We updated this piece on the four-day school week, originally published in June 2018, on July 15, 2023 to include new research and other information.

More than 2,100 public schools in 25 states have switched to a four-day school week, often in hopes of recruiting teachers, saving money and boosting student attendance, researchers estimate.

Small, rural schools facing significant teacher shortages have led the trend, usually choosing to take off Mondays or Fridays to give employees and students a three-day weekend every week. To make up for the lost day of instruction, school officials typically tack time onto the remaining four days.

In some places where schools made the change, school district leaders have marveled at the resulting spikes in job applications from teachers and other job seekers. Teacher shortages, made worse by the COVID-19 pandemic, have plagued public schools nationwide for decades.

“The number of teacher applications that we’ve received have gone up more than 4-fold,” Dale Herl, superintendent of the Independence, Missouri school district, told CBS News late last year.

The impact on students, however, has not been as positive. Although peer-reviewed research on the topic is limited, focusing only on a single state or small group of states, there is evidence that some groups of students learn less on a four-day schedule than on a five-day schedule.

A new analysis of student performance in six states — Colorado, Iowa, Kansas, Montana, North Dakota and Wyoming — finds that students who went to class four days a week, as a whole, made less progress in reading during the academic year than students who went five days a week. Kids on a four-day schedule earned lower reading scores on a spring assessment known as the Measures of Academic Progress Growth, on average.

However, the authors of the paper, published last month, also found that the condensed schedule had little to no effect on the rural students they studied, on average. Schools located in towns and suburbs, on the other hand, saw student performance drop considerably after adopting a four-day week.

The authors also discovered differences among student groups. For example, Hispanic students going to class four days a week made less progress in math during the school year than white students on the same schedule. White students made less progress in math than Native American students during the 11-year study.

“For policymakers and practitioners, this study addresses previous ambiguity about the effects of four-day school weeks on academic outcomes and provides evidence supporting concerns about four-day school week effects on student achievement and growth, particularly for those implemented in non-rural areas,” write the authors, Emily Morton, Paul Thompson and Megan Kuhfeld.

In the spring before the COVID-19 pandemic, a total of 662 public school districts used the schedule — up more than 600% since 1999, Thompson and Morton write in a 2021 essay for the Brookings Institution. That number climbed to 876 during the 2022-23 academic year, they told The Journalist’s Resource in email messages.

In addition to studying the schedule’s effect on student achievement, researchers are also investigating its impact on other aspects of school operations, including education spending, student discipline and employee morale. To make the research easier to find, the University of Oregon’s HEDCO Institute for Evidence-Based Educational Practice has created the Four-Day School Week Research Database.

Anyone can use the interactive platform to sift through research completed as of May 2023. It’s worth noting that most research in the database is not peer-reviewed journal articles. Seventy of the more than 100 papers are student dissertations, theses and other papers.

If you keep reading, you’ll find that we have gathered and summarized several relevant journal articles below. To date, the scholarly literature indicates:

• Some schools cut instructional time when they adopt a four-day schedule.
• The impact of a four-day school week differs depending on a range of factors, including the number of hours per week a school operates, how the school structures its daily schedule and the race and ethnicity of students.
• The condensed schedule does not save much money, considering employee salaries and benefits make up the bulk of school expenses. In a 2021 analysis, Thompson estimates schools save 1% to 2% by shortening the school week by one day.
• Staff morale improves under a four-day school week.
• Fighting and bullying decline at high schools.

Both Thompson and Morton urged journalists to explain that the amount of time schools dedicate to student learning during four-day weeks makes a big difference.

“It’s pretty critical to the story that districts with longer days (who are possibly delivering equal or more instructional time to their students than they were on a five-day week) are not seeing the same negative impacts that districts with shorter days are seeing,” Morton, a researcher at the American Institutes of Research, wrote to JR in late 2023.

In a follow-up conversation with JR in July 2024, Morton pointed out that parents like the four-day schedule despite concerns raised by education scholars. In interviews with researchers, she wrote, “parents mention that they appreciate the additional family time and perceive other benefits of the schedule for their children, and they overwhelmingly indicate that they would choose to keep a four-day schedule over switching back to a five-day schedule.”

Morton would not recommend schools adopt a four-day schedule if their main aim is saving money, boosting student attendance or recruiting and retaining teachers. Research findings “do not provide much support for the argument that four-day school weeks are delivering the intended benefits,” she wrote to JR.

Keep reading to learn more. We’ll update this collection of research periodically.

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A Multi-State, Student-Level Analysis of the Effects of the Four-Day School Week On Student Achievement and Growth
Emily Morton, Paul N. Thompson and Megan Kuhfeld. Economics of Education Review, June 2024.

Summary: This study looks at how switching to a four-day school week affects student achievement over the course of the school year in Colorado, Iowa, Kansas, Montana, North Dakota and Wyoming. A key takeaway: On average, across those six states, students on a four-day schedule learned less during the school year than students who went to class five days a week. However, students in rural areas fared better on that schedule than students in “non-rural” areas.

Researchers studied the scores that students in grades 3-8 earned on an assessment called the Measures of Academic Progress Growth, administered each fall and spring to gauge how much kids learned over the course of the school year. The analysis uses 11 years of test score data in reading and math, collected from the 2008-09 to the 2018-19 academic year.

Researchers found that students who went to school four days a week, as a whole, made smaller gains in reading during the academic year than students who went five days a week. They also earned lower scores in reading on the spring assessment, on average.

When researchers looked at the data more closely, however, they found differences between students attending rural schools and students attending schools located in towns and suburbs — communities the researchers dubbed “non-rural.”

Although adopting a four-day schedule had little to no impact on kids at rural schools, student performance fell considerably at schools in non-rural areas. Those children, as a whole, made less progress in reading and math during the academic year than children attending non-rural schools that operated five days a week. They also earned lower scores in both reading and math on the spring exam.

“The estimated effects on math and reading achievement in non-rural four-day week schools are ‘medium’ and meaningful,” the researchers write, adding that the difference is roughly equivalent to a quarter of a school year worth of learning in the fifth grade.

Researchers also discovered that student performance at schools with four-day schedules varied by gender and race. At schools using a four-day-a-week schedule, girls made smaller gains in reading and math than boys, on average. Hispanic students made less progress in math than white students, who made less progress in math than Native American students.

“The estimated effects on math and reading gains during the school year are not ‘large’ by the developing standards used to interpret effect sizes of education interventions, but they are also not trivial,” the researchers write. “For the many districts and communities who have become very fond of the schedule, the evidence presented in this study suggests that how the four-day school week is implemented may be an important factor in its effects on students.”

Impacts of the Four-Day School Week on Early Elementary Achievement
Paul N. Thompson; et al. Early Childhood Research Quarterly, 2nd Quarter 2023.

Summary: This study is the first to examine the four-day school week’s impact on elementary schools’ youngest students. Researchers looked at how children in Oregon who went to school four days a week in kindergarten later performed in math and English Language Arts when they reached the third grade. What they found: Overall, there were “minimal and non-significant differences” in the test scores of third-graders who attended kindergarten on a four-day schedule between 2014 and 2016 and third-graders who went to kindergarten on a five-day schedule during the same period.

When the researchers studied individual groups of students, though, they noticed small differences. For example, when they looked only at children who had scored highest on their pre-kindergarten assessments of letter sounds, letter names and early math skills, they learned that kids who went to kindergarten four days a week scored a little lower on third-grade tests than those who had gone to kindergarten five days a week.

The researchers write that they find no statistically significant evidence of detrimental four-day school week achievement impacts, and even some positive impacts” for minority students, lower-income students,  special education students, students enrolled in English as a Second Language programs and students who scored in the lower half on pre-kindergarten assessments.

There are multiple reasons why lower-achieving students might be less affected by school schedules than high achievers, the researchers point out. For example, higher-achieving students “may miss out on specialized instruction — such as gifted and enrichment activities — that they would have had time to receive under a five-day school schedule,” they write.

Effects of 4-Day School Weeks on Older Adolescents: Examining Impacts of the Schedule on Academic Achievement, Attendance, and Behavior in High School
Emily Morton. Educational Evaluation and Policy Analysis, June 2022.

Summary: Oklahoma high schools saw less fighting and bullying among students after switching from a five-day-a-week schedule to a four-day schedule, this study finds. Fighting declined by 0.79 incidents per 100 students and bullying dropped by 0.65 incidents per 100 students.

The other types of student discipline problems examined, including weapons possession, vandalism and truancy, did not change, according to the analysis, based on a variety of student and school data collected through 2019 from the Oklahoma State Department of Education and National Center for Education Statistics.

“Results indicate that 4-day school weeks decrease per-pupil bullying incidents by approximately 39% and per-pupil fighting incidents by approximately 31%,” writes the author, Emily Morton, a research scientist at NWEA, a nonprofit research organization formerly known as the Northwest Evaluation Association.

Morton did not investigate what caused the reduction in bullying and fighting. She did find that moving to a four-day schedule had “no detectable effect” on high school attendance or student scores on the ACT college-entrance exam.

Only a Matter of Time? The Role of Time in School on Four-Day School Week Achievement Impacts
Paul N. Thompson and Jason Ward. Economics of Education Review, February 2022.

Summary: Student test scores in math and language arts dipped at some schools that adopted a four-day schedule but did not change at others, according to this analysis of school schedule switches in 12 states.

Researchers discovered “small reductions” in test scores for students in grades 3 through 8 at schools offering what the researchers call “low time in school.” These schools operate an average of 29.95 hours during the four-day week. The decline in test scores is described in terms of standard deviation, not units of measurement such as points or percentages.

At schools offering “middle time in school” — an average of 31.03 hours over four days — test scores among kids in grades 3 through 8 did not change, write the researchers, Paul N. Thompson, an associate professor of economics at Oregon State University, and Jason Ward, an associate economist at the RAND Corp., a nonprofit research organization.

Scores also did not change at schools providing “high time in school,” or 32.14 hours over a four-day school week, on average.

When describing this paper’s findings, it’s inaccurate to say researchers found that test scores dropped as a result of schools adopting a four-day schedule. It is correct to say test scores dropped, on average, across the schools the researchers studied. But it’s worth noting the relationship between test scores and the four-day school week differs according to the average number of hours those schools operate each week.

For this analysis, researchers examined school districts in states that allowed four-day school weeks during the 2008-2009 academic year through the 2017-2018 academic years. They chose to focus on the 12 states where four-day school weeks were most common. The data they used came from the Stanford Educational Data Archive and “a proprietary, longitudinal, national database” that tracked the use of four-day school weeks from 2009 to 2018.

The researchers write that their findings “suggest that four-day school weeks that operate with adequate levels of time in school have no clear negative effect on achievement and, instead, that it is operating four-day school weeks in a low-time-in-school environment that should be cautioned against.”

Three Midwest Rural School Districts’ First Year Transition to the Four Day School Week
Jon Turner, Kim Finch and Ximena Uribe-Zarain. The Rural Educator, 2019.

Abstract: “The four-day school week is a concept that has been utilized in rural schools for decades to respond to budgetary shortfalls. There has been little peer-reviewed research on the four-day school week that has focused on the perception of parents who live in school districts that have recently switched to the four-day model. This study collects data from 584 parents in three rural Missouri school districts that have transitioned to the four-day school week within the last year. Quantitative statistical analysis identifies significant differences in the perceptions of parents classified by the age of children, special education identification, and free and reduced lunch status. Strong parental support for the four-day school week was identified in all demographic areas investigated; however, families with only elementary aged children and families with students receiving special education services were less supportive than other groups.”

Juvenile Crime and the Four-Day School Week
Stefanie Fischer and Daniel Argyle. Economics of Education Review, 2018.

Abstract: “We leverage the adoption of a four-day school week across schools within the jurisdiction of rural law enforcement agencies in Colorado to examine the causal link between school attendance and youth crime. Those affected by the policy attend school for the same number of hours each week as students on a typical five-day week; however, treated students do not attend school on Friday. This policy allows us to learn about two aspects of the school-crime relationship that have previously been unstudied: one, the effects of a frequent and permanent schedule change on short-term crime, and two, the impact that school attendance has on youth crime in rural areas. Our difference-in-difference estimates show that following policy adoption, agencies containing students on a four-day week experience about a 20 percent increase in juvenile criminal offenses, where the strongest effect is observed for property crime.”

Staff Perspectives of the Four-Day School Week: A New Analysis of Compressed School Schedules
Jon Turner, Kim Finch and Ximena Uribe–Zarian. Journal of Education and Training Studies, 2018.

Abstract: “The four-day school week is a concept that has been utilized in rural schools for decades to respond to budgetary shortfalls. There has been little peer-reviewed research on the four-day school week that has focused on the perception of staff that work in school districts that have recently switched to the four-day model. This study collects data from 136 faculty and staff members in three rural Missouri school districts that have transitioned to the four-day school week within the last year. Quantitative statistical analysis identifies strong support of the four-day school week model from both certified educational staff and classified support staff perspectives. All staff responded that the calendar change had improved staff morale, and certified staff responded that the four-day week had a positive impact on what is taught in classrooms and had increased academic quality. Qualitative analysis identifies staff suggestions for schools implementing the four-day school week including the importance of community outreach prior to implementation. No significant differences were identified between certified and classified staff perspectives. Strong staff support for the four-day school week was identified in all demographic areas investigated. Findings support conclusions made in research in business and government sectors that identify strong employee support of a compressed workweek across all work categories.”

The Economics of a Four-Day School Week: Community and Business Leaders’ Perspectives
Jon Turner, Kim Finch and Ximena Uribe–Zarian. Journal of Education and Training Studies, 2018.

Abstract: “The four-day school week is a concept that has been utilized in rural schools in the United States for decades and the number of schools moving to the four-day school week is growing. In many rural communities, the school district is the largest regional employer which provides a region with permanent, high paying jobs that support the local economy. This study collects data from 71 community and business leaders in three rural school districts that have transitioned to the four-day school week within the last year. Quantitative statistical analysis is used to investigate the perceptions of community and business leaders related to the economic impact upon their businesses and the community and the impact the four-day school week has had upon perception of quality of the school district. Significant differences were identified between community/business leaders that currently have no children in school as compared to community/business leaders with children currently enrolled in four-day school week schools. Overall, community/business leaders were evenly divided concerning the economic impact on their businesses and the community. Community/business leaders’ perceptions of the impact the four-day school week was also evenly divided concerning the impact on the quality of the school district. Slightly more negative opinions were identified related to the economic impact on the profitability of their personal businesses which may impact considerations by school leaders. Overall, community/business leaders were evenly divided when asked if they would prefer their school district return to the traditional five-day week school calendar.”

Impact of a 4-Day School Week on Student Academic Performance, Food Insecurity, and Youth Crime
Report from the Oklahoma State Department of Health’s Office of Partner Engagement, 2017.

Summary: “A Health Impact Assessment (HIA) utilizes a variety of data sources and analytic methods to evaluate the consequences of proposed or implemented policy on health. A rapid (HIA) was chosen to research the impact of the four-day school week on youth. The shift to a four-day school week was a strategy employed by many school districts in Oklahoma to address an $878 million budget shortfall, subsequent budget cuts, and teacher shortages. The HIA aimed to assess the impact of the four-day school week on student academic performance, food insecurity, and juvenile crime … An extensive review of literature and stakeholder engagement on these topic areas was mostly inconclusive or did not reveal any clear-cut evidence to identify effects of the four-day school week on student outcomes — academic performance, food insecurity or juvenile crime. Moreover, there are many published articles about the pros and cons of the four-day school week, but a lack of comprehensive research is available on the practice.”

Does Shortening the School Week Impact Student Performance? Evidence from the Four-Day School Week
D. Mark Anderson and Mary Beth Walker. Education Finance and Policy, 2015.

Abstract: “School districts use a variety of policies to close budget gaps and stave off teacher layoffs and furloughs. More schools are implementing four-day school weeks to reduce overhead and transportation costs. The four-day week requires substantial schedule changes as schools must increase the length of their school day to meet minimum instructional hour requirements. Although some schools have indicated this policy eases financial pressures, it is unknown whether there is an impact on student outcomes. We use school-level data from Colorado to investigate the relationship between the four-day week and academic performance among elementary school students. Our results generally indicate a positive relationship between the four-day week and performance in reading and mathematics. These findings suggest there is little evidence that moving to a four-day week compromises student academic achievement. This research has policy relevance to the current U.S. education system, where many school districts must cut costs.”

Other resources

• The Education Commission of the States offers a 50-state comparison of public school students’ instructional time requirements. For example, students in Colorado are required to be in school for a minimum of 160 days each academic year while in Vermont, the minimum is 175 days and in North Carolina, it’s 185.
• The State of the American Teacher project offers insights into how teachers feel about their jobs and the education field as a whole. In early 2022, RAND Corp. surveyed a nationally representative sample of teachers, asking questions on topics such as job-related stress, school safety, COVID-19 mitigation policies and career plans. Survey results show that 56% of teachers who answered a question about their attitude toward their job “strongly” or “somewhat” agreed with the statement, “The stress and disappointments involved in teaching aren’t really worth it.” Meanwhile, 78% “strongly” or “somewhat” agreed with the statement, “I don’t seem to have as much enthusiasm now as I did when I began teaching.”
• Opinions about the four-day school week vary among school board members, district-level administrators, school principals and teachers. These organizations can provide insights: the Schools Superintendents Association, National School Boards Association, National Association of Elementary School Principals and National Association of Secondary School Principals.

Looking for more research on public schools? Check out our other collections of research on student lunches, school uniforms, teacher salaries and teacher misconduct.

The post Four-day school week: Research suggests impacts of a condensed schedule vary by student group, school type appeared first on The Journalist's Resource.

With rising rents and financial strife from the COVID-19 pandemic rippling through U.S. cities, some municipalities are turning to rent regulation as a policy to help tenants stay in their homes.

Voters in St. Paul, Minnesota, passed one of the nation’s strictest rent regulation measures in early November, capping rent hikes there at 3% annually. Unlike other ordinances, rent regulation in St. Paul is not linked to inflation and new construction is not exempt. The St. Paul ordinance is also unusual in that it applies to all types of rentals in buildings of any age.

