Adjustment factors for all state-year combinations (1993-2014). (XLS 46 kb)
Policy Points The historical mission of public health is to ensure the conditions in which people can be healthy, and yet the field of public health has been distracted from this mission by an excessive reliance on randomized-control... more
Policy Points The historical mission of public health is to ensure the conditions in which people can be healthy, and yet the field of public health has been distracted from this mission by an excessive reliance on randomized-control trials, a lack of formal theoretical models, and a fear of politics. The field of population health science has emerged to rigorously address all of these constraints. It deserves ongoing and formal institutional support.
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Behavioral economics is a collection of empirical results, without a theoretical framework to tie them together. Nonetheless, a strong heuristic of a two-system brain has been invoked by many behavioral economists to help communicate... more
Behavioral economics is a collection of empirical results, without a theoretical framework to tie them together. Nonetheless, a strong heuristic of a two-system brain has been invoked by many behavioral economists to help communicate similarities across studies and implications for practice. This two-system heuristic holds that we make quick, intuitive decisions with a System 1 brain, and careful, deliberative decisions with a System 2 brain. Institutional economics provides a valuable critique and counterpoint to this twosystem theory. It argues that our thoughts are built up of cognitive habits and that more sophisticated decisions are constructed from simpler habits. Where two-system theory holds that deliberative decisions must be as rational as available information allows, the institutionalist perspective holds that deliberative decisions can and do inherit biases from basic intuitions. Institutionalism further holds that cognitive habits are not either rational or irrational,...
Background. Difference-in-Difference makes a critical assumption that the changes in the outcomes, over the post-treatment period, are similar between the treated and control groups—the parallel trends assumption. Evaluation of this... more
Background. Difference-in-Difference makes a critical assumption that the changes in the outcomes, over the post-treatment period, are similar between the treated and control groups—the parallel trends assumption. Evaluation of this assumption is often done either by graphical examination or by statistical tests in the pre-treatment period. They result in a binary conclusion about the validity of the assumption. Purpose. This paper proposes a sensitivity analysis that quantifies the departure from parallel trends necessary to meaningfully change the estimated treatment effect. Results. Sensitivity analyses have an advantage over traditional parallel trends tests: they use all available data and thereby work even if only one pre-period is available, and they quantify the strength of unobserved confounder(s) required to change the conclusions of a study. Conclusions. We apply the sensitivity analysis metrics developed by Cinelli and Hazlett (2020) and illustrate them on two studies.
Background: The movement of firearm across state lines may decrease the effectiveness of state-level firearm laws. Yet how state-level firearm policies affect cross-state movement have not yet been widely explored. This study aims to... more
Background: The movement of firearm across state lines may decrease the effectiveness of state-level firearm laws. Yet how state-level firearm policies affect cross-state movement have not yet been widely explored. This study aims to characterize the interstate movement of firearms and its relationship with state-level firearm policies. Methods : Cross-sectional time series network analysis of interstate firearm movement using Bureau of Alcohol, Tobacco, Firearms, and Explosives firearm trace data (2010 -2017). We constructed the network of firearm movement between 50 states. We used zero-inflated negative binomial regression to estimate the relationship between the number of a state’s firearm laws and number of states for which it was the source of 100 or more firearms, adjusting for state characteristics. We used a similar model to examine the relationship between firearm laws and the number of states for which a given state was the destination of 100 or more firearms. Results : O...
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OBJECTIVE: To test the independent association of adult language input, television viewing, and adult-child conversations on language acquisition among infants and toddlers. METHODS: Two hundred seventy-five families of children aged 2 to... more
OBJECTIVE: To test the independent association of adult language input, television viewing, and adult-child conversations on language acquisition among infants and toddlers. METHODS: Two hundred seventy-five families of children aged 2 to 48 months who were representative of the US census were enrolled in a cross-sectional study of the home language environment and child language development (phase 1). Of these, a representative sample of 71 families continued for a longitudinal assessment over 18 months (phase 2). In the cross-sectional sample, language development scores were regressed on adult word count, television viewing, and adult-child conversations, controlling for socioeconomic attributes. In the longitudinal sample, phase 2 language development scores were regressed on phase 1 language development, as well as phase 1 adult word count, television viewing, and adult-child conversations, controlling for socioeconomic attributes. RESULTS: In fully adjusted regressions, the ef...
