Changes in the Welfare Caseload and the Health of Low-educated Mothers

Declines in the welfare caseload in the late 1990s brought significant change to the lives of many low-educated, single mothers. Many single mothers left welfare and entered the labor market and others re-arranged their lives in order to avoid going on public assistance. These changes may have affected the health and health behaviors of these women. To date, there has been no study of this issue. In this paper, we obtained estimates of the association between the welfare caseload and welfare policies, and three health behaviors --smoking, drinking, and exercise and two self-reported measures of health --days in poor mental health, and overall health status. The results of our study reveal that changes in the caseload had little effect on measures of health status, but were significantly associated with two health behaviors: binge drinking and regular exercise. The fall in the welfare caseload was associated with a decrease in binge drinking and an increase in regular and sustained physical activity.

Impact of alternative approaches to assess outlying and influential observations on health care costs

The distributions of medical costs are often skewed to the right because small numbers of patients use large amounts of health care resources. Using data from a study of colon cancer costs, we show, by example, the impact and magnitude of outliers and influential observations on health care costs and compared the effects of statistical costing methods for addressing the disproportionate influence of outliers and influential observations. We used data from a retrospective cohort study of 3,842 elderly veterans with colon cancer who were enrolled in and used health care from, both the Department of Veterans Affairs and Medicare in 1999–2004. After calculating the average colon cancer episode cost and distribution for the full cohort, we used box-plot methods, Winsorization, DFBETAs, and Cook's distance to identify and assess or adjust the outlying and/or influential observations. The number of observations identified as outlying and/or influential ranged from 13 when the predicted DFBETA measurement was greater than 0.15 and the observation was a qualified box-plot outlier to 384 cases using the Winsorization method at the 5th and 95th percentiles. Average costs of colon cancer episodes using these methods were similar. The method of choice from the results of this particular analysis can be conditionally based on whether the purpose is to control only for influential observations or to simultaneously control for outliers and influential observations. Understanding how estimates could change with each approach is important in assessing the impact of a particular method on the results

Educational attainment and cancer mortality, 1960--2000: Patterns, trends, and pathways.

Educational attainment and cancer mortality, 1960--2000: Patterns, trends, and pathways

Changes in the welfare caseload and the health of low-educated mothers

Declines in the welfare caseload in the late 1990s brought significant change to the lives of many low-educated, single mothers. Many single mothers left welfare and entered the labor market and others found different ways to avoid going on public assistance. These changes may have affected the health and health behaviors of these women. To date, there has been little study of this issue. In this paper, we obtained estimates of the association between changes in the welfare caseload caused by welfare policy, and four health behaviors-smoking, drinking, diet, and exercise-and four self-reported measures of health-weight, days in poor mental health, days in poor physical health, and general health status. The results of our study reveal that recent declines in the welfare caseload were associated with less binge drinking, but otherwise welfare reform had little effect on health and health behaviors. © 2006 by the Association for Public Policy Analysis and Management

The price of ultra-processed foods and beverages and adult body weight: Evidence from US veterans

The consumption of ultra-processed foods in the U.S. and globally has increased and is associated with lower diet quality, higher energy intake, higher body weight, and poorer health outcomes. This study drew on individual-level data on measured height and weight from U.S. Department of Veterans Affairs medical records for adults aged 20 to 64 from 2009 through 2014 linked to food and beverage price data from the Council for Community and Economic Research to examine the association between the price of ultra-processed foods and beverages and adult body mass index (BMI). We estimated geographic fixed effects models to control for unobserved heterogeneity of prices. We estimated separate models for men and women and we assessed differences in price sensitivity across subpopulations by socioeconomic status (SES). The results showed that a one-dollar increase in the price of ultra-processed foods and beverages was associated with 0.08 lower BMI units for men (p <= 0.05) (price elasticity of BMI of -0.01) and 0.14 lower BMI units for women (p <= 0.10) (price elasticity of BMI of -0.02). Higher prices of ultra-processed foods and beverages were associated with lower BMI among low-SES men (price elasticity of BMI of -0.02) and low-SES women (price elasticity of BMI of -0.07) but no statistically significant associations were found for middle- or high-SES men or women. Robustness checks based on the estimation of an individual-level fixed effects model found a consistent but smaller association between the price of ultra-processed foods and beverages and BMI among women (price elasticity of BMI of -0.01) with a relatively larger association for low-SES women (price elasticity of BMI of -0.04) but revealed no association for men highlighting the importance of accounting for individual-level unobserved heterogeneity. (C) 2019 Elsevier B.V. All rights reserved343948National Cancer InstituteUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Cancer Institute (NCI) [R01CA172726]; Edward Hines, Jr.; VA Hospital; VA Health Services Research and Development ServiceUS Department of Veteran Affair

Long-Term Weight Loss Effects of a Behavioral Weight Management Program: Does the Community Food Environment Matter?

