Welcome Mats and On‐Ramps for Older Adults: The Impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid

For many low‐income Medicare beneficiaries, Medicaid provides important supplemental insurance that covers out‐of‐pocket costs and additional benefits. We examine whether Medicaid participation by low‐income adults age 65 and up increased as a result of Medicaid expansions to working‐age adults under the Affordable Care Act (ACA). Previous literature documents so‐called “welcome mat” effects in other populations but has not explicitly studied older persons dually eligible for Medicare and Medicaid. We extend this literature by estimating models of Medicaid participation among persons age 65 and up using American Community Survey data from 2010 to 2017 and state variation in ACA Medicaid expansions. We find that Medicaid expansions to working‐age adults increased Medicaid participation among low‐income older adults by 1.8 percentage points (4.4 percent). We also find evidence of an “on‐ramp” effect; that is, low‐income Medicare beneficiaries residing in expansion states who were young enough to gain coverage under the 2014 ACA Medicaid expansions before aging into Medicare were 4 percentage points (9.5 percent) more likely to have dual Medicaid coverage relative to similar individuals who either turned 65 before the 2014 expansions or resided in non‐expansion states. This on‐ramp effect is an important mechanism behind welcome mat effects among some older adults.     

The Downside of Patriarchal Benevolence: Ambivalence in Addressing Domestic Violence and Socio-Economic Considerations for Women of Tamil Nadu,India

Social values and status cause diverse obstacles for escaping abuse (e.g., belief in the sanctity of marriage vs. financial necessity to stay for survival). India provides a unique opportunity to explore the interplay of status and corresponding patriarchal values in relation to the incidence of domestic violence and how it is viewed, coped with, and psychologically impacting native women. Sixty-four women of Tamil Nadu, India were surveyed. Women of higher status were found to be less likely to acknowledge abuse as a societal problem, accurately identify abuse events, and seek help or report abuse. Women who had more realistic conceptions of abuse were more likely to seek help but also likely to experience more severe psychological distress. All of the women surveyed had symptoms of post-traumatic stress disorder that were exacerbated by unsuspected variables. The implications of these findings are discussed in light of public health strategies.     

The development of a sexual abuse severity score: characteristics of childhood sexual abuse associated with trauma symptomatology, somatization, and alcohol abuse

Childhood sexual abuse (CSA) is common and is associated with both mental and physical health problems in adulthood. Using data from an age- and sex-stratified population survey of 600 Olmsted County, Minnesota, residents, a Sexual Abuse Severity Score was developed. The abuse characteristics of 156 CSA respondents were associated with self-reported trauma, somatization, and alcohol use. Characteristics included age of first sexual abuse, more than one perpetrator, degree of coercion, severity of abuse (i.e., attempted intercourse is more severe than fondling), and the number of occurrences. This is one of the few reports to develop a risk summary that quantifies the severity of CSA.     

The impact of after‐school programs on the routine activities of middle‐school students: Results from a randomized,controlled trial*

Research Summary Unsupervised after‐school time for adolescents is a concern for parents and policymakers alike. Evidence linking unsupervised adolescent socializing to problem behavior outcomes heightens this concern among criminologists. Routine activities theory suggests that, when youth peer groups congregate away from adult authority, both opportunity for and motivation to engage in deviant acts increase. After‐school programs are a possible solution to unsupervised teen socializing during afternoon hours and are much in demand. However, empirical research has yet to test the relationship between the availability of after‐school programs and youth routine activities. This study presents evidence from a multisite, randomized, controlled trial of an after‐school program for middle‐school students in an urban school district. Policy Implications Youth in the treatment group engaged in less unsupervised socializing after school than youth in the control group but not as much less as would be expected if the after‐school program was providing consistent supervision to youth who would otherwise be unsupervised. Additional analyses examined why the influence of the after‐school program was not more pronounced. We found that, although program attendance was related to decreases in unsupervised socializing, the program did not attract many delinquency‐prone youths who were unsupervised, which suggests that the students most in need of the program did not benefit. Furthermore, data obtained from a mid‐year activity survey revealed that youth in the study were highly engaged in a variety of after‐school activities. The addition of the after‐school program into the mixture of available activities had little effect on the frequency with which students participated in organized activities after school.     

Improving police response to persons with mental illness: a multi-level conceptualization of CIT

The large numbers of people with mental illness in jails and prisons has fueled policy concern in all domains of the justice system. This includes police practice, where initial decisions to involve persons in the justice system or divert them to mental health services are made. One approach to focus police response in these situations is the implementation of Crisis Intervention Teams (CIT). The CIT model is being implemented widely, with over 400 programs currently operating. While the limited evidence on CIT effectiveness is promising, research on CIT is limited in scope and conceptualization-much of it focusing on officer characteristics and training. In this paper we review the literature on CIT and present a conceptual model of police response to persons with mental illness that accounts for officer, organizational, mental health system and community level factors likely to influence implementation and effectiveness of CIT and other approaches. By moving our conceptualizations and research in this area to new levels of specificity, we may contribute more to effectiveness research on these interventions.     

"The red zone": temporal risk for unwanted sex among college students

The "red zone" usually refers to the first few weeks of the first semester at college, when female students are believed to be at greatest risk for experiencing unwanted sex. We tested this notion using data from a survey study of 207 first-and second-year students (121 women, 84 men) at a small, liberal arts university. Results demonstrated only one significant elevation in incidence rates of first- and second-year women's unwanted sexual experiences (sexual touching, attempted and completed anal, oral, and vaginal sex), between the end of the first month and fall break (mid-October) during the second year at school. Previous research and local information about the relevant behaviors of sorority and fraternity members is discussed in light of these findings to provide heuristic material for further empirical testing. Because risk may involve both temporal and situational factors, systematic collection and dissemination of local data are recommended.     

Fatal intoxication due to tramadol alone: case report and review of the literature

Poisoning may also lead to both coma and multiple organ failure, also in youngsters without a known major medical history. As not all toxic agents are routinely screened when a poisoning is suspected, it is useful to consider less frequently encountered poisons in certain cases. We describe the occurrence of asystole and multiple organ failure which occurred in a young man after a suspected tramadol overdose. The tramadol concentration on admission in the ICU was indeed 8 microg/ml (mg/l), far above the therapeutic range. Subsequently, the patient developed severe acute liver failure, finally leading to death. Post-mortem toxicology did not reveal any other poison responsible for this unfavourable course as only very high serum and tissue tramadol and desmethyltramadol concentrations were found. Only a few fatal poisonings attributable to tramadol alone, as observed in our case, have been reported. An overview of these cases is presented.     

Gender and evidence-based planning: the CIET methods

Epidemiological combined with experiential evidence from communities can produce important and sometimes surprising insights into gender relations, to inform policies that address changing needs. CIET has standardised a community-based cross-design for the gender-sensitive collection and analysis of three types of evidence: impact, coverage, and costs. Five steps help to ensure that women's voices are heard in planning. Gender-stratified analysis of existing data is a starting point. Stratification of all responses by sex of the respondent prevents a numerical bias in favour of men translating into a gender bias in the analysis. Female focus groups inform survey design, interpretation, and appropriate strategies for change. Gender is a factor in risk and resilience analysis. Finally, gender-sensitive logistics ensure women's equal participation. First-order outputs include actionable gender data to advocate in favour of women. Second-order outputs include an enabling environment for equitable development, challenging the gendered patterns of economic marginalisation.     

Lesbian writing

Karla Jay and Joanne Glasgow (eds) Lesbian Texts and Contexts: Radical Revisions, (New York University Press), New York and London, 1990.