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Concept: American middle class


US medical spending growth slowed between 2004 and 2013. At the same time, many Americans faced rising copayments and deductibles, which may have particularly affected lower-income people. To explore whether the health spending slowdown affected all income groups equally, we divided the population into income quintiles. We then assessed trends in health expenditures by and on behalf of people in each quintile using twenty-two national surveys carried out between 1963 and 2012. Before the 1965 passage of legislation creating Medicare and Medicaid, the lowest income quintile had the lowest expenditures, despite their worse health compared to other income groups. By 1977 the unadjusted expenditures for the lowest quintile exceeded those for all other income groups. This pattern persisted until 2004. Thereafter, expenditures fell for the lowest quintile, while rising more than 10 percent for the middle three quintiles and close to 20 percent for the highest income quintile, which had the highest expenditures in 2012. The post-2004 divergence of expenditure trends for the wealthy, middle class, and poor occurred only among the nonelderly. We conclude that the new pattern of spending post-2004, with the wealthiest quintile having the highest expenditures for health care, suggests that a redistribution of care toward wealthier Americans accompanied the health spending slowdown.

Concepts: Health care, Poverty, Household income in the United States, Wealth, Working class, Quintile, Upper middle class, American middle class


U.S. employment-based health benefits are exempt from income and payroll taxes, an exemption that provided tax subsidies of $326.2 billion in 2015. Both liberal and conservative economists have denounced these subsidies as “regressive” and lauded a provision of the Affordable Care Act-the Cadillac Tax-that would curtail them. The claim that the subsidies are regressive rests on estimates showing that the affluent receive the largest subsidies in absolute dollars. But this claim ignores the standard definition of regressivity, which is based on the share of income paid by the wealthy versus the poor, rather than on dollar amounts. In this study, we calculate the value of tax subsidies in 2009 as a share of income for each income quintile and for the wealthiest Americans. In absolute dollars, tax subsidies were highest for families between the 80th and 95th percentiles of family income and lowest for the poorest 20%. However, as shares of income, subsidies were largest for the middle and fourth income quintiles and smallest for the wealthiest 0.5% of Americans. We conclude that the tax subsidy to employment-based insurance is neither markedly regressive, nor progressive. The Cadillac Tax will disproportionately harm families with (2009) incomes between $38,550 and $100,000, while sparing the wealthy.

Concepts: Poverty, United States, Household income in the United States, Public transport, Subsidy, United States dollar, American middle class, Mixed economy


Intrusive parenting has been positively associated with child anxiety, although examinations of this relationship to date have been largely confined to middle to upper middle class families and have rarely used longitudinal designs. With several leading interventions for child anxiety emphasizing the reduction of parental intrusiveness, it is critical to determine whether the links between parental intrusiveness and child anxiety broadly apply to families of all financial means, and whether parental intrusiveness prospectively predicts the development of child anxiety. This study employed latent growth curve analysis to evaluate the interactive effects of maternal intrusiveness and financial means on the developmental trajectory of child anxiety from 1st grade to age 15 in 1,121 children (50.7 % male) and their parents from the NICHD SECCYD. The overall model was found to provide good fit, revealing that early maternal intrusiveness and financial means did not impact individual trajectories of change in child anxiety, which were stable from 1st to 5th grade, and then decrease from 5th grade to age 15. Cross-sectional analyses also examined whether family financial means moderated contemporaneous relationships between maternal intrusiveness and child anxiety in 3rd and 5th grades. The relationship between maternal intrusiveness and child anxiety was moderated by family financial means for 1st graders, with stronger links found among children of lower family financial means, but not for 3rd and 5th graders. Neither maternal intrusiveness nor financial means in 1st grade predicted subsequent changes in anxiety across childhood. Findings help elucidate for whom and when maternal intrusiveness has the greatest link with child anxiety and can inform targeted treatment efforts.

Concepts: Grade, Child, Mother, Trajectory, Trajectory of a projectile, Middle class, Upper middle class, American middle class


The world of work remains gender-segregated, and research is needed to identify factors that may give rise to women’s and men’s vocational choices. This study explored bidirectional relations between youth’s gendered career aspirations and the proportions of youth’s leisure time spent in stereotypically gendered activities and gendered social contexts. Participants were 203 youth (52% girls) from predominantly white, working and middle class families living in the US, who reported on their occupational aspirations and gendered interests in home interviews and on their daily activities in a series of 7 nightly phone interviews on two occasions, in middle childhood (Mage = 10.9) and in adolescence (Mage = 17.3). Path models revealed that aspirations predicted youth’s time use more so than the reverse. Time in gendered social contexts, specifically time in female-only contexts, but not time in gender-typed activities, predicted career aspirations. Implications of these findings and suggestions for future research are discussed.

Concepts: Time, Future, Childhood, Youth, Middle class, Social class, Leisure, American middle class


Social Security and Medicare enjoy strong political coalitions within the mass public because middle-class Americans believe they derive benefits from these programs and stand alongside lower-income beneficiaries in defending them from erosion. By pooling data from nine nationally representative surveys, this article examines whether the Affordable Care Act (ACA) is cultivating a similar cross-class constituency. The results show that middle-income Americans are less likely than low-income Americans to say the ACA has helped them personally so far. On the other hand, partisanship conditions the relationship between income and beliefs about benefits likely to be derived from the ACA in the long run. In total, the results suggest that cross-class Democratic optimism about long-run benefits may enable the ACA to reap positive beneficiary feedbacks, but a large and bipartisan cross-class constituency appears unlikely. Drawing on these results, this article also makes theoretical contributions to the policy feedback literature by underscoring the need for research on prospections' power in policy feedbacks and proposing a strategy for researchers, policy makers, and public managers to identify where partisanship intervenes in the standard policy feedback logic model, and thereby to better assess how it fragments and conditions positive feedback effects in target populations.

