Inverse Probability Weighted Regression Adjustment Research Articles

Gender dynamics of the impact of cash transfer on female educational expenditure of informal settlements in Bangladesh

Gender-biased educational investment remains a critical issue for vulnerable households. Despite increased female enrolment in the past decade, motivation to invest on female education remains low. Resource scarcity and low woman empowerment are two major reasons of low educational expenditure on female children of a vulnerable household. As the most vulnerable households in a society, informal settlers (slum households) are supposed to spend less on female children. However, whether there is any gender bias in informally settled households’ spending on education remains a question. Further, Cash Transfer (CT) programs provide resources to vulnerable households for investing on human capital elements like education. This study aims to examine three research questions: whether a informally settled household’s spending on education is gender biased, whether the households in which women receive CT spend more for female education than those in which women do not receive CT, and finally whether the impact of female receipt of CT differs from that of male receipt of CT in terms of female education expenditure. As the assignment of female access to CT is not randomized, the simple comparison between the treated and untreated suffers from selection bias. We employ propensity score matching (PSM) as an identification strategy to address selection bias. Inverse probability weighted regression adjustment (IPWRA) has been applied as a robustness check. The study's policy implications highlight the significance for policymakers in the domains of women's education, empowerment, and the achievement of Sustainable Development Goals.

Real-world outcomes in patients with chronic spontaneous urticaria receiving omalizumab: insights from a clinical practice survey

Objective: Chronic spontaneous urticaria (CSU) is a debilitating inflammatory skin condition, often impacting quality of life. International guidelines recommend omalizumab, an anti-immunoglobulin E antibody, for second-line treatment. Our objective was to understand patient characteristics associated with prescription of omalizumab, and assess real-world outcomes in patients with CSU treated with omalizumab. Methods: We analyzed data from the Adelphi Real World CSU Disease Specific Programme™, a cross-sectional survey with retrospective data collection (December 2020–October 2021) from physicians and patients with CSU in the United States. Results: Data from allergists (n = 45), dermatologists (n = 51), and primary care physicians (PCPs; n = 20) were included. At the time of data collection, one-third of patients were receiving omalizumab (n = 220) and 67% were eligible for but not receiving omalizumab (n = 455). Using logistic regression, the odds of receiving omalizumab were higher in patients whose entire bodies were affected by hives [OR = 2.551; 95% CI 1.502-4.333; p < 0.001] or with deteriorating/unstable prognoses at treatment initiation [OR = 2.219; 95% CI 1.031-4.777; p = 0.042], and lower in patients managed by PCPs [OR = 0.276; 95% CI 0.130-0.584; p < 0.001]. Estimates from an inverse probability weighted regression adjustment model indicated that patients receiving omalizumab had higher treatment satisfaction, improvements in itching, hives, angioedema, insomnia, and anxiety, and lower impact on work productivity, compared with patients not receiving omalizumab. Conclusion: Around two-thirds of patients with CSU considered eligible for omalizumab were not receiving the guideline-recommended therapy. Patients receiving omalizumab had better real-world outcomes compared with patients not receiving omalizumab. Ensuring patients receive the most appropriate treatment could benefit patients with CSU.

Climate change adaptation and smallholder farmers welfare: Empirical evidence from the Sahelian Region of West Africa

