national dataset of annual county and state-level grocery taxes from 2009 through 2016, the following three essays in the dissertation investigate the health impacts of grocery sales taxes and the causes of grocery sales taxes in a framework of tax competition.

In the first essay, we document the spatial and temporal variation in grocery taxes and …

The Full Impact Of The Affordable Care Act On Political Participation, Charles J. Courtemanche, James Marton, Aaron Yelowitz

Economics Faculty Publications

This article examines the impact of both the Medicaid expansion and the private insurance-related components of the Affordable Care Act (ACA) on voter turnout and registration. We employ a difference-in-difference-in-differences identification strategy exploiting variation over time, state Medicaid expansion status, and within-state local area pre-ACA uninsured rates. Using data between 2006 and 2016 from the November Current Population Survey and the Census Bureau's Small Area Health Insurance Estimates, our results suggest little effect of the ACA on voter turnout or registration.

Did Social-Distancing Measures In Kentucky Help To Flatten The Covid-19 Curve?, Charles J. Courtemanche, Joseph Garuccio, Anh Le, Joshua C. Pinkston, Aaron Yelowitz

Institute for the Study of Free Enterprise Working Papers

In the absence of a vaccine or more effective treatment options, containing the spread of novel coronavirus disease 2019 (COVID-19) must rely on non-pharmaceutical interventions. All U.S. states adopted social-distancing measures in March and April of 2020, though they varied in both timing and scope. Kentucky began by closing public schools and restaurant dining rooms on March 16th before progressing to closing other non-essential businesses and eventually issuing a “Healthy at Home” order with restrictions similar to the shelter-in-place (SIPO) orders adopted by other states. We aim to quantify the impact of these measures on COVID-19 case growth in the …

Examining The Effects Of Public Policies And Addiction On Purchase Of Tobacco Products With Causal Inference And Machine Learning Methods, Xueting Deng

Theses and Dissertations--Agricultural Economics

My three essays explore the effects of tobacco policies and addiction on the consumption of e-cigarettes and other tobacco products. Recently, jurisdictions imposed taxes and other regulations on e-cigarettes, with the hope to raise tax revenues and address health concerns regarding e-cigarette use, especially youth addiction. My first essay in Chapter 1 focuses on the effects of e-cigarette taxes on sales of e-cigarettes. It compares the two types of tax policies on sales of e-cigarettes, cigarettes, and smoking-cessation products. This comparison provides information for lawmakers on decisions of taxes regarding the perspectives of revenue generation and tobacco control. Second, after …

The Effects Of E-Cigarette Taxes On E-Cigarette Prices And Tobacco Product Sales: Evidence From Retail Panel Data, Chad Cotti, Charles J. Courtemanche, Joanna Catherine Maclean, Erik Nesson, Michael F. Pesko, Nathan Tefft

Institute for the Study of Free Enterprise Working Papers

We explore the effect of e-cigarette taxes enacted through 2017 in eight states and two large counties on e-cigarette prices, e-cigarette sales, and sales of other tobacco products. We use the Nielsen Retail Scanner data for the years 2011 to 2017, comprising approximately 35,000 retailers nationally. We calculate a Herfindahl–Hirschman Index of 0.251 for retail-based purchases of e-cigarettes, indicating high market concentration. We estimate a tax-to-price pass-through of 1.55 (p < 0.01) and an e-cigarette own-price elasticity of -2.6 (p < 0.01) for the average e-cigarette tax. We also estimate a positive cross-price elasticity of demand for e-cigarettes and traditional cigarettes of roughly 1.1 for the average tax, suggesting that e-cigarettes and traditional cigarettes are economic substitutes. Our results suggest that higher e-cigarette taxes would increase e-cigarette prices and reduce e-cigarette sales, with an unintended effect of increasing traditional cigarette sales. We simulate that for every one standard e-cigarette pod (a device that contains liquid nicotine in e-cigarettes) of 0.7 ml no longer purchased as a result of an e-cigarette tax, the same tax increases traditional cigarettes purchased by 6.2 extra packs.

Three Essays On Trade, Environment, And Health, Sookti Chaudhary

Theses and Dissertations--Economics

My dissertation consists of three essays on trade, environment and health. The first essay empirically evaluates domestic facilities' environmental response to Chinese import competition in the United States (US) manufacturing sector from 2000 to 2010. Using facility-level data on chemical emissions and employing an instrumental variables approach, the paper finds that industry/regional exposure to increased import competition had very little impact on the environmental decisions of domestic facilities.

