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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 Bayesian methods incorporate model parameter information prior to data collection. Eliciting information from content experts is an option, but has seen little implementation in Bayesian item response theory (IRT) modeling. This study aims to use ethical reasoning content experts to elicit prior information and incorporate this information into Markov Chain Monte Carlo (MCMC) estimation. A six‐step elicitation approach is followed, with relevant details at each stage for two IRT items parameters: difficulty and guessing. Results indicate that using content experts is the preferred approach, rather than noninformative priors, for both parameter types. The use of a noninformative prior for small samples provided dramatically different results when compared to results from content expert–elicited priors. The WAMBS (When to worry and how to Avoid the Misuse of Bayesian Statistics) checklist is used to aid in comparisons. - Journal of Educational Measurement, Volume 55, Issue 3, Page 373-402, Fall 2018.

--- - |2 Abstract This study investigates the effect of multidimensionality on extraction of latent classes in mixture Rasch models. In this study, two‐dimensional data were generated under varying conditions. The two‐dimensional data sets were analyzed with one‐ to five‐class mixture Rasch models. Results of the simulation study indicate the mixture Rasch model tended to extract more latent classes than the number of dimensions simulated, particularly when the multidimensional structure of the data was more complex. In addition, the number of extracted latent classes decreased as the dimensions were more highly correlated regardless of multidimensional structure. An analysis of the empirical multidimensional data also shows that the number of latent classes extracted by the mixture Rasch model is larger than the number of dimensions measured by the test. - Journal of Educational Measurement, Volume 55, Issue 3, Page 403-420, Fall 2018.

--- - |2 Abstract Person reliability parameters (PRPs) model temporary changes in individuals’ attribute level perceptions when responding to self‐report items (higher levels of PRPs represent less fluctuation). PRPs could be useful in measuring careless responding and traitedness. However, it is unclear how well current procedures for estimating PRPs can recover parameter estimates. This study assesses these procedures in terms of mean error (ME), average absolute difference (AAD), and reliability using simulated data with known values. Several prior distributions for PRPs were compared across a number of conditions. Overall, our results revealed little differences between using the χ or lognormal distributions as priors for estimated PRPs. Both distributions produced estimates with reasonable levels of ME; however, the AAD of the estimates was high. AAD did improve slightly as the number of items increased, suggesting that increasing the number of items would ameliorate this problem. Similarly, a larger number of items were necessary to produce reasonable levels of reliability. Based on our results, several conclusions are drawn and implications for future research are discussed. - Journal of Educational Measurement, Volume 55, Issue 3, Page 421-432, Fall 2018.

--- - |2 Abstract This research derived information functions and proposed new scalar information indices to examine the quality of multidimensional forced choice (MFC) items based on the RANK model. We also explored how GGUM‐RANK information, latent trait recovery, and reliability varied across three MFC formats: pairs (two response alternatives), triplets (three alternatives), and tetrads (four alternatives). As expected, tetrad and triplet measures provided substantially more information than pairs, and MFC items composed of statements with high discrimination parameters were most informative. The methods and findings of this study will help practitioners to construct better MFC items, make informed projections about reliability with different MFC formats, and facilitate the development of MFC triplet‐ and tetrad‐based computerized adaptive tests. - Journal of Educational Measurement, Volume 55, Issue 3, Page 357-372, Fall 2018.

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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.

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.

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).

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.

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.

Background Malaria is a major global health challenge. This study aims to clarify the manner in which contextual factors determine the use and maintenance of bed nets and the extent to which malaria prevention policy is responsive to them in Southern Benin. Methods Semi‐structured interviews and direct observations were undertaken with 30 pregnant women in the municipality of So‐Ava from June to August 2015. Key informants in the Ministry of Health and local community health workers were also interviewed regarding malaria prevention policy formation, and the monitoring and evaluation of bed net interventions, respectively. Data were analyzed through categorical content analysis and grouped into themes. Results The majority of pregnant women participants (80%) declared non‐adherence to instructions for hanging and maintaining insecticide‐treated nets (ITNs). The distributed bed nets were washed like clothes, which affected their bio‐efficacy, and were in poor condition (ie, torn or had holes). Multiple factors contributed to the poor condition of ITNs: Pregnant women's limited understanding of risk including their inability to connect the key environmental factors to personal risk, gendered responsibility for installing bed nets, and lack of public measures that would enable women to re‐treat or access new bed nets as needed. Poverty that determined structural aspects of housing such as the size and quality of homes and access to bed nets exacerbated the challenges. Conclusion Institutionalizing an iterative process of monitoring, review, and responsive adaptation throughout the entire policymaking cycle would better support malaria preventive policy implementation in Benin.

Introduction Administration is vital for health care. Its importance may increase as health care systems become more complex, but academic attention has remained minimal. We investigated trends in administrative expenditure across OECD countries, cross‐country spending differences, spending differences between health care system typologies, and differences in the scale and scope of administrative functions across typologies. Methods We used OECD data, which include health system governance and financing‐related administrative activities by regulators, governance bodies, and insurers (macrolevel), but exclude administrative expenditure by health care providers (mesolevel and microlevel). Results We find that governance and financing‐related administrative spending at the macrolevel has remained stable over the last decade at slightly over 3% of total health spending. Cross‐country differences range from 1.3% of health spending in Iceland to 8.3% in the United States. Voluntary private health insurance bears much higher administrative costs than compulsory schemes in all countries. Among compulsory schemes, multiple payers exhibit significantly higher administrative spending than single payers. Among single‐payer schemes, those where entitlements are based on residency have significantly lower administrative spending than those with single social health insurance, albeit with a small difference. Discussion These differences can partially be explained because multi‐payer and voluntary private health insurance schemes require additional administrative functions and enjoy less economies of scale. Studies in hospitals and primary care indicate similar differences in administrative costs across health system typologies at the mesolevel and microlevel of health care delivery, which warrants more research on total administrative costs at all the levels of health systems.

