Research

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                    [post_date] => 2019-02-26 06:00:12
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                    [post_content] => My colleagues and I conducted a qualitative study to explore Muslim women’s experiences of intimate partner violence from the perspectives of frontline service providers.

The results revealed that pre- and post-migration stresses shape Muslim survivors’ experiences, among other important factors such as collectivist culture, patriarchy, honor, shame, and faith.

We found that women’s experiences are exacerbated by their position as immigrants due to limited language skills, social isolation, unemployment, acculturation stress, and citizenship status. As one of the service providers explained:
“The women don’t really have a choice, but to stay [in an abusive relationship] because of their citizenship, because of their sponsorship status. So, they are constantly being threatened by the perpetrator to be sent back home, the children will stay and they do not see children anymore. So that fear creates a huge impact.”
Another service provider reflected on women’s lack of social skills due to their immigration status:
“As an immigrant she needs lots of assistance to adapt, to learn the skills, to integrate, to be 100% independent. She needs lots of preparation, training and education to make that decision to leave home or accept help to make that decision to leave that relationship. In her mind, yes, there is abuse. But she is unfamiliar with the environment. At least now she knows what is going to happen and what to expect.”
Our findings reflect that collectivist values can instruct women to give higher priority to the needs of their children and extended family members than to their own needs, desires, and safety. Within collectivist culture, strong emphasis is placed on having a good reputation within one’s social network. This is reflected in the words of another provider:
“We are here, we can help you, support you, find you a place, and take you to a lawyer. We can try to keep the children but that’s not her priority. Her priority as a Muslim woman is keeping family together. She does not want to see herself as a single mother or as a widow or divorced woman living on her own and taking all these responsibility by herself.”
Gender inequality and the male dominance in social interactions are key factors in understanding why women remain in abusive relationships worldwide, which were also among our findings. This respondent explained the power dynamics within relationships:
“I think the power differential that exist between man and woman in the culture, or the perceived inequality, is a huge risk because lots of women feel that they are not worthy to or capable of living on their own, and believe that men are superior.” 
Patriarchal interpretations of religion also lead women to accept the violence. They are sometimes misled by religious leaders who are unaware of the nature of intimate partner violence. Also, perpetrators often distort or manipulate religious doctrines to rationalize or justify their violent behavior. A service provider stated:
“I have worked with women who have been told by their imams throughout the years or by the religious people through the mosque that they need to go back, that they need to be a better wife. They need to do what they are told. And so, when someone that powerful tells that to you, you know you [must be a] pretty strong person to go against it.”
In conducting research with vulnerable and culturally diverse populations, it is important to contextualize cultural factors within systemic and historical structures such as racism, colonialism, ethnocentrism, and class privilege. Mental health practitioners must be aware of and sensitive to the sociocultural contexts of survivors, and they must also explore ways in which culture can facilitate unique solutions. Considering the significance of sociocultural factors, practitioners should advocate for clients and empower them to advocate for themselves.

Feature image: pepifoto/iStock, model in photo used for illustrative purposes only. 
                    [post_title] => Muslim Women's Experiences of Intimate Partner Violence
                    [post_excerpt] => Muslim women’s experiences of intimate partner violence are shaped by collectivist culture, patriarchy, honor, shame, and faith.
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                    [post_date] => 2019-02-25 07:00:19
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                    [post_content] => When I tell people that I research the relationship between religion, immigration, and health I sometimes get a reaction such as "Wow, three hot topics always in the news, there must be a lot to say about this!" Surprisingly, however, little has been written about the intersection of these three topics, despite the prominence of each individually and despite potentially important implications.  For example, the Handbook of Religion and Health is a tome with more than one thousand pages where the topic of immigrants/migration doesn’t even warrant an index entry.

In my recently published study, I shine a brighter light on this topic. I used data from the New Immigrant Survey, analyzing a randomly selected sample of over 1,200 legal Latino immigrants in the United States, to examine the relationship between religious involvement, as measured by current church attendance, and indicators of a healthy lifestyle. I found that those immigrants who attended church at least weekly smoked less, drank alcohol less, and engaged in more physical activity compared to those who did not attend church.
I found that those immigrants who attended church at least weekly smoked less, drank alcohol less, and engaged in more physical activity compared to those who did not attend church.

