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Publication Correcting Pessimistic Mortality Beliefs May Reduce Vaccine Hesitancy, Malawi Study Shows(2024-09-11) Purcell, Helene; Ciancio, Alberto; Mwera, James; Delavande, Adeline; Mwapasa, Victor; Kohler, Hans-PeterHelping people accurately understand their risk of dying or surviving may support public health campaigns years later. A new strategy for improving health behavior is supported by a randomized controlled trial from the longrunning Malawi Longitudinal Study of Families and Health (MLSFH) that showed that a 2017 intervention to correct misconceptions about mortality risk was linked to higher COVID-19 vaccination rates five years later. Vaccination was 7.8 percentage points higher in the intervention than the control group. Effects spread to families of intervention participants, whose siblings had higher vaccination rates than the control group.Publication Alcohol Use, Genetics, and Cognitive Decline(2024-10-01) Ho, Pei-ChuanAlcohol Use Disorder (AUD) is a major public health issue in the U.S., affecting 14.5 million people aged 12 and older in 2019, though only 7.2% sought treatment. AUD is linked to cognitive decline and dementia, placing a significant burden on individuals, families, and society. Both alcohol consumption and cognitive decline are often influenced by unobserved factors such as genetics and personality, raising concerns about endogeneity. To address the endogeneity stemmed from genetics, we used Health and Retirement Study (HRS) data to study alcohol consumption in individuals aged 50 and by taking advantage of the availability of both alcohol consumption behavior data and genetic information. By using polygenic scores (PGS), which summarize the genetic predisposition of alcohol consumption, we found some evidence of positive correlation between alcohol consumption and cognitive decline: heavy alcohol consumption was associated with worse cognitive status. Though it is still difficult to claim causal relationship between alcohol consumption and cognitive decline due to the complexity of unobserved characteristics related to both, our approach was able to alleviate endogeneity stemmed from genetics.Publication Understanding the Dynamic Process of Older Adult Behavior Changes for Disaster Preparedness: An Application of the Integrated Transtheoretical Model with Social Cognitive Theory and Protection Motivation Theory(2024-09-30) Ma, Chenyi; Culhane, Dennis; Bachman, Sara S.Integrating the Transtheoretical Model with Social Cognitive Theory and Protection Motivation Theory, we propose a new model to study the progress of behavior changes towards disaster preparedness along three developmental stages: from “not prepared” (NP), to “intention to prepare” (IP), to “already prepared” (AP). Using the 2021 National Household Survey data (FEMA, N = 6,180), we tested this model by employing a series of nested weighted generalized ordered logistic regressions. We found that, although Hispanics have a larger prevalence of IP than their non-Hispanic white counterparts, they are less likely to move to the AP stage. The observed ethnicdisparity is largely due to the disparities in actual behavioral capabilities in essential knowledge and access to resources between the two groups. Personal disaster experience, social/observational learning, self-efficacy, and risk perception each facilitate behavior changes from the NP to IP or AP stage (i.e., departure from NP stage) and from NP or IP stage to AP stage (i.e., arrival at AP stage). Although income does not necessarily influence one’s decision to depart from the NP stage, it determines one’s arrival at the AP stage. Increasing one’s income further boosts the realization of AP for people with high-risk perceptions. However, for people with moderate or low levels of risk perceptions, increased income did not lead to arrival at the AP stage. Additional research is needed to more fully apply this processoriented approach with new measurement introduced in this paper to study the behavior changes among subpopulations in exposure to specific hazards.Publication Does Schooling Improve Cognitive Abilities at Older Ages(2023-02-02) Amin, Vikesh; Behrman, Jere R.; Fletcher, Jason M.; Flores, Carlos A.; Flores-Lagunes, Alfonso; Kohler, Hans-PeterAn estimated 11% of U.S. adults aged 65 or older have dementia, and as the population ages, dementia cases are predicted to nearly double from 5.2 million in 2019 to 10.2 million by 2050. Understanding how education levels may affect cognitive decline and presumably dementia is important for projecting future dementia in the population and potentially helping individuals understand and possibly reduce their risk. Prior research has suggested a link between more schooling and better later-life performance on cognitive tests. However, most of these studies provided suggestive associations rather than causal estimates. When prior studies did provide causal estimates, inferences were generally based on changes in educational levels after compulsory schooling laws were enacted. This limited estimated causal effects of schooling to the lower grade levels targeted by the laws and the individuals affected by them. In this study, the authors expanded the evidence about causal effects of schooling on older adults to higher levels of schooling, such as attending college, and to a broader population. The authors applied advanced methods to data from a national, longitudinal cohort study representative of U.S. individuals over age 50.Publication U.S. Long-term Care Infrastructure and Co-resident Kin Living Arrangements among Older Adults(2024-09-23) Parrish, Elise M.Population aging and the retraction