Examining the Impacts of Health Insurance Costs and Health Reform on Private Insurance Coverage, Employment, and Wages

This dissertation is focused on private health insurance coverage, health reform and labor market outcomes. Using novel and rigorous empirical strategies, the first two essays estimate the impact of health insurance tax credits adopted during Massachusetts’s 2006 health reform and as a part of the Affordable Care Act (ACA) in 2014 on non-group private health insurance coverage. In Massachusetts, I find a large response on the margin for the tax credits. For the ACA, I document robust, positive effects on private coverage at the lowest eligibility threshold and weak evidence of effects at higher thresholds. Separating these effects from other important ACA policies, such as Medicaid expansion or the individual mandate, is vital to future efforts to modify and sustain the progress made by the ACA. The third essay addresses a significant gap in the literature, examining how employer-sponsored health insurance (ESI) affects the earnings distribution. I examine the role of sample selection and selection bias as an explanation for the inconsistent findings in the literature. Using quantile regression, I show that that cost-shifting due to compensating wage differentials occurs and that cost-shifting can be offset for higher earnings due to higher marginal tax rates, producing net-positive effects. Together, my dissertation indicates that reducing reliance on ESI may have beneficial effects on earnings for low- and middle-income individuals and that health insurance tax credits provide an appealing, alternative coverage option.Doctor of Philosoph

Psychosocial Workplace Factors and Healthcare Utilization: A Study of Two Employers

Abstract Background: While a large literature links psychosocial workplace factors with health and health behaviors, there is very little work connecting psychosocial workplace factors to healthcare utilization. Methods: Survey data were collected from two different employers using computer-assisted telephone interviewing as a part of the Work-Family Health Network (2008-2013): one in the information technology (IT) service industry and one that is responsible for a network of long-term care (LTC) facilities. Participants were surveyed four times at six month intervals. Responses in each wave were used to predict utilization in the following wave. Four utilization measures were outcomes: having at least one emergency room (ER)/Urgent care, having at least one other healthcare visit, number of ER/urgent care visits, and number of other healthcare visits. Population-averaged models using all four waves controlled for health and other factors associated with utilization. Results: Having above median job demands was positively related to the odds of at least one healthcare visit, odds ratio [OR] 1.37 (P<.01), and the number of healthcare visits, incidence rate ratio (IRR) 1.36 (P<.05), in the LTC sample. Work-to-family conflict was positively associated with the odds of at least one ER/urgent care visit in the LTC sample, OR 1.15 (P<.05), at least one healthcare visit in the IT sample, OR 1.35 (P<.01), and with more visits in the IT sample, IRR 1.35 (P<.01). Greater schedule control was associated with reductions in the number of ER/urgent care visits, IRR 0.71 (P<.05), in the IT sample. Conclusion: Controlling for other factors, some psychosocial workplace factors were associated with future healthcare utilization. Additional research is needed

March Mammal Madness and the power of narrative in science outreach.

March Mammal Madness is a science outreach project that, over the course of several weeks in March, reaches hundreds of thousands of people in the United States every year. We combine four approaches to science outreach - gamification, social media platforms, community event(s), and creative products - to run a simulated tournament in which 64 animals compete to become the tournament champion. While the encounters between the animals are hypothetical, the outcomes rely on empirical evidence from the scientific literature. Players select their favored combatants beforehand, and during the tournament scientists translate the academic literature into gripping "play-by-play" narration on social media. To date ~1100 scholarly works, covering almost 400 taxa, have been transformed into science stories. March Mammal Madness is most typically used by high-school educators teaching life sciences, and we estimate that our materials reached ~1% of high-school students in the United States in 2019. Here we document the intentional design, public engagement, and magnitude of reach of the project. We further explain how human psychological and cognitive adaptations for shared experiences, social learning, narrative, and imagery contribute to the widespread use of March Mammal Madness

Proceedings of the 3rd Biennial Conference of the Society for Implementation Research Collaboration (SIRC) 2015: advancing efficient methodologies through community partnerships and team science

