Economics Commons^™

Improving Access To Addiction Recovery Care In Central Appalachia Through Organizational Collaboration, Katy Stigers

Journal of Appalachian Health

Fahe, a Network of 50+ members throughout Appalachia based in Berea KY, has brought together a coalition to finance, build, and manage several addiction recovery care centers across Kentucky and West Virginia, increase access to employment, and deploy vouchers for supportive services.

Disparities In Quality Of Life By Appalachian-Designation Among Women With Breast Cancer, Robin C. Vanderpool, Ann L. Coker, Heather M. Bush, Sarah E. Cprek

Journal of Appalachian Health

Introduction: Few studies have examined the association of geography and quality of life (QOL) among breast cancer patients, particularly differences between Appalachian and non-Appalachian Kentucky women, which is important given the cancer and socioeconomic disparities present in Appalachia.

Purpose: The purpose of this study was to determine whether women with breast cancer residing in Appalachian Kentucky experience poorer health outcomes in regards to depression, stress, QOL, and spiritual wellbeing, relative to those living in non-Appalachian Kentucky after adjusting for demographic, socioeconomic, and health-related factors.

Methods: Women, aged 18–79, recruited from the Kentucky Cancer Registry between 2009 and 2013 with an …

Investigating The Impact Of The Diseases Of Despair In Appalachia, Michael Meit, Megan Heffernan, Erin Tanenbaum

Journal of Appalachian Health

Introduction: Appalachia is one of the regions most significantly impacted by the opioid crisis. This study investigated mortality due to diseases of despair within the Appalachian Region, with an additional focus on deaths attributable to opioid overdose.

Methods: Diseases of despair include: alcohol, prescription drug and illegal drug overdose, suicide, and alcoholic liver disease/cirrhosis of the liver. Mortality data from the National Center for Health Statistics (NCHS) National Vital Statistics System (NVSS) Multiple Cause of Death database were analyzed for this study, focusing on individuals aged 15–64.

Results: Over the past two decades, the mortality rate due to diseases of …

Root Causes Of Appalachia’S Deaths Of Despair, F. Douglas Scutchfield Md

Journal of Appalachian Health

The U.S. is experiencing a decline in life expectancy, particularly among rural white males in their most productive years. Appalachia is disproportionally represented in mortality rates, accounting for 30% of the U.S. population, but 50% of the excess mortality attributed to the “deaths of despair”: drug overdose, suicide, and alcoholic cirrhosis. A substantial proportion of that excess mortality is related to the current opioid crisis we are experiencing. We have data on evidence-based solutions to the treatment of addiction, but little information on prevention of addiction as well as the other deaths of despair, likely with the same etiologic agent. …

The Allocation And Exchange Of Property Rights As A Way To Understand Comparative Economics Systems And Managerial Economics, John Garen

Institute for the Study of Free Enterprise Working Papers

This paper discusses how economic systems can be described by the manner that property rights are allocated to individuals, to the government, or to interests groups. Property rights entail control of use of assets, claim on the net income from an asset, and transferability of the previous two. Economics systems (e.g., capitalism, socialism, cronyism) are characterized by who holds these rights, in whole or in part, and this determines the success or failure of an economy. A related analysis is applied to understanding business organization, e.g., the corporate and non-corporate form, franchising, and employee compensation methods. Each entails a (voluntary) …

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 Economic Impact Of Diabetes In Kentucky, Michael W. Clark, Jenny A. Minier, Charles J. Courtemanche, Bethany L. Paris, Michael T. Childress

CBER Research Report

Excerpt from the Executive Summary:

The Kentucky Department of Public Health is responsible for improving the health and safety of Kentucky’s residents by preventing disease and injuries and encouraging healthy lifestyles. The department administers nearly 150 programs that address critical health issues affecting Kentuckians. These programs screen newborns for health problems, prevent the spread of infectious diseases, promote oral health, and provide numerous other services.

Diabetes represents a growing health concern for the nation and Kentucky. It is a chronic condition that causes blood sugar levels to rise and contributes to other serious health conditions such as heart and kidney …

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.

Dusty Shoes: Appalachia Wisdom Fertilizing The Future Of Religious Leadership, Jill Crainshaw

Journal of Appalachian Health

Dust from their journeys through the hills and hollows of Appalachia clings to their shoes and has forever shaped their vocational journeys. This is a refrain I have distilled from the reflections of students who have participated in Wake Forest University School of Divinity’s multicultural contexts course that includes a 10-day sojourn in the mountains of North Carolina.