The second essay empirically explores a possible link between the environmental justice efforts during the Obama administration and the change in environmental inequity by examining the change in US facilities' underlying environmental …

Evidence-Based Approach To Drug Crisis, Jiebing Wen

Theses and Dissertations--Public Policy and Administration

I am devoted to health policy research, especially tackling the opioid crisis, and evaluating marijuana laws and newly emerging issues associated with legal recreational drugs. Opioid overdose in the United States continues to jeopardize public health. Meanwhile, the majority of states have legalized medical marijuana and one third of them further liberalized recreational marijuana. Marijuana liberalization, although originally independent of the growing opioid crisis, may be a harm reduction approach to the crisis because marijuana may be a substitute for opioids in pain management at a relatively lower risk. However, marijuana liberalization may also lead to marijuana-related harms, such as …

The Effects Of Opioids On Kentucky's Workforce, Michael W. Clark, Jenny A. Minier, Charles J. Courtemanche, Bethany L. Paris, Michael T. Childress

CBER Research Report

From the executive summary:

Opioid abuse represents a significant and growing public health issue for both the nation and Kentucky. In 2016, opioids contributed to more than 62,000 deaths nationally and 1,406 deaths in Kentucky. National studies have placed the societal costs of opioid abuse at $55.7 billion in 2007 and $78.5 billion in 2013 (Birbaum et al. (2011) and Florence et al. (2016)). These costs included increased health care expenditures, higher criminal justice costs, and lost earnings due to reduced employment and premature deaths. The While House Council of Economic Advisors (2017) estimated the societal costs of opioid abuse …

Medicaid Coverage Across The Income Distribution Under The Affordable Care Act, Charles J. Courtemanche, James Marton, Aaron Yelowitz

Institute for the Study of Free Enterprise Working Papers

This chapter examines trends in Medicaid enrollment across the income distribution after the ACA’s Medicaid expansion.Using data from the American Community Survey between 2012and 2017, we compare Medicaid coverage over time in 9 states that expanded Medicaid in 2014 with no previous expansion for able-bodied, working-age adults with 12 states that had not expanded Medicaid by 2019 and also had no previous expansion for such adults. A difference-in-differences model is used to formalize this comparison. Similar to many previous studies, we find that Medicaid coverage increased dramatically for income-eligible adults under 138% of the federal poverty level (FPL). In addition, …

The Effects Of Traditional Cigarette And E-Cigarette Taxes On Adult Tobacco Product Use, Michael F. Pesko, Charles J. Courtemanche, Joanna Catherine Maclean

Institute for the Study of Free Enterprise Working Papers

We study the effects of traditional cigarette tax rate changes and e-cigarette tax adoption on use of these products among US adults. Data are drawn from the Behavioral Risk Factor Surveillance System and National Health Interview Survey data over the period 2011to 2017. Using a difference-in-differences model, we find that higher traditional cigarette taxes reduce adult traditional cigarette use and increase adult e-cigarette use, suggesting that the products are economic substitutes. E-cigarette tax adoption reduces e-cigarette use, with some heterogeneity across groups, and dilutes the own-tax responsiveness of traditional cigarettes.

The Three-Year Impact Of The Affordable Care Act On Disparities In Insurance Coverage, Charles J. Courtemanche, James Marton, Benjamin Ukert, Aaron Yelowitz, Daniela Zapata, Ishtiaque Fazlul

Economics Faculty Publications

Objective
To estimate the impact of the major components of the ACA (Medicaid expansion, subsidized Marketplace plans, and insurance market reforms) on disparities in insurance coverage after three years.

Data Source
The 2011-2016 waves of the American Community Survey (ACS), with the sample restricted to nonelderly adults.

Design
We estimate a difference-in-difference-in-differences model to separately identify the effects of the nationwide and Medicaid expansion portions of the ACA using the methodology developed in the recent ACA literature. The differences come from time, state Medicaid expansion status, and local area pre-ACA uninsured rates. In order to focus on access disparities, we …

The Impact Of Medicare Part D On Mortality And Financial Stability, Katherine Toran

Theses and Dissertations--Economics

Using the Health and Retirement Study Panel core files from 1996 to 2014, I analyze how Medicare Part D impacted access to prescription drug coverage by various demographic factors such as race, gender, and income. In Chapter 1, I find the highest take-up rates for those who were white, female, and with higher incomes. However, increases in coverage were high across the board, such that Medicare Part D also improved drug insurance coverage for those who were black, male, and with lower income. Thus, although Medicare Part D did increase prescription drug insurance coverage for seniors across the board, I …

Essays On Child Well-Being And The Social Safety Net, Cody N. Vaughn

Theses and Dissertations--Economics

This dissertation consists of three essays examining the role of two particular social safety net programs, the Temporary Assistance for Needy Families (TANF) program and the Supplemental Nutrition Assistance Program (SNAP), on the well-being of children from disadvantaged households. While the impact of these programs on the adults and parents of the household have been studied extensively, less is known about their effect on children. This is true for both their immediate impact on child well-being and any long-run impacts on children who grow up under these programs. Given the demonstrated importance of child well-being on later life adult outcomes, …

Essays On Health Economics Using Big Data, Samane Zarebanadkoki

Theses and Dissertations--Agricultural Economics

This dissertation consists of three essays addressing different topics in health economics. In the first essay, we perform a systematic review of peer-reviewed articles examining consumer preference for the main electronic cigarette (e-cigarette) attributes namely flavor, nicotine strength, and type. The search resulted in a pool of 12,933 articles; 66 articles met the inclusion criteria for this review. Current literature suggests consumers preferred flavored e-cigarettes, and such preference varies with age groups and smoking status. Consumer preference for nicotine strength and types depend on smoking status, e-cigarette use history, and gender. Adolescents consider flavor the most important factor trying e-cigarettes …