 
How to explain these results? The survey did not collect information on all potential causal factors, but findings are consistent with the hypothesis that health is related to having social, psychological, and religious resources. According to the literature, each of these can be a kind of capital associated with better health and found in larger quantities among those who frequently attend religious congregations.

Why should those of us concerned about public health care about these findings? Some might assume the lesson is that people should start to join religious congregations and attend church regularly to improve their health. I think that would be a mistake for a number of reasons, not least of which is that attending church services for non-religious reasons would likely lead to different results.

Some might argue that my findings show there is little need to target the religiously involved because they already are in better health. However, not all immigrants who attend church have a healthy lifestyle. Findings from this study suggest there is an opportunity for churches, or houses of worship of other religions, to promote health among congregants. Congregations serving the poor and vulnerable, where immigrants are disproportionately represented, are least likely to offer health promotion programs.
Findings from this study suggest there is an opportunity for churches, or houses of worship of other religions, to promote health among congregants.

 
Attending a religious congregation is not necessarily a magic bullet to improve health, even for those religiously committed. I also looked or associations between attending religious services in country of origin and a healthy lifestyle. I found little evidence of a relationship between home country church attendance and current health behaviors. There was a positive association between church attendance and physical activity, but even that association was weak.

Why the difference in results? There are a number of possibilities, including differences between countries, but a plausible explanation, consistent with the literature, is that religion helps those who migrate integrate into their new country and communities.

Although some speak of individual responsibility as central to a healthy lifestyle, the context in which people live can make choosing healthy behaviors much easier. We need to pay more attention to factors such as religion and migration and the intertwining of identities when trying to improve the public's health.

Feature image: Chandelier Ceiling Architecture San Gabriel Mission, ChuckSchugPhotography/iStock
                    [post_title] => Churches Are Places of Habits and Hearts
                    [post_excerpt] => Immigrants to the US who attended church regularly had healthier lifestyles. Houses of worship could promote health and integration into a new country and community. 
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                    [post_date] => 2019-02-22 05:30:36
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                    [post_content] => Cigarette smoking typically begins in adolescence. The younger the age of initiation, the greater the risk of daily smoking, heavy cigarette consumption, nicotine dependence and difficulty quitting. Pediatricians and family practitioners are important sources of preventive counseling, but the lack of a screening tool to rapidly identify which adolescents need tobacco counseling is a major barrier in busy clinical practices.

My colleagues and I, at the Research Centre of the University of Montreal Hospital Centre in Montreal designed a new tool that quickly and accurately identifies adolescents at risk of starting to smoke in the next year. Our goal is to streamline counseling referrals for those who most need it.

We used data from the Nicotine Dependence in Teens (NDIT) study, which investigates the natural course of cigarette smoking in youth. The NDIT cohort includes 1,294 students initially recruited in 1999 at age 12-13 (grade 7) in ten Montreal-area high schools. Students completed in-class questionnaires every three months during the 10-month school year, from grade 7 to 11 (1999-2005), for a total of 20 cycles. In addition to information on cigarette smoking, they provided data on demographic characteristics, academic performance, smoking habits of family and peers, physical and mental health, weight, nicotine dependence, substance use, other lifestyle-related variables, and school and neighborhood smoking context.
Using state-of-the art artificial intelligence methods to select from among 58 known predictors of smoking initiation, we identified variables for inclusion in the screening tool.

 
A total of 370 adolescents began smoking during high school. Using state-of-the art artificial intelligence methods to select from among 58 known predictors of smoking initiation, we identified variables for inclusion in the screening tool. Adolescents need to respond to 12 questions including their age and alcohol consumption in order for us to be able to predict their risk of initiating smoking in the next year. The questionnaire includes questions on tobacco, such as whether the teen feels the need for a cigarette, whether they find it difficult not to smoke when others are smoking, and whether they have friends who smoke. The questionnaire contains two questions on self-esteem, one question on feeling hopeless about the future, and four stress questions focused on loneliness, weight, health problems, and relationships with siblings.

Each answer corresponds to a certain number of points which are summed to create a risk prediction for smoking initiation. Items associated with a reduced risk of smoking initiation were assigned negative points. Items associated with an increased risk of initiation were assigned positive points.