Identifying Priority And “Bright-Spot” Counties For Diabetes Preventive Care In Appalachia: An Exploratory Analysis, Peter J. Mallow, Michael Topmiller, Jennifer Rankin, Jene Grandmont, David Grolling, Jessica L. Mccann, Mark Carrozza

Journal of Appalachian Health

Introduction: Type 2 diabetes mellitus (T2DM) prevalence and mortality in Appalachian counties is substantially higher when compared to non-Appalachian counties, although there is significant variation within Appalachia.

Purpose: The objectives of this research were to identify low-performing (priority) and high-performing (bright spot) counties with respect to improving T2DM preventive care.

Methods: Using data from the Centers for Medicare and Medicaid (CMS), the Dartmouth Atlas of Health Care, and the Appalachia Regional Commission, conditional maps were created using county-level estimates for T2DM prevalence, mortality, and annual hemoglobin A1c (HbA1c) testing rates. Priority counties were identified using the following criteria: top 33rd …

The Social Determinants Of Health And The Decline In U.S. Life Expectancy: Implications For Appalachia, Steven H. Woolf, Heidi Schoomaker, Latoya Hill, Christine M. Orndahl

Journal of Appalachian Health

For the past century, life expectancy in industrialized countries has increased, and the U.S. has shared in that progress. However, beginning in the 1980s, advances in U.S. life expectancy began to lose pace with peer countries. By 1998, U.S. life expectancy had fallen below the average for Organisation for Economic Cooperation and Development nations. U.S. life expectancy peaked in 2014 and has been decreasing for three consecutive years, a trend not been seen since the influenza pandemic a century ago. Put simply, U.S. health is in decline.

Delivering Health Knowledge And Wisdom From The Hills And Hollows Of Appalachia, F. Douglas Scutchfield Md, Erin N. Haynes, Robert M. Shapiro Ii, Charlotte S. Seidman

Journal of Appalachian Health

There is knowledge in the pages of Appalachia’s hills. This journal is positioned to find and publish those translations. It grows from a need to provide an outlet for scholarship about Appalachia’s health so that knowledge, and occasionally wisdom, is shared with those who care about and are committed to improving the region’s health.

Kentucky Annual Economic Report 2019, Michael T. Childress, Jenny Minier, William H. Hoyt, Simon Sheather

Kentucky Annual Economic Report

This report is one of the important ways that the Center for Business and Economic Research fulfills its mission as specified in the Kentucky Revised Statutes (KRS 164.738) to examine various aspects of the Kentucky economy. The analysis and data presented here cover a variety of topics that range from an economic forecast for Kentucky in 2019 to a broad presentation of factors affecting the economy.

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 …

Social Security And Medicare Spending Growth: Is It Just More Seniors Or More Per Senior?, John Garen

Institute for the Study of Free Enterprise Working Papers

Long-term federal budget forecasts show sizable increases in federal spending in the coming decades. This is concerning to those who worry that the growth of government will diminish incentives, reduce productivity, and limit economic growth. A large share of the forecasted increase in spending is due to Social Security and Medicare. This paper considers how much of this increase is simply due to the growth in the eligible population and how much is due to growth in spending per beneficially. The findings show both the former and the latter account for sizable shares of the growth. Thus, there is room …

The Federal-Private Wage Differential: How Has It Evolved?, Sun-Ki Choi, John Garen

Institute for the Study of Free Enterprise Working Papers

Federal, state, and local budget issues in the aftermath of the Great Recession stimulated a revival of interest in government worker pay. In the paper, we study the evolution of the federal-private pay differential from 1995 to 2017 using Current Population Survey data, enabling us to examine the current pay gap and how it has changed over time. Wage regressions are estimated by year for federal and private sector workers and used to calculate the yearly federal-private wage differential. To deal with unobserved heterogeneity, we adopt control function methods. We also estimate of the probability of receiving employer-provided health insurance …

The Digital Knowledge Economy Index: Mapping Content Production, Sanna Ojanperä, Mark Graham, Matthew Zook

