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Article Reference Troff document (with manpage macros)The COVID-19 epidemic in rural U.S. counties
Having first reached epidemic proportions in coastal metropolitan areas, COVID-19 has spread 4 around the country. Reported case rates vary across counties from zero to 125 per thousand 5 population (around a state prison in the rural county of Trousdale, Tennessee). Overall, rural 6 counties are underrepresented relative to their share of the population, but a growing proportion 7 of all daily cases and deaths have been reported in rural counties. This analysis uses daily 8 reports for all counties to present the trends and distribution of COVID-19 cases and deaths in 9 rural counties, from late March to May 16, 2020. I describe the relationship between population 10 density and case rates in rural and non-rural counties. Then I focus on noteworthy outbreaks 11 linked to prisons, meat and poultry plants, and nursing homes, many of which are linked to 12 high concentrations of Hispanic, American Indian, and Black populations. The growing 13 epidemic in rural counties is apparently driven by outbreaks concentrated in these institutional 14 settings, which are conducive to transmission. The impact of the epidemic in rural areas may 15 be heightened due to their weaker health infrastructure and more vulnerable populations, 16 especially due to age, socioeconomic status, and health conditions. As a result, the epidemic 17 may contribute to the ongoing decline of health, economic, and social conditions in rural areas.
Located in MPRC People / Philip Cohen, Ph.D. / Philip Cohen Publications
The Effects of Changes in Medicaid Physician Fees on the Use of Preventative Care
Faculty Associate Karoline Mortensen to model effects of Affordable Care Act on Medicaid enrollees
Located in Research / Selected Research
Misc Reference Troff document (with manpage macros)The Effects of Non-Contributory Pensions on Material and Subjective Well Being
Public expenditures on non-contributory pensions are equivalent to at least 1 percent of GDP in several countries in Latin America and is expected to increase. We explore the effect of noncontributory pensions on the well-being of the beneficiary population by studying the Pension 65 program in Peru, which uses a poverty eligibility threshold. We find that the program reduced the average score of beneficiaries on the Geriatric Depression Scale by nine percent and reduced the proportion of older adults doing paid work by four percentage points. Moreover, households with a beneficiary increased their level of consumption by 40 percent. All these effects are consistent with the findings of Galiani, Gertler and Bando (2016) in their study on a non-contributory pension scheme in Mexico. Thus, we conclude that the effects of non-contributory pensions on well-being in rural Mexico can be largely generalized to Peru
Located in MPRC People / Sebastian Galiani, Ph.D. / Sebastian Galiani Publications
Article Reference Troff document (with manpage macros)The Effects of the Affordable Care Act on Health Care Access and Utilization Among Asian American Subgroups
Objectives:  We examined changes in  health care access  and utilization associated with the Patient Protection and  Affordable Care Act  (ACA) for different Asian American subgroups relative to non-Latino whites (whites). Research Design:  Using 2003–2017 California Health Interview Survey data, we examined changes in 4  health care access  measures and 2 utilization measures among whites and 7 Asian American subgroups. We estimated the unadjusted and adjusted percentage point changes on the absolute scale from the pre-ACA to post-ACA periods. Adjusted estimates were obtained from multivariable logistic regression models that controlled for predisposing, enabling, and need factors. We also estimated the pre-ACA to post-ACA changes between whites and Asian American subgroups using a difference-in-difference approach. Results:  After the ACA was implemented, uninsurance decreased among all Asian American subgroups, but improvements in disparities relative to whites in these measures were limited. In particular, Koreans had the largest absolute reduction in uninsurance (−16.8 percentage points) and were the only subgroup with a significant reduction in terms of disparities relative to whites (−10.1 percentage points). However, little or no improvement was observed in the other 3 access measures (having a usual source of care, delayed medical care in past year, or delayed prescription drug use in past year) and 2 utilization measures (having a physician visit or emergency department visit in past year). Conclusions:  Despite coverage gains among Asian American subgroups, especially Koreans, disparities in access and utilization persisted across all Asian American subgroups.