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... Dimitri A. Christakis, MD, MPH Department of Pediatrics Frederick J. Zimmerman, PhD Department of Health Services University of Washington Seattle, WA 98115 REFERENCES 1. Stevens T, Mulsow M. There is no meaningful relationship... more
... Dimitri A. Christakis, MD, MPH Department of Pediatrics Frederick J. Zimmerman, PhD Department of Health Services University of Washington Seattle, WA 98115 REFERENCES 1. Stevens T, Mulsow M. There is no meaningful relationship between television exposure and ...
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Research Interests: Sociology, Social Theory, Economics, Anthropology, Health Economics, and 13 morePublic Health Ethics, Culture, Social Determinants of Health, Population Health, Public Health, Medicine, Social Science & Medicine, Humans, Habits, Public health systems and services research, Psychology of Power, Multilevel Analysis, and Psychological Theory
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To measure whether the implementation of Healthvana-an online patient engagement platform and smartphone application-reduced the number of days between sexually transmitted infection (STI) testing, notification, and treatment at AIDS... more
To measure whether the implementation of Healthvana-an online patient engagement platform and smartphone application-reduced the number of days between sexually transmitted infection (STI) testing, notification, and treatment at AIDS Healthcare Foundation (AHF) Wellness Centers. We analyzed the retrospective data for 917 male clients who tested positive and received treatment for chlamydia, gonorrhea, or syphilis between January 1, 2014, and December 31, 2015. We included 8 AHF Wellness Centers from California and Florida in the study. We used regression models to evaluate the relationship between Healthvana implementation (pre-Healthvana vs post-Healthvana) and the number of days between the STI test, notification, and treatment. Following Healthvana implementation at the AHF Wellness Centers, the mean number of days decreased between the STI test and notification, from 8 to 6 days. The mean number of days between the overall STI test and treatment decreased from 12 to 10 days. Regression models found the reduction in the number of days from STI test to notification to be statistically significant. Smartphone applications like Healthvana are promising technologies to ensure clients are successfully and immediately notified of their STI test results.
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Support for policies to combat obesity is often undermined by a public sense that obesity is largely a matter of personal responsibility. Industry rhetoric is a major contributor to this perception, as the soda/fast food/big food... more
Support for policies to combat obesity is often undermined by a public sense that obesity is largely a matter of personal responsibility. Industry rhetoric is a major contributor to this perception, as the soda/fast food/big food companies emphasize choice and individual agency in their efforts to neutralize policies that are burdensome. Yet obesity experts recognize that environmental forces play a major role in obesity. We investigate whether exposure to a taste-engineering frame increases support for food and beverage policies that address obesity. A taste-engineering frame details strategies used by the food industry to engineer preferences and increase the over-consumption of processed foods and sugary beverages. We also examine the effects of exposure to two contextualized values that have recently been promoted in expert discourse-consumer knowledge and consumer safety - on public support of policies. Our research shows how causal frames and contextualized values may effectiv...
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Page 1. Cinderella Goes to School The Effects of Child Fostering on School Enrollment in South Africa Frederick J. Zimmerman ABSTRACT Fostering is a common institution throughout developing countries, where up to 25 percent of children... more
Page 1. Cinderella Goes to School The Effects of Child Fostering on School Enrollment in South Africa Frederick J. Zimmerman ABSTRACT Fostering is a common institution throughout developing countries, where up to 25 percent of children are fostered. ...
