Demographic Disparities in the Efficacy of a Family-based Treatment Program for Pediatric Obesity

Background: Family-based behavioral weight loss treatment (FBT) is an evidence-based intervention for pediatric overweight/obesity (OV/OB), but little research has examined the relative efficacy of FBT across socioeconomic status (SES), and racial groups. Method: 172 youth (7-11 y; 61.6% female; 70.1% White, 15.7% Black; child percent OV=64.2±25.2; SES=44.0±10.2; 14.5% low-income) completed 4 months of FBT and 8 months of additional intervention (either weight-control or education control). Parents reported family income, social status (Barratt Simplified Measure of Social Status), and child race at baseline. Income was dichotomized with low-income defined as family income less than 50% of the area median family income. Treatment efficacy was assessed by change in child % OV (BMI % above median BMI for age and sex), which was objectively measured at baseline, at 4-months, and at 12-months. Latent change score models examined differences in change in child % OV between 0-4 months and 4-12 months for income, social status, and race (White, Black and Other). Results: All groups achieved and maintained clinically significant weight loss (at least 9 unit decrease from baseline) at 4-months and 12-months. However, Black children had significantly less weight loss (3.3 [SE=1.5] fewer units) compared to White children at 4-months. Marginal effects were detected for children of other races compared to White children and for low-income children compared to higher-income children at 4-months. Social status was not associated with differences in child % OV reductions. No differences were detected between 4 and 12-months. Conclusions: Findings suggest that FBT is effective at producing child weight loss across different SES and racial groups, but more work is needed to understand observed differences in efficacy and optimize treatment across all groups

The State of State EITCs: An Overview and Their Implications for Low- and Moderate-Income Households

The success of the federal Earned Income Tax Credit (EITC) has prompted numerous states to develop and administer their own EITC programs. This brief presents the results of analyses that used data from a large sample of low- and moderate-income households to learn more about the relationship between state and federal EITCs as well as about their relationships, respective and combined, with financial behaviors and the experience of financial and material hardship. Given that many EITC beneficiaries face substantial risk of experiencing income volatility and financial shocks, insights gained from this brief can assist policymakers in understanding the importance of expanded EITCs and promoting emergency saving at tax time

Promoting Savings at Tax Time: Insights from Online and In-Person Tax Preparation Services

This report presents findings and insights from Refund to Savings: Applications for myRA, a collaborative project involving the U.S. Department of the Treasury, Washington University in St. Louis, and Intuit, Inc. The project explored methods of promoting the myRA (My Retirement Account) savings program at tax time—that is, when households file their taxes. It focused specifically on opportunities in an online tax-filing setting and in person at Volunteer Income Tax Assistance (VITA) sites. The first component of the project examined the retirement needs of low- and moderate-income (LMI) tax filers through a large, national, online survey. It also assessed the appeal of different messaging strategies with these filers. The project’s second component tested promotional messaging strategies as well as interventions grounded in behavioral economics. Both were delivered via online tax-filing software. The final component used key informant interviews with VITA site directors, staff, volunteers, and taxpayers to explore barriers to and opportunities for the promotion of myRA at VITA sites. In 2017, the U.S. Department of the Treasury announced that the myRA program would be discontinued, but this report identifies several findings with applications for general tax-time savings promotion. In particular, the key findings provide useful insights around messaging and in-person savings promotion at VITA sites. The results may also inform the development of future retirement products or programs. This study clearly shows that the need for retirement savings is great among LMI households. Despite barriers, tax time continues to present an opportunity for the promotion of both retirement savings and savings in general

A Toolkit for Expanding Financial Capability at Tax Time

This work expands upon The Volunteer Income Tax Preparer’s Toolkit: Showing Clients Why Tax Time is the Right Time to Save, a 2015 Toolkit by the Center for Social Development. This new offering presents the current evidence underpinning various tax-time efforts to expand financial capability among low- and moderate-income households. It includes sections on creating a VITA program and on several financial-capability products and services that organizations can offer alongside free tax-preparation services. The evidence comes from a variety of sources, but we highlight findings from research conducted by CSD, particularly that conducted as part of the Refund to Savings (R2S) Initiative. We created this Toolkit for anyone who is interested in or is in the process of designing a tax-time financial capability program. Our hope is that this Toolkit will also serve as a useful guide for other supporters of tax-time financial capability efforts—funders, advocates, policymakers, and community members—who want to understand the evidence behind related initiatives

Refund to Savings 2015-2016: Field Experiments to Promote Tax-Time Saving in Low- and Moderate-Income Households

This report covers the design and impacts of the R2S experiments in the 2015 and 2016 tax seasons (which include the 2014 and 2015 tax years), and also includes results from a 6-month follow-up survey conducted in 2015 to assess how the impacts of R2S interventions persist over time. These interventions reached a large number of tax filers in both of these years; 646,116 in 2015 and 284,125 in 2016

Home Delinquency Rates Are Lower Among ACA Marketplace Households: Evidence From a Natural Experiment

This brief uses administrative income tax data coupled with survey responses from roughly 5,000 households living near the poverty line to estimate how access to the Affordable Care Act’s health insurance Marketplaces have affected households’ experiences of extreme illiquidity, which is measured by delinquencies on home payments. To estimate this relationship, we exploit a natural experiment underway in states that did not expand Medicaid and created by the eligibility rules for Marketplace subsidies. Results suggest that insured households living near the poverty line are better able to make timely rent and mortgage payments compared with similar, uninsured households. Given housing instability’s well-documented links with downstream financial and developmental outcomes, findings presented in this brief suggest that the Affordable Care Act’s health insurance programs have improved the short-term financial well-being of low- and moderate-income households in a way that may have longer term implications

