Participation Rates In Programs Research Articles

Enrollment and participation in a universal child savings program: Evidence from the rollout of Israel's National Program

Child Development Accounts (CDAs) are savings or investment accounts typically opened at birth or during a child's early years with the aim of promoting savings and asset accumulation for child development purposes, such as post-secondary education or homeownership. Beginning in January of 2017, the Israeli government established a universal CDA program called the Saving for Every Child Program (SECP). Under the program, every Israeli child gets a personal investment fund into which the government makes monthly contributions, and parents can further opt to make additional monthly deposits and change the default deposit location for these funds (a savings account versus an investment fund). Using population-level administrative data, this paper examines SECP enrollment and participation patterns for the first six months following the program's inception. We observe generally high rates of program participation among SECP-eligible households. However, we also find that more affluent, better educated, more employed, and ethnic majority households tend to engage with the program at higher rates and in ways that will likely yield higher economic returns in the future. These results indicate that while the SECP, as currently designed, may increase the overall financial security of Israelis, it may also contribute to growing economic inequality.

Energy efficiency and energy justice for U.S. low-income households: An analysis of multifaceted challenges and potential

Energy poverty intertwines with the issues of energy inequality and energy justice, presenting a particular challenge for low-income households (LIHs). This study explores energy justice in the U.S. through the lens of several interconnected questions: Do energy assistance programs have adequate participation rates? How accessible are energy efficiency (EE) appliances? Are there different energy practices across income groups? How does time schedule of energy practices differ across income groups, and how is it connected to energy demand flexibility? Based on two representative data sets, this study finds that affordability and accessibility remain serious problems for LIHs. LIHs have lower participation rates in many EE programs and own fewer EE appliances and smart grid technologies. Additionally, thermostat control strategies are different across income levels. LIHs tend to set one fixed temperature, even when they own a programmable thermostat, which is less energy efficient. LIHs engage in more energy practices throughout the daytime than their counterparts and show the least pronounced morning and evening peaks, indicating a relatively inflexible schedule and barriers to accepting demand response programs. This study concludes with policy implications for making energy more affordable, accessible, flexible, and better for the environment, while being fair to those often underserved.

Promoting Enrollment in Parenting Programs Among a Filipino Population: A Randomized Trial.

Evidence-based parenting programs prevent the onset and escalation of youth conduct problems. However, participation rates in such programs are low among hard-to-reach populations, including Filipino individuals. Compared with other ethnic groups, Filipino adolescents have significant mental health disparities. We evaluated the effectiveness of a theory-based, culturally tailored video versus a usual-care mainstream video on enrollment in an evidence-based parenting program among Filipino caregivers of children ages 6 to 12 years and tested theoretical mediators of intervention effect. We randomly assigned 215 Filipino participants to view either a theory-based, culturally tailored video based on the Health Belief Model and Theory of Planned Behavior or a control video. The primary outcome was actual enrollment in an evidence-based parenting intervention. Mediators (knowledge and perceived susceptibility) were modeled as latent variables in a structural equation model. After the intervention, participants in the intervention group had significantly higher knowledge of Filipino adolescent behavioral health disparities and higher perceived susceptibility to adolescent risky sexual activity and illegal drug use. Controlling for child sex, parents in the intervention group had significantly greater odds of actual enrollment in the Incredible Years program (odds ratio = 2.667; 95% confidence interval: 1.328-5.354; P = .006). The intervention effects were mediated by increased knowledge and perceived susceptibility. Results demonstrated the effectiveness of a theory-based, culturally tailored intervention aimed at increasing participation of a hard-to-engage population in parenting interventions. Videos that include parents and health professionals with whom audiences can identify can be used to produce shifts in knowledge and behavior.

Demographic, Social, and Behavioral Determinants of Lung Cancer Perceived Risk and Worries in a National Sample of American Adults; Does Lung Cancer Risk Matter?