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The effects of early exposure to television remain poorly defined. Although some have speculated that television may be habit-forming, evidence is lacking especially in young children. To test the hypothesis that television viewing in the... more
The effects of early exposure to television remain poorly defined. Although some have speculated that television may be habit-forming, evidence is lacking especially in young children. To test the hypothesis that television viewing in the first 4 years of life is associated with protesting having the television turned off at age 6. We used data from the National Longitudinal Survey of Youth. Parents reported how much television their children watched before the age of 4. They also reported how often their children protested having the television turned off at age 6. Their responses to this question were dichotomized to almost never vs other. Multivariate logistic regression was used to test the independent association of early television watching with subsequent protest at turning off the television, controlling for externalizing behavior scores at age 6, parenting style, and other covariates. Data were available for 1331 children. Sixty-three percent of children protested having the television turned off at age 6. In a logistic regression model, hours of television viewed per day before age 4 was associated with increased odds of protesting at age 6 (1.08 [1.02-1.15]). Early television exposure is associated with resistance to turning off the television at school age.
Research Interests: Television, Child Behavior, Humans, Child, Female, and 4 moreMale, Time Factors, Age Factors, and Child preschool
... Carsten Obel, MD, PhD Perinatal Epidemiological Research Unit Department of Obstetrics and Pediatrics Aarhus University Hospital 8200 Aarhus N, Denmark Danish Epidemiological Science Centre Department of Epidemiology and Social... more
... Carsten Obel, MD, PhD Perinatal Epidemiological Research Unit Department of Obstetrics and Pediatrics Aarhus University Hospital 8200 Aarhus N, Denmark Danish Epidemiological Science Centre Department of Epidemiology and Social Medicine Aarhus University 8000 ...
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Current recommendations emphasize developmental screening and surveillance to identify developmental delays (DDs) for referral to early intervention (EI) services. Many young children without DDs, however, are at high risk for poor... more
Current recommendations emphasize developmental screening and surveillance to identify developmental delays (DDs) for referral to early intervention (EI) services. Many young children without DDs, however, are at high risk for poor developmental and behavioral outcomes by school entry but are ineligible for EI. We developed models for 2-year-olds without DD that predict, at kindergarten entry, poor academic performance and high problem behaviors. Data from the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B), were used for this study. The analytic sample excluded children likely eligible for EI because of DDs or very low birth weight. Dependent variables included low academic scores and high problem behaviors at the kindergarten wave. Regression models were developed by using candidate predictors feasibly obtainable during typical 2-year well-child visits. Models were cross-validated internally on randomly selected subsamples. Approximately 24% of all 2-year-old children we...
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ABSTRACT OBJECTIVE: Illicit drug use that commences during young adulthood represents an important public health concern. The social, economic, and health consequences of illicit drug use in adolescence may persist throughout young... more
ABSTRACT OBJECTIVE: Illicit drug use that commences during young adulthood represents an important public health concern. The social, economic, and health consequences of illicit drug use in adolescence may persist throughout young adulthood and negatively impact employment opportunities. We examine the association between employment status, occupation type, and illicit drug use among U.S. young adults. METHODS: We analyzed data on 1,009 U.S. adults ages 20-25 (representing an annual 5,119,332 young adults) participating in the 2001-2004 National Health and Nutrition Examination Survey, who reported on their lifetime use of cocaine or street drugs (crack or freebase), employment status, occupation type, and socio-demographic characteristics. RESULTS: The overall lifetime prevalence of cocaine or street drug use among U.S. young adults was 21.7%3.4; highest among males (12.71.9), non-Hispanic whites (13.72.9), those with a high school diploma or GED (7.91.4), unmarried (13.72.6), and those with an annual household income of less than $20,000 (8.12.5). Young adults employed as blue-collar workers (8.11.8), those with a job (14.73.1), those in Construction trades (23.71.2) and Health Service occupations (12.31.4) all had the highest proportion of workers reporting a lifetime prevalence of cocaine or street drug use. Employed young adults were significantly more likely 1.32 [1.01-1.98] (adjusted odds ratio [95% Confidence Interval]) to report lifetime use of cocaine or street drugs even after controlling for important socio-demographic characteristics, as compared to unemployed young adults. CONCLUSION: The workplace may be utilized for illicit drug use educational interventions targeted toward high-risk employed young adults.
