Mathematica Policy Research Research Articles

Home visiting: A lifeline for families during the COVID-19 pandemic

Home visiting: A lifeline for families during the COVID-19 pandemic

Ensuring Equitable Access to School Meals

Ensuring Equitable Access to School Meals

Medicaid's Institutions for Mental Diseases (IMD) Exclusion Rule: A Policy Debate-Argument to Retain the IMD Rule.

Medicaid's Institutions for Mental Diseases (IMD) Exclusion Rule: A Policy Debate-Argument to Retain the IMD Rule.

Overcoming Obstacles to Preparing for College

This research study examines the major obstacles low-income rural youth face in preparing to attend college and how to overcome these obstacles through the participation in an Upward Bound program. The data for this study are from a single-site of the regular (“Classic”) Upward Bound program at a public university in a rural New England state and include surveys and interviews with students, guidance counselors, and parents and/or guardians of Upward Bound students. The results of this study indicated that there are two primary barriers that low-income rural students face in preparing for college: financial and social. Students and parents considered applying to the program not only for academic reasons but also for financial and social reasons. Once enrolled in the program, rural students began to benefit academically, financially, and socially. The retention rate at this public university is significantly higher than the national retention rate reported by Mathematica Policy Research, Inc. Several recommendations for practice for rural Upward Bound programs and high schools serving rural Upward Bound-eligible students are included.

When evidence-based literacy programs fail

More than ever, educators are expected to implement evidence-based interventions to improve student outcomes. This is often easier said than done, as illustrated by a recent study by Mathematica Policy Research in Oakland, California. To help secondary students who were several years behind in reading, the district piloted an intensive program for struggling readers that had been proven to work in early grades. The study showed that the intervention was difficult to implement in secondary schools and actually did more harm than good. The findings highlighted the importance of considering context and implementation, in addition to evidence of effectiveness, when choosing an intervention program.

The need for better marijuana sales data.

As marijuana markets open, tracking key transaction information is important for public health and economic analysis. Washington State's seed-to-sale database appears to have had little oversight and non-standard reporting, leading to a database less promising than its potential should allow for measuring cannabinoid levels and relating potency to price. Documenting and studying the dynamics of legal marijuana markets in terms of product types and cannabinoid availability are important additions to this emerging policy area. Smart et al. 1 provide a valuable report on how the Washington state market has moved towards higher potency products. Putting aside whether this violates the Iron Law of Prohibition, or questions of model specification or over-powered analysis, we wish to draw attention to the need for better data. Imagine how much stronger the conclusions of Smart et al. might have been without measurement error in both potency and price, and with the ability to analyze across product types. Our experience with these same data has revealed numerous problems with the potency results, some of which are hinted at in Smart et al., as when they note that: ‘unlike with edibles, their [usable marijuana and extracts for inhalation] potency characteristics are readily retrievable from the traceability data’ (p. 2). The database has fields for Total tetrahydrocannabinol (THC), THC, tetrahydrocannabinolic acid (THC-A) and cannabidiol (CBD) potency results. Our experience has shown idiosyncratic use of these fields by those inputting the traceability data as mandated by the state Liquor and Cannabis Board (LCB). Some appear to ignore the Total THC field, some simply repeat the THC result and some provide the sum of THC and CBD or (possibly) of all cannabinoids. Data problems include: potency profiles with minimal CBD reported in which Total THC and/or THC are less than 1 (perhaps reporting a proportion); edibles listed at 80 or more for either THC or CBD, which appears to be the total milligrams for the 10-pack; and topicals described as ‘5 ampules—300 mg’ where the total THC is 68.8 or 93.1. The inconsistencies within potency results and between potency and marketing are troubling. There appears to be no guidance from the LCB as to how to report potencies, and so we are left to guess whether small values are proportions, results are for a single serving or the whole package and results for liquids are in milligrams, percentage by weight or percentage by volume. (We should note that the LCB announced recently that the tracking database is going to be revised with a new vendor.) This is why Smart et al. smartly apply the formula Total THC = THC + .877 × THC-A to all observations before analysis, drop observations with adjusted Total THC of 0 or greater than 100%, and swiftly drop all product types but usable marijuana, apparently concluding that even the concentrates are problematic. This may be borne out in their histograms of potency, which appear to indicate very low potency concentrates. While limiting potencies to the range of 0–100 eliminates clearly impossible results, the idiosyncratic entry of the potency fields means the remaining data are measured with some unknown level of error. We have seen similar inconsistency in the pricing field, RetailPrice: some appear to report the per-package price before any discounts, while most assume this is the total amount paid for all similar packages in that transaction. Within the usable marijuana category, this amounts to measurement error in potency and perhaps price, which lowers the power of any analysis regressing one on the other. A full analysis of how recreational users might be moving to more potent forms of marijuana and the price elasticity of potency, however, would require having comparably valid data on the prices and potencies of all forms of marijuana. Our experience, and the analytical choices of Smart and colleagues, reveal that the vast Washington state seed-to-sale database does not contain the requisite data. There are fields that might collect these data, but currently those fields are mostly useless. We hope that Washington, and any other states with comparable data systems, will collect clear, accurate and useful data in the future. Contributions of J.R.W and C.B-G. funded in part by the Washington State Dedicated Marijuana Fund for research at the University of Washington, sourced from marijuana excise taxes. C.B-G. and D.A.B. funded in part by NIH/NIDA R03DA038806. D.A.B. is a paid consultant for Mathematica Policy Research on a study of marijuana use funded by the Massachusetts Department of Public Health. None.

