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--- - |2 Abstract During the 2016 U.S. presidential election, Trump supporters expressed that they believed Trump was a moral candidate because of his past successes. Such statements are consistent with our argument that people judge others’ morality based on their success and failure‐related outcomes, even though these outcomes are usually associated with judgments of competence. Moreover, we argue that these outcome‐based perceptions of morality play a crucial role in responses to political candidates, independent of perceived competence. In three experiments, we manipulated a hypothetical candidate's outcomes (past successes vs. failures, or success in light of past misfortune vs. good fortune). We examined the effect of the manipulation on perceptions of the candidate's morality and competence, as well as support for the candidate (e.g., voting intentions). Across the three experiments, candidates’ outcomes affected not only perceptions of their competence, but also their morality. In turn, outcome‐based perceptions of competence and morality independently predicted candidate support. Our findings have implications for how people responded to the campaigns in the 2016 U.S. presidential election, especially the campaign run by Donald Trump. - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract Although national flags arguably reflect a unified nation, support for a particular flag design may vary across ideological cleavages within the electorate. Here, we examined the impact of system‐challenging and system‐justifying ideologies, as well as political party support, on support for flag‐change in a large (N = 13,559) nationally representative sample of New Zealand adults. As hypothesized, system‐justifying ideologies (e.g., conservatism, right‐wing authoritarianism, historical negation, and symbolic exclusion) correlated negatively with flag change support, whereas system‐challenging ideologies (e.g., support for multiculturalism) correlated positively with support for change. Yet, consistent with an identity politics perspective, support for the National Party—the center‐right/conservative party in New Zealand whose leader advocated change—correlated positively (rather than negatively) with support for changing the flag. These results demonstrate the countervailing effects of system‐justifying and system‐challenging ideologies on support for change, and identify a boundary condition of conservatives’ opposition to change (namely, party support). - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract According to a 2017 U.S. Department of Agriculture (USDA) survey, 12.3% of households face food insecurity (FI)—the economic and social condition of limited or uncertain access to adequate food. Given the pervasiveness of the problem, there is surprisingly little research examining how the general population perceives FI. Is FI expected in all societies? Is it a societal disgrace for individuals in the United States to go hungry? When it occurs, who is responsible? This research drew from existing surveys and practitioner expertise to develop a comprehensive instrument to assess attitudes toward FI. Data were collected in two studies to test a multidimensional model developed through examination and categorization of FI‐related items. We examined dimensionality of attitudes through exploratory (Study 1, N = 503) and then confirmatory (Study 2, N = 510) factor analysis of representative samples of Amazon Mechanical Turk (MTurk) participants. Seven dimensions were identified and related to reported contributions to food organizations and demographic characteristics (e.g., gender, age, and political orientation). Our findings help understanding of attitudes toward FI and can provide antipoverty organizations with information to shape policy, challenge inaccurate perceptions, and develop approaches to address FI. - Analyses of Social Issues and Public Policy, EarlyView.

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--- - |2 Abstract Following 9/11 and the wars in Iraq and Afghanistan, anti‐Muslim antipathy dramatically escalated in the United States. We argue that a major contributor to this hostility is endorsement of Right‐Wing Authoritarianism (RWA) because people high in RWA tend to respond aggressively toward groups that they view as threatening particularly when they perceive that such aggression is supported by authority figures. We posit that Americans high in RWA view Muslims as threatening traditional American norms and perceive that the U.S. government is at war with Islam. Across three studies, we present consistent support for our hypothesis that RWA is associated with endorsing and engaging in hostile behavior toward Muslims. In addition, this hostility is mediated by the perception that Muslims threaten societal norms and that the government is actively at war with Islam (Study 3). The implications for the reduction of aggression toward Muslims and the impact of RWA on hostility toward other outgroups are discussed. - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract The first known university food pantry started at Michigan State University in 1993. Since then, campus food pantries are more widespread, although little is known about them. The current study examined how college pantries best serve students and foster their success. Twenty‐eight food pantry directors and staff from across sixteen Michigan college campuses engaged in concept mapping, a technique used to examine the interrelationships among concepts understood by stakeholders. Analyses identified six concepts, examined importance of each concept as assigned by participants, and evaluated variation among institutions. Implications for findings and future research directions are discussed. - Analyses of Social Issues and Public Policy, EarlyView.

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--- - |2 Abstract Increasingly, individuals identify with two or more racial or cultural, yet are sometimes externally misclassified, contributing to experiences of invisibility within U.S. society. Using computational techniques, we examined the transmission of cultural identity terms through time, providing some evidence for the changing representation of social identity. We examined the usage patterns of identity terms with the prefixes (mono‐, bi‐, multi‐), modifying the social identity terms: culture, ethnicity, and race (e.g., comparing monocultural, monoethnic, and monoracial). For bicultural and multicultural terms, those with ‐racial suffixes were the earliest used terms, while those with ‐cultural and ‐ethnic suffixes gained more popularity in recent years. We examined the evolution of the higher frequency social identity terms in lay sources (the NY Times, Reddit), and found that interracial and multicultural were the most popular over time, peaking recently. We examined the potential time lag in the sequence of identity terms among academic (PsycINFO, NIH, and NSF Databases), lay (the NY Times), and mixed sources (Google Books N‐Grams), demonstrating that newer terms (e.g., multicultural) are first used and gain prevalence in lay sources, then mixed sources, and eventually academic sources. The implications of these findings for research, public policy, and psychosocial experiences of individuals are discussed. - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract The Internet represents a powerful tool for racist groups to build a sense of group consciousness and promote their cause. In the current study, we examined the language used by racist (n = 87), anti‐racist (n = 50), and nonactivist (n = 1379) groups when describing their self‐defining beliefs online. We used computerized linguistic analysis software to measure psychological indicators and antecedents of group consciousness and to examine the persuasive techniques used in online group communication. Racist and anti‐racist groups were similar on some linguistic indicators of group consciousness (e.g., use of words reflecting perceived injustice), but differed on others (e.g., use of words reflecting group identification). Linguistic indicators of antecedents of group consciousness (moral foundations and focus on religion) differed across groups, with racist groups focused more on purity, respect for authority, and religion, and less on fairness than anti‐racist groups. Racist groups also used less cognitively complex language than nonactivist groups (but similar levels to anti‐racist groups). Our results contribute to understanding how racist groups promote their self‐defining beliefs online, and identify several key factors that should be considered when designing policies to reduce racist groups’ growth and impact. - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract In 2002, Care Not Cash/Proposition N was introduced to respond to public concern over San Francisco's chronic homeless epidemic. The controversial initiative, which significantly reduced General Assistance (cash aid) to unhoused people, diverted funds to direct services such as shelter, food, medical assistance, and substance abuse programs. To investigate the underlying attitudes and beliefs that framed homelessness and the Care Not Cash policy in the months leading up to the citywide vote articles from the San Francisco Chronicle were analyzed. Of particular interest was assessing the prevalence of individualistic framing, constructions of dependency, and the problems Care Not Cash was presented as solving. Our analysis found that homelessness was framed as a threat to businesses, tourism, and residents of San Francisco and welfare as enabling deviant behavior (e.g., substance abuse) among people experiencing homelessness. Similar to federal welfare reform, Care Not Cash was portrayed as a compassionate solution that would both solve the problem of homelessness and address problematic behaviors associated with people who are unhoused (Stryker & Wald, 2009). Implications for economic justice are discussed. - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract In the wake of the 2016 election, which surprised pundits and voters on both the left and the right, there has been renewed interest in understanding what predicts American voters’ choices. In this article, we investigate the roles of personality and issue importance in how people voted in the 2016 U.S. election. In this longitudinal study of 403 MTurk workers who voted in the election, we assessed the relations between personality (openness, social dominance orientation, and national identity importance) and issue importance (group rights and social justice, economic rights, and individual and national rights), and voting for Clinton or Trump. Our results indicate that both individual differences and issue importance as measured in July 2016 predicted votes in November. We also found that the links between personality and voting were mediated by issue importance. Implications for political psychology and the study of personality, campaign issues, and voting behavior are discussed. - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract The aim of the study was to investigate levels of posttraumatic stress due to the recent economic crisis in a Greek community sample and identify particularly vulnerable demographic groups. A sample of 1,208 residents of a western Athens borough completed the Impact of Events Scale—Revised. According to the findings, almost 60% of respondents reported severe and 28% moderate symptoms. Individuals in employment presented similar levels as the unemployed, while caring for dependants, having lower educational attainment, and being female and older were associated with greater posttraumatic stress. The present findings suggest a high prevalence of posttraumatic stress in a community sample, indicating that policymakers in Greece, Europe, and worldwide need to take very seriously the growing evidence for the detrimental effects of austerity politics on both individual and collective well‐being. - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract Donald Trump's 2017 inaugural address was scored with a content analysis measure of implicit motives. The results show that compared to other 20th and 21st century U.S. presidents, he scores very high in achievement and power motive imagery, but only about average in affiliation imagery. Based on previous research on presidents’ motive imagery, this profile suggests some predictions about the Trump presidency and possible problems for it. In political leaders, high achievement motivation often leads to frustration with the political process. Power motivation, while associated with rated greatness, is related to polarization of public opinion and war. The effects of motives are further channel by temperament and traits—in Trump's case, high extraversion and low agreeableness. - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract When judging a voter's decision, does that voter's reason for casting their vote influence moral and interpersonal judgments about them? In the context of the 2016 U.S. Presidential Election, past research suggests two competing predictions. First, people regularly account for an actor's intentions when forming judgments of the actor, indicating that judgments may vary according to a voter's motives. However, people are unlikely to see nuance among outgroups, especially amid divisive political partisanship, suggesting that judgments would ignore information about voters’ motives. In Study 1, results supported the first prediction, showing that both Hillary Clinton and Donald Trump supporters distinguished between different voting motives when making moral and interpersonal judgments of outgroup voters. In Studies 2 and 3, when some voters’ motives became more extreme, Clinton and Trump supporters again distinguished between voting motives for outgroup and ingroup voters, respectively, albeit in a different pattern of results. - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract Hillary Clinton was the first woman nominated for President by a major political party in the United States. Like most women in politics, she faced negative evaluations, in part, due to the inconsistency between the traits typically associated with leaders (competence) versus women (warmth). Because understanding the categorization of an individual female politician is essential to the development of successful bias interventions, we examined the extent to which Hillary Clinton and a novel female politician were categorized as women versus female politicians. In three studies we investigated how the warmth and competence stereotypes associated with women and female politicians contributed to the warmth and competence traits associated with Hillary Clinton and a novel female political candidate. Consistent with a subtyping account, the warmth and competence stereotypes associated with female politicians, but not women, predicted Hillary Clinton's warmth and competence traits (Studies 1–3). However, consistent with a subgrouping account, the warmth and competence stereotypes associated with both women and female politicians predicted a novel female politician's warmth and competence traits (Study 3). Implications for bias reduction interventions are discussed. - Analyses of Social Issues and Public Policy, EarlyView.

