Databyte

The Remaining Uninsured Americans

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                    [post_content] => The Affordable Care Act (ACA) has survived 70 repeal attempts and wavering public support. In the eight years since its passage, approximately 20 million Americans have gained health insurance coverage through either the private marketplace or state-based Medicaid expansion. However, the uninsured rate is still nine percent nationally, so it is important to look at where further improvements are possible.

The figure above, from the Kaiser Family Foundation, reveals racial disparities in health insurance coverage among non-elderly adult and children. Although all races saw decreases in the uninsured rate between 2013 and 2016, Hispanic and Black adults are still more likely to be uninsured compared to their White counterparts.

In 2016, Hispanic and Black adults were also less likely than White adults to have private insurance and more likely to use Medicaid or Medicare. Despite significant gains in coverage for Hispanic adults, 22 percent remain uninsured. And unfortunately, many of the uninsured Black adults live in states that have yet to expand Medicaid, which also limits their options.
For both adults and children, racial disparities in health insurance coverage persist. Given the ongoing attacks on the ACA, these disparities are unlikely to be meaningfully addressed in the near future.  
Hispanic and Black children, too, have higher uninsured rates than White children, though the magnitude of the difference is less than the adult population. This lower magnitude can largely be attributed to coverage through the Children’s Health Insurance Program, which provides low-cost health insurance to families whose income is too high to qualify for Medicaid. For both adults and children, racial disparities in health insurance coverage persist. Given the ongoing attacks on the ACA, these disparities are unlikely to be meaningfully addressed in the near future. Over the last two years, the Trump administration has spent less money to advertise how and when Americans can find insurance coverage and has failed to assist those seeking coverage through the ACA marketplace. Meanwhile, 15 states have either applied for or enacted work requirements for Medicaid, creating another barrier to accessing insurance. At least for now, health care in the United States very much remains a privilege and not a right. Image: "Changes in Health Coverage by Race and Ethnicity since Implementation of the ACA, 2013-2017," Samantha Artiga, Kendal Orgera, and Anthony Damico, 2019 [post_title] => The Remaining Uninsured Americans [post_excerpt] => Disparities in health insurance coverage persist. Hispanic and Black adults are still more likely to be uninsured compared to their White counterparts. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => the-remaining-uninsured-americans [to_ping] => [pinged] => [post_modified] => 2019-03-21 14:29:53 [post_modified_gmt] => 2019-03-21 18:29:53 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_databyte&p=6487 [menu_order] => 0 [post_type] => bu_databyte [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Disparities in health insurance coverage persist. Hispanic and Black adults are still more likely to be uninsured compared to their White counterparts.

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Databyte

Income Inequality Between Black and White Males

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                    [post_date] => 2019-03-20 07:00:44
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                    [post_content] => The uneven distribution of income is a key contributor of economic injustice in the US. Income inequality is influenced by policy, education, and globalization, among other factors. Raj Chetty and colleagues, in collaboration with the US Census Bureau, studied race and intergenerational earnings, important contributors to income inequality, as part of the Opportunity Insights project.

Black Americans have lower rates of upward mobility and higher rates of downward mobility than Whites. The figure above shows gaps in income ranks for Black and White males in adulthood, juxtaposed with the income of their parents. The image displays that on average, neither Black or White males reach the income level of their parents. The gap between Black and White males’ earnings is especially stark. One finding is particularly striking: even when they grow up in households with comparably high incomes, black males earn less than White males in adulthood.

Take a look at the parent household income rank at the 75th percentile. When White male children with parental income at the 75th percentile become income-earning adults, their average income rank falls to the 64th percentile. When Black male children with parental income at the 75th percentile become income earning adults, their average income rank falls to the 52nd percentile.

The Black-White income gap in the US is driven by the difference in income outcomes of Black and White males; no such gaps are evident between Black and White women.

Areas with the smallest Black-White male income gaps tend to be low-poverty neighborhoods with low levels of racial bias among Whites, and high rates of father presence among Blacks. The question then becomes, how do we replicate these conditions across the entire country to narrow gaps in income and improve the overall quality of life for Black men? The authors call attention to endeavors, such as Black male role models mentoring boys in their communities, that offer an opportunity to increase upward mobility across generations.