Located in MPRC People / Jie Chen, Ph.D. / Jie Chen Publications
Article ReferenceThe Eighteen of 1918–1919: Black Nurses and the Great Flu Pandemic in the United States
This article examines the role of Black American nurses during the 1918–1919 influenza pandemic and the aftermath of World War I. The pandemic caused at least 50 million deaths worldwide and 675 000 in the United States. It occurred during a period of pervasive segregation and racial violence, in which Black Americans were routinely denied access to health, educational, and political institutions. We discuss how an unsuccessful campaign by Black leaders for admission of Black nurses to the Red Cross, the Army Nurse Corps, and the Navy Nurse Corps during World War I eventually created opportunities for 18 Black nurses to serve in the army during the pandemic and the war’s aftermath. Analyzing archival sources, news reports, and published materials, we examine these events in the context of nursing and early civil rights history. This analysis demonstrates that the pandemic incrementally advanced civil rights in the Army Nurse Corps and Red Cross, while providing ephemeral opportunities for Black nurses overall. This case study reframes the response to epidemics and other public health emergencies as potential opportunities to advance health equity. In 1918, Aileen Cole and Clara Rollins ached to become Red Cross war nurses. 1  Cole, aged 24 years, had recently passed her registration exams, and Rollins, 34, had years of nursing experience. 2  The two boarded with other nurses in a Washington, DC, brick row house near Freedmen’s Hospital, where they had all graduated from the rigorous nurse training school. The Red Cross had enrolled Cole and Rollins on paper, but had done nothing else: the US Army and Navy, for which the Red Cross served as the official recruiter, did not accept Black nurses. 3 In October, the influenza pandemic brought change. The Red Cross called up Cole, Rollins, and several other Black nurses for civilian duty, and sent them to West Virginia to battle pandemic influenza. 4  This 1918–1919 pandemic was responsible for at least 50 million deaths worldwide and 675 000 in the United States. 5  It also created opportunities for previously excluded Black nurses, including the first 18 to serve in the Army Nurse Corps (ANC) between December 1918 and August 1919. 6 Although Black nurses’ roles in World War I and the pandemic have been noted by numerous historians, this article represents the first effort to move these nurses from periphery to center, and to critically analyze their struggle to serve as a seminal episode in the long and ongoing movement for civil rights and racial health equity. 7  Using archival materials, news reports, census records, and published literature, we highlight how Black nurses fulfilled a critical need for skilled care during the pandemic and the war’s aftermath, but received little recognition. We also show how nurses and Black community leaders viewed this service as a political act. We present this story as a historical case study of nursing and racism in a public health emergency, while raising transhistorical questions: Do public health emergencies spur advancements in health equity? Or do they merely allow exploitation of already-marginalized persons? Although a single case study cannot offer definitive answers, it can provide valuable insights.
Located in Retired Persons / Marian Moser Jones, Ph.D. / Marion Moser Jones Publications
The Healthy Generations Program: Improving Access to Mental Health Care
New model of integrated service delivery makes mental health services more accessible to teenaged parents
Located in Research / Selected Research
Article Reference Troff document (with manpage macros)The Impact of Community Size, Community Climate, and Victimization on the Physical and Mental Health of SGM Youth
Sexual and gender minority (SGM) youth experience high rates of victimization leading to health disparities. Community size and community climate are associated with health outcomes among SGM youth; however, we lack studies that include them as covariates alongside victimization to understand their collective impact on health. This study utilized minority stress theory to understand how community context shapes experiences of victimization and health among SGM youth. SGM youth in one Midwestern U.S. state completed an online survey ( n = 201) with measures of physical health, mental health, community context, and victimization. Data were analyzed via multiple regression using a path analysis framework. Results indicate that perceived climate was associated with mental, but not physical, health; Community size was unrelated to health outcomes. Victimization mediated the association between community climate and mental health. Findings are discussed in light of current literature and implications for research and practice are shared.