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--- - |2 Abstract Are female politicians disadvantaged by adverse economic conditions in ways their male counterparts are not? To examine this issue, we had participants read a news article about the current economic situation. The article emphasized either economic stability or volatility. Afterward, they evaluated an advertisement for either a female or a male candidate for the U.S. Senate. Exposure to news depicting economic instability caused devaluation of the female but not the male candidate. A second study provided a direct replication of this finding with a larger sample.  An omnibus analysis (N = 535) showed that this devaluation pattern occurred primarily among male participants. Study 2 also examined whether gender stereotypes play a role in this process.  Indeed, men's confidence in the female candidate's ability to handle stereotypically masculine issues decreased under economic instability and this tendency mediated their devaluation of the female candidate. - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract The 2016 U.S. Presidential Election provided a unique opportunity to examine how ageism and sexism may impact attitudes (perceived presidential qualities and endorsement of positive and negative age stereotypes) toward Hillary Clinton and Donald Trump. Community participants (N = 875) indicated their attitudes and voting intentions 3 weeks before the election. Endorsement of positive and negative age stereotypes and perceived presidential qualities for Clinton and Trump varied based on participants’ attitudes toward women, political stance (conservative/liberal), and demographic characteristics (racial/ethnic identification, education, gender identification). Individuals who perceived sexism to be more prevalent and perceived women as more competent in general had more positive attitudes toward Clinton, in contrast, only perceptions of lower prevalence of sexism (and not competence of women) predicted attitudes toward Trump. Individuals who perceived sexism as less prevalent viewed Clinton as less presidential and endorsed stronger negative age stereotypes for Clinton, while they viewed Trump as more presidential and endorsed stronger positive and weaker negative age stereotypes for Trump. Our findings suggest that both ageism and sexism present barriers for qualified women when pursuing positions of power. Implications for future research are discussed. - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract The present study investigated preference for linguistically biased characterization of events attributed to Hillary Clinton and Donald Trump during the 2016 Presidential election cycle. The linguistic intergroup bias (LIB) reflects abstract characterization of positive events attributed to ingroup members and negative events attributed to outgroup members; conversely, it also reflects concrete characterization of negative events attributed to outgroup members and positive events attributed to outgroup members. University students (N = 117) who preferred Hillary Clinton completed on‐line measures before and after the 2016 Presidential election, including liberal‐conservative ideology and measures of LIB. Participants showed clear preference for characterizations consistent with LIB (e.g., Clinton is intelligent; Trump is quick‐tempered). This pattern was more pronounced as strength of liberal ideology increased; it also was more pronounced immediately following the election than after time had passed. A smaller sample of Trump supporters also showed LIB favoring Trump. This study is the first to demonstrate that members of the electorate gravitate towards linguistic characterizations that favor their preferred political candidates and that this tendency is exacerbated by a relevant individual difference. Findings have implications for the continued polarization of the American electorate. - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract White women's general failure to vote for Hillary Clinton in the 2016 United States presidential election (only 43% of White women did so) was largely unexpected. We tested the hypothesis that White women's gender‐related attitudes and beliefs, including their (i) feminist identification, (ii) views of societal gender discrimination, (iii) personal experiences with gender discrimination, and (iv) beliefs about female role models, were related to their levels of support for Hillary Clinton and her opponents (Sanders, Trump). A sample of White women (N = 314; 18–75 years, M = 32.71, SD = 13.37) recruited during June and July of 2016 from MTurk and college campuses completed surveys of their gender‐related attitudes and beliefs, as well as political preferences. Results indicated that women's gender‐related attitudes and beliefs predicted their views of both Clinton and Trump, after accounting for political ideology. For example, feminist identification was positively related to support for Clinton. Additionally, stronger endorsement of the notion that societal gender discrimination persists in the United States predicted both more favorable ratings of Clinton and less favorable ratings of Trump. More frequent personal experiences with discrimination, in contrast, predicted weaker support for Clinton. - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract Social psychological models of group identity and collective action should be particularly adept at providing psychological explanations for growing rates of populism in the Western World. Because populism tends to arise in times of societal shifts that reflect both economic and cultural changes, populist attitudes are likely grounded in perceptions of intergroup relations and collective attitudes. We surveyed 95 demonstrators at the 2016 Republican National Convention and 108 demonstrators at the Democratic National Convention. Results support the idea that relative anger prototypicality, in this case, the extent to which people believe that their own anger toward politicians is representative of most Americans’ anger, predicts feelings of group‐based relative deprivation. Importantly, these feelings of deprivation mediate the relationship between prototypical anger and populist attitudes. These findings provide a unique picture of current political engagement, motivated by feelings of shared anger and collective feelings of lacking representation and voice. - Analyses of Social Issues and Public Policy, EarlyView.