For example, the risk of initiation decreases with older age, worry about loneliness or health, and having high self-esteem. Consuming alcohol, worry about weight, and having friends who smoke increases the risk. We recommend that any young person with a positive score needs tobacco counseling. Since most variables included in this tool represent issues that can be addressed in preventive care, results can also guide physicians in how to counsel the youth identified as at-risk of becoming smokers.

A version of the tool is available online. This new screening tool shows good predictive properties, and takes only a minute to complete. Teens can easily do so while waiting to see their physician.

Feature image: imantsu/iStock
                    [post_title] => Tool to Identify Adolescent Cigarette Smoking Risk
                    [post_excerpt] => Cigarette smoking typically begins in adolescence. Sylvestre and colleagues designed a new tool that identifies adolescents at risk of starting to smoke in the next year.
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                    [post_date] => 2019-02-21 07:00:08
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                    [post_content] => By 2050, the global population will be almost 10 billion. Those are a lot of mouths to feed. In order to provide enough food for the world, we need to figure out how to produce 56% more calories than we produced in 2010. Simply growing more food is not the answer.

After the energy sector, agriculture is the second largest emitter of greenhouse gases. According to a report by the World Resources Institute, a 56% increase in global caloric production would produce an estimated 15 gigaton of carbon dioxide emissions a year—causing our climate to warm way above the targeted 2℃ change deemed ‘safe’ by climate scientists. In order to not exceed the 2℃, we need to aim for an agricultural sector that produces a mere four gigatons of carbon dioxide emissions a year. Some dramatic changes need to take place in the agricultural industry to be able to feed everyone in an environmentally sustainable manner. So how can we grow more food without farming more land?

Food loss and food waste is a major contributor to agriculture’s greenhouse gas creation. Roughly 1/3 of our food goes to waste. Food loss occurs along the whole production chain (from processing, to distribution, to consumption) making it a challenging issue to manage. Interventions that target food rescue and redistribution would not only help decrease greenhouse gas emissions, but would also serve to provide food to communities in-need. Grassroots organizations, such as Boulder Food Rescue and Food Not Bombs, are examples of local organizations that have identified businesses with surplus food and locations for redistribution to close existing food gaps.
But reducing and redistributing surplus food alone won’t solve our problem. We also need to figure out how to produce more food without increasing agricultural land use.

 
But reducing and redistributing surplus food alone won’t solve our problem. We also need to figure out how to produce more food without increasing agricultural land use. The World Resources Institute implores researchers and scientists to find ways to boost crop yields, such as by planting crops more frequently. Another possibility would be through the selective breeding, genetic modification (introducing foreign DNA) or genetic editing (editing existing DNA) of crops, to enhance their ability to absorb nutrients or resist pests and disease. Although genetically-altered crops pose little threat to human health, there is the potential for pests and weeds to become resistant to these altered strains, which could lead to an increase in future pesticide use.

Cattle, sheep, and goats produce roughly half of agriculture’s greenhouse gases. Digestive bacteria in the guts of ruminants produce large amounts of methane gas that is expelled as burps. Scientists have tried reducing the amount of gas released through special food supplements, but this scheme can be difficult to implement. Another greenhouse gas reduction option is introducing chemical inhibitors into pastures that diminish the breakdown of manure into nitrogen, found to be successful in New Zealand. Finally, reducing our meat consumption to 1.5 servings a week would cut back meat consumption by 40%.

The US government spends $20 billion a year on agricultural subsidies—funded by taxpayers—with little environmental oversight and no explicit goals regarding the needed increase in calorie production in our food supply.

Feature image: georgeclerk/iStock
                    [post_title] => Climate Change and the Food Gap
                    [post_excerpt] => By 2050, the global population will be almost 10 billion. Simply growing more food is not the answer to feed us all. 
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                    [post_content] => Natural, organic, chemical free, and homeopathic are all buzzwords people tend to associate with safety and efficacy. In many cases this is far from the truth. Many people look for this terminology on packaging and product descriptions when purchasing dietary supplements and vitamins. This class of natural products intended to aid health can be broadly called nutraceuticals or ultraceuticals. People buy these products for countless reasons, often due to a lack of trust in pharmaceutical products, low cost, privacy, or a desire to avoid medication side effects. Nutraceuticals are not regulated by the Food and Drug Administration or any other agency to ensure their claims or ingredients are as advertised. What is really in them? What do they really do?