Global climate change has threatened sustainable agricultural growth over the years, severely affecting food sufficiency and the livelihood of farmers. The Climate-Smart Agricultural Technologies (CSAT), as a form of adaptation, offer pathways for mitigating the negative effect of climate change on crop producers in developing countries. This study uses cross-country (Mali and Niger) cross-sectional data to examine the welfare (proxied by crop sales revenue and income) impact of multiple adoptions of CSAT on smallholder farm households. To control for potential endogeneity that leads to bias estimates, we employ the multinomial endogenous treatment effect (METE) model, complemented with the inverse probability weighted regression adjustment (IPWRA) for the analysis. The result reveals that household (education, location, and assets) and plot (plot size, plot topography, and soil fertility) characteristics, institutional factors (farmer-based organization, access to formal credit, and extension service) and crop disease shock significantly influence different combinations of CSAT adoption. The impact estimates show that adopting joint combinations of CSAT leads to higher crop sales revenue and income among the farmers in most cases. These findings suggest that the adoption of CSAT as a package should be encouraged and disseminated in the West Africa Sahel region. Moreover, some sociodemographic and institutional factors such as education, credit access, farmer-based organizations, and extension services could be strengthened for easy and rapid adoption of CSAT by smallholder farmers, which subsequently improves their economic welfare.

IV Thrombolysis in Basilar Artery Occlusion: Outcomes and Comparison With Endovascular Thrombectomy.

Recanalization is considered a prerequisite for favorable outcome in basilar artery occlusion (BAO). Intravenous thrombolysis (IVT) has been successfully used for eligible patients with BAO well beyond the 4.5-hour time window but has been largely underrepresented in the best medical management arms in recent randomized controlled trials of recanalization therapy in BAO. We aimed to analyze the outcomes of patients with BAO treated with IVT only and to compare IVT with endovascular thrombectomy (EVT). This observational single-center, retrospective cohort study included consecutive patients with BAO treated with IVT and/or EVT up to 48 hours of symptom onset during 1995-2022. The primary outcome was favorable functional outcome (modified Rankin Scale 0-3) at 3 months collected by a stroke physician by phone. In the first part, we described the outcomes and factors associated with functional outcome in the IVT-only cohort during 1995-2022. In the second part, we used doubly robust inverse probability-weighted regression adjustment models to compare functional outcome of patients treated with IVT vs EVT+/-IVT during 2010-2022. In the whole cohort of 376 patients with acute BAO treated with recanalization therapy, 245 (65.2%) received only IVT. In the IVT-only cohort, most patients had moderate-to-severe clinical presentation (median NIH Stroke Scale 18) but no extensive early ischemic changes in the posterior circulation on admission. Half of them had onset-to-treatment time over 6 hours. 46.5% of the IVT-treated patients achieved 3-month favorable functional outcome, whereas mortality was 35.9%. sICH occurred in 11.1%. In a multivariable analysis, younger age, milder symptom severity, and less baseline ischemic changes predicted favorable functional outcome. In the 2010-2022 cohort, when compared with patients treated with EVT+/-IVT (n = 121), the IVT-only cohort (n = 122) had higher odds for favorable functional outcome (IVT 58.2% vs EVT 43.0% (aOR 2.82 [95% CI 1.31-6.05]). IVT alone produced outcomes comparable with those in recent trials of endovascular BAO recanalization. Furthermore, in head-to-head comparison in our cohort, the IVT-only approach was more often associated with favorable outcome than EVT+/-IVT. Thus, it should not be overlooked as the first-line recanalization therapy in acute BAO, even in longer time windows. This study provides Class IV evidence that tPA is as effective as thrombectomy for basilar artery thrombosis.

Gendered health effects of cooking fuel technologies in southern Ghana

The introduction of clean cooking technologies in many developing countries ensures environmental quality and improved well-being through reduction in indoor air pollution. This study examines the adoption of cooking fuel technologies and its effect on health outcomes using panel data from two districts in the Greater Accra region of Ghana. The inverse probability weighting regression adjustment (IPWRA) approach was used to examine the effect of cooking fuel technologies on health outcomes. The empirical results show that factors such as tenancy, kitchen design, assets, gender, education, access to internet and tarred roads influence the adoption of cooking fuel technologies, including clean cooking fuels. The study finds that clean cooking fuels decrease female illness incidence but not male illness incidence, with large improvement for adults. The findings suggest that policies and programs aimed at promoting clean cooking fuel technologies can significantly improve well-being of females in developing countries.