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This paper presents a model that endogenizes asset-based risk- coping in an environment of unmediated risk and subsistence constraints. It uses an individually-rational, stochastic dynamic programming model to explore intertemporal... more
This paper presents a model that endogenizes asset-based risk- coping in an environment of unmediated risk and subsistence constraints. It uses an individually-rational, stochastic dynamic programming model to explore intertemporal portfolio decisions in an environment in which both yield risk and endogenous asses-price risk exist. The results show that agents pursue one the three distinct investment strategies, depending on their
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Research Interests: Pediatrics, Primary Health Care, Quality of Care, Humans, Child, and 15 moreFemale, Male, Continuity of Care, Patient Satisfaction, Ambulatory, Washington, Parents, Adult, Continuity of Patient Care, Cross Sectional Studies, Child Health Services, Ambulatory Care, Child preschool, Health Care Surveys, and Paediatrics and reproductive medicine
ABSTRACT Previous studies on the benefits of homeownership suggest higher health status and improved health outcomes. One gap in the literature is the effect of homeownership on health within different racial and ethnic minority groups.... more
ABSTRACT Previous studies on the benefits of homeownership suggest higher health status and improved health outcomes. One gap in the literature is the effect of homeownership on health within different racial and ethnic minority groups. This study tests whether race moderates the effects of homeownership on self-reported health status, physical and psychological health outcomes, delays in medical care and delays in obtaining prescription medication. We pooled data from the 2003, 2005, and 2007 California Health Interview Survey and included US born Latinos (N = 11,867), African Americans (N = 6,314) and non-Latino whites (N = 79,109) only. We used ordinal logistic regression to examine differences in self-perceived health status; zero inflated count regression to predict incidence risk ratios for number of psychological and general health conditions; and logistic regression to predict odds ratios for delays in medical care and obtaining prescription medication. Our data confirmed that race significantly moderates the effect of homeownership on health, adjusting for a variety of socio-demographic and economic factors. However, while homeownership is a robust, independent predictor for each of these health outcomes in the non-Latino white population, homeownership is non-significant in predicting health outcomes in racial and ethnic minorities. In spite of the recent housing crisis and economic recession, homeownership continues to be aggressively promoted within racial and ethnic communities. We discuss the idea that housing security is more directly linked to improved health outcomes than homeownership itself for ethnic minorities. Policies that improve housing security and decrease mortgage indebtedness for ethnic minorities are recommended.
Screen media overuse is associated with negative physical and mental health effects in children. The American Academy of Pediatrics recommends limiting screen media use at home; however, there are no similar guidelines for children's... more
Screen media overuse is associated with negative physical and mental health effects in children. The American Academy of Pediatrics recommends limiting screen media use at home; however, there are no similar guidelines for children's hospitals. This study was conducted to explore caregiver (parent or other guardian) perceptions about screen media use, compare at-home with in-hospital screen media use, and measure screen use among hospitalized children. We obtained data from a convenience cohort of hospitalized children at a single, comprehensive tertiary care children's hospital over 3 periods of 2 weeks each from 2013 to 2014. Home and hospital screen media use was measured through survey and study personnel directly observed hospital screen use. Descriptive statistics are reported and generalized estimating equation was used to identify characteristics associated with screen media use. Observation (n = 1490 observations) revealed screen media on 80.3% of the time the hospi...