Effects Of The Affordable Care Act On Health Care Access And Self-Assessed Health After 3 Years, Charles J. Courtemanche, James Marton, Benjamin Ukert, Aaron Yelowitz, Daniela Zapata

Economics Faculty Publications

Using data from the Behavioral Risk Factor Surveillance System, we examine the causal impact of the Affordable Care Act on health-related outcomes after 3 years. We estimate difference-in-difference-in-differences models that exploit variation in treatment intensity from 2 sources: (1) local area prereform uninsured rates from 2013 and (2) state participation in the Medicaid expansion. Including the third postreform year leads to 2 important insights. First, gains in health insurance coverage and access to care from the policy continued to increase in the third year. Second, an improvement in the probability of reporting excellent health emerged in the third year, with …

Effects Of The Affordable Care Act On Health Behaviors After Three Years, Charles J. Courtemanche, James Marton, Benjamin Ukert, Aaron Yelowitz, Daniela Zapata

Institute for the Study of Free Enterprise Working Papers

This paper examines the impacts of the Affordable Care Act (ACA) – which substantially increased insurance coverage through regulations, mandates, subsidies, and Medicaid expansions – on behaviors related to future health risks after three years. Using data from the Behavioral Risk Factor Surveillance System and an identification strategy that leverages variation in pre-ACA uninsured rates and state Medicaid expansion decisions, we show that the ACA increased preventive care utilization along several dimensions, but also increased risky drinking. These results are driven by the private portions of the law, as opposed to the Medicaid expansion. We also conduct subsample analyses by …

Capitalization Of Green Space And Water Quality Into Residential Housing Values, Willie B. Bedell

Theses and Dissertations--Agricultural Economics

This thesis investigates how proximity to parks, historic district designations, and water quality are valued at residential housing prices. The first essay argues that the negative influences of parks and historic districts, if not noticed, could promote negative externalities and unincentivized investments. I find a negative impact on housing values for a close proximity to a park, suggesting disamenities in park features. When the boundary discontinuity and park amenities are considered, I find a positive valuation for a park. Overall, these results imply a mixed influence of parks on homeowners. From the historic district standpoint, I find a positive valuation …

Willingness-To-Pay For Attributes Of Health Care Facilities In Rural Kentucky, Emmanuel Owusu-Amankwah

Theses and Dissertations--Agricultural Economics

Background: As rural hospitals in Kentucky face insolvency, stakeholders must assess the value of rural hospitals as well as alternatives such as rural clinics and private physician offices.

Objective: To identify the value of attributes of healthcare facilities based on Kentucky’s rural residents’ willingness-to-pay (WTP).

Methods: A survey instrument was created and distributed to ten counties in rural Kentucky. A conditional logit model was used to obtain baseline values and then a mixed logit model was used to address heterogeneity among consumers in estimating WTP. WTP values incorporated respondents’ demographic characteristics and their health status from self-reported frequency of use …

Essays On Transfer-Program Interactions Among Low-Income Households, Nicholas S. Moellman

Theses and Dissertations--Economics

This dissertation consists of three essays examining the role of transfer-program interactions for families and households who participate in the social safety net. The safety net is comprised of many different programs, run by different agencies, governed by different rules, and often administered by disparate and secluded entities. However, many households participate in multiple programs, subjecting them to the milieu of administrative hurdles. In this dissertation, I try to untangle some of the intended and unintended effects of program participation that may be experienced by these households.

In Essay 1, I examine the effect of the Patient Protection and Affordable …

Essays On The Role Of Government Regulation And Policy In Health Care Markets, Grayson L. Forlines

Theses and Dissertations--Economics

Understanding how health care markets function is important not only because competition has a direct influence on the price and utilization of health care services, but also because the proper functioning, or lack thereof, of health care markets has a very real impact on patients who depend on health care markets and providers for their personal well-being. In this dissertation, I examine the role of government policies and regulation in health care markets, with a focus on the response of health care providers. In Chapter 1, I analyze the impact of Medicare payment rules on hospital ownership of physician practices. …

Early Effects Of The Affordable Care Act On Health Care Access, Risky Health Behaviors, And Self-Assessed Health, Charles J. Courtemanche, James Marton, Benjamin Ukert, Aaron Yelowitz, Daniela Zapata

Institute for the Study of Free Enterprise Working Papers

The goal of the Affordable Care Act (ACA) was to achieve nearly universal health insurance coverage through a combination of mandates, subsidies, marketplaces, and Medicaid expansions, most of which took effect in 2014. We use data from the Behavioral Risk Factor Surveillance System to examine the impacts of the ACA on health care access, risky health behaviors, and self-assessed health after two years. We estimate difference-in-difference-in-differences models that exploit variation in treatment intensity from state participation in the Medicaid expansion and pre-ACA uninsured rates. Results suggest that the ACA led to sizeable improvements in access to health care in both …

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 …

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.

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.