Impact of integrated soil fertility management on maize yield, yield gap and income in northern Ghana

This paper analyzes the impact of integrated soil fertility management (ISFM) on maize yield, yield gap and net income in northern Ghana using an inverse-probability-weighted regression adjustment (IPWRA). In this study, ISFM is restricted to the adoption of crop rotation (CR), inorganic fertilizer (FT), and farmyard manure (MN) either in isolation or in combination. We find a synergy in yield gain (86.52 % increase in yield) and a decrease in yield gap (of 10.22 %) with the adoption of all three technologies as a package (CR+FT+MN). The joint adoption of all three technologies is also associated with a 51.29 % increase in net income from maize production and has a Benefit-Cost Ratio of 3.23.

Does dam-based irrigation affect the sustainability of natural capital ?: A doubly robust analysis

This study assesses the impact of dam-based irrigation on the adoption of management practices for sustaining the natural capital of a region, with a focus on soil and water resources, using survey data from 1020 farmlands in northwestern Tunisia. Because treatment effect estimates are frequently prone to misspecification in either the treatment or outcome models, we use the doubly-robust inverse probability weighted regression adjustment estimator on four soil and water sustaining agricultural practices. As a robustness check, we also apply propensity score matching, with both methods consistently indicating a positive impact of dam irrigation on the adoption of these practices. Overall, these findings emphasize the indirect positive ecological effects of dams on a region's natural capital sustainability.

Combining social protection interventions for better food security: Evidence from female-headed households in Amhara region, Ethiopia.

Ethiopia introduced its flagship poverty-targeted social protection program, the Productive safety net program (PSNP), in 2005 and Community-Based Health Insurance (CBHI) in 2011. Although both programs operate in several districts with some overlaps, evidence is scarce on how these large-scale programs jointly affect the food security of vulnerable groups. This study examines the impacts of a combination of these programs on food security outcomes among female-headed households in a chronically food-insecure and drought-prone district. Cross-sectional data were collected from 365 female-headed households selected through multi-stage sampling technique and analyzed using Inverse-probability-weighted regression adjustment (IPWRA) strategy to assess the effect of the programs on food security. The results show that while 63.6% of sample households are enrolled in CBHI and 48.8% are beneficiaries of PSNP's conditional cash transfer (CCT) component, membership in both social protection programs was 38.9%. The IPWRA analysis finds that inclusion in the CCT combined with CBHI, on average, increased dietary diversity score by 0.918 (95% CI 0.779-1.057) and food consumption score by 0.576 (95% CI 0.464-0.688). It also reduced household food insecurity access scale by 8.658 (95% CI -9.775 - -7.541). In all assessments, a combination of CBHI and CCT always produced results of a larger magnitude than each of CBHI and CCT alone. The findings provide evidence of the potentials of integrating social protection programs to increase food security outcomes among the most vulnerable and marginalized groups in a developing country. In addition, the results have also useful implications to achieve sustainable development goals related to ending hunger and achieving food security among vulnerable groups.

Impact of access to cash remittances on cocoa yield in Southwestern Nigeria

Access to cash remittances has a positive impact on the food security of people living in developing countries. However, little is known about the impact of access to cash remittances concerning cocoa yield. Therefore, the study investigates the impact of access to cash remittances on cocoa yield. A multistage sampling technique was used to select 300 cocoa farming households for the study. The data were analysed using the exponential double hurdle model (Churdle) estimation process, inverse probability weighted regression adjustment (IPWRA), and endogenous switching regression model (ESRM). According to the ATU estimate, the average farmer would produce a yield of 0.824 times more when he/she has access to cash remittances. The conditional treatment effect (ATT), which assesses the impact of access to cash remittances on cocoa yield, was correspondingly approximately 0.828 and statistically significant at 1 %. As a result, the typical farmer who has access to cash remittances would produce a yield that is 0.828 times more than it would be if he/she did not have access to cash remittances. The study found that access to cash remittances has a positive impact on cocoa yield among farmers in rural Nigeria after adjusting for both observable and unobserved factors.