The law is set to take effect next year, though the city still has to work out the details and some housing developers have told the Minneapolis Star Tribune they will re-evaluate their building plans.

Other cities are moving in the same direction. Minneapolis also recently paved the way for rent regulation; Santa Ana, California, passed a rent cap ordinance; and Boston Mayor Michelle Wu is on the record as a rent regulation supporter.

Rent control versus rent stabilization

Rent regulation is a blanket term for government intervention in the residential rental market involving either rent control or rent stabilization measures. Rent control generally refers to hard rent caps, limiting the amount a landlord can charge for a protected unit. Rent stabilization allows for yearly rent increases, usually a small percentage of the previous year’s rent.

Economists typically think strict rent caps constrain housing supply in the long run. The argument boils down to this: The U.S. needs more housing, not less, and rent control stifles developers’ profit incentive to build. For economists, it’s about how supply and demand affect prices. When it comes to rental housing, supply and demand are out of whack — there’s more demand than supply. Freddie Mac, the government-sponsored mortgage buyer, estimates the U.S. is short 3.8 million residential units — apartments or houses for rent or sale. More supply should lead to lower rents, the economists’ argument goes.

“Advocates argue that, in some markets, rent control policies are a necessity to ensure affordability, tenant stabilization, and the rights of tenants,” write University of Dayton political science professor Joshua Ambrosius and his co-authors in one of the papers featured below. “Critics, including many economists, free-market supporters, and landlords, counter that these policies — even in mild forms — create inefficiencies in the rental housing market and have adverse effects on the quantity and quality of rental housing.”

Research focuses on dollars and cents

Economists have tended to focus on the quantity, quality and cost of housing when they study rent regulation. From an academic perspective, it can be difficult to study in detail how tenants benefit by being able to stay in their neighborhoods for years.

These benefits could include relationships, professional, personal and educational, that develop over time and can promote upward economic mobility. Maybe a tenant in a rent-regulated unit can afford to live close enough to walk their kids to school, or have a short commute to work. Simply put, there are non-monetary benefits that come with housing stability.

Public financial data captures monthly rents, property sales and new construction that developers undertake (or don’t) in response to rent regulation. That data can’t quantify the value an individual or family gets from being in a neighborhood for a long time. Such data can be gathered through surveys or interviews with tenants, but qualitative studies can be costly and there are ethical considerations for researchers, such as ensuring confidentiality for subjects. In short, the data that is easily available on tenants and rental buildings is the data that gets studied.

“Economists tend to slight the importance tenants attach to security of tenure,” University of California, Riverside economics professor Richard Arnott wrote in 2003.  “A housing unit is a tenant’s home. Coming to know her neighbors and the local shops, she will develop at least some sense of community.”

A brief history of rent regulation in the U.S.

California, Maryland, New Jersey, New York and Oregon offer various forms of rent regulation at the state level, according to the nonprofit National Multifamily Housing Council. There are 25 states that prevent municipalities from enacting rent control.

Rent control emerged in the U.S. after the country entered World War II. “Putting the country on a war footing required massive relocation of labor, with consequent pressure on many local housing markets,” Arnott explains in a 1995 paper. “Controls were imposed to ensure affordable housing and to prevent profiteering.”

After the war came a homebuilding boom. By 1950, New York City was the only place that kept wartime rent controls, essentially freezing rent increases. Arnott refers to those measures as first-generation rent control. They form “the basis for the common opposition to rent control among economists,” according to Arnott.

Most modern versions of rent regulation emerged in the 1970s, including in Boston, Los Angeles, San Francisco and Washington, D.C. These second-generation rent regulations “commonly permit automatic percentage rent increases related to the rate of inflation,” Arnott writes.

They often allow landlords to apply for exemptions — for example, if they are having trouble with cash flow. The new St. Paul ordinance allows landlords to apply for exemptions for a variety of reasons, including property tax changes and unavoidable maintenance costs.

The third generation of rent control, which Arnott explores in the 2003 paper, is called tenancy rent control. This is where rent increases are controlled for a particular tenant, but the base rent can be adjusted for new tenants once the original tenant vacates.

Arnott argues in the 2003 paper that tenancy rent control can be a decent compromise between the need for tenants to achieve housing stability and landlords to make money and invest in building upkeep. For example, when a tenant vacates a unit, the landlord could raise the base rent above market rate to front-load profits, in anticipation of gaining below market rent in later years of the new tenant’s tenure.

In a recent non-peer-reviewed policy brief from the New York University Furman Center, Sophie House and her co-authors propose rent regulation measures should focus on preventing egregious rent hikes and include targeted subsidies, such as property tax credits for landlords.

Local building regulations and the design of specific rent regulation ordinances will vary. It’s important that journalists understand whether proposed or adopted rent control ordinances look more like first wave or third wave historical rent regulation. And it’s not just rent control that can affect housing supply — zoning laws on the books in certain jurisdictions can limit the supply of multifamily housing.

Here are a few takeaways from the papers featured in the research roundup below:

• Rent regulation helps tenants stay in their homes, but landlords and developers may respond in the long run by building more expensive housing not subject to rent regulation.
• Buildings covered by rent regulation may still be subject to investor takeovers aimed at displacing tenants from rent-regulated units.
• Strict rent controls can depress property values for rent-controlled and nearby market-rate buildings.
• But less restrictive rent regulation is not associated with lower rates of new housing construction or lower overall property values.

Read on for more.

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The Effects of Rent Control Expansion on Tenants, Landlords, and Inequality: Evidence from San Francisco. Rebecca Diamond, Tim McQuade and Franklin Qian. American Economic Review, September 2019.

The research focus: The authors explore whether a 1994 rent control expansion in San Francisco meant tenants were more likely to stay in their homes and in the city.

• Because rent control was linked to the year a building was built, the law produced a natural experiment, leaving “very similar buildings and tenants without rent control,” the authors write.

Key background: Buildings in San Francisco with five or more apartments became subject to rent control in 1979. New construction was exempt — so were owner-occupied buildings with four or fewer units. Over the years, investors would buy those smaller buildings, then sell a portion of building shares to someone living in the building or someone who would move in, making the buildings owner-occupied.

• “These small multi-family structures made up about 44% of the rental housing stock in 1990, making this a large exemption to the rent control law,” the authors write.

• For buildings built before 1980, the 1994 law removed this mom-and-pop loophole investors were exploiting.

The data: The authors use address history for San Franciscans from 1980 to 2016. This dataset from private firm Infutor includes subsequent addresses of people who left the city and moved somewhere else in the U.S. during those years. They parse renters from buyers using property records from private firm DataQuick, and they track large building investments with permit data from the city planning office. Lastly, they track condo conversions with parcel history data from the city assessor’s office. The authors split renters into two groups: those living in a small multifamily building built between 1900 and 1979 and those in a small multifamily building built between 1980 and 1990.

• The second group covers a much smaller timeframe, so it includes fewer renters. But, they span many neighborhoods across the city.

What the research says: Tenants in rent-controlled apartments stayed in their homes longer — they were 10% to 20% more likely to be at their 1994 address 10 years on. They were also less likely to leave San Francisco compared with tenants not living in rent-controlled apartments. Black, Hispanic and Asian tenants in rent-controlled apartments were all more likely to stay in the city relative to white tenants covered by rent control.

• “We find tenants covered by rent control do place a substantial value on the benefit, as revealed by their choice to remain in their apartments longer than those without rent control,” the authors write.

• But, because landlords and investors responded to the 1994 law with condo conversions and new construction, rent control “not only lowered the supply of rental housing in the city, but also shifted the city’s housing supply toward less affordable types of housing that likely cater to the tastes of higher income individuals,” the authors find.

New Dynamics of Rent Gap Formation in New York City Rent-Regulated Housing: Privatization, Financialization, and Uneven Development. Benjamin Teresa. Urban Geography, March 2019.

The research focus: Benjamin Teresa, an assistant professor of real estate and finance at Virginia Commonwealth University, takes a close look at how investors in 2005 bought the Riverton Houses, a rent-regulated, multifamily housing development in Harlem, New York, to try to profit from rent gaps.

• A rent gap is the difference between rent charged and rent that could be charged in the market if the building owner regularly invested in things like building upgrades and grounds maintenance — or, if the owner neglected the property.

• “Since 2001 professional investors connected to broader capital markets, such as private equity firms, have purchased tens of thousands of rent-regulated housing units, with some estimates placing investors’ market share at 10% of the total regulated rental housing stock and higher in some neighborhoods,” Teresa writes.

Key background: The New York City Council in 1994 loosened renter protections through something called vacancy decontrol. If rent on a stabilized unit reached $2,000 per month and the tenant moved out, the landlord could charge market rates thereon. Stabilization permitted landlords to impose only modest rent hikes. The threshold for vacancy decontrol bumped to about $2,700 per month in 2015. State law eliminated vacancy decontrol in 2019. Teresa explores one example of how investors profited from 25 years of vacancy decontrol.

The data: Teresa used public data on deed transfers, mortgage agreements and tax records for the Riverton Houses from 2005 to 2014, and the Commercial Mortgage Backed Security prospectus where investors projected the property’s income growth.

• Plus, Teresa interviewed 18 experts in affordable housing, including attorneys who represent tenants and staff members of housing development organizations. He also interviewed five real estate finance experts.

• Teresa focuses on the injection of speculative capital into the rent-stabilized market — less so on what happened to tenants in the Riverton Houses as a result of that speculation.

What the research says: The rent gap, and the potential for profit, was large for the Riverton Houses. Teresa calculates the average rent-stabilized unit would have taken about three decades to reach the deregulation threshold, where it could then be rented for market rates. The investors noted they would need to achieve market rates faster than that to make their debt payments. They didn’t meet their marks, “throwing Riverton into foreclosure and a series of new owners,” Teresa writes.

• The case of the Riverton Houses is ultimately a snapshot of the interplay between profit potential and inner city revitalization that occurred throughout the 1990s and 2000s across the U.S.

• The potential for high rents in low-rent buildings was “no longer limited to disinvested neighborhoods,” and “‘already gentrified’ neighborhoods may experience new cycles of investment because previous reinvestment waves have further increased potential rents,” Teresa finds.

A caveat: The paper explores one residential development in the nation’s most populous city. The findings are informative, but not necessarily generalizable to other developments in other cities.

• Still, “situating changing rent control law within the realm of privatization, and in this case more specifically the state’s role in expanding the scope for private extraction of urban land rent, connects this case with other examples of privatization that produce new income streams,” Teresa writes, specifically noting similar deregulation laws in San Francisco.

Forty Years of Rent Control: Reexamining New Jersey’s Moderate Local Policies after the Great Recession. Joshua Ambrosius, John Gilderbloom, William Steele, Wesley Meares and Dennis Keating. Cities, August 2015.

The research focus: There is no statewide rent control policy in New Jersey, but municipalities there can enact their own ordinances on rent regulation. The authors explore how 40 years of rent control in the state affect median rents, new construction and overall property values.

• “New Jersey, a national leader in tenants’ rights since the 1960s, is an excellent case study of the effects of moderate rent controls because so many (over 100) of its municipal governments have adopted these controls,” the authors write. “While not completely ideal, New Jersey is the best available laboratory for examining the impacts of rent control.”

Key background: Rent control ordinances in New Jersey cities arose during the 1970s. More recent rent control policies fall under the second wave of rent control, which tend to be less restrictive than the first wave. New Jersey has a variety of types of municipalities — cities, boroughs, towns and townships — but the authors refer to all of them as “cities” for short. Some cities tether allowable rent increases to cost of living calculations, while others allow a specific percentage increase within a range, most commonly between 3% and 4%.

The data: Focusing on 2010, the authors identified 87 cities without rent control and 74 cities with rent control, with an average population of 28,800. They use 2010 census data, the most recent available at the time, to parse differences between cities with and without rent control ordinances.

What the research says: Average monthly rents are $63 higher in non-rent control cities — $1,090 versus $1,027 in cities with rent control. Rent control cities have twice the population, on average, as non-rent control cities. From 2000 to 2010, the authors do not observe any major difference in new construction or changes in property values between rent control and non-rent control cities.

• “Rent control cities have, on average, 50% more rental units, 70% more Black residents, and nearly 25% lower median incomes,” the authors write, with rent control cities experiencing greater population growth and lower vacancy rates from 2000 to 2010.

• Median income, not the presence of rent control, is a stronger predictor of rents, rooms per unit and rent per room. The authors note that recent rent control ordinances in New Jersey often “lack the teeth of past approaches that created firm price ceilings.”

Housing Market Spillovers: Evidence from the End of Rent Control in Cambridge, Massachusetts. David Autor, Christopher Palmer and Parag Pathak. Journal of Political Economy, June 2014.

The research focus: The authors take advantage of a natural experiment occurring in the mid-1990s in Cambridge, Massachusetts, to assess how a strict rent control ordinance there for decades directly and indirectly affected rental prices. Roughly 100,000 people lived in the city at the time.

• “Distinct from the ‘direct’ effect of decontrol, which by definition operates only on formerly controlled properties, the indirect channel may affect the market value of both decontrolled and never-controlled properties by increasing the desirability of the neighborhoods in which they are located,” the authors write.

Key background: Certain rentals in Cambridge were subject to strict caps on rent increases from 1970 to 1994. The caps applied to rentals built before 1969 that were not owner-occupied. Rent-controlled units were often about 40% cheaper than non-rent controlled units, and controlled and non-controlled buildings stood side-by-side. A statewide popular vote in 1994 ended rent control by a 51%-to-49% margin, though 60% of Cambridge residents who voted wanted to keep the controls.

• Tenants in rent-controlled units tended to have less income than those in market rate units, “though a significant number of units were also occupied by wealthy professionals,” the authors write.

The data: The main data comes from city administrative records on the assessed value of every condo and house in 1994 and 2004, plus information on condo conversions and the prices of every residential property sale from 1988 to 2005. The authors also track demographic changes with a decade of data from the Cambridge city census.

What the research says: Rent-controlled buildings were about half as valuable as market rate properties. After rent decontrol, their values jumped 25% compared with non-rent controlled buildings during the period studied. Market rate buildings also appreciated in value.  

• Residential property in Cambridge appreciated $7.7 billion from 1994 to 2004. The authors attribute $2 billion of that value increase to rent decontrol. About half of the appreciation came from units that were never controlled. The value of market rate properties was suppressed by the strict rent control ordinance, they find.

• Landlords invested more in their properties after rent decontrol, with the total permitted building improvements jumping from $21 million per year from 1991 to 1994 to $45 million per year from 1995 to 2004.

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Small-town commercial districts are potential job creators for thousands of rural communities in the U.S.

New research in Economic Development Quarterly reveals how the nation’s most widely known downtown redevelopment effort, the nonprofit Main Street Program, affects economic outcomes.

The paper looks at two measures of economic vitality — job creation and new business formation — linked to 494 small-town Main Street programs introduced in Iowa, Michigan, Ohio and Wisconsin from 1997 to 2019. It finds no evidence the programs substantially affected those measures of economic success in communities in three of the states.

But in Iowa, the results were different. Participation led to 20 new downtown retail jobs per 1,000 residents, two new downtown businesses per 1,000 residents, and $650 more in taxable retail sales per resident on average for the five years after a Main Street program launched.

“These findings suggest that Main Street Program participation effects are not generalizable across states and that implementation and local context matter,” writes study author Andrew Van Leuven, a postdoctoral fellow at the University of Missouri. He points out that community goals vary and economic success can be defined in other ways — for example, by how a Main Street revitalization program affects home prices.

“The concept of economic vitality is ambiguous,” he says.

Van Leuven focused on Iowa, Michigan, Ohio and Wisconsin for the period studied because of data availability and because those states had consistent, statewide Main Street programs over those decades.

The communities studied had an average population of 6,325, with a low of 776 and a high of 36,837. For some towns, success might not be measured in jobs created or new businesses. A town might measure success by the number of historic buildings preserved, or whether the program leads to a safe, central space for community members to gather.

In related research under review at a separate academic journal, Van Leuven finds that in Ohio sale prices tend to be higher for houses farther from downtowns — except in towns that participate in the Main Street Program, where the relationship flips.

“In those towns, in the years after the program gets adopted, the houses closer to downtown increase in value,” Van Leuven says. “Again, that’s just another way to evaluate economic vitality.”

Iowa’s success story

The nonprofit National Trust for Historic Preservation launched the Main Street Program in 1977 as a pilot in Galesburg, Illinois; Madison, Indiana and Hot Springs, South Dakota. The program went national three years later. As Van Leuven writes, the program began as a response to widespread car ownership pushing commercial districts into low-density areas outside of towns and close to major roadways.

Towns that adopt the program make a long-term commitment to pursue strategies that enhance the economic vitality, design, promotion and organization of their pedestrian-friendly downtowns. The town’s first step is to hire a full-time director to manage its program, but community members also volunteer significant time and energy over the years, Van Leuven explains. State coordinators and the national program provide informational resources and technical expertise.

While most Main Street communities are small towns like Mount Vernon, Iowa and Millersburg, Ohio, big cities like Boston, Orlando, and Washington, D.C. also participate. There are roughly four dozen Main Street coordinating programs nationwide. Some coordinating programs operate as nonprofits while others are state funded. Some states, like Iowa, have highly engaged statewide coordination for their local Main Street efforts. Dubuque, Keokuk and several other communities there have participated since the early- and mid-1980s.

Longstanding institutional knowledge, plus a strong small-town culture, are two reasons the program has yielded new jobs and businesses, says Main Street Iowa state coordinator Michael Wagler.

“We have approximately 940 towns and three-quarters of those are under 5,000 in population,” Wagler says. “So we have a lot of communities that have a sense of self-sustainability. That really drives some of the local entrepreneurialism.”