Background: Perceived risk and worries of developing cancer are important constructs for cancer prevention. Many studies have investigated the relationship between health behaviors and subjective risk perception. However, factors correlated with lung cancer risk perception and worries in individuals more susceptible to lung cancer have rarely been investigated. Objective: To determine demographic, social, and behavioral determinants of cancer perceived risk and worries and to explore heterogeneities in these associations by the level of lung cancer risk in a nationally representative sample of American adults. Methods: For this cross-sectional study, data came from the Health Information National Trends Survey (HINTS) 2017, which included a 2277 representative sample of American adults. Smoking status, cancer perceived risk, cancer worries, age, gender, race, education, income, and insurance status were measured. We ran structural equation models (SEMs) for data analysis. Results: “Ever smoker” status was associated with higher cancer perceived risk (b = 0.25; 95% CI = 0.05–0.44, p = 0.013) and worries (b = 0.34, 95% CI = 0.18–0.50, p < 0.001), suggesting that “ever smokers” experience higher levels of cancer perceived risk and worries regarding cancer, compared to “never smokers”. Other factors that correlate with cancer perceived risk and worries were race, age, income, and insurance status. Blacks demonstrated less cancer perceived risk and worry (b = −0.98, 95% CI = −1.37–0.60, p < 0.001) in both low and high risk lung cancer groups. However, the effects of social determinants (income and insurance status) and age were observed in low but not high risk group. Conclusions: Determinants of cancer perceived risk and worries vary in individuals depending on the level of lung cancer risk. These differences should be considered in clinical practice and policy makings with the goal of improving participation rates in lung cancer screening programs.

Barriers to skill acquisition: Evidence from English training in India

Abstract Skill development is viewed as an escape from the low education – high unemployment trap in developing countries. Despite investments in skill development programs, participation and completion rates in many programs remain low. We investigate factors that prevent individuals from acquiring spoken English, a skill with potentially high returns in the labour market. Using data from a field experiment in India, we find that offering subsidies increases the probability of participating in a spoken English training program. Simultaneously, distance to the training center, pre-existing knowledge of spoken English, and past enrolment in a similar course act as significant barriers to take-up. These findings suggest that multidimensional policy solutions are required to overcome barriers to skill development in developing countries.

Housing Voucher Take-Up and Labor Market Impacts.

Low participation rates in government assistance programs are a major policy concern in the United States. This paper studies take-up of Section 8 housing vouchers, a program in which take-up rates are quite low among interested and eligible households. We link 18,109 households in Chicago that were offered vouchers through a lottery to administrative data and study how baseline employment, earnings, public assistance, arrests, residential location, and children's academic performance predict take-up. Our analysis finds mixed evidence of whether the most disadvantaged or distressed households face the largest barriers to program participation. We also study the causal impact of peer behavior on take-up by exploiting idiosyncratic variation in the timing of voucher offers. We find that the probability of lease-up increases with the number of neighbors who recently received voucher offers. Finally, we explore the policy implications of increasing housing voucher take-up by applying reweighting methods to existing causal impact estimates of voucher receipt. This analysis suggests that greater utilization of vouchers may lead to larger reductions in labor market activity. Differences in take-up rates across settings may be important to consider when assessing the external validity of studies identifying the effects of public assistance programs.

Low rates of participation and completion of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease in primary health care.

Only 6% of patients with chronic obstructive pulmonary disease (COPD) participate in pulmonary rehabilitation programs (PR) and only 50% of those who participate, complete these programs. To determine rates of PR program participation and completion among patients with COPD in Chile. Analysis of a database available at the Ministry of Health, which included data of 277491 patients with COPD (55% females) and their participation in PR programs, between 2014 and 2016. Forty percent of patients were over 75 years of age. Participation rates in PR programs ranged from 2.4 to 2.9%. Rates of completion ranged from 26 to 36%. There is a low rate of participation in PR programs among patients with COPD. Approximately one third of participants complete these programs.