Maximizing impact: The power of combining land tenure formalization and productive social safety nets programmes in Tanzania

While standard economic theory considers formal property rights as vital for agricultural productivity and economic prosperity, its potential can be limited by absence of important complementary factors necessary for the mechanism to operate. This study sheds some light on complementarities between Land Tenure Formalization (LTF) and Productive Social Safety Nets (PSSN) programmes in Tanzania. Using the Tanzania national panel survey data (2020/21 wave), we employed a doubly robust Inverse Probability Weighted Regression Adjustment (IPWRA) to estimate the stand-alone and joint impacts of LTF and PSSN on farm productivity, consumption and food security. We find that joint participation in LTF and PSSN programmes significantly improve farm productivity, households’ consumption and food security. We show that joint impacts of LTF and PSSN are greater than sum of stand-alone impacts suggesting a great complementarity between the programmes. Our cross-tenure analysis suggests a stronger joint impact of statutory LTF with PSSN than that of customary LTF with PSSN, and the true opposite for stand-alone impacts. The study recommends the design of pro-poor productive interventions that incorporate potentially complementary interventions for more optimal outcomes. We suggest for further research on possible interactions between LTF and other anti-poverty interventions for more clarity and sound policy implications.

Sustaining beyond the production of cocoa for beans: The preference and impact of products from the cocoa husk

The cocoa pod husk, a waste in most cocoa farms, has recently received alternative uses in various industries. To cocoa farmers, potash and black soap are their main products from the husk. This alternative use presents an excellent opportunity for improving the livelihoods of cocoa farmers. Nevertheless, there is sparse evidence of farmers' willingness to produce black soap and its potential implication on their welfare. We employed a multistage sampling approach to close this gap to draw data from 150 cocoa farmers from Ahafo Ano North District, Ghana. We analysed the data with binary probit, ordered probit and Inverse Probability Weighted Regression Adjustment. We found that marital status, membership of FBO, knowledge of black soap production, and credit access influence farmers' willingness to produce (WTP) black soap. Again, gender, marital status, age, farm income, farming experience and knowledge of black soap have a significant but heterogeneous effect on the tipping point that stimulates farmers' willingness to accept (WTA) black soap production. The impact assessment revealed that black soap production has substantial welfare gains. Thus, it increases farmer's per capita expenditure. Therefore, stakeholders like the Cocoa Research Institute, Ghana COCOBOD and cocoa-licensed buying companies should invest in procuring portable ashing kilns at subsidised prices and train farmers on packaging and labelling to expedite, revitalise and modernise black soap production. Notwithstanding, future research could look at the profitability analysis of black soap production.

The Impact of Long-Term Finance on Job Quality, Investments and Firm Performance: Cross-Country Evidence

AbstractDespite its importance for development, long-term finance is particularly scarce in countries with lower income levels. This not only results in unrealized growth and employment creation, but may also undermine a broader shift towards better jobs. After all, many long-term investments comprise investments in labor that have the potential to contribute to improvements in job quality. This paper uses more than 17,000 firm-level observations from 73 mostly low- and middle-income countries to provide first empirical evidence of the extent to which LTF affects the quality of jobs. Additionally, it looks into effects on investments and firm performance. The findings, based on inverse probability weighted regression adjustment, indicate that long-term finance increases the likelihood of formal training by 4.4 to 4.8 percentage points, raises average wage by 4.1 percentage points and the share of permanent employees by 1.3 percentage points. Effects are also significant for investments in fixed assets and process innovation as well as for employment and sales growth. The fact that the positive effects on job quality increase with loan maturities underlines the importance of longer-term finance for better jobs. Despite several robustness checks, it cannot be ruled out completely that unobservable variables affect the estimation of effect sizes.