Since the 1990s, researchers and organizations have failed in standardizing regulation for nutraceuticals. The market for these products has grown exponentially in recent years. Amazon, eBay, and other online international retail stores have become a major platform for manufacturers to sell nutraceuticals directly to consumers. These online retail outlets empower consumers to choose from an enormous selection of products from all over the world. Usually, more choice is a good thing for a consumer, but the absence of regulation may attract manufacturers who cut corners to profit from this lucrative market.
Pesticides, heavy metals, harmful bacteria, unreported active pharmaceutical ingredients, and fraudulent adulterated pharmaceuticals could be and have been found lurking in these products...

 
While many of these products may contain and do what they say, no one is checking. Pesticides, heavy metals, harmful bacteria, unreported active pharmaceutical ingredients, and fraudulent adulterated pharmaceuticals could be and have been found lurking in these products, as reported by our research group previously for male enhancement and weight loss nutraceuticals. Transparency in labelling is vital to consumer health as natural herbs and food may impact how medications work or cause allergic reactions. Moreover, manufacturing standards vary greatly between countries, as most of these products are imported. Although the United States has clearly defined standards for what is acceptable in drugs and food, these regulations don’t exist for nutraceuticals.

[caption id="attachment_6389" align="aligncenter" width="500"] Figure 1: Average amount of Sildenafil citrate (mg) in indvidual batches of Viagra®, Tiger King, Plant Viagra, Hercules, Natural Viagra and Herbal Viagra[/caption]

Many nutraceuticals offer a seemingly simple fix to people’s insecurities that can be discreetly ordered online: weight loss, memory, energy, and erectile dysfunction. Though rarely discussed, erectile dysfunction is a common problem with many clinical and psychological causes. The pharmaceuticals available to treat erectile dysfunction alter blood pressure, so many health conditions prevent its safe use. Consequently, men look to nutraceuticals for a safe alternative. What they don’t know is that many contain pharmaceutical ingredients, some at dangerous doses, as shown in Figure 1. This may give some weight to the claims of efficacy, but it puts the health and safety of men using them at risk of serious side effects and even death, which is a major public health concern.

Manufacturers and online retail outlets have a responsibility to advertise honestly and ensure the safety and efficacy of their product. Companies that profit from selling these products should be held accountable for illegal therapeutic label claim and any adverse effects that may result.

The lack of legislation to protect the people who use nutraceuticals borders on negligence. As the market for nutraceuticals rapidly expands, it is imperative to implement a set of standards to protect health. Consumers should shop at their own risk and use a healthy dose of skepticism when purchasing these of products.



 

Flowchart (courtesy of the authors) showing steps to help determine quality of a supplement. Figure 1: (courtesy of the authors) Average amount of Sildenafil citrate (mg) in individual batches of Viagra®, Tiger King, Plant Viagra, Hercules, Natural Viagra and Herbal Viagra analyzed via High Performance Liquid Chromatography (HPLC). Sildenafil citrate is a phosphodiesterase inhibitor type 5 used clinically for erectile dysfunction and can lead to severe low blood pressure, myocardial infarction (heart attack), ventricular arrhythmias, stroke, increased intraocular pressure, headache, flushing, indigestion, nasal congestion, and impaired vision, including photophobia and blurred vision. 

Feature image: real444/iStock. 
                    [post_title] => What's Supplementing Your Supplements?
                    [post_excerpt] => Dietary supplements and vitamins are often described as natural, organic, chemical free, and homeopathic. Because nutraceuticals are not federally regulated, these claims about performance and ingredients are difficult to verify. 
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                    [post_content] => Over the past two years, the federal government has passed a series of highly-publicized anti-immigrant laws. Some of these laws limit the number of new immigrants who can enter the US legally, and prohibit immigration from certain countries. Other laws make life harder for immigrants who are already in the US—for example, by stripping legal status from migrants who are here on humanitarian programs. While it’s too early to know how these policy changes will affect our communities over the long term, they could worsen health disparities for Latinos for decades and generations to come. The courts haven’t allowed the Trump administration to implement some of their harshest policies, but these effects might emerge even if the policies aren’t implemented.

The health impacts of state and local laws that increase immigration enforcement and decrease access to services and benefits for undocumented immigrants are well-documented by researchers. In a recent study, I asked how anti-immigrant laws in ten states impacted health care access for Latino children who were born in the US to noncitizen parents, and whether these effects differed depending on characteristics of the counties where families lived.

