Difference-in-differences Estimate Research Articles

Does Tuition-Setting Authority Determine Whether Tuition Increases at Community Colleges with New Promise Programs?

ABSTRACT We evaluate whether the Bennett Hypothesis applies to local-level, single-institution promise programs and account for whether colleges have the authority to raise tuition, versus an external entity holding such authority. Using a sample of 29 community colleges affected by promise programs, we analyze changes in tuition across years 2001–02 to 2015–16 using two-way fixed effects difference-in-differences (DD) analyses, robust and weighted DD estimators, and panel event-studies. Among colleges with the sole authority to set their own tuition, the implementation of a promise program produces 14–17% lower tuition rates, suggesting that colleges do not strategically raise rates to capture promise-based financial aid dollars. When a governor or legislature is the sole entity that sets tuition, colleges experience negligible changes to slight declines in tuition levels, demonstrating that elected officials attempt to keep tuition rates stable or lower. When a statewide, systemwide, or local board retains tuition-setting authority, colleges observe no changes to tuition. Overall, our findings suggest a unique scenario for single-institution programs, where the college initiates or partners with a promise program; these colleges are motivated to keep tuition low to avoid counteracting affordability policies.

Designing Difference-in-Difference Studies with Staggered Treatment Adoption: Key Concepts and Practical Guidelines.

Difference-in-difference (DID) estimators are a valuable method for identifying causal effects in the public health researcher's toolkit. A growing methods literature points out potential problems with DID estimators when treatment is staggered in adoption and varies with time. Despite this, no practical guide exists for addressing these new critiques in public health research. We illustrate these new DID concepts with step-by-step examples, code, and a checklist. We draw insights by comparing the simple 2 × 2 DID design (single treatment group, single control group, two time periods) with more complex cases: additional treated groups, additional time periods of treatment, and treatment effects possibly varying over time. We outline newly uncovered threats to causal interpretation of DID estimates and the solutions the literature has proposed, relying on a decomposition that shows how the more complex DIDs are an average of simpler 2 × 2 DID subexperiments.

What is the impact of successive COVID-19 lockdowns on population mental health? Findings from an Australian natural experiment using health service data.

ObjectiveThe causal effect of successive population-wide lockdowns in response to increased COVID-19 cases on mental health has yet to be examined using robust methods. A natural experiment design underpinned by objective data can improve our understanding surrounding the definitive impact of social distancing restrictions.MethodsThe study employed a natural experiment design underpinned by objective data. Health service cost for visits to general practitioners and psychologists and medication dispensing costs served as objective measures of mental health. Difference-in-difference (DID) estimators, which in this study quantify differences in spending changes between groups over time, were produced based on three comparisons: Victoria 2020 lockdown comparison, Victoria 2021 lockdown comparison, and New South Wales (NSW) 2021 lockdown comparison. Specifically, differences in public health service spending during lockdown periods and the same timeframe in 2019 for Victoria and NSW, and control groups (remaining states and territories), were compared.ResultsPositive estimator values indicate that public health service spending for Victoria and NSW increased more during lockdown periods compared to control states and territories. The Victorian lockdowns of 2020 and 2021, but not the NSW lockdown of 2021, resulted in increased public spending for general practitioner mental health consults (2020 DID estimator: $8498.96 [95% CI $4012.84, $12,373.57], 2021 DID estimator: $6630.06 [95% CI $41.27, $13,267.20], all monetary values in AUD$) and short visits to psychologists (2020 DID estimator: $628.82 [95% CI $466.25, $796.00], 2021 DID estimator: $230.11 [95% CI $47.52, $373.98]). The first Victorian lockdown in 2020 and the NSW lockdown in 2021 resulted in greater spending on short visits to clinical psychologists. Spending on long visits to psychologists and clinical psychologists and medication spending did not change.ConclusionsStrict lockdowns can have an adverse impact on population mental health. The impact is particularly evident in those who have a history of previous mental health concerns but does not necessitate extra use of medications, suggesting that psychological care can address the adverse impact of the lockdowns.

