Dispelling An Urban Legend: Frequent Emergency Department Users Have Substantial Burden Of Disease
Health Affairs, 32, no.12 (2013):2099-2108
Billings, John and Maria C. Raven
Urban legend has often characterized frequent emergency department (ED) patients as mentally ill substance users who are a costly drain on the health care system and who contribute to ED overcrowding because of unnecessary visits for conditions that could be treated more efficiently elsewhere. This study of Medicaid ED users in New York City shows that behavioral health conditions are responsible for a small share of ED visits by frequent users, and that ED use accounts for a small portion of these patients’ total Medicaid costs. Frequent ED users have a substantial burden of disease, and they have high rates of primary and specialty care use. They also have linkages to outpatient care that are comparable to those of other ED patients. It is possible to use predictive modeling to identify who will become a repeat ED user and thus to help target interventions. However, policy makers should view reducing frequent ED use as only one element of more-comprehensive intervention strategies for frequent health system users.
Putting a Price on the Welfare of Our Children and Grandchildren
In "The Globalization of Cost-Benefit Analysis in Environmental Policy", edited by Michael A. Livermore, and Richard L. Revesz. New York: Oxford University Press, 2013.
Maria Damon, Kristina Mohlin, and Thomas Sterner
Discount rates have a profound effect on estimates for costs and benefits that accrue over time or in the future. Given that minute differences in discount rates can result in enormous differences in future values, discounting implicates moral as well as technical issues. This chapter reviews some of the main issues that discounting presents and discusses some important recent debates over time-varying discount rates and the importance of relative prices when examining effects of public policy in the far future. The authors also collect and discuss the discount rates currently used by decision makers around the world, and explain how differences in level of development should and should not affect the discount rates used by analysts.
Access to primary care in Hong Kong, Greater London and New York City
Cambridge University Press 2013. Health Economics, Policy and Law / Volume 8 / Issue 01 / January 2013, pp 95 109, Published online
Pui Hing Chau, Jean Woo, Michael K. Gusmano, Daniel Weisz, Victor G. Rodwin and Kam Che Chan
We investigate avoidable hospital conditions (AHC) in three world cities as a way to assess access to primary care. Residents of Hong Kong are healthier than their counterparts in Greater London or New York City. In contrast to their counterparts in New York City, residents of both Greater London and Hong Kong face no financial barriers to an extensive public hospital system. We compare residence-based hospital discharge rates for AHC, by age cohorts, in these cities and find that New York City has higher rates than Hong Kong and Greater London. Hong Kong has the lowest hospital discharge rates for AHC among the population 15–64, but its rates are nearly as high as those in New York City among the population 65 and over. Our findings suggest that in contrast to Greater London, older residents in Hong Kong and New York face significant barriers in accessing primary care. In all three cities, people living in lower socioeconomic status neighborhoods are more likely to be hospitalized for an AHC, but neighborhood inequalities are greater in Hong Kong and New York than in Greater London.
Infant Antibiotic Exposures and Early-Life Body Mass
International Journal of Obesity , (21 August 2012) | doi:10.1038/ijo.2012.132
Trasande, Leonardo, Jan Blustein, Mengling Liu, Elise Corwin, Laura M Cox, Martin J Blaser
To examine the associations of antibiotic exposures during the first 2 years of life and the development of body mass over the first 7 years of life.
Longitudinal birth cohort study.
A total of 11 532 children born at 2500 g in the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based study of children born in Avon, UK in 1991–1992.
Exposures to antibiotics during three different early-life time windows (
Antibiotic exposure during the earliest time window (
Exposure to antibiotics during the first 6 months of life is associated with consistent increases in body mass from 10 to 38 months. Exposures later in infancy (6–14 months, 15–23 months) are not consistently associated with increased body mass. Although effects of early exposures are modest at the individual level, they could have substantial consequences for population health. Given the prevalence of antibiotic exposures in infants, and in light of the growing concerns about childhood obesity, further studies are needed to isolate effects and define life-course implications for body mass and cardiovascular risks.
“Introduction” and “Strengthening social protection in low income countries”
Fritzen, S. and V. Kumar [eds.] (2004), Social security in a developing world context, New Delhi: Serials Publications, pp. 1-17 and 90-108.