Using ten years of data from the CDC National Health Interview Survey, I looked at how Medicaid enrollment rates changed after states passed omnibus laws. I also wanted to know if these changes in enrollment differed based on the percent of the county population who were Latino.
Across counties with anti-immigrant policies in place, Latino adults report more anti-immigrant discrimination as county Latino density increases.

 
I found that law passage did not affect Medicaid enrollment for Latino children who lived in counties with relatively few Latino residents. However, as size of the Latino populations increased, the laws had harmful effects. Children in counties that were 25% Latino were 10% less likely to have Medicaid coverage after the laws passed. In counties that were 35% Latino, children were 21 percentage-points less likely to have coverage. Most of these children became uninsured. They did not move to private health insurance plans. This loss of health insurance will likely translate to worse health, lower educational attainment, and lower earnings into adulthood.

Why does living in a county with a high percentage of Latino residents place children at risk of losing Medicaid coverage when an anti-immigrant law passes? The explanation may lie in how native-born Americans react to large and growing immigrant populations. Across counties with anti-immigrant policies in place, Latino adults report more anti-immigrant discrimination as county Latino density increases. And Latinos in counties with very high concentrations are at greater risk of being deported. Both discrimination and risk of deportation discourage parents from seeking health care for their children.

So, what can local governments, immigrant advocates, and public health professionals do to promote health equity for immigrant families? Possibilities include: working with trusted community organizations to enroll eligible children in benefits. Making sure state Medicaid workers don’t ask about parents’ immigration statuses when they apply for benefits for their eligible children. And reducing barriers to transportation to program offices and clinics.

Feature image: brazzo/iStock 
                    [post_title] => The Legal Landscape and Latino Children
                    [post_excerpt] => Anti-immigrant laws impact health care access for Latino children born in the US to noncitizen parents, especially in counties with high percentages of Latino residents. 
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                    [post_content] => My friends are surprised when I tell them that climate change and mental health are related. But it’s true. Heat waves are related to increased risk of suicide, hurricanes are linked to depression, and flooding can cause post-traumatic stress. As the world heats up, we can expect to see hotter average summer temperatures and more extreme weather events. And these changes are going to have an impact on people’s mental health. A recent study by Nick Obradovich and his colleagues at the MIT Media Lab was the first of its kind to quantify how climate change influences people’s mental health on a large-scale.

Obradovich and his team paired health survey data from over 2 million US residents collected by the CDC’s Behavioral Risk Factor Surveillance System with meteorological data from 2002-2012. The CDC mental health survey asked respondents to report whether they experienced any stress, depression, and/or emotional distress in the past 30 days. Changes in an area’s average mental health were then compared to different climate events.

Climate events were categorized as: short-term weather exposures (such as higher than average monthly temperatures or rain), long-term warming temperatures, and tropical cyclones.
The team found that, over longer periods, increasing average temperatures corresponded with increasing mental stress.

 
Hot weather and heavy rain increased depression, anxiety, and emotional distress. Areas which experienced average temperatures above 30°C (86°F) in a month, or more than 25 days of rain, had significantly more people reporting poor mental health than in cooler or drier areas. An additional 2 million people are expected to experience worsened mental health should average monthly temperatures shift from warm to hot weather (25°C to 30°) across the United States. Low-income populations, less able to cope with the environmental impacts of extreme weather, experienced worsened mental health from short-term hot temperatures and heavy rain.

The team found that, over longer periods, increasing average temperatures corresponded with increasing mental stress. More specifically, a 1°C increase in average summer high temperatures caused a two percent increase in the number of people who reported experiencing poor mental health.

Hurricane Katrina, which started as a tropical cyclone, had the greatest impact of recent weather events on wellbeing. The number of people who reported poor mental health in response to the Hurricane increased by four percentage points in the region affected.

According to Obradovich, exposure to climate stressors will continue to harm mental health. “Climate change has a day-to-day impact on our lives,” he explained. “It’s not just huge floods and hurricanes, though those obviously matter, too. The reality is climate change is so substantial that we’re not going to adapt perfectly. We need to improve quality and access to mental health care while also reducing our impact through mitigation techniques to slow down climate change.”

