Percentage Of High School Graduates Research Articles

BYM CARBayes Model on data of unemployment in East Java and thus mapping using LISA analysis

East Java is the biggest province in Indonesia with 38 regions that contribute to much unemployment in Indonesia. This article aims to model unemployment in each region by taking any factor that significantly influences the number of unemployment using the BYM CARBayes model. The previous research about spatial modeling on unemployment data are using the SAR and SEM model, and the BYM CARBayes model is usually used for disease mapping. In this research, use the BYM CARBayes model on the data of unemployment in East Java. Furthermore, the fitted number of unemployment is used to map each region in East Java with LISA analysis. The mapping of each region is used to determine the region that has an outlier of unemployment with the number of spatial auto correlation is calculated using Moran’I analysis. The modeled data using the BYM CARBayes give the result that the total population and percentage of high school graduates affect the number of unemployment significantly and negatively. The number of the working-age population, GDP, and the minimum wages in each region are affecting the number of unemployment significantly and positively. The map of each region in East Java using the number of unemployment gives 3 regions with an outlier of unemployment. There are Sidoarjo regency, Gresik Regency, and Surabaya city.

County-Level Health and Demographic Factors and Baby-Friendly Hospital Initiative Facility Birth Rates in the Contiguous US

Abstract Objectives The Baby-Friendly Hospital Initiative (BFHI) is a global effort designed to protect and promote breastfeeding. The BFHI designation in hospitals and birthing facilities may help reduce disparities in breastfeeding in low-resource, vulnerable communities in the US. As such, we evaluated associations between county-level health and demographic factors and birth rates in both established and emerging BFHI facilities. We hypothesized that birth rates among counties with a higher-income, largely White population would be associated with more established BFHI facility births but that rural counties with larger communities of color would be associated with more emerging BFHI facility births. Methods We obtained birth data from American Hospital Association's 2019 survey and information on BFHI designation from Baby-Friendly USA. Next, we geocoded facility locations and then assigned each facility county-level contextual descriptors using demographic information from Robert Wood Johnson's 2019 County Health Rankings data. We employed linear mixed effect modeling to estimate associations between standardized county-level factors and the percentage of emerging and established BFHI facility births after controlling for female population (ages 15–44 years), state grouping structure, and an error structure assumed to be spatially dependent across counties within states. Results Our sample included births from 548 established and 192 emerging BFHI facilities from 1457 counties (about 47% of US counties). We found that violent crime offenses (β 0.04, CI 0.02, 0.06; p = <0.001) and infant mortality were positively associated with birth rates at established facilities. Conversely, higher percentage of teen births (β −0.07, CI −0.1, −0.05; P = <0.001), higher percentage of high school graduates (β −0.02, CI −0.04, −0.001; P = 0.04), and greater rurality (β −0.02, CI −0.04, −0.001; P = 0.04) were negatively associated with established facility birth rates. We did not observe any significant associations for emerging facilities. Conclusions County-level health and demographic factors were significantly associated with percentage of births at established but not BFHI facilities. Targeted interventions to increase BFHI facilities in rural and more vulnerable communities may be warranted. Funding Sources W.K. Kellogg Foundation.

Abstract P4-12-15: Whole breast radiation therapy completion in early stage breast cancer following lumpectomy