Lower buffet prices lead to less taste satisfaction

Lower buffet prices lead to less taste satisfaction

Re-Defining the Who, When, and Where of Mentoring for Professional Statisticians

ABSTRACTOrganizations tailor their mentoring strategies to accommodate internal resources and preferences, producing different approaches in academic, government, and corporate environments. Across these settings, three common barriers impede effective mentoring of statisticians: overspecialization, time constraints, and geographic dispersion. The authors share mentoring strategies that have emerged at their organization, Mathematica Policy Research, to overcome these obstacles. Practices include creating a methodology working group to unite researchers with diverse backgrounds, integrating mentoring into existing workflows, and harnessing modern technological infrastructure to facilitate virtual mentoring. Although these strategies emerged within a specific professional context, they suggest opportunities for statisticians to expand the channels through which mentorship can occur.

Supplemental Nutrition Assistance Program Reform:: Retail Requirements, Eligible Foods.

The Supplemental Nutrition Assistance Program (SNAP) supports 45 million people, mostly children, elderly, and disabled individuals, at risk for food insecurity. Congress’s Declaration of SNAP Policy states that the program’s goal is to alleviate hunger and malnutrition by raising the levels of nutrition among low-income households. 1 Supplemental Nutrition Assistance Program, 7 USC § 2011 et seq. SNAP has been found to successfully reduce food insecurity 2 Mabli J, Ohls J, Dragoset L, Castner L, Santos B. Measuring the Effect of Supplemental Nutrition Assistance Program (SNAP) Participation on Food Security. Prepared by Mathematica Policy Research for the U.S. Department of Agriculture, Food and Nutrition Service. http://www.fns.usda.gov/sites/default/files/Measuring2013.pdf. Accessed Published August 2013. September 1, 2016 Google Scholar ; however, the program does not seem to be meeting its nutrition-related goals. SNAP participants consume more foods associated with chronic disease, such as sugary beverages, and less foods considered healthful than income-eligible nonparticipants. 3 Leung C.W. Blumenthal S.J. Hoffnagle E.E. et al. Associations of food stamp participation with dietary quality and obesity in children. Pediatrics. 2013; 131: 463-472https://doi.org/10.1542/peds.2012-0889 Crossref PubMed Scopus (79) Google Scholar , 4 Leung C.W. Ding E.L. Catalano P.J. Villamor E. Rimm E.B. Willett W.C. Dietary intake and dietary quality of low-income adults in the Supplemental Nutrition Assistance Program. Am J Clin Nutr. 2012; 96: 977-988https://doi.org/10.3945/ajcn.112.040014 Crossref PubMed Scopus (166) Google Scholar As a result, SNAP participants’ Healthy Eating Index scores have been assessed to be 10% lower than low-income nonparticipants due to lower scores for fruits, vegetables, whole grains, solid fats, added sugar, and alcohol. 5 Gregory C. Ver Ploeg M. Andrews M. Coleman-Jensen A. Supplemental Nutrition Assistance Program (SNAP) Participation Leads to Modest Changes in Diet Quality. US Department of Agriculture, Economic Research Service, Washington, DCApril 2013 Google Scholar Moreover, adult SNAP participants are significantly more likely to be obese than income-eligible nonparticipants. 6 Condon E. Drilea S. Jowers K. et al. Diet Quality of Americans by SNAP Participation Status: Data from the National Health and Nutrition Examination Survey, 2007−2010. Prepared by Walter R. McDonald & Associates, Inc. and Mathematica Policy Research for the Food and Nutrition Service. U.S. Department of Agriculture, Food and Nutrition Service, Alexandria, VA2015 Google Scholar Supplemental Nutrition Assistance Program, 7 USC § 2011 et seq. Supplemental Nutrition Assistance Program, 7 USC § 2011 et seq. U.S. Public Law 93-86 (August 10, 1973).