Iowa has 55 active Main Street programs across the state, Wagler says. COVID-19, which in March 2020 shuttered retail shops, restaurants and other businesses that rely on personal transactions, also brought new challenges for Main Street programs. Wagler’s team held multiple monthly video calls with Iowa Main Street directors to discuss disbursing federal aid funds, how to interpret federal and state health guidance, and to act as a sounding board for the economic and emotional toll of the pandemic.

“We did a lot of listening,” he says. “I found out personally and professionally that just listening sometimes is all that someone needs. The other thing we really focused on, not only on my team but also within our network across the state, was working with local communities on steps they can take within their control and influence, knowing there was so much outside of our control.”

A big part of a Main Street director’s job is to cultivate relationships with business owners through face-to-face meetings. With those meetings sidelined, directors turned to video and phone calls with downtown building and business owners. Directors found they could make more connections over a few days than they had previously been able to make over weeks, Wagler says. While individual communities in Iowa suffered during the pandemic, overall “we saw a net gain of business in downtowns,” he adds.

Study methods

To conduct the study, Van Leuven focused on communities outside of metropolitan statistical areas — rural towns and villages likely to lie beyond the economic and cultural influence of a city. He explains in his paper, “The Impact of Main Street Revitalization on the Economic Vitality of Small-Town Business Districts,” that most of the programs are relatively small budget, compared with other economic development efforts, such as enterprise zones, which come with state or federal subsidies and tax credits.

Van Leuven used a difference-in-differences design, “an important tool to establish causality,” he says, to explore how Main Street programs affected economic growth. Difference-in-differences measure how the outcomes of two similar variables change when something happens to one of the variables.

Imagine a set of twins, Jan and Bob, competing to see who can take the most steps each week. Every Monday, they wake up refreshed from their weekend rest. Jan takes 10,000 steps while Bob takes 8,000 steps. After four weeks, a trend emerges: As the week wears on, the twins grow tired and they take 1,000 fewer steps per day. By Friday, Jan usually takes 6,000 steps while Bob takes 4,000 steps.

On the Sunday of the fifth week, Bob is frustrated that he keeps losing and gulps down an energy drink from a gas station. The drink promises to, “Give you a boost that’ll last.” Throughout the week he still feels more and more tired, but finds he is taking only 500 fewer steps per day. That Friday, he takes 6,000 steps, equaling Jan. Over the week, Bob has managed to close the gap a bit with his twin. The difference: He swigged an energy drink, Jan didn’t.

The Midwestern communities in Van Leuven’s study are like the twins. Those communities’ trends in job growth and business creation were roughly parallel at the start of the study period. At the end of the study period, the difference is that some of them adopted Main Street programs, others didn’t.

Van Leuven stresses his results should be interpreted with some nuance. It’s not that Main Street programs didn’t work in Michigan, Ohio and Wisconsin, but rather that towns in those states did not show major improvement for the two economic measures he tracked. He notes that apart from economic outcomes there are intangible social benefits a town can reap from a vibrant, walkable commercial center.

“It’s possible these new jobs downtown are coming from somewhere else within the town,” he says. “Downtown revitalization is not so much about growing the pie. It’s about redirecting economic vitality into the town center, which is traditionally a source of cultural identity.”

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The COVID-19 pandemic likely will accelerate “one of the most concerning and constant trends” in U.S. medicine — the formation of large hospital chains that also acquire local physician practices, write three health policy experts in a February 2021 Viewpoint article in JAMA, “Overcoming the Market Dominance of Hospitals.”

Hundreds of independent physician practices and smaller hospitals lost revenue due to the pandemic’s disruption of routine medical care. These financial hits are likely to feed a drive for mergers and acquisitions that already had raised the cost of medical care, without improving its quality, they write.

“Consolidation has been a predominant business strategy for hospitals and physicians in the United States for decades,” write authors Dr. Robert P. Kocher, an adjunct professor at Stanford University; Soleil Shah, an MD candidate at Stanford; and Dr. Amol S. Navathe, an assistant professor of medical ethics and health policy at the University of Pennsylvania. “Hospitals consolidate to gain market share and use resulting leverage to charge higher prices to private payers or employers large enough to self-insure.”

These consolidations tend to raise prices for private health insurance providers without necessarily improving quality of care, according to a wide body of research published in major peer-reviewed research journals, including the New England Journal of Medicine, The Quarterly Journal of Economics and JAMA. 

Meanwhile, the Federal Trade Commission (FTC) in January 2021 announced plans for a major study of the effects of physician group and healthcare facility consolidation between 2015 and 2020.

Hospital acquisitions have continued even amid the disruptions caused by the pandemic. The number of announced hospital transactions for 2020 was 79, surpassing the 74 reported for 2010, but marking a drop from 92 in 2019, according to a tally kept by Kaufman Hall, a merger consultancy based in Chicago. However, the average size of each transaction increased – with the seller size by revenue averaging more $800 million in the second quarter of 2020,  according to Kaufman Hall. Another consulting firm, Deloitte, reported in December that it expected hospital mergers and acquisitions to continue in much of the United States.

Another trend to watch is vertical consolidation, in which hospitals gain dominance in their regions by acquiring a number of physician groups or other smaller medical clinics.

There are potential benefits for patients from hospital mergers, write economists David M. Cutler and Robert S. Huckman of Harvard University and Sayeh Nikpay of the University of Minnesota in a May 2020 Viewpoint article in JAMA.

“The benefit of consolidation will be facilities that do not close and communities that maintain sources of care,” the authors write in their article, titled “The Business of Medicine in the Era of COVID-19.”

“But there are likely to be costs as well. Consolidation among hospitals and between hospitals and physicians significantly increases health care prices,” they continue. “This trend will further increase health care spending at a time when the lingering effects of the virus will already be raising private insurance premiums.”

Over the years, the American Hospital Association, a health care industry trade group, has publicly criticized published research that has reported unfavorable results for consumers from hospitals’ mergers and acquisitions.

In covering the issue of hospital consolidation, journalists would do well to understand the basis of competing claims coming from the AHA and the findings in published papers from economists and other scholars.

Get to know the MedPAC report

A 2020 report from the Medicare Payment Advisory Commission (MedPAC) can be a good resource for reporters new to this topic.

Like journalists, lawmakers often get conflicting views about issues from different parties. MedPAC serves as a kind of on-call research firm for Congress. Due to MedPAC’s expertise, members of Congress sometimes order the commission to weigh in on the arguments being made in disputes on health policy, even on matters beyond Medicare’s payment rates.

In August 2018, the House Energy and Commerce Committee tasked MedPAC with reviewing what was known about the effects of hospital consolidation on costs.  

“Through its public hearings, the committee has heard differing views from experts on the extent to which consolidation is a cost driver in the Medicare program and the degree to which payment policies of the Medicare program encourage such consolidation,” wrote then Energy and Commerce Chairman Greg Walden, an Oregon Republican, and colleagues, in a directive to MedPAC.

In response, MedPAC staff did a wide sweep of studies and reports on hospital consolidation.

MedPAC looked at the AHA’s commissioned research, which that hospital trade group released to the public and promoted. The AHA had paid the consulting group Charles River Associations to study consolidation. In September 2019, AHA released a report in which Charles River consultants concluded that the increased scale of operations resulting from hospital consolidation allowed for an estimated 2.3% reduction in annual operating expenses. They also said their analysis supported a claim of improved quality following mergers and suggested hospitals may pass along these savings to patients.

The MedPAC staff also examined more than two dozen articles published in economic and medical journals, including studies that had gone through peer review. (This means the journal asks other experts in the field to review the study before publication and offer comments and criticisms.) The MedPAC staff also examined papers produced by think tanks, testimony presented to Congress and work published by the National Bureau of Economic Research. The MedPAC staff looked as well at FTC’s reports. MedPAC’s extensive review included some of the works that the AHA had challenged in its press releases.

What did MedPAC conclude about the effect of hospital consolidation on prices?

“Taken together, the preponderance of evidence suggests that hospital consolidation leads to higher prices,” the MedPAC report states. “These findings imply that hospitals seek higher prices from insurers and will get them when they have greater bargaining power.”

Does consolidation lead to better or worse care for patients?

“Because the literature is mixed, we cannot make a definitive conclusion about the effect of mergers on the quality of care other than to say the effect is not large enough to result in consistent findings across studies,” according to the MedPAC report.

In this research roundup, we’ll introduce you to some of the papers cited in that MedPAC report. Getting acquainted with the published literature on hospital consolidation will help you cover this topic thoroughly.

“The academic research can be an important underpinning for these kinds of stories,” says Reed Abelson, a reporter at the New York Times who covers the business of health care.

Understanding these studies can help journalists press hospital officials who likely will present their proposed mergers and acquisitions as beneficial to patients, adds Dan Gorenstein, executive producer and host of the health care podcast Tradeoffs and a former health reporter for Marketplace.

Reading up on the research ahead of an interview may be especially helpful to local reporters who are newer to covering health care. It can be intimidating to confront officials of hospitals, which often are major employers in regions. They may have organized public relations staffers ready to promote their messages. But academic researchers and economists have largely drawn similar conclusions about the negative effects of hospital consolidation, he says.

“Journalists can take heart in that,” Gorenstein says. “They can familiarize themselves with the research and can use that to help them ask the tough questions that need to be asked.”

Research Roundup

The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured

Zack Cooper, Stuart V. Craig, Martin Gaynor and John Van Reenen. The Quarterly Journal of Economics, February 2019.    

Prices for common procedures were found to be 12% higher when performed at hospitals that so dominate a region that they can be classified as having a monopoly compared with hospitals in markets where four or more rival hospitals compete, conclude Zack Cooper of Yale University, Stuart V. Craig of the Wharton School, Martin Gaynor of Carnegie Mellon University and John Van Reenen, now of the Massachusetts Institute of Technology.

That’s one of the key takeaways from their research, published in an earlier form in 2015 as a National Bureau of Economics Research (NBER) working paper with the same title. (Note: this research received financial support from the National Institute for Health Care Management Foundation, which also supports The Journalist’s Resource.)

To study how hospital consolidation affected prices, the authors worked with data from the independent nonprofit Health Care Cost Institute (HCCI). Three of the nation’s largest insurance companies – Aetna, Humana and UnitedHealth – had provided claims information. This pool of data represented services delivered between 2007 to 2011.

The dataset used by the authors represented the largest national sample of private medical insurance claims ever analyzed by academics. As Margot Sanger-Katz and Kevin Quealy note in a 2015 New York Times article about this research, “there is no national database of all insurance claims, which would give us a complete and perfect picture of how health care dollars are spent.”

In their work, the authors of “The Price Ain’t Right?” also look in depth at prices for seven common procedures: hip replacements, knee replacements, cesarean sections, vaginal births, diagnostic colonoscopies, certain MRIs of lower-limb joints and coronary angioplasties, which are procedures done to improve blood flow in clogged arteries. In examining 366 hospital mergers and acquisitions that occurred between 2007 and 2011, they find prices increased by more than 6% when the merging hospitals were geographically close, but not when they were distant.

Hospitals with a monopoly on services had more cases involving set prices set as a share of their charges, the authors conclude. Hospitals in more competitive markets seemed more likely to enter into what are called prospective agreements with insurers, with set prices for services, often using Medicare prices as a reference point.

Note: The authors acknowledge limitations in their work, most notably a lack of data from Blue Cross Blue Shield plans. That’s a point raised as well by the American Hospital Association in the press releases it has posted criticizing the work of Cooper and colleagues, such as this one, “The Price Ain’t Right” Ain’t Right Again!”

Cooper and colleagues addressed some of the issues AHA raised in their own 2019 webinar, which coincided with the hospital lobbying group’s release of the Charles River Associates report.

In this webinar, Cooper and other economists walked through the results reported in their papers and their methods for examining the potential costs to consumers of hospital consolidation and their results. This webinar makes a nice introduction for those less acquainted with this topic.  More detailed information on this study, including data visualizations, is available at www.healthcarepricingproject.org.

Changes in Quality of Care after Hospital Mergers and Acquisitions

Nancy D Beaulieu, Leemore S Dafny, Bruce E Landon, Jesse B Dalton, Ifedayo Kuye and J. Michael McWilliams. New England Journal of Medicine, January 2020.

Hospital mergers and acquisitions were associated in this study with a modest deterioration in patient experiences, as well as small and nonsignificant changes in readmission and mortality rates, the authors write in this comparative study by Nancy D. Beaulieu, Leemore S. Dafny, Bruce E Landon, Jesse B Dalton, Ifedayo Kuye, and J. Michael McWilliams, all affiliated with Harvard University at the time of publication.

Previous research showed hospital mergers led to higher prices paid by people with commercial insurance, but less was known about the effects on quality of care. To study how mergers and acquisitions affect quality, the authors devised a study comparing results on quality measures for hospitals that were part of consolidations against those for hospitals that had not.

The authors sought to do what is called a difference-in-differences analysis, a before-and-after natural experiment of sorts that allows researchers to study how an event that that’s already happened may have affected outcomes.

In trying to isolate whether hospital consolidation made a difference in the quality of medical care, the authors made their own version of active and control groups for the difference-in-difference analysis. They identified a pool of 246 hospitals that had been acquired in 198 transactions, and then another 1,986 hospitals to use as controls. They then looked at Medicare claims and data from the Centers for Medicare and Medicaid Services’ Hospital Compare site to check reported performance on four measures of quality of care. These included the rate of readmission after discharge and mortality as well as two composite measurements. One checked on what are called clinical-process measures, meaning it tracked how often doctors and nurses carried out expected tasks for patients such as making sure people were given the right antibiotic for pneumonia. The other composite measure was based on patients’ evaluation of their stays.

There was no significant differential change in 30-day readmission rates or in 30-day mortality between the two groups, the authors report. The researchers also find that a hospital’s having been acquired is associated with a modest differential decline in performance on the patient-experience measure.

Acquired hospitals had a significant differential improvement in performance on the clinical-process measure, meaning that doctors and nurses took expected steps in handling cases, but this could not be attributed conclusively to a change in ownership because differential improvement occurred before acquisition, the authors write.

Note: Melanie Evans of the Wall Street Journal wrote about this study in this January 2020 article,  Hospitals Merged. Quality Didn’t Improve.

Medicare Spending after 3 Years of the Medicare Shared Savings Program    

J Michael McWilliams, Laura A Hatfield, Bruce E Landon, Pasha Hamed and Michael E Chernew. New England Journal of Medicine, Sept. 20, 2018.

This study finds independent physician groups achieved greater savings when participating in a Medicare test program than did large health systems, which saw no improvement, on average, during the study period. This research challenged the prevailing assumption that large-scale consolidation would result in more efficient treatment of patients, thus reducing waste in health spending.

 McWilliams worked with Harvard University colleagues Laura Hatfield, Bruce Landon, Pasha Hamed and Michael E. Chernew to examine spending for patients whose doctors participated in the Medicare Shared Savings Program, an initiative meant to better coordinate medical treatments and thus potentially save money for the government and for older Americans.

As part of this research, the researchers looked at the results for two kinds of accountable care organizations (ACOs). These are physician groups and health systems that have agreed to work with Medicare on ways to try to reduce unnecessary spending by making treatment more efficient. McWilliams and colleagues looked at results achieved for ACOs that had entered the program in three different years, 2012, 2013 and 2014.

The effect of hospital acquisitions of physician practices on prices and spending    

Cory Capps, David Dranove and Christopher Ody. Journal of Health Economics, May 2018.

Hospitals’ acquisitions of physician practices led to an average price increase of 14.1% for services of doctors who shifted from independent practices to work for these organizations, write Cory Capps, a former staff economist at the DOJ’s antitrust division who now works at the consulting firm Bates White; and David Dranove and Christopher Ody, both of the Kellogg School of Management at Northwestern University.

The three researchers find variation among specialties, with prices for primary care physicians rising by 15%, for example, and those for care by cardiologists rising by 33.5%.

The authors drew these conclusions from an analysis of medical claims data from 2007 to 2013 from a data provider whose identity they agreed to withhold. In their paper, the authors explain the data came from claims made in states that represent more than 12% of the U.S. population. The average resident in these states was slightly older than the average American and had a slightly lower average household income, but the sample was otherwise demographically similar to the nation overall.

To track vertical integration in the hospital sector, the authors look at tax identification numbers in the claims data and what was then known as the SK&A database of physicians. (SK&A since has been acquired by the consulting firm IQVIA.)

The researchers did difference-in-differences analyses to see how the acquisition of physician practices affected prices. They compared pricing for patients seen at the hospital-acquired groups with pricing for patients of physician practices that had not been acquired.

They conclude that vertical integration of physician practices into hospitals was the most likely explanation for the 14.1% price increase reported in the paper.

One of the drivers of vertical integration, in this case the acquisition of physician practices by hospitals, are Medicare’s payment policies. The giant federal health program in some cases pays more for the same service if it is provided by a doctor affiliated with a hospital. Commercial insurers then look to these Medicare prices in setting rates.

“Thus, when a hospital acquires a physician practice, this can automatically trigger higher prices for the same procedure performed by the same physician at the same location. In the long run, private insurers may renegotiate these rates,” the authors write.

In their paper, the authors note that Congress acted in the Bipartisan Budget Act of 2015 to remove one incentive for new acquisitions of physician practices. Payments for certain hospital outpatient departments would not be made at rates higher than what Medicare paid independent physicians.

Note: In 2019, Capps presented a summary of this research paper to the Senate Judiciary Committee. Titled Your Doctor/Pharmacist/Insurer Will See You Now: Competitive Implications of Vertical Consolidation in the Healthcare Industry, this hearing also provides a good overview of this topic. There’s a recorded webcast on that Senate Judiciary webpage.

Physician Practice Consolidation Driven by Small Acquisitions, So Antitrust Agencies Have Few Tools to Intervene    

Cory Capps, David Dranove and Christopher Ody. Health Affairs, September 2017.

This paper presents research showing a pattern of growth of large physician groups through transactions individually too small to draw scrutiny by the Department of Justice or FTC. For 2016, for example, the size-of-transaction threshold for reporting proposed mergers and acquisitions subject to antitrust enforcement was set at $78.2 million.