Abstract Introduction: Whole breast radiation therapy (RT) has become standard of care in treatment of early-stage breast cancer following lumpectomy. The impact of standard fractionation versus hypofractionated RT on treatment completion has yet to be examined on a nationwide scale. Methods: The National Cancer Data Base (NCDB) from 2004-2015 identified early-stage breast cancer patients having undergone lumpectomy. Standard fractionation whole breast radiation was defined as receipt of at least 46 Gray (Gy) in 1.8-2.0 Gy/fraction. Hypofractionated whole breast radiation therapy was defined as receipt of at least 40 Gy in 2.66-2.70 Gy/fraction. A multivariable logistic regression model characterized completion of RT, adjusting for several factors including patient age, race, insurance status, income, percentage of high school graduates in the region, analytic group stage, fractionation type, geographic location of treatment, facility type, and distance from treatment facility. Results: 105,388 patients with reliable fraction sizes (dose divided by fraction number) were identified, of whom more than 87% completed RT. Compared to patients with a median income of $38,000-$47,999 per year, patients in the lowest median income quartile (less than $38,000 per year) had 1.23 times the odds of not completing RT (OR = 1.23; 95% CI = 1.14-1.32; p < 0.0001). Compared to private insurance, patients with Medicare or Medicaid had 1.23 times the odds of not completing RT (OR = 1.23; 95% CI = 1.18-1.29). More than two-thirds (66.8%) of United States patients with early-stage breast cancer following lumpectomy were treated with standard fractionation compared with 33.2% receiving hypofractionation, yet hypofractionation significantly increased over time (5.2% increase/year; p < 0.0001). RT completion rates were significantly greater following hypofractionation (99.3%) versus standard fractionation (81.0%) on univariable and multivariable analyses, with standard fractionation associated with nearly 37 times the odds of not completing RT compared with hypofractionation [odds ratio (OR) = 36.8; 95% confidence interval (CI) = 32.5-41.7; p < 0.0001] on multivariable analysis. Multivariable analysis revealed that African-American patients (OR = 20; 95% CI = 13.9-28.7; p < 0.0001) and Caucasian patients (OR = 38; 95% CI = 33.2-43.5; p < 0.0001) treated with standard fractionation versus hypofractionation had 20 and 38 times the odds of not completing RT. Conclusions: The majority of radiation therapy for early-stage breast cancer in the United States has remained standard fractionation, however hypofractionation has increased in popularity with time. Overall, patients treated with standard fractionation had 37 times the odds of not completing RT than those treated with hypofractionation. With the potential of hypofractionation to reduce healthcare costs, RT access disparities, and increase rate of RT completion, a wise approach towards improving healthcare in the United States would be to place more of an emphasis on early-stage breast cancer patients receiving hypofractionated radiation therapy. Citation Format: Shearwood McClelland III, Heather N Burney, Richard C Zellars, Ryan M Rhome. Whole breast radiation therapy completion in early stage breast cancer following lumpectomy [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-12-15.

Longitudinal Study of the Vocational and High School Graduation Rate from 2011 to 2016 in Erie County, New York

This study highlighted the discrepancies of education outcomes in urban-suburban settings and the differences between the graduates of vocational high schools and general high schools from 2011 to 2016 in Erie County, New York State, United States. Erie was infamous for racial segregation and the discrepancy of school quality between urban, suburban, and rural areas. New York State Department of Education has invested efforts to improve the education outcomes of vocational and high school education in the region. However, the education outcome gap still existed between those schools. The data source was derived from the School Report Card from 2011 to 2016 published by New York State Department of Education. The outcome variable was the percentage of high school graduates who attained Regent diploma (New York State standard) or the graduation rate. Methods utilized were an independent sample t-test, an analysis of variance, and a hierarchical linear model to measure the difference in longitudinal growth of graduation rate from 2011 to 2016. The results showed that there was a significant difference in the means of the graduation rate between vocational and general high schools. Teacher academic qualifications and certifications had a positive relationship with the graduation rate. The implication of this study called for tremendous efforts to improve the educational outcome, leverage teacher competencies, and close the gap.

STEM learning in regular and vocational high schools on the topic of scientific menu card fabrication

Only a small percentage of high school graduates in Indonesia successfully enter university and the rest returned to their community without life skill. Therefore, it is crucial to stimulate entrepreneurial practices among students by integrating with science and technology. This study was initiated by developing STEM students’ worksheet and subsequently tested the effectiveness for regular and vocational high school students. The worksheet was previously developed with R and D method following STEM syntax on the topic of scientific-menu-card fabrication. The STEM project related to student’s innovation on fabricating of scientific menu card that containing nutritional data and the efficacy of fruit juice beverage. Students respond to STEM learning process were collected based on product assessment sheets, and questionnaire. The vocational students have a higher score in design card which general high school students were better in menu card presentation. There was not significantly different score among students except on indicator of motivation to accomplish the project, entrepreneurship motivation, and vision broadening. Vocational students have better responds on these indicators. STEM worksheet was recommended by students & teachers to use as an alternative teaching material in entrepreneurial learning.