Book Reviews

Matthew T. Johnson of Mathematica Policy Research reviews “Job Skills and Minority Youth: New Program Directions,” by Barton J. Hirsch. The Econlit abstract of this book begins: “Evaluates the After School Matters program in Chicago, concentrating on the domain of marketable job skills or youth workforce development, and assesses the incorporation of a job interview training program. Aimed at readers whose primary interest is in programs to increase minority youth employment, as well as in developing positive youth programs. Discusses preparing youth for work; whether the youth in After School Matters have more marketable job skills; a comparison of the strongest and the weakest apprenticeships; which apprenticeship has the best model for scaling up; what human resource interviewers reported about youth employability; a program for teaching youth how to do well in job interviews; and guidelines for the future.”

Federal Expenditures on Children: What Budget Policy Means for Children's Policy and commentaries

Federal Expenditures on Children: What Budget Policy Means for Children's Policy and commentaries

Effective Evidence-Based Programs For Preventing Sexually-Transmitted Infections: A Meta-Analysis.

Educational programs for preventing sexually transmitted infections (STIs) have often been implemented in different settings and populations. Mathematica Policy Research and Child Trends conducted a systematic review of 289 evidence-based interventions aiming to reduce STIs and sexual risk behavior in adolescents in the United States. These interventions were published between 1989 and 2012. We conducted a meta-analysis of the interventions that assessed incidence of STIs at follow up, and we identified key characteristics of successful interventions. Results showed that on average interventions reduced incidence roughly from 7 to 6 out of 100 people (17% relative risk reduction (RRR)). Interventions focused on abstinence had no effect, while comprehensive education programs aiming to improve skills and promote safe sexual practices reduced risk by 4 percent (23% RRR). In particular, interventions teaching condom use skills or communication and negotiation skills reduced incidence of STIs by 3 to 4 percent (30% RRR). Finally, interventions decreasing frequency of intercourse or number of sexual partners and interventions increasing condom use also reduced incidence of STIs by 5 to 7 percent (28-36% RRR). Overall properly designed interventions with the above-mentioned characteristics can achieve a 30% reduction of STI incidence. Implications for designing successful interventions to prevent STIs in adolescents are discussed.

Discourse Analysis of Curriculum on Sexuality Education: FLASH for Special Education

Family life and sexual health (FLASH) is the chosen sexuality education curriculum for special education in both King County (Washington) and Multnomah County (Oregon), the most populous in the two states. FLASH is currently undergoing a longitudinal, randomized, behavioral evaluation by Mathematica Policy Research, Inc., supported by the U.S. Department of Health and Human Services, for which the results will be available in 2015 (King County, n.d.). Using discourse analysis to examine the FLASH curriculum, I deconstruct and highlight the dominant discourse(s) and discursive frameworks that construct and maintain the concept of intellectual/developmental disability (I/DD) as it has historically been understood. I argue that FLASH, similar to other sexuality education curricula for special education, highlights the discourse of I/DD over sexuality. As social workers, we work closely with not only schools and support services, but also the I/DD labeled community, including family members and caregivers. Social workers have an ethical duty, per the National Association of Social Workers’ (NASW) Code of Ethics, to advocate for social justice, respect the inherent dignity and worth of persons, and recognize the importance of human relationships. However, the dominant discourse maintained and supported by this curriculum is in direct opposition to the NASW ethics, leading to a call for social workers to advocate for a change in sexuality education curricula.

The American Reinvestment and Recovery Act investment in comparative effectiveness research: lessons learned and implications for future investments.