The authors describe this pattern of growth as “whale eats krill,” as opposed to the larger “shark eats shark” transactions that do trigger federal inquiries.

In their research, the authors used insurance claims from a data provider, whose identity Health Affairs allowed the authors to keep hidden due to a previous confidentiality agreement. The claims studied were made between 2007 and 2013 in several states and collectively contained information pertaining to 12% of the US population. The authors restricted their analysis of market concentration to nine large specialties: primary care, surgery, diagnostic radiology, obstetrics/gynecology, pediatrics, dermatology, gastroenterology, cardiology, and otolaryngology. These nine specialties accounted for roughly 75% of physician output in the claim database.

They also looked only at claims from people living in what are called Metropolitan Statistical Areas (MSAs), which federal officials have defined for many years as urban regions with populations of at least 50,000. In their work, the authors also used a commonly accepted measure of market concentration, known as the Herfindahl-Hirschman Index (HHI).

The average size of the largest practices studied, those with more than 101 physicians, rose from an average of 261.37 physicians in 2007 to 345.56 by 2013, a gain of about 84 physicians. On average, of those 84 additional physicians, roughly one-seventh came from acquisitions of practices with 11 or more physicians, while one-half came from acquisitions of small practices with 10 or fewer physicians and about one-third came from other channels such as direct hires.

In other words, the authors find that the substantial majority—about 85%—of the growth of these largest groups came from acquisitions of small practices with 10 or fewer physicians and direct hiring. Small acquisitions and hiring, which they describe as “whales eating krill,” were unlikely to draw antitrust scrutiny, raising the prospect of continuing consolidation without antitrust review, they report.

At this time, federal officials don’t have the resources to address piecemeal consolidation of physician practices, which can result in higher costs of medical care, according to the authors. They suggested that policymakers consider several steps for “to slow the formation of powerful physician groups in highly concentrated markets.” The agencies could lower a benchmark, known as the Hart-Scott-Rodino threshold, for cases where the FTC and DOJ would look at physician practice acquisitions. State officials also could play a larger role, the authors write.

Additional research and resources:

Consolidation by Any Other Name: The Emergence of Clinically Integrated Networks    

M. Susan Ridgely, Justin W. Timbie, Laura J. Wolf, Erin Lindsey Duffy, Christine Buttorff, Ashlyn Tom and Mary E. Vaiana. Rand Corp. paper, 2020.

Ridgely and colleagues dive into the issues surrounding the emergency of clinically integrated networks (CINs), in which different medical services are bundled into organizations such a group of independent physicians who contract to jointly provide care and share profits. “There is no standardization of how CINs are structured or function, and there is only theory, but no evidence, of a positive effect on quality,” Ridgely and colleagues write. “CINs bear watching because their effects on price and quality are potentially as important as the effects of mergers and acquisitions.”

The Risks to Patient Safety From Health System Expansions

Susan Haas, Atul Gawande and Mark E. Reynolds. JAMA, May 2018.

Haas, a principal investigator of Ariadne Labs’ Project on System Expansion Risks to Patient Safety, and her colleagues examine the challenges for doctors and nurses as health systems merge. These include needing to get up to speed on new electronic health record systems, sometimes without enough planning having been done to aid them in this adaption. Hospital mergers can force doctors to quickly adapt to work in new practice sites, the authors write.

“When clinicians travel, they often receive little systematic orientation to their new setting, leaving them to practice with infrastructure, processes, teams, and a clinical culture that can vary in significant and unexpected ways from those at their home institutions,” Haas and her colleagues write in this Viewpoint article. “In the absence of guidance, physicians indicated that they have adapted to these new circumstances through trial and error, which can put patients at risk.”

Ariadne Labs is a joint center for health systems innovation at Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health.

Making health care markets work: Competition policy for health care    

Martin Gaynor, Farzad Mostashari and Paul B. Ginsburg. Brookings Institution, April 13, 2017.

This report offers an overview of the concerns about consolidation in health care and includes suggestions for increasing and maintaining competition, including making it easier for doctors to stick with independent practices. JAMA also published a summary of this report as a Viewpoint article with the same title in 2017.

The authors are Gaynor, a professor at Carnegie Mellon University and a former director of the FTC’s Bureau of Economics; Mostashari, who served as national coordinator for health information technology in the Obama administration and then founded a start-up, Aledade, aimed at helping primary care doctors make their independent practices more efficient and competitive; and Ginsburg, who was founding executive director of the predecessor to the Medicare Payment Advisory Commission (MedPAC) and its current vice chairman.

Health Care Costs Institute’s Healthy Marketplace Index and Hospital Concentration Index    

The nonprofit Health Care Costs Institute (HCCI) posts on its website detailed analyses of local medical costs and markets. HCCI’s Hospital Concentration Index offers a granular look at regions, while providing important context about variation seen in the United States in terms of hospital competition.

The Healthy Marketplace Index provides a broader look at how spending compares in different parts of the United States. In a 2017 article in Health Affairs, Understanding Health Spending: Lessons From The Healthy Marketplace Index, the staff of HCCI explain the kinds of comparisons that can be done with this online tool.

For more on covering this topic, see “Covering hospital mergers and acquisitions of physician practices: 3 tips from experienced health care journalists.”

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During the tough-on-crime 1990s, a California juvenile justice law introduced in the name of fiscal responsibility led to an immediate, drastic drop in youth criminal court commitments to state-run juvenile facilities, new research finds.

The legislation from state Sen. Rob Hurtt, a Republican, took effect in August 1996 and shifted huge chunks of the cost of incarcerating youths adjudicated of minor offenses from the state to counties. The bill was meant to shrink the cost of incarcerating youth — $31,000 a year on average to hold someone under 18, according to news reports at the time.

“The idea was, ‘You have to take care of your own kids and the state should not be paying for things that we think you can deal with,’” says University of Pennsylvania economist and criminologist Aurélie Ouss, who wrote the paper, “Misaligned Incentives and the Scale of Incarceration in the United States,” published in November 2020 in the Journal of Public Economics.

California counties hardly had any financial ties to state juvenile facilities before the 1996 law. Counties paid a flat rate — $25 per month for each of their youths held in a state juvenile facility. Their share covered about 1% of the monthly cost.

Under Hurtt’s law, that base fee bumped to $150, almost 6% of the monthly cost. The state would cover the remaining cost of holding youths who committed the most violent crimes, like murder or armed robbery.

But for youths adjudicated of less severe offenses and sent to state facilities, counties had to pick up more or all of the tab. Incarceration is often called commitment in the juvenile system, and adjudication is akin to an adult conviction, according to the nonprofit National Juvenile Defender Center.

By Ouss’ calculations, counties owed $1,300 per month for their youths adjudicated of serious but lesser offenses, like burglary. They owed $1,950 per month for their youths committed to state facilities adjudicated of yet lesser offenses, like car theft.

For youths sent to a state facility after being adjudicated of the least severe offenses, like parole violation and misdemeanors, counties had to pay the full monthly cost: $2,600.

A ‘jaw dropping’ decline

In the 1990s, youths committed to state-run facilities in California most often were adjudicated in juvenile court, though some juvenile cases were heard in adult criminal courts. The language in the Hurtt law specifically refers to juvenile court commitments to state facilities.

Accurate, historical, county-level data on juvenile court commitments to state facilities are hard to come by — Ouss instead analyzed figures on youths committed to state facilities from criminal courts, with data from the National Corrections Reporting Program. Other researchers note that some states inconsistently report data to the program, but have not found inconsistencies in California’s data during the period Ouss studied.

After the Hurtt law went into effect in August 1996, Ouss documents a sudden decline of roughly 40% in monthly criminal court commitments to state juvenile facilities. The effect was long-lasting. There were, on average, 94 monthly criminal court commitments to California facilities across the six years prior to the reform. For the four years after, average monthly commitments fell to about 57.

“When you see a massive drop in the incarceration of juveniles from the day before to the day after the law passed, it’s just so much bigger in magnitude than most of the policy interventions that we study,” says Megan Stevenson, an associate professor of law at the University of Virginia, who provided Ouss feedback on the paper. “It’s jaw dropping.”

Yearly data on first-time state juvenile facility intakes offer a broader view, similarly showing a drop-off from 1996 to 1997. The number of youths sent to state juvenile facilities each year from 1994 to 1996 hovered between roughly 3,600 and 3,800. In 1997, that total dropped to about 2,200, with similar totals for the rest of the decade.

Ouss documents a small and slow increase in youths entering adult facilities following the reform, though not nearly enough to offset the overall drop in youths committed to state juvenile facilities. She suggests probation officers likely played a key role in dismissing cases or diverting youths away from juvenile facilities and into counseling or other services. For two large California counties — Orange and Santa Clara — Ouss finds no major change in the fraction of youths sent to county facilities and a spike in the fraction of juvenile cases dismissed or diverted.

Probation departments are different in the juvenile justice system than the adult justice system. In juvenile justice, probation officers are there to guide youths and their families through the system. Part of their job is to determine whether a case should proceed to a court hearing and recommend dispositions — the equivalent of sentences in the adult system — after adjudication. County probation departments would have known about the new sliding scale for cost sharing and accounted for it in “figuring out the right recommendations to make,” Ouss says.

County district attorneys and judges also held heavy influence on whether juvenile cases ended up in adult courts and whether youths were sent to state facilities, and the relationship between their budgets and county budgets was “more of a thin dotted line than a direct line,” says Josh Gauger, a lobbyist with the California State Association of Counties who focuses on criminal justice and public safety legislation. “There’s no impact to a district attorney’s budget as to whether someone goes to a state or local facility.”

Decades of corrections

The 1996 reform heralded major changes to California’s juvenile justice system. New policies over the ensuing decades slashed the number of youths in state facilities.

In the mid-1990s, California housed about 10,000 youths in state juvenile institutions. By the end of 2019, that number was down to roughly 750. The nonprofit Human Rights for Kids considers the state’s juvenile justice system the most humane in the nation.

California is now one of two states, along with Massachusetts, that set age 12 as the minimum for prosecution in juvenile court. Most states don’t set a minimum age. Californians between age 18 and 23 may still end up in juvenile court if their alleged offense happened before they turned 18.

Darby Kernan, executive director of legislative services at the California State Association of Counties, says spending concerns and media coverage helped drive California lawmakers to try to lower the juvenile incarceration rate.

“There were some really bad news stories about kids being sent out of state and dying within the juvenile system,” Kernan says. “That was one of the factors. And the cost — the cost of holding a juvenile — it was very expensive. Those two factors played a role in trying to figure out how to realign the system.”

The tough-on-crime mindset persisted for a time in the public consciousness, however. In 2000, California voters passed a proposition making it easier for district attorneys to charge youths accused of violent offenses as adults.

That same year, the state’s Crime Prevention Act of 2000 provided stable funding for counties to build out local juvenile justice programs, reserving state facilities for youths adjudicated of serious offenses. The state requires that local programs follow proven strategies for reducing juvenile delinquency to qualify for funding. That could include incarceration, but also a continuum of efforts that don’t involve punishment, such as school and community programs aimed at supporting at-risk children and preventing juvenile offenses in the first place.

Then-Gov. Arnold Schwarzenegger signed legislation in 2007 authorizing more state funding to enhance county probation department supervision and rehabilitative services for youths. Those moves represented “significant investments in the success of county probation departments to serve these youths locally,” Gauger says.

At the same time that legislation was passed, a decades-long class action lawsuit originally filed by California taxpayer Margaret Farrell, whose juvenile nephew was in state custody, was playing out to major effect.

Farrell in 2003 alleged the California Youth Authority, which ran the state’s juvenile facilities, was failing to provide required youth treatment and rehabilitation. In 2005, the youth authority became the Division of Juvenile Justice, and the long-running litigation over time became known as the Farrell Lawsuit.

Following years of reforms, Alameda County Superior Court terminated the suit in 2016. It essentially determined the state had corrected the wrongs Farrell alleged.

“So many significant changes were made with Farrell, but I think the key would be the culture shift,” said then-Division of Juvenile Justice Director Mike Minor, in a statement. “We became an organization that’s built on evidence-based treatment programs that help youth build skills to be successful upon release.”

As of 2019, youths under age 16 in California can’t be tried as adults, though ongoing litigation could reverse that law. The policy changes in California paralleled emerging research on how the adolescent brain develops, much of which suggests harsh carceral punishments are inappropriate for youthful offenders. A variety of social and neurological factors come into play, but, in short, regions of the brain that govern decision-making are still maturing at age 18.

As retired Supreme Court Justice Anthony Kennedy wrote for the majority in a landmark 2010 case, “developments in psychology and brain science continue to show fundamental differences between juvenile and adult minds. For example, parts of the brain involved in behavior control continue to mature through late adolescence.”

The majority ruling in that case, Graham v. Florida, barred life imprisonment without parole for offenders under age 18, except those convicted of homicide offenses. Previously, in 2005, the Supreme Court barred capital punishment for juvenile offenders. And in 2012, in Miller v. Alabama, the court barred life imprisonment without parole for almost all juvenile offenders, even those convicted of murder.

Today, most juvenile cases in California are handled at the county level and judges won’t be able to commit youths to state-run facilities at all come July. Advocates have lauded the eventual shuttering of the remaining state juvenile facilities, but stress safeguards are still needed to protect boys of color, who are disproportionately held in California’s juvenile facilities.

Checks and imbalances

While California has shown success in reducing youth incarceration, other states haven’t. Nearly 40,000 youths were held in correctional facilities in the U.S. on October 24, 2018, the date of the most recent count from the Department of Justice’s Office of Juvenile Justice and Delinquency Prevention. That figure has trended down in recent decades, but the U.S. still incarcerates more youth than any other country, according to the American Civil Liberties Union.

According to Human Rights for Kids’ 2020 State Ratings Report, six states are “likely in violation of international human rights standards.”

Those states are Alabama, Georgia, Maryland, Mississippi, Tennessee and Wyoming.

Georgia, for one, has made some strides in recent years by reducing mandatory minimum confinements, barring juvenile incarceration for certain low-level offenses and routing $30 million toward community-based alternatives to incarceration. California, Rhode Island and West Virginia are the only states where youths cannot be held in adult facilities, according to the report.

Two decades of reform in California show states can give kids who commit crimes a second chance. Incarcerated kids are less likely to graduate high school and more likely to be locked up as adults, according to research from 2015 in the Quarterly Journal of Economics, which puts the yearly cost of youth corrections in the U.S. in the billions. Ouss’ new paper adds a dash of economic psychology to the mix.

“If you have misaligned incentives where the people making decisions to incarcerate are very much removed from those managing budgets and costs, you’re going to get excessively overzealous incarceration,” says Stevenson, the University of Virginia law professor. “That’s true in the adult system as well.”

Or, as Ouss puts it: “Who pays matters.”

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In 2019, Journalist’s Resource tackled some major policy proposals from the Democratic presidential candidates by exploring recent and foundational academic research on those topics. One of them: Raising the federal minimum wage to $15. As a candidate, Joe Biden was among a dozen contenders who backed raising the federal minimum wage to $15 an hour. In one of his first acts as president, Biden followed through, including a $15 federal hourly wage hike by 2025 in his $1.9 trillion COVID-19 relief package that members of Congress are now debating. Because the topic looms large for local and national journalists alike, we have updated and adapted this article from our November 2019 original.

An ongoing subject of debate among some labor economists is how raising the federal minimum wage would affect employment. Research shows raising the federal minimum wage to $15 an hour would increase earnings for millions of low-wage workers. A higher minimum wage would also have some effect on employment, according to the 17 academic studies and other research surveyed below. Most analyses have found overall small employment effects, but Congressional Budget Office analyses suggest the potential for, though not the certainty of, relatively large job losses.

A February 2021 CBO analysis of the proposed $15 wage hike suggests it could lead to 1.4 million fewer jobs and an increase to the budget deficit of $54 billion from 2021 to 2031. In 2018, the CBO estimated a $1.9 trillion budget hit over 10 years from the 2017 federal tax cuts. A recent policy brief from University of California, Berkeley economist Michael Reich, by contrast, estimates that raising the federal minimum wage to $15 an hour would add $65 billion to government coffers, from increased tax revenue and reduced federal safety net expenses. The CBO analysis estimates a one-third chance of zero to 1 million jobs lost and one-third chance that 1 and 2.7 million jobs could be lost, while the number of people in poverty would fall by 900,000.

While those earning the current federal minimum of $7.25 would more than double their wages with a $15 federal minimum, there would likewise be some degree of job loss at this lower end of the wage spectrum. Some research suggests job losses would hit teenagers hardest, and not all economists are convinced that raising the minimum wage is the best way to help the working poor.

A 2018 analysis from the Bureau of Labor Statistics found about 8% of teenagers aged 16 to 19 earned the federal minimum or less, with 1% percent of workers aged 25 and up earning the federal minimum. The analysis, based on hourly wages workers reported, doesn’t include overtime, tips or commissions. Roughly 29 million people of all ages, representing a quarter of the full-time, year-round workforce, had annual earnings in 2018 equal to less than $15 an hour, according to the Current Population Survey Annual Social and Economic Supplement from the U.S. Census Bureau.

The federal floor hasn’t budged from $7.25 an hour in more than a decade, but states and cities can set their own minimum wage. Many states around the country have already raised their minimums above the federal level. New York’s minimum wage, for example, stands at $12.50 an hour for most jobs outside New York City, where the minimum is $15 an hour for businesses with more than 11 employees. Washington has one of the highest cash wage minimums for tipped workers at $13.69 an hour.

The University of California, Berkeley Labor Center maintains a database of municipalities with minimum wage ordinances. Emeryville, California, a small town north of Oakland that’s home to the animation studio Pixar, has among the highest minimum wages in the country at $16.84 per hour. The federal minimum is the floor for many states in the south. Louisiana and South Carolina have the highest percentage of workers making at or below the federal hourly minimum, according to BLS.

The federal minimum wage: Formative findings

Academic studies that explore minimum wage changes tend to look at how those changes affect employment levels. There are hundreds of studies on this. Many look at how raising the minimum wage would affect teen employment, since teenagers tend to work in low-wage jobs likely to be affected by minimum wages.