of the long term care infrastructure likely have important consequences for the care and living arrangements of older adults and their families, but this is relatively unexplored. Advancing a political economy of long-term care (LTC) approach, this study considers whether, how, and for whom, variation in state and local LTC infrastructure is consequential for older adults’ co-resident kin living arrangements. I construct a novel dataset merging eight years (2012–2019) of individual-level data from the American Community Survey (N=4,170,768), state Medicaid LTC expenditure data, and county-level nursing home data. Descriptive analyses show that low-SES, Black and/or Latinx, and disabled older adults are more likely to live in areas with weaker local care infrastructure. Results from fixed effects models indicate that higher state expenditures on long-term care and higher local availability of nursing home care correspond with decreases in the likelihood that older adults who are disabled, aged 75+, and low-SES will live with an adult child or other non-spousal family member. Taken together, these findings suggest that insufficient long-term care infrastructure environments may coerce family co-resident care and systematically exacerbate existing inequalities by constraining the care options available to structurally vulnerable older adults and their family members.Publication The library of Daniel Garrison Brinton(University of Pennsylvania. Museum of Archaeology and Anthropology.) Weeks; Weeks, John M.This book includes an introductory essay and item-by-item catalog for the personal library of Daniel Garrison Brinton. First a professor of Ethnology and Anthropology at the Academy of Natural Sciences, then later Penn’s first Professor of Archaeology and Linguistics, Brinton (1837-1899) is considered one of the fathers of American anthropology. He built a substantial personal library of over 4000 items, mainly focused on the languages and culture of indigenous peoples of North and Central America. It included several early-modern manuscripts, modern transcriptions, and early printed books from the estate of ethnologist and linguistic scholar, Carl Hermann Berendt (1817-1878), and from the Mayanist, Charles Etienne Brasseur de Bourbourg (1814-1874). After his death, Brinton’s library passed to the Penn Museum for the creation of the Penn Museum Library in 1900.Publication Community Health Centers and Value-Based Payment(Leonard Davis Institute of Health Ecoomics, 2024-04-01) Weiner, JanetCommunity health centers (CHCs) are a bedrock of the social safety net in the United States, providing care to vulnerable people in their communities, often for little or no cost to them. CHCs operate through funding streams and reimbursement mechanisms that pose challenges to participating in newer forms of value-based payment. This issue brief provides a snapshot of CHCs and the people they serve, how they currently are funded and reimbursed, how they fit into the landscape of value-based payment, and how alternative payment policies can align with their mission and mandate.Publication Expiration of the USDA Supplemental Nutrition Assistance Program (SNAP) Emergency Allotments(Leonard Davis Institute of Health Ecoomics, 2023-08-31) Richterman, Aaron; Roberto, Christina; Thirumurthy, HarshaThe U.S. Department of Agriculture (USDA) Supplemental Nutrition Assistance Program (SNAP) is the nation’s largest federal nutrition assistance program, providing monthly benefits for food to more than 42 million low-income people.1 SNAP has been proven to lift families from poverty and reduce food insecurity–inconsistent access to an adequate, nutritious diet.2 The COVID-19 pandemic brought U.S. food insecurity to its highest levels in recent history,3 prompting Congress to pass legislation allowing temporary issuance of additional SNAP benefits, called Emergency Allotments, to SNAP recipients. Emergency Allotments increased SNAP benefits substantially, adding an average of $126 to the monthly benefit in the first year and $166 in subsequent years.4 Emergency Allotments ended in March 2023, but 18 states ended them early, when their state public health emergency expired.Publication Medicare Payment Policy for Post-Acute Care in Nursing Homes(2023-09-14) Schotland, Samuel; Werner, Rachel M.; Janet WeinerThe costs and quality of post-acute care (PAC) have come under increasing scrutiny for the value they provide to the nearly 40% of patients receiving specialized nursing or rehabilitation after hospital discharge. Much of this scrutiny focuses on skilled nursing facilities (SNFs), which account for a disproportionate amount of spending. The stakes are high for Medicare, the primary payer of post-acute services, for the nursing home industry, which relies on these short-stay patients to subsidize long-term residents, and for patients and families themselves. This Issue Brief reviews Medicare coverage and payment policy around PAC, trends in utilization and costs in SNFs, and what we know about quality and outcomes. We recommend ways to improve the value of these services through payment policies that align incentives across payers and settings.Publication Using Financial Incentives to Treat Stimulant Use Disorders(2024-01-18) Beatty, Benicio; Komaragir, Ameya; Weiner, JanetStimulants are playing a prominent role in the current U.S. overdose crisis. As stimulant use continues to mount, the need for evidence-based treatment grows more urgent. This brief highlights contingency management, the most effective treatment for stimulant use disorder, and reviews the current barriers to its widespread use along with practice and policy strategies for increasing implementation.