Background Few studies explore stroke survivor views and motivations towards stem cell therapy (SCT). This qualitative study explores the views and motivations of both stroke survivors and their partners/carers towards a proposed 2‐arm Phase III Randomised Controlled Trial (RCT) comparing intracerebral insertion of stem cells with placebo neurosurgery in stroke survivors with disability. Objective To explore views and motivations towards a proposed 2‐arm stem cell trial and identify factors that may impede and enhance participation. Design This study adopts a naturalistic design to explore the complexity of this field, employing a participatory action‐research approach comprising a specialized Conversation (World) Café form of focus group. Data were collected via 5 Conversation Cafés with stroke survivors (age 40‐75) and partners/carers between June and October 2016. Of 66 participants, 53 (31 male, 22 female) were stroke survivors and 13 (6 female, 7 male) were partners/carers. Qualitative data were analysed using a thematic approach. Discussion and Conclusion Stroke survivor views and motivations reflect anticipation of the personal and future benefits of regenerative medicine. Partners/carers sought to balance the value of stroke survivor hope with carrying the weight of hope as carer, a conflict burden adding to known caregiver burden. All participants expressed the need for during and post‐trial psychological support. This study provides a rare opportunity to explore the prospective views and motivations of stroke survivors and their partners/carers towards a proposed Phase III 2‐arm RCT. This adds weight to qualitative evidence exploring capacity, consent, decision making, perceptions of treatment risk and supports required for clinical trial participation.

In this article, I ask whether a principle analogous to the principle of clinical equipoise should govern the design and conduct of RCTs evaluating the effectiveness of policy interventions. I answer this question affirmatively, and introduce and defend the principle of policy equipoise. According to this principle, all arms of a policy RCT must be, at minimum, in a state of equipoise with the best proven policy that is also morally and practically attainable and sustainable. For all arms of a policy RCT, policy experts must either (1) reasonably disagree about whether the trial arms are more effective than this policy, or (2) know that they are.

Purpose To examine the relationship between area population density and community pharmacy‐based Alzheimer's Disease (AD)‐related services: pharmacists’ medication knowledge and counseling, immunizations, and in‐stock cognitive enhancers in 3 predominantly rural regions of the United States. Methods A standardized interview was administered by telephone to a 100% sample of community pharmacies in 3 areas: Northern California/Southern Oregon (n = 206), North and South Dakota (n = 278), and West Virginia (n = 420). Key study outcomes included: pharmacists’ medication knowledge, availability of immunization services, and cognitive enhancers in stock. Respondents were classified by population density (persons/mi2) by pharmacy location to evaluate the relationship between rurality and AD‐related pharmacy services. Chi‐squared and logistic regression analyses were performed using Stata 10.1. Findings Pharmacies in more rural areas (50.1‐100.0, 25.1‐50.0, and ≤25.0 persons/mi2) were about 50% less likely to offer immunizations (95% CI: 0.32‐0.91; 0.32‐0.76; 0.28‐0.80, respectively) compared to the least rural areas (>100.0 persons/mi2). Compared to the least rural areas, pharmacists in the most rural areas (≤25.0 persons/mi2) were less likely to name ≥2 gastrointestinal adverse effects of donepezil (OR = 0.50, 95% CI: 0.31‐0.82) or have memantine XR 28 mg (OR = 0.61, 95% CI: 0.41‐0.89) and other surveyed medications (OR = 0.57, 95% CI: 0.39‐0.82) in stock. Conclusions We found disparities in AD‐related services in community pharmacies located in more rural counties, wherein individuals with AD and their caregivers may face barriers to obtaining quality pharmaceutical care. There is a need to strengthen pharmacists’ knowledge and improve pharmacy services to reduce disparities.

A growing literature highlights complexity of policy implementation and governance in global health and argues that the processes and outcomes of policies could be improved by explicitly taking this complexity into account. Yet there is a paucity of studies exploring how this can be achieved in everyday practice. This study documents the strategies, tactics, and challenges of boundary‐spanning actors working in 4 Sub‐Saharan Africa countries who supported the implementation of multisectoral nutrition as part of the African Nutrition Security Partnership in Burkina Faso, Mali, Ethiopia, and Uganda. Three action researchers were posted to these countries during the final 2 years of the project to help the government and its partners implement multisectoral nutrition and document the lessons. Prospective data were collected through participant observation, end‐line semistructured interviews, and document analysis. All 4 countries made significant progress despite a wide range of challenges at the individual, organizational, and system levels. The boundary‐spanning actors and their collaborators deployed a wide range of strategies but faced significant challenges in playing these unconventional roles. The study concludes that, under the right conditions, intentional boundary spanning can be a feasible and acceptable practice within a multisectoral, complex adaptive system in low‐ and middle‐income countries.