Medicaid Expansions and Fertility in the United States

Beginning in the mid-1980s and extending through the early to mid-1990s, a substantial number of women and children in the United States gained eligibility for Medicaid through a series of income-based expansions. Using natality data from the National Center for Health Statistics, we estimate fertility responses to these eligibility expansions. We follow Currie and Gruber (2001) and measure changes in state Medicaid-eligibility policy by simulating the fraction of a standard population that would qualify for benefits in different states and different time periods. From 1985 to 1996, the fraction of women aged 15–44 who were eligible for Medicaid coverage for a pregnancy increased more than 20 percentage points. When we use a state and year fixed-effects model with a limited set of covariates, our estimates indicate that fertility increases in response to Medicaid expansions. However, after we include fixed effects for demographic characteristics, the estimated relationship diminishes substantially in size and is no longer statistically significant. We conclude that there is no robust relationship between Medicaid expansions and fertility.     

Transition to Parenthood: The Role of Social Interaction and Endogenous Networks

Empirical studies indicate that the transition to parenthood is influenced by an individual’s peer group. To study the mechanisms creating interdependencies across individuals’ transition to parenthood and its timing, we apply an agent-based simulation model. We build a one-sex model and provide agents with three different characteristics: age, intended education, and parity. Agents endogenously form their network based on social closeness. Network members may then influence the agents’ transition to higher parity levels. Our numerical simulations indicate that accounting for social interactions can explain the shift of first-birth probabilities in Austria during the period 1984 to 2004. Moreover, we apply our model to forecast age-specific fertility rates up to 2016.     

National Income and Income Inequality,Family Affluence and Life Satisfaction Among 13 year Old Boys and Girls: A Multilevel Study in 35 Countries

Adolescence is a critical period where many patterns of health and health behaviour are formed. The objective of this study was to investigate cross-national variation in the relationship between family affluence and adolescent life satisfaction, and the impact of national income and income inequality on this relationship. Data from the 2006 Health Behaviour in School-aged Children: WHO collaborative Study (N = 58,352 across 35 countries) were analysed using multilevel linear and logistic regression analyses for outcome measures life satisfaction score and binary high/low life satisfaction. National income and income inequality were associated with aggregated life satisfaction score and prevalence of high life satisfaction. Within-country socioeconomic inequalities in life satisfaction existed even after adjustment for family structure. This relationship was curvilinear and varied cross-nationally. Socioeconomic inequalities were greatest in poor countries and in countries with unequal income distribution. GDP (PPP US$) and Gini did not explain between country variance in socioeconomic inequalities in life satisfaction. The existence of, and variation in, within-country socioeconomic inequalities in adolescent life satisfaction highlights the importance of identifying and addressing mediating factors during this life stage.     

Determining the non-inferiority margin for patient reported outcomes

One of the cornerstones of any non-inferiority trial is the choice of the non-inferiority margin delta. This threshold of clinical relevance is very difficult to determine, and in practice, delta is often "negotiated" between the sponsor of the trial and the regulatory agencies. However, for patient reported, or more precisely patient observed outcomes, the patients' minimal clinically important difference (MCID) can be determined empirically by relating the treatment effect, for example, a change on a 100-mm visual analogue scale, to the patient's satisfaction with the change. This MCID can then be used to define delta. We used an anchor-based approach with non-parametric discriminant analysis and ROC analysis and a distribution-based approach with Norman's half standard deviation rule to determine delta in three examples endometriosis-related pelvic pain measured on a 100-mm visual analogue scale, facial acne measured by lesion counts, and hot flush counts. For each of these examples, all three methods yielded quite similar results. In two of the cases, the empirically derived MCIDs were smaller or similar of deltas used before in non-inferiority trials, and in the third case, the empirically derived MCID was used to derive a responder definition that was accepted by the FDA. In conclusion, for patient-observed endpoints, the delta can be derived empirically. In our view, this is a better approach than that of asking the clinician for a "nice round number" for delta, such as 10, 50%, π, e, or i.     

