FREE ELECTRONIC LIBRARY - Theses, dissertations, documentation

Pages:     | 1 |   ...   | 20 | 21 || 23 | 24 |   ...   | 56 |

«Moving to opportunity voluMe 14, nuMber 2 • 2012 U.S. Department of Housing and Urban Development | Office of Policy Development and Research ...»

-- [ Page 22 ] --

GAD required that the adult experience a period of at least 6 months in which they had excessive anxiety about multiple things and at least three of the following symptoms: restlessness, easy fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance. In addition, the anxiety Our TOT estimates assume that families who are offered a voucher but do not take up the offer (that is, do not use a program voucher to move) are not affected by the offer itself. This assumption may not be strictly true, because families may have changed some of their thinking or behaviors (such as looking at apartments) as a result of the offer. We think, however, that the effects of actually using the voucher are likely to be much larger than any effects of being offered the voucher and not using it, and that it is reasonable to assume that the ITT effects are driven strictly by effects on compliers.

120 Moving to Opportunity The Long-Term Effects of Moving to Opportunity on Adult Health and Economic Self-Sufficiency had to cause significant distress or impair respondents’ functioning. Our measure of PTSD used a subset of the CIDI questions and then imputed the probability of PTSD from those responses using data from a national study.5 To be categorized as having PTSD, the respondent had to have experienced, witnessed, or been confronted by a traumatic event that involved actual or threatened death or serious injury to themselves or others,6 and the trauma had to invoke at least three of the following symptoms: avoiding activities, places, or people that arouse recollections of the trauma;

reduced interest in activities; feelings of detachment; restricted range of feelings; and a foreshortened sense of the future. PTSD also involves difficulty falling or staying asleep, an exaggerated startle response, and impairment of functioning.

We measured alcohol or drug dependence using the Severity of Dependence Scale (SDS). The SDS consists of five questions about out-of-control use, anxiety or worry about missing a fix or a drink, worry about use, frequency of desire to end use, and difficulty of going without use (Gossop et al., 1995). The SDS ranges from 0 to 15, and we consider a score of 3 or greater to indicate substance dependence.

Physical Health Measures We studied physical health outcomes using a combination of survey questions, physical measurements, and assays from dried blood spot samples. The survey asked adults if their health was excellent, very good, good, fair, or poor; if they had suffered an asthma or a wheezing attack in the past year; and if their health limited them in climbing several flights of stairs or lifting or carrying groceries (Wiener et al., 1990). To assess obesity, interviewers measured each respondent’s height and weight.7 We calculated BMI by dividing respondents’ weight in kilograms by the square of their height in meters. We looked at effects stratified by three levels of obesity (BMI of 30 or greater, 35 or greater, and 40 or greater)8 because of evidence that very high BMI values may be strongly associated with subsequent adverse health outcomes (NHLBI Obesity Education Initiative, 1998).

A woman who is of average height in the United States (5 feet, 4 inches) would need to weigh 204 pounds to have a BMI of 35 and would need to weigh 233 pounds to have a BMI of 40. In addition to height and weight, interviewers took respondents’ seated blood pressure using an automated cuff.9 We used the average of two readings to assess hypertension10 and considered individuals to be hypertensive if their average systolic pressure was 140 millimeters of mercury or higher or their average diastolic pressure was 90 millimeters of mercury or higher (Chobanian et al., 2003).

We used data from the National Comorbidity Survey Replication (Kessler and Merikangas, 2004) to calculate the likelihood of PTSD based on the questions asked in the MTO survey and taking into account age, gender, race, and ethnicity.

The MTO survey asked about the following events: beaten up as a child by a primary caregiver, a spouse or romantic partner, or someone else; raped or sexually assaulted; mugged or threatened with a weapon; unexpected death of a loved one; traumatic event experienced by a loved one; witnessed physical fights at home; witnessed death or saw a dead body or someone seriously hurt; or some other traumatic event.

We measured height and weight in accordance with the protocols developed for the Health and Retirement Survey (ISR, 2008).

Ludwig et al. (2011) reported findings on MTO’s effects on obesity and diabetes.

The automated sphygmomanometer used was Omron model HEM-711DLX.

We considered a reading valid if diastolic blood pressure (pressure when the heart is at rest between contractions) was more than 40 millimeters of mercury, the systolic blood pressure (pressure when the heart is contracting) was more than 60 millimeters of mercury, and the systolic was at least 10 points higher than the diastolic.