This study examined whether community food environments altered the longer-term effects of a nationwide behavioral weight management program on body mass index (BMI). The sample was comprised of 98,871 male weight management program participants and 15,385 female participants, as well as 461,302 and 37,192 inverse propensity-score weighted matched male and female controls. We measured the community food environment by counting the number of supermarkets, convenience stores, and fast food restaurants within a 1-mile radius around each person’s home address. We used difference-in-difference regression models with person and calendar time fixed effects to estimate MOVE! effects over time in sub-populations defined by community food environment attributes. Among men, after an initial decrease in BMI at 6 months, the effect of the program decreased over time, with BMI increasing incrementally at 12 months (0.098 kg/m$^2$, p < 0.001), 18 months (0.069 kg/m$^2$, p < 0.001), and 24 months (0.067 kg/m$^2$, p < 0.001). Among women, the initial effects of the program decreased over time as well. Women had an incremental BMI change of 0.099 kg/m2 at 12 months (p < 0.05) with non-significant incremental changes at 18 months and 24 months. We found little evidence that these longer-term effects of the weight management program differed depending on the community food environment. Physiological adaptations may overwhelm environmental influences on adherence to behavioral regimens in affecting longer-term weight loss outcomes

A step-by-step approach to improve data quality when using commercial business lists to characterize retail food environments

Abstract Background Food environment characterization in health studies often requires data on the location of food stores and restaurants. While commercial business lists are commonly used as data sources for such studies, current literature provides little guidance on how to use validation study results to make decisions on which commercial business list to use and how to maximize the accuracy of those lists. Using data from a retrospective cohort study [Weight And Veterans\u2019 Environments Study (WAVES)], we (a) explain how validity and bias information from existing validation studies (count accuracy, classification accuracy, locational accuracy, as well as potential bias by neighborhood racial/ethnic composition, economic characteristics, and urbanicity) were used to determine which commercial business listing to purchase for retail food outlet data and (b) describe the methods used to maximize the quality of the data and results of this approach. Methods We developed data improvement methods based on existing validation studies. These methods included purchasing records from commercial business lists (InfoUSA and Dun and Bradstreet) based on store/restaurant names as well as standard industrial classification (SIC) codes, reclassifying records by store type, improving geographic accuracy of records, and deduplicating records. We examined the impact of these procedures on food outlet counts in US census tracts. Results After cleaning and deduplicating, our strategy resulted in a 17.5% reduction in the count of food stores that were valid from those purchased from InfoUSA and 5.6% reduction in valid counts of restaurants purchased from Dun and Bradstreet. Locational accuracy was improved for 7.5% of records by applying street addresses of subsequent years to records with post-office (PO) box addresses. In total, up to 83% of US census tracts annually experienced a change (either positive or negative) in the count of retail food outlets between the initial purchase and the final dataset. Discussion Our study provides a step-by-step approach to purchase and process business list data obtained from commercial vendors. The approach can be followed by studies of any size, including those with datasets too large to process each record by hand and will promote consistency in characterization of the retail food environment across studies

Would increasing access to recreational places promote healthier weights and a healthier nation?

Addressing gaps in evidence on causal associations, this study tested the hypothesis that better access to recreational places close to home helps people to maintain lower body mass index (BMI) using a retrospective longitudinal study design and up to 6 years of data for the same individuals (1,522,803 men and 183,618 women). Participants were military veterans aged 20–64 who received healthcare through the U.S. Department of Veterans Affairs in 2009–2014 and lived in a metropolitan area. Although there were cross-sectional associations, we found no longitudinal evidence that access to parks and fitness facilities was associated with BMI for either men or women in the full sample or in subgroups of residential movers and stayers. Our findings suggest that simply increasing the number of parks and fitness facilities may not be enough to achieve needed population-level reductions in weight