Social and Behavioral Sciences Commons^™

Export Strength And Opportunities For Kentucky Industries, Christopher R. Bollinger, Derrick Jenniges

CBER Research Report

Executive Summary:

This project's primary goal is to quantify export strengths and opportunities in Kentucky industries. We measure export strength as the relative dollar value of exports per worker in four digit industries using U.S. dollar value of exports per worker as the base. Tables were prepared for total exports and a selection of 50 countries representing 98.5% of Kentucky exports and 93.2% of U.S. exports. In addition to the export index, a measure of industry strength based upon labor and comparisons to regional competitor states is provided.

• Industries with a low index value, either overall or for specific countries, …

Public Health Return On Investment: Making The Case, Glen P. Mays

Health Management and Policy Presentations

Fiscal pressures and policy imperatives have created a need for rigorous economic analyses of public health programs and policies. ROI analyses can reveal whether the benefits of public health strategies justify their costs, who realizes these benefits and costs, and under what circumstances.

Comparative Effectiveness Research And Patient Centered Outcomes Research In Public Health Settings: Design, Analysis, And Funding Considerations, Glen P. Mays

Health Management and Policy Presentations

The principles and methods of CER and PCOR have developed primarily with therapeutics in mind, but they must also be applied to the study of public health programs, policies, and delivery systems. This session surveys the emerging field, and provides examples of CER/PCOR methods applied in public health settings using practice-based research networks (PBRNs).

Is There More To Food Insecurity Among Children Than Poverty? The Importance Of Measurement, Neeraj Kaushal, Jane Waldfogel, Irwin Garfinkel, Vanessa Wight

University of Kentucky Center for Poverty Research Discussion Paper Series

This paper examines the association between poverty and food insecurity among children using the official measure of poverty and the newsupplemental poverty measure of the Census Bureau based on a more inclusive definition of family resources and needs. Our objective is to study whether the association between food insecurity and poverty improves with a more comprehensive measure of income and needs. We find a strong and statistically significant association between income-to-needs ratio based on the official poverty metric and food insecurity among children—particularly very low food security among children. A more inclusive measure of income-to-needs-ratio, based on the supplemental poverty …

Does Economic Decline Contribute To A Decline In Children’S Food Security?, Kimberly Groover, Bradford Mills, George Davis

University of Kentucky Center for Poverty Research Discussion Paper Series

Most Americans believe that children should not experience persistent worry about the quality or quantity of food consumed due to low household resources. Since 1995, the USDA has tracked children’s food security based upon household responses to the annual Current Population Survey Food Security Supplement (CPS-FSS). During this time, a small, but recently growing, share of U.S. households report multiple indicators of reduced food intake and disrupted eating patterns among children due to inadequate resources to obtain food (Coleman- Jenson et al, 2012). The USDA classifies children as food secure, low food secure, or very low food secure based upon …

Multigenerational Families And Food Insecurity, James P. Ziliak, Craig Gundersen

University of Kentucky Center for Poverty Research Discussion Paper Series

The prevalence of multigenerational families is on the rise in the United States, as is food insecurity. We estimate the effect of resident grandchildren on the risk of and transitions in food insecurity using repeated cross sections and longitudinally linked two-year panels of the Current Population Survey from 2001-2010. We find that rates of food insecurity in families with a grandchild present are at least twice as high in a typical year compared to families without a resident grandchild, and the extent of very low food security increased substantially faster among these households over the past decade. The rise in …

Estimating Scale And Scope Effects In Public Health Delivery: Implications For Regionalization, Glen P. Mays, Rachel A. Hogg, Rick Ingram, Kristina Rabarison

Health Management and Policy Presentations

OBJECTIVES: The nation's public health delivery system comprises nearly 3000 local public health agencies that vary widely in capabilities. Economic pressures, workforce shortages, and new national accreditation standards are leading these agencies to explore mechanisms for pooling resources to enhance delivery and improve population health.