Abstract A89: Estimating potential years of life lost and productivity lost due to avoidable premature colorectal cancer deaths in U.S. counties with lower educational attainment

Abstract Background: Measures of socioeconomic status (SES) are inversely associated with colorectal cancer (CRC) mortality. This study aims to estimate potential years of life lost and productivity lost due to premature cancer deaths among United States residents of lower SES areas, as measured by percentage of high school graduates. Methods: 2008-2012 mortality and population data were used to estimate the number of expected CRC deaths between the ages of 50-74 years by applying the mortality rate from higher SES areas (≥85% high school graduation) to lower SES areas, by race/ethnicity, age, and gender. Excess deaths (observed minus expected deaths) were used to estimate the years of potential life lost (YPLL) and the human capital method was used to estimate productivity lost due to YPLL. Results: Risk of CRC deaths was inversely associated with SES among non-Hispanic whites, non-Hispanic blacks and Hispanics. Of the 85,484 CRC deaths during 2008-2012 in lower SES groups, 16.8% (n=14,398) were potentially preventable if the CRC mortality rates in all areas were the same as higher SES areas. Eliminating avoidable CRC deaths would result in $4.2 billion in productivity gains in men and $2.2 billion in women based on a 3% discount rate. Conclusion: A substantial number of CRC deaths are potentially preventable through routine colorectal screening. SES disparities represent a large number of these deaths and result in a large economic burden in lower SES areas. Eliminating educational disparities could help decrease CRC cancer deaths and associated productivity lost in the US. These estimates do not include the costs to diagnose, treat and care for CRC patients. Citation Format: Hannah K. Weir, Chunyu Li, Jane Henley, Djenaba Joseph. Estimating potential years of life lost and productivity lost due to avoidable premature colorectal cancer deaths in U.S. counties with lower educational attainment. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A89.

Residential Mobility, Neighborhood Effects, and Educational Attainment of Blacks and Whites

This paper proposes a new model to identify if and how much the educational attainment gap between blacks and whites is due to the difference in their neighborhoods. In this model, individuals belong to two unobserved types: the endogenous type, which may move in response to the neighborhood effect on their education; or the exogenous type, which may move for reasons unrelated to education. The Heckman sample selection model becomes a special case of the current model in which the probability of one type of individuals is zero. Although we cannot find any significant neighborhood effect in the usual Heckman sample selection model, we do find heterogeneous effects in our two-type model. In particular, there is a substantial neighborhood effect for the movers who belong to the endogenous type. No significant effects exist for other groups. We also find that the endogenous type has more education and moves more often than the exogenous type. On average, we find that the neighborhood variable, the percentage of high school graduates in the neighborhood, accounts for about 28.96% of the education gap between blacks and whites.

Low rate of bone density testing in men receiving androgen deprivation therapy

Low rate of bone density testing in men receiving androgen deprivation therapy

The Impact of Comorbidity on Treatment (Chemoradiation and Laryngectomy) of Advanced, Nondistant Metastatic Laryngeal Cancer

To investigate whether patients treated with laryngectomy had less comorbidity than those treated with chemoradiation, which could help explain the improved survival for the laryngectomy cohorts in recent studies. Observational cross-sectional study. Patients receiving diagnoses of primary invasive advanced squamous cell carcinoma of the larynx between 2003 and 2008 were selected from the National Cancer Database, which collects information from more than 1400 facilities accredited by the American College of Surgeons' Commission on Cancer. Patient-level independent variables included age at diagnosis, sex, diagnosis year, race/ethnicity, primary payer status, and zip code-level education. Primary treatment information. The association between treatment and patient clinical, sociodemographic, and facility-level and zip code-level socioeconomic status variables were analyzed using univariate statistics and multivariate models. Charlson Deyo Comorbidity and The Washington University Head and Neck Comorbidity Index scores were calculated from the hospital face sheet. The study demonstrated that receipt of treatment (chemoradiation vs total laryngectomy) was significantly associated with comorbidity. Treatment was not significantly associated with insurance status, race/ethnicity, or age. Patients with comorbidity were less likely to receive chemoradiation than subtotal or total laryngectomy, with a risk ratio (RR) of 0.84 (95% CI, 0.81-0.87) for patients with 1 or more comorbidities compared with those without any comorbidity, after controlling for factors such as tumor stage, age, race/ethnicity, insurance, and socioeconomic status. Patients were also less likely to receive chemoradiation than total laryngectomy if they had stage IV disease (RR, 0.81; 95% CI, 0.79-0.83) and if they had been diagnosed at a teaching or research institution (RR, 0.80; 95% CI, 0.77-0.84). Patients were more likely to receive chemoradiation if they were diagnosed after 2003 (RR, 1.37; 95% CI, 1.30-1.45) or if they lived in a zip code with a high percentage of high school graduates (RR, 1.1; 95% CI, 1.05-1.15). This is the first study, to our knowledge, that demonstrates that patients with advanced laryngeal cancer with 1 or more comorbidities are more likely to receive surgery than chemoradiation compared with patients without any comorbidity, independent of numerous clinical and nonclinical variables among a large national cohort. A limitation of this study is the use of comorbidity data from the National Cancer Database, which gathers its information from hospital discharge face sheets. We recognize that the National Cancer Database may be an imperfect system for the collection of comorbidity data and encourage discussion on different methods to improve the system, including incorporating comorbidity data from the Surveillance, Epidemiology, and End Results Medicare Database and medical chart-based comorbidity data collection by cancer registrars.