–  –  –

We measured diabetes using both survey questions and blood samples. Interviewers asked respondents whether they had diabetes (or high blood sugar) or had received treatment for it during the past year. Because many people with diabetes are unaware of their condition, we collected blood spot samples from respondents and measured glycosylated hemoglobin level as an indicator of diabetes.11 Economic Measures Our last set of measures focused on the economic self-sufficiency of adults. We measured employment, earnings, household income, and use of government assistance programs through both survey questions and administrative records. We drew on employment questions from the Current Population Survey and considered MTO respondents to be employed currently if they reported working for pay during the week prior to the interview (or reported being temporarily absent from their job because of illness or vacation). Interviewers asked respondents how much money they earned in the previous year, whether they were currently receiving food stamps or Temporary Assistance for Needy Families (TANF), and how much income their household (all members combined) received in the previous year. Information on household income enabled us to determine whether their household was above or below the U.S. Census Bureau’s poverty threshold.

For example, a family consisting of one mother and two children would be below the poverty threshold if they had an income of less than $17,285 in 2009. We also matched the MTO sample to administrative data on quarterly earnings from state unemployment insurance (UI) agencies and to TANF and food stamps records from state (or county) agencies. We used the matched data to look at employment and earnings in 2007 and at receipt of TANF or food-stamp benefits over the 2-year period from July 2007 through June 2009.12 MTO Effects on Adult Outcomes In this section we present our estimates of MTO’s effects on the mental health, physical health, and economic self-sufficiency of adults in the program. Our impact estimates are based on the regression model from equation 1.

Mental Health Effects Exhibit 3 shows evidence of beneficial MTO effects on the mental health of adults in terms of lower depression and levels of psychological distress, but the experimental group also shows an increase in substance dependence. All remaining exhibits are structured the same way as Exhibit 3. Each row presents the findings for the outcome listed in the left-hand column; the first outcome is depression. The second column, Control Mean, shows that approximately 20.3 percent of adults in the control group suffered from major depression during their lifetime. The third column displays the ITT effect of being offered an experimental voucher, estimated by comparing the entire experimental group with the entire control group. Adults in the experimental group met the criteria for major depression at a rate that was 3.2 percentage points less than the rate for adults in the Glycosylated hemoglobin (HbA1c) captures the average glucose level in the blood during the past several months. The American Diabetes Association (2010) recommends using HbA1c levels of 6.5 percent or higher to diagnose diabetes.

Data availability limits our analyses of TANF and food stamps to participants from Boston, Chicago, and Los Angeles.

122 Moving to Opportunity The Long-Term Effects of Moving to Opportunity on Adult Health and Economic Self-Sufficiency

–  –  –

control group (p.10, as indicated by the tilde). The standard error (shown in parentheses) is

1.7 percentage points.13 In the fourth column, our estimates suggest that moving using an experimental voucher, or the TOT effect, reduces the prevalence of lifetime depression by 6.6 percentage points (about twice the size of the ITT effect). In the fifth and sixth columns, we turn to the effects (ITT and TOT) for the Section 8 group. Being offered a traditional Section 8 voucher reduces the prevalence of lifetime depression by 4.8 percentage points, and actually using the voucher reduces depression by an estimated 7.7 percentage points (p.05). The final column of the table shows the number of observations used in the analysis.

The standard error indicates the estimate’s precision. The effect plus or minus the standard error, multiplied by 1.96, captures the 95-percent confidence interval around the effect, in this case implying a confidence interval ranging from an increase of 0.1 percentage points to a decrease of 6.5 percentage points in depression.

–  –  –

Similar percentages (about 6.5 percent in each group) of adults in both the control group and the experimental group met the criteria for generalized anxiety disorder (lifetime). Adults in the Section 8 group were marginally less likely than adults in the control group to have had GAD (p =.057). Of adults in the control group, 22 percent met the criteria for PTSD, and the prevalence for the voucher groups was not significantly different from this.

Turning to a more global measure of mental health—psychological distress—we find beneficial program effects. The average psychological distress levels of adults in the experimental and Section 8 groups are about one-tenth of a standard deviation less than adults in the control group. The impact estimate achieves statistical significance for the experimental group (p =.011) but not the Section 8 group (p =.084). (To make the K6 results easier to interpret, we standardized the units by subtracting off the control group mean and dividing by the control group standard deviation to create what is known as a z-score.) We observe an adverse effect on substance dependence. About 5.5 percent of adults in the control group met the criteria for substance dependence during the past month and assignment to the experimental group was associated with a prevalence that was 2.9 percentage points higher than that of the control group. For the Section 8 group, we do not detect a statistically significant effect on dependence.

