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Background: Rising health care costs and consequent increases inMedicare reimbursements have led tomany payment reforms over the years. Implementation of the prospective payment system (PPS) for hospitals in 1983 incentivized hospitals to either purchase skilled nursing facilities (SNFs) or utilize their excess capacity to establish one within the hospital. With PPS reimbursement being applied to SNFs in 1998, prior monetary incentives for hospitals to own an SNF disappeared. However, despite the reduction in numbers, many hospitals continued to operate their hospitalbased skilled nursing facilities (HBSNFs). Purpose: This study examines the organizational andmarket-level factors associated with the survival of HBSNFs using the population ecology of organizations framework. Methodology: Using American Hospital Association survey data, event histories of all U.S. acute care hospitals with an open HBSNF in 1998 were plotted to examine if a hospital closed its HBSNF during a 22-year period (1998-2020). The primary independent variables included hospital size, ownership, totalmargin, market competition, andMedicare Advantage penetration. The independent and control variableswere lagged by 1 year. Cox regressionswere conducted to estimate the hazard ratios capturing the risk of HBSNF closure. Results: The results showed that HBSNFs located in large, not-for-profit hospitals and those operating in less competitive markets had greater odds of surviving. Practice Implications: The HBSNF administrators of small, for-profit hospitals and those operating in highly competitive markets could utilize the findings of this study to judiciously allocate slack resources to theirHBSNFs to keep those open given the current emphasis on continuity of care by regulatory bodies. [ABSTRACT FROM AUTHOR]

Objective State medicaid programs provide access to effective contraception for people with lower incomes. This study examined contraception use and pregnancy among reproductive-age women enrolled in the South Carolina Medicaid, by eligibility program and socio-demographic sub-groups. Methods A retrospective cohort of women aged 15-45 who were newly eligible for South Carolina Medicaid from 2012 to 2016 was examined. Log-binomial regression and average marginal effects assessed relationships between contraception use and pregnancies ending in live and non-live births. Contraception was categorized as permanent, long acting reversible contraception (LARC), short-acting hormonal contraception (SAC), or no contraceptive claims. Women with family planning or full-benefit medicaid coverage were included. Results Approximately 11% of women used LARC methods, 41% used SAC methods, and 46% had no evidence of contraceptive claims. Method utilization varied by eligibility program, race/ethnicity and age. The likelihood of pregnancy was lower among SAC users and lowest among LARC users compared to women with no evidence of contraception across all three programs (family planning APR = 0.44; 95% CI 0.41-0.49 and APR = 0.13, 95% CI 0.10-0.17; Low income families APR = 0.82; 95% CI 0.77-0.88 and APR = 0.33, 95% CI 0.28-0.38; Partners for Healthy Children APR = 0.72; 95% CI 0.68-0.77 and APR = 0.35, 95% CI 0.30-0.43, respectively). Non-Hispanic Black and Hispanic teens were less likely to experience a pregnancy than non-Hispanic white teens. Conclusions for Practice The likelihood of pregnancy was lower among women using SAC methods and markedly lower among women using LARC. Variation in contraceptive use among racial/ethnic groups was noted despite Medicaid coverage. As new policies and initiatives emerge, these findings provide important context for understanding the role of Medicaid programs in reducing financial barriers to contraceptive services and ensuring access to effective contraception, while fostering reproductive health autonomy among women., Author(s): Nathan Hale [sup.1] , Wondimu S. Manalew [sup.1] , Edward Leinaar [sup.1] , Michael Smith [sup.1] , Bisakha Sen [sup.2] , Pradeep Sharma [sup.3] , Amal Khoury [sup.1] Author [...]

Objective To propose a tailored social ecological model for Autism Spectrum Disorders and explore relationships between variables in a large nationally-representative dataset. Methods A tailored social-ecological model was developed and examined across variables in the 2016/2017 National Survey of Children's Health. A series of iterative multivariable logistic regressions were performed including individual, family, and community/neighborhood variables. A multivariable logistic regression using state-level fixed effects was performed to understand dynamics related to macro-level policies. Results In the full model, gender, disability severity, certain types of insurance coverage and household income were significantly related to ASD diagnosis. Females had lower odds of a diagnosis compared to males (aOR: 0.27; CI:0.18-0.41). Children with at least one other moderate/severe disability had odds 7.61 higher (CI:5.36-10.82) of a diagnosis than children without moderate/severe disabilities. Children with public insurance only (aOR:1.66; CI:1.14-2.41) or both private and public insurance coverage (aOR: 2.62; CI:1.6-4.16) had higher odds of a diagnosis compared to children with private insurance only. For those who reported it was 'somewhat' or 'very often' hard to cover basics with their income, odds of a diagnosis were higher compared to those who reported it was 'never' or 'hardly ever' hard to cover basics (aOR: 1.676; CI:0.21-2.56). Conclusions for Practice Patterns of ASD diagnosis are related to individual and family characteristics. There is some evidence that a child's environment has some relationship to reported ASD diagnosis. Professionals should be aware of an individual's environmental factors or context when assessing for ASD., Author(s): Anne E. Brisendine [sup.1] , Sarah E. O'Kelley [sup.2] , Julie K. Preskitt [sup.1] , Bisakha Sen [sup.1] , Martha S. Wingate [sup.1] Author Affiliations: (1) grid.265892.2, 0000000106344187, Department [...]