Economics Course Enrollments in U.S. High Schools

High school transcript data were used in this study to estimate the percentage of high school graduates who complete an economics course, and to examine course-taking trends in economics from 1982 to 2009. In 2009, 58 percent of high school graduates took an economics course, up from about 45 percent from 1990 to 2005. The increases in economics enrollments over the years included in this study are consistent with the trends in the number of states mandating an economics course to be taken for graduation. Estimated percentages are reported across the demographics of high school students. Enrollments in economics are compared to enrollments in other high school social studies courses.

The effects of social‐economic status of consumers on purchasing, behaving and attitude to food products

PurposeThe aim of the study is to group consumers according to their own perception of socio‐economic status and to determine consumption habits, behaviors, approach and tendency towards food products.Design/methodology/approachIn this study, consumers in urban areas of Van, in Turkey, were grouped according to their self‐perceived social‐economic status and their behaviors and attitudes on purchase of food products are examined according to that social‐economic status. The study was conducted in Van province, Turkey, during 2007‐2008. Face to face interviews with 300 consumers work through the survey data was collected. Participants were asked to indicate their socio‐economic status from a choice of top, middle and bottom level groups.FindingsWithin the top and middle level of this grouping, the percentage of high school graduates is high; at the bottom level of this status, the proportion of university graduates is high. A large percentage of the consumers are public servants and business owners. It was observed that as the socio‐economic status increased, the proportion of business owners increased as well. Consumers in lower status groups spend the biggest portion of their income on food products. As the wages increase, the level of spending on food product decreases proportionally and the ability to make savings increases. The highest status consumers always check the price labels of the food products with a high percentage (66.67 percent). More than half of consumers do not believe that producers write all information and ingredients of the products on the packaging. A total of 77 percent of study participants stated that they were open to trying new food products. Consumers within the top socio‐economic groups are most careful about food ingredients.Originality/valueIn this study, the consumers themselves are classified according to their socio‐economic status. These are the top, middle and bottom status as determined. Consumers are clustered according to the general characteristics of the correspondence analysis.

The Emerging Education Reversal in the United States: National and State-Level Trends

For over two hundred years, educational attainment in the United States has climbed, with the largest gains occurring recently from 1940 through 1980. Today the adult population is at or near its highest level ever with 88 to 89 percent high school graduates and close to 30 percent college graduates. But there are signs of change. Shortly after 2000, attainment amongst adults has flattened. A closer look at this educational ‘ceiling’ reveals that the educational gains of the population have not only stopped but are beginning to decline: Census and ACS data show that a reversal is underway. This reversal emerged for the newest members of the adult population around 2000. In addition, college completion rates, although not yet reversed, are slowing dramatically. Looking at the problem spatially, no state had an educational reversal in 1990, but, by 2000, in nearly every western state the percentage of high school graduates was lower among young adults (age 25 to 34) than among prime age adults (age 45 to 64). By 2007, the reversal was deepening in several western states, had spread east through Texas and the Great Lakes region, and also appeared along the south Atlantic seaboard and the East Coast.