Physical Health Effects As shown in Exhibit 4, MTO appears to reduce the share of adults with diabetes and the likelihood of severe obesity, but we do not detect any treatment effects on several other health measures. About 56 percent of adults in the control group indicated that their current health was good or better;

reports by adults in the experimental and Section 8 groups were similar. About 29 percent of adults in the control group reported having had an asthma attack in the past year. The rates were slightly lower for the two treatment groups, but the differences were not statistically significant. The average weight of adults in the control group was about 190 pounds, and about 58 percent of controls met the criteria for obesity (BMI of 30 or greater). Although we detect no statistically significant effects on the likelihood of having a BMI of 30 or more, we do detect beneficial program effects at more extreme obesity levels. The experimental and Section 8 groups are 4.6 and 5.3 percentage points, respectively, less likely to have had a BMI of 35 or greater compared with adults in the control group who had a prevalence of 35 percent (p.05). These estimates imply that actually moving using a voucher reduces the prevalence of a BMI of 35 or greater by about 9.5 percentage points for the experimental group and 8.6 percentage points for the Section 8 group. For a BMI of 40 or greater, the ITT effect was a 3.4-percentage-point reduction for adults in the experimental group (p.05) and a 2.9-percentage-point reduction for adults in the Section 8 group (not significant).

Both types of diabetes measures (self-reports and blood samples) point in the direction of lower diabetes rates among adults in the treatment groups compared with adults in the control group, although the exact magnitudes and levels of statistical significance vary. When we rely on respondent self-reports to measure diabetes, we find that the estimated decline in diabetes prevalence for adults in the experimental group relative to adults in the control group is not quite statistically significant, whereas adults in the Section 8 group have a significantly lower rate (ITT of 6.1 percentage points) compared with adults in the control group. Compared with self-reports, the blood test results 124 Moving to Opportunity The Long-Term Effects of Moving to Opportunity on Adult Health and Economic Self-Sufficiency

–  –  –

show that a greater share of adults in the control group had diabetes. Using the blood test results, we find a statistically significant 5.2-percentage-point experimental ITT effect (and corresponding 10.8-percentage-point TOT effect), but we do not detect an effect for the Section 8 group. (We previously reported diabetes results for MTO adult women in Ludwig et al., 2011.) The last two health measures we present are physical limitations and hypertension, on which we only detect an effect on health limitations among adults in the experimental group. Of adults in the control group, 51 percent reported that their health limited them in everyday activities, and adults in the experimental group were 4.8 percentage points less likely to report this type of limitation.

The difference between the control group and the Section 8 group was not statistically significant.

Nearly 32 percent of adults in the control group had hypertension, and the incidence of hypertension for adults in the experimental and Section 8 groups was similar to that of adults in the control group, with no significant differences detected.

Pages:     | 1 |   ...   | 20 | 21 || 23 | 24 |   ...   | 56 |

Similar works:

«Number 21 October 2008 Policy Making in the Bush White House James P. Pfiffner EXECUTIVE SUMMARY T he White House Office is Recent Issues in Governance Studies so large and complex that “Change” or Plus Ça Change.? a systematic process of Pondering Presidential Politics policy evaluation is essential in and Policy After Bush” (September 2008) order to provide the president with a range of options on all “The Climate of Opinion: State important policy decisions. Views on Climate Change...»

«Assessment & Inquiry-Based Science Education: Issues in Policy and Practice Assessment & Inquiry-Based Science Education: Issues in Policy and Practice In recent years there has been a rapid expansion of interest in inquiry-based science education (IBSE). Classroom and laboratory practices and materials which encourage students to take an active part in making sense of events and phenomena in the world around are being promoted and developed through pilot projects in countries across the globe....»

«U.S. Citizenship and Immigration Services Office of the Director (MS 2000) Washington, DC 20529-2000 February 18, 2015 PM-602-0104 Policy Memorandum SUBJECT: Adjudication of H-1B Petitions for Nursing Occupations Purpose This policy memorandum (PM) provides guidance on the adjudication of H-1B petitions for nursing positions. Specifically, this PM assists U.S. Citizenship and Immigration Services (USCIS) officers in determining whether or not a nursing position meets the definition of a...»