Concepts: Economics, Feedback, Proposal, Audio feedback, Legal terms, American middle class, Short-run, The Long Run


Associated with overweight, obesity and chronic diseases, the nutrition transition process reveals important socioeconomic issues in Mexico. Using panel data from the Mexican Family Life Survey, the purpose of the study is to estimate the causal effect of household socioeconomic status (SES) on nutritional outcomes among urban adults. We divide the analysis into two steps. First, using a mixed clustering procedure, we distinguish four socioeconomic classes based on income, educational and occupational dimensions: (i) a poor class; (ii) a lower-middle class; (iii) an upper-middle class; (iv) a rich class. Second, using an econometric framework adapted to our study (the Hausman-Taylor estimator), we measure the impact of belonging to these socioeconomic groups on individual anthropometric indicators, based on the body-mass index (BMI) and the waist-to-height ratio (WHtR). Our results make several contributions: (i) we show that a new middle class, rising out of poverty, is the most exposed to the risks of adiposity; (ii) as individuals from the upper class seem to be fatter than individuals from the upper-middle class, we can reject the assumption of an inverted U-shaped relationship between socioeconomic and anthropometric status as commonly suggested in emerging economies; (iii) the influence of SES on central adiposity appears to be particularly strong for men.

Concepts: Nutrition, Obesity, Sociology, Household income in the United States, Middle class, Social class, Social classes, American middle class


A comprehensive study on the potential of pyrolysis of activated sludge to generate substances that can be used to produce energy was evaluated for its technical and environmental viability. The products of the process viz., pyrolysis gas, pyrolysis oil and char can readily be used by the major energy consumers viz., electricity and transportation. Based on the results obtained it is estimated that a 1ton capacity process for pyrolysis of activated sludge can serve the electrical needs of a maximum of 239, 95 and 47 Indian houses per day, considering lower middle class, middle class and upper middle class, respectively. In addition the process would also produce the daily methane (CNG) requirement of 128 public transport buses. The process was determined to be technically feasible at low and medium temperatures for both, pyrolysis gas and electrical energy. The gas generated could be utilized as fuel directly while the oil generated would require pretreatment before its potential application. The process is potentially sustainable when commercialized and can self-sustain in continuous mode of operation in biorefinery context.

Concepts: Electricity, Petroleum, Middle class, Pyrolysis, Social classes, Lower middle class, Upper middle class, American middle class


To assess primary care providers' (PCPs) opinions related to recommending home blood pressure monitoring (HBPM) for their hypertensive patients, the authors analyzed a Web-based 2010 DocStyles survey, which included PCPs' demographics, health-related behaviors, recommendations on HBPM, views of patient knowledge, and use of continuing medical education. Of the 1254 PCPs who responded, 539 were family practitioners, 461 were internists, and 254 were nurse practitioners; 32% recommended HBPM to ≥90% of their patients and 26% recommended it to ≤40% of their patients. Nurse practitioners were significantly more likely to recommend HBPM than were internists (odds ratio, 0.55; 95% confidence interval, 0.40-0.78). The top reasons for not recommending HBPM were “patient can’t afford it” and “patient doesn’t need it.” A total of 20% of PCPs indicated that their patients were poor to lower middle class; these PCPs were less likely to recommend HBPM to their patients than were those PCPs with most patients in higher economic classes. Additional efforts are needed to provide education to providers, especially physicians, about the benefits of HBPM in improved and cost-effective blood pressure control in the United States.

Concepts: United States, Physician, General practitioner, Medical school, Residency, Middle class, Lower middle class, American middle class


OBJECTIVES: To evaluate the impact of asthma on activity limitation, symptoms and emotional function in the health-related quality of life (HRQL) of asthmatic children. METHODS: A cross-sectional study involving 59 children of 7 to 12 y of age. A standardized version of the Pediatric Asthma Quality of Life Questionnaire was used to evaluate HRQL and the current criteria for socioeconomic stratification in Brazil were used to assess socioeconomic status. Independent variables evaluated included clinical and sociodemographic characteristics. The association between mean HRQL scores and the independent variables was evaluated using the Mann-Whitney, Kruskal-Wallis and Dunn tests. Statistical significance was defined as a p-value < 0.05. RESULTS: Thirty-two families (56.1 %) had a total household income of more than two minimum wages, while 37 families (62.7 %) were considered lower middle class. Mean overall HRQL score was 4.8 ± 1.3 (out of a maximum score of 7), suggesting reasonable HRQL. There was a weak association between independent variables and mean overall HRQL scores and the mean scores in the emotional function domain. Higher socioeconomic status was related to higher scores for the symptoms domain (p = 0.041). Furthermore, children exposed to indoor mould reported greater impairment in the symptoms domain(p = 0.022). The severity of asthma was associated with the activity limitation domain (p = 0.025). CONCLUSIONS: These results showed a reasonable mean HRQL score and an association between the severity of asthma and the activity limitation domain.

Concepts: Statistics, Statistical hypothesis testing, Rio de Janeiro, Household income in the United States, Minimum wage, Lower middle class, Upper middle class, American middle class