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Subjective social status is associated with a range of health outcomes. Few studies have tested the relevance of subjective social status among Latinos in the U.S.; those that have yielded mixed results. Data come from the Latino... more
Subjective social status is associated with a range of health outcomes. Few studies have tested the relevance of subjective social status among Latinos in the U.S.; those that have yielded mixed results. Data come from the Latino subsample of the 2003 National Latino and Asian American Study (N = 2554). Regression models adjusted for socioeconomic and demographic factors. Stratified analyses tested whether nativity status modifies the effect of subjective social status on health. Subjective social status was associated with better health. Income and education mattered more for health than subjective social status among U.S.-born Latinos. However, the picture was mixed among immigrant Latinos, with subjective social status more strongly predictive than income but less so than education. Subjective social status may tap into stressful immigrant experiences that affect one's perceived self-worth and capture psychosocial consequences and social disadvantage left out by conventional ...
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Page 1. ADHD and Television: A Reply to Barkley Frederick J. Zimmerman PhD and Dimitri A Christakis MD MPH We take no issue with much of what Dr. Barkley has written: The bulk of his edi-torial simply reprises what we ...
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Objective Many youth seek opportunities to earn money through informal work experiences such as baby-sitting, newspaper routes, and yard work. Formal work has been associated with delinquent behaviors and substance abuse, but through use... more
Objective Many youth seek opportunities to earn money through informal work experiences such as baby-sitting, newspaper routes, and yard work. Formal work has been associated with delinquent behaviors and substance abuse, but through use of cross-sectional data. This study initially seeks to examine the incidence of substance use and delinquency among youth reporting informal work relative to those who do not and, ultimately, assess a causal relationship between early informal work and substance use and delinquency. Methods Using data from the National Longitudinal Survey of Youth 1997 (NLSY97), we estimate numerous models to determine whether informal work experience is in fact associated with substance use and delinquency; and if so, whether this association may be causal. Continuous and dichotomous measures of dependent variables (e.g., any substance use, any delinquency) and predictors (e.g., any and type of informal work, number of hours worked) are employed. Results Among adol...
Background: Young workers (<24 years) are at increased risk for injury and possibly negative health behaviors (e.g. early tobacco or drug use); at the same time, research has shown that young people who work may attain higher... more
Background: Young workers (<24 years) are at increased risk for injury and possibly negative health behaviors (e.g. early tobacco or drug use); at the same time, research has shown that young people who work may attain higher employment rates and better wages as long as a decade after high school graduation. Methods: Using data derived from the National Health Interview Survey (NHIS), a representative annual survey of the US civilian population, and 2 additional representative databases of US youth (i.e. the National Longitudinal Survey of Youth'79 [NLSY79] and National Study of Adolescent Health [AddHealth]), we are studying the health disparities, costs, morbidity, disability, risk behaviors, and mortality for younger workers. Results: After adjustment for sample weights and design effects, using the 1997-2004 NHIS data for 16,908 young adult workers age18-24 years (representing an estimated 17 million U.S. youth workers), the prevalence of negative health indicators (e.g. ...
We sought expert opinion on the problems with 2 dominant obesity-prevention discourse frames-personal responsibility and the environment-and examined alternative frames for understanding and addressing obesity. We conducted 60-minute,... more
We sought expert opinion on the problems with 2 dominant obesity-prevention discourse frames-personal responsibility and the environment-and examined alternative frames for understanding and addressing obesity. We conducted 60-minute, semistructured interviews with 15 US-based obesity experts. We manually coded and entered interview transcripts into software, generating themes and subthematic areas that captured the debate's essence. Although the environmental frame is the dominant model used in communications with the public and policymakers, several experts found that communicating key messages within this frame was difficult because of the enormity of the obesity problem. A subframe of the environmental frame--the taste-engineering frame--identifies food industry strategies to influence the overconsumption of certain foods and beverages. This emerging frame deconstructs the environmental frame so that causal attributes and responsible agents are more easily identifiable and p...