2014 The Journal of Comparative Effectiveness Research is pleased to bring you this special issue examining the lessons that have been learned following the American Reinvestment and Recovery Act (ARRA) investment in comparative effectiveness research (CER), guest edited by Sheldon Greenfield (U niversity of California, Irvine). The ARRA was signed into law in the USA in 2009, and involved economic stimulus in many areas, including healthcare. Specifically, the Act assigned US$1.1 billion to study the comparative effectiveness of h ealthcare treatments. This special issue of the Journal of Comparative Effectiveness Research presents initial findings from a midstream assessment conducted by Mathematica Policy Research. This unique portfolio of investments included more than 420 projects managed by major US government agencies and conducted by university researchers and private sector contract research firms. The articles included here describe the ARRA CER investments at a high level, provide detailed analysis of core areas of the investment, identify public perceptions of CER at the time of the investment, and includes lessons learned for future investments in CER. The issue also includes research conducted by AcademyHealth, focusing on ARRA CER infrastructure investments, including those to support learning health systems. The accomplishments achieved to date bode well for the future for CER; it is worth bearing in mind that many of the principles and methods being used in these projects were only just being developed at the time the ARRA funding was awarded. Indeed, some of these principles (including, for example, proper comparisons, heterogeneity of treatment effects, stakeholder engagement, assessment of harms and electronic data infrastructure, among others), are being addressed intensively in current waves of research. The articles are accompanied by opinion articles from leaders in the field of CER and health policy in the USA, including AcademyHealth, the Agency for Healthcare Research and Quality and the PatientCentered Outcomes Research I nstitute. We hope that this issue will provide a valuable insight into the ARRA CER investment to date, and provide useful information for future investments. We very much welcome your comments on the current issue, and input and feedback for future features and articles.

Does marriage affect survival among the elderly in China?

Q. HUANG, G. CHEN. Does marriage affect survival among the elderly in China? Gerontechnology 2014; 13(2):214; doi:10.4017/gt.2014.13.02.329.00 Purpose Marriage provides key social ties that can offer both economic and social advantages and thus protect people against poor health outcomes1. However, research related to the link between marriage and mortality are not as rigorous as other research topics due to limitations in research such as selection bias and limited sampling, when compared with the links between marriage and other health outcomes2,3. This paper attempts to present more rigorous evidence by using the Cox Model to analyze the relationship with longitudinal data and provide some insight on this issue. Method Five sets of data collected in 1998, 2000, 2002, 2005 and 2008 are derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and 8,589 subjects were included after deleting samples with missing data. To enhance the statistical power, missing data was input using the values of the same variable in the former or latter survey. Current marital status is divided into two categories including ‘married’ and ‘unmarried’, and the quality of previous marriages were measured by the total evaluation scores of all relationship histories with former spouses. Basic survival function curves and correlative methods (log-rank tests) were used to explore associations between socio-demographic factors together with dynamics of current marriages, marital history status and changes in survival time. Cox’s semi-parametric regression model was used to explore the marital effects on survival time. Results & Discussion Of people analyzed in this study, 37%, 33.1%, 49.7%, 45.8% of the subjects died in 1998–2000, 2000– 2002, 2002–2005 and 2005–2008, respectively. The total time at risk was 341,311 person-months; average survival time was 39.7 months. Those who were married were more likely to survive longer than unmarried people (Figure 1) and the survival rate between married and unmarried people were significantly different throughout the log-rank tests. The hazard ratio of death of married people is 23% lower than those who are unmarried (p=0.000) and those who have a better evaluation of marriage history are likely to survive longer than unmarried people (p=0.057) after controlling for other covariates. For the elderly, marriage can protect health by providing emotional support and care services; thus married people live longer than those who are not married. This result is consistent with other studies4. Social initiatives, such as designing specific marriage markets as well as social networking and communication tools that help elderly get remarried, or entertainment robots to reduce loneliness for singles or widows should be launched to reduce the negative effects of being unmarried in order to improve the longevity of the elderly.

Do In-person Interviews Reduce Bias in a Mixed-Mode Survey of Persons with Disabilities?

For people with certain disabilities, completing an interview by telephone or mail may be difficult or impossible, making in-person interviews necessary. However, in-person interviews are generally more expensive than telephone or mail and may be cost prohibitive for large samples. The National Beneficiary Survey (NBS), sponsored by the Social Security Administration (SSA), is a multiwave survey of persons who receive Supplemental Security Income (SSI) or Social Security Disability Income (SSDI). The survey was conducted four times between 2004 and 2010 by Mathematica Policy Research using computerassisted telephone interviewing (CATI) with computer-assisted personal interviewing (CAPI) follow-up for telephone nonrespondents.1 We achieved significant cost savings by limiting field operations to only those beneficiaries who could not be reached or interviewed by telephone. The mixed mode design also furnished higher response rates than would be achievable with a telephoneonly design. The purpose of this analysis was to assess whether survey estimates would be affected if CAPI was scaled back or eliminated in the NBS. Specifically, we compared respondent attributes and responses for three groups of overlapping respondents:

The HCBS taxonomy: a new language for classifying home- and community-based services.