Geographic Variation in Compliance With FOBT Colorectal Cancer Screening Programs: The Role of Attitudes Toward Health and Help Seeking

Background: Utilization of health services is thought to vary between urban and nonurban residents. In Australia, colorectal cancer (CRC) patients in peri-urban and rural areas tend to be diagnosed at a more advanced stage than their urban counterparts and have poorer 5 year survival rates. Aim: In this study, we investigate the effect that attitudes toward health and health related help-seeking have on compliance with population CRC screening programs and whether this varied among varied locations. We also examined the rate of recipients complying with overall program guidelines as opposed to the commonly reported participation rates in mail-out screening programs. Methods: A cross-section of recipients (n=371) who reported receiving a mail-out fecal occult blood test (FOBT) as part of the National Bowel Cancer Screening Program (NBCSP) in Australia were surveyed in 2017 regarding compliance. Attitudinal constructs including fatalism, stoicism and consideration of future consequences known to impact health-related help seeking were also measured. Logistic regression models were tested to assess the attitudinal predictors of program compliance in urban, peri-urban and rural groups. Results: Program participation (% returning kits) was relatively even across geographical locations, however, compliance with overall screening guidelines (returning kit or engaging in suitable alternative) was significantly lower in peri-urban, compared with urban, areas. Higher levels of stoicism and lower levels of consideration for future consequences were associated with lower NBCSP compliance in rural and peri-urban, but not urban areas. Fatalism was not associated with NBCSP compliance. Conclusion: Attempts to increase compliance with mail-out CRC screening program guidelines need to consider the use of appropriately tailored interventions that reflect the different ways in which socio-cultural and psychological factors impact cancer screening practices in geographically diverse communities. Interventions to enhance compliance in nonurban areas should promote the consideration of one's future, and discourage stoic attitudes to health.

Bowel Cancer Screening Participation in Rural Tasmania: A Comparative Case Study of Four Local Government Areas

Background: Bowel cancer is a preventable condition, yet it is the second most common cancer after prostate cancer, with one in 12 Australians developing the disease by age 85. If detected early, the chances of survival are very high. One way to detect bowel cancer before it becomes a problem is through the use of a screening kit. The Australian government has distributed free kits to specific age groups since 2006, through their National Bowel Cancer Screening Program (NBCSP). Participation in the NBCSP is currently quite low (39% Australia-wide). In Tasmania, participation rates among local government areas (LGAs) range from 28% to 47%. These differences in participation are especially apparent in rural and remote areas and form the focus of this research. Aim: Our research aims to determine why there are marked differences in National Bowel Cancer Screening Program participation rates between rural LGAs in Tasmania. Secondary aims include developing future strategies for increased screening uptake in rural Tasmania. Method: A total of four LGAs, identified as having either high (n=2) or low (n=2) NBCSP participation rates, were included in the study. Face to face interviews with community members and stakeholders across the four LGAs were recorded and transcribed to obtain qualitative data. A total of 50 male and female community members aged 50-75 were recruited and interviewed regardless of whether they had used the NBCSP kit. A total of 28 health professionals including doctors, pharmacists, nurses and health promotion officers, working in each of the four LGAs were also interviewed. All interviews were recorded and transcribed. Thematic analysis was conducted to elucidate common barriers and enablers for screening, as well as suggestions for increasing NBCSP participation rates in Tasmania. Demographic data including age, gender, and educational attainment were collected from community members to further identify potential associations with screening participation. Results: All interviews have been successfully completed and transcribed, and thematic analysis has begun. Themes emerging from the data to date include the importance of community connectedness; the role of women in encouraging men to screen; health literacy; new/transient versus established/stable communities; and access to follow-up colonoscopies. Final results will be available shortly and presented in full. Conclusion: The findings from this study will highlight differences and reasons for screening participation in four rural Tasmanian LGAs. The results will have implications for the NBCSP in terms of recommendations for increasing participation in the program.

Reforming the lifeline program: Regulatory federalism in action?

This paper considers whether common national standards for determining participants' eligibility and designating service providers in the Lifeline program are preferable to a decentralized system where state utility commissions have greater influence over these program parameters. Two recent decisions of the Federal Communications Commission (FCC), a 2016 Order and its reversal in March 2017, on the designation of Eligible Telecommunications Carriers to provide broadband Lifeline service, centered on this question. Statistical analysis of program data demonstrates that state-by-state variations in enrollment may be attributed to state-level policy actions, after controlling for alternative demographic and economic explanations. This paper concludes that national standards may reduce state-by-state variations in program participation rates.