Assessing the Impact of Covid-19 in Mozambique in 2020

AbstractTaking advantage of the 2019/2020 Mozambican household budget survey, in the field both before and during the first phases of the Covid-19 pandemic, we assess the impact of Covid-19 on welfare in 2020, aiming to disentangle this impact from the effect of other shocks. Comparing a number of welfare metrics, and applying propensity score matching and inverse probability weighted regression adjustment approaches, we find that consumption levels are significantly lower and poverty rates substantially higher during the first phases of Covid-19 than in the pre-Covid-19 period. Moreover, the impact was greater in urban areas and accordingly in the more urbanised southern region. Non-food expenditures suffered relatively more than food expenditures, likely a coping strategy, while the impact on consumption levels was greater for people working in the secondary and tertiary sectors than for workers in the primary sector, mainly agriculture. Stunting among under-5 children also suffered. Only a limited number of countries have actual, collected in-person, survey data that span across the initial phases of the Covid-19 pandemic. Thus, the present analysis adds value to our understanding of the welfare consequences of Covid-19 in a low-income context, where automatic social safety nets were not in place during the early phases of the pandemic. More specifically, it helps in assessing the results of previous welfare impact simulations, compared to real data. Even though our main findings are broadly in line with existing estimates based on simulations or phone surveys, important differences between the predictions and the actual results emerge. We conclude that it is critically important for Mozambique and its development partners to develop stronger and more targeted policies and tools to respond to temporary shocks.

COMPARISON OF LONELINESS AND SOCIAL NETWORK BETWEEN OLDER ADULT CAREGIVERS AND NONCAREGIVERS

Abstract In ageing societies, more older adults are taking up informal caregiving roles. Caregivers, compared to non-caregivers, are found to have poorer psychosocial outcomes such as loneliness and social isolation in various studies. However, most of this research is not specific to older adult caregivers and does not account for selection bias into caregiving. We compare loneliness and social network between older adult caregivers and older adult non-caregivers in Singapore, applying inverse probability weighted regression adjustment (IPWRA), to address selection bias into caregiving, on data from a nationally representative longitudinal study of older adults. Those providing unpaid assistance to any person because of their health condition were considered as caregivers. Loneliness (score: 0-12; higher score=lonelier) and social network (0-60; higher score=greater network) were measured using validated scales. The relationship of caregiving status with loneliness and social network was estimated using IPWRA, controlling for multiple demographic and health characteristics. Of the 2639 respondents, 7.2% were caregivers. Older adult caregivers, versus non-caregivers, were more likely to experience loneliness (average treatment effect [ATE] β-coefficient for loneliness score: 0.328 (95% confidence interval: 0.011-0.645; p-value: 0.042); and odds ratio for being lonely: 1.080 (1.001-1.165); p-value: 0.047). However, they did not differ in terms of their social network (ATE β-coefficient for social network score: 1.456 (-0.405-3.316); p-value: 0.125). Our findings suggest that even with a similar extent of social network, older adult caregivers are at a higher risk of loneliness, i.e., perceived social isolation or relational deficits, compared to non-caregivers.

Does participation in innovation platform improve welfare? Insights from smallholder maize farmers in Ghana

This paper investigates the impact of participation in innovation platforms (IPs) on smallholder maize farmers’ welfare in the Brong Ahafo region of Ghana using data collected from 477 rural farm households. We employed the doubly robust inverse probability weighted regression adjustment method (IPWRA) and propensity score matching (PSM) approach to examine the impact of IP participation on yield, income, and per capita consumption expenditure. The empirical results show that age, farming experience, farm size, land ownership, and credit access are the main determinants of participation in IPs in Ghana. In addition, the results show that participation in IPs increases yields and household income and reduces per capita expenditure of smallholder maize farmers in Ghana. Furthermore, the advantages of engaging in the IPs go beyond the traditional extension service delivery approach. This highlights the importance of policymakers and agricultural development agencies in developing nations to establish policies that encourage the establishment of IPs and promote their involvement among small-scale farmers, resulting in better living standards.