Impact of Socioeconomic Factors on Prostate Cancer Outcomes in Black Patients Treated with Surgery

The role of socioeconomic factors in the worse outcome of black men with prostate cancer remains unclear. To determine whether socioeconomic factors affect prostate cancer outcomes, we studied a cohort of only black patients to minimize known confounding factors. We studied black men treated with radical prostatectomy at New York Veterans Administration Medical Center and Memorial Sloan-Kettering Cancer Center between 1990 and 2005. A centralized pathology review process determined the Gleason score of all cases. Prostate-specific antigen (PSA) recurrence at both sites was defined as PSA of 0.2 or greater with a confirmatory rise. By matching patients' home zip codes to the U.S. Census Bureau database, we obtained corresponding socioeconomic data regarding median household income (income) and percentage of population with a high school (degree). We analyzed income, education, and clinical and pathological parameters for the whole cohort. We studied 430 black patients. They resided in neighborhoods where median household income was $41,498.10 and mean percentage of high school graduates was 73.4%. A total of 88 patients (20.9%) had PSA recurrence. Median follow-up for survivors was 37 months. Neither income nor education evaluated as continuous or categorical variables were predictors of PSA recurrence. When evaluated as composite categorical variable, the combination of greater income and education did not predict disease-free survival. Data suggest that socioeconomic factors have limited impact on PSA recurrence in black men treated with radical prostatectomy. Thus, biologic factors might have a role in the poor outcomes in this population.

Population-based Study of the Geographic Variation in Colon Cancer Incidence in Alabama: Relationship to Socioeconomic Status Indicators and Physician Density

The objective of this population-based study was to examine the relationship between race, socioeconomic characteristics (socioeconomic status, SES), physician density, and colon cancer incidence in Alabama. Data for 5,788 colon cancer cases from 1996 to 1999 provided by the Alabama Statewide Cancer Registry are linked to county-level measures of SES, including median household income, percentage of high school graduates, percentage of families below poverty level, and occupational and health care factors. Poisson regression is used to model the predictors adjusting for age, gender, and race. Blacks had higher incidences of colon cancer compared with whites and presented with later stages (20.4% versus 14.8% for distant disease (P = 0.0089). After controlling for race, gender, and age at diagnosis, significant associations were detected between colon cancer incidence and higher education (RR = 1.10; 95% CI, 1.03-1.17), and increased number of physicians per 1,000 (RR = 1.14; 95% CI, 1.06-1.22). The county percentage of families below poverty is associated inversely with localized disease and positively with distant stage. Colon cancer incidence varies geographically across Alabama and is positively related to aggregate SES factors, including education and physician density. A higher incidence of distant disease is related to black race and increased poverty. Health disparities in colon cancer across Alabama warrant further investigation.

New Entry and the Rate of Return to Education: The Case of Registered Nurses

In the 1970s, the percentage of high school graduates completing RN training increased with little change in the rate of return to training. During the 1980s, this percentage declined, despite large increases in the rate of return. The national data employed here examine long-run trends (with emphasis on the 1970s and 1980s) in financial incentives and entry into the nursing profession and suggest that broader professional career opportunities in the 1980s exerted a large impact vis-a-vis the 1970s, among other factors. Rates of return remain high in the 1990s with modest signs of the market stabilizing. Successful policies to ensure stability in health care service delivery must incorporate these varying trends in the RN market.

Voided Ballots in the 1996 Presidential Election: A County-Level Analysis

This county-level study examines factors associated with the rate of voided presidential ballots in the 1996 elections. Evidence indicates that voided ballots are significantly more prevalent in counties with higher percentages of African Americans and Hispanics. The relationship between voided ballots and African Americans disappears, however, in counties using voting equipment that can be programmed to eliminate overvoting. The rate of voided ballots is lower in larger counties and in counties with a higher percentage of high school graduates. The rate of voided ballots declines as the number of presidential candidates on the ballot increases, but only up to a point, and then rises with further increases. Lever machines generate the lowest rates of voided ballots among types of voting equipment, with punch card systems generating the highest rates.