Image: Opportunity Insights, Race and Economic Opportunity in the United States: An Intergenerational Perspective, by Raj Chetty, Nathaniel Hendren, Maggie R. Jones, Sonya R. Porter, March 2018
                    [post_title] => Income Inequality Between Black and White Males
                    [post_excerpt] => If uneven distribution of income is a key contributor of economic injustice, how do we replicate conditions to narrow gaps in income for Black men?
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If uneven distribution of income is a key contributor of economic injustice, how do we replicate conditions to narrow gaps in income for Black men?

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Databyte

Un-Well-Being

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                    [post_date] => 2019-03-19 07:00:16
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                    [post_content] => In recent years, wellbeing has become an important topic in discussions about health. As society embraces a definition of health beyond the absence of disease, more people are recognizing the critical role of emotional, psychological, and social wellbeing in leading a fulfilling life.

The Gallup-Sharecare Well-Being Index measures Americans' perceptions of their lived experiences by measuring sense of purpose, social relationships, financial security, relationship to community, and physical health. Index scores fall between 0 (the lowest possible score) and 100 (the highest score attainable). Since the index began in 2008, the overall score for wellbeing in the US has remained relatively stable.

2017 marked the first time no state reported an improvement in wellbeing from the year before. The map shows that 21 states experienced a decline in wellbeing while scores for the remaining 29 states remained unchanged. Nationally, the wellbeing index score was 61.5—the lowest in the index’s history.

South Dakota, Vermont, and Hawaii ranked the highest in wellbeing, while Arkansas Louisiana, and West Virginia ranked lowest.

Sense of purpose and social wellbeing were indicators mostly responsible for declines. This was reflected in an overall decrease in satisfaction with standard of living and an increase in clinical diagnoses of depression.

Greater wellbeing facilitates better performance at work and stronger relationships with family and friends. As such, the result of the Index report underscores the need to improve the wellbeing of Americans by fostering opportunities that promote purposeful engagement and strengthen mental health services.

Image from “Record 21 Sates See Decline in Well-being in 2017," Gallup, 2017. 
                    [post_title] => Un-Well-Being
                    [post_excerpt] => 2017 marked the first time no state reported an improvement in well-being from the year before according to the Gallup-Sharecare Well-Being Index.
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2017 marked the first time no state reported an improvement in well-being from the year before according to the Gallup-Sharecare Well-Being Index.

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Databyte

Transgender Individuals See Improvements in HIV Outcomes

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                    [post_content] => CD4 counts are an indication of immune system function, with a higher CD4 count indicating better health. A normal CD4 count ranges from 500-1500. When someone with HIV has a CD4 count of less than 200, they are diagnosed with AIDS.

Researchers at the Division of Disease Control in New York City used HIV surveillance data to assess the CD4 counts of cisgender and transgender people living with HIV. The graph above compares the percentages of HIV-positive cisgender women, cisgender men, and transgender people with CD4 counts above 500 in between 2007 and 2016.

The percentage of HIV-positive cisgender people who had a CD4 count higher than 500 increased from 38% in 2007 to 61%. Among transgender people with HIV, CD4 counts over 500 increased from 32% to 60% in the same time frame, narrowing the gap between the two populations.

Several factors may have played a role in these CD4 count improvements. Greater insurance coverage of antiretroviral medications may have increased access to life-saving treatment, and decreasing stigma in health care settings could have lead to greater adherence to treatment among transgender persons.

Design: David Gaitsgory @dgaitsgo. Source: “Reduction in Gaps in High CD4 Count and Viral Suppression Between Transgender and Cisgender Persons Living With HIV in New York City, 2007–2016,” by Qiang Xia, Selam Seyoum, Ellen W. Wiewel, Lucia V. Torian, Sarah L. Braunstein, American Journal of Public Health 109, no. 1 (January 1, 2019): pp. 126-131. DOI: 10.2105/AJPH.2018.304748
                    [post_title] => Transgender Individuals See Improvements in HIV Outcomes
                    [post_excerpt] => Researchers assessed the CD4 counts of cisgender and transgender people living with HIV and showed a narrowing of the gap between two populations.
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Researchers assessed the CD4 counts of cisgender and transgender people living with HIV and showed a narrowing of the gap between two populations.

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Databyte

I Would if I Could: Bike Share

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                    [post_content] => Bike share programs are booming. Present in over 100 cities across the US, bike sharing is an inexpensive form of transportation that can save time during a commute, while also offering numerous health benefits.

However, a disproportionate amount of city residents who participate are White and high-income. But it’s not a lack of interest keeping lower-income residents and people of color from participating. Rather, several barriers block access for underserved and underrepresented groups, including cost, lack of bike stations in low-income neighborhoods, lack of bank accounts, and lack of familiarity with bike share.