Occupational feminization, gender, and wages: evidence from Thailand

This study examines the relationship between occupational feminization and wages in Thailand using the Thailand Labor Force Survey data (LFS) (2008-2017). Employing the Augmented Inverse Probability Weighting (AIPW) and the Inverse Probability Weighted Regression Adjustment (IPWRA) double robust matching techniques, this study investigates the effects of occupational feminization and the interaction effect of occupational feminization and gender on wages. The findings indicate that occupational feminization decreased wages in Thailand, and the negative effect weakened over time. While the gender wage gap persisted in feminized occupations over the years, there was a reduction in the gender wage gap in non-feminized occupations. The wage gap between females in feminized occupations and males in non-feminized occupations decreased over time, even though it remained larger than the overall gender wage gap. Male workers continued to take advantage and ride the “glass escalator” in both feminized and non-feminized occupations.

Soil and water conservation measures and rainfed agriculture in Telangana, India: Role of community and neighborhood conservation measures

Soil erosion is a significant problem in rain-fed areas in India. This study attempts to evaluate the causal effects of on-farm soil and water conservation (SWC) measures on farm profit and yield. The study uses the inverse-probability-weighted regression adjustment (IPWRA) method to assess the causal impact of SWC measures on agriculture output while controlling socioeconomic, institutional, and village-level characteristics. The results suggest a significant difference in overall agricultural profit, crop-wise profit, and crop-wise yields among the adopters and non-adopters of the SWC measures. The study highlights that there is a complementarity between the causal impact of community-level SWC measures and individual SWC measures on agricultural outcomes. Further, the neighbor’s adoption of SWC measures plays a pivotal role on farmer’s agricultural profits. The study highlights that farmer’s profit for rainfed crops such as maize further increases if their adjacent neighbors also undertake SWC measures. Such complementary effects, however, are not observed in case of irrigated crops such as paddy.

Outcomes of Trauma "Walk-Ins" in the American College of Surgeons Trauma Quality Program Database.

Outcomes of trauma "walk-in" patients (using private vehicles or on foot) are understudied. We compared outcomes of ground ambulance vs walk-ins, hypothesizing that delayed resuscitation and uncoordinated care may worsen walk-in outcomes. A retrospective analysis 2020 American College of Surgeons Trauma Quality Programs (ACS-TQP) databases compared outcomes between ambulance vs "walk-ins." The primary outcome was in-hospital mortality, excluding external facility transfers and air transports. Data was analyzed with descriptive statistics, bivariate, multivariable logistic regression, including an Inverse Probability Weighted Regression Adjustment with adjustments for injury severity and vital signs. The primary outcome for the 2019 (pre-COVID-19 pandemic) data was similarly analyzed. In 2020, 707,899 patients were analyzed, 556,361 (78.59%) used ambulance, and 151,538 (21.41%) were walk-ins. We observed differences in demographics, hospital attributes, medical comorbidities, and injury mechanism. Ambulance patients had more chronic conditions and severe injuries. Walk-ins had lower in-hospital mortality (850 (.56%) vs 23,131 (4.16%)) and arrived with better vital signs. Multivariable logistic regression models (inverse probability weighting for regression adjustment), adjusting for injury severity, demographics, injury mechanism, and vital signs, confirmed that walk-in status had lower odds of mortality. For the 2019 (pre-COVID-19 pandemic) database, walk-ins also had lower in-hospital mortality. Our results demonstrate better survival rates for walk-ins before and during COVID-19 pandemic. Despite limitations of patient selection bias, this study highlights the need for further research into transportation modes, geographic and socioeconomic factors affecting patient transport, and tailoring management strategies based on their mode of arrival.