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--- - |2 Abstract A defining feature of American politics, including party identification, is the question of the proper role of government. Partisanship is a prevailing way that individuals organize their attitudes. Democrats should take the Democratic Party's positions, and Republicans should take the Republican Party's positions. Instead, people have conflicting considerations that shape their opinions. Given that gender is integral in structuring individuals’ positions in society, it is reasonable to expect that gender differences might produce intraparty differences. This article establishes a gender gap in scope of government that transcends partisanship. Using the cumulative American National Election Study Data 1994–2008, I find strong evidence that for a number of issue areas, women are more supportive of an activist government than men of the same party. Preferences regarding the scope of government provide a coherent explanation for these observed gaps. - Analyses of Social Issues and Public Policy, Volume 17, Issue 1, Page 379-405, December 2017.

--- - |2 Abstract Numerous recent encounters between police officers and Black citizens have resulted in the deaths of African American men and have drawn renewed public scrutiny of police practices. We examine the public's attributions about these encounters. Does the public perceive violent confrontations between police officers and Black citizens as a result of broader problems in police practices or simply as isolated incidents? We employ attribution theory and social identity theory to understand how social and political identities influence beliefs about police use of force against African Americans. We argue that racial and political identities predispose individuals to believe certain attributional perspectives over others. We test several hypotheses using individual level survey data from two national surveys. Our findings suggest that racial and political identities strongly shape attributions, and these patterns have implications for public trust in government institutions and the ability of police to operate effectively. We conclude with recommendations for police and policymakers. - Analyses of Social Issues and Public Policy, Volume 17, Issue 1, Page 358-378, December 2017.

--- - |2 Abstract Support for presidential candidate Donald Trump increased in the aftermath of the 2015 terrorist attacks in Paris, France, and San Bernardino, California, similar to Americans’ greater enthusiasm for President George W. Bush after the September 11, 2001 terrorist attacks on the Pentagon and World Trade Center. According to terror management theory (Greenberg, Pyszczynski, & Solomon; Solomon, Greenberg, & Pyszczynski), people are prone to embrace charismatic politicians in times of historical upheaval to mitigate existential terror. Consistent with this view, previous research has demonstrated that reminders of death (relative to an aversive control condition) increased support for a charismatic leader in a hypothetical gubernatorial election, and support for President Bush and his policies in Iraq prior to the 2004 presidential election. The present Study 1 hypothesized and found that a death reminder increased support for Donald Trump. Study 2 found that while Hillary Clinton was viewed more favorably than Donald Trump in an aversive control condition, Mr. Trump was viewed more favorably in response to a death reminder while impressions of Mrs. Clinton were unaffected. Study 3 demonstrated that asking people to think about immigrants moving into their neighborhood increased the accessibility of implicit death thoughts. These findings suggest that electoral outcomes and public policy can be affected when existential concerns are aroused. - Analyses of Social Issues and Public Policy, Volume 17, Issue 1, Page 339-357, December 2017.

--- - |2 Abstract To inform current public policy regarding suicide prevention, this study examined the longitudinal relationships between four resources (public insurance, primary care services, school‐based mental health treatment, and family support) and depression and suicidality in a nationally representative sample of suicidal adolescents (n = 1,355). Longitudinal regression analyses were conducted using data from three waves of the National Longitudinal Study of Adolescent to Adult Health (Add Health). Parental support at Wave I was predictive of lower levels of depression across all three waves, but not significantly associated with the suicide‐specific outcomes. While type of insurance was not significantly associated with any of the outcomes, receipt of public assistance was associated with a higher likelihood of suicidal ideation and higher levels of depression at all three waves. Neither receipt of a routine physical nor access to school‐based mental health treatment were associated with any of the outcomes. Intervention points for future policy that are discussed include the following: integrating family interventions into current screening and referral protocols, targeted screening and outreach for those youth and young adults receiving public assistance, the inclusion of integrated behavioral health in primary care settings, and the inclusion of suicide‐specific evidence‐based treatments in the school setting. - Analyses of Social Issues and Public Policy, Volume 17, Issue 1, Page 319-338, December 2017.

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This study reviews the economic viability of the Rashtriya Swasthya Bima Yojana (RSBY), India's landmark health insurance program for below poverty line (BPL) populations in West Bengal state of India. It addresses the issue through in‐depth analysis of literature, national and state level data, and a number of key stakeholder interviews. The study argues that the market failure conditions of this insurance model will continue to perpetuate losses for not only the state, but also for insurance companies, unless they adjust on a continuous basis for profit by raising the premium rate. This will further deplete state budgets for health care affecting the viability of the scheme in the long run.

Objective To quantify the effect of Medicaid expansions on office‐based care among the newly eligible. Data Source 2008–2014 Medical Expenditure Panel Survey. Study Design The main sample is adults age 26–64 with incomes ≤138% of poverty who were not eligible for Medicaid prior to the Affordable Care Act. For this population, difference‐in‐differences linear probability models compare utilization between expansion and nonexpansion states and between 2008–2013 and 2014. Extraction Methods Medicaid eligibility is simulated using data on family relationships, state of residence, and income. Principal Findings Relative to comparable adults in nonexpansion states, newly eligible adults in expansion states were 9.1 percentage points more likely to have any office‐based primary care physician visit in 2014, a 21.4% increase from 2013 (p‐value = .004); 6.9 percentage points more likely to have a specialist visit, a 25.2% increase from 2013 (p‐value = .036); and 5.1 percentage points more likely to have a visit with a nurse practitioner, nurse, or physician assistant, a 34.5% increase from 2013 (p‐value = .016). Conclusions State Medicaid expansions in 2014 were associated with greater likelihoods of visits with a variety of office‐based providers. The estimated effects are larger among newly eligible compared with previous estimates on broader populations of low‐income adults.

Objective To explore organizations’ experiences providing family planning during the first year of an expanded primary care program in Texas. Data Sources Between November 2014 and February 2015, in‐depth interviews were conducted with program administrators at 30 organizations: 7 women's health organizations, 13 established primary care contractors (e.g., community health centers, public health departments), and 10 new primary care contractors. Study Design Interviews addressed organizational capacities to expand family planning and integrate services with primary care. Data Extraction Interview transcripts were analyzed using a theme‐based approach. Themes were compared across the three types of organizations. Principal Findings Established and new primary care contractors identified several challenges expanding family planning services, which were uncommon among women's health organizations. Clinicians often lacked training to provide intrauterine devices and contraceptive implants. Organizations often recruited existing clients into family planning services, rather than expanding their patient base, and new contractors found family planning difficult to integrate because of clients’ other health needs. Primary care contractors frequently described contraceptive provision protocols that were not evidence‐based. Conclusions Many primary care organizations in Texas initially lacked the capacity to provide evidence‐based family planning services that women's health organizations already provided.

Aim To cross‐culturally adapt and validate the Comprehensive Frailty Assessment Instrument (CFAI) among Chinese community‐dwelling older adults. Methods The Chinese CFAI was developed through forward–backward translations. An urban sample of 1235 community‐dwelling older adults received face‐to‐face interviews to examine the validity (construct validity and criterion validity) and reliability (internal consistency and test–retest reliability). Results The Chinese CFAI achieved semantic and idiomatic equivalence, and showed acceptable reliability and an expected factor structure, except for the social support domain. The exploratory factor analysis extracted five factors explaining 53.8% of the total variance of frailty. The confirmatory factor analysis showed that the data fit well to the second‐order factor theoretical model, with a root mean square error of approximation of 0.05, Tucker‐Lewis Index of 0.93 and Comparative Fit Index of 0.95. The receiver operating characteristic analysis presented an acceptable criterion validity using the Rockwood Frailty Index as an external criterion (area under the curve 0.80), with balanced sensitivity (65.31%) and specificity (81.19%) at the optimal 39‐point frailty cut‐off of the CFAI. Conclusions The Chinese CFAI has good validity and reliability as a practical frailty measure in Chinese community‐dwelling older adults.

Aim The aim of the present study was to investigate the relationship between physical activity (PA) and depressive symptoms in community‐dwelling older Japanese adults. Methods A cross‐sectional study design was used to obtain data from 3191 community‐dwelling older Japanese adults aged 70–95 years. Depressive symptoms were assessed using self‐reported scores on the Geriatric Depression Scale‐15. PA was objectively measured using an accelerometer worn for a maximum of 40 days, and average daily durations of light‐intensity PA (LPA), moderate‐to‐vigorous intensity PA (MVPA) and step count were calculated. PA was compared between participants with and without depressive symptoms by carrying out analysis of covariance and multivariable logistic regression analysis adjusted for all covariates by using propensity scores. Results Depressive symptoms were present in 598 participants (19.6%). A comparison of propensity‐score adjusted PA showed that step count (5059.6 ± 53.7 vs 5003.0 ± 112.1 count/day; P = 0.652) and moderate‐to‐vigorous intensity PA duration (23.0 ± 0.4 vs 23.8 ± 0.7 min/day; P = 0.358) were not significantly different between participants with and without depressive symptoms, respectively. However, participants without depressive symptoms had a significantly higher LPA duration than those with depressive symptoms (39.4 ± 0.3 vs 37.3 ± 0.7 min/day, respectively; P < 0.01). Conclusions The present results suggest that individuals with lower LPA have a higher risk of depressive symptoms. These findings imply that PA recommendations, especially for older adults, should emphasize LPA, which appears to be especially effective at preventing depressive symptoms.

Aim To evaluate the relationship between kidney function without diabetes and components of the frailty phenotype in community‐dwelling Japanese older adults. Methods Participants were 8343 residents who completed baseline assessments, classified into four categories according to eGFR. Frailty status was defined using five criteria: (i) slow gait speed; (ii) muscle weakness; (iii) low physical activity; (iv) exhaustion; and (v) unintentional weight loss. Results After multivariate adjustment, participants with the lowest kidney function were at higher risk of frailty (OR 1.57, 95% CI 1.02–3.50) than those with normal kidney function. In addition, after adjustment for multiple confounders, estimated glomerular filtration rate <30 was associated with a greater risk of the individual frailty components of weight loss (OR 2.14, 95% CI 1.11–4.12), low physical activity (OR 1.35, 95% CI, 1.01–2.54) and slowness (OR 1.82, 95% CI 1.36–3.77) compared with estimated glomerular filtration rate ≥60. Conclusions Lower kidney function was associated with a higher risk of weight loss, low physical activity and slowness among community‐dwelling Japanese older adults.

