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Browsing by Author "Morrison, Gwendolyn"
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Item Childhood Bully Victimization and Adverse Life Outcomes(2023-10) Adhikary, Satabdi; Tennekoon, Vidhura; Royalty, Anne; Morrison, Gwendolyn; Ottoni-Wilhelm, Mark; Xu, HuipingBullying is widely prevalent in the US. Although anti-bullying laws have been implemented across the country since 1999, bullying prevalence rates remain high. Research suggests that being a bully or a bully victim or both makes an individual more likely to experience worse physical, mental, and financial health. This dissertation comprises of three essays examining the adverse effects of bully victimization on life outcomes. The first essay examines, using Panel Study of Income Dynamics (PSID) data, how being a victim of bullying affects sleep hours of an individual over the years. Results suggest that being a bully victim during teenage years reduces sleep hours, both contemporaneously and during early adulthood. The second essay uses the National Longitudinal Survey of Youth 1997 (NLSY97) data to examine how repeated bully victimization experiences in childhood and teenage years affect future labor market outcomes. A standard Mincer wage equation is used in a Heckman selection model and Inverse Probability Weighting (IPW) model to derive the estimates. Results indicate that being repeatedly bullied in teenage years reduces future earnings, mainly through reduced wage rates. The third essay, using NLSY97, looks at the effect of repeated bully victimization on wealth accumulation during early adult ages in difference-in-difference type framework. Measures of wealth accumulation include net household worth and its components, financial and non-financial assets, and financial debt at 20, 25, 30 and 35 years of age. Results indicate that the bully victims accumulate fewer net assets during the ages 20-35 than their non-victimized counterparts.Item Specification, estimation and testing of treatment effects in multinomial outcome models : accommodating endogeneity and inter-category covariance(2018-06-18) Tang, Shichao; Terza, Joseph V.; Carlin, Paul; Lin, Hsien-Chang; Morrison, Gwendolyn; Seo, BoyoungIn this dissertation, a potential outcomes (PO) based framework is developed for causally interpretable treatment effect parameters in the multinomial dependent variable regression framework. The specification of the relevant data generating process (DGP) is also derived. This new framework simultaneously accounts for the potential endogeneity of the treatment and loosens inter-category covariance restrictions on the multinomial outcome model (e.g., the independence from irrelevant alternatives restriction). Corresponding consistent estimators for the “deep parameters” of the DGP and the treatment effect parameters are developed and implemented (in Stata). A novel approach is proposed for assessing the inter-category covariance flexibility afforded by a particular multinomial modeling specification [e.g. multinomial logit (MNL), multinomial probit (MNP), and nested multinomial logit (NMNL)] in the context of our general framework. This assessment technique can serve as a useful tool for model selection. The new modeling/estimation approach developed in this dissertation is quite general. I focus here, however, on the NMNL model because, among the three modeling specifications under consideration (MNL, MNP and NMNL), it is the only one that is both computationally feasible and is relatively unrestrictive with regard to inter-category covariance. Moreover, as a logical starting point, I restrict my analyses to the simplest version of the model – the trinomial (three-category) NMNL with an endogenous treatment (ET) variable conditioned on individual-specific covariates only. To identify potential computational issues and to assess the statistical accuracy of my proposed NMNL-ET estimator and its implementation (in Stata), I conducted a thorough simulation analysis. I found that conventional optimization techniques are, in this context, generally fraught with convergence problems. To overcome this, I implement a systematic line search algorithm that successfully resolves this issue. The simulation results suggest that it is important to accommodate both endogeneity and inter-category covariance simultaneously in model design and estimation. As an illustration and as a basis for comparing alternative parametric specifications with respect to ease of implementation, computational efficiency and statistical performance, the proposed model and estimation method are used to analyze the impact of substance abuse/dependence on the employment status using the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) data.Item Three Essays in Health Economics: The Role of Coordination in Improving Outcomes and Increasing Value in Health Care(2022-06) Sheff, Zachary Thompson; Ottoni-Wilhelm, Mark; Royalty, Anne; Tennekoon, Vidhura; Morrison, Gwendolyn; Dixon, Brian E.Hospital costs are the largest contributor to US health expenditures, making them a common target for cost containment policies. Policies that reduce fragmentation in health care and related systems could increase the value of these expenditures while improving outcomes. Efforts to address fragmentation of health care services, such as Accountable Care Organizations, have typically been enacted at the scale of health systems. However, coordination within health care facilities should also be explored. In three essays, I analyze the role of coordination in several forms. First, I examine the introduction of interdisciplinary care teams within a hospital. This analysis features care coordination within a health care facility with the potential to reduce resource utilization through improved communication between team members and between patients and their care