Exploring Retirement for Individuals With Intellectual and Developmental Disabilities: An Analysis of National Core Indicators Data.

To begin to understand retirement, we examined age-related differences in (a) employment rates, employment hours, and rates of individual-plan employment goals; and (b) participation rates in unpaid formal day programs. We report weighted analyses of 2014-15 National Core Indicators data from 32 states. Unlike younger age groups, a similar proportion of workers with intellectual and developmental disabilities continued working beyond age 65 as for the general community. We found that most workers with intellectual and developmental disabilities retire in older age and that their retirement appears to be sudden, rather than a gradual reduction in work hours. Facility-based day programs were the only program with an increased participation rate in older age groups, revealing an even greater reliance on facility-based services for older participants.

Health Management in Commercially Insured Populations: It Is Time to Include Social Determinants of Health.

: Employers have been challenged by low employee participation rates in health-related programs, and have often relied on incentives and other engagement approaches to overcome this difficulty. One of the apparent barriers to employee engagement in health-related activities is represented by social determinants of health. According to some, these factors comprise as much as 40% of an individual's health status, and while they have been the focus of attention in the public health domain, their role in the workplace has not been broadly recognized. In this manuscript, we provide an overview of the significance of social determinants of health in the workplace, addressing their influence on employee involvement in health-related offerings. We also acknowledge the unique role of the workplace as both a physical and social determinant of worker health.

Increasing consumer participation rates for green pricing programs: A choice experiment for South Korea

This study examines the factors that can increase consumer participation rates in green pricing programs by conducting a choice experiment in South Korea. Estimation results were obtained from a conditional logit, conditional logit with interaction terms, random parameter logit, random parameter logit with correlation, and individual-level coefficient models. A novelty of our analysis was the consideration of monetary and non-monetary incentives as factors influencing consumer uptake in green pricing programs. The estimation results show that increased consumer participation in green pricing programs is positively linked with green energy sources that produce fewer externalities, more jobs, and monetary incentives such as tax credits or green mileage. However, there is an inverted U-shaped relationship between participation rates and the share of green electricity in total electricity supply. Mean willingness to pay for fuel cells is highest, followed by solar and wind energy. Estimation from the random parameter logit with allowing for correlations among random coefficients of attributes reveals that consumers are divided into ‘green (pro-environment) consumers’ and ‘blue (growth-oriented) consumers’. Green consumers prefer a higher green electricity share, solar or fuel cell to wind, a greater proximity of green power plants to their homes, and green mileage or green parks to tax credits. In comparison, ‘blue consumers’ favor a lower green electricity share, green power plants that are far from their homes, and monetary incentives rather than non-monetary incentives. The results of this study suggest guidelines for the design of successful green pricing programs. Green pricing programs that are designed with information on types of green energy sources, consider the distance of power plants to consumers' residences, focus on the share of green electricity, and incorporate monetary incentives are likely to have increased consumer participation rates.

A Coaching by Telephone Intervention on Engaging Patients to Address Modifiable Cardiovascular Risk Factors: a Randomized Controlled Trial.

A large proportion of deaths and chronic illnesses can be attributed to three modifiable risk factors: tobacco use, overweight/obesity, and physical inactivity. To test whether telephone-based health coaching after completion of a comprehensive health risk assessment (HRA) increases patient activation and enrollment in a prevention program compared to HRA completion alone. Two-arm randomized trial at three sites. Primary care clinics at Veterans Affairs facilities. Four hundred seventeen veterans with at least one modifiable risk factor (BMI ≥ 30, < 150min of at least moderate physically activity per week, or current smoker). Participants completed an online HRA. Intervention participants received two telephone-delivered health coaching calls at 1 and 4weeks to collaboratively set goals to enroll in, and attend structured prevention programs designed to reduce modifiable risk factors. Primary outcome was enrollment in a structured prevention program by 6months. Secondary outcomes were Patient Activation Measure (PAM) and Framingham Risk Score (FRS). Most participants were male (85%), white (50%), with a mean age of 56. Participants were eligible, because their BMI was ≥ 30 (80%), they were physically inactive (50%), and/or they were current smokers (39%). When compared to HLA only at 6months, health coaching intervention participants reported higher rates of enrollment in a prevention program, 51 vs 29% (OR = 2.5; 95% CI: 1.7, 3.9; p < 0.0001), higher rates of program participation, 40 vs 23% (OR = 2.3; 95% CI: 1.5, 3.6; p = 0.0004), and greater improvement in PAM scores, mean difference 2.5 (95% CI: 0.2, 4.7; p = 0.03), but no change in FRS scores, mean difference 0.7 (95% CI - 0.7, 2.2; p = 0.33). Brief telephone health coaching after completing an online HRA increased patient activation and increased enrollment in structured prevention programs to improve health behaviors. CLINICALTRIALS. NCT01828567.