METHODS: A longitudinal cohort design is used to analyze changes in the availability and perceived effectiveness of services delivered by local public health providers. A stratified random sample of the nation's 3000 local public health agencies (n=497) were surveyed in 1998 and again in 2006 and 2011 (70% response) to measure the availability of 20 …

Food Insecurity Across The First Five Years: Triggers Of Onset And Exit, Alison Jacknowitz, Taryn W. Morrissey

University of Kentucky Center for Poverty Research Discussion Paper Series

Very low food security among young children is associated with developmental deficiencies. However, little is known about the factors that predict entry into or exit from very low food security during early childhood. This study seeks to: (1) Understand the triggers that explain movements into or out of very low food security among children from birth to age five; (2) Examine the first aim using different definitions of food insecurity. The analysis relies on the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), a longitudinal, nationally representative dataset of approximately 10,700 children, to estimate linear probability models. Results suggest that residential moves …

The Impact Of Incarceration On Food Insecurity Among Households With Children, Sally Wallace, Robynn Cox

University of Kentucky Center for Poverty Research Discussion Paper Series

This study seeks to determine the role that parental incarceration plays on the probability of food insecurity among families with children and very low food security of children using micro-level data from the Fragile Families and Child Well Being Study (FFCWS). The data set contains the 18-question food security module which allows us to explore the link between incarceration and food insecurity and very low food security among children, families, and adults. The incidence of very low food security in our data is somewhat higher than the national average, but the incidence of other levels of food security is similar …

The Effect Of Safety Net Programs On Food Insecurity, Lucie Schmidt, Lara Shore-Sheppard, Tara Watson

University of Kentucky Center for Poverty Research Discussion Paper Series

Does the safety net reduce food insecurity in families? In this paper we investigate how the structure of benefits for five major safety net programs – TANF, SSI, EITC, SNAP, and Medicaid – affects low food security in families and very low food security among children. We build a calculator for the years 2001-2009 to impute eligibility and benefits for these programs in each state, taking into account cross-program eligibility rules. To identify a causal effect of the safety net, we instrument for imputed eligibility and benefits using simulated eligibility and benefits for a nationally representative sample. Focusing on non-immigrant, …

Unlocking The Complexity Of The Health Care System: Kentucky’S Health Navigators, Michael T. Childress

CBER Research Report

From the preface:

Health navigation comes in many forms. Sometimes it takes the form of helping an individual find the treatment, medication, or health services they need. Other times navigation takes the form of helping a patient overcome barriers of child care, finances, or transportation so they can see a doctor. In other cases navigation means working with patients to enhance health literacy so they comply with medical instructions and are not readmitted to a hospital. And sometimes health navigation entails lending an empathetic hand to patients under‐ going the rigors of cancer treatment.

Here we adopt a fairly broad …

Identifying The Effect Of Wic On Very Low Food Security Among Infants And Children, Brent Kreider, John V. Pepper, Manan Roy

University of Kentucky Center for Poverty Research Discussion Paper Series

The Women, Infants, and Children Program (WIC) is considered a crucial component of the social safety net in the United States, yet there is limited supporting evidence on the effects of WIC on the nutritional well-being and food security of infants and young children. Two key identification problems have been especially difficult to address. First, the decision to take up WIC is endogenous as households are not randomly assigned to the program; recipients are likely to differ from nonrecipients in unobserved ways (e.g., prior health) that are related to associated outcomes. Second, survey respondents often fail to report receiving public …

Family Structure, Work Patterns And Time Allocations: Potential Mechanisms Of Food Insecurity Among Children, Kelly Balistreri

University of Kentucky Center for Poverty Research Discussion Paper Series

Over 469 thousand households in the U.S. experienced very low food security among children, a severe condition characterized by reductions in food intake due to an inability to afford enough food. But food insecurity is not simply about economic resources. There exists a paradox in which some poor households with children are food secure while some non-poor households with children are food insecure. This study moves beyond a singular focus on income and considers how the family context may protect or generate risk of food insecurity for children. The goals of the proposed project were to: 1) to provide a …

Report To Governor’S Blue Ribbon Commission On Tax Reform By Economic Consultants, William Hoyt, William Fox, Michael T. Childress, James Saunoris

CBER Research Report

Excerpts from the executive summary:

Two basic points come from our analysis of Kentucky’s tax system: a broader tax base is needed so that revenue can keep pace with future economic growth, and changes are needed to improve Kentucky’s economic competitiveness.