THE EFFECT OF PANDEMICS ON TRUST IN DOCTOR IMPROVEMENT AMONG CHINESE OLDER ADULTS: LESSONS FROM COVID-19

Abstract The COVID-19 pandemic has had a major impact on the physician-patient relationship. For older adults, trust in doctors during the pandemic affects their lives and health. This study aimed to estimate the effect of the first wave of COVID-19 transmissibility in China on older adults’ trust in doctors. We obtained individual data from the Chinese Family Panel Studies (CFPS). A total of 2,225 participants aged 65 and older were included in this study. The COVID-19 pandemic was used as a natural experiment. We obtained difference-in-differences (DID) estimates of the pandemic’s effects by exploiting temporal variation in the timing of COVID-19 exposure across participants interviewed from 2018 to 2020 together with the geographical variation in COVID-19 severity at the provincial district level. Overall, the DID estimates showed that the COVID-19 pandemic could significantly increase trust in doctors after controlling for multiple covariates (adjusted β: 0.053, 95% CI: 0.028–0.078). Stratified analyses showed that the effect was only in females and the more educated ones but not in their counterparts. In addition, the COVID-19 pandemic showed a positive effect on trust in doctors among 65-79-year-olds (0.082, 0.056–0.109), but older adults over the age of 80 showed significantly reduced trust in doctors (-0.236, -0.418–-0.055). Our findings confirm the association between the COVID-19 pandemic and trust in doctors among older Chinese people. Hospitals and other medical organizations should pay more attention to improving older adults’ trust in doctors and building a better physician-patient relationship to face the future pandemic.

Better together? Student's benefits of educational market integration

Educational market integration have become a common practice in various countries, changing potentially student's application and enrollment behavior. We implement a difference-indifference estimation exploiting student's geographic exposure to market integration in Chile to understand student's gain and losses from this process. Using administrative data, we show that the market integration process has no effect on overall university enrollment but changes the enrollment composition: new platform institutions increased enrollment and old ones decreased. The reduction in application costs and the release of additional information, particularly historical cutoff data, seem to play a more significant role in shaping these dynamics than the congestion reduction. Heterogeneity analysis shows that low-income students enrollment increase, reflecting application barriers to decentralized admission institutions and implying gains in equity and efficiency of the system.

Health economic analysis of inpatient prostate cancer treatment in Austrian hospitals

Abstract Background Prostate cancer (PrC) is the fourth most prevalent type of cancer worldwide. Its high incidence and 5-year survival rates contributing to high inpatient care costs make it an important public health issue. In Austria, surgery has been the most common inpatient procedure for PrC, despite clinical recommendations not clearly indicating its benefits over alternatives. No health economic comparison of these procedures has considered the period after treatment yet. We bridge this gap by analysing the health economic impact of treatment pathways. Methods We use a large administrative dataset of all inpatient PrC patients in Austria who received either only surgery or only radiation therapy from 2005-2014 (n = 34,286). To assess the health economic impact, we used diagnosis-related-group (DRG) points and length of stay (LOS). Monthly DRG points and LOS for each patient ±12-months around the index procedure were analysed using the difference in difference (DID) method. We controlled for age, and physical comorbidity burden using Charlson Comorbidity Index (CCI) scores. Results Looking at unadjusted averages, patients in the surgery group were significantly younger and had a lower CCI compared to the radiation group. Consequently, the surgery group had lower nominal average DRG points and LOS. However, when controlling for age and CCI, we found that radiation treatment was less resource intensive. A DID estimation found a shorter average LOS and lower DRG points for the radiation group compared to surgery for the 12 months post index. Conclusions We found significant additional costs and LOS times for surgical pathways following risk adjustment in Austria. This implies a potential excess burden of ∼4,400 hospitalisation days and ∼4 million DRG points (€4.8m) a year for the healthcare system during the observed period. Considering international evidence on higher patient burden in surgical pathways, these findings may call for clinical reconsiderations of PrC care. Key messages • Patient characteristics of different inpatient treatment pathways for PrC in Austria were very heterogenous. • Health economic outcomes in the post treatment period for PrC inpatient treatment were significantly better for radiation treatment compared to surgery.