In 2015, Better Bike Share Partnership (BBSP) provided funding to six cities in efforts to increase access to bike share in low-income and underserved communities. They went on to co-fund a study with the National Institute for Transportation and Communities at Portland State University to research how BBSP interventions impacted bike share use in Chicago, Philadelphia, and Brooklyn. The study measured ongoing barriers by collecting user and non-user perceptions towards bike share in BBSP target neighborhoods.
The team collected 1,885 responses and compared the results of four demographic groups: higher-income people of color, lower-income people of color, higher-income white, and lower-income white residents.  
English and Spanish surveys were sent out to communities in Chicago, Philadelphia, and Brooklyn. Race/ethnicity was self-reported; individuals were divided into higher- and lower-income categories based on their household income (either over or under 150% of the poverty level). The team collected 1,885 responses and compared the results of four demographic groups: higher-income people of color, lower-income people of color, higher-income white, and lower-income white residents. Reported barriers are represented in the word-cloud graphic above; the bolder the font, the more often it was reported. The cost of a membership was a barrier for almost half of the lower-income residents of color. Over 50% of lower-income residents of color were concerned about damaging the bike and being held liable. Having to use a credit card was a barrier for over a quarter of lower-income residents of color (37%), as was unfamiliarity with the system (34%). The most common barrier reported by lower- and higher-income white residents was a preference for riding their own bike (45%). Lower-income white residents also cited cost and availability as barriers to using bike share. People’s enthusiasm for bike share, however, was not lost in the face of these barriers. The majority of residents expressed a liking for the system, and strong interest to utilize it. Even though almost all of the survey residents reported seeing a bike share in their neighborhood, unfamiliarity with using the bike share was found to be an overall barrier. Two-thirds of the surveyed respondents reported that they would be more likely to use bike share if discounted membership rates were available. Bike share programs in all three cities have cash-payment or reduced-fee options to help make it more affordable. If bike share programs could implement strategies to spread awareness of the affordability and simplicity of use, there’s a good chance more people would use them. Image from "Breaking Barriers to Bike Share: Insights from Residents of Traditionally Underserved Neighbourhoods" Natham McNeil, Jennifer Dill, John MacArthur, Joseph Broach, Steven Howland. NITC-RR-884b. Portland, OR: Transportation Research and Education Center (TREC), 2017. doi: 10.15760/trec.176 [post_title] => I Would if I Could: Bike Share [post_excerpt] => Better Bike Share Partnership increased access to bike share programs in low-income and underserved communities in six cities. This study assessed ongoing barriers to use in Chicago, Philadelphia, and Brooklyn. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => i-would-if-i-could-bike-share [to_ping] => [pinged] => [post_modified] => 2019-02-14 22:31:41 [post_modified_gmt] => 2019-02-15 03:31:41 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_databyte&p=6304 [menu_order] => 0 [post_type] => bu_databyte [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Better Bike Share Partnership increased access to bike share programs in low-income and underserved communities in six cities. This study assessed ongoing barriers to use in Chicago, Philadelphia, and Brooklyn.

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Databyte

Rural Living and Dying

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                    [post_content] => For the past few decades, nonmetropolitan areas have been facing a phenomenon called the “rural mortality penalty.” This penalty was once associated with cities, as crowding and poor sanitation helped contagious diseases spread quickly in urban environments. But this burden has shifted to rural areas over the last 40 years. The difference between urban and rural excess deaths, or the number of deaths that exceed the predicted amount each year, grew almost ten-fold from the 1980s to the early 2000s. Further, the death rate in the US in 2014 was the lowest in the country’s history, yet rural deaths by cancer and heart-disease between 1999 and 2014 declined at a slower rate than those in urban areas.

A new report in the American Journal of Public Health highlights changes in death rates in the United States between 1970 and 2016. The researchers consistently found poverty, education, race, and income to be associated with deaths by all causes over the 47-year study period.

The breakdown of mortality by poverty levels in urban and rural areas is depicted in the figure above. Rural high poverty areas had the highest mortality rates in 2016, at 900 deaths for every 100,000 people, and urban low poverty areas had the lowest rates, at 700 deaths for every 100,000 people. This gap in 2016 between the two areas is the widest since 1970. Looking specifically within rural areas, the gap between high and low poverty areas is also the widest it has been since 1970, with a difference of around 150 deaths per 100,000 people.