One of the most famous minimum wage studies first appeared as an October 1993 National Bureau of Economic Research working paper from Princeton University economists David Card and the late Alan Krueger. (It was published as a peer-reviewed paper in 1994 in the American Economic Review.) This paper compared employment effects in New Jersey and Pennsylvania after New Jersey raised its minimum wage in 1992 while Pennsylvania’s held steady. Low-wage fast food jobs grew 13% more in New Jersey than in Pennsylvania, they found. Prices also went up at the New Jersey-based fast food establishments, “suggesting that much of the burden of the minimum wage rise was passed on to consumers,” according to the paper.

Before Card and Krueger, common economic knowledge assumed raising the minimum wage would lower employment. But the strength of that relationship has been and remains a subject of great debate. A survey of economic research in the Journal of Economic Literature, published in 1982, found many studies concluded that each 10% increase in the federal minimum wage lowers teenage employment by about 1%. Toward the end of the 1980s — a decade in which the federal minimum wage plateaued at $3.35 — one of the authors of that 1982 paper, Charles Brown, was a bit less convinced. He wrote in the Journal of Economic Perspectives in 1988 that “the effects of the minimum wage on employment are smaller than I would have supposed.”

Recent research

One comprehensive recent meta-analysis of research on federal, state and local minimum wage changes comes from Paul Wolfson at Dartmouth College and Dale Belman at Michigan State University.

Wolfson and Belman looked at 15 years of research since 2000 in a paper published July 2019 in Labour. Across 37 studies and 739 estimates of how minimum wage affects employment, they found “the minimum wage has negative employment effects, but these have become notably smaller and are largely localized to teenagers.” They speculate that the smaller employment downturns from higher minimum wages might be because teenagers don’t work as much as they used to.

Another recent analysis in the Quarterly Journal of Economics examined 138 state minimum wage increases from 1979 to 2016 and found “the overall number of low-wage jobs remained essentially unchanged over the five years following the increase.” A 2015 study in the Journal of Human Resources doesn’t point to a sudden drop in employment following state-level minimum wage increases from 1975 to 2012, but rather suggests slower job growth over ensuing years following minimum wage hikes.

Research from New York Federal Reserve economists from September 2019 echoes Card and Kreuger’s original work. That research compared retail and hospitality jobs, like fast-food service, in 19 counties along the New York-Pennsylvania border. New York began raising its minimum wage in 2014, while Pennsylvania’s has remained at the federal floor. Non-tipped fast food workers in New York were making $12.75 an hour by the end of 2018 and will make $13.75 by the end of this year — compared with the $7.25 an hour fast food workers in Pennsylvania make. Hospitality job earnings have risen in the New York counties compared with Pennsylvania, with no change in employment. Employment in the retail sector shrunk at a similar rate in both states, despite rising wages in New York.

In a comprehensive study from July 2019, the Congressional Budget Office estimated that raising the federal minimum wage by a smaller amount would have few employment effects, but would also raise wages for far fewer workers. A $10 federal minimum wage would raise wages for 1.5 million workers with “little effect on employment in an average week in 2025,” according to the study. The $15-per-hour option would increase wages for 17 million workers, but the CBO is less certain about the job effects. Their median estimate is that 1.3 million workers would lose their jobs — a less than 1 percent decrease in employed workers, according to the report. The range of job loss from the $15-per-hour option is quite large, from none to millions. The CBO estimates “a two-thirds chance that the change in employment would be between about zero and a decrease of 3.7 million workers.”

The CBO offers an interactive calculator — based on its analysis — that shows how different levels of minimum wage increases might affect jobs.

A federal minimum wage increase to $12 could lift 6.6 million people out of poverty, reducing the poverty rate by 2.45 percentage points, according to a 2017 Institute of Labor Economics discussion paper by University of Massachusetts Amherst economist Arindrajit Dube. Price hikes would be small compared with financial gains for those earning the least, Dube found.

Not all economists are convinced raising the minimum wage is the best way to help the working poor. San Diego State economist Joseph Sabia and Cornell University economist Richard Burkhauser have found that state and federal minimum wage increases from 2003 to 2007 didn’t affect state poverty rates, and that the working poor were hit hardest by job losses.

Further reading

Minimum Wages and Racial Inequality
Ellora Derenoncourt and Claire Montialoux. The Quarterly Journal of Economics, February 2021.

The gist: “The 1967 extension of the minimum wage can explain more than 20% of the reduction in the racial earnings and income gap during the civil rights era. Our findings shed new light on the dynamics of labor market inequality in the United States and suggest that minimum wage policy can play a critical role in reducing racial economic disparities.”

Minimum Wage Employment Effects and Labor Market Concentration
José Azar, Emiliano Huet-Vaughn, Ioana Marinescu, Bledi Taska and Till von Wachter. NBER working paper, July 2019.

The gist: “While increases in the minimum wage are found to significantly decrease employment of workers in low concentration markets, minimum wage-induced employment changes become less negative as labor concentration increases, and are even estimated to be positive in the most highly concentrated markets.”

Minimum Wage Increase and Firm Productivity: Evidence from the Restaurant Industry
Hong Soon Kim, SooCheong Jang. Tourism Management, April 2019.

The gist: “The results revealed that increasing the federal minimum wage immediately enhances restaurant productivity for up to two years.”

The Econometrics and Economics of the Employment Effects of Minimum Wages: Getting from Known Unknowns to Known Knowns
David Neumark. NBER working paper, revised November 2018.

The gist: “There is a great deal of uncertainty about the employment effects of a $15 minimum wage.  One thing we do know is that it would impact far more workers than the current minimum wage, especially in lower-wage states and lower-wage areas of most states.”

People versus Machines: The Impact of Minimum Wages on Automatable Jobs
Grace Lordon and David Neumark. NBER working paper, revised January 2018.

The gist: “The findings imply that groups often ignored in the minimum wage literature are in fact quite vulnerable to employment changes and job loss because of automation following a minimum wage increase.”

Minimum Wage Shocks, Employment Flows, and Labor Market Frictions
Arindrajit Dube, T. William Lester and Michael Reich. Journal of Labor Economics, July 2016.

The gist: “Minimum wage increases over the past decade appear to have substantially reduced turnover and increased job stability, with small effects on overall employment levels for highly affected groups, such as teens.”

Updated February 9, 2021, with figures from a new Congressional Budget Office analysis.

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As the 2020 general election quickly approaches, voters across America are poised to cast an unprecedented number of mail ballots to avoid voting in person and risking contracting COVID-19.

In a normal year, most U.S. voters cast their ballots at polling places on Election Day or during early voting. Some vote by mail for various reasons, including being disabled or temporarily located in another state or serving overseas in the military. For the 2018 general election, about one-fourth of voters submitted mail ballots, according to a report the U.S Election Assistance Commission, an independent, bipartisan commission established by the federal Help America Vote Act of 2002, released in 2019.

“By-mail voting (often called absentee voting) allows individuals to receive their ballot in the mail before the election and mark their ballot away from the election office,” the report explains. “The marked ballot can be returned by mail to an election office or, in some states, dropped off at physical polling sites or designated drop-off boxes.”

Some 30.4 million Americans voted by mail for the 2018 general election — not counting citizens living abroad who are allowed to vote absentee under the Uniformed and Overseas Citizens Absentee Voting Act. Election officials rejected 1.4% of these mail ballots for a range of reasons such as arriving late, lacking a required signature and having a signature on the ballot return envelope that does not match the official voter signature on file.

This year, more than 82 million mail ballots have been requested or automatically distributed to eligible voters nationwide, an analysis from the United States Elections Project at the University of Florida shows.

Because mail ballots likely will play a significant role in this year’s presidential election, Journalist’s Resource set out to answer three big questions that many news outlets and their audiences will be pondering. We pored over the academic literature searching for studies that attempt to answer — or at least provide insights on — these three questions:

Does in-person voting raise the risk of COVID-19 infection?
If someone submits a mail ballot, what are the odds it will be rejected?
Do mail-in ballots benefit one political party over another?

Below, check out a sampling of recent journal articles and working papers we think newsrooms will find helpful. Four of them focus on voting in two battleground states — Florida, which allowed election officials to offer early in-person voting as early as Oct. 19, and Wisconsin, where early voting begins today. We provide a summary of each, highlighting key data and findings to help journalists cover these issues on deadline.

———–

Does in-person voting raise the risk of COVID-19 infection?

The following two studies examine voting during the Wisconsin primary election in April. While their findings appear to be contradictory, they are not. The two groups of researchers take different approaches to investigate the issue.

In the first, researchers look at the link between in-person voting and COVID-19 infection statewide, offering a high-level view. In the second study, researchers study in-person voting and positive tests for COVID-19 at the county level, allowing them to spotlight areas where an increase in voters per polling site was associated with a rise in the rate at which people in that state tested positive for the illness.

No Detectable Surge in SARS-CoV-2 Transmission Attributable to the April 7, 2020 Wisconsin Election
Kathy Leung, Joseph T. Wu, Kuang Xu and Lawrence M. Wein. American Journal of Public Health, August 2020.

Voting during the Wisconsin primary in April appears to have been “a low-risk activity,” according to a statewide analysis by researchers from the World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control at the University of Hong Kong and the Stanford University Graduate School of Business.

The April 7 election “produced a large natural experiment to help understand the transmission risks” of COVID-19, the authors write. Of the almost 1.6 million votes cast, about 413,220 were from people who voted in person.

The researchers note that if voters contracted the coronavirus on April 7, infections would have been reported by April 17, on average. Considering the illness’ incubation period, most cases would have been reported between April 11-22.

The researchers learned that the number of COVID-19 tests conducted in the state that month remained stable. Meanwhile, hospitalizations for the illness declined in April.

The Relationship Between In-Person Voting and COVID-19: Evidence From the Wisconsin Primary
Chad D. Cotti, et al. National Bureau of Economic Research Working Paper No. 27187, October 2020.

This paper provides a more in-depth look at in-person voting and COVID-19 transmission than did the prior analysis, which offers a statewide look at COVID-19 transmission in the wake of Wisconsin’s April primary election. By examining data collected in individual counties rather than across the state, researchers “observed a positive statistical relationship between county level in-person voting per location and COVID-19 spread.”

“Results show that counties which had more in-person voting per voting location (all else equal) had a higher rate of positive COVID-19 tests than counties with relatively fewer in-person voters,” write the authors. “Our results suggest that a 10% increase in voters per polling location leads to about an 18% increase in the test-positive rate.”

The researchers point out that in the weeks leading up to the primary, the Wisconsin Elections Commission allowed election clerks to make changes to the number of voting sites and voting setup. “Among clerks who modified the voting locations available to their registered voters, nearly all sought to consolidate — a decision that almost certainly increased the in-person voter density per voting location,” explain the paper’s authors, from the University of Wisconsin-Oshkosh, University of Wisconsin-Madison and Ball State University.

The authors suggest election officials reduce voter density to prevent the spread of COVID-19.

“Although our results are not definitive,” they write, “they do suggest it may be prudent, to the extent possible during the COVID-19 epidemic and weighed against other factors, for policymakers and election clerks to take steps to either expand the number of polling locations, voting times, early voting opportunities, or encourage absentee voting in order to keep the population density of voters as low as possible. The above recommendations could be particularly beneficial to urban voters who face longer weight times and minority voters with substandard voting accessibility.”

If someone uses a mail ballot, what are the odds it will be rejected?

Vote-By-Mail Ballot Rejection and Experience With Mail-In Voting
David Cottrell, Michael C. Herron and Daniel A. Smith. Working paper, October 2020.

This analysis of ballot rejections during three elections in another key battleground state — Florida — finds that election officials were about three times more likely to reject the mail ballots of voters who did not have experience using them, compared with voters who had used mail ballots in prior elections.

In the 2020 primary election, for example, election officials rejected 1.22% of the mail ballots sent by voters who lacked experience using them after those ballots arrived late. They rejected 0.47% of mail ballots submitted by experienced users because of lateness, according to this working paper, from researchers at the University of Georgia, Dartmouth College and the University of Florida.

In this study, researchers deemed voters “experienced” if they submitted mail ballots in the two most recent general elections in Florida and their mail ballots were accepted.

They examined voting records across three elections — the 2016 and 2018 general elections and the 2020 primary election. In Florida, voting records are public, making it possible for researchers to see how many mail ballots were rejected and why. The researchers also were able to disaggregate rejection rates by age, gender and party registration as well as race and ethnicity.

Lack of experience was most harmful to Black and Hispanic voters and voters not affiliated with a major political party. Their mail ballots were most likely to be rejected because they arrived late or lacked a required signature or because of some other voter error — for example, the signature on the ballot return envelopes did not match the official voter signature on file.

“We suspect that one explanation for the latter is that independently minded voters wait longer to vote than do partisans, thus raising the risk of late mail-in ballots,” the authors explain. “This is compounded when independently minded voters are inexperienced with mail-in voting.”

The authors stress that their findings apply specifically to Florida and cannot be generalized to other parts of the country.

“We cannot be sure that our findings on the role of voter experience extend to other states, but the vast majority of states simply cannot be scrutinized in the way that Florida can,” they write.

Voting by Mail and Ballot Rejection: Lessons from Florida for Elections in the Age of the Coronavirus
Anna Baringer, Michael C. Herron and Daniel A. Smith. Election Law Journal: Rules, Politics, and Policy, September 2020.

In this study of Florida voting records from the 2016 and 2018 general elections, researchers find that younger voters, those needing assistance to vote and those not registered with a major political party were more likely than other voters to have their mail ballots rejected. This paper, however, focuses only on mail ballots that arrived at election offices on time.

“We also find disproportionately high rejection rates of mail ballots cast by Hispanic voters, out-of-state voters, and military dependents in the 2018 general election,” the authors write. “Lastly, we find significant variation in the rejection rates of VBM [vote-by-mail] ballots cast across Florida’s 67 counties in the 2018 election, suggesting a non-uniformity in the way local election officials verify these ballots.”

In November 2016, more than 27,700 mail ballots — about 1% — were rejected despite arriving on time, the analysis reveals. In November 2018, elections officials rejected almost 32,000 mail ballots, or about 1.2%, that made it to election officials on time.

The rejection rate of mail ballots among voters aged 18 to 21 years was 3.9% in 2016 and 5.4% in 2018. The researchers also find that while voters aged 18 to 29 years cast 2.7% of all mail ballots in the 2016 general election, their ballots accounted for more than 11% percent of the mail ballots that arrived by the Election Day deadline but were not counted.

Researchers suggest differences in how election administrators evaluate voter signatures might explain some of the variation in rejection rates.

“Local elections officials have considerable leeway when evaluating the veracity of a signature on a VBM [vote-by-mail] ballot return envelope,” they explain. “Discretion of local election officials or county canvassing boards may result in unequal treatment of VBM ballots due to implicit biases or partisanship, allowing racial or party preferences to be subconsciously present.”

Do mail ballots benefit one political party over another?

Universal Vote-By-Mail Has No Impact on Partisan Turnout or Vote Share
Daniel M. Thompson, Jennifer A. Wu, Jesse Yoder and Andrew B. Hall. PNAS, June 2020.

Does allowing voters to cast their ballots by mail benefit one of the two major political parties more than the other? This study of elections held from 1996 to 2018 in three states finds that universal vote-by-mail — when every voter is mailed a ballot before an election and allowed to mail it back — “does not affect either party’s share of turnout or either party’s vote share.”

It does, however, increase the number of people who vote. An additional 2.1% to 2.2% of the voting age population participates in an election, estimate the researchers, who write that they believe their paper is “the most comprehensive confirmation to date of VBM’s [vote-by-mail’s] neutral partisan effects.”

Daniel M. Thompson, an assistant professor of political science at UCLA, and his colleagues studied elections held from 1996 to 2018 in California, Utah and Washington — three states that rolled out universal vote-by-mail county by county during that period. By comparing counties that had implemented vote-by-mail with counties in the same state that had not yet implemented the policy, researchers were able to study its impact on elections featuring the same set of candidates.

Thompson and his colleagues find that universal vote-by-mail leads to a larger number of people mailing their ballots — an estimated 14% to 19% more.

“As the country debates how to run the 2020 election in the shadow of COVID-19, politicians, journalists, pundits, and citizens will continue to hypothesize about the possible effects of VBM [vote-by-mail] programs on partisan electoral fortunes and participation,” they write. “We hope that our study will provide a useful data point for these conversations.”

America’s Electorate is Increasingly Polarized Along Partisan Lines About Voting by Mail During the COVID-19 Crisis
Mackenzie Lockhart, et al. PNAS, October 2020.

Two national surveys indicate a divide has emerged this year in terms of how voters aligned with the two major political parties want to vote in the 2020 presidential election. In both, Democrats were much more likely than Republicans to say they preferred to cast their ballots by mail.

Researchers used online surveys to ask two groups of eligible voters — 5,612 people in April and then 5,818 in June — how they wanted to vote and whether they support national legislation requiring states to provide absentee ballots for all voters requesting them.

“In April, 40.1% of Democrats indicated that they would like to vote by mail in November while 30.5% of Republicans wanted to vote by mail,” the authors write. “In June, this gap doubled as 44.8% of Democrats and only 25.5% of Republicans indicated they would like to vote by mail at this point.”

The surveys show high levels of support for national legislation requiring states to provide absentee ballots to voters who want to use them. In April, 87.3% of Democrats supported the proposal as did 64.1% of Republicans. In June, though, support was 2.3% lower for Democrats and 12.6% lower for Republicans, “suggesting an increasing partisan divide on the issue,” the authors write.

The researchers write that news outlets could be partly to blame for the change.

“One potential explanation for this is increasing media coverage that frames voting by mail as a partisan issue,” they write.

For more information to help you cover the 2020 election, see these 10 tips from the experts and our research roundup on voter intimidation.

This image was obtained from the Flickr account of Maryland GovPics and is being used under a Creative Commons license. No changes were made.