Can the design of community-driven development reduce the risk of elite capture? Evidence from Indonesia
World Development 35(8): 1359-1375.
Community-Driven Development (CDD) projects have motivated both large amounts of funding from international development agencies and a number of general critiques centering on the potential susceptibility of decentralized projects to local elite capture. Drawing on case analysis and surveys fielded in 250 Indonesian sub-districts, this paper subjects the design logic of a CDD project to close empirical testing. Results suggest that while CDD projects can help create spaces for a broader range of elite and non-elite community leaders to emerge, elite control of project decision-making is pervasive. However, its effects can be influenced by project-initiated accountability arrangements, such as democratic leadership selection.
What influences government adoption of new vaccines in developing countries? A policy process approach.
Social Science & Medicine 65: 1751-1764.
Munira, S.L., Fritzen, S.
This paper proposes a framework for examining the process by which
government consideration and adoption of new vaccines takes place, with specific reference to developing country settings. The cases of early hepatitis B vaccine adoption in Taiwan and Thailand are used to explore the relevance of explanatory factors identified in the literature as well as the need to go beyond a variablecentric focus by highlighting the role of policy context and process in determining the pace and extent of adoption. The cases suggest the feasibility and importance of modeling ‘causal diversity’ – the complex set of necessary and sufficient conditions leading to particular decisional outcomes – in a broad range of country contexts. A better understanding of the lenses through which government decision makers filter information, and of the arenas in which critical decisions are shaped and taken, may assist both analysts (in predicting institutionalization of new vaccines) and advocates (in crafting targeted strategies to accelerate their diffusion).
A School-Randomized Clinical Trial of an Integrated Social-Emotional Learning and Literacy Intervention: Impacts on Third-Grade Outcomes
Journal of Consulting and Clinical Psychology, 78(6): 829-842
Jones, S.M., Brown, J.L, Hoglund, W.L.G., & J.L. Aber.
Objective: To report experimental impacts of a universal, integrated school-based intervention in social–emotional learning and literacy development on change over 1 school year in 3rd-grade children's social–emotional, behavioral, and academic outcomes. Method: This study employed a school-randomized, experimental design and included 942 3rd-grade children (49% boys; 45.6% Hispanic/Latino, 41.1% Black/African American, 4.7% non-Hispanic White, and 8.6% other racial/ethnic groups, including Asian, Pacific Islander, Native American) in 18 New York City public elementary schools. Data on children's social–cognitive processes (e.g., hostile attribution biases), behavioral symptomatology (e.g., conduct problems), and literacy skills and academic achievement (e.g., reading achievement) were collected in the fall and spring of 1 school year. Results: There were main effects of the 4Rs Program after 1 year on only 2 of the 13 outcomes examined. These include children's self-reports of hostile attributional biases (Cohen's d = 0.20) and depression ( d = 0.24). As expected based on program and developmental theory, there were impacts of the intervention for those children identified by teachers at baseline with the highest levels of aggression ( d = 0.32–0.59) on 4 other outcomes: children's self-reports of aggressive fantasies, teacher reports of academic skills, reading achievement scaled scores, and children's attendance. Conclusions: This report of effects of the 4Rs intervention on individual children across domains of functioning after 1 school year represents an important first step in establishing a better understanding of what is achievable by a schoolwide intervention such as the 4Rs in its earliest stages of unfolding. The first-year impacts, combined with our knowledge of sustained and expanded effects after a second year, provide evidence that this intervention may be initiating positive developmental cascades both in the general population of students and among those at highest behavioral risk.
Growing Older in Hong Kong, New York and London
The Hong Kong Jockey Club Charities Trust. Hong Kong, 2012.
P. Chau, J. Woo, M. Gusmano, D. Weisz, and Rodwin, V.
Declining birth rates, increasing longevity and urbanization have created a new challenge for cities: how to respond to an ageing population. Although population ageing and urbanization are not new concerns for national governments around the world, the consequences of these trends for quality of life in cities has only recently started to receive attention from policy makers and researchers. Few comparative studies of world cities examine their health or long-term care systems; nor have comparisons of national systems for the provision of long-term care focused on cities, let alone world cities.