Feature image: spinster cardigan, sweltering, used under CC BY 2.0
                    [post_title] => Feeling Hot and Bothered
                    [post_excerpt] => Heat waves may increase risk of suicide. Nick Obradovich and colleagues developed a method to quantify the influence of climate change on mental health.
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                    [post_date] => 2019-02-13 05:00:42
                    [post_date_gmt] => 2019-02-13 10:00:42
                    [post_content] => California aims to eliminate tuberculosis by 2040, and has a five-year plan that lays out specific steps to achieve this goal. But the current burden of infection in the state may not allow for that goal to be met.

Tuberculosis has been, and still is, a nationally notifiable disease, meaning clinicians must report new cases to their local health departments, which then report to the Centers for Disease Control and Prevention. There were 9,105 reports of new tuberculosis cases in 2017, the lowest number in the US ever. But costly treatment and drug-resistant strains of Mycobacterium tuberculosis, the bacteria that cause the infection, continue to make it difficultAlt to achieve elimination in this century.

About 20% of the cases reported nationally in 2017 occurred in California. Eighty percent of tuberculosis infections in California were latent, and did not present any signs of illness.

Researchers at University of California, Davis were interested in understanding the specific impact of national economic crisis on the disease. In particular, they aimed to assess how tuberculosis cases in California were affected by the recession between 2007 and 2009.

The researchers used annual tuberculosis surveillance reports from the California Department of Public Health between 2000 and 2016. They measured the number of new tuberculosis cases in the state each year, the rate of those cases per 100,000 people per year, and the number of annual deaths from the infection. The researchers also collected information on tuberculosis-related hospitalization and emergency room visits. They then observed how these measures compared before the beginning of the recession in 2007 and after the end in 2009.

The results of this study indicate that tuberculosis cases declined at a slower rate annually in post-recession periods than in pre-recession years in California. Tuberculosis case rates decreased overall from 2000 to 2009, but then plateaued at fairly steady rates until 2016. Hospitalization from tuberculosis dropped drastically from 2000 to 2010, but then began to decrease at a much slower pace. Yet, people visited emergency rooms for tuberculosis twice as much between 2010 and 2016, as compared to the period before the recession. This may have been a result of changes in insurance in the wake of the recession.

Although tuberculosis rates fluctuated from high to low in the years of the recession, the researchers conclude that the economic crisis slowed the decline of tuberculosis in California.

Their study is the first in the US to examine the influence of national economic difficulties on tuberculosis. European research has explored and found evidence of associations between recession and tuberculosis control. The infection can be prevented and cured when managed and treated effectively, but economic downturn may negatively impact control efforts. Tuberculosis is already difficult to manage in the US, as it is often overlooked by clinicians in some areas that do not consider it a local threat. If the decline in tuberculosis cases continues to slow, it will challenge California’s goal to eliminate the infection by 2040.

Feature image: NIH, 3D print of Mycobacterium tuberculosis, the bacterium that causes tuberculosis. NIH 3D Print Exchange at 3dprint.nih.gov, used under CC BY 2.0 
                    [post_title] => Recessions and Tuberculosis
                    [post_excerpt] => Researchers examined the impact of the 2007-2009 recession on tuberculosis in California. They found the recession slowed the decline of TB in the state. 
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                    [post_date] => 2019-02-12 07:00:46
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                    [post_content] => Catastrophic medical expenditure is the main cause of bankruptcy in the United States. In 2007, 62.1% of all bankruptcies were for medical reasons. In 2010, some states expanded Medicaid under the Affordable Care Act (ACA) to adults with incomes below 138% of the federal poverty level. As a result, states implementing this legislation succeeded in expanding insurance coverage, reducing the probability of medical and personal bankruptcies, lowering the amount of medical and payday-loan debt, and improving credit scores. In theory, these reductions in the cost of health care among low-income families relax budget constraints and increase consumption of other goods.

My colleagues and I investigated whether or not obtaining health insurance through Medicaid expansion under the ACA helped to reduce worries and stress related to paying rent or mortgage and buying nutritious meals. We examined low-income Americans aged 18-64 years residing in 12 states (including five ACA Medicaid expansion states) in 2015, using data from the Behavioral Risk Factor Surveillance System (BRFSS). In the BRFSS, the respondents were asked: How often in the past 12 months were you worried or stressed about having enough money to pay the rent/mortgage or to buy nutritious meals?
We found that each 10% increase in obtaining health insurance following the ACA Medicaid expansion reduced worries and stress regarding the affordability of nutritious meals by 7.2%.