Effect of sacubitril/valsartan on cardiac remodeling compared with other renin–angiotensin system inhibitors: a difference-in-difference analysis of propensity-score matched samples

BackgroundIn patients with heart failure with reduced ejection fraction (HFrEF), treatment with sacubitril–valsartan (S/V) may reverse left ventricular remodeling (rLVR). Whether this effect is superior to that induced by other renin–angiotensin system (RAS) inhibitors is not well known.MethodsHFrEF patients treated with S/V (n = 795) were compared, by propensity score matching, with a historical cohort of 831 HFrEF patients (non-S/V group) treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (RAS inhibitors). All patients were also treated with beta-blockers and shared the same protocol with repeat echocardiogram 8–12 months after starting therapy. The difference-in-difference (DiD) analysis was used to evaluate the impact of S/V on CR indices between the two groups.ResultsAfter propensity score matching, compared to non-S/V group (n = 354), S/V group (n = 354) showed a relative greater reduction in end-diastolic and end-systolic volume index (ESVI), and greater increase in ejection fraction (DiD estimator = + 5.42 mL/m2, P = 0.0005; + 4.68 mL/m2, P = 0.0009, and + 1.76%, P = 0.002, respectively). Reverse LVR (reduction in ESVI ≥ 15% from baseline) was more prevalent in S/V than in non-S/V group (34% vs 26%, P = 0.017), while adverse LVR (aLVR, increase in ESVI at follow-up ≥ 15%) was more frequent in non-S/V than in S/V (16% vs 7%, P < 0.001). The beneficial effect of S/V on CR over other RAS inhibitors was appreciable across a wide range of patient’s age and baseline end-diastolic volume index, but it tended to attenuate in more dilated left ventricles (P for interaction = NS for both).ConclusionIn HFrEF patients treated with beta-blockers, sacubitril/valsartan is associated with a relative greater benefit in LV reverse remodeling indices than other RAS inhibitors.Graphical abstract

Market Competition and Anemia Management in the United States Following Dialysis Payment Reform.

Whether market competition influences health care provider responses to national reimbursement reforms is unknown. We examined whether changes in anemia management after the expansion of Medicare's dialysis payment bundle varied with market competition. With data from the US dialysis registry, we used a difference-in-differences (DID) design to estimate the independent associations of market competition with changes in anemia management after dialysis reimbursement reform. A total of 326,150 patients underwent in-center hemodialysis in 2009 and 2012, representing periods before and after reimbursement reform. Outcomes were erythropoiesis-stimulating agent (ESA) and intravenous iron dosage, the probability of hemoglobin <9g/dL, hospitalizations, and mortality. We also examined serum ferritin concentration, an indicator of body iron stores. We used a dichotomous market competition index, with less competitive areas defined as effectively having <2 competing dialysis providers. Compared with areas with more competition, patients in less competitive areas had slightly more pronounced declines in ESA dose (60% vs. 57%) following reimbursement reform (DID estimate: -3%; 95% CI, -5% to -1%) and less pronounced declines in intravenous iron dose (-14% vs. -19%; DID estimate: 5%; 95% CI, 1%-9%). The likelihoods of hemoglobin <9g/dL, hospitalization, and mortality did not vary with market competition. Serum ferritin concentrations in 2012 were 4% (95% CI, 3%-6%) higher in less competitive areas. After the expansion of Medicare's dialysis payment bundle, ESA use declined by more, and intravenous iron use declined by less in concentrated markets. More aggressive cost-reduction strategies may be implemented in less competitive markets.

The effect of capacity building evidence-based medicine training on its implementation among healthcare professionals in Southwest Ethiopia: a controlled quasi-experimental outcome evaluation

BackgroundEvidence-based medicine (EBM) bridges research and clinical practice to enhance medical knowledge and improve patient care. However, clinical decisions in many African countries don’t base on the best available scientific evidence. Hence, this study aimed to determine the effect of training interventions on background knowledge and awareness of EBM sources, attitude, competence, and practice of EBM among healthcare professionals.MethodWe designed a controlled group quasi-experimental pre-post test study to evaluate the effect of capacity-building EBM training. A total of 192 healthcare professionals were recruited in the study (96 from the intervention and 96 from the control group). We used a difference-in-differences (DID) analysis to determine the effect of the training. Along the way, we used a fixed effect panel-data regression model to assess variables that could affect healthcare professionals’ practice of EBM. The cut point to determine the significant effect of EBM training on healthcare professionals’ background knowledge and awareness of EBM sources, attitude, and competence was at a P-value < 0.05.ResultThe DID estimator showed a significant net change of 8.0%, 17.1%, and 11.4% at P < 0.01 on attitude, competence, and practice of EBM, respectively, whereas no significant increment in the background knowledge and awareness of EBM sources. The fixed effect regression model showed that the attitude [OR = 2.288, 95% CI: (1.049, 4.989)], competence [OR = 4.174, 95% CI: 1.984, 8.780)], technical support [OR = 2.222, 95% CI: (1.043, 3.401)], and internet access [OR = 1.984, 95% CI: (1.073, 4.048)] were significantly affected EBM practice.ConclusionThe capacity-building training improved attitude, competence, and EBM practice. Policymakers, government, and other concerned bodies recommended focusing on a well-designed training strategy to enhance the attitude, competence, and practice towards EBM among healthcare professionals. It was also recommended to enhance internet access and set mechanisms to provide technical support at health facilities.