By extending the work of the CADENZA and World Cities Projects , this report investigates how three world cities -- Hong Kong, New York and London -- are coping with this challenge. These world cities are centers of finance, information, media, arts, education, specialized legal services and advanced business services, and contribute disproportionate shares of GDP to their national economies. But are these influential centers prepared to meet the challenge posed by the “revolution of longevity?” How will these world cities accommodate this revolutionary demographic change? Are they prepared to implement the health and social policy innovations that may be required to serve their residents, both old and young? Will they be able to identify the new opportunities that increased longevity may offer? Can they learn from one another as they seek to develop creative solutions to the myriad issues that arise? Finally, can other cities learn from the experience of these three cities as they confront this challenge?
To address these questions, we examine comparable data on the economic and health status of older persons, as well as the availability and use of health, social and long-term care across and within these cities. In the report “How Well Are Seniors in Hong Kong Doing? An International Comparison”, a first attempt was made to compare the situation in Hong Kong with five economically developed countries. This report extends this study by comparing the situation in Hong Kong with two other world cities—New York City and London, which are more comparable in terms of population size and economic characteristics.
Adherence to antiretroviral therapy among older children and Adolescents with HIV: A qualitative study of psychosocial contexts
AIDS Patient Care & STDs. 22: 977-987.
Merzel C., N. VanDevanter, and M. Irvine.
Abstract Survival among perinatally infected children and youth with HIV has been greatly extended since the advent of highly active antiretroviral therapies. Yet, adherence to HIV medication regimens is suboptimal and decreases as children reach adolescence. This paper reports on a qualitative study examining psychosocial factors associated with adherence among perinatally infected youth ages 10-16 years. The study was based on in-depth interviews with a sample of 30 caregivers participating in a comprehensive health care program in New York City serving families with HIV. A subsample comprising 14 caregivers of children ages 10 and above is the focus of this paper. The analysis identified a number of themes associated with the psychosocial context of managing adherence among older children. Maintaining adherence was an ongoing challenge and strategies evolved as children matured. Regimen fatigue and resistance to taking the medications were major challenges to maintaining adherence among the oldest children. In other cases, caregivers developed a kind of partnership with their child for administering the medications. Disclosure to the child of his or her HIV status was used as a strategy to promote adherence but seemed to be effective only under certain circumstances. Social support appeared to have an indirect influence on adherence, primarily by providing caregivers with temporary help when needed. Health care professionals were an important source of disclosure and adherence support for parents. The study illustrates the interplay of maturational issues with other contextual psychosocial factors as influences on adherence among older children and adolescents.
Beyond Entitlement: The Social Obligations of Citizenship
Free Press, 1986.
Mead, Lawrence M.
Government Matters: Welfare Reform in Wisconsin
Princeton University Press, 2004.
Mead, Lawrence M.
Expanding Work Programs for Poor Men
AEI Press, 2011.
Mead, Lawrence M.
At Rope’s End: Single Women Mothers, Wealth and Asset Accumulation in the United States
Mariko Chang, PhD and C. Nicole Mason, PhD
A commissioned report for the Opportunity Series of the Women of Color Policy Network, this report examines the economic security and vulnerability of single mothers through the lens of wealth and asset accumulation as opposed to income and employment.
Calorie Labeling And Food Choices: A First Look At The Effects On Low-Income People In New York City
Health Affairs (Millwood). 2009;28(6):w1110-21 (published online October 6; 10.1377/ hlthaff.28.6.w1110)
Elbel, B., Kersh, R., Brescoll, V.L. & Dixon, L.B.
We examined the influence of menu calorie labels on fast food choices in the wake of New York City's labeling mandate. Receipts and survey responses were collected from 1,156 adults at fast-food restaurants in low-income, minority New York communities. These were compared to a sample in Newark, New Jersey, a city that had not introduced menu labeling. We found that 27.7 percent who saw calorie labeling in New York said the information influenced their choices. However, we did not detect a change in calories purchased after the introduction of calorie labeling. We encourage more research on menu labeling and greater attention to evaluating and implementing other obesity-related policies.
Race, Segregation, and Physicians' Participation in Medicaid
The Milbank Quarterly Vol. 84, Iss. 2, June
Greene, J., Blustein, J. & Weitzman, B.C.
