Medicaid: Anatomy of a Dilemma

The Medicaid program-title XIX of the Social Security Act-was passed amid great hope on the part of the liberals as the so-called sleeper of the Social Security Act of 1965. The optimistic saw Medicare (title XVIII) as a step towards a Swedish form of social insurance and title XIX as a step towards something like the British National Health Service. They could not have been more wrong. While title XVIII has achieved general acceptance, title XIX has lived up to almost none of the expectations of its proponents; it has served only to confirm many of the doubts about government programs of medical care on the part of professional critics and fiscal conservatives

Walkable new urban LEED_Neighborhood-Development (LEED-ND) community design and children's physical activity: selection, environmental, or catalyst effects?

<p>Abstract</p> <p>Background</p> <p>Interest is growing in physical activity-friendly community designs, but few tests exist of communities explicitly designed to be walkable. We test whether students living in a new urbanist community that is also a pilot LEED_ND (Leadership in Energy and Environmental Design-Neighborhood Development) community have greater accelerometer-measured moderate-to-vigorous physical activity (MVPA) across particular time periods compared to students from other communities. We test various time/place periods to see if the data best conform to one of three explanations for MVPA. Environmental effects suggest that MVPA occurs when individuals are exposed to activity-friendly settings; selection effects suggest that walkable community residents prefer MVPA, which leads to both their choice of a walkable community and their high levels of MVPA; catalyst effects occur when walking to school creates more MVPA, beyond the school commute, on schooldays but not weekends.</p> <p>Methods</p> <p>Fifth graders (n = 187) were sampled from two schools representing three communities: (1) a walkable community, Daybreak, designed with new urbanist and LEED-ND pilot design standards; (2) a mixed community (where students lived in a less walkable community but attended the walkable school so that part of the route to school was walkable), and (3) a less walkable community. Selection threats were addressed through controlling for parental preferences for their child to walk to school as well as comparing in-school MVPA for the walkable and mixed groups.</p> <p>Results</p> <p>Minutes of MVPA were tested with 3 × 2 (Community by Gender) analyses of covariance (ANCOVAs). Community walkability related to more MVPA during the half hour before and after school and, among boys only, more MVPA after school. Boys were more active than girls, except during the half hour after school. Students from the mixed and walkable communities--who attended the same school--had similar in-school MVPA levels, and community groups did not differ in weekend MVPA, providing little evidence of selection effects.</p> <p>Conclusions</p> <p>Even after our controls for selection effects, we find evidence of environmental effects on MVPA. These results suggest that walkable community design, according to new urbanist and LEED_ND pilot design standards, is related to higher MVPA among students at certain times.</p

Trends in Americans food-related time use: 1975-2006

Journal ArticleObjective: To describe how the time spent in food-related activities by Americans has changed over the past 30 years. Design: Data from four national time diary surveys, spanning 1975-2006, are used to construct estimates of trends in American adults' time spent in food-related activities. Multivariate Tobits assess how food-related activities have changed over time controlling for sociodemographic and economic covariates. Results: Both bivariate and multivariate estimates reveal that between 1975 and 2006, American women's time spent in food preparation declined substantially, whereas the time spent in these activities by American men changed very little. On the contrary, grocery shopping time increased modestly for both men and women. The primary eating time (i.e. time when eating/drinking was the respondent's main focus) declined for both men and women over this historical period, and the composition of this time changed with less primary eating time being done alone. Concurrently, secondary eating time (i.e. time when something else had the respondent's primary attention, but eating/drinking simultaneously occurred) rose precipitously for both women and men between 1975 and 1998. Conclusions: The total time spent in eating (i.e. primary plus secondary eating time) has increased over the past 30 years, and the composition of this time has shifted from situations in which energy intake can be easily monitored to those in which energy intake may be more difficult to gauge. Less time is also being spent in food preparation and clean-up activities. Future research should explore possible links between these trends and Americans' growing obesity risk

Time use choices and healthy body weight: A multivariate analysis of data from the American Time use Survey

<p>Abstract</p> <p>Background</p> <p>We examine the relationship between time use choices and healthy body weight as measured by survey respondents' body mass index (BMI). Using data from the 2006 and 2007 American Time Use Surveys, we expand upon earlier research by including more detailed measures of time spent eating as well as measures of physical activity time and sedentary time. We also estimate three alternative models that relate time use to BMI.</p> <p>Results</p> <p>Our results suggest that time use and BMI are simultaneously determined. The preferred empirical model reveals evidence of an inverse relationship between time spent eating and BMI for women and men. In contrast, time spent drinking beverages while simultaneously doing other things and time spent watching television/videos are positively linked to BMI. For women only, time spent in food preparation and clean-up is inversely related to BMI while for men only, time spent sleeping is inversely related to BMI. Models that include grocery prices, opportunity costs of time, and nonwage income reveal that as these economic variables increase, BMI declines.</p> <p>Conclusions</p> <p>In this large, nationally representative data set, our analyses that correct for time use endogeneity reveal that the Americans' time use decisions have implications for their BMI. The analyses suggest that both eating time and context (i.e., while doing other tasks simultaneously) matters as does time spent in food preparation, and time spent in sedentary activities. Reduced form models suggest that shifts in grocery prices, opportunity costs of time, and nonwage income may be contributing to alterations in time use patterns and food choices that have implications for BMI.</p

Pennsylvania Folklife Vol. 30, No. 2

• A Search for the Origin of the Pennsylvania Barn • A Forebay Bank Barn in Texas • The Swiss Bank House Revisited: Messerschmidt-Dietz Cabin • Paul R. Wieand, Lehigh County Folk Artist • Aldes un Neies / Old & Newhttps://digitalcommons.ursinus.edu/pafolklifemag/1090/thumbnail.jp