Digital transition and the clean renewable energy adoption in rural family: evidence from Broadband China

IntroductionThe increasing digital transformation and the global need for sustainable energy solutions have sparked considerable interest in the examination of digital technologies' impact on the adoption of clean renewable energy. However, limited research focuses on energy consumption in rural households, especially in developing countries such as China.MethodsThis study leverages the quasi-natural experiment provided by the Broadband China Policy (BCP) and utilizes data from the China Labor-force Dynamics Survey (CLDS) spanning 2012 to 2016. Our investigation aims to understand the effect of the digital transition on the adoption of clean renewable energy within rural families. We employ staggered Difference-in-Difference (DID) and Doubly Robust Staggered DID estimators to assess this impact, allowing us to explore regional heterogeneity.ResultsOur findings reveal that implementing the BCP significantly influences clean renewable energy adoption, although this effect varies across different regions. Specifically, in the middle region, the BCP results in a notable 5.8% increase in clean renewable energy adoption compared to non-pilot cities. However, in the east and west regions, the BCP is associated with a decrease of 12.6% and 13.5%, respectively, in clean renewable energy adoption. Dynamic effect analysis further indicates that the east region had already experienced high clean renewable energy adoption prior to the BCP's implementation, while the BCP positively influences clean renewable energy intentions in the west region.DiscussionOur analysis identifies three significant channels through which the BCP affects clean renewable energy adoption: population size, economic size, and income level. Larger populations and greater economic size enhance the BCP's impact on clean renewable energy adoption. These findings provide empirical evidence for developing countries that seek to harness digital development for technological advancement, industrial upgrading, and carbon emission reduction.

The implementation of IFRS9 in Gulf banks: using the GMM and the difference-in-differences with multiple time periods approaches

Purpose This paper aims to examine the impact of the mandatory adoption of (International Financial Reporting Standards [IFRS] 9) on loan provisions, nonperforming loans (NPL) and impairment loan loss in Gulf banks. This study also investigates potential variations in outcomes compared to prior models and explores the use of the Callaway and Sant’Anna (2021) estimator for difference-in-differences (DiD) with multiple time periods. Design/methodology/approach The research is based on a sample of 53 Gulf banks covering the period from 2012 to 2020. The study analyzes the changes in loan provisions, impairment loss and NPL following the implementation of IFRS 9. It uses statistical analysis and the DiD method to compare the outcomes between the experimental group (treated by IFRS 9) and the control group (not treated). Findings The findings reveal a statistically insignificant increase in loan provisions, impairment loss and NPL after the adoption of IFRS 9. These results align with previous studies and suggest that Gulf banks were proactive in anticipating and mitigating the impact of the new standard. The study also observes a synchronization of provisioning practices across Gulf countries and a certain level of consistency in recognizing loan losses. Practical implications The practical implications of this study suggest that Gulf banks have successfully absorbed the impact of IFRS 9 and have implemented collaborative approaches. Originality/value The study offers some new sight into IFRS9 outcomes in developing countries and opens the door for implementing a novel DiD estimation in future research studies.

FDI and onshore task composition: evidence from German firms with affiliates in the Czech Republic

How does a firm’s foreign direct investment (FDI) in a low-wage country change its onshore task demand in a high-wage country? Is the shift more intensive for jobs that the literature has designated offshorable? We address these questions using a matched difference-in-differences (DiD) approach with data on German firms that have similar propensities to conduct FDI in the Czech Republic. Our novel matching procedure draws on post-lasso logit estimates and shows that high task intensities of managing, administration, and labor legislation play a major role in firms’ engagement in international expansion. The outcomes of the DiD estimation show that after acquiring a foreign affiliate, multinational enterprises (MNEs) increase the intensities of their activities typical of headquarters such as managing, analyzing, and negotiating relative to the corresponding task intensities among non-MNEs. We also find sector-specific decreases, such as a reduction in typical production tasks (monitoring, producing, measuring) in manufacturing MNEs or typical service tasks (informing, medical, repairing) in service MNEs.

