Mental Health Parity Legislation, Cost-Sharing and Substance Abuse Treatment Admissions

Treatment is highly cost-effective in reducing an individual’s substance abuse (SA) and associated harms. However, data from Treatment Episodes (TEDS) indicate that per capita treatment admissions substantially lagged behind increases in heavy drug use from 1992-2007. Only ten percent of individuals with clinical SA disorders receive any treatment, and almost half who forgo treatment point to accessibility and cost constraints as barriers to care. This study investigates the impact of state mental health and SA parity legislation on treatment admission flows and cost-sharing. Fixed effects specifications indicate that mandating comprehensive parity for mental health and SA disorders raises the probability that a treatment admission is privately insured, lowering costs for the individual. Despite some crowd-out of charity care for private insurance, mandates reduce the uninsured probability by a net 2.4 percentage points. States mandating comprehensive parity also see an increase in total treatment admissions. Thus, increasing cost-sharing and reducing financial barriers may aid the at-risk population in obtaining adequate SA treatment. Supply constraints mute effect sizes, suggesting that demand-focused interventions need to be complemented with policies supporting treatment providers. These results have implications for the effectiveness of the 2008 Federal Mental Health Parity and Addiction Equity Act in increasing SA treatment admissions and promoting cost-sharing.

How Does the Business Cycle Affect Eating Habits?

As economic expansions raise employment and wages, associated shifts in income and time constraints would be expected to also impact individuals’ health. This study utilizes information from the Behavioral Risk Factor Surveillance System (1990-2007) to explore the relationship between the risk of unemployment and the consumption of various healthy and unhealthy foods. Estimates, based on fixed effects methodologies, indicate that a higher risk of unemployment is associated with reduced consumption of fruits and vegetables and increased consumption of “unhealthy” foods such as snacks and fast food. In addition to estimation of the average population effect, heterogeneous responses are also identified through detailed sample stratifications and by isolating the effect for those predicted to be at highest risk of unemployment based on their socio-economic characteristics. Among individuals predicted to be at highest risk of being unemployed, a one percentage point increase in the resident state’s unemployment rate is associated with a 2-8% reduction in the consumption of fruits and vegetables. The impact is somewhat higher among married individuals and older adults. Supplementary analyses also explore specific mediating pathways, and point to reduced family income and adverse mental health as significant channels underlying the procyclical nature of healthy food consumption.

Exercise, Physical Activity, and Exertion over the Business Cycle

As economic recessions reduce employment and wages, associated shifts in time and income constraints would be expected to also impact individuals’ health behaviors. Prior work has focused exclusively on recreational exercise, which typically represents only about 4% of total daily physical exertion. The general presumption in these studies is that, because exercise improves health, if unemployment increases exercise it must also improve health. Yet a person may be laid off from a physically demanding job, exercise more, and still be less physically active than when employed. Thus the relevant question is whether unemployment leads persons to become more physically active. We study this question with the American Time Use Survey (2003-2010), exploring the impact of the business cycle (and specifically the Great Recession) on individuals’ exercise, other uses of time, and physical activity during the day. We also utilize more precise measures of exercise (and all other physical activities), which reflect information on the duration as well as intensity of each component activity, than has been employed in past studies. Using within-state variation in employment and unemployment, we find that recreational exercise tends to increase as employment decreases. In addition, we also find that individuals substitute into television watching, sleeping, childcare, and housework. However, this increase in exercise as well as other activities does not compensate for the decrease in work-related exertion due to job-loss. Thus total physical exertion, which prior studies have not analyzed, declines. These behavioral effects are strongest among low-educated males, which is validating given that the Great Recession led to some of the largest layoffs within the manufacturing, mining, and construction sectors. Due to the concentration of low-educated workers in boom-and-bust industries, the drop in total physical activity during recessions is especially problematic for vulnerable populations and may play a role in exacerbating the SES-health gradient during recessions. We also find some evidence of intra-household spillover effects, wherein individuals respond to shifts in spousal employment conditional on their own labor supply.

Effects of Welfare Reform on Educational Acquisition of Young Adult Women

Education beyond traditional ages for schooling is an important source of human capital acquisition among adult women. Welfare reform, which began in the early 1990s and culminated in the passage of the Personal Responsibility and Work Opportunity Reconciliation Act in 1996, has promoted work rather than educational acquisition for this group. Exploiting variation in welfare reform across states and over time and using relevant comparison groups, we undertake a comprehensive study of the effects of welfare reform on adult women’s educational acquisition. We first estimate effects of welfare reform on high school drop-out of teenage girls, both to improve on past research on this issue and to explore compositional changes that may be relevant for our primary analyses of the effects of welfare reform on the educational acquisition of adult women. We conduct numerous specification checks and explore the mediating role of work. We find robust and convincing evidence that welfare reform significantly decreased the probability of college enrollment among adult women, by at least 20 %. It also appears to have decreased the probability of high school enrollment on the same order of magnitude. These results suggest that the gains from welfare reform in terms of increases in employment and reductions in caseloads have come at a cost in terms of lower educational attainment among adult women at risk for relying on welfare.

Isolating the Effect of Major Depression on Obesity: Role of Selection Bias

There is suggestive evidence that rates of major depression have risen markedly in the U.S. concurrent with the rise in obesity. The economic burden of depression, about $100 billion annually, is under-estimated if depression has a positive causal impact on obesity. If depression plays a causal role in increasing the prevalence of obesity, then policy interventions aimed at promoting mental health may also have the indirect benefits of promoting a healthy bodyweight. However, virtually the entire existing literature on the connection between the two conditions has examined merely whether they are significantly correlated, sometimes holding constant a limited set of demographic factors. This study utilizes multiple large-scale nationally-representative datasets to assess whether, and the extent to which, the positive association reflects a causal link from major depression to higher BMI and obesity. While contemporaneous effects are considered, the study primarily focuses on the effects of past and lifetime depression to bypass reverse causality and further assess the role of non-random selection on unobservable factors. There are expectedly no significant or substantial effects of current depression on BMI or overweight/obesity, given that BMI is a stock measure that changes relatively slowly over time. Results are also not supportive of a causal interpretation among males. However, among females, estimates indicate that past or lifetime diagnosis of major depression raises the probability of being overweight or obese by about seven percentage points. Results also suggest that this effect appears to plausibly operate through shifts in food consumption and physical activity. We estimate that this higher risk of overweight and obesity among females could potentially add about 10$9.7 billion) to the estimated economic burden of depression.

Effects of Welfare Reform on Illicit Drug Use of Adult Women

Exploiting changes in welfare policy across states and over time and comparing relevant population subgroups within an econometric difference-in-differences framework, we estimate the causal effects of welfare reform on adult women’s illicit drug use from 1992 to 2002, the period during which welfare reform unfolded in the U.S. The analyses are based on all available and appropriate national datasets, each offering unique strengths and measuring a different drug-related outcome. We investigate self-reported illicit drug use (from the National Surveys on Drug Use and Health), drug-related prison admissions (from the National Corrections Reporting Program), drug-related arrests (from the Uniform Crime Reports), drug-related treatment admissions (from the Treatment Episode Data Set), and drug-related emergency room episodes (from the Drug Abuse Warning Network). We find robust and compelling evidence that welfare reform led to declines in illicit drug use and increases in drug treatment among women at risk for relying on welfare, and some evidence that the effects operate, at least in part, through both TANF drug sanctions and work incentives.

Re-examining the Effects of Medicaid Expansions for Pregnant Women

This paper analyzes the effect of Medicaid eligibility expansions on the health insurance coverage of women giving birth and on the use of prenatal care and infant health, controlling for year and state effects and state-specific trends that may be correlated with expansions in Medicaid eligibility. We combine estimates from the two sets of analyses to construct estimates of the effect of health insurance on use of prenatal care and infant health. We find that the eligibility expansions reduced the proportion of pregnant women who were uninsured by approximately 10 percent, although this decrease in uninsured came with the expense of a substantial reduction in private insurance coverage. Changes in Medicaid eligibility were associated with very small and statistically insignificant changes in prenatal care use, birth weight, and incidence of low-birth weight.