As states make home- and community-based services (HCBS) more accessible, researchers have become more interested in understanding service use and spending. Because state Medicaid programs differ in the types of services they offer and in how they report these services, analyzing HCBS at the national level is challenging. Describe the HCBS taxonomy and present findings on HCBS waiver expenditures and users. This brief analyzed fee-for-service claims from 28 approved states in 2010 Medicaid Analytic eXtract (MAX) files. We summed all expenditures and counted the unique number of users across each HCBS taxonomy service and category. The taxonomy was developed jointly by Truven Health (at that time Thomson Reuters) and Mathematica Policy Research, with stakeholder input, and reviewed using procedure codes. Today, the taxonomy is organized by 18 categories and over 60 specific services. For calendar year 2010, 28 states spent almost $23.6 billion on HCBS, with 80 percent of expenditures categorized as round-the-clock, home-based, and day services. Other services, such as case management, or equipment, modifications, and technology were widely used, but are not particularly costly and do not account for a large proportion of expenditures in every state. By providing a common language, the taxonomy presents detailed information on services and makes it easier to assess and identify state-level variation for HCBS.

Collaborative Care Well Suited to New Medicaid Health Home Option

Collaborative Care Well Suited to New Medicaid Health Home Option

Revised Design for the Mother and Infant Home Visiting Program Evaluation

Home visiting programs in the United States seek to improve maternal and child health, child development, and family economic self-sufficiency by supporting and educating families with young children. Today, home visiting is seen as an important strategy for high-risk families who may be difficult to engage in other services. The Patient Protection and Affordable Care Act (ACA) of 2010 included $1.5 billion over five years for states to operate the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. It also required a national evaluation of the programs. This document describes the design of that evaluation — the Mother and Infant Home Visiting Program Evaluation (MIHOPE). MIHOPE was launched in 2011 by the Administration for Children and Families and the Health Resources and Services Administration within the U.S. Department of Health and Human Services. The evaluation is being conducted by MDRC in partnership with Mathematica Policy Research, James Bell Associates, Johns Hopkins University, the University of Georgia, and Columbia University.MIHOPE will include the following components:-An analysis of state needs assessments will describe the communities that states chose to target with MIECHV program services.-An implementation study will collect information on the services provided by local programs as well as the factors that helped shape those programs.-An impact analysis will estimate the effects of home visiting programs on family outcomes, both overall and for key subgroups of families.-An economic analysis will assess program costs and savings.The study will include approximately 5,100 families with a pregnant woman or a child under 6 months old. Families who enroll in the study will be randomly assigned to a home visiting group or to a comparison group that can use other services available in their community. Families will be spread across about 85 local programs in about 12 states. Sites must be operating one of four national models of home visiting: Early Head Start-Home Visiting Option, Healthy Families America, Nurse-Family Partnership, or Parents as Teachers. These four models were chosen because they are being implemented using MIECHV program funds in at least 10 states.Data for the implementation and impact studies will be collected from a variety of sources, including interviews with parents; observations of the home environment; observed interactions of parents and children; direct assessments of children’s development; observations of home visitors in their work with families during home visits; logs, observations, and interviews with home visitors, supervisors, and program administrators; program model documentation from program developers, grantees, and local sites; and administrative data on child abuse, health care use, maternal health, birth outcomes, and employment and earnings.The study will produce a report to Congress in 2015 that includes information on families and sites included in the evaluation as well as information on how states made decisions about how to spend home visiting funds. Later reports will provide more information on program implementation, the effects of home visiting programs for families, and the features of programs that are associated with larger effects.

Ensuring Data Quality: What Criteria do Monitors Use to Rate Interviewers?

Like most survey research organizations, Mathematica Policy Research monitors telephone interviewers to ensure that they collect high-quality data. Monitors identify problems with survey questions, recommend interviewing techniques, and retrain interviewers whose performance do not meet expectations. Because monitoring is a critical quality assurance tool, we are interested in understanding the behavior of monitors – specifically, their ability to provide effective and consistent feedback on interviewers’ performance. Mathematica implements several best practices to promote monitoring consistency: