Search

We evaluate the impacts of small high schools on youth risky behaviors and mental health in New York City, using a two-sample-instrumental-variable approach to address endogenous school enrollment. We find heterogeneous effects. School size, overall, has little effect. Among students most likely to attend small schools opened after an educational-achievement-oriented reform, however, diagnoses of violence-associated injuries and mental health disorders increased. Among students most likely to attend traditional small schools opened prior to the reform, pregnancy rates and diagnoses of mental health disorders declined. School focus is more important than school size as a determinant of student well-being outcomes. [ABSTRACT FROM AUTHOR]

This study examines autism diagnosis prevalence within the New York City (NYC) Universal Pre-K for All (UPK) program expansion into racially, ethnically, and socioeconomically diverse NYC neighborhoods. Here, it is hypothesized that racial/ethnic differences in autism diagnoses may close as more children are referred for testing by UPK programs, which they have more thorough interactions with, instead of by public health clinics or other medical avenues. Using NYC Medicaid claim data from 2006 to 2016, descriptive analyses were conducted by estimating linear probability regression and generalized multiple logistic regression to examine whether the probabilities of being diagnosed with autism in comparison to two other disability types (as counterfactuals), learning disabilities (LD) and physical disabilities (PD), differ by race. Subsequently, a difference in difference (DID) strategy (with pre- and post-UPK expansion cohorts) was used to examine the effects of UPK on the probabilities of receiving disability diagnoses. Notably, Latinx and "Other" racially identified children have much higher odds than White children of being diagnosed with autism. By contrast, all non-White groups had much lower odds of being diagnosed with a LD. These findings offer important insight for future UPK and childhood program implementation. [ABSTRACT FROM AUTHOR]

While SARS-CoV-2 is a novel virus, contagious respiratory illnesses are not a new problem. Limited research has examined the extent to which place- and race-based disparities in severe illness are similar across waves of the COVID-19 pandemic and historic influenza seasons. In this study, we focused on these disparities within a low-income population, those enrolled in Medicaid in New York City. We used 2015–2020 New York State Medicaid claims to compare the characteristics of patients hospitalized with COVID-19 during three separate waves of 2020 (first wave: January 1–April 30, 2020; second wave: May 1–August 31, 2020; third wave: September 1–December 31, 2020) and with influenza during the 2016 (July 1, 2016–June 30, 2017) and 2017 influenza seasons (July 1, 2017–June 30, 2018). We found that patterns of hospitalization by race/ethnicity and ZIP code across the two influenza seasons and the first wave of COVID-19 were similar (increased risk among non-Hispanic Black (aOR = 1.17, 95% CI: 1.10–1.25) compared with non-Hispanic white Medicaid recipients). Black/white disparities in hospitalization dissipated in the second COVID wave and reversed in the third wave. The commonality of disparities across influenza seasons and the first wave of COVID-19 suggests there are community factors that increase hospitalization risk across novel respiratory illness incidents that emerge in the period before aggressive public health intervention. By contrast, convergence in hospitalization patterns in later pandemic waves may reflect, in part, the distinctive public health response to COVID-19. [ABSTRACT FROM AUTHOR]

The original article can be found online at https://doi.org/10.1007/s11524-022-00612-y. B Correction to: J Urban Health b https://doi.org/10.1007/s11524-022-00612-y In this article as originally published, Fig. Also, Table 3 should be titled "Appendix Table 1" - Table 4 should be titled "Appendix Table 2" The original article has been corrected. [Extracted from the article]

How effective was organizational reform implemented inside one critical New York City health agency? Specifically, we examine the extent to which the reorganization of the HIV/AIDS Services Administration (HASA) into the Medical Insurance Services Administration (MICSA) achieved three goals: (1) realizing synergies among the component MICSA programs; (2) cross-fertilizing ideas among MICSA agencies; and (3) facilitating HASA operations through the lens of organization change theory. Qualitative methods including interviews, site visits, and document analysis triangulate the effects of the reorganization. Implications for organization change literature are explored, especially highlighting where more theoretical and empirical studies are needed. [ABSTRACT FROM AUTHOR]

Research Objective: People with a history of incarceration have high rates of physical and behavioral health conditions as well as increased hospitalizations and emergency department visits. This research extends the existing literature about the health profile of individuals with a history of justice involvement by examining patterns of Medicaid utilization and costs. Study Design: We linked New York State Medicaid and New York City Department of Correction Data from 2012–2016 and examined patterns of jail utilization, health care utilization (including inpatient, emergency department, and outpatient use) and health care cost by categories of service, as well as the prevalence of chronic physical and mental health disorders. We selected two sets of comparisons, any jail contact vs. no jail contact and high jail contact vs. low jail contact. Population Studied: Individuals with at least one jail admission in 2012 were defined as having any jail contact. Individuals with only one jail admission between 2012–2016 are defined as having low jail contact. Those who were in the top 10 percentile of number of jail admissions are defined as having high jail contact. The no jail contact group is defined as Medicaid recipients matched with individuals with any jail contact on age, sex, race/ethnicity, Medicare status and number of Medicaid enrollment months. Principal Findings: Comparing to individuals with no jail contact, any jail contact was associated with a higher prevalence of both chronic physical and mental health conditions; those with any jail contact had a doubling in the risks of mortality and of health care resource use; the average number of hospitalizations was 4 times higher among people with any jail contact; people with jail contact had Medicaid costs that were 3 to 7 times greater, with inpatient costs largely driving these differences for people with the most frequent jail contact. Compared to individuals with low jail contact, individuals with high jail contact had drastically higher prevalence of both chronic physical and mental health conditions, triple the number of hospitalizations, and quadruple the number of emergency department visits. The annual inpatient expenditure of an individual with high jail contact is $12 k higher than that of an individual with low jail contact; total Medicaid expenditures of high contact individuals averages over $33 k per year and are twice as high as those of low contact individuals. Conclusions: The prevalence of physical and mental health conditions was very high among individuals with high jail contact, as were their health care costs. Only a small fraction of costs for this group were for outpatient primary care, behavioral health treatment, and case management that could help to address these needs and prevent hospitalization. Implications for Policy or Practice: These findings highlight the need for more effective health care engagement strategies for people with a history of incarceration. Specifically, preventative, primary care and behavioral health care services — particularly outpatient substance use services — that are tailored to the needs of this population could lead to more effective health care engagement, reduced health care costs, and improved health and well‐being for individuals who have had some contact with NYC jails. Primary Funding Source: The Robert Wood Johnson Foundation. [ABSTRACT FROM AUTHOR]