Improving internal control quality as a corporate response to the Forbes Rich List

This study takes advantage of the Forbes Rich List as an external shock to examine its effect on internal control quality in mainland China. Using the difference-in-differences (DiD) method for a large sample of 17,910 firm-year observations from 2000 to 2014, we find that firms controlled by entrepreneurs included in the Forbes Rich List tend to have higher internal control quality than firms not controlled by entrepreneurs in the list. The listed entrepreneurs improve their firms’ internal control quality by means of reducing the information asymmetry between the firms and outsiders. Further tests show that the event effect is more pronounced when firms have higher misreporting costs and when listed entrepreneurs hold chairman positions than in other situations. Our results remain robust after applying the propensity score matching method, stacked DiD estimation, and an alternative measure of internal control quality. These findings enrich the literature on the effect of the Rich List and the determinants of internal control quality in emerging markets.

Success of health cell approach in improving knowledge, attitude and practice related to COVID-19: difference-in-differences analyses of a community-based quasi-experimental trial

ObjectivesThere remain hesitations and miscommunication regarding appropriate public health behaviours and conceptions related to COVID-19. We tested the effectiveness of the community-based health cell approach in improving knowledge, attitude and...

Affordable Care Act Medicaid expansion associated with increased liver transplant waitlist access without worsening mortality.

It is unclear what impact Affordable Care Act (ACA) Medicaid expansion has had on the liver transplantation (LT) waitlist. We aimed to assess associations between ACA Medicaid expansion and LT waitlist outcomes. The United Network for Organ Sharing Standard Transplant Analysis and Research (UNOS STAR) database was queried for patients listed for LT between January 1, 2009, and December 31, 2018. Our primary outcome was waitlist mortality and our secondary outcomes included Medicaid use on the LT waitlist and transplant rate. States were divided into groups based on their expansion status and the study period was divided into 2 time intervals-pre-expansion and post-expansion. Difference-in-difference (DiD) models were created to assess the impacts of expansion on each of the outcomes and for racial/ethnic and sex groups. In total, 56,414 patients from expansion states and 32,447 patients from nonexpansion states were included. Three-year waitlist mortality decreased at a similar rate in both cohorts [DiD estimate: 0.1, (95% CI, -1.1, -1.4), p = 0.838], but Medicaid use increased [DiD estimate: +7.7, (95% CI, 6.7, 8.7), p < 0.001] to a greater degree in expansion states after expansion than nonexpansion states. Between the 2 time intervals, Medicaid use on the LT waitlist increased from 19.4% to 26.1% in expansion states but decreased from 13.4% to 12.1% in nonexpansion states. In patients on Medicaid, there was a slight increase in the 3-year transplant rate associated with Medicaid expansion [DiD estimate +5.0, (95% CI, 1.8, 8.3), p = 0.002], which may in part be explained by differences in patient characteristics. Medicaid expansion was associated with increased Medicaid use on the LT waitlist without worsening overall waitlist mortality or transplant rate, suggesting that lenient and widespread public health insurance may increase access to the LT waitlist without adversely affecting outcomes.

High-speed mobile networks and police repression during the COVID-19 pandemic: the case of Nigeria

PurposeGovernment repression against civilians while enforcing COVID-19 related lockdowns was widely reported in Africa. At the same time, many have claimed that high-speed (4G) mobile network proliferation provide an accountability mechanism that may constrain police abuses. This study focused on Nigeria to examine (1) the effect of COVID-19 lockdowns on police repression and (2) whether widespread high-speed mobile data networks constrain police repression.Design/methodology/approachUsing data from the Armed Conflict Location and Event Database (ACLED) and the Mobile Coverage Database, this study used difference-in-differences (DID) and triple difference (DDD) estimation on a sample of 423,925 observations (local government area-days) between January 1, 2019 and June 30, 2020 to estimate the causal effects of COVID-19 lockdowns and high-speed (4G) mobile data on police repression.FindingsLockdowns increased certain forms of police repression in areas with substantial high-speed (4G) mobile networks. Separate from the lockdowns, widespread 4G network increased police repression even without lockdowns.Research limitations/implicationsProliferation of high-speed mobile networks in Nigeria appears to facilitate, rather than constrain, police repression. It is possible that high-speed mobile data networks allow police to detect and repress citizen behaviors, rather than permitting citizens to correct repressive police behaviors.Originality/valueAlthough many studies have explored the COVID-19 pandemic and police behavior in Western countries, only a few have examined its effects in states with even more troubled policing institutions, including those in sub-Saharan Africa, using DID and DDD estimation.