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Since the COVID-19 pandemic began, deaths from drug overdoses have reportedly surged, even as a relaxing of federal restrictions and a rapid shift by treatment providers has led to an explosion in telemedicine options for receiving help with substance use disorders.

The move to telemedicine — defined as delivering clinical services using telecommunications technology — alleviates some longstanding barriers to treatment, but it also raises new questions, particularly as pandemic-related workplace closures and other stressors put people struggling with addiction at increased risk. (Telehealth is a broader term that generally encompasses clinical services as well as nonclinical services such as provider training.)

More than 20 million American adults have a substance use disorder, according to the Substance Abuse and Mental Health Services Administration, including 2.5 million who are addicted to opioids and more than 18 million with alcohol use disorder. The annual death toll from these conditions in the United States is more than 160,000. Nearly 72,000 Americans died of an overdose last year, according to the Centers for Disease Control and Prevention, with opioid overdose deaths breaking records and the number of deaths involving methamphetamine and cocaine continuing to trend upward. Meanwhile, excessive alcohol use is responsible for more than 88,000 deaths per year in America, and the misuse of other prescription and illicit drugs is on the rise.

Despite the scale of this co-occurring public health crisis, most people with substance use disorders never receive treatment. Many of them reside in rural areas where addiction specialists and treatment programs are unavailable. Stigma, insurance coverage and a belief in solving one’s own problems have also been identified as common barriers to treatment.

Telemedicine has long been seen as a potential remedy, but pre-pandemic adoption rates were low among addiction treatment providers, according to studies by Lori Uscher-Pines, a senior policy researcher at the RAND Corporation, and Haiden Huskamp, a health economist at Harvard Medical School, who, along with their colleagues, are researching telemedicine care delivery for substance use disorder treatment. Since March, they have watched a treatment paradigm historically centered on strict in-person monitoring and layers of regulation quickly transform into one that relies heavily on virtual care.

“Everything has changed since COVID-19,” says Uscher-Pines. “The regulatory barriers, patient readiness barriers, all of those things are different now… Our research shows that only about 17% of licensed treatment facilities had any telemedicine capabilities prior to the pandemic. What we’re seeing now, both qualitatively and quantitatively, is an explosion of telemedicine use.”

Virtual 12-step program meetings, online psychotherapy, and private companies offering remote medication-assisted treatment (MAT) to opioid use disorder sufferers have become the norm since the pandemic began. Early research suggests that MAT prescribers transitioned easily to telemedicine with established patients but have been hesitant to take on new ones.

The process of initiating MAT, usually with methadone or buprenorphine, is subject to specific federal and state regulations. Many of these and other regulations have been loosened to facilitate increased access to treatment via telemedicine during the pandemic, but the regulatory environment remains complex.

The following federal policy changes, detailed in a recent study by the nonprofit Center for Connected Health Policy, are in place at least for the duration of the coronavirus pandemic and have opened up options for telemedicine-delivered addiction treatment for patients with access to a computer or telephone:

• The passage of HR 6074 (the Coronavirus Preparedness and Response Supplemental Appropriations Act) and HR 748 (the Coronavirus Aid, Relief and Economic Security Act – CARES Act) made more telehealth services eligible for reimbursement through Medicare.
• A Medicare requirement that patients be located in a clinic to receive telehealth services was removed. (The SUPPORT Act of 2018 eliminated this and other telemedicine treatment barriers, but a pathway for implementation of these provisions had not been put in place prior to the pandemic). Patients in most states can now receive treatment services, including prescriptions, over the phone or computer from their homes. (State decisions about Medicaid expansion, along with other factors, have caused regional variations in telehealth accessibility.)
• An emergency exception to the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 allows qualified providers to prescribe buprenorphine without an initial in-person visit. To get a prescription for methadone, which is highly regulated, patients must still be examined in person first. The Substance Abuse and Mental Health Services Administration posted this FAQ about federal policy changes related to prescribing buprenorphine and methadone during the pandemic.
• Some HIPAA restrictions have been relaxed, allowing providers to see patients via videoconference using various online platforms, including Zoom, Skype and FaceTime.

Many states have relaxed licensing requirements for providers, and reimbursement for certain addiction-related services delivered via telemedicine has become more commonplace among private health insurers and Medicaid programs.

To eliminate inadequate broadband internet access as a barrier to telehealth treatment, the Telehealth Buprenorphine Consortium, a group of clinicians and public health experts, is calling on federal policymakers to allow audio-only treatment services via telephone to continue post-pandemic.

Addiction treatment has a complicated history in the U.S. and continues to exist largely outside the primary health care system, despite broad recognition of substance use disorder as a medical condition. Unlike other chronic health conditions that are behavior-related, such as type 2 diabetes, substance use disorders carry a history of stigma and criminalization that some experts believe has led to a misguided focus on in-person visits and accountability in treatment.

“This paradigm of not trusting patients and assuming that they need to be hyper-monitored all the time in order to provide safe care is not patient-centered; it’s not harm-reduction oriented,” says Noa Krawczyk, an assistant professor in the population health department at New York University’s Grossman School of Medicine, whose research focuses on studying ways to address barriers to treatment and improve quality of care. “It’s not effective in making people feel welcome or in making it so that their lives are actually easier because they are in treatment, which is what we want.”

Krawczyk says the policy changes necessitated by COVID-19 and the increasing adoption of telemedicine more broadly have the potential to help reset the standard of care for addiction, depending on the extent to which the new policies remain in place after the pandemic — an open question at this point.

Combined with the limitations that social distancing guidelines imposed on in-person care, the sudden move to telemedicine — or to hybrid treatment models that blend virtual care with in-person visits — has created what researchers call a natural experiment, which enables them to study new phenomena without the typical concerns about selection bias.

Still, with so many pandemic-induced changes occurring at once, disentangling cause and effect will take some time, especially given the long lag for receiving data from Medicaid, a disproportionate payer for substance use disorder treatments, says Huskamp.

“We know the underlying need for treatment is changing, and there are all these other factors we can’t control, but we need to try to use this period to understand as much as we can about how telemedicine should be used going forward, to improve treatment and outcomes for patients.” says Huskamp, who is leading a mixed-methods research project that combines analysis of insurance claims data with provider interviews.

Although early research suggests potential benefits of telemedicine for both substance use disorder patients and treatment providers, clinicians have also reported quality concerns. At this point, much remains unknown about the safety and efficacy of providing remote care for people with addictions.

“There are no randomized controlled trials looking at the impact of medication treatment for patients at home, so we don’t know if these services are equivalent to in-person services, because there’s just a dearth of research on this model,” says Uscher-Pines. “There is research in progress, but right now policymakers have to make decisions without a lot of data.”

That said, studies published in recent years have examined the scope of telemedicine use within the addiction treatment field as well as outcomes related to specific telemedicine interventions and patient groups. What follows is a curated list of seven recent peer-reviewed studies on treating patients with addiction via telemedicine, including three papers by Huskamp and Usher-Pines, along with summaries of their most important findings.

Research Roundup:

Telemedicine-Delivered Treatment Interventions for Substance Use Disorders: A Systematic Review
Lewei (Allison) Lin, et al. Journal of Substance Abuse Treatment, June 2019

This meta-analysis reviews 13 research papers that examined the use of teleconferencing to deliver psychotherapy and medication treatment for either nicotine addiction, opioid use disorder or alcohol use disorder and that were published between 1998 and 2018. The included studies vary widely in size, quality, and design, but most found that patient satisfaction was high among those who received telemedicine interventions.

Several of the studies suggest that telemedicine could be associated with lower drop-out rates among treatment participants when compared with participants having to travel for in-person treatment.

“Retention is particularly important for medication treatment for opioid use disorder,” the researchers write, “where patients, especially those in rural areas, often have to travel long distances for treatment that is ongoing, and active receipt of medication treatment has been associated with improved mortality and other outcomes.”

The researchers note the critical need for more data and research – randomized controlled trials, in particular – to help understand the potential of telemedicine-delivered treatments for a wider range of substance use disorders.

How Is Telemedicine Being Used In Opioid And Other Substance Use Disorder Treatment?
Haiden A. Huskamp, Alisa B. Busch, Jeffrey Souza, Lori Uscher-Pines, Sherri Rose, Andrew Wilcock, Bruce E. Landon, and Ateev Mehrotra. Health Affairs, December 3, 2018

A helpful overview of the pre-COVID landscape, this research article is based on claims data from 2010-2017 for a large U.S. commercial insurer. It shows a roughly twentyfold increase (from 97 visits in 2010 to 1,989 visits in 2017) in the use of telemedicine among addiction treatment providers during the study period.

Despite this growth, the study notes low overall usage rates for telemedicine, which accounted for just .1% of all substance use disorder visits reimbursed during the study period. The researchers consider this “a missed opportunity,” given the wide gap between the number of people who need addiction help and those who actually receive it.

Telehealth was most frequently used in outpatient settings, for initial evaluations, and among patients with severe opioid use disorder. The analysis suggests the most common treatment model involved physicians with addiction treatment experience performing an initial evaluation and/or prescribing medication from a remote location to a patient at a clinic. Patients frequently received telehealth support following intensive inpatient or outpatient treatment, the study results suggest.

The study also identified characteristics of the telehealth users. More than 60% were male and about 55% were under age 40. Despite hopes that telehealth would make treatment available to people in rural areas, the researchers found that the “vast majority” of patients studied who used telehealth for addiction care lived in urban areas, and telemedicine use was more common in areas with relatively higher household incomes.

“This finding is in contrast to the results of prior research on tele-mental health use, which found that use was greatest in poorer communities,” the researchers write, adding that “targeted interventions to increase access in rural areas may be needed.”

Treatment of Opioid Use Disorder During COVID-19: Experiences of Clinicians Transitioning to Telemedicine
Lori Uscher-Pines, Jessica Sousa, Pushpa Raja, Ateev Mehrotra, Michael Barnettt, Haiden Huskamp
Journal of Substance Abuse Treatment, August 29, 2020

Based on interviews conducted in April 2020, this new qualitative study by Uscher-Pines and colleagues offers clinicians’ perspectives on the rapid transition to telehealth approaches for substance use disorder treatment during the pandemic.

The researchers interviewed 18 waivered providers (meaning they can prescribe buprenorphine) in 10 states working in both hospitals and clinics at a time when government-mandated shutdowns severely restricted in-person care. Of those interviewed, more than half were providing only telemedicine care.

Asked how their overall practice patterns had changed, some interviewees reported waiving toxicology screenings, sending patients home with more doses of medication, and reducing the number of required visits.

About 20% of telemedicine visits occurred over the telephone, with the rest involving the use of various videoconferencing platforms. Some clinicians said they were hesitant to see new patients via telemedicine; others stopped accepting new patients altogether.

Benefits of telemedicine observed by the clinicians included increased access and convenience, as well as reduced wait times, appointment no-shows, and patient embarrassment about being seen getting treatment in their communities.

But seeing patients remotely also had downsides in terms of care quality, according to the interviewees. Clinicians reported difficulty establishing rapport with new patients and difficulty observing physical symptoms of withdrawal, such as goosebumps and pupil dilation.

“Because telemedicine prevented clinicians from using their full powers of observation, they reported asking patients more questions about their physical symptoms and relying more on patient self-report than observation,” the researchers write.

Clinicians also cited technical difficulties as negatively affecting the quality of patient interactions.

The level of telemedicine care for substance use disorders that will continue after the pandemic remains unknown. Several providers said they would like to continue to use it in combination with in-person visits. Study participants also noted that their future use of telemedicine would depend on the reimbursement and regulatory environment.

Measures of Effectiveness, Efficiency, and Quality of Telemedicine in the Management of Alcohol Abuse, Addiction, and Rehabilitation: Systematic Review
Clemens Scott Kruse et al. Journal of Medical Internet Research, January 2020

This analysis of 22 research papers on telemedicine interventions for alcohol use disorder found that mobile apps and text message were the most common and effective treatment models among those studied.

Telemedicine proved effective in reducing alcohol consumption and depression among users in the majority of studies, the researchers said. Remote interventions also were associated with increased patient satisfaction and accessibility, as well as decreased cost.

“Organizations were able to expand practice without expanding square footage,” the researchers wrote, “and [telemedicine] solutions continued to provide care outside the boundaries of 8 a.m. to 5 p.m., a traditional treatment day.”

The authors note the need for further study of particular telemedicine approaches and how they improve outcomes for people seeking help with alcohol use disorders.

The included studies were conducted in the United States, European Union and Australia.

Treatment of Opioid Use Disorder in Pregnant Women via Telemedicine A Nonrandomized Controlled Trial
Constance Guille, Annie N. Simpson, Edie Douglas
JAMA Network, Jan. 31, 2020

Opioid addiction among pregnant women in the United States quadrupled between 1999 and 2014, increasing from 1.5 to 6.5 cases per 1,000 hospital births. When exposed to opioids in utero, infants can experience withdrawal symptoms at birth, known as neonatal abstinence syndrome (NAS), the rate of which increased from 1.5 to 8 per 1,000 hospital births between 2004 and 2014.

Telemedicine has been identified as a tool to expand addiction care for pregnant women, particularly in rural areas, writes lead study author Dr. Constance Guille, an associate professor at the Medical University of South Carolina who developed the telemedicine protocol used to provide medication-assisted treatment (MAT) to the study participants.

This is a nonrandomized controlled trial that included 98 pregnant women with opioid use disorder in which 44 received opioid use disorder (OUD) treatment via telemedicine from their obstetrician’s office and 54 received in-person OUD care in their obstetrician’s office. There were no statistically significant differences in rates of retention in treatment between the two groups, with more than 80% of participants in both groups remaining in treatment after six weeks. These results held when the researchers looked at diagnoses of neonatal abstinence syndrome among the newborns.

This study used a method called propensity score matching to reduce selection bias and improve generalizability of the results, given the small sample. By incorporating demographic information of the study subjects, the researchers calculated the probability of treatment assignment for each, known as the propensity score. By giving these scores different weights and matching them together, the researchers artificially created treatment and control groups, mimicking aspects of a randomized controlled trial.

A note on the research: The telemedicine protocol Dr. Constance Guille, an associate professor at the Medical University of South Carolina, and her team developed made it possible for pregnant women with opioid use disorder to receive specialized addiction services from a remote provider during their regular prenatal appointments.

Because the patients were receiving care in the presence of another provider with a Drug Enforcement Administration license (that is, an obstetrician), Guille had petitioned the South Carolina Board of Medical Examiners for permission to treat them with MAT via telemedicine without an initial in-person visit, based on a pre-COVID exemption in the federal Ryan Haight Act.

The board initially denied the request, citing the South Carolina Telemedicine Act, which conflicts with federal law, Guille says. Legally, the team was advised that they could continue, she says, but they heeded the board’s recommendation in order to maintain positive relations with the state. Later, after a pregnant woman died of an overdose while waiting to schedule an in-person visit, the research team went back and made the same proposal to the board, which reversed its original decision.

Guille says the experience highlights the complex web of federal and state regulations that treatment providers need to navigate in order to provide telemedicine services, a situation that is likely to persist post-COVID.

“There’s the whole legal aspect of it, and then there’s the issue of how you collaborate with your key stakeholders across your state to get this work done,” she says. “There’s a lot of gray area there.”

The Effectiveness of Telemedicine-Delivered Opioid Agonist Therapy in a Supervised Clinical Setting
Joseph K. Eibl, et al.
Drug and Alcohol Dependence, July 2017

This 2017 research involves a non-randomized cohort comparison study of 3,733 patients with opioid use disorder initiating medication treatment (methadone or buprenorphine) between 2011 and 2012, across 58 clinic sites in the province of Ontario, Canada. The analysis was based on a database of patients’ electronic medical records.

Of the patients studied, about 47% received more than 75% of visits via telemedicine. The rest received less than 25% of visits by telemedicine. The analysis suggests that patients treated via telemedicine were more likely to stick with their treatment programs than patients treated in-person. Telemedicine patients demonstrated a retention rate of 50% at one year whereas in-person patients were retained at a rate of 39%.

Like in the U.S., physicians who can prescribe medication for addiction treatment are in short supply in Canada because the medications themselves are regulated by the federal government as controlled substances. Providers must apply for and receive a federal waiver before prescribing methadone or buprenorphine, a requirement that remains in place in the U.S. during the pandemic. This provider shortage often leads to patients needing to travel long distances for frequent provider visits, a problem that telemedicine can address.

A Pilot Study of a Telemedicine-based Substance Use Disorder Evaluation to Enhance Access to Treatment Following Near-Fatal Opioid Overdose
Jeffrey T. Lai, et al.Proceedings of the Annual Hawaii International Conference on System Sciences, Jan. 7, 2020

This was an observational study of patients who were hospitalized in Massachusetts after receiving naloxone (the antidote for opioid overdose) following an opioid overdose. The researchers asked 27 patients who presented in a hospital emergency department whether they would be willing to test a telemedicine intervention; 20 agreed to participate.

The researchers developed a system using iPads outfitted with HIPAA-compliant software that enabled recently revived patients to undergo an initial addiction screening with a specialist immediately following overdose – a critical time for initiating treatment.

All 20 participants reported liking the technology, with two subjects describing the iPad as “cool.” One participant described the intervention as the “best thing since sliced bread and bacon, and I’m a Georgia boy so I love bacon.”

Most of the participants found that undergoing the screening via telemedicine was equivalent (or in some cases preferable) to standard in-person evaluations. They also reported feeling assured that the assessment was private and confidential.

Despite one major technical malfunction (a dead battery), the researchers deemed the intervention a success, writing that telemedicine “can enhance access to addiction treatment programs and facilitate the efficient and effective delivery of evidence-based post-overdose care, including ED-based initiation of [medication-assisted treatment].”

They write, “Our technology platform represents an innovative method of delivering treatment for opioid use disorder during the critical post-overdose period, and holds immense potential for improving access to addiction care” in underserved areas.

