Browsing by Author "Royalty, Anne"

Now showing 1 - 5 of 5
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    Childhood Bully Victimization and Adverse Life Outcomes
    (2023-10) Adhikary, Satabdi; Tennekoon, Vidhura; Royalty, Anne; Morrison, Gwendolyn; Ottoni-Wilhelm, Mark; Xu, Huiping
    Bullying 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.
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    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.
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    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, Samilia
    The 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.
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    Three essays on the impact of political and economic shocks during childhood on health outcomes : evidence from developing countries
    (2016-11-07) Hawash, Ronia Ahmed; Royalty, Anne; Osili, Una; Gupta, Sumedha; Wessel, Jennifer
    The dissertation consists of three essays which attempt to capture causal relationships between shocks during childhood and before birth, and later health outcomes. Exogenous shocks such as the experiences of war and political upheaval are treated as natural experiments which minimize problems of endogeneity and selection that are present in most association studies. The first essay examines how exposure to civil war during childhood affects females’ outcomes including age at first marriage, fertility, and second generation infant mortality using the Biafra war which took place in Nigeria between years 1967 and 1970. The study uses difference-in-difference analysis to show that females that witnessed war during early adolescence got married younger than their peers not exposed to the war, and were more likely to have higher fertility and second-generation infant mortality. The second essay uses the same shock, the Biafra war, to test if males’ and females’ exposure to community-level violence results in higher risk of experiencing domestic violence in their marital relationships in the long-run. The study conducts difference-in-difference analysis on females and males separately to show that the males’ exposure to the war at ages 13 and older is the main mechanism behind females being victims of domestic violence in the long-run. The third essay examines the impact of acute prenatal stress on birth weight using the 2011 Egyptian revolution fatalities as an indicator for exposure to violence and stressful events. Results show that higher prenatal stress resulting from political conflict during the first and second trimesters of pregnancy has a significant negative impact on birth weight. This finding is robust to restricting the sample to siblings’ data and using mother fixed effects, suggesting that neither observable nor unobservable characteristics of mothers are driving the results.
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    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, Sumedha
    This 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.