Geography Faculty Publications

We propose the construction of a Digital Knowledge Economy Index, quantified by way of measuring content creation and participation through digital platforms, namely the code sharing platform GitHub, the crowdsourced encyclopaedia Wikipedia, and Internet domain registrations and estimating a fifth sub-index for the World Bank Knowledge Economy Index for year 2012. This approach complements conventional data sources such as national statistics and expert surveys and helps reflect the underlying digital content creation, capacities, and skills of the population. An index that combines traditional and novel data sources can provide a more revealing view of the status of the world’s digital …

Maternal Work Hours And Childhood Obesity: Evidence Using Instrumental Variables Related To Sibling School Eligibility, Charles J. Courtemanche, Rusty Tchernis, Xilin Zhou

Economics Faculty Publications

This study exploits plausibly exogenous variation derived from the youngest sibling’s school eligibility to estimate the effects of maternal work on the weight outcomes of older children. We first show that mothers’ work hours increase gradually along both the extensive and intensive margins as the age of the youngest child rises, whereas mothers’ spouses’ work hours do not appear to be responsive. We develop an instrumental-variables model that shows that mothers’ work hours lead to larger increases in children’s body mass index z-scores and probabilities of being overweight/obese than those identified in previous studies. Subsample analyses find that the …

Investment In Human Capital And Labor Mobility: Evidence From A Shock To Property Rights, Christopher P. Clifford, William C. Gerken

Institute for the Study of Free Enterprise Working Papers

We show that the assignment of property rights to client relationships affects employee behavior in the industry for financial advice. Our identification comes from staggered firm-level entry into the Protocol for Broker Recruiting. The protocol effectively transfers the ownership of the client relationship from the firm to the employee. We document that entering into the protocol increases employee labor mobility among member firms. Further, we find that upon protocol inclusion, employees are less likely to generate customer complaints and more likely to invest in their own general human capital, but less likely to invest in firm-specific human capital. We use …

Two Essays In Fertilizer Management For Improved Profitability, Shelby Dawn Wade

Theses and Dissertations--Agricultural Economics

Corn production in the United States has become increasingly efficient over the years. The use of nitrogen fertilizers has played a substantial role in this efficiency. Nitrogen drives biomass production which leads to increased yields. Unlike other nutrients, nitrogen is more mobile making it easier to lose through leaching and volatilization. The first part of this analysis uses an econometric model to examine the relationship between nitrogen usage and weather data. This relationship leads to farm management decisions to reduce nitrogen fertilization expenses. In addition to the use of nitrogen fertilizers, farmers in Kentucky take advantage of an abundance of …

Reducing Survey Hypothetical Bias Through Revealed Behavior Priming: A Case Of Student Preference For Beef Served By University Dining, Gaby De Nascimento Mandlhate

Theses and Dissertations--Agricultural Economics

Economists are still searching for methods to reduce/eliminate Hypothetical Bias (HB). Different methods have been previously applied some with success and others without. In this study, we aimed to further test the cognitive dissonance approach (CD) through a learning design method to estimate the WTP for five beef attributes: Non-quality, Kentucky Proud, Appalachian, Grass Fed and a mix of 25% Non-quality and 75% Kentucky Proud, using a one and one half bounded model. To test the CD, 881 participants from the University of Kentucky, were randomly assigned to a real/hypothetical market for a battery recycling project at first and afterwards …

Economic Impact Of Ethanol Biorefineries In The U.S. Midwest From 2001 To 2015: A Quasi-Experimental Approach, Scott W. Hall

Theses and Dissertations--Agricultural Economics

The objective of this dissertation is to analyze the economic impact of newly operational ethanol biorefineries on rural counties in the U.S. Midwest region for the period 2001 to 2015 using a quasi-experimental approach. Rapid growth in the ethanol industry expanded the number of ethanol plants located in the U.S. Midwest from 54 in 2001 to 173 in 2015. Out of the counties with 119 new ethanol biorefineries, 97 counties met the general treatment criteria defined in this dissertation, but only 56 of those counties qualified for the rural treatment criteria. Counties with ethanol biorefineries that qualified for treatment were …

Effects Of Shifts In The Local Tax Base On Economic Outlook, Shelby Buckman

Posters-at-the-Capitol Presentations

In Kentucky, local governments can impose taxes on property and income. Tax options and maximum rates are limited by the classification of the city, which is loosely based on population size. In the summer of 2017, the City of Henderson, Kentucky’s City Council passed an ordinance that lowered real estate tax rates and raised the occupational payroll tax rates. This shift is forecasted to be net neutral for city revenue, which raised the question of how changes in the local tax burden affect a Kentucky city’s long run economic outlook.