Adoption of Telemedicine Services by Substance Abuse Treatment Facilities in the U.S.
Lori Uscher-Pines, Jonathan Cantor, Haiden A.Huskamp, Ateev Mehrotra, Alisa Busch, Michael Barnett
Journal of Substance Abuse Treatment, October 2020

This pre-COVID-19 study used data from the National Directory of Drug and Alcohol Abuse Treatment Facilities for a period from 2016 to 2019 to study an average of 12,334 substance use disorder treatment facilities in the United States. During the study period, facilities offering telemedicine grew from 13.5% to 17.4%.

The results of the analysis suggest the following factors positively influence telemedicine adoption: rural location; offering multiple treatment settings; offering medication-assisted treatment; and serving both adult and pediatric patients.

In 2019, there was wide state-to-state variation in facility adoption of telemedicine; less than 7% of facilities in Connecticut, Hawaii, Rhode Island, and Vermont offered telemedicine services, compared with more than 40% in Alaska, Missouri, and Wyoming.

The same team of researchers is continuing to study telemedicine adoption for substance abuse treatment since the pandemic began, including analyzing variations by state.

5 tips for reporters covering telemedicine-delivered treatment for substance use disorders

1. Get to know your state’s telehealth laws and rules. Rules and regulations for telehealth practice and prescribing vary by state. Each state’s health department and medical licensing review board can set and waive rules. The Federation of State Medical Boards maintains this up-to-date list of state licensing policy changes due to COVID-19, including when they expire. The Center for Connected Health Policy plans to update this report on state telehealth laws and reimbursement later this fall.

2. Ask questions about reimbursement. The degree to which telemedicine services can be reimbursed by insurance is likely to play a role in the degree to which providers and medical societies support their ongoing use and implementation once the pandemic eases.

For example, unlike urine toxicology screenings, saliva tests can be conducted under direct supervision via telemedicine, says Noa Krawczyk of NYU’s Grossman School of Medicine, but so far, the test is not eligible for reimbursement and is used mainly for research.

Per a 2012 Supreme Court ruling, Medicaid expansion is an optional decision for states. In states that have expanded Medicaid, a disproportionate payer for people with substance use disorders, it is easier for providers to get reimbursed for telemedicine.

3. Cover addiction as a chronic disease, not a crime. Some researchers argue that a telemedicine model for addiction treatment makes sense because it both improves access and moves away from traditional substance use disorder treatment programs that are rooted in the perspective that drug use is criminal, as opposed to behavioral.

In a new book, The Opioid Fix, Barbara Andraka-Christou, an assistant professor in the department of health management and informatics at the University of Central Florida, traces the history of treatment and argues that medication-assisted treatment should be available to all patients with a opioid use disorder.

When arguing in favor of telemedicine treatments for substance use disorders, researchers and providers often make a comparison with type 2 diabetes, which is also primarily behavioral, but patients are not as strictly monitored. PBS News Hour covers this topic in its recent piece, “Could the pandemic change addiction medicine for the better?”

4. Visit Reddit. There are many people with substance use disorders who are active on the social network Reddit, which hosts communities, known as subreddits, where people with similar interests can have discussions and promote  input and responses. Krawczyk is working on a research paper that analyzes active subreddits where people are discussing changes in opioid addiction treatment during the pandemic.

Krawczyk says it’s important to include the perspectives of people with substance use disorders in research and reporting on the changes that are occurring. “Some people feel like it’s great and it’s much easier to get treatment,” she says. “And other people are saying they’re worried about, you know, having too much methadone with them at home.”

To read active subreddits, visit: www.reddit.com/r/addiction, www.reddit.com/r/redditorsinrecovery, www.reddit.com/r/opiatesrecovery and www.reddit.com/r/stopdrinking.

5. Use person-first language. When covering issues surrounding addiction and substance use, it’s important to avoid terminology like “addicts” and “alcoholics.” Instead, use “a person with substance use disorder,” “someone suffering from addiction.” Krawczyk says this language avoids characterizing people based solely on a medical condition and better reflects current thinking about substance abuse disorders.

Similarly, the AP Stylebook advises: “Avoid words like ‘abuse’ or ‘problem’ in favor of the word ‘use’ with an appropriate modifier such as ‘risky,’ ‘unhealthy,’ ‘excessive’ or ‘heavy.’ ‘Misuse’ is also acceptable. Don’t assume all people who engage in risky use of drugs or alcohol have an addiction. Avoid ‘alcoholic,’ ‘addict,’ ‘user,’ and ‘abuser’ unless individuals prefer those terms for themselves or if they occur in quotations or names of organizations, such as Alcoholics Anonymous.”

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Over the past 12 weeks, the coronavirus pandemic has forced millions of employees in America to begin working from home. Before the pandemic, 2.5% of U.S. employees teleworked full-time, according to the Federal Reserve Bank of Atlanta. Now, almost everyone who can telework is doing so.

Some economists expect the share of people teleworking full-time to remain high even after the pandemic ends. We collected a variety of research to address big questions employers, employees and cities face as America’s office workers consider the future of working from home.

Research indicates there is no one-size-fits all approach when it comes to telework arrangements. Everyone now teleworking faces challenges, from caring for children to adjusting to virtual collaboration with coworkers. Some people will be more productive working from home, some people less so.

One constant in the academic literature is that the type of work matters when it comes to whether telework arrangements are successful. People with complex jobs that can be performed independently generally fare better than those with less complex jobs that require extensive interaction with colleagues.

It’s important to remember most jobs cannot be done at home, and tens of millions of workers have temporarily or permanently lost their jobs — though the economy regained 2.5 million jobs in May. An estimated 37% of U.S. jobs are conducive to telework, according to an analysis from University of Chicago economists Jonathan Dingel and Brent Neiman.

Google and Facebook are two major employers that have told employees to plan on teleworking through 2020. Twitter has told employees if they can telework and want to keep teleworking, they can “do so forever.”

Work-from-home arrangements will likely expand beyond the tech world — and beyond the pandemic. Executives at about 1,750 firms from a variety of industries across the country expect 10% of full-time employees to telework every workday after the pandemic ends, according to the May monthly panel survey by economists at the Atlanta Fed, Stanford University and the University of Chicago. The executives expect 30% of their workforce to telework at least one day a week after the pandemic, triple the 10% rate before.

Keep reading to find out what the research says about employee productivity and setting boundaries while working at home, how mass teleworking could transform cities — and more.

My work and home life have completely melded. How can I set boundaries?

It’s one of the bigger questions for workers thrust into full-time telework — especially those simultaneously caring for children. Academic research can provide guidance for striking a balance.

For the paper “Strategies for Successful Telework: How Effective Employees Manage Work/Home Boundaries,” from June 2016 in Strategic HR Review, Kelly Basile and T. Alexandra Beauregard conducted 40 in-depth interviews with people teleworking full or part-time at an organization that did not have a culture of long work hours. Basile is an assistant professor of management at Emmanuel College. Beauregard is a reader in organizational psychology at Birbeck, University of London.

“When work and home activities take place in the same physical space, physical, temporal and psychological boundaries between work and home can become blurred,” Basile and Beauregard write.

The workers they interviewed use physical, time-based, behavioral and communicative strategies to set boundaries. For example, after their workday was done, full-time teleworkers with dedicated office space at home had an easier time devoting their full attention to non-work responsibilities, compared with those without a home office.

Teleworkers accountable to other responsibilities, like walking a dog or caring for children after school, had stronger work-home boundaries than those only accountable to themselves. Certain routine behaviors, like shutting down a computer at the end of the day, or turning off the ringer on a work phone, also helped establish boundaries. Those with children or spouses at home during telework time were most successful when they communicated clearly and consistently that they needed their workday to be free of household noise and interruptions.

“In organizations where after-hours communications, early meetings and weekend working are the norm, employees preferring segmentation will have difficulty establishing and maintaining boundaries between work and personal time,” Basile and Beauregard write. It’s another theme throughout the academic literature: Whether telework works for individual employees depends on company culture.

For “Toward Understanding Remote Workers’ Management of  Work-Family Boundaries: The Complexity of Workplace Embeddedness,” from December 2015 in Group and Organization Management, Kimberly Eddleston and Jay Mulki conducted 52 interviews with sales and service employees from across the U.S. who worked from home full-time. Eddleston is a professor of entrepreneurship and innovation at Northeastern University and Mulki is an associate professor of marketing there.

Many of the interviewees worked at organizations where it was common to work more than 40 hours a week, sometimes outside of regular hours. Even though interviews were in-depth, the authors caution that because their sample is small, their findings cannot be generalized to the broader population.

Still, the findings indicate a telework divide between men and women. About 62% of the interviewees were women. Some women experienced benefits — spending time with their families while also being able to step away for urgent deadlines. But more than half of women working remotely — compared with just a tenth of men — reported their spouse didn’t respect boundaries between work and family. “You know, I get distracted by my private life,” one woman told the researchers. “It kind of interferes with my professional life.”

With an acuity applicable to today’s era of widespread coronavirus telework, Eddleston and Mulki write that “organizations should educate remote workers on the need to establish boundaries between work and family, and train these workers to resist temptations to perform work activities during family time.”

How does telework affect worker productivity?

Tens of millions of Americans are unemployed because of the new coronavirus, and data from the Bureau of Labor statistics show labor productivity is down considerably. The BLS defines labor productivity as “a measure of economic performance that compares the amount of goods and services produced (output) with the number of hours worked to produce those goods and services.”

For those who still have jobs and are teleworking, productivity can depend on personal motivation, type of work and home environment. Research indicates people who work from home can, overall, be as productive as office-dwellers.

In one widely cited November 2014 paper in the Quarterly Journal of Economics, researchers found call center workers at a large Chinese travel agency randomly assigned to work from home four days a week for nine months increased performance 13% compared with those who stayed in the office. Attrition also halved among teleworkers. The authors note that “the job of a call center employee is particularly suitable for telecommuting. It requires neither teamwork nor in-person face time.” The company required teleworkers in the office one day a week for training on new products and services.

In “Are Telecommuters Remotely Good Citizens?” from May 2014 in Personnel Psychology, Ravi Gajendran, David Harrison and Kelly Delaney‐Klinger surveyed 323 employees from various industries, including technology, banking, health care and manufacturing. Gajendran is an associate professor of management at Florida International University. Harrison is a professor of management at the University of Texas, Austin. Delaney-Klinger is an associate professor of management at the University of Wisconsin-Whitewater.

About 37% of the sample had a telework arrangement, with 80% of teleworkers working from home. The researchers found an association between teleworking and higher job performance ratings from supervisors. They suggest higher performance among teleworkers has to do with their finding that teleworkers believe they have more autonomy than regular commuters.

“Further, perceived autonomy is likely to be influenced by telecommuting intensity — the more extensive telecommuting is, the higher the discretion employees perceive over where and when they work,” write Gajendran, Harrison and Delaney-Klinger.

Work-from-anywhere arrangements could be even better for productivity than working from home, depending on the type of work. That’s according to “Work-From-Anywhere: The Productivity Effects of Geographic Flexibility,” a Harvard Business School working paper by Prithwiraj Choudhury, Cirrus Foroughi and Barbara Larson, released in December 2019. Work-from-home arrangements assume employees live close enough to go to the office a few days a week, or as needed, according to the authors. Work-from-anywhere arrangements let employees work remotely and physically far from their organization’s offices.

The authors exploit a natural experiment at the U.S. Patent and Trademark Office, where in 2012 management and union representatives launched a work-from-anywhere policy. The rollout was staggered, so employees transitioned at different times from being in-office, to work-from-home, to work-from-anywhere. The authors find that patent examiners working from anywhere were 4.4% more productive than examiners working from home. All examiners had at least two years on the job.

“[Work-from-anywhere] examiners relocate to lower cost-of-living locations and we report a correlation between relocating to a below-median cost-of-living location and productivity,” Choudhury, Foroughi and Larson write. They note two limitations: Their study focuses on a single organization, and patent examiners, by and large, don’t depend on coworker interaction to do their jobs.

Flexible work arrangements could also allow some older workers to work longer, if they want to. That’s according to a January 2020 paper in the American Economic Journal: Macroeconomics. The authors surveyed 2,772 clients of The Vanguard Group, an investment company. Participants were at least 55 years old with at least $10,000 in their Vanguard accounts. The sample skews wealthier, healthier and more educated than the national population.

“The willingness to work is stronger when jobs offer a flexible choice of hours worked,” the authors find. “Individuals are willing to take substantial earnings reductions to gain an hour of flexibility.”

Won’t I miss out on office relationships and opportunities for collaboration?

A constant throughout the literature is that whether telework arrangements are successful or not depends on the type of work. One study, published February 2018 in the Journal of Business and Psychology, surveyed 273 telecommuters and supervisors from a company with a voluntary telework program. The authors found teleworkers with complex jobs had better job performance than telecommuters with less complex jobs, “and their performance increased with higher levels of telecommuting.”

Then there are individual personalities. An outgoing person, for example, might miss office camaraderie, while an introvert might relish the demise of water cooler chatter. In “Getting Away From Them All: Managing Exhaustion from Social Interaction with Telework,” from February 2017 in the Journal of Organizational Behavior, Jaime Windeler, Katherine Chudoba and Rui Sundrup find that part-time telework allowed exhausted workers the chance to recover.

Windeler is an associate professor of business analytics at the University of Cincinatti. Chudoba is an associate professor of management information systems at Utah State University. Sundrup is an assistant professor of computer information systems at the University of Louisville.

Based on survey results from 258 workers from a variety of industries and regions in the U.S., the authors found workers were less exhausted when they had quality in-person interactions with coworkers. Quality is a subjective measure that “reflects an individual’s appraisal of the adequacy of support or satisfaction with interpersonal interactions,” the authors write.

But exhaustion increased as interactions became more frequent. Telework acted as a salve for office exhaustion. Participants represented the demographic characteristics of people with jobs conducive to telework and uniformly worked at small, medium and large companies. Taking a break from the office may be a good way to recharge, but collaboration remains fundamental to the human experience.

“The tendency for people to work together — to establish and run businesses, to conduct research projects, and to create and share music — is a foundation of human culture,” write then-Stanford University doctoral researcher Priyanka Carr and Stanford associate psychology professor Gregory Walton in a July 2014 paper in the Journal of Experimental Social Psychology. “For individuals, working with others affords enormous social and personal benefits.”

Will my career growth suffer if I’m not able to go to the office?

Some research suggests workers who want flexibility, like a telework option, may face stigma in the workplace. But the current widespread telework situation is unprecedented. If everyone at a company is teleworking, then, by definition, regular commuters can’t level stigma toward teleworkers.

If work life ends up looking similar to pre-COVID times, with some number of workers still regularly going to an office and others going in sometimes or not at all, promotions may hinge on what’s normal for each employee’s work unit. That’s according to “Is There a Price Telecommuters Pay?” from February 2020 in the Journal of Vocational Behavior by Timothy Golden and Kimberly Eddleston. Golden is a professor of enterprise management and organization at Rensselaer Polytechnic Institute. Eddleston is the Northeastern University professor mentioned earlier.

The authors analyzed survey results and salary and promotion growth data from a sample of 405 employees of a technology services firm. Roughly equal numbers were women and men.

People who teleworked extensively received more promotions when teleworking was part of their work unit’s culture and when they did extra work outside regular hours. Extensive teleworkers who did extra work and had the opportunity for face-to-face interactions with their supervisors also saw higher salary growth.

“Indeed, while work context factors examined in our study tended to decrease career penalties for telecommuters including those who telecommuted extensively, the greatest career benefits were attained by those who only occasionally telecommuted,” Golden and Eddleston write.

What will happen to cities if office workers don’t come back?

It’s another big question that may come down to whether coronavirus telework arrangements persist — and, if they do, how city leaders fill the void from lost office rent and ancillary business revenue, like workers buying lunch at cafes.

Research shows telework may affect whether people live in cities or suburbs. More telework could mean more urban sprawl, with people moving away from city cores and reducing density. In a simulated mid-sized city where every worker teleworks at least one day a week, transportation costs decrease 20% and geographic area expands by about 26% — according to “Telework: Urban Form, Energy Consumption and Greenhouse Gas Implications,” by William Larson and Weihua Zhao in Economic Inquiry from April 2017.

Larson is a senior economist at the Federal Housing Finance Agency and Zhao is an assistant professor of economics at the University of Louisville. Their simulated city is based on characteristics of the Charlotte, Indianapolis, Kansas City and San Antonio metropolitan areas, including average geographic area, average number of occupied units and median household income.

Greenhouse gas emissions fall slightly and housing units become slightly larger in Larson and Zhao’s telework simulation. Another potential side effect: “While telework increases the welfare of those who telework, it also makes those who do not telework better off through reduced congestion,” they write.

The authors of “Working from Home and the Willingness to Accept a Longer Commute,” from July 2018 in The Annals of Regional Science, also hint at a link between teleworking and urban sprawl. Based on surveys of nearly 7,500 Dutch workers spanning 2002 to 2014, they find people working from home at least one day per month were willing to accept 5% longer commute times, on average. Researchers report similar findings from the Netherlands in a September 2007 paper in the Journal of Housing and the Built Environment, with telecommuters more likely than regular commuters to live on the edge of or outside cities.

On the other hand, if fewer workers drive every day into city centers, that could free up space for more bicycling and public transportation, according to E&E News, an energy and environmental news outlet.

Check out our other coronavirus-related resources, including tips on covering biomedical research preprints and a roundup of research that looks at how infectious disease outbreaks affect people’s mental health. Also, don’t miss our feature on rural broadband in the time of coronavirus.

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In the lead-up to the 2020 elections, the Journalist’s Resource team is combing through the Democratic presidential candidates’ platforms and reporting what the research says about their policy proposals. We want to encourage deep coverage of these proposals — and to do our part to help deter horserace journalism, which research suggests can lead to inaccurate reporting and an uninformed electorate. Our criteria for the proposals we’re covering is simple: We’re focusing on proposals that have a reasonable chance of becoming policy, and for us that means at least 3 of the 5 top-polling candidates need to have signed on. We’re starting with the topic of minimum wage. Nearly every candidate polling above half a percentage point nationally supports raising the federal minimum wage to $15 an hour.