providers. I find that care coordination reduced length of stay for some patients while maintaining care quality. This combination results in higher value care for patients and hospitals. Second, I explore whether these interdisciplinary care teams impact resource utilization and patient flow throughout the hospital. The primary outcome is reduction in patient transfers to the ICU. Here, care coordination includes interdisciplinary teams as well as coordination between interdisciplinary teams and intensivists in ICUs. Findings from this analysis suggest that ICU transfers were unaffected by care coordination. Finally, I examine coordination on a larger scale. I leverage data from a national database of trauma patients to compare mortality among adolescent patients with isolated traumatic brain injury between adult trauma centers and pediatric trauma centers. Previous work has shown that younger pediatric patients with this injury benefit from treatment at pediatric trauma centers. However, it is unclear whether this benefit extends to older pediatric patients on the cusp of adulthood. I find that, after adjusting for differences in injury severity, adolescent patients have no difference in mortality risk when treated at adult or pediatric trauma centers. This finding supports the current regionalized model of trauma care where severely injured patients are taken to the nearest trauma center, regardless of designation as pediatric or adult.Item Three Essays on the Impact of Medicaid Expansion on Cancer Care and Mis-Measured Self-Reports of Cancer Screening Status(2022-09) Bhattacharyya, Oindrila; Morrison, Gwendolyn; Tennekoon, Vidhura; Royalty, Anne; Ottoni-Wilhelm, Mark; Xu, Huiping; Obeng-Gyasi, SamiliaThe dissertation consists of three essays attempting to assess the impact of expanded health insurance policy on cancer care continuum and measure the unbiased program effects after taking care of mis-measured cancer screening self-reports. The first essay examines the impact of the Affordable Care Act’s Medicaid expansion on time to oral cancer treatment initiation since diagnosis, quality of hospital care such as length of stay in the hospital, planned and unplanned readmissions post-surgery, and care outcome such as ninety-day mortality since surgery. The study uses two-way fixed effects linear model analysis under a difference-in-difference estimation setting to show that Medicaid expansion eligibility reduced overall oral cancer treatment initiation timing since diagnosis, including radiation initiation as well as first surgery of the primary site. It also shortened the length of stay in the hospital post-surgery. The second essay assesses the value of electronic medical records from Indiana health information exchange (IHIE) and survey self-reports of Indiana residents seen at Indiana University Health in measuring population-based cancer screening for colorectal, cervical, and breast cancer. Between the two measures of screening, the study examines association using Spearman’s rank correlation and concordance using Percent Agreement and Gwet’s Agreement Coefficient. Health information exchange and self-reports, both provided unique information in measuring cancer screening, and the most robust measurement approach entails collecting screening information from both HIE and patient self-report. In this study, we find evidence of measurement error in self-reports in terms of reporting bias. The majority of the publicly available datasets collect information on cancer screening behavior through patient interviews which are self-reported and may suffer from potential measurement errors. The third essay uses a nationwide population-based database and examines the true, unbiased impact of Medicaid expansion on cancer screening for breast, colorectal, cervical, and prostate cancers after correcting for any bias due to possible misclassification of the self-reported screening status. This study conducts a modified two-way fixed effects probit model under a difference-in-difference estimation setting to identify and correct the errors in the self-reports and estimate the unbiased program effect which shows positive impact on cancer screening with increased effect sizes.Item Tracking Patterns of Needs During a Telephone Follow-up Program for Family Caregivers of Persons with Stroke(Taylor and Francis, 2016-09) Bakas, Tamilyn; Jessup, Nenette M.; McLennon, Susan M.; Habermann, Barbara; Weaver, Michael T.; Morrison, Gwendolyn; Economics, School of Liberal ArtsPurpose Programs that address stroke family caregiver needs and skill-building are recommended based on the literature and patient care guidelines for stroke rehabilitation. The purpose of this study was to explore patterns of perceived needs and skill-building during a stroke caregiver intervention program. Method Descriptive statistics were used to analyze data from 123 stroke caregivers enrolled in the intervention group of a randomized controlled clinical trial. Caregivers received 8 weekly telephone sessions, with a booster session a month later. At each session, the Caregiver Needs and Concerns Checklist (CNCC) was used to identify and prioritize current needs that were then addressed through skill-building strategies. Results Perceived needs changed over time. Information about stroke was the highest priority need during Session 1. Managing survivor emotions and behaviors was the highest priority for Sessions 2 through 4. Caregivers generally waited until Sessions 5 through 9 to address their own emotional and physical health needs. Physical and instrumental care needs were relatively low but stable across all 9 sessions. Skill-building was consistently high, though it peaked during Sessions 2 and 3. Conclusions Tracking patterns of needs and skill-building suggest appropriate timing for targeting different types of family caregiver support during stroke rehabilitation.