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Concept: American Community Survey

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The launch of the Affordable Care Act was accompanied by major insurance information campaigns by government, nonprofit, political, news media, and private-sector organizations, but it is not clear to what extent these efforts were associated with insurance gains. Using county-level data from the Census Bureau’s American Community Survey and broadcast television airings data from the Wesleyan Media Project, we examined the relationship between insurance advertisements and county-level health insurance changes between 2013 and 2014, adjusting for other media and county- and state-level characteristics. We found that counties exposed to higher volumes of local insurance advertisements during the first open enrollment period experienced larger reductions in their uninsurance rates than other counties. State-sponsored advertisements had the strongest relationship with declines in uninsurance, and this relationship was driven by increases in Medicaid enrollment. These results support the importance of strategic investment in advertising to increase uptake of health insurance but suggest that not all types of advertisements will have the same effect on the public.

Concepts: Health care, Health insurance, Advertising, Mass media, United States Census, United States Census Bureau, Census, American Community Survey

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Creating environments that support all types of physical activity, including active transportation, is a public health priority (1). Public health surveillance that identifies the locations where community members walk and bicycle (i.e., engage in active transportation) can inform such efforts. Traditional population-representative active transportation surveillance incurs a considerable time lag between data collection and dissemination, and often lacks geographic specificity (2). Conversely, user-generated active transportation data from Global Positioning System (GPS)-based activity tracking devices and mobile applications can provide near real-time information, but might be subject to self-selection bias among users. CDC analyzed the association between GPS-based commuting data from a company that allows tracking of activity with a mobile application (Strava, Inc., San Francisco, California) and population-representative commuting data from the U.S. Census Bureau’s American Community Survey (ACS) (3) for four U.S. cities. The level of analysis was the Census block group. The number of GPS-tracked commuters in Strava was associated with the number of ACS active commuters (Spearman’s rho = 0.60), suggesting block groups were ranked similarly based on these distinct but related measurements. The correlation was higher in high population density areas. User-generated active transportation data might complement traditional surveillance systems by providing near real-time, location-specific information on where active transportation occurs.

Concepts: Population, Population density, Census block, Census block group, Bicycle, United States Census, United States Census Bureau, American Community Survey

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The federal 340B program gives participating hospitals and other medical providers deep discounts on outpatient drugs. Named for a section of the Veterans Health Care Act of 1992, the program’s original intent was to help low-income and uninsured patients. But the program has come under scrutiny by critics who contend that some hospitals exploit the drug discounts to generate profits instead of either investing in programs for the poor or passing the discounts along to patients and insurers. We examined whether the program is expanding in ways that could maximize hospitals' ability to generate profits from the 340B drug discounts. We matched data for 960 hospitals and 3,964 affiliated clinics registered with the 340B program in 2012 with the socioeconomic characteristics of their communities from the US Census Bureau’s American Community Survey. We found that hospital-affiliated clinics that registered for the 340B program in 2004 or later served communities that were wealthier and had higher rates of health insurance compared to communities served by hospitals and clinics that registered for the program before 2004. Our findings support the criticism that the 340B program is being converted from one that serves vulnerable patient populations to one that enriches hospitals and their affiliated clinics.

Concepts: Health care, Health insurance, Hospital, Population, Illness, United States Census, United States Census Bureau, American Community Survey

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Neighborhoods provide resources that may affect children’s achievement or moderate the influences of other developmental contexts, such as early care and education (ECE). Using a sample (N ≈ 12,430) from the 2010-2011 Early Childhood Longitudinal Study-Kindergarten Cohort, merged with census tract-level poverty data from the 2008-2012 American Community Survey, this article examines associations between center-based ECE participation, neighborhood poverty, and children’s academic skills and behavior at kindergarten entry. Findings suggest that children who attend center-based care in the year prior to kindergarten show higher math and reading scores across neighborhood contexts. Results provide limited evidence that neighborhood poverty moderates the associations between either Head Start or other types of center-based ECE participation and children’s outcomes at kindergarten, with children in moderate-high poverty neighborhoods showing stronger positive associations between who participated in Head Start or center care participation and math and reading scores, respectively, compared to those participating in low-poverty neighborhoods. Research and policy implications are discussed. (PsycINFO Database Record