 
We found that each 10% increase in obtaining health insurance following the ACA Medicaid expansion reduced worries and stress regarding the affordability of nutritious meals by 7.2%. Also, a 10% increase in access to health insurance reduced worries for paying the rent or mortgage by 8.6 % among low-income people.

Housing, nutrition, and healthcare are each determinant of health. Housing costs can cause financial strain. Financial strain due to housing instability is related to poor health status and related-behaviors, such as poor self-rated health, hypertension, and non-adherence to healthcare and prescription drugs. Poor health resulting from financial strain, in turn, may result in excess health expenditures, creating further financial pressure on family budgets.

Expanding access to health insurance among low-income groups helps to break this cycle. Furthermore, we found that stress or worry related to buying nutritious meals and paying for rent/mortgage was associated with being female, living with children, and being unemployed. In turn, these groups were most likely to benefit from ACA Medicaid expansion.

Among low-income people, improved access to health insurance helps reduce worry and stress associated with being able to afford nutritious meals and pay rent or a mortgage. Expanding health insurance access may have contributed to increasing the disposable income of low-income groups.

Feature image: Alice Pasqual on Unsplash (detail) 
                    [post_title] => Medicaid Expansion Reduces Financial Worry
                    [post_excerpt] => Obtaining health insurance through ACA Medicaid expansion helped to reduce people's worries about rent or mortgage payments and buying nutritious meals.
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                    [post_content] => Individuals are living longer and spending a larger fraction of their lives in retirement, a trend that puts strain on both private retirement resources and public-sector programs that support retirees. These pressures have prompted policy discussions on taking steps to extend or facilitate longer working lives. An important factor in weighing the costs and benefits of longer working lives is how retirement impacts individual health and well-being. Moreover, how retirement influences health can have secondary fiscal consequences when much of the health spending for retirees is financed by the government.

Our research seeks to determine the causal impact of retirement on health and well-being. On one hand, retirement may cause loneliness or a sedentary lifestyle, leading to declining health and well-being. On the other hand, lack of work responsibilities may reduce stress and leave more time for social activities or health-improving activities like exercise.

The existing evidence on the impact of retirement on health and well-being is mixed. Given that people often choose to retire because of poor health or an adverse life event, many studies have found correlations between poor health and retirement. However, these correlations do not provide evidence about how retirement influences individual health and happiness.
However, the health improvements do not appear immediately. Instead, many health improvements develop four or more years after retirement.

 
Our empirical approach uses variation in retirement policies at different ages to assess the impact of retirement on health and well-being. For instance, at age 62 individuals become eligible to claim social security retired worker benefits, inducing some individuals to retire. By exploiting variation in eligibility for government programs and private pensions, we estimate the causal impact of retirement on health and well-being both immediately and many years after retirement.

Using the Health and Retirement Study, a rich set of nationally representative data, we found that retirement improves self-reported health and functional limitations. However, the health improvements do not appear immediately. Instead, many health improvements develop four or more years after retirement. This makes sense because it often takes time for investments in health to come to fruition. That is, many health improving activities such as exercise do not make us instantly healthier but generate future health gains if done consistently over time.

Our research also finds that retirement leads to immediate improvements in life satisfaction, and these improvements persist into the long-run. A large body of research finds that people often return back to a set state of happiness after major life events temporarily influence their emotional balance. This line of research suggests that the effect of retirement on life satisfaction may fade out after the initial retirement period. However, our results show that retirement improves happiness and well-being well beyond one’s retirement date.

These improvements in health and life satisfaction do not seem to be driven by increased health-care use, nor do they appear to reduce health-care expenditures. Our study finds retirement is unlikely to have large effects on medical expenses.

Overall, this research suggests that policies to extend working lives may have detrimental consequences on the health and happiness of individuals and are unlikely to have substantial direct effects on health-care spending. These possible negative consequences should be considered when evaluating policies that extend working lives.

Feature image: BeyondImages/iStock
                    [post_title] => Retirement Brings Health and Happiness
                    [post_excerpt] => Research suggests that retirement leads to improvements in life satisfaction. Policies that extend working lives may have detrimental consequences on health and happiness.
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