Without fundamental reforms Kentucky could face a $1 billion shortfall by 2020, and could find itself at a competitive disadvantage to neighboring states for business growth, retention, and recruitment.

The options we present below can improve future revenue growth and economic competitiveness—which are evaluated with respect to other important factors, such as fairness and simplicity. The Commission should view …

Two Can Live As Cheaply As One...But Three’S A Crowd, Christopher Bollinger, Cheti Nicoletti, Stephen Pudney

University of Kentucky Center for Poverty Research Discussion Paper Series

To measure poverty, incomes must be equivalized across households with different structures. In this paper, we use a very flexible ordered response model to analyze the relationship between income, demographic structure and subjective assessments of financial wellbeing drawn from the 1991-2008 British Household Panel Survey. Our results suggest the existence of large scale economies within marital/cohabiting couples, but substantial diseconomies from the addition of children or further adults. This pattern contrasts sharply with commonly-used equivalence scales, and is consistent with explanations in terms of the capital requirements associated with additions to the core couple.

Was There A ‘Race To The Bottom’ After Welfare Reform?, Sarah K. Burns

University of Kentucky Center for Poverty Research Discussion Paper Series

Leading up to the passage of the 1996 welfare reform, there was much speculation and debate over the possibility that states would "race to the bottom" in setting welfare generosity if given more control over their individual programs. In the fifteen years after welfare reform, did such a race to the bottom ensue? Using a spatial dynamic econometric approach I investigate welfare competition across multiple policy instruments and across three distinct welfare periods - the AFDC regime, the experimental waiver period leading up to the reform, and the TANF era. Results suggest strategic policy setting occurs over multiple dimensions of …

A Profile Of Kentucky Medicaid Mental Health Diagnoses, 2000‐2010, Michael T. Childress

CBER Research Report

Good policy is dependent upon good data. This is especially true in health policy. Here we provide data on the number of Kentucky Medicaid beneficiaries who have received a mental or behavioral health diagnosis from 2000 to 2010. A Profile of Kentucky Medicaid Mental Health Diagnoses, 2000‐2010 provides information on the total number of individuals who have been diagnosed with a mental health disorder as well as a year‐by‐year count of the 15 broad categories used to classify these diagnoses. Presented for children (age 18 and younger) and adults (19 and older), these data are organized at the state, regional, …

Kentucky’S Structural Deficit, Michael T. Childress, William Hoyt

Issue Brief on Topics Affecting Kentucky’s Economy

No abstract provided.

Is Earnings Nonresponse Ignorable?, Christopher R. Bollinger, Barry T. Hirsch

University of Kentucky Center for Poverty Research Discussion Paper Series

Earnings nonresponse in the Current Population Survey is roughly 30% in the monthly surveys and 20% in the March survey. If nonresponse is ignorable, unbiased estimates can be achieved by omitting nonrespondents. Little is known about whether CPS nonresponse is ignorable. Using sample frame measures to identify selection, we find clear-cut evidence among men but limited evidence among women for negative selection into response. Wage equation slope coefficients are affected little by selection but because of intercept shifts, wages for men and to a lesser extent women are understated, as are gender gaps. Selection is least severe among household heads.

Reinventing The 21st Century Public Health Workforce: Innovation, Evaluation & Practice-Based Research, Glen P. Mays

Health Management and Policy Presentations

Compelling opportunities exist for incorporating practice-based research to into the design, implementation, and evaluation of public health workforce training and development programs. Public Health Training Centers (PHTCs) can collaborate with practice-based research networks (PBRNs) to discover and disseminate evidence-based strategies for workforce development.