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Past studies have noted a digital divide, or inequality in computer and Internet access related to socio-economic class. This study sought to measure how many households in a pediatric primary care outpatient clinic had household access... more
Past studies have noted a digital divide, or inequality in computer and Internet access related to socio-economic class. This study sought to measure how many households in a pediatric primary care outpatient clinic had household access to computers and the Internet, and whether this access differed by socio-economic status or other demographic information. We conducted a phone survey of a population-based sample of parents with children ages 0 to 11 years old. Analyses assessed predictors of having home access to a computer, the Internet, and high-speed Internet service. Overall, 88.9% of all households owned a personal computer, and 81.4% of all households had Internet access. Among households with Internet access, 48.3% had high speed Internet at home. There were significant associations between home computer ownership or Internet access and parental income or education. There was no relationship these factors and high speed Internet access. Over 60% of families with annual house...
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Although continuity of care has been found to be associated with improved health outcomes in children, little is known about what factors predict having consistent contact with a pediatric provider. This study explored what patient,... more
Although continuity of care has been found to be associated with improved health outcomes in children, little is known about what factors predict having consistent contact with a pediatric provider. This study explored what patient, family, provider, and system factors are associated with high continuity of both total and well-child care. This cross-sectional study involved 759 patients presenting to a primary care pediatric clinic. Patients completed surveys about demographic variables, attitudes about continuity of care, and family functioning, as well as provider-level information. Outcomes were measured with a continuity of care index that quantified the degree to which a patient experienced continuous care with a provider. In Tobit regression models, the variables associated with increased total continuity of care were continuity belief, higher family control, increased provider availability, and better provider rating. Associated with decreased total continuity of care were: n...
Research Interests: Pediatrics, Education, Primary Health Care, Family Medicine, Family, and 15 moreLinear models, Humans, Child, Female, Male, Infant, Questionnaires, Risk Factors, Continuity of Patient Care, Cross Sectional Studies, Child preschool, attitude to health, Health Services Accessibility, Health Care Surveys, and Medical and Health Sciences
This study examines whether four types of selection bias in estimates of the effectiveness of prenatal care utilization for improving birthweight occur in a population of economically disadvantaged women. We categorized adequacy of... more
This study examines whether four types of selection bias in estimates of the effectiveness of prenatal care utilization for improving birthweight occur in a population of economically disadvantaged women. We categorized adequacy of prenatal care use using the Adequacy of Prenatal Care Utilization Index (APNCU) and the Revised-GINDEX for 142,381 Medicaid recipients who gave birth to a live, singleton infant in Washington State (1994-1998). Multinomial logistic regression was used to model categories of adequacy of prenatal care use as functions of variables chosen to indicate high- or low-risk status. A series of linear regression models were estimated to quantify the magnitude and direction of any bias in the effects of prenatal care on birthweight that could be attributed to accounting for each risk covariate. Results were examined for patterns of risk, prenatal care use, and estimation bias equated with the four selection processes. We found modest evidence of adverse, favorable, ...
Research Interests: Birth Weight, Adverse Selection, Pregnancy, Humans, Female, and 15 moreRisk factors, Medicaid, Washington, Maternal child health, Adult, Washington State, Risk Factors, Multinomial Logistic Regression, Indexation, Low Risk, Selection Bias, Linear Regression Model, Logistic Models, Prenatal Care, and Medical and Health Sciences
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Page 1. ADHD and Television: A Reply to Barkley Frederick J. Zimmerman PhD and Dimitri A Christakis MD MPH We take no issue with much of what Dr. Barkley has written: The bulk of his edi-torial simply reprises what we ...
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Antibiotics are commonly recognized as non-indicated for acute bronchitis and upper respiratory tract infection (URI), yet their widespread use persists. Clinical decision support in the form of electronic warnings is hypothesized to... more
Antibiotics are commonly recognized as non-indicated for acute bronchitis and upper respiratory tract infection (URI), yet their widespread use persists. Clinical decision support in the form of electronic warnings is hypothesized to prevent non-indicated prescriptions. The purpose of this study was to identify the effect of clinical decision support on a common type of non-indicated prescription. Using National Ambulatory Medical Care Survey data from 2006 to 2010, ambulatory visits with a primary diagnosis of acute bronchitis or URI and orders for antibiotic prescriptions were identified. Visits were classified on the basis of clinician report of decision-support use. Generalized estimating equations were used to assess the effect of decision support on likelihood of antibiotic prescription receipt, controlling for patient, provider, and practice characteristics. Clinician use of decision support increased sharply between 2006 (16% of visits) and 2010 (55%). Antibiotic prescribing...