Effects of Welfare Reform on Vocational Education and Training

Exploiting variation in welfare reform across states and over time and using relevant comparison groups, this study estimates the effects of welfare reform on an important source of human capital acquisition among women at risk for relying on welfare: vocational education and training. The results indicate that welfare reform reduced enrollment in full-time vocational education and had no significant effects on part-time vocational education or participation in other types of work-related courses, though there is considerable heterogeneity across states with respect to the strictness of educational policy and the strength of work incentives under welfare reform. In addition, we find heterogeneous effects by prior educational attainment. We find no evidence that the previously-observed negative effects of welfare reform on formal education (including college enrollment), which we replicated in this study, have been offset by increases in vocational education and training.

The Impact of Early Occupational Choice On Health Behaviors

Occupational choice is a significant input into individuals’ health investments, operating in a manner that can be either health-promoting or health-depreciating. Recent studies have highlighted the potential importance of initial occupational choice on subsequent outcomes pertaining to morbidity. This study is the first to assess the existence and strength of a causal relationship between initial occupational choice at labor entry and subsequent health behaviors and habits. We utilize the Panel Study of Income Dynamics to analyze the effect of first occupation, as identified by industry category and blue collar work, on subsequent health outcomes relating to body mass index, obesity, alcohol consumption, and physical activity in 1999-2005. Our findings suggest that initial occupations described as craft, operative, and service are related to higher body mass index and obesity later in life, while labor occupations are related to higher probabilities of smoking later in life. Blue collar work early in life is associated with increased probabilities of obesity and smoking, and decreased physical activity later in life, although effects may be masked by unobserved heterogeneity. Few effects are found for the effect of initial occupation on alcohol consumption. The weight of the evidence bearing from various methodologies, which account for non-random unobserved selection, indicates that at least part of this effect is consistent with a causal interpretation. These estimates also underscore the potential durable impact of early labor market experiences on later health.

Pantoea: A Versatile bacterial Candidate of Agricultural Importance

Genus Pantoea is a diverse group of the family Enterobacteriaceae which inhabit various ecological niches. Various species of Pantoea are found associated with a diverse host range that include plants, animals, insects and humans. Besides this Pantoea spp. has been widely distributed in nature including water, soil, dairy products, meat and fish. It is commonly associated with plants as epiphyte or pathogen. Pantoea was first recognized as a genus about 25 years ago, but since then, approximately 20 species with a wide range of characteristics have been discovered. Identification of plant-pathogenic Pantoea species is difficult, due to the high degree of phenotypic similarity between species of this genus and related Enterobacteriaceae. Pantoea species are typically characterized based on colony morphology, physiological and biochemical tests, and in some cases, fatty acid analysis or quinone composition. These have a wide range of plant hosts where they live as nonpathogenic endophytes as well as epiphytes that colonize the leaves, stems and roots. In this perspective, some Pantoea strains can be beneficial to the plant host by providing growth promoting substances such as the plant-growth hormone indole-acetic acid (IAA), phosphate solubilization or nitrogen fixation. Number of Pantoea species are also involved in bioremediation of various pesticides and organic chemical compounds. This indicates the potential to degrade some recalcitrant and xenobiotic compounds. Some Pantoea strains also provide effective protection to plants against various bacterial and fungal diseases and post-harvest fruit rots. On the other hand, some of the species are recognized as a human pathogen and has led to controversy as limited documented cases of P. agglomerans bacteremia and infections have been reported. Most of the cases reported among immunocompromised patients or the pediatric population. Thus, Pantoea is a multifaceted bacterium that plays a significant role in agriculture as a plant growth promoter by producing hormone like IAA, inorganic pollutant degradation by producing potent enzymes and also protects some plants against pathogens by producing antibacterial and antifungal compounds. In some cases, these also cause diseases in human beings. Therefore, this genus is very important for studies. In this review, the industrial, agricultural as well as ecological significance of the genus Pantoea is emphasized