It is well documented that the majority of adults, children and families in need of evidence-based behavioral health interventionsi do not receive them [1, 2] and that few robust empirically supported methods for implementing evidence-based practices (EBPs) exist. The Society for Implementation Research Collaboration (SIRC) represents a burgeoning effort to advance the innovation and rigor of implementation research and is uniquely focused on bringing together researchers and stakeholders committed to evaluating the implementation of complex evidence-based behavioral health interventions. Through its diverse activities and membership, SIRC aims to foster the promise of implementation research to better serve the behavioral health needs of the population by identifying rigorous, relevant, and efficient strategies that successfully transfer scientific evidence to clinical knowledge for use in real world settings [3]. SIRC began as a National Institute of Mental Health (NIMH)-funded conference series in 2010 (previously titled the “Seattle Implementation Research Conference”; $150,000 USD for 3 conferences in 2011, 2013, and 2015) with the recognition that there were multiple researchers and stakeholdersi working in parallel on innovative implementation science projects in behavioral health, but that formal channels for communicating and collaborating with one another were relatively unavailable. There was a significant need for a forum within which implementation researchers and stakeholders could learn from one another, refine approaches to science and practice, and develop an implementation research agenda using common measures, methods, and research principles to improve both the frequency and quality with which behavioral health treatment implementation is evaluated. SIRC’s membership growth is a testament to this identified need with more than 1000 members from 2011 to the present.ii SIRC’s primary objectives are to: (1) foster communication and collaboration across diverse groups, including implementation researchers, intermediariesi, as well as community stakeholders (SIRC uses the term “EBP champions” for these groups) – and to do so across multiple career levels (e.g., students, early career faculty, established investigators); and (2) enhance and disseminate rigorous measures and methodologies for implementing EBPs and evaluating EBP implementation efforts. These objectives are well aligned with Glasgow and colleagues’ [4] five core tenets deemed critical for advancing implementation science: collaboration, efficiency and speed, rigor and relevance, improved capacity, and cumulative knowledge. SIRC advances these objectives and tenets through in-person conferences, which bring together multidisciplinary implementation researchers and those implementing evidence-based behavioral health interventions in the community to share their work and create professional connections and collaborations

Evaluating Time in Primary Care: What Are We Busy About?

Excerpt: Twenty years ago, I (Jodi Polaha) had a freshly minted PhD in Child Clinical Psychology and a strong desire to be a Mental Health Hero of Rural and Underserved Places

Health Behavior Among Men Occupying Multiple Family Roles and the Moderating Effects of Perceived Partner Relationship Quality

Men in the U.S. are increasingly involved in their children’s lives and currently represent 40% of informal caregivers to dependent relatives or friends aged 18 years or older. Yet, much more is known about the health effects of varying family role occupancies for women relative to men. The present research sought to fill this empirical gap by first comparing the health behavior (sleep duration, cigarette smoking, alcohol consumption, exercise, fast food consumption) of men who only occupy partner roles and partnered men who also fill father, informal caregiver, or both father and informal caregiver (i.e., sandwiched) roles. The moderating effects of perceived partner relationship quality, conceptualized here as partner support and strain, on direct family role-health behavior linkages were also examined. Secondary analysis of survey data from 366 cohabiting and married men in the Work, Family and Health Study indicated that men’s multiple family role occupancies were generally not associated with health behavior. With men continuing to take on more family responsibilities, as well as the serious health consequences of unhealthy behavior, the implications of these null effects are encouraging: additional family roles can be integrated into cohabiting and married men’s role repertoires without health behavior risks. Moderation analysis revealed, however, that men’s perceived partner relationship constituted a significant factor in determining whether multiple family role occupancies had positive or negative consequences for their sleep duration, alcohol consumption, and fast food consumption. These findings are discussed in terms of their empirical and practical implications for partnered men and their families

Investigating the Negative Relationship between Wages and Obesity: New Evidence from the Work, Family, and Health Network

A substantial literature has established that obesity is negatively associated with wages, particularly among females.  However, prior research has found limited evidence for the factors hypothesized to underlie the obesity wage penalty.  We add to the literature using data from IT workers at a U.S. Fortune 500 firm that provides us with direct measures of employee income and BMI, and health measures that are unavailable in national-level datasets.  Our estimates indicate that the wage-obesity penalty among females only occurs among obese mothers, and is not attributable to differences in health or human capital that may be caused by having children. Published: Online November 2018.