Discussion: Affordable Care Act on Breastfeeding & Vaccine Health Strategy

Discussion: Affordable Care Act on Breastfeeding & Vaccine Health Strategy ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Affordable Care Act on Breastfeeding & Vaccine Health Strategy I’m stuck on a Psychology question and need an explanation. Discussion: Affordable Care Act on Breastfeeding & Vaccine Health Strategy Summarize the two articles below by answering the question below it. Articles have been provided for you in the uploaded file. Use APA in text citation and no plagiarism! tutor.docx effect_of_the_affordable_care_act_on_breastfeeding.pdf addressing_vaccine_h Summarize the two articles below by answering the question below it. Articles have been provided for you in the uploaded file . Use APA in text citation and no plagiarism! Gurley-Calvez, T., Bullinger, L., & Kapinos, K. A. (2018). Effect of the Affordable Care Act on Breastfeeding Outcomes. American Journal of Public Health, 108(2), 277–283. Summarize the main points of the article. Explain the role public policy had on the health care issue from your research. Discuss other ways public policy could address the health care issue from your research. Evaluate the importance of the health psychologist’s role in addressing/advancing/solving the public policy issues presented in research. (Support with a scholarly source) Laura Williamson, & Hannah Glaab. (2018). Addressing vaccine hesitancy requires an ethically consistent health strategy. BMC Medical Ethics, 19(1), 1–8. Summarize the main points of the article. Explain the role public policy had on the health care issue from your research. Discuss other ways public policy could address the health care issue from your research. Discussion: Affordable Care Act on Breastfeeding & Vaccine Health Strategy Evaluate the importance of the health psychologist’s role in addressing/advancing/solving the public policy issues presented in research (Support with a scholarly source). Summarize the two articles below by answering the question below it. Articles have been provided for you in the uploaded file. Use APA in text citation and no plagiarism! Gurley-Calvez, T., Bullinger, L., & Kapinos, K. A. (2018). Effect of the Affordable Care Act on Breastfeeding Outcomes. American Journal of Public Health, 108(2), 277–283. 1. 2. 3. 4. Summarize the main points of the article. Explain the role public policy had on the health care issue from your research. Discuss other ways public policy could address the health care issue from your research. Evaluate the importance of the health psychologist’s role in addressing/advancing/solving the public policy issues presented in research. (Support with a scholarly source) Laura Williamson, & Hannah Glaab. (2018). Addressing vaccine hesitancy requires an ethically consistent health strategy. BMC Medical Ethics, 19(1), 1–8. 1. 2. 3. 4. Summarize the main points of the article. Explain the role public policy had on the health care issue from your research. Discuss other ways public policy could address the health care issue from your research. Evaluate the importance of the health psychologist’s role in addressing/advancing/solving the public policy issues presented in research (Support with a scholarly source). AJPH RESEARCH Effect of the Affordable Care Act on Breastfeeding Outcomes Tami Gurley-Calvez, PhD, Lindsey Bullinger, MPA, and Kandice A. Kapinos, PhD Objectives. To assess how the 2012 Affordable Care Act (ACA) policy change, which required most private health insurance plans to cover lactation-support services and breastfeeding equipment (without cost-sharing), affected breastfeeding outcomes. Methods. We used a regression-adjusted difference-in-differences approach with cross-sectional observational data from the US National Immunization Survey from 2008 to 2014 to estimate the effect of the ACA policy change on breastfeeding outcomes, including initiation, duration, and age at ?rst formula feeding. The sample included children aged 19 to 23 months covered by private health insurance or Medicaid. Results. The ACA policy change was associated with an increase in breastfeeding duration by 10% (0.57 months; P = .007) and duration of exclusive breastfeeding by 21% (0.74 months; P = .001) among the eligible population. Results indicate no signi?cant effects on breastfeeding initiation and age at ?rst formula feeding. Conclusions. Reducing barriers to receiving support services and breastfeeding equipment shows promise as part of a broader effort to encourage breastfeeding, particularly the duration of breastfeeding and the amount of time before formula supplementation. (Am J Public Health. 2018;108:277–283. doi:10.2105/AJPH.2017. 304108) See also Hawkins, p. 164.Discussion: Affordable Care Act on Breastfeeding & Vaccine Health Strategy A large body of literature links breastfeeding to positive near-term child and maternal health outcomes.1,2 In particular, breastfeeding has been associated with a reduced risk of acute otitis media, gastrointestinal infections, respiratory tract diseases, childhood obesity, and type 2 diabetes for normal-term infants.2,3 For mothers, breastfeeding is associated with a lower incidence of type-2 diabetes, hyperlipidemia, hypertension, and cardiovascular disease, and lower risk of breast and ovarian cancers.4,5 Evidence from randomized controlled trials of breastfeeding-support services suggests positive effects of breastfeeding on infant cognitive ability and health outcomes.6 Although the percentage of mothers reporting any breastfeeding has increased over time from 74% in 2008 to 80% in 2014, only about half of mothers who initiate breastfeeding are still breastfeeding at 6 months with 22% breastfeeding exclusively through 6 months. Only about 30% breastfeed the full year recommended by February 2018, Vol 108, No. 2 AJPH the American Academy of Pediatrics.1,7 Moreover, evidence suggests that mothers would like to breastfeed longer than they are able.8 There have been several recent calls and policy efforts for more public health promotion of breastfeeding, including the 2011 US Surgeon General’s Call to Action to support breastfeeding,9 and provisions in the Affordable Care Act (ACA) of 2010. Speci?cally, the ACA required large employers to provide reasonable break time and a private place for expressing breastmilk, and mandated insurance coverage of lactation-support services and equipment without cost-sharing for new health insurance policies beginning on or after August 1, 2012 (section 2713). The ACA’s coverage requirement applies to private, nongrandfathered insurance plans. Of note, this change largely did not apply to mothers insured through the Medicaid program. Use of lactation-support services can increase a woman’s commitment to breastfeeding long term.10–12 Breast pumps are critical for mothers who need to be separated from their infants for work or school and can also stimulate milk production to address low milk supply issues.13–15 Breastfeeding promotion interventions, including the provision of lactation-support services, peer counselors, and breast pumps, have shown promising evidence of increasing breastfeeding rates.10,11,13–16 These breastfeeding promotion interventions may mitigate challenges a new mother faces and increase her con?dence in her ability to breastfeed. Early empirical evidence of the ACA policy changes suggests there have been effects on breastfeeding behaviors. Workplace requirements increased the likelihood of exclusive breastfeeding at 6 months for mothers who gave birth in 2011 and 2012, but only 40% of the study population reported access to time and space accommodations.17 Mandated private health insurance coverage of lactation-support services and breast pumps was associated with increased breastfeeding at the time of hospital discharge.18 Little is known, however, about the effects of the ACA policy changes on sustained, or longer-term, breastfeeding and infant feeding practices. The ACA lactation-support coverage provision might ABOUT THE AUTHORS Tami Gurley-Calvez is with the University of Kansas Medical Center, Kansas City. Lindsey Bullinger is with the School of Public and Environmental Affairs, Indiana University, Bloomington.Discussion: Affordable Care Act on Breastfeeding & Vaccine Health Strategy Kandice A. Kapinos is with the RAND Corporation, Arlington, VA. Correspondence should be sent to Kandice Kapinos, RAND Corporation, 1200 S Hayes St, Arlington, VA 22202 (e-mail: [email protected]). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This article was accepted August 26, 2017. doi: 10.2105/AJPH.2017.304108 Gurley-Calvez et al. Peer Reviewed Research 277 AJPH RESEARCH affect the duration of breastfeeding if lactation consultants can assist with early dif?culties, or if breast pumps make work and school transitions easier, allowing women to successfully follow through with intentions to breastfeed.8,19,20 This study ?lls this gap in the literature by examining the effect of the ACA mandate, including coverage of lactation consultant visits and breast pumps, on longer-term breastfeeding behaviors. METHODS We used 2008 to 2014 data from the US National Immunization Survey (NIS), a nationally representative survey of mothers with children aged 19 to 35 months sponsored by the National Center for Immunizations and Respiratory Diseases (NCIRD) and conducted jointly by NCIRD and the Centers for Disease Control and Prevention (CDC).21 Although the survey primarily addresses childhood immunizations, the questionnaire contains detailed questions on breastfeeding behavior. Response rates for the NIS household interview are around 82%.21 We restricted the sample to children aged 19 to 23 months at the time of the survey (Figure A, available as a supplement to the online version of this article at http://www. ajph.org). In the public-use version of the NIS, child age is available in 3 categories: 19 to 23 months, 24 to 29 months, and 30 to 35 months. We excluded the 2 older age groups, as none of these children would have been born after the ACA mandate. Most children in the group aged 19 to 23 months in the 2014 NIS would have been born after the ACA mandate. Importantly, these children were born before the January 1, 2014, implementation of many other ACA provisions that might bias our results. To estimate the policy effect, we restricted the sample to children who were covered by private health insurance (treatment group) or Medicaid (best-available comparison group). Our ?nal analytic sample size was 38 842 children. Measures Following earlier studies, we de?ned breastfeeding initiation as equal to 1 if the child was ever breastfed. In addition, we analyzed a broader range of longer-term outcome 278 Research Peer Reviewed Gurley-Calvez et al. measures including breastfeeding duration (in months), time spent exclusively breastfeeding without supplementation (in months), an indicator variable equal to 1 if the child was ever