The rural mortality penalty that first became evident in the 1980s continues to exist, and seems to impact high-poverty rural areas the most. Rural America may be at particular risk because healthcare is more limited than in urban America.

Graph: Figure 4—Trends in Age-Adjusted All-Cause Mortality Rates for Rural, High-Poverty Counties; Rural, Low-Poverty Counties; Urban, High-Poverty Counties; and Urban, Low-Poverty Counties: United States, Centers for Disease Control and Prevention WONDER, 1970–2016, American Journal of Public Health. 2019;109:155–162. doi:10.2105/AJPH.2018.304787
                    [post_title] => Rural Living and Dying
                    [post_excerpt] => There is a widening gap in US rural and urban death rates. Researchers report that these changes are not sudden and have been happening since 1970.
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There is a widening gap in US rural and urban death rates. Researchers report that these changes are not sudden and have been happening since 1970.

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Databyte

The Unexpected: Less Lead in New Orleans

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                    [post_date] => 2019-01-31 06:30:29
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                    [post_content] => After Hurricane Katrina researchers feared that storm surge flooding would cause heavy metal contaminants in soil to increase. Instead, they found that that lead levels dropped. This was good news for Dr. Mielke at Tulane University, who has committed his career to mitigating lead poisoning in children. For over two decades, Dr. Mielke and his students have collected soil samples in New Orleans to measure how lead in soil corresponds to blood lead in children. Researching soil lead levels before and after Katrina has given Dr. Mielke insight as to why lead concentrations in soil have dropped.

The maps above represent pre- and post-Katrina soil lead levels across 172 New Orleans census tracts. Tracts with darker red represent higher levels of contamination, concentrated in areas of high-industrialization along the river. After the Hurricane, soil lead concentration dropped by a factor of 2. Mielke and his team found that this corresponded with a drop in reported children’s blood lead levels by a factor of 2.5. Something had caused lead levels to drop over time.

Post-Katrina urban redevelopment may have helped to dilute and bury lead deeper below the surface as new soil was dumped for new houses. However, more recent findings from Mielke indicate that lead levels dropped ubiquitously between areas that did and did not undergo flooding and redevelopment. He suggests that the phasing out of tetraethyl lead from gasoline in 1970s and 80s may have had the most impact in reducing lead levels in soil and children. The removal of lead from gasoline was accomplished in the wake of the Clean Air Act signed into law in 1970.

Although dangerous levels of legacy lead are still concentrated in high-density traffic areas of the city, Mielke’s results are indicative of the positive change that can come about when public health policy prevails. Although long-term, daily exposure to low amounts of lead can still cause developmental harm, the levels that are present in New Orleans today present a much lower risk.

Map from "Soil Lead and Children’s Blood Lead Disparities in Pre- and Post-Hurricane Katrina New Orleans (USA)," International Journal of Environmental Research and Public Health. 2017 Apr;14(4):407. doi: 10.3390/ijerph14040407
                    [post_title] => The Unexpected: Less Lead in New Orleans
                    [post_excerpt] => After Hurricane Katrina, researchers found that storm surge flooding did not increase heavy metal contaminants in soil. Instead, lead levels dropped. 
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After Hurricane Katrina, researchers found that storm surge flooding did not increase heavy metal contaminants in soil. Instead, lead levels dropped.

...more
Databyte

The 2 Degree Solution

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                    [post_content] => Our globe is on a fast-track to exceed 2˚C in warming by 2050, leading to more extreme weather events. So what, specifically, would it take for us not to surpass a 2˚C increase in global temperature in the next 30 years? An energy policy firm, Energy Innovation, chose to tackle that question head-on, by modeling how current energy policies will impact future emissions.

To have a 50% chance of not overshooting 2˚C by 2050, we must reduce our carbon emissions by 1156 gigatons, or 41%, from we might expect to produce over the next 30 years. This is achievable if the top 20 greenhouse gas emitting countries (with China and the US in the lead) reduce their emissions collectively. The figure above illustrates the cumulative emissions that need to (and can) be reduced across five sectors of the economy, and land use, in order to remain below the most dangerous levels in 2050.

Industry has the greatest potential for cutting back on global emissions through policies focused on more efficient energy production and stricter emissions standards (such as regulating oil and gas leaks). Power sector (electricity) emissions would decline with renewable energy incentives and improving the grid’s capability to accommodate multiple energy sources. Transportation sector emissions would drop with stricter fuel economy standards and more green urban transportation systems (improved public transportation, bike lanes, and sidewalks). A buildings’ energy consumption could decrease with more efficient building codes and appliance standards (such as improved insulation and energy-saving electronics). Carbon Pricing is a cross-sectional policy that would create carbon taxes and caps, while land use emissions could be reduced through policies aimed at reducing deforestation and forest degradation.