In a theoretical model, the businesses and population would move …

Can Credit Rating Agencies Affect Election Outcomes?, Igor Cunha, Miguel A. Ferreira, Rui C. Silva

Institute for the Study of Free Enterprise Working Papers

We show that credit rating agencies can have a significant effect on election outcomes. We identify these effects by exploiting exogenous variation in municipal bond ratings due to Moody’s recalibration of its scale in 2010. We find that incumbent politicians in upgraded municipalities experience an increase in their likelihood of reelection and their vote shares. These rating upgrades improve voters’ opinions about the incumbent and produce positive wealth effects through voters’ holdings of local municipal bonds. In addition, rating upgrades cause an expansion of local governments’ debt capacity that allows the incumbent to increase spending and improve local economic conditions.

Ambulance Service Ownership And Management: How It Affects Quality Of Service Delivery For Medicare Patients, Sookti Chaudhary, Kenneth R. Troske, Suzanne Troske, Alison Davis

Institute for the Study of Free Enterprise Working Papers

This study investigates how ownership and/or management affects ambulance services across the United States. We investigate whether ambulance quality, measured by patient transportation time, varies by organization type. We estimate the effect of ownership structure on response time variables using data from the National EMS Information System (NEMSIS) for the years 2010–2015, the most comprehensive data set on emergency medical services. Focusing on ground transportation (as opposed to air and water transportation) and on Medicare-eligible (age 65 years and older) patients, we find that, on average, ambulance services owned by fire departments respond faster than those managed by other types …

Effects Of Agricultural Loans In Developing Countries – Benin Case Study, Nicaise S. M. Sagbo

Theses and Dissertations--Agricultural Economics

Limited access to financial services is known as a major constraint to agricultural development (FAO, 2002). Farmers need liquidity to face agricultural expenses throughout the production cycle but mainly at the beginning. Mainstream financial institutions are reluctant to serve the agricultural sector for several reasons. First, they consider the sector to be highly risky with low performance. Also, agricultural activities depend on the weather, they take place in remote rural areas, and commodities prices are volatile. All these aspects make it hard for standard banks to reach their profit goals when lending to farmers. Since microfinance was conceived, it has …

Utilizing Large Scale Datasets To Evaluate Aspects Of A Sustainable Bioeconomy, Gwanseon Kim

Theses and Dissertations--Agricultural Economics

This dissertation combines large scale datasets to evaluate crop prediction, land values, and consumption of a crop being considered to advance a sustainable bioeconomy. In chapter 2, we propose a novel application of the multinomial logit (MNL) model to estimate the conditional transition probabilities of crop choice for the state of Kentucky. Utilizing the recovered transition probabilities the forecast distributions of total acreages for alfalfa, corn, soybeans, tobacco, and wheat produced in the state from 2010 to 2015 can be recovered. The Cropland Data Layer is merged with the Common Land Unit dataset to allow for the identification of crop …

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 …

Essays On Price Discrimination And Demand Learning, Benjamin E. Wallace

Theses and Dissertations--Economics

This dissertation consists of three essays examining how and why firms set prices in markets. In particular, this dissertation shows how firms may utilize nonlinear pricing to price discriminate, how firms may experiment with the prices they set to learn about the demand function in the market they serve in later periods and the effects of these pricing strategies on consumer welfare.

In Essay 1, I show how firms in the milk market use nonlinear price schedules -- quantity discounts -- to price discriminate and increase profits. I find that firms have a greater ability to price discriminate on their …

Price Discrimination On Complementary Goods: Evidence From The Men's Shaving Razor Market, Zheng Yang

Theses and Dissertations--Economics

This dissertation analyzes the men's razor market to examine whether a monopolist can implement price discrimination for the complementary goods. I estimate a demand system for razors using the random coefficient logit model with market level sales data from the Nielsen Store Scanner dataset and individual demographic data from the March CPS. The estimated parameters are used to construct price-cost markups. By comparing the markups of different products, I find evidence that Gillette uses a two-part tariff strategy. This conclusion can be generalized as that of a monopolist setting the prices of tie-in products consistent with a two-part tariff.