Race, Hispanic Ethnicity, and the Future of the College Business Major in the United States

This article explores the impact of race and Hispanic ethnicity on the business major. Results of a survey show that, when other characteristics are held constant, Asians and non-Hispanic Blacks are less likely and Hispanics more likely to major in business than non-Hispanic Whites are. If, for each demographic group, the high school graduation rate, the percentage of high school graduates attending 4-year institutions, and the percentage of students majoring in business remain constant, an increase in the number of business majors can be expected. However, if Hispanics and non-Hispanic Blacks make socioeconomic advances, the number of business majors is likely to increase to a lesser degree and may even decrease.

Diagnosis and treatment of pediatric fever by caretakers

Assessment of pediatric temperature is a multistep task involving both manipulative and cognitive skills. Emergency Physicians typically assume that parents possess these skills, but this assumption has never been fully tested. A prospective survey was conducted of caretakers of children ≤ 36 months of age presenting to an inner city emergency department or pediatric clinic. Participants were asked to read a Fahrenheit scale mercury thermometer and to demonstrate use of that thermometer to “take” the temperature of an infant doll. They were then asked what temperature constituted a “fever” and what temperature would require antipyretic therapy. Caretakers were also asked how they would treat a fever in the child they had brought for treatment. Proportions of correct responses were tabulated and also compared by age and level of education of caretaker. Eighty-two of 92 caretakers (89.1%) possessed working thermometers in their homes. Thirty-six subjects (39.1%) were able to measure temperature appropriately using the mercury thermometer, 52 (56.5%) were able to read the mercury thermometer correctly, and 28 (30.4%) could both measure and read correctly. Sixty-seven subjects (72.8%) described correct treatment of fever. Overall, 27 subjects (29.3%) could measure, read, and treat fever appropriately. There was no statistically significant difference in age or percentage of high school graduates between caretakers who could successfully measure, read and treat and those who could not. In this inner city patient population, caretakers of any pediatric patient whose discharge instructions contain a reference to patient temperature should receive a brief refresher along with written instructions on temperature measurement and treatment.

Socioeconomic Characteristics and Melanoma Incidence

PURPOSE: This investigation examines the relationship between socioeconomic status (SES) and melanoma incidence in counties included in the Surveillance, Epidemiology, and End Results Registry (SEER) in the United States from 1973 to 1993. METHODS: Cases included whites, aged at least 15 years, with a morphologic diagnosis of malignant melanoma, residing in one of 199 counties at the time of diagnosis. County level measures of SES including median household income, percentage of high school graduates, and percentage of families below poverty were abstracted from the 1950, 1960, 1970, 1980, and 1990 U.S. Census data. The relationship between SES factors and melanoma rates was examined by hierarchical Poisson regression. RESULTS: The percentage of high school graduates was significantly and positively associated with the incidence of melanoma (relative risk (RR), 1.28; 95% confidence interval (CI), 1.21–1.35), after controlling for age at diagnosis, gender, time period, latitude, and percentage of Hispanics in the county. Percentage of families below poverty was significantly inversely associated with the incidence of melanoma (RR, 0.66; 95% CI, 0.55–0.78). When education and poverty were included in the same model, both the positive effects of education (RR, 1.23; 95% CI, 1.16–1.31) and the negative effects of poverty (RR, 0.85; 95% CI, 0.74–0.98) persisted. In contrast, median household income was not associated with melanoma incidence in a similar multivariable model (RR, 1.00; 95% CI, 0.99–1.00). CONCLUSION: Whether the effect of education on incidence of melanoma reflects lifestyle behaviors that modify exposure to sunlight or some other factor remains unclear. Nonetheless, the findings of this study suggest that the determinant is primarily related to education, not income.

Parents' Views on the Value of a College Education and How They Will Pay for It

A college education is a rite of passage for many young adults in the United States. The rate of college attendance by high school graduates has been growing steadily for more than 20 years. More than six in ten high school graduates now continue their education after high school by attending a postsecondary institution. While the percentage of high school graduates attending college has grown, so has the cost of attending college. College costs since the 1980s have outpaced inflation while families' real incomes have remained stagnant. During this time, inflation adjusted dollars available to students through federal grants and scholarships remained relatively constant. Taken together, these economic factors are a major cause of the crisis of college affordability.