The Child And Adult Care Food Program And Food Insecurity, Colleen Heflin, Irma Arteaga, Sara Gable

University of Kentucky Center for Poverty Research Discussion Paper Series

High rates of food insecurity are a significant problem in the United States. It is currently estimated that more than 48.8 million people live in food insecure households, meaning that at some time during the previous year, they were unable to acquire or were uncertain of having enough food to meet basic needs due to inadequate household resources (Coleman-Jensen, Nord, Andrews, & Carlson, 2011). Rates of food insecurity are substantially higher among those in households with incomes below the poverty line (40.2%) and in households with children headed by a single woman (35.1%). Levels of food insecurity increased across U.S. …

Childhood Income Volatility And Adult Outcomes, Bradley Hardy

University of Kentucky Center for Poverty Research Discussion Paper Series

Using data linked across generations in the Panel Study of Income Dynamics, I estimate the relationship between exposure to volatile income during childhood and a set of socioeconomic outcomes in adulthood. The empirical framework is an augmented intergenerational income mobility model that includes controls for income volatility. I measure income volatility at the family level in two ways. First, instability as measured by squared deviations around a family-specific mean, and then as percent changes of 25 percent or more. Volatility enters the model both separately and interacted with income level. I find that family income instability during childhood has a …

Antipsychotics: Broadened Use Brings Concerns, Michael T. Childress

Issue Brief on Topics Affecting Kentucky’s Economy

No abstract provided.

Adhd Medication: Wide Variation Across Kentucky Raises Questions, Michael T. Childress

Issue Brief on Topics Affecting Kentucky’s Economy

No abstract provided.

Analgesic Narcotics: Effects Beyond Pain Relief, Michael T. Childress

Issue Brief on Topics Affecting Kentucky’s Economy

No abstract provided.

Kentucky Medicaid Pharmaceutical Utilization Guide, 2000‐2010, Michael T. Childress

CBER Research Report

From the preface:

Understanding Medicaid pharmaceutical utilization in Kentucky is important: over $6.6 billion was expended in the state from 2000 to 2010 on outpatient medication; it has the potential to fundamentally transform the health and well‐being individuals, and by extension wider communities; and there is a continuing trend in the nonmedical use (and abuse) of prescription drugs, exacting a heavy toll on individuals, their families, and the wider community. The Kentucky Medicaid Pharmaceutical Utilization Guide, 2000‐2010 provides information on the 50 most utilized pharmaceuticals in Kentucky with respect to prescriptions, costs, and total grams—and presents this information for children …

Decomposing Trends In Income Volatility: The ‘Wild Ride’ At The Top And Bottom, Bradley Hardy, James P. Ziliak

University of Kentucky Center for Poverty Research Discussion Paper Series

We provide a detailed accounting of the trend increase in family income volatility in recent decades by quantifying the contributions of household head earnings, spouse earnings, non-transfer non-labor income, transfer income, and tax payments (inclusive of the refundable Earned Income Tax Credit), along with covariances among the income components. Using twoyear matched panels in the Current Population Survey from 1980 to 2009, we find that the volatility of family income, as measured by the variance of the arc percent change, doubled over the past three decades. The increase in volatility was most pronounced among the top 1% of the income …

Making The Case For Public Health: Estimating Roi And Value, Glen P. Mays

Health Management and Policy Presentations

This presentation describes recent progress and new directions for estimating the value of public health strategies and infrastructure.

Quantifying The Value Of Public Health Investments, Glen P. Mays

Health Management and Policy Presentations

This session reviews recent findings from a series of studies that estimate the health and economic effects attributable to investments in public health services and delivery systems.

Developing Service Delivery Measures For Studies Of Practice Variation: The Mprove Study, Glen P. Mays

Health Management and Policy Presentations

OBJECTIVES: A growing body of evidence indicates that the delivery of public health activities varies widely across states and communities, creating missed opportunities for prevention as well as inequities in health protection. Consequently, HHS recently used a consensus-based process to develop a framework for improving quality in public health and to identify a set of nine priority areas for improvement. As next steps in operationalizing this framework, measures of quality in public health are needed to guide public health improvement initiatives and to support research on the comparative effectiveness of alternative public health strategies. This presentation profiles the methodology developed …