Homeowner acceptance of voluntary property acquisition offers

Property acquisition programs are an important part of government mitigation efforts. Since they are voluntary, understanding how property owners make the decision to accept an offer is critical in determining how best to design such programs and assess their likely success. This paper uses logistic regression analysis of stated preference data collected through a phone survey of residents of Eastern North Carolina to identify the attributes of the property, the homeowner, and the homeowner's attachment to the community that influence the property acquisition decision. The results provide evidence that increased probability of acquisition offer acceptance is associated with location in a floodplain, shorter expected future tenure in the home, having experienced more past hurricanes, less feeling of control, and being White. Additional research is needed to better predict which homeowners will accept a specified offer and overall program participation rates.

Symptoms of Depression and Anxiety as Barriers to Participation in Cardiac Rehabilitation Programs Among Arab and Jewish Patients in Israel

Despite its proven efficacy, low participation rates in cardiac prevention and rehabilitation programs (CPRPs) prevail worldwide, especially among ethnic minorities. This is strongly evident in Israel's Arab minority. Since psychological distress has been found to be associated with CPRP participation and minorities are subjected to higher levels of distress, it is plausible that distress may be an important barrier for CPRP participation among minority patients. The current prospective study assessed the contribution of depression and anxiety symptoms to participation in a CPRP after acute coronary syndrome, both in the enrollment phase and when considering adherence over time, among Jewish (majority) and Arab (minority) patients in Israel. Patients were interviewed during hospitalization about their emotional status and at a 6-mo follow-up concerning participation in a CPRP. Analyses were performed on 397 patients. The Brief Symptom Inventory was used. Logistic regression modeling was applied. Symptoms of depression, but not anxiety, were frequently observed among Arab patients compared with their Jewish counterparts. In analyses adjusted for age, sex, ethnicity, and sociodemographic and clinical characteristics, having symptoms of anxiety was associated with less participation in a CPRP, evident for both Jews and Arabs; this association was less evident for symptoms of depression. Multivariable adjusted models did not show a significant association of symptoms of anxiety or depression with adherence in a CPRP. Accounting for psychological distress did not reduce the sharp difference between Jews and Arabs in CPRP participation. Symptoms of distress may serve as barriers to CPRP participation, regardless of ethnic origin.

Consumer Engagement in Health Care Among Millennials, Baby Boomers, and Generation X: Findings from the 2017 Consumer Engagement in Health Care Survey

The EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey (CEHCS) is an online survey that examines issues surrounding consumer-driven health care, including the cost of insurance, the cost of care, satisfaction with health care, satisfaction with health care plans, reasons for choosing a plan, and sources of health information. It is co-sponsored by the Employee Benefit Research Institute (EBRI) and Greenwald & Associates, with support from seven private organizations. The 2017 survey was conducted online Aug. 10 to Sept. 1, 2017, using the Ipsos’ consumer panel. Over 3,560 adults ages 21−64 who had health insurance provided through an employer, purchased directly from a carrier, or purchased through a government exchange participated in the survey. However, most survey participants (82 percent) received coverage through an employer. The sample was weighted to reflect the actual proportions in the population ages 21–64 with private, health-insurance coverage. This Issue Brief focuses on differences in consumer engagement in health care by generational cohorts – i.e., Millennials, Baby Boomers, and Gen Xers. Key findings: • Millennials are more satisfied than other generational cohorts with various aspects of their health coverage. More than other generational cohorts, Millennials are satisfied with their health coverage, out-pocket costs, and health plan choices. • Millennials and Generation X engage with health care providers differently than Baby Boomers. Baby Boomers are more likely than Gen Xers and Millennials to have a primary care provider (PCP). Among those with a PCP, Baby Boomers are more likely than Generation X and Millennials to report that they make healthier lifestyle choices after seeing a PCP; that it is important that their PCP knows them and their medical history personally; that their PCP is aware of all of the other medical care that they receive; and that they are comfortable telling their PCP about their health issues. Both Millennials and Generation X are more likely than Baby Boomers to report that they have used a walk-in clinic. • Millennials have the highest rates of wellness program participation. Millennials are nearly across the board more likely than Baby Boomers to participate in various aspects of wellness programs. They are more likely to report that they have visited an on-site clinic; made a tobacco-free pledge or participated in a smoking cessation program; participated in counseling or stress management training; participated in activity-based wellness challenges; received reimbursement for fitness club memberships; attended free seminars; and received financial wellness resources. Millennials are less likely than Baby Boomers to have completed a health risk assessment or biometric screenings.

Quality is the Key for Emerging Issues of Population-Based Colonoscopy Screening.

Colonoscopy is currently regarded as the gold standard and preferred method of screening for colorectal cancer (CRC). However, the benefit of colonoscopy screening may be blunted by low participation rates in population-based screening programs. Harmful effects of population-based colonoscopy screening may include complications induced by colonoscopy itself and by sedation, psychosocial distress, potential over-diagnosis, and socioeconomic burden. In addition, harmful effects of colonoscopy may increase with age and comorbidities. As the risk of adverse events in population-based colonoscopy screening may offset the benefit, the adverse events should be managed and monitored. To adopt population-based colonoscopy screening, consensus on the risks and benefits should be developed, focusing on potential harm, patient preference, socioeconomic considerations, and quality improvement of colonoscopy, as well as efficacy for CRC prevention. As suboptimal colonoscopy quality is a major pitfall of population-based screening, adequate training and regulation of screening colonoscopists should be the first step in minimizing variations in quality. Gastroenterologists should promote quality improvement, auditing, and training for colonoscopy in a population-based screening program.

Quality is the key for emerging issues of population-based colonoscopy screening.

Colonoscopy is currently regarded as the gold standard and preferred method of screening for colorectal cancer (CRC). However, the benefit of colonoscopy screening may be blunted by low participation rates in population-based screening programs. Harmful effects of population-based colonoscopy screening may include complications induced by colonoscopy itself and by sedation, psychosocial distress, potential over-diagnosis, and socioeconomic burden. In addition, harmful effects of colonoscopy may increase with age and comorbidities. As the risk of adverse events in population-based colonoscopy screening may offset the benefit, the adverse events should be managed and monitored. To adopt population-based colonoscopy screening, consensus on the risks and benefits should be developed, focusing on potential harm, patient preference, socioeconomic considerations, and quality improvement of colonoscopy, as well as efficacy for CRC prevention. As suboptimal colonoscopy quality is a major pitfall of population-based screening, adequate training and regulation of screening colonoscopists should be the first step in minimizing variations in quality. Gastroenterologists should promote quality improvement, auditing, and training for colonoscopy in a population-based screening program.

Bringing the Effects of Occupational Licensing into Focus: Optician Licensing in the United States

The labor market institution of occupational licensing continues to grow in scope in the United States and abroad. In this paper, we estimate the effects of occupational licensing on opticians using data from the US Census and American Community Survey. Our results suggest that optician licensing is associated with opticians receiving as much as 16.9 percent more in annual earnings. In an examination of malpractice insurance premiums in all states and participation rates in optician certification programs in Texas, we find little evidence that optician licensing has enhanced the quality of services delivered to consumers. By and large, optician licensing appears to be reducing consumer welfare by raising the earnings of opticians without enhancing the quality of services delivered to consumers.