Investigates the relationship between hospital financing patterns and hospital resources for the care of babies born at low birthweight in New York City. Insurance status of newborns; Supply of neonatal intensive care beds; Births by birthweight.

We examine the effect of New York City's universal pre-kindergarten program (UPK) on the health and utilization of children enrolled in Medicaid using a difference-in-regression-discontinuities design. We find that UPK increases the probability that a child is diagnosed with asthma or with vision problems, receives treatment for hearing or vision problems, or receives an immunization or screening during the pre-kindergarten year. These effects are not offset by lower rates in the kindergarten year, suggesting that UPK accelerates the rate at which children are identified with and treated for conditions that could potentially delay learning and cause behavioral problems. [ABSTRACT FROM AUTHOR]

• Living in higher density neighborhoods is not associated with greater risk of COVID hospitalization. • Living in larger multifamily buildings is not linked to COVID hospitalization risk. • Living in public housing developments is associated with lower COVID hospitalization risk. • But people living in large households or in neighborhoods with high levels of crowding were more likely to be hospitalized for COVID. • There is also a strong correlation between being unstably housed or living in institutional settings and COVID hospitalizations. We study the relationship between density and COVID during three distinct waves of the pandemic in New York City. Unlike prior work, our analysis uses individual Medicaid claims records, which include a rich array of demographic characteristics and pre-existing medical conditions and cover a near universe of low-income New Yorkers. In brief, our results suggest that living in higher density neighborhoods did not heighten the risk of COVID hospitalization. The size of a multifamily building made little difference either, and people living in public housing developments, which are typically highly dense environments, were less likely to be hospitalized for COVID. However, while neighborhood and building density do not seem to matter, we find significant, positive relationships between COVID hospitalization rates and household size. Specifically, we see that people living in large households or in neighborhoods with high levels of crowding were more likely to be hospitalized for COVID. In other words, our results suggest that crowded living quarters – which can occur at any level of population density – and not density itself, increase the risk of COVID hospitalization. We also see a strong correlation between being unstably housed or living in institutional settings and COVID hospitalizations. [ABSTRACT FROM AUTHOR]

Introduction: Although growing evidence links residential evictions to health, little work has examined connections between eviction and healthcare utilization or access. In this study, eviction records are linked to Medicaid claims to estimate short-term associations between eviction and healthcare utilization, as well as Medicaid disenrollment.Methods: New York City eviction records from 2017 were linked to New York State Medicaid claims, with 1,300 evicted patients matched to 261,855 non-evicted patients with similar past healthcare utilization, demographics, and neighborhoods. Outcomes included patients' number of acute and ambulatory care visits, healthcare spending, Medicaid disenrollment, and pharmaceutical prescription fills during 6 months of follow-up. Coarsened exact matching was used to strengthen causal inference in observational data. Weighted generalized linear models were then fit, including censoring weights. Analyses were conducted in 2019-2021.Results: Eviction was associated with 63% higher odds of losing Medicaid coverage (95% CI=1.38, 1.92, p<0.001), fewer pharmaceutical prescription fills (incidence rate ratio=0.68, 95% CI=0.52, 0.88, p=0.004), and lower odds of generating any healthcare spending (OR=0.72, 95% CI=0.61, 0.85, p<0.001). However, among patients who generated any spending, average spending was 20% higher for those evicted (95% CI=1.03, 1.40, p=0.017), such that evicted patients generated more spending on balance. Marginally significant estimates suggested associations with increased acute, and decreased ambulatory, care visits.Conclusions: Results suggest that eviction drives increased healthcare spending while disrupting healthcare access. Given previous research that Medicaid expansion lowered eviction rates, eviction and Medicaid disenrollment may operate cyclically, accumulating disadvantage. Preventing evictions may improve access to care and lower Medicaid costs. [ABSTRACT FROM AUTHOR]

Research experience programs engage teachers in the hands-on practice of science. Program advocates assert that program participation enhances teachers' skills in communicating science to students. We measured the impact of New York City public high-school science teachers' participation in Columbia University's Summer Research Program on their students' academic performance in science. In the year before program entry, students of participating and nonparticipating teachers passed a New York State Regents science examination at the same rate. In years three and four after program entry, participating teachers' students passed Regents science exams at a rate that was 10.1% higher (P = 0.049) than that of nonparticipating teachers' students. Other program benefits include decreased teacher attrition from classroom teaching and school cost savings of U.S. $1.14 per $1 invested in the program. [ABSTRACT FROM AUTHOR]