Assessing Retirement Needs and Interest in myRa: Findings From the Refund to Savings Initiative

As part of the U.S. Department of the Treasury’s ongoing effort to promote the myRA starter retirement account, we used the Refund to Savings Initiative’s Household Financial Survey to assess low- to moderate-income tax filers’ retirement needs, attitudes towards retirement, and interest in a myRA-type account. We also tested different messaging approaches for promoting myRA. The report found that 32% of survey respondents did not own a retirement account and that lack of money and lack of access to an employer-based account were major impediments to retirement account ownership. The report also found that only 10% to 15% of respondents felt on track to retire comfortably. Several aspects of myRA appealed to respondents including the absence of a minimum balance and the absence of penalties for early withdrawal. Additionally, a simple, direct, informational approach to promotional messaging proved more effective than personal messaging at driving interest in myRA

A survey of the teaching of English as a second language in Nova Scotia, April 1983 - March 1984

[7], 83 leaves : ill. ; 29 cm.Bibliography: leaves 60-66.The purpose of this study was to examine and describe programs for the teaching of English as a Second Language (ESL) in Nova Scotia as they existed in the period April 1983 to March 1984. Answers were sought to the following questions: 1. Where are ESL programs found and who administers them? 2. Who are the students in ESL programs as defined by age and native language? 3. When are classes taught? 4. What books and teaching materials are used in ESL programs? How and by whom are they chosen? 5. What qualifications are required of ESL teachers? 6. What ESL teacher-training facilities exist in Nova Scotia? 7. What are the characteristics (goals, entrance requirements, program requirements, teaching methods recommended) of ESL teacher training facilities? To obtain this information, three questionnaires were constructed: one for elementary and secondary ESL programs, one for adult ESL programs and one for ESL teacher training programs. These questionnaires were sent to the superintendents of all provincial school boards, the principals of all regional vocational schools, the directors of provincial continuing education programs, federally funded programs, university programs and teacher-training programs. The percentage returns for the three questionnaires were 71.8 per cent for elementary and secondary programs, 72.5 per cent for adult programs and 85.7 per cent for teacher-training programs. Some of the more important findings from the survey are: 1. There were approximately 200 students of school age and 420 adults enrolled in ESL classes. 2. There were large numbers of non-English speaking adults in Nova Scotia who were not enrolled in ESL classes, the majority of these adults being French-speaking Canadians. 3. ESL programs existed throughout the province. 4. Textbooks were primarily chosen from American and British sources. 5. In most ESL programs, the only qualification required of teachers was fluency in English. Those hired to teach children were required to have a teaching certificate. 6. There is only one one-credit university course in Teaching English as a Second Language (TESL) offered in Nova Scotia

Relative food insecurity, mental health and wellbeing in 160 countries

Food insecurity contributes to various stress-related health problems and previous research found that its association with mental illness is stronger in more affluent countries. We hypothesised that this pattern is a function of relative deprivation whereby the severity of individual food insecurity relative to others in a reference group determines its associations with mental health and wellbeing after differences in absolute food insecurity are controlled for. Using survey data from the Gallup World Poll collected in 160 countries and a measure of relative deprivation (Yitzhaki index), we found that relative food insecurity-based on national or regional reference groups-related to more mental health symptoms, lower positive wellbeing and lower life satisfaction after controlling for absolute food insecurity, household income, and country differences. Our analysis also found that relative food insecurity was more strongly related to mental health and wellbeing where the prevalence of food insecurity was lower. The findings underscore the negative health consequences of material deprivation and unfavourable social comparisons. Consistent with relative deprivation theory, individuals who live with constant worries about not getting enough food, have to skip meals, or face chronic hunger are deprived of material and social resources that support mental health and wellbeing, especially in settings where food insecurity is less common and potentially more stigmatised. The implications of these findings for global food policy and surveillance efforts are discussed

Dignity and Distress towards the End of Life across Four Non-Cancer Populations.

OBJECTIVE:The purpose of this study was to identify four non-cancer populations that might benefit from a palliative approach; and describe and compare the prevalence and patterns of dignity related distress across these diverse clinical populations. DESIGN:A prospective, multi-site approach was used. SETTING:Outpatient clinics, inpatient facilities or personal care homes, located in Winnipeg, Manitoba and Edmonton, Alberta, Canada. PARTICIPANTS:Patients with advanced Amyotrophic Lateral Sclerosis (ALS), Chronic Obstructive Pulmonary Disease (COPD), End Stage Renal Disease (ESRD); and the institutionalized alert frail elderly. MAIN OUTCOME MEASURE:In addition to standardized measures of physical, psychological and spiritual aspects of patient experience, the Patient Dignity Inventory (PDI). RESULTS:Between February 2009 and December 2012, 404 participants were recruited (ALS, 101; COPD, 100; ESRD, 101; and frail elderly, 102). Depending on group designation, 35% to 58% died within one year of taking part in the study. While moderate to severe loss of sense of dignity did not differ significantly across the four study populations (4-11%), the number of PDI items reported as problematic was significantly different i.e. ALS 6.2 (5.2), COPD 5.6 (5.9), frail elderly 3.0 (4.4) and ESRD 2.3 (3.9) [p < .0001]. Each of the study populations also revealed unique and distinct patterns of physical, psychological and existential distress. CONCLUSION:People with ALS, COPD, ESRD and the frail elderly face unique challenges as they move towards the end of life. Knowing the intricacies of distress and how they differ across these groups broadens our understanding of end-of-life experience within non-cancer populations and how best to meet their palliative care needs