Browsing by Author "Qiao, Nan"
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Item Factors affecting the Affordable Care Act Marketplace stand-alone pediatric dental plan premiums(Wiley, 2018-09) Qiao, Nan; Carroll, Aaron E.; Bell, Teresa Maria; Surgery, School of MedicineBACKGROUND: Children from lower income families have inadequate dental insurance coverage and poorer dental health in the United States. The Affordable Care Act (ACA) created Health Insurance Exchange Marketplaces to increase competition among health insurers and to provide low-income families with less costly health plans. The study examined Marketplace pediatric stand-alone dental plans (SADPs) and factors that affect their premiums. METHODS: The data used were 2016 Federal-Facilitated and State-Partnership Marketplace pediatric SADP data. Ordinary least squares regressions were applied to estimate contributing factors' effects on SADP premiums. RESULTS: Great premium variation was found among low and high coverage level SADPs, respectively. Premiums of Health Maintenance Organization (HMO) SADPs were significantly less expensive than Preferred Provider Organization (PPO) SADPs. SADPs charged significantly higher premiums for more types of services covered. SADPs also charged higher premiums in states where there are larger proportions of low-income people who report poor dental health, more dentists per capita, or higher dentists' wages. The number of insurance companies offering pediatric SADPs in a Marketplace was negatively associated with premiums. CONCLUSION: The current Marketplace pediatric SADPs may have limited effects on increasing economically disadvantaged children's access to quality dental care. Marketplaces can promote competition among its pediatric dental insurers on providing lower-cost pediatric SADPs.Item National Instant Criminal Background Check and Youth Gun Carrying(American Academy of Pediatrics, 2020-01) Timsina, Lava R.; Qiao, Nan; Mongalo, Alejandro C.; Vetor, Ashley N.; Carroll, Aaron E.; Bell, Teresa M.; Economics, School of Liberal ArtsBackground: Despite being unable to purchase firearms directly, many adolescents have access to guns, leading to increased risk of injury and death. We sought to determine if the National Instant Criminal Background Check System (NICS) changed adolescents' gun-carrying behavior. Methods: We performed a repeated cross-sectional study using National Youth Risk Behavior Survey data from years 1993 to 2017. We used a survey-weighted multivariable logistic regression model to determine if the NICS had an effect on adolescent gun carrying, controlling for state respondent characteristics, state laws, state characteristics, the interaction between the NICS and state gun laws, and time. Results: On average, 5.8% of the cohort reported carrying a gun. Approximately 17% of respondents who carried guns were from states with a universal background check (U/BC) provision at the point of sale, whereas 83% were from states that did not have such laws (P < .001). The model indicated that the NICS together with U/BCs significantly reduced gun carrying by 25% (adjusted relative risk = 0.75 [95% confidence interval: 0.566-0.995]; P = .046), whereas the NICS independently did not (P = .516). Conclusions: Adolescents in states that require U/BCs on all prospective gun buyers are less likely to carry guns compared with those in states that only require background checks on sales through federally licensed firearms dealers. The NICS was only effective in reducing adolescent gun carrying in the presence of state laws requiring U/BCs on all prospective gun buyers. However, state U/BC laws had no effect on adolescent gun carrying until after the NICS was implemented.Item Three Healthcare Topics: Adult Children's Informal Care to Aging Parents, Working Age Population's Marijuana Use, and Indigenous Adolescents' Suicidal Behaviors(2019-01) Qiao, Nan; Royalty, Anne; Ottoni-Wilhelm, Mark; Simon, Kosali; Akosa Antwi, Yaa; Gupta, SumedhaThis dissertation examines three vulnerable groups’ health and healthcare access. The first research uses the 2002–2011 Health and Retirement Study data to estimate the effects of adult children’s employment on their caregiving to aging parents. State monthly unemployment rates are used as an instrument for employment. Results show that being employed affects neither male nor female adult children’s caregiving to aging parents significantly. The findings imply that the total amount of informal care provided by adult children might not be affected by changes in labor market participation trends of the two genders. The second research studies the labor impact of Colorado and Washington’s passage of recreational marijuana laws in December 2012. The difference-in-differences method is applied on the 2010–2013 National Survey on Drug Use and Health state estimates and the 2008–2013 Survey of Income and Program Participation data to estimate legalization’s effects on employment. The results show that legalizing recreational marijuana increases marijuana use and reduces the number of weeks employed in a given month by 0.090 among those aged 21 to 25. The laws’ labor effects are not significant on those aged 26 and above. To reduce legalization’s negative effects on employment, states may consider raising the minimum legal age for recreational marijuana use. The third research examines disparities in suicidal behaviors between indigenous and non-indigenous adolescents. The study analyzes the 2001–2013 Youth Risk Behavior Survey data. Oaxaca decomposition is applied to detect sources of disparities in suicide consideration, planning, and attempts. The study finds that the disparities in suicidal behaviors can be explained by differences in suicidal factors’ prevalence and effect sizes between the two groups. Suicidal behavior disparities might be reduced by protecting male indigenous adolescents from sexual abuse and depression, reducing female indigenous adolescents’ substance use, as well as involving male indigenous adolescents in sports teams.