formula fed, and the age at which the child received his or her ?rst formula (in months). We note that the exclusive breastfeeding rate excludes time when the child was fed formula, but not other foods. We adjusted for several maternal and household characteristics known to in?uence breastfeeding behaviors as well as state ?xed effects to capture geographic differences in breastfeeding promotion campaigns as well as in breastfeeding attitudes. Discussion: Affordable Care Act on Breastfeeding & Vaccine Health Strategy Control variables included child sex, race, and ethnicity; mother’s age, education, and marital status; and household participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (ever) and number of children. Maternal employment information was not available. Statistical Analyses We used a quasi-experimental statistical design that allowed us to compare changes over time across “treatment” and “comparison” groups to isolate the impact of the policy from other impacts on outcomes that are attributable to secular changes.22 Our treatment group included children covered by private health insurance, as the preventive services coverage mandate only applied to new private health insurance plans. Uninsured women and children or those covered by Medicaid were not directly impacted by this ACA provision and represent potential comparison groups for the analysis. The exception would be mothers newly eligible for Medicaid in states that expanded Medicaid early with eligibility thresholds near or greater than thresholds in the ACA provision (California, Connecticut, District of Columbia, Minnesota, New Jersey, and Washington). We address this possibility in our sensitivity analysis. In this framework, we used the ACA policy change as a natural experiment or exogenous shock to test the effects of access to no-cost lactation-support services and breast pumps on child feeding outcomes. The statistical validity of this approach relies on the assumption that trends in breastfeeding behaviors were similar (parallel) for both the treatment and comparison group before the ACA policy changes. We used the control group (Medicaid mothers and children) to set the baseline of what would be expected for the treatment group (privately insured mothers and children) if there were no policy change. We examined trends in breastfeeding measures over time for privately insured children, those covered by Medicaid, and those without health insurance. We also formally tested for statistically signi?cant differences in the prepolicy trends by comparing the slopes across the different groups. As discussed in the Results section, trends in breastfeeding outcomes among the Medicaid group were not statistically different from trends in the privately insured group, implying that the group of Medicaid mothers was the best-available comparison group for our estimation. We used a regression-adjusted differencein-differences approach, comparing adjusted breastfeeding rates of children covered by private health insurance to those covered by Medicaid. We estimated models with binary outcomes (ever breastfed and ever formula fed) with probit models. For the duration outcomes (months breastfeeding and months exclusively breastfeeding), we only observed duration for those who reported “yes” to ever breastfeeding. We accounted for this selection by estimating a 2-part model that ?rst predicted the probability of breastfeeding and then estimated duration conditional on any breastfeeding.23 We estimated age at ?rst formula for those ever receiving formula similarly. In all results, we report marginal effects holding all covariates at their means. We considered 2-sided P values of less than .05 to indicate statistical signi?cance. Discussion: Affordable Care Act on Breastfeeding & Vaccine Health Strategy All estimations included state ?xed effects, standard errors clustered at the state level, and have been weighted with NIS sampling weights. We used Stata version 13 to conduct the analyses (StataCorp LP, College Station, TX). Most children covered by Medicaid would not have been affected by the ACA mandate, but newly eligible Medicaid enrollees enrolled as a result of the state Medicaid expansions would have been covered by the preventive services mandate. Therefore, children in our comparison group residing in early Medicaid expansion states whose mothers were newly enrolled at the time AJPH February 2018, Vol 108, No. 2 AJPH RESEARCH RESULTS Figure 1 presents trends in mean rates of breastfeeding duration (similar ?gures for ever breastfed, ever formula fed, and age at ?rst formula by child’s insurance status are in Figure A). Although mothers with privately insured children tend to breastfeed longer than other mothers, the trends in breastfeeding duration of children insured by Medicaid were mostly similar to those of privately insured children before August 2012, particularly from 2010 to 2013. In most cases, the pre-2012 slopes were not statistically signi?cantly different for Medicaid and privately insured children. However, breastfeeding behaviors among the uninsured appeared to be noisier, suggesting that they would be a less suitable control group. The fact that mothers covered by Medicaid tend to be less likely to breastfeed and to breastfeed for shorter durations did not bias our estimation because we were examining changes in breastfeeding trends— not levels—so any time-invariant differences in Medicaid compared with privately insured women