The Paris Agreement provides targets for reducing emissions, but it’s policy implementation that will allow for those targets to be met. This is the first time we have access to clear guidelines for what we need to do in order to curb our emissions for a safer future. How to make the necessary changes is less clear, but will certainly be impossible without focused and concerted international effort.

Graphic from Energy Innovation, How to Prioritize Policies for Emissions Reduction
                    [post_title] => The 2 Degree Solution
                    [post_excerpt] => What would it take for us to avoid a 2˚C increase in global temperature in the next 30 years? An energy policy firm tackles the question, modeling how current energy policies will impact future emissions.
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What would it take for us to avoid a 2˚C increase in global temperature in the next 30 years? An energy policy firm tackles the question, modeling how current energy policies will impact future emissions.

...more
Databyte

Immigrants and Private Insurance: Pay More, Use Less

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                    [post_content] => Between 2002 and 2009, immigrants paid an estimated $115.2 billion more into Medicare than they used. However, half of immigrants are covered by private insurance so it is important to understand contributions and expenditures in that type of insurance as well.

A study published in Health Affairs used data from the Medical Expenditure Panel Survey (MEPS) to measure both premiums and expenditures from private health insurance. Data from the Medical Expenditure Panel Survey and the National Health Interview Surveys were linked for this study.

The graph above shows the premiums, expenditures, and net contributions of all documented and undocumented immigrants and US natives. Both groups of immigrants had positive net contributions, meaning they paid more toward their private insurance coverage than they spent in receiving health services. Undocumented immigrants had an even higher net contribution (Yes, undocumented immigrants get paychecks and these paychecks have deductions). US natives had a negative net contribution, meaning that, per capita, their expenditures on health care were greater than their premiums.

These findings upend the common belief that immigrants are a drain on the US health care system. Indeed, the opposite is true. Immigrants who contribute to Medicare and to private health insurers are subsidizing the health care of US citizens.

Graph from "Immigrants Pay More In Private Insurance Premiums Than They Receive In Benefits," Leah Zallman, Steffie Woolhandler, Sharon Touw, David U. Himmelstein, and Karen E. Finnegan, HEALTH AFFAIRS 37, NO. 10 (2018): 1663–1668, doi: 10.1377/hlthaff.2018.0309
                    [post_title] => Immigrants and Private Insurance: Pay More, Use Less
                    [post_excerpt] => New research in Health Affairs upends the belief that immigrants are a drain on the US health care system. 
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New research in Health Affairs upends the belief that immigrants are a drain on the US health care system.

...more
Databyte

Not Just Dads Getting that Bread

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                    [post_content] => As definitions and expectations of genders continue to evolve, so do family, work, and home lives. Earlier this year, the Pew Research Center examined changes in American parenthood in terms of employment, participation in household duties, and opinions on parent roles over the past half-century. The findings on fatherhood indicate a rise in stay-at-home fathers and single fathers over the past few decades. The time dads spend on child care has increased from 2.5 in 1965 to 8 hours per week in 2016, compared to moms at 10 to 14 hours per week. Paid work for dads has decreased from 46 to 43 hours per week.

Although these changes are small, especially considering the 50-year timeline, the research suggests a substantial drop in families in which fathers are the only employed adult. As of 2016, within heterosexual couples fathers alone worked in only 27% of families that had at least one child under 18 years; most families with children are dual income. The proportion of couples with mothers as the sole breadwinner rose very little since 1970.

Pew also found that 63% of dads in the United States believe they spend too little time caring for their children. Most adults who think it is ideal for one parent to stay home for child-rearing prefer that one parent to be the mother; 75% think that having more working women makes child-rearing more difficult. Gender roles have shifted over the past five decades, but women in the work force has remained steady for the last three.

Graph from Pew Research Center, "7 facts about American dads," by Kim Parker and Gretchen Livingston, June 13, 2018
                    [post_title] => Not Just Dads Getting that Bread
                    [post_excerpt] => Research on fatherhood indicates a rise in stay-at-home fathers and single fathers over the past few decades. 
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Research on fatherhood indicates a rise in stay-at-home fathers and single fathers over the past few decades.

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