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.

Development And Pilot-Testing Of A Patient Decision Aid For Left Ventricular Assist Device Placement, Kristin Kostick, Estevan D. Delgado, Lidija A. Wilhelms, Courtenay R. Bruce, Jerry D. Estep, Matthias Loebe, Charles Minard, Jennifer S. Blumenthal-Barby

The VAD Journal

Objectives: This paper describes the development methodology and pilot-testing of a decision aid for Left Ventricular Assist Device (LVAD) placement, combining traditional needs-assessment with a novel user-centered approach.

Background: Studies indicate suboptimal patient understanding of the capabilities, lifestyle implications, and risks of LVAD therapy.

Methods and Results: We developed the decision aid in line with the Ottawa Decision Support Framework (ODSF) and the International Patient Decision Aids Standards (IPDAS) for ensuring quality, patient-centered content. Structured interviews were conducted with patients, caregivers, candidates for LVAD treatment, and expert clinicians (n=71) to generate content based on patient values and …

Farmed And Wild-Caught Shrimp In Kentucky And South Carolina: Consumer Preference For Homegrown By Heroes, Community Supported Fishery, And Other Quality Attributes, Graham T. Soley

Theses and Dissertations--Agricultural Economics

As information regarding origin, production method, and environmental certifications characterize a progressing seafood market, scare analysis has been made to understand market responses. This study focuses on consumer preference for wild-caught and farm-raised shrimp with several attributes. These include the Homegrown By Heroes label and Best Aquaculture Practices certification, as well as other existing attributes including the Marine Stewardship Council and each state’s local label. Also considered are hypothetical labels including Community Supported Fishery (CSF) and National Oceanic & Atmospheric Administration (NOAA). This study surveys consumers in Kentucky and South Carolina while utilizing a choice experiment to elicit willingness-to-pay measures …

Financial Implications Of The Medicaid Expansion For Academic Medical Centers, Madeleine Oritt

MPA/MPP/MPFM Capstone Projects

On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (ACA), with the goal of reforming the United States health care system and providing insurance for millions of uninsured citizens and residents. One component of the legislation was the expansion of Medicaid eligibility, which would extend to include all individuals “under age 65 whose family income is at or below 138 percent of the federal poverty guidelines ($14,484 for an individual and $29,726 for a family of four in 2011)” (NCSL, 2015). This provision was challenged in the United States Supreme Court, which ruled …

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.

Is There A Trade-Off? Infant Health Outcomes And Managed Care Competition, Shana L. Moore

Theses and Dissertations--Public Policy and Administration

This study offers insights into the impact of competition among Managed Care organizations (MCOs) on infant birthing charges and birth outcomes. Kentucky provides one of the nation’s first case studies to determine successes and failures of Medicaid MCOs, and by doing so, provides a prediction of the impact of Patient Protection Affordable Care Act (PPACA) competition on healthcare costs and birth outcomes. An analysis of a natural policy experiment in the state of Kentucky reveals that infants insured by a Medicaid MCO stay longer in hospitals, are less healthy, and cost more than those insured under Traditional Medicaid prior to …

The Impact Of Cash Transfers On Labor Force Participation And Household Consumption: Evidence From Post-Apartheid South Africa, Steve M. M. Muchiri

Theses and Dissertations--Economics

The Old Age Pension (OAP) program for elderly South Africans puts a significant cash transfer in the hands of many poor households. This dissertation investigates its impact on labor force participation and consumption of selected household items. In the first half of the dissertation, we take advantage of a policy reform that lowered men's OAP eligibility age from 65 to 60 for men to match that of women for estimation identification. Using the General Household Survey data, we first demonstrate that both men and women respond to the eligibility age by dropping from labor force participation at the eligibility age, …

Coffee In China: Market Trend And Consumer Demand, Jesse W. Mattingly

Theses and Dissertations--Agricultural Economics

Although it remains a tea consuming nation, both production and consumption of coffee in China has been increasing at double-digit rates and is not expected to slow down (International Coffee Organization (ICO), 2015). With investments and upward trends in production and rapid increases in consumption of coffee in China it is important for producers and retailers of the bean¹ in China to understand the new Chinese coffee consumer. Using survey data from Wuhan, China we help understand the Chinese coffee consumer by explaining their consumption using standard OLS regression. Results show that whether or not consumers make/brew their own …

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.

Vocational Rehabilitation Outcomes For Hispanic Consumers In Traditional Settlement Areas And New Immigrant Destinations: A 17-Year Trend Analysis, Karen E. Waddle Cinnamond

Theses and Dissertations--Social Work

At the end of the 20^th century, economic and political forces converged to create an unprecedented migration of Hispanics across and within U.S. borders. Many migrated for work in new destinations like the Southeast instead of traditional regions in the Southwest. In the Southeast many communities struggled to meet the economic and social needs of its newest members of a population that grew seemingly overnight.

The state-federal vocational rehabilitation system is an important service to meet the economic and social needs of people with disabilities that impair their ability to work. Current scholarship suggests Hispanics and other minorities experience …

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.

Income And Physical Activity Choices: A Comparison Between United States And China, Xiaowen Hu

Theses and Dissertations--Agricultural Economics

The low income population often appears to make poor health choices, including physical activity deficiency. Since outdoor physical activity does not have to be monetarily costly, one explanation for this phenomenon is related to the idea of time preference. Briefly, the benefit of future good health appears to be valued less by those with low income, and they face a choice between consumption today and better health in the future. The objective of this study is to further investigate the determinants of participation in physical activity with an emphasis on the effect of annual household income. This dissertation consists of …

Three Essays On Unemployment Insurance In The 21St Century, Lewis H. Warren

Theses and Dissertations--Economics

My dissertation consists of three essays focusing on unemployment insurance (UI) and how it affects recipients. The first essay examines how UI generosity affects the search intensity of recipients through matching American Time Use Survey respondents to all of their observations in the Current Population Survey (CPS), the population from which they are drawn. Earnings from the CPS are then run through a benefit calculator that determines eligibility and benefit amounts which are used to determine how UI generosity affects search times. The second essay uses the Survey of Income and Program Participation to examine how lesser known policies affecting …