Many studies have explored the extent to which physicians’ characteristics and Medicaid program factors influence physicians’ decisions to accept Medicaid patients. In this article, we turn to patient race/ethnicity and residential segregation as potential influences. Using the 2000/2001 Community Tracking Study and other sources we show that physicians are significantly less likely to participate in Medicaid in areas where the poor are nonwhite and in areas that are racially segregated. Surprisingly—and contrary to the prevailing Medicaid participation theory—we find no link between poverty segregation and Medicaid participation when controlling for these racial factors. Accordingly, this study contributes to an accumulating body of circumstantial evidence that patient race influences physicians’ choices, which in turn may contribute to racial disparities in access to health care.
How Do Urban Communities Affect Youth? Using Social Science Research to Inform the Design and Evaluation of Comprehensive Community Initiatives
In J.P. Connell, A. Kubisch, L. Schorr, & C. Weiss (Eds.) New Approaches to Evaluating Comprehensive Community Initiatives: Concepts, Methods and Contexts, (pp. 93-125). Roundtable on Comprehensive Community Initiatives for Children and Families, The Aspen Institute.
Connell, J.P., Aber, J.L. & Walker, G.
Child Poverty in the U.S.: An Evidence-Based Conceptual Framework for Programs and Policies
In R. M. Lerner, F. Jacobs, & D. Wertlieb (Eds.) Promoting positive child, adolescent, and family development: A handbook of program and policy innovations, (pp. 81-136). Thousand Oaks, California: Sage Publications,
Gershoff, E.T., Aber, J.L. & Raver, C.C.
Introduce the concrete reality of family finances when living on the line. Describe the great variation in "supports" for low-income families & their children within & across States.
Dept. of Building, Winning the West
The New Yorker, July 5,
Whitagker, C. & Finnegan, W.
Both sides have started punching harder lately in the brawl over whether or not to build a seventy-five-thousand-seat football stadium over the Hudson rail yards on Manhattan’s far West Side. The New York Jets, who would own the place, will be taking computers from the mouths of needy schoolchildren if the state and the city are forced to provide the six hundred million dollars that would be their part of the deal—or, at least, that’s what the television ads paid for by the Dolan family, the owners of Madison Square Garden, say. Nonsense, say the Jets and their supporters, who include Mayor Bloomberg, Governor Pataki, and the construction unions. The stadium will be such a financial success that it will end up giving computers to needy schoolchildren. Opponents say that the stadium will sink New York City’s bid to host the 2012 Olympics (the International Olympic Committee does not like controversy). No, say the stadium’s backers, it is the centerpiece of the city’s Olympic hopes.
Variation in Teenage Mothers’ Experiences of Child Care and Other Components of Welfare Reform: Selection Processes and Developmental Consequences
Child Development, Volume 72, pp. 299-317,
Yoshikawa, H., Rosman, E.A. & Hsueh, J..
Developmental evaluations of the current wave of welfare reform programs present challenges with regard to (1) assessing child outcomes; (2) accounting for heterogeneity among low-income families in both baseline characteristics and involvement in self-sufficiency activities and supports, and (3) development of alternatives to experimental approaches to causal inference. This study (N = 1,079) addresses these challenges by examining effects on 4- to 6-year-old children of different patterns of child care, self-sufficiency activities, and other service utilization indicators among experimental-group mothers in a 16-site welfare reform program. Outcomes in areas of cognitive ability and behavior problems were investigated. The study identified seven subgroups of participants engaging in different patterns of service utilization and activity involvement. A two-stage simultaneous equation methodology was used to account for selection, and effects on child cognitive ability of participation in specific patterns of services and activities were found. For example, children of mothers characterized by high levels of involvement in center-based child care, education, and job training showed higher levels of cognitive ability than children of mothers in groups characterized by high involvement in center-based care and education, or center-based care and job training. In addition, children of mothers in groups with high levels of involvement in any of these activities showed higher levels of cognitive ability than those with low levels of involvement. The bulk of selection effects occurred through site-level differences, rather than family-level socio-economic status or maternal depression indicators. Implications for welfare reform program and policy concerns are discussed.