The paper examines the value‐generating strategies used in some of New Zealand's primary activities in a rapidly changing trading context in which the countries of East Asia increasingly figure. These strategies range from scaling up volume, with a consequent conspicuous impact on rural landscapes, to innovative value‐enhancing relationships linking producers, processors and consumers in processes which value landscapes for the contribution they make to provenance stories. Our argument is that higher‐value strategies are necessarily more intensely collaborative and involve a pursuit of engaged relationships, especially between onshore producers and manufacturers and consumers at a distance. We term this collaborative form of strategising as ‘the relationships economy’. We illustrate our argument using two case studies, dairying and merino. While there are great differences in scale between them, and dairying focuses significantly on volume‐generating capacity, there are players in dairying who are adopting higher‐value relationships‐based approaches similar to those developed in the merino industry. The common thread connecting the case studies is that of intentional enactment, which echoes earlier periods in New Zealand's trading history when considerable work was undertaken by industry participants to create new markets for primary products.

The 2010 Affordable Care Act extended dependent coverage for adult children up to age 26 in the USA. Since then, considerable studies have assessed its various impacts among young adults. However, little is known about whether there is any change in health care use when young adults age out of dependent coverage. This study examines health care consumption changes among young adults prior to their aging out process. I used data from a large insurance claim database and studied health care utilization of young adults under parents' coverage during a 2‐year period in a difference‐in‐difference framework. I found that young adults had relative reductions in health services use, except ER visits, compared with individuals who stayed under parents' coverage. This pattern was the same for both male and females. Individuals with regular medical needs had greater relative reductions compared with those without regular medical needs. The relative reductions in health care use during the aging out process may have an important impact on young adults' health, especially for those with regular medical needs. More efforts could be made to help them maintain regular medical utilization during the transition.

Objective We examine whether drugs’ excluded versus recommended status on pharmacy benefit manager exclusion lists corresponds to evidence from cost‐effectiveness analyses, lack of evidence, or rebates. Data Sources To find cost‐effectiveness data for drugs on 2016 exclusion lists of CVS Caremark and Express Scripts, we searched the Tufts Cost‐Effectiveness Analysis Registry and the peer‐reviewed literature. Study Design For each excluded and recommended drug, we compared the mean cost‐per‐QALY, and we calculated the difference between the numbers of excluded and recommended drugs for which we could find no cost‐effectiveness evidence. Data Collection As keywords in our searches, we used the brand and generic drug name and “cost‐effectiveness” and “cost‐per‐quality‐adjusted life‐year.” Of 240 retrieved studies, 110 were selected for analysis. Principal Findings The mean cost‐per‐QALY for excluded drugs was higher ($51,611) than the cost‐per‐QALY for recommended drugs ($49,474), but not statistically significant. We could find no cost‐effectiveness evidence in the Registry or peer‐reviewed literature for 23 of the excluded drugs, and no evidence for 5 of the recommended drugs. Conclusions Cost‐effectiveness does not correlate with a drug's excluded or recommended status. Lack of cost‐effectiveness evidence favors a drug's excluded status.

Objective To build and test a model that predicts community discharge probabilities for Medicaid‐eligible nursing home (NH) residents who remain in the nursing home at 90 days after admission and, thus, would be candidates for the Money Follows the Person (MFP) program. Data Source The Minimum Data Set, Medicaid Management Information Systems, and Minnesota Vital Statistics file. Data Cohort of 33, 590 nursing home stays that qualified for Medicaid by the 90th day of their stay from 383 Minnesota nursing homes from July 2011 to June 2013. Study Design Mixed effects logistic regression model to predict community discharge. Principal Findings The scoring system had a high level of accuracy in predicting community discharge for both the fitting and validation cohorts. Subpopulations with severe mental illness or intellectual disability were well represented across the entire score range. Conclusions Findings are being applied in the Minnesota's MFP initiative (Moving Home Minnesota) to target Medicaid‐eligible NH residents for transitioning to the community. This approach could be applied to MFP in other states.

Objective To examine the effects of the penetration of dual‐eligible special needs plans (D‐SNPs) on health care spending. Data Sources/Study Setting Secondary state‐level panel data from Medicare‐Medicaid Linked Enrollee Analytic Data Source (MMLEADS) public use file and Special Needs Plan Comprehensive Reports, Area Health Resource Files, and Medicaid Managed Care Enrollment Report between 2007 and 2011. Study Design A difference‐in‐difference strategy that adjusts for dual‐eligibles’ demographic and socioeconomic characteristics, state health resources, beneficiaries’ health risk factors, Medicare/Medicaid enrollment, and state‐ and year‐fixed effects. Data Collection/Extraction Methods Data from MMLEADS were summarized from Centers for Medicare and Medicaid Services (CMS)'s Chronic Conditions Data Warehouse, which contains 100 percent of Medicare enrollment data, claims for beneficiaries who are enrolled in the fee‐for‐service (FFS) program, and Medicaid Analytic Extract files. The MMLEADS public use file also includes payment information for managed care. Data in Special Needs Plan Comprehensive Reports were from CMS's Health Plan Management System. Principal Findings Results indicate that D‐SNPs penetration was associated with reduced Medicare spending per dual‐eligible beneficiary. Specifically, a 1 percent increase in D‐SNPs penetration was associated with 0.2 percent reduction in Medicare spending per beneficiary. We found no association between D‐SNPs penetration and Medicaid or total spending. Conclusion Involving Medicaid services in D‐SNPs may be crucial to improve coordination between Medicare and Medicaid programs and control Medicaid spending among dual‐eligible beneficiaries. Starting from 2013, D‐SNPs were mandated to have contracts with state Medicaid agencies. This change may introduce new effects of D‐SNPs on health care spending. More research is needed to examine the impact of D‐SNPs on dual‐eligible spending.