Association between state Medicaid policies and accrual of Black and Hispanic patients to cancer clinical trials.

1510 Background: The U.S. Medicaid health insurance program may play a key role in mitigating racial and ethnic disparities in cancer clinical trial enrollment, given Medicaid’s disproportionate representation of these populations and its coverage of the routine costs of trial participation in some states. We sought to evaluate the effect of Medicaid expansion under the Affordable Care Act (ACA) on changes in the accrual of racial and ethnic minority patients in cancer clinical trials, across all states and specifically those mandating Medicaid coverage of routine trial costs. Methods: The study used anonymous enrollment data from Medidata Rave, a large commercial clinical trial data collection platform. We conducted a retrospective difference-in-differences (DID) analysis to examine accrual demographics in states that expanded Medicaid eligibility under the ACA compared with non-expansion states, before and after expansion; and assessed effect modification based on state-mandated Medicaid coverage of routine trial costs. Participants included adults enrolled in interventional cancer clinical trials from 2012-2019, located in U.S. hospital referral regions with &gt;5% Black or Hispanic population. The primary outcome was participant race/ethnicity, defined dichotomously as Black or Hispanic (vs non-Black, non-Hispanic). We used ordinary least squares regression to model participant race/ethnicity as a function of (1) an indicator for trial enrollment in an expansion state after policy implementation, (2) state fixed effects, and (3) year fixed effects, with standard errors clustered at the state level. To assess effect modification, we stratified the main model across states with and without coverage mandates of routine trial costs. Results: The study included 75,700 participants across 1,409 clinical trials and 351 sites. In expansion states, the proportion of participants who identified as Black and/or Hispanic increased from 13.4% before expansion to 13.8% after expansion (0.4 percentage-point [PP] change, 95% CI -0.8 to 1.7). In non-expansion states, this proportion decreased from 17.0% to 15.2% (-1.7 PP change, 95% CI -3.7 to 0.2). These trends yielded a non-significant DID estimate of 2.0 PP (95% CI -1.0 to 5.0). In stratified analyses, Medicaid expansion was associated with a 4.5 PP (95% CI 0.4 to 8.6) increase in the enrollment of Black and/or Hispanic participants in states with coverage mandates, but not in states without coverage mandates (1.1 PP, 95% CI -2.6 to 4.8). Conclusions: Medicaid expansion was associated with a significant increase in the proportion of Black and Hispanic oncology trial participants in states that mandated Medicaid coverage of the routine costs of trial participation, but not overall across all states. These findings suggest that Medicaid policies have the potential to advance equitable enrollment in cancer clinical trials.

Medicaid enrollment changes among U.S. adult survivors of childhood cancer following medicaid expansion: A report from the Childhood Cancer Survivor Study (CCSS).