This study evaluated the impact of an interdisciplinary care teams (IDCT) care management program on cost and quality outcomes using a novel algorithm to identify 400 high-risk patients out of 48,235 Medicare Advantage (MA) beneficiaries. Of the 400, 252 were enrolled in the IDCT care management intervention program, while the remaining 148 were not enrolled. A second comparison group consisted of 660 who were referred to the IDCT program but not selected by the algorithm. The program's effectiveness was evaluated 1-year postintervention. Analyses found that health care costs for members enrolled in the IDCT program were reduced by US$1,121.76 and US$1,625.61 per member per month, respectively, relative to those not enrolled and those enrolled by referral. The cost reduction from the program generated a net savings of US$1.9MM, covering the program's cost. Findings suggest IDCTs can cost-effectively manage populations of high-risk patients with better selection and fostering greater interdependence. [ABSTRACT FROM AUTHOR]

This chapter focuses on vulnerable youth, the challenges they face during their transitions to adulthood, and the adverse effects of limited support systems on those transitions. The authors offer recommendations on how adult educators can help facilitate smooth transitions into adulthood for vulnerable youth.

Obesity is epidemic in the United States, and there is an imperative need to identify policy tools that may help fight this epidemic. A recent paper in the economics literature finds an inverse relationship between gasoline prices and obesity risk--suggesting that increased gasoline prices via higher gasoline taxes may have the effect of reducing obesity prevalence. This study builds upon that paper. It utilizes cross-sectional time series data from the American Time Use Survey (ATUS) over 2003-2008, utilizes the increases that occurred in gasoline prices in this period due to Hurricane Katrina and to the global spike in gasoline prices as a "natural experiment," and explores how time spent by Americans on different forms of physical activity is associated with gasoline price levels. Economic theory suggests that higher gasoline prices may alter individual behavior both via a "substitution effect" whereby people seek alternatives to motorized transportation, and an "income effect" whereby the effect of higher gasoline prices on the disposable family budget leads people to make various adjustments to what they spend money on. The latter may lead to some increase in physical activity (for example, doing one's own yard work instead of hiring help), but may also lead to decreases in other physical activities that involve expenses, such as team sports or workouts at the gym. Thus, ultimately, the relationship between gasoline prices and physical activity must be empirically determined. Results from multivariate regression models with state and time fixed effects indicate that higher gasoline prices are associated with an overall increase of physical activity that is at least moderately energy intensive. The increases are most pronounced in periods where gasoline prices fluctuate more sharply and unexpectedly. These results appear robust to a number of model specifications. One of the major components of this increase appears to be an increase in housework that is at least moderately energy intensive--such as interior and exterior cleaning, garden, and yard work. This tentatively suggests that there is an income effect of higher gasoline prices, or a possible increase in prices of such services when gasoline prices increase. However, the increases in physical activity associated with increased gasoline prices are weaker among minorities and low socioeconomic status (SES) individuals. Hence, while a policy that increases gasoline prices via raised gasoline taxes may have benefits in terms of increasing overall physical activity levels in the United States, these benefits may not accrue to low SES individuals to the same extent as to their higher SES counterparts. This suggests that if increasing physical activity is the primary goal, then it may be more efficient to use a tax that can exert an income effect on mid-to-high SES households, such as a targeted income tax. On the other hand, if gasoline taxes are imposed to address other negative externalities of gasoline use, then these taxes may have the added benefit of increasing physical activity at least among some segments of U.S. society. (Contains 21 footnotes, 6 tables, and 4 figures.)

Objective: To examine the association between frequency of family dinners (FFD) and selected problem behaviors for adolescents after adjusting for family connectedness, parental awareness, other family activities, and other potentially confounding factors. Methods: Data are drawn from the National Longitudinal Survey of Youth, 1997. The primary variable of interest is self-reported FFD in a typical week. Problem behaviors studied are substance-use, physical violence, property-destruction, stealing, running away from home, and gang membership. Multivariate logistic models are estimated for each behaviors. Linear regression models are estimated for behavior-frequency for the sub-samples engaging in them. Analysis is done separately by gender. Results: FFD is negatively associated with substance-use and running away for females; drinking, physical violence, property-destruction, stealing and running away for males. Conclusion: Family meals are negatively associated to certain problem behaviors for adolescents even after controlling rigorously for potentially confounding factors. Thus, programs that promote family meals are beneficial. (Contains 6 tables.)