Objective To examine associations among substance use disorder (SUD) and measures of length of stay (LOS) and non‐psychiatric medical comorbidity (MEDCO) in older‐adult inpatients with serious mental illness (SMI), hypothesizing SUD would be related to worse clinical outcomes. Methods A cross‐sectional study analyzed medical records from 2010 to 2016 of 7258 inpatients with SMI ≥ age 50, obtained from a 274‐bed psychiatric hospital. Descriptive analyses examined prevalence rates for SUD status (+/−), individual drug classes, and total number of SUDs (polysubstance use disorders). Regression models examined the influence of 2 independent variables of interest: (1) SUD status (+/−) and (2) type of SUD (ie, specific drug), controlling for demographic factors and additional (non‐SUD) psychiatric disorders. Two dependent (outcome) variables were examined: LOS and MEDCO. Results The overall SUD rate was 26%; cocaine was the most common SUD (≈ 10%). SUD status and additional (non‐SUD) psychiatric diagnoses were significantly associated with longer LOS (both P < 0.001). For individual SUDs, cocaine, marijuana, opiates, and alcohol were all significantly associated with LOS (all P < 0.01). SUD status, age, sex, admission status, and race were significantly associated with MEDCO (all P < 0.002). For individual SUDs, barbiturates, opiates, and alcohol were all significantly associated with MEDCO (P < 0.01). Conclusions The prevalence of SUD in this sample underscores concerns related to treating older adults presenting providers with comorbid SUD and SMI. This combination may increase the burden and complexity of care, warranting further investigation into mechanisms and long‐term consequences.

Aim The aim of the present study was to evaluate whether the effect of one‐time brief additional counseling in periodic health examinations (PHE) through the National Screening Program for the Translational Ages in Korea is sustained after 2 years. Methods We collected data from National Screening Program for the Translational Ages participants in 2007 and 2008. To evaluate behavior change after 2 years, we collected the participants’ health behavior data 2 years later (2009 and 2010). We defined the basic group as participants who only received PHE, and the additional group as received PHE and counseling. We carried out propensity score matching to ensure that additional counseling was the only different variable affecting health behavior between the two groups. Results After propensity score matching, 50 630 remaining matched participants were matched for each group. Of these participants, 26.5% (26 855/101 260) were aged 66 years, and 60.9% (61 653/101 260) were men. The additional group showed a significant increase in odds of smoking cessation among the 66‐year‐olds (adjusted OR 1.173, 95% CI 1.003–1.372). This effect was significant, especially when the participants did not have hypertension or hypercholesterolemia (adjusted OR 1.193, 95% CI 1.000–1.423 for hypertension and adjusted OR 1.188, 95% CI 1.009–1.398 for hypercholesterolemia). However, there was no significant association for alcohol drinking and regular exercise. Conclusions The effect of one‐time brief counseling added to a PHE in cigarette smoking was observed only among the 66‐year‐olds. However, the effect was so small that it is doubtful to be clinically relevant. Repeated counseling is required to sustain the effect of the initial motivation of counseling. Geriatr Gerontol Int 2017; ••: ••–••

Many people believe that the abortion debate will end when at some point in the future it will be possible for fetuses to develop outside the womb. Ectogenesis, as this technology is called, would make possible to reconcile pro‐life and pro‐choice positions. That is because it is commonly believed that there is no right to the death of the fetus if it can be detached alive and gestated in an artificial womb. Recently Eric Mathison and Jeremy Davis defended this position, by arguing against three common arguments for a right to the death of the fetus. I claim that their arguments are mistaken. I argue that there is a right to the death of the fetus because gestating a fetus in an artificial womb when genetic parents refuse it violates their rights not to become a biological parent, their rights to genetic privacy and their property rights. The right to the death of the fetus, however, is not a woman's right but genetic parents’ collective right which only can be used together.

This paper presents a copula‐based method for identifying and estimating the coefficient of a binary endogenous regressor in a Poisson regression. The method offers advantages over existing approaches. Most importantly, it relies upon standard maximum likelihood approaches, and it does not require numerical integration. Further, as part of its implementation, the method provides a convenient test for the presence of endogeneity. The empirical application investigates the effect of insurance status (a binary measure) on doctor visits (a count measure).

This article examines the “chicken‐egg” two‐way relationships between online consumer reviews and sales, and assesses the dual influencer and indicator roles of online consumer reviews in relation to purchase behavior. Considering the time factor, we adopt the methodology of Granger causality test and track 3,390 products on Amazon.com over a 2‐month period. The results reveal that a causality loop exists between online consumer review volume and sales. Specifically, our findings indicate that the volume of negative consumer reviews drive consumers' purchasing decisions, but the volume of positive consumers reviews only marginally affects purchasing decisions. Also, consumers generate more positive reviews than negative reviews after sales. Our results highlight the importance of negative consumer reviews; negative reviews not only lead to sales, but sales, in turn, lead to higher volume of negative reviews. The findings suggest an alternative strategy for practitioners to address negative online consumer reviews and highlight the awareness effect of online consumer review postings that can later convert into purchase behaviors.