10011 Background: Little is known about whether Medicaid expansion under the Affordable Care Act (ACA) affected insurance coverage among adult survivors of childhood cancer, a population at high-risk for poor health outcome. We addressed this gap by evaluating the association between ACA Medicaid expansion and Medicaid enrollment among participants in the Childhood Cancer Survivor Study (CCSS). Methods: The CCSS cohort of 5-year survivors of childhood cancer was linked to administrative Medicaid insurance data in 2010-2016. We identified 13,895 adult survivors (aged 18-64 years) diagnosed with cancer under age 21 and between 1970 and 1999. Outcomes included (1) percentage with any Medicaid enrollment by year; and (2) Medicaid-covered days (number of days when a survivor was enrolled in Medicaid) during each year. Multivariable difference-in-differences (DD) models were used to examine outcome changes pre vs. post ACA Medicaid expansion, in expansion- vs. non-expansion states, adjusting for age, sex, race/ethnicity, income, education, and chronic conditions. Multivariable models were conducted overall and then stratified by cancer type, race/ethnicity, income, and education. Results: Medicaid enrollment rates increased more in expansion states (17.6% pre-expansion to 24.1% post-expansion) than non-expansion states (16.4% to 16.9%), leading to a net increase in enrollment of 6.6 percentage points (ppt; 95% CI = 5.5-7.7) in the multivariable DD model. Multivariable DD model showed a net increase of 18.4 days (95% CI = 13.8-23.1) in Medicaid-covered days in expansion states relative to non-expansion states. The expansion-associated increase in Medicaid enrollment rates was greatest among survivors of leukemia (multivariable DD estimate: 8.9 ppt, 95% CI = 6.9-11.0) and non-Hodgkin lymphoma (8.0 ppt, 95% CI = 5.0-10.9). Greater increases in Medicaid enrollment were seen in non-Hispanic Black (13.5 ppt, 95% CI = 8.0-19.1) and Hispanic survivors (15.8 ppt, 95% CI = 10.6-21.0) than non-Hispanic White peers (5.1 ppt; 95% CI = 4.0-6.2); in survivors with &lt; $20K household income (11.7 ppt, 95% CI = 8.9-14.4) compared to those with ≥$60K household income (2.9 ppt, 95% CI = 1.6-4.2); and in survivors with high school or lower education (9.3 ppt, 95% CI = 6.9-11.8) compared to those with a college or higher degree (3.9 ppt, 95% CI = 2.6-5.3). Similar patterns were observed across survivor subgroups when examining Medicaid-covered days. Conclusions: We provide the first evidence on increased Medicaid enrollment and longer coverage duration among adult survivors of childhood cancer following Medicaid expansion, with greater increases seen among survivors of underrepresented racial/ethnic populations, those with low socioeconomic status, and high medical need survivors.

The Long-Term Impact of Famine Experience on Harvest Losses

Approximately one-third of the global food supply is lost or wasted each year. Given that the harvesting process is the initial stage following food production, minimizing losses in this crucial phase holds paramount significance in augmenting the food supply and ensuring food security. The 1959–1961 famine in China was one of the most catastrophic events in history and had long-term effects on human beings, particularly farmers. This paper aims to provide a new perspective on the variations in harvest losses across age cohorts by examining the impact of famine experiences. Using survey data from the 2016 Postproduction Food Loss and Waste Survey conducted by China Agricultural University and the Rural Economic Research Center, which involved 3538 farming households across 28 provinces, we construct a cohort difference-in-difference (DID) model to investigate the impact of famine experience on household harvest losses. The standard cohort DID estimation results indicate that in areas with severe famine, a 1% increase in excess mortality would reduce the rate of harvest loss by 3%, suggesting that farmers who have experienced extreme famine have a deeper memory of the event, which subsequently helps them reduce harvest losses. Moreover, the results of the heterogeneity test reveal that the more serious the famine that the household head experienced in early life was, the less harvest losses there were, particularly for those who were adolescents during the famine. The findings elucidate the importance of historical events in shaping current behaviors and contribute to a better understanding of the variation in harvest losses across age cohorts.

Contribution of home garden vegetables on reducing stunting among 6- to 23-month-old children in South Tigray, northern Ethiopia.

The study was conducted to analyze the contribution of home garden vegetables in reducing stunting among 6- to 23-month-old children from South Tigray, Northern Ethiopia. The quasi-experimental study design was used. Multistage sampling technique was used to select the districts and study communities. A total of 94 purposively selected vegetable producer (intervention) households and 260 randomly selected non-producer (control) households were included in the study (1:3 ratio). The recumbent length of children was measured using horizontal wooden board to the nearest 0.1 cm. The length-for-age Z-scores were computed using WHO-Anthro 2006 software. Propensity score-matching and difference-in-difference (DID) estimates were used to analyze data using STATA software version 12. Prevalence of child stunting was 19.8 (12.7-29.4) and 21.1 (16.4-26.7)% (baseline) and 43.5 (33.5-54.1) and 46.5 (45.7-47.2)% (end line) among intervention and control groups, respectively. Child stunting was higher for boys and older children from both intervention and control households. DID estimation revealed that there was no significant difference in child stunting between intervention and control households (DID = 1.7, p = .604). However, there was an intervention effect of -0.5, 2.5, and 1.7% in the prevalence of child stunting among females, males, and both sexes, respectively. Vegetable production as an intervention strategy reduced the prevalence of stunting in children aged 6-23 months. However, vegetable production needs to be well integrated with other nutrition-sensitive interventions to realize the objective of reducing child stunting.