Outcomes of Veterans Treated in Veterans Affairs Hospitals vs Non–Veterans Affairs Hospitals

Many veterans enrolled in the Veterans Affairs (VA) health care system have access to non-VA care through insurance and VA-purchased community care. Prior comparisons of VA and non-VA hospital outcomes have been limited to subpopulations. To compare outcomes for 6 acute conditions in VA and non-VA hospitals for younger and older veterans using VA and all-payer discharge data. This cohort study used a repeated cross-sectional analysis of hospitalization records for acute myocardial infarction (AMI), coronary artery bypass graft (CABG), gastrointestinal (GI) hemorrhage, heart failure (HF), pneumonia, and stroke. Participants included VA enrollees from 11 states at VA and non-VA hospitals from 2012 to 2017. Analysis was conducted from July 1, 2022, to October 18, 2023. Treatment in VA or non-VA hospital. Thirty-day mortality, 30-day readmission, length of stay (LOS), and costs. Average treatment outcomes of VA hospitals were estimated using inverse probability weighted regression adjustment to account for selection into hospitals. Models were stratified by veterans' age (aged less than 65 years and aged 65 years and older). There was a total of 593 578 hospitalizations and 414 861 patients with mean (SD) age 75 (12) years, 405 602 males (98%), 442 297 hospitalizations of non-Hispanic White individuals (75%) and 73 155 hospitalizations of non-Hispanic Black individuals (12%) overall. VA hospitalizations had a lower probability of 30-day mortality for HF (age ≥65 years, -0.02 [95% CI, -0.03 to -0.01]) and stroke (age <65 years, -0.03 [95% CI, -0.05 to -0.02]; age ≥65 years, -0.05 [95% CI, -0.07 to -0.03]). VA hospitalizations had a lower probability of 30-day readmission for CABG (age <65 years, -0.04 [95% CI, -0.06 to -0.01]; age ≥65 years, -0.05 [95% CI, -0.07 to -0.02]), GI hemorrhage (age <65 years, -0.04 [95% CI, -0.06 to -0.03]), HF (age <65 years, -0.05 [95% CI, -0.07 to -0.03]), pneumonia (age <65 years, -0.04 [95% CI, -0.06 to -0.03]; age ≥65 years, -0.03 [95% CI, -0.04 to -0.02]), and stroke (age <65 years, -0.11 [95% CI, -0.13 to -0.09]; age ≥65 years, -0.13 [95% CI, -0.16 to -0.10]) but higher probability of readmission for AMI (age <65 years, 0.04 [95% CI, 0.01 to 0.06]). VA hospitalizations had a longer mean LOS and higher costs for all conditions, except AMI and stroke in younger patients. In this cohort study of veterans, VA hospitalizations had lower mortality for HF and stroke and lower readmissions, longer LOS, and higher costs for most conditions compared with non-VA hospitalizations with differences by condition and age group. There were tradeoffs between better outcomes and higher resource use in VA hospitals for some conditions.

Does Participation in the “Grain for Green Program” Change the Status of Rural Men and Women? An Empirical Study of Northeast China

The Grain for Green (GfG) program is an afforestation project created by the Chinese Government to protect the environment. Farmers who participate in GfG return farmland to forest. Losing arable land means losing an income source, so farmers have to reorient their livelihood strategies, leading to potential changes in the gender division of labor. To assess gender differences in the impact of policies, we use indicators from the Women’s Empowerment in Agriculture Index (WEAI), which measures the status of women relative to that of men. Using sex-disaggregated data from farmers in mountainous areas of northeast China and applying the inverse probability weighted regression adjustment (IPWRA) estimator, we found that the status of men and women had increased with GfG participation, but women’s status had improved more than men’s. However, this was not because of their smooth participation in the program, but because of its challenges. Their decision-making skills improved unexpectedly due to pressure to protect their interests. Rural women worried about their families’ livelihoods, so they tried to improve their family welfare and diversified their income sources. In this process, women had more interactions with outside communities. Our results underline the strong need to continuously monitor the gender impacts of environmental policies.