This representative study of German search engine users (N = 1,000) focuses on the ability of users to distinguish between organic results and advertisements on Google results pages. We combine questions about Google's business with task‐based studies in which users were asked to distinguish between ads and organic results in screenshots of results pages. We find that only a small percentage of users can reliably distinguish between ads and organic results, and that user knowledge of Google's business model is very limited. We conclude that ads are insufficiently labelled as such, and that many users may click on ads assuming that they are selecting organic results.

Objective The objective of this literature review was to summarise current research regarding how consumers seek health‐related information from social media. Primarily, we hope to reveal characteristics of existing studies investigating the health topics that consumers have discussed in social media, ascertaining the roles social media have played in consumers’ information‐seeking processes and discussing the potential benefits and concerns of accessing consumer health information in social media. Methods The Web of Science Core Collection database was searched for existing literature on consumer health information seeking in social media. The search returned 214 articles, of which 21 met the eligibility criteria following review of full‐text documents. Conclusion Between 2011 and 2016, twenty‐one studies published explored various topics related to consumer information seeking in social media. These ranged from online discussions on specific diseases (e.g. diabetes) to public health concerns (e.g. pesticide residues). Consumers’ information needs vary depending on the health issues of interest. Benefits of health seeking on social media, in addition to filling a need for health information, include the social and emotional support health consumers gain from peer‐to‐peer interactions. These benefits, however, are tempered by concerns of information quality and authority and lead to decreased consumer engagement.

Objective To investigate the impact on patient waiting times of a role substitution model introducing an advanced allied health practitioner as the first point of contact within a geriatric outpatient context. Methods A pre‐ to postintervention design was used to determine impact over a five‐year period (2008–2012). All patients referred to the geriatric specialist outpatient department were included (n = 1514). Data relating to waiting times were analysed using one‐way ANOVA and post hoc Tukey tests to determine effects on patient waiting times. Results Waiting times were reduced from an average of 82 to as low as 35 days, in a context of increasing referral rates. Medical specialist capacity was increased through improvements to available outpatient times and reduced appointment lengths. Patients seen within their designated triage category timeframe increased from 47 to 86%. Conclusion Health professional substitution in geriatrics can be an effective intervention for reducing patient waiting times and improving access to care.

Despite its high political interest, the impact of removing user charges for health care in low‐income settings remains a debatable issue. We try to clear up this contentious issue by estimating the short‐term effects of a policy change that occurred in 2006 in Zambia, when 54 of 72 districts removed fees. We use a pooled synthetic control method in order to estimate the causal impact of the policy on health care use, the provider chosen, and out‐of‐pocket medical expenses. We find no evidence that user fee removal increased health care utilisation, even among the poorest group. However, we find that the policy is likely to have led to a substitution away from the private sector for those using care and that it virtually eliminated medical expenditures, thereby providing financial protection to service users. We estimate that the policy was equivalent to a transfer of US$3.2 per health visit for the 50% richest but of only US$1.1 for the 50% poorest.

Aim To investigate whether being part of a community organization interfered with older adults’ overall functionality. The magnitude of responses to a community exercise program based on functional circuits in socially active and socially non‐active older adults was also investigated. Methods A total of 200 older adults aged ≥60 years from Requinoa, Chile, participated in the study. Participants were separated into two groups according to the level of social participation: socially active (SA) and socially non‐active (SNA). During an evaluation, data regarding the presence of comorbidities (Charlson Comorbidity Index), disability level (Modified Health Assessment Questionnaire), dynamic balance (Timed Up and Go test), muscle force (handgrip dynamometry) and sociodemographic conditions were collected. Participants followed an exercise program consisting of a functional exercise circuit including balance, resistance and aerobic exercises, twice a week, for 12 weeks. Results Both the Charlson Comorbidity Index and disability were higher in SNA compared with SA participants on inclusion. Both groups improved disability (Δ–0.25 patients [−0.5 – −0.0625 patients] for SNA and (Δ–0.125 patients [−0.5–0 patients] for SA) and balance (Δ–2 s [−3–0 s] for SNA and (Δ–1 s [−3–0 s] for SA) after training (P < 0.05 for all). Changes from baseline were statistically higher in the SNA group. Handgrip force improved only in participants in the SNA group (Δ1.7 kg [0.6–2.8 kg], P = 0.0001). No differences, however, were observed between the magnitude of improvements of handgrip between groups. Conclusions Although socially non‐active older adults had more comorbidity and disability than their socially active counterparts, they showed a higher response to a community exercise program. Geriatr Gerontol Int 2017; ••: ••–••.

Purpose This study examined the time from breast cancer diagnosis to initiation of treatment among Alaska Native (AN) women. We evaluated the impact of age, cancer stage, and rural/urban residence at diagnosis. Methods We evaluated characteristics of women recorded in the Alaska Native Tumor Registry who received a first diagnosis of breast cancer between 2009 and 2013. Median time from diagnosis to treatment was assessed. Associations of demographic and clinical characteristics with timely initiation of treatment were evaluated using logistic regression and Cox proportional hazards models. Results Two hundred seventy‐eight (278) AN women were diagnosed with invasive breast cancer in years 2009‐2013. Mean age at diagnosis was 56.8 years (SD = 13.0). The median time from diagnosis to initiation of treatment was 23 days (P < .05) with most (94.6%, n = 263) meeting the ≤60‐day guideline target. Time to treatment was not associated with rural/urban residence, age, or stage at cancer diagnosis. Conclusion These findings indicate that most AN women diagnosed with breast cancer within the AN Tribal Health System receive timely treatment after diagnosis.