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Health information exchange (HIE) is an important tool for improving efficiency and quality and is required for providers to meet Meaningful Use certification from the United States Centers for Medicare and Medicaid Services. However... more
Health information exchange (HIE) is an important tool for improving efficiency and quality and is required for providers to meet Meaningful Use certification from the United States Centers for Medicare and Medicaid Services. However widespread adoption and use of HIE has been difficult to achieve, especially in settings such as smaller-sized physician practices and federally qualified health centers (FQHCs). We assess electronic data exchange activities and identify barriers and benefits to HIE participation in two underserved settings. We conducted key-informant interviews with stakeholders at physician practices and health centers. Interviews were recorded, transcribed, and then coded in two waves: first using an open-coding approach and second using selective coding to identify themes that emerged across interviews, including barriers and facilitators to HIE adoption and use. We interviewed 24 providers, administrators and office staff from 16 locations in two states. They ident...
Research Interests: Electronic Health Records, Qualitative Research, California, Library and Information Studies, Humans, and 8 moreHealth Information Exchange, United States, Diffusion of Innovation, Public health systems and services research, Private Practice, Community Health Centers, Patient care management, and Interviews as topic
Electronic health records (EHRs) may help local health departments (LHDs) to improve services and thereby promote and protect population health. Yet, little is known about nationwide trends and correlates of EHR use by LHDs. We examine... more
Electronic health records (EHRs) may help local health departments (LHDs) to improve services and thereby promote and protect population health. Yet, little is known about nationwide trends and correlates of EHR use by LHDs. We examine relative contributions of LHD finances, leadership, and governance to EHR adoption and use from 2010 to 2013. The impact of LHD service provision and meaningful use factors on EHR use is explored in depth. Combining data from the National Association of County & City Health Officials Profile survey and the Area Health Resource File, logistic regression models were used to examine EHR use in 2013. Multinomial logistic models examined EHR adoption, use, or discontinuation from 2010 to 2013. EHR usage data were available for 514 and 488 LHDs in 2010 and 2013, respectively. A total of 117 LHDs had data for both 2010 and 2013. Outcomes included dichotomized measures of LHD self-reported use of EHRs in 2010 and 2013. For LHDs with 2 years of data, a 4-categ...
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Research objective Examine the association between binge drinking and earnings, work hours, benefits, and occupational attributes.BackgroundAlcohol misuse is prevalent among working-age populations and imposes substantial social costs.... more
Research objective Examine the association between binge drinking and earnings, work hours, benefits, and occupational attributes.BackgroundAlcohol misuse is prevalent among working-age populations and imposes substantial social costs. However, alcohol consumption over a wide range yields an earnings premium, resulting in an unexplained “alcohol-income puzzle.” Binge drinkers might earn more but be in “worse” jobs insofar as they are riskier, require
Research Objective:Physical activity and obesity are both strong predictors of morbidity and mortality in the short and long term. These behaviors also change over the life course of individuals. There is little data available to analyze... more
Research Objective:Physical activity and obesity are both strong predictors of morbidity and mortality in the short and long term. These behaviors also change over the life course of individuals. There is little data available to analyze the long term impact of physical activity and obesity on expenditures. Using simulation modeling of health behaviors and associated expenditures over the life course of individuals it is possible to construct lifetime expenditure patterns conditional on health behaviors. The objective of this study is to evaluate and validate this approach to better understand total lifetime expenditures associated with physical activity and obesity.Study Design:We used a microsimulation model to construct individual lifetime histories of simulated individuals that represent the population of the United States. Behaviors, relative risks and expenditures (2005 constant dollars) were modeled conditional on gender, race/ethnicity, age and birth cohort. Additionally rel...