«Towards a Global Framework for Corporate and Enterprise Digital Policy Management Jean-Henry Morin and Michel Pawlak Abstract. While DRM has now matured to be a recognized and established domain it is currently struggling with interoperability issues mainly on a sector basis (entertainment and media, mobile, enterprise). In the enterprise sector, DRM was fueled by corporate scandals leading to compliance issues mandated by emerging regulatory frameworks. In this context, we make the case for...»

«A. l oiicyniaKer s Guide to Accrual Funding of Military Retirement RAND William M. Hix William W. Taylor DISTRIBUTION STÄTEMEWfX Approval for public release; Arroyo Center Distribution Unlimited The research described in this report was sponsored by the United States Army under Contract No. DASW0196-C-0004. Library of Congress Cataloging in Publication Data Hix, William M. (William Michael), 1940A policymaker's guide to accrual funding of military retirement / William M. Hix, William W....»

«November 8, 2016 Elections Candidacy Requirements For U.S. House of Representatives Revised 12/28/2015 General Disclaimer This candidacy requirements bulletin provides an overview of Virginia electoral requirements. It is not legal advice nor a binding statement of official policy. Applicable laws and regulations are subject to change in content and interpretation. Candidates are responsible for verifying the status and complying with current laws and regulations. Introduction This bulletin and...»

«Overcoming Barriers to Administrative Simplification Strategies guidance for policy makers Overcoming Barriers to Administrative Simplification Strategies: Guidance for Policy Makers Regulatory Policy Division Directorate for Public Governance and Territorial Development TABLE OF CONTENTS – 3 Table of contents 1. Introduction 1.1. Administrative simplification 1.2. Leading initiatives and international co-operation 2. Designing and implementing administrative simplification strategies. 15...»

«POLICY MEMORANDUM: Preventing Indiscriminate Attacks and Wilful Killings of Civilians by the Myanmar Military March 2014 The International Human Rights Clinic at Harvard Law School works to protect the human rights of clients and communities around the world. The Clinic undertakes projects focusing on fact-finding, litigation, legal and policy analysis, report drafting for international oversight bodies, and the development of advocacy strategies. Through supervised practice, students learn the...»

«A Journal of Policy Development and Research Mixed Messages on Mixed incoMes Volume 15, Number 2 • 2013 U.S. Department of Housing and Urban Development | Office of Policy Development and Research Managing Editor: Mark D. Shroder Associate Editor: Michelle P. Matuga Advisory Board Peter Dreier Occidental College Richard K. Green University of Southern California Keith R. Ihlanfeldt The Florida State University Annette M. Kim Massachusetts Institute of Technology Carlos E. Martín Abt...»

«The new Common Agricultural Policy schemes in England: August 2014 update Including ‘Greening: how it works in practice’ Please read this important information Contents Latest news page 2 Cross compliance: latest news page 6 CAP Information Service page 7 Greening: how it works in practice page 9 In this leaflet, you’ll see the following icons.When you see this icon: It means that this information: is important information that you need to know has been decided and will be part of the new...»

«U.S. Citizenship and Immigration Services Office of the Director (MS 2000) Washington, DC 20529-2000 June 25, 2015 PM-602-0117 Policy Memorandum SUBJECT: Updated Implementation of the Special Immigrant Juvenile Perez-Olano Settlement Agreement Purpose The purpose of this policy memorandum (PM) is to update the guidance previously provided to U.S. Citizenship and Immigration Services (USCIS) personnel in PM-602-0034: Implementation of the Special Immigrant Juvenile Perez-Olano Settlement...»

«A Shopper’s Guide To Long-Term Care Insurance About the NAIC. The National Association of Insurance Commissioners (NAIC) is the oldest association of state government officials. Its members consist of the chief insurance regulators in all 50 states, the District of Columbia and five U.S. territories. The primary responsibility of the state regulators is to protect the interests of insurance consumers, and the NAIC helps regulators fulfill that obligation in a number of different ways. This...»

<<  HOME   |    CONTACTS
2016 www.theses.xlibx.info - Theses, dissertations, documentation

Materials of this site are available for review, all rights belong to their respective owners.
If you do not agree with the fact that your material is placed on this site, please, email us, we will within 1-2 business days delete him.