Concepts: Child, Childhood, Academia, Community, Early childhood education, Neighbourhood, Moderate, American Community Survey

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Using premium subsidies for private coverage, an individual mandate, and Medicaid expansion, the Affordable Care Act (ACA) has increased insurance coverage. We provide the first comprehensive assessment of these provisions' effects, using the 2012-2015 American Community Survey and a triple-difference estimation strategy that exploits variation by income, geography, and time. Overall, our model explains 60% of the coverage gains in 2014-2015. We find that coverage was moderately responsive to price subsidies, with larger gains in state-based insurance exchanges than the federal exchange. The individual mandate’s exemptions and penalties had little impact on coverage rates. The law increased Medicaid among individuals gaining eligibility under the ACA and among previously-eligible populations (“woodwork effect”) even in non-expansion states, with no resulting reductions in private insurance. Overall, exchange premium subsidies produced 40% of the coverage gains explained by our ACA policy measures, and Medicaid the other 60%, of which ½ occurred among previously-eligible individuals.

Concepts: Effect, Economics, Gain, Explanation, Individual, Insurance, Exchange, American Community Survey

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Childhood socioeconomic status (SES) is inversely associated with adult weight in high income countries. Whether the influence of childhood SES on adult weight is best described using a critical period model or an accumulation of risk model is not yet settled. This research tests whether childhood SES is associated with adult BMI and likelihood of obesity independent of adult socioeconomic status and neighborhood characteristics. Data on individual childhood and adult characteristics come from the Health and Retirement Study (N = 13,545). Data on neighborhood characteristics come from the 2000 Decennial Census and American Community Survey (2005-2009). In the fully adjusted models, perceived financial hardship before the age of sixteen and having a father who was unemployed are associated with higher BMI among males and, among females, paternal education remains associated with adult BMI. However, childhood SES is not associated with likelihood of obesity after fully adjusting for adult SES and neighborhood characteristics, suggesting that the direct effects of early childhood SES on BMI are small relative to the other factors associated with obesity in adulthood.

Concepts: Child development, Income, Adult, Coming of age, Critical period, United States Census, United States Census Bureau, American Community Survey

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This paper analyzes earnings outcomes of Iraq/Afghanistan-era veterans. We utilize the 2009-2013 American Community Survey and a worker-matching methodology to decompose wage differences between veteran and non-veteran workers. Among fully-employed, 25-40 year-olds, veteran workers make 3% less than non-veteran workers. While male veterans make 9% less than non-veterans, female and black veterans experience a wage premium (2% and 7% respectively). Decomposition of the earnings gap identifies some of its sources. Relatively higher rates of disability and lower rates of educational attainment serve to increase the overall wage penalty against veterans. However, veterans work less in low-paying occupations than non-veterans, serving to reduce the wage penalty. Finally, among male and white subgroups, non-veterans earn more in the top quintile due largely to having higher educational attainment and greater representation in higher-paying occupations, such as management.

Concepts: Male, Female, Gender, Sex, Decomposition, Veteran, American Community Survey, Veterans Day

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Using data from the 2013 American Community Survey, we found that 24.3 million people (about 1 in 4) who were either eligible for Medicaid/Children’s Health Inusrance Program (CHIP) or appeared likely to shop for Qualified Health Plan (QHP) lacked residential high-speed Internet. Specifically, 28.6% or 18.9 million people eligible for Medicaid/CHIP and 17.1% or 5.5 million people who appeared likely to shop for a QHP did not have high-speed Internet in the home. For both the Medicaid/CHIP eligible and those likely to shop for a QHP, the proportion of people living in households without Internet varied substantially by race, geography, and other socio-demographic characteristics.

Concepts: Health care, Health economics, Healthcare reform, Health insurance, Internet, Disability insurance, Home, American Community Survey

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Our objective was to evaluate the reliability and predictability of ten socioeconomic indicators obtained from the 2006-2013 annual and multi-year ACS data cycles for unintentional drowning and submersion injury surveillance.

Concepts: Psychometrics, American Community Survey