Located in MPRC People / Jessica N Fish, Ph.D. / Jessica N Fish Publications
Article ReferenceThe Impact of Community Size, Community Climate, and Victimization on the Physical and Mental Health of SGM Youth
Sexual and gender minority (SGM) youth experience high rates of victimization leading to health disparities. Community size and community climate are associated with health outcomes among SGM youth; however, we lack studies that include them as covariates alongside victimization to understand their collective impact on health. This study utilized minority stress theory to understand how community context shapes experiences of victimization and health among SGM youth. SGM youth in one Midwestern U.S. state completed an online survey ( n  = 201) with measures of physical health, mental health, community context, and victimization. Data were analyzed via multiple regression using a path analysis framework. Results indicate that perceived climate was associated with mental, but not physical, health; Community size was unrelated to health outcomes. Victimization mediated the association between community climate and mental health. Findings are discussed in light of current literature and implications for research and practice are shared.
Located in MPRC People / Jessica N Fish, Ph.D. / Jessica N Fish Publications
Incollection Reference Troff document (with manpage macros)The Informative Role of Advertising and Experience in Dynamic Brand Choice: an Application to the Ready-to-Eat Cereal Market
We study how consumers make brand choices when they have limited information. In a market of experience goods with frequent product entry and exit, consumers face two types of information problems: first, they have limited information about a product’s existence; second, even if they know a product exists, they do not have full information about its quality until they purchase and consume it. In this chapter, we incorporate purchase experience and brand advertising as two sources of information and examine how consumers use them in a dynamic process. The model is estimated using the Nielsen Homescan data in Los Angeles, which consist of grocery shopping history for 1,402 households over 6 years. Taking ready-to-eat cereal as an example, we find that consumers learn about new products quickly and form strong habits. More specifically, advertising has a significant effect in informing consumers of a product’s existence and signaling product quality. However, advertising’s prestige effect is not significant. We also find that incorporating limited information about a product’s existence leads to larger estimates of the price elasticity. Based on the structural estimates, we simulate consumer choices under three counterfactual experiments to evaluate brand marketing strategies and a policy on banning children-oriented cereal advertising. Simulation suggests that the advertising ban encourages consumers to consume less sugar and more fiber, but their expenditures are also higher because they switch to family and adult brands, which are more expensive.
Located in MPRC People / Ginger Zhe Jin, Ph.D. / Ginger Zhe Jin Publications
Article Reference Troff document (with manpage macros)The Interrelationship between Race, Social Norms, and Dietary Behaviors among College-attending Women
Objective:  The association between social norms and dietary behaviors is well-documented, but few studies examine the role of race. The aim of this study was to determine the interrelationships among race, social norms, and dietary behaviors.  Methods:  We used data from the Healthy Friends Network Study (a pilot study of women attending a southern university). Dietary behaviors, social norms, and self-identified race were obtained.  Results:  African Americans had lower odds of daily vegetable (OR = 0.55, 95% CI = 0.38-0.79) and fruit consumption (OR = 0.45, 95% CI = 0.30-0.67), but no race difference in frequent consumption of fatty/fried/salty/sugary foods was observed in fully adjusted models. Proximal descriptive norms were associated with all dietary behaviors, but distal injunctive social norms were associated with lower odds of frequent unhealthy food consumption (OR = 0.10, 95% CI = 0.05-0.21). Race differences in family descriptive norms were found to mediate race differences in vegetable and fruit consumption by 7%-9%. However, race differences in friend and family injunctive norms mediated 20%-50% of the effects of race on frequent unhealthy food consumption.  Conclusions:  Proximal injunctive norms account for race differences in unhealthy food consumption. Future studies should further explicate the mechanisms and seek to utilize social norms in behavior change interventions.
Located in Retired Persons / Caryn Bell, Ph.D. / Caryn Bell Publications