Infusing lesbigay research into the counseling research classroom

Despite research findings that lesbigays value, want, and use counseling services, some counselors report they are not adequately prepared to work with the lesbigay population. Lesbigay students have reported biases and discrimination in their programs. Research has found that some mental health professionals engage in a number of harmful practices when working with lesbigay clients. These findings challenge counselor education programs to find better ways of infusing lesbigay issues into their curricula. This article discusses how lesbigay issues might be infused into the counseling research classroom in ways that provide students the opportunity to think critically; learn about research design and ethics; expand their levels of tolerance; develop a deeper appreciation of the work involved in doing research; and see the power of research to change the course of history.     

Devalued, deskilled and diversified: explaining the proliferation of the strip industry in the UK

This paper looks beyond the debates that focus on the objectification of the female body to examine the question as to why strip clubs have proliferated and found a permanent place in the night-time economy in the UK. Using empirical qualitative and quantitative data from the largest study into the strip industry in the UK to date, we challenge the common assumption that 'demand' is responsible for the rise in erotic dance. Instead, we argue that the proliferation of strip clubs is largely due to the internal economic structures of the industry which have developed partly in response to the financial crisis beginning in 2008. First, we argue that clubs profit from individual dancers through an exploitative system of fees and fines, rendering a strip club business a low cost investment with high returns and little risk to club owners. Second, we note that the last decade has seen diversification of the industry accompanied by deskilling and devaluing of dancing and dancers' labour. Third, we demonstrate that despite the negative effects of these changes on workers, there has been an expansion of the industry as the ability to make profit, even during a financial crisis was ensured through the transferral of risk to workers. Overall, we suggest that far from proliferating as a response to demand, the industry has maintained its market presence due to its ability to establish highly financially exploitation employment relationships with dancers at a time of economic fragility.     

Will gay and bisexually active men at high risk of infection use over-the-counter rapid HIV tests to screen sexual partners?

The Food and Drug Administration may license OraQuick?, a rapid HIV test, for over-the-counter (OTC) sale. This study investigated whether HIV-uninfected, non-monogamous, gay and bisexual men who never or rarely use condoms would use the test with partners as a harm-reduction approach. Sixty participants responded to two computer-assisted self-interviews, underwent an in-depth interview, and chose whether to test themselves with OraQuick. Over 80% of the men said they would use the kit to test sexual partners or themselves if it became available OTC. Most participants understood that antibody tests have a window period in which the virus is undetectable, yet saw advantages to using the test to screen partners; 74% tested themselves in our offices. Participants offered several possible strategies to introduce the home-test idea to partners, frequently endorsed mutual testing, and highlighted that home testing could stimulate greater honesty in serostatus disclosure. Participants drew distinctions between testing regular versus occasional partners. Non-monogamous men who have sex with men, who never or rarely use condoms, may nevertheless seek to avoid HIV. Technologies that do not interfere with sexual pleasure are likely to be used when available. Studies are needed to evaluate the advantages and disadvantages of using OTC rapid HIV tests as one additional harm-reduction tool.     

The medicalization of women's sexual pain

The medicalization of women's sexual problems under the overall rubric of female sexual dysfunction (FSD) has been thoroughly critiqued by feminist scholars, health practitioners, and sex therapists. However, there has been much less commentary on the medicalization of women's sexual pain-currently, a subset of an official FSD diagnosis. This article critically examines interdisciplinary understandings and ways of addressing sexual pain. It analyzes these frameworks in relation to feminist theories on medicalization, heteronormativity, and the reciprocal relationship between these two processes. We argue that many women who experience sexual pain have been eager for medicalization as a path to minimizing pain during sexual activity and reinstating normative heterosexual practices and identities. These goals have been lobbied for by patient advocacy groups and noted by professionals in the field. Although there are some clear benefits to this case for medicalization, there are also theoretical, personal, and political costs. Guided by a growing body of feminist theoretical and qualitative, empirical research on this topic, as well as the first author's personal experience of sexual pain, this article highlights some alternatives to medicalization and makes suggestions for change.