were controlled for by our model. Summary statistics for outcome and control variables are presented in Table 1 for the sample of privately insured and Medicaid mothers. Privately insured mothers were more likely to report ever breastfeeding (84%) than were Medicaid mothers (69%). Mothers with private insurance breastfed about 2 months longer than did those covered by Medicaid and breastfed exclusively more than 1 month longer on average. Those privately insured also used formula less and began formula feeding later. With the exception of the child’s sex, means for the control variables were statistically different at the less-than-1% level across all control variables. Children in the February 2018, Vol 108, No. 2 AJPH private insurance category were less likely to be Hispanic; to live in a household that ever received Special Supplemental Nutrition Program for Women, Infants, and Children bene?ts; to have siblings; and were more likely to live in the south and to be identi?ed as White. Privately insured mothers were older, more likely to have a college education, and more likely to be married. These differences should not bias our results, however, unless there was a change in the characteristics of mothers who obtained private insurance that was correlated with the timing of the policy change in August 2012. Although several provisions of the ACA may change the composition of the insured,25 these other provisions went into effect at different times from the policy change we evaluated. We present regression-adjusted means in the pre- and postperiods for both children covered by private insurance and those covered by Medicaid in Table 2, ?rst differences, and the difference-in-differences estimates for all outcomes. These were all computed by using the margins command in Stata (as predicted probabilities or means, holding all other covariates at their means). Overall, we found that breastfeeding initiation increased for both groups with a slightly larger increase for children covered by Medicaid relative to private insurance, but with no overall change in breastfeeding initiation. Similarly, the percentage of children who were ever fed formula decreased signi?cantly for both groups of children 14 to 17 percentage points (P < .001). Although the decline was greater for children covered by Medicaid, this difference was not statistically signi?cant. Our results suggest statistically signi?cant changes in breastfeeding duration for privately insured children. We found that privately insured children were breastfed about 0.83 additional months in the postperiod (P = .001), versus a nonsigni?cant increase of 0.26 months for Medicaid children.Discussion: Affordable Care Act on Breastfeeding & Vaccine Health Strategy These changes net an additional 0.57 months (P = .007) in breastfeeding duration following the mandate, an almost 10% increase. Children covered by private insurance and Medicaid were breastfed exclusively for an additional 1.44 months (P < .001) and 0.70 months (P < .001), respectively, yielding an overall increase in exclusive breastfeeding duration of 0.74 months (P = .001) for those privately insured, a roughly 21% increase. The results for age at ?rst formula mirrored those for ever-fed formula. Both private insurance and Medicaid groups saw little change in age at ?rst formula feeding. Private HI 8 Mean Months Breastfed of their birth would be “treated,” which would dilute the true policy effect. In other words, we might observe increases in breastfeeding for those children covered by Medicaid as well, resulting in a difference-indifferences effect smaller than the true effect. To address this issue, as a sensitivity check, we re-estimated all models restricting our sample to non–Medicaid expansion states.24 Medicaid No HI 7 6 5 4 2008 2009 2010 2011 2012 2013 2014 Year of Interview Note. HI = health insurance. The whiskers indicate 95% con?dence intervals. FIGURE 1—Mean Breastfeeding Duration in Months, by Insurance Status: National Immunization Survey, United States, 2008–2014 Gurley-Calvez et al. Peer Reviewed Research 279 AJPH RESEARCH DISCUSSION TABLE 1—Sample Descriptive Statistics by Health Insurance Coverage: National Immunization Survey, United States, 2008–2014 Measures All Private Insurance Medicaid Outcomes Ever breastfed, % 77.96 84.10 69.07 Breastfeeding months, mean 5.61 6.51 4.31 Exclusive breastfeeding months, mean 3.42 3.95 2.65 84.72 82.70 87.63 2.49 2.54 2.41 Ever fed formula, % Age at ?rst formula feeding (months), mean Covariates Female (child), % 49.41 49.18 49.75 Hispanic (child), % 27.06 19.04 38.64 Child’s race, % Black 14.39 9.70 21.15 White 72.05 77.22 64.59 13.56 13.08 14.26 Ever received WIC (household), % Multi/other 55.61 30.01 92.58 College education (mother), % 33.24 52.03 6.12 Married (mother), % 53.32 67.83 32.37 Mother’s age, % £ 19 y 2.98 1.38 5.30 20–29 y 41.43 30.23 57.60 ‡ 30 y 55.59 68.39 37.11 1 28.40 30.74 25.02 2 or 3 ‡4 56.46 15.14 57.54 11.72 54.90 20.08 Northeast 15.14 17.46 13.47 Midwest 21.69 23.30 19.38 South 38.06 33.87 44.11 West 24.42 25.38 23.04 No. of children in household, % Census region, % Total observations, no. 36 288 24 889 11 399 Preperiod observations, no. 31 487 24 889 9 669 Postperiod observations, no. 4 801 3 071 1 730 Note. WIC = Special Supplemental Nutrition Program for Women, Infants, and Children. Entries represent percentages except for breastfeeding months, exclusive bre … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10