Candidates in favor

Joe Biden, Cory Booker*, Steve Bullock*, Julian Castro*, John Delaney*, Tulsi Gabbard*, Kamala Harris*, Amy Klobuchar*, Bernie Sanders*, Tom Steyer*, Elizabeth Warren*, Marianne Williamson*

What the research says

Research shows raising the federal minimum wage to $15 an hour would increase earnings for millions of low-wage workers. A higher minimum wage would also have some effect on employment, according to the 15 academic studies and other research surveyed below. Many analyses have found overall small employment effects, but some estimate relatively large job losses. While those earning the current federal minimum of $7.25 would more than double their wages with a $15 federal minimum, there would likewise be some degree of job loss at this lower end of the wage spectrum. Some research suggests job losses would hit teenagers hardest, and not all economists are convinced that raising the minimum wage is the best way to help the working poor.

Key context

A recent analysis from the Bureau of Labor Statistics found about 8% of teenagers aged 16 to 19 earned the federal minimum or less, with 1% percent of workers aged 25 and up earning the federal minimum. The analysis, based on hourly wages workers reported, doesn’t include overtime, tips or commissions. Roughly 29 million people of all ages, representing a quarter of the full-time, year-round workforce, had annual earnings in 2018 equal to less than $15 an hour, according to the Current Population Survey Annual Social and Economic Supplement from the U.S. Census Bureau.

The federal floor hasn’t budged from $7.25 an hour in more than a decade, but states and cities can set their own minimum wage. Many states around the country have already raised their minimums above the federal level. New York’s minimum wage, for example, stands at $11.10 an hour for most jobs outside New York City, where the minimum is $15 an hour for businesses with more than 11 employees. Hawaii has one of the highest minimums for tipped workers at $10.10 an hour.

The University of California, Berkeley Labor Center maintains a database of municipalities with minimum wage ordinances. Emeryville, California, a small town north of Oakland that’s home to the animation studio Pixar, has the highest minimum wage in the country at $16.30 per hour. The federal minimum is the floor for many states in the south. Louisiana and South Carolina have the highest percentage of workers making at or below the federal hourly minimum, according to BLS.

Formative findings

Academic studies that explore minimum wage changes tend to look at how those changes affect employment levels. There are hundreds of studies on this. Many look at how raising the minimum wage would affect teen employment, since teenagers tend to work in low-wage jobs likely to be affected by minimum wages.

One of the most famous minimum wage studies first appeared as an October 1993 National Bureau of Economic Research working paper from Princeton University economists David Card and the late Alan Krueger. (It was published as a peer-reviewed paper in 1994 in the American Economic Review.) This paper compared employment effects in New Jersey and Pennsylvania after New Jersey raised its minimum wage in 1992 while Pennsylvania’s held steady. Low-wage fast food jobs grew 13% more in New Jersey than in Pennsylvania, they found. Prices also went up at the New Jersey-based fast food establishments, “suggesting that much of the burden of the minimum wage rise was passed on to consumers,” according to the paper.

Before Card and Krueger, common economic knowledge assumed raising the minimum wage would lower employment. But the strength of that relationship has been and remains a subject of great debate. A survey of economic research in the Journal of Economic Literature, published in 1982, found many studies concluded that each 10% increase in the federal minimum wage lowers teenage employment by about 1%. Toward the end of the 1980s — a decade in which the federal minimum wage plateaued at $3.35 — one of the authors of that 1982 paper, Charles Brown, was a bit less convinced. He wrote in the Journal of Economic Perspectives in 1988 that “the effects of the minimum wage on employment are smaller than I would have supposed.”

Recent research

One comprehensive and recent meta-analysis of research on federal, state and local minimum wage changes comes from Paul Wolfson at Dartmouth College and Dale Belman at Michigan State University. Wolfson and Belman looked at 15 years of research since 2000 in a paper published July 2019 in Labour. Across 37 studies and 739 estimates of how minimum wage affects employment, they found “the minimum wage has negative employment effects, but these have become notably smaller and are largely localized to teenagers.” They speculate that the smaller employment downturns from higher minimum wages might be because teenagers don’t work as much as they used to.

Another recent analysis in the Quarterly Journal of Economics examined 138 state minimum wage increases from 1979 to 2016 and found “the overall number of low-wage jobs remained essentially unchanged over the five years following the increase.”

Research from New York Federal Reserve economists from September 2019 echoes Card and Kreuger’s original work. The new research compared retail and hospitality jobs, like fast-food service, in 19 counties along the New York-Pennsylvania border. New York began raising its minimum wage in 2014, while Pennsylvania’s has remained at the federal floor. Non-tipped fast food workers in New York were making $12.75 an hour by the end of 2018 and will make $13.75 by the end of this year — compared with the $7.25 an hour fast food workers in Pennsylvania make. Hospitality job earnings have risen in the New York counties compared with Pennsylvania, with no change in employment. Employment in the retail sector shrunk at a similar rate in both states, despite rising wages in New York.

In a comprehensive study from July 2019, the Congressional Budget Office estimated that raising the federal minimum wage by a smaller amount would have few employment effects, but would also raise wages for far fewer workers. A $10 federal minimum wage would raise wages for 1.5 million workers with “little effect on employment in an average week in 2025,” according to the study. The $15-per-hour option would increase wages for 17 million workers, but the CBO is less certain about the job effects. Their median estimate is that 1.3 million workers would lose their jobs — a less than 1 percent decrease in employed workers, according to the report. The likely range of job loss from the $15-per-hour option is quite large, from none to millions. The CBO estimates “a two-thirds chance that the change in employment would be between about zero and a decrease of 3.7 million workers.”

The CBO offers an interactive calculator — based on its analysis — that shows how different levels of minimum wage increases might affect jobs.

A federal minimum wage increase to $12 could lift 6.6 million people out of poverty, reducing the poverty rate by 2.45 percentage points, according to a 2017 Institute of Labor Economics discussion paper by University of Massachusetts Amherst economist Arindrajit Dube. Price hikes would be small compared with financial gains for those earning the least, Dube found. But not all economists are convinced raising the minimum wage is the best way to help the working poor. San Diego State economist Joseph Sabia and Cornell University economist Richard Burkhauser have found that state and federal minimum wage increases from 2003 to 2007 didn’t affect state poverty rates, and that the working poor were hit hardest by job losses.

Further reading

Minimum Wage Employment Effects and Labor Market Concentration

José Azar, Emiliano Huet-Vaughn, Ioana Marinescu, Bledi Taska and Till von Wachter. NBER working paper, July 2019.

The gist: “While increases in the minimum wage are found to significantly decrease employment of workers in low concentration markets, minimum wage-induced employment changes become less negative as labor concentration increases, and are even estimated to be positive in the most highly concentrated markets.”

Minimum Wage Increase and Firm Productivity: Evidence from the Restaurant Industry

Hong Soon Kim, SooCheong Jang. Tourism Management, April 2019.

The gist: “The results revealed that increasing the federal minimum wage immediately enhances restaurant productivity for up to two years.”

The Econometrics and Economics of the Employment Effects of Minimum Wages: Getting from Known Unknowns to Known Knowns

David Neumark. NBER working paper, revised November 2018.

The gist: “There is a great deal of uncertainty about the employment effects of a $15 minimum wage.  One thing we do know is that it would impact far more workers than the current minimum wage, especially in lower-wage states and lower-wage areas of most states.”

People versus Machines: The Impact of Minimum Wages on Automatable Jobs

Grace Lordon and David Neumark. NBER working paper, revised January 2018.

The gist: “The findings imply that groups often ignored in the minimum wage literature are in fact quite vulnerable to employment changes and job loss because of automation following a minimum wage increase.”

Minimum Wage Shocks, Employment Flows, and Labor Market Frictions

Arindrajit Dube, T. William Lester and Michael Reich. Journal of Labor Economics, July 2016.

The gist: “Minimum wage increases over the past decade appear to have substantially reduced turnover and increased job stability, with small effects on overall employment levels for highly affected groups, such as teens.”

Subject experts

Sylvia Allegretto, co-chair of the Center on Wage and Employment Dynamics. University of California, Berkeley.

Dale Belman, labor economics professor. Michigan State University.

Charlie Brown, professor of economics. University of Michigan.

Richard Burkhauser, professor emeritus of policy analysis. Cornell University.

David Card, Class of 1950 professor of economics. University of California, Berkeley.

Arindrajit Dube, professor of economics. University of Massachusetts Amherst.

SooCheong “Shawn” Jang, professor of hospitality and tourism management. Purdue University.

Fatih Karahan, senior economist. Federal Reserve Bank of New York.

David Neumark, distinguished professor of economics and co-director of the Center for Population, Inequality and Policy. University of California-Irvine.

Joseph Sabia, professor of economics and director of the Center for Health Economics & Policy Studies. San Diego State University.

Till Marco von Wachter, professor of economics, UCLA.

Paul Wolfson, statistical research associate. Dartmouth College.

*Dropped out of race since publication date.

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Print newspaper coverage of suicide falls short of expert recommendations suggested by the website Reporting on Suicide and the American Foundation for Suicide Prevention, new research in JAMA Network Open finds.

How the news media covers suicide matters. Research suggests that reports on celebrity suicides are linked to subsequent increases in suicides — a so-called “copycat” or contagion effect. Mental health advocates urge that thoughtful reporting — for example, stressing the preventable nature of suicide, working to destigmatize mental illness and avoiding the glamorization of a celebrity’s death — may prevent contagion and connect individuals with needed mental health resources.

Accordingly, projects such as Reporting on Suicide have enlisted the expertise of journalism and suicide prevention experts to develop guidelines for reporting on suicide. It’s worth noting here that these are recommendations, not rules. Individual newsrooms and news organizations may have their own guidelines for how to approach the topic of suicide — or have no guidelines at all. And individual journalists may have differing opinions about the media’s responsibility in covering the issue.

It’s also worth noting that the guidelines are largely based on peer-reviewed research. As the “About” page on the Reporting on Suicide website explains, “The recommendations are based on more than 50 international studies on suicide contagion.”

The new study scrutinizes 10 print newspapers’ coverage of two celebrities who recently died by suicide — designer Kate Spade on June 5, 2018 and chef Anthony Bourdain on June 8, 2018.

The newspapers included in the study represent all regions of the U.S. and had a minimum print circulation of 200,000.  The papers included were the Chicago Tribune, Denver Post, Houston Chronicle, Los Angeles Times, New York Times, Seattle Times, Tampa Bay Times, USA Today, Wall Street Journal and Washington Post.

The authors wanted to focus on papers with wide readership because of their larger impact and because they tend to feature original reporting and writing on suicide deaths instead of republishing wire stories, John P. Ackerman, senior author on the paper and the suicide prevention coordinator for the Center for Suicide Prevention and Research at Nationwide Children’s Hospital in Columbus, Ohio explains.

In coverage from the day after each of the deaths, researchers examined how closely the publications followed 14 guidelines gleaned from Reporting on Suicide and the American Foundation for Suicide Prevention on covering suicide responsibly. June 11 was used for reporting on Bourdain’s death in USA Today, because it publishes in print on weekdays only.

“A really unfortunate natural experiment arose with Kate Spade and Anthony Bourdain’s deaths that occurred closely together,” says Ackerman.

Some of the media coverage of Spade’s death was criticized by suicide prevention organizations and research organizations (such as the Annenberg Public Policy Center) for its sensationalist bent, including details such as the color of a scarf used as the lethal means.

He explains that his team was interested in whether coverage of Bourdain’s death just a few days after Spade’s followed more guidelines, perhaps in response to this criticism.

The researchers find that reports of Bourdain’s death adhered to more of the 14 guidelines than reports on Spade’s death. That, they note, indicates that criticism of the coverage of Spade’s death might have influenced how journalists covered Bourdain’s death.

However, none of the papers studied adhered to all 14 guidelines in their coverage of either death.

They all followed two of the guidelines, however: to avoid including “a single-cause explanation for suicide death” and avoid “referring to suicide as a growing problem, epidemic, or skyrocketing.”

None of the newspapers followed these two guidelines: to share a hopeful message that suicide is preventable and convey that suicidal behaviors can be reduced with mental health support.

For both deaths, most newspapers followed less than half the 14 guidelines.

Fewer than one-third followed six of them.

“Fairly consistently, [newspapers] weren’t doing the things that we know are pretty straightforward,” Ackerman says. He calls it “a missed opportunity to support those who are most vulnerable.”

He says the main goal of the study “is not to wag fingers at journalists.”

“It’s to say, not only can you reduce the harm of a story about a celebrity suicide, but there’s things that you can do that can potentially create a very positive impact,” he says. “There’s so many messages out there that could really be helpful.”

Ackerman says that effective journalistic practices include linking suicide to underlying mental health causes, stressing that suicidal crises are typically short-lived, providing details about resources available and reporting that most people who survive suicide attempts will not go on to die by suicide.

He suggests that training journalists early in their careers could help improve adherence to guidelines. He also recommends newsrooms use a checklist developed by Reportingonsuicide.org.

“It’s striking that we still treat the topic of suicide with a level of stigma and morbid curiosity that we don’t cover other forms of death with,” he says. “If a person died of a heart attack, would you be talking about the scarf that they were wearing? So I think we still have a ways to go in not sensationalizing this.”

But, he says, the groundwork is in place for positive change to occur.

“There are guidelines that are easily accessible,” he says “There are resources that can be added to any story, without too much additional effort or space.”

What to do (and what to avoid) when reporting on suicide

According to the 14 guidelines, responsible news coverage of suicide:

Shares a hopeful message that suicide is preventable.

Conveys that suicidal behaviors can be reduced with mental health support and treatment.

Provides helpful information, such as warning signs or risk factors of suicide.

Does not provide details about the location of the death.

Provides the National Suicide Prevention Lifeline phone number.

Does not include details or images of the lethal means or method used.

Is not prominently placed in the newspaper.

Does not describe suicide as inexplicable or without warning.

Does not report specific details concerning notes left behind.

Uses language preferred by mental health advocates, e.g., “died by suicide” rather than “committed suicide.”

Uses a photo that focuses on the individual’s life instead of his or her death.

Uses a non-sensational headline.

Avoids single-cause explanation for suicide death.

Avoids referring to suicide as a growing problem, epidemic or skyrocketing.

Per the guidelines above, we are including the number for the National Suicide Prevention Lifeline, a toll-free hotline available to people having thoughts of suicide. That number is 1-800-273-8255 (TALK). SpeakingOfSuicide.com/resources includes a list of additional resources for people having suicidal thoughts, as well as resources for their friends and families.

More research: Journalists perpetuate myth about suicide during winter holidays; Suicide prevention: Research on successful interventions; How the news media impacts suicide trends: Research roundup

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Communities around the country grapple with what to do with their vacant and abandoned buildings, which, over time, can become eyesores. Dilapidated buildings can hurt the value of surrounding property and become public health hazards. Elected leaders know they are also major barriers to revitalizing urban areas such as downtown shopping districts and low-income neighborhoods.

Vacant and abandoned buildings are such serious problems that some local governments threaten steep fines if owners allow their unused buildings to fall into disrepair or become safety hazards. Some states have adopted laws to fight urban blight. For example, in 2016, New York Gov. Andrew Cuomo signed sweeping legislation to prevent foreclosures and rehabilitate “zombie properties.” A law in Washington state that takes effect in May 2018 will allow cities to force lending institutions to maintain properties that are empty during foreclosure.

Many journalists covering local governments will inevitably have to cover issues related to abandoned property and urban renewal. To help, Journalist’s Resource has gathered a sampling of research that looks at redevelopment efforts in cities such as Detroit and Cleveland as well as studies that examine how abandoned structures affect crime, property values and public health.

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Preventing and reusing abandoned buildings

“Reuse of Abandoned Property in Detroit and Flint”
Dewar, Margaret. Journal of Planning Education and Research, 2015. DOI: 10.1177/0739456X15589815.

Abstract: “When owners stop paying property taxes, a government forecloses on the property. This research compares outcomes after auctions, the common way governments sell tax-reverted property, with outcomes after sales from a city department and a land bank authority. Data on a random sample of sold properties came from field research and administrative sources. Auctions failed in returning property to reuse compared to other ways of selling tax-reverted property. Managed sales led to more owner-occupied homes, additions of side lots to homes and businesses, and redevelopment and reuse as well as fewer returns to foreclosure and less property flipping.”

“Vacant and Abandoned Properties: Turning Liabilities Into Assets”
U.S. Department of Housing and Urban Development report, Winter 2014.

Highlights: “The absence of universal definitions of vacancy and abandonment complicates efforts to assess the number of vacant and abandoned properties nationally. Vacant and abandoned properties are linked to increased rates of crime (particularly arson) and declining property values. The maintenance or demolition of vacant properties is a huge expense for many cities. It is critical to match strategies for combating vacancy to neighborhood market conditions.”

 “Greening the Rust Belt: A Green Infrastructure Model for Right Sizing America’s Shrinking Cities”
Schilling, Joseph; Logan, Jonathan. Journal of the American Planning Association, 2008. DOI: 10.1080/01944360802354956.

Purpose: “We define strategies shrinking cities can use to convert vacant properties to valuable green infrastructure to revitalize urban environments, empower community residents, and stabilize dysfunctional real estate markets. To do this we examine shrinking cities and their vacant property challenges; identify the benefits of urban greening; explore the policies, obstacles, and promise of a green infrastructure initiative; and discuss vacant property reclamation programs and policies that would form the nucleus of a model green infrastructure right-sizing initiative designed to stabilize the communities with the greatest level of abandonment.”

“Selling Tax-Reverted Land: Lessons from Cleveland and Detroit: New This Spring Westchester”
Dewar, Margaret. Journal of the American Planning Association, 2006. DOI: 10.1080/01944360608976737.

Abstract: “Property abandonment is widespread in many northeastern and midwestern cities. Some cities succeed better than others at moving abandoned properties to new uses. Comparing Detroit and Cleveland, where indicators of demand for land look similar, reveals that Clevelanďs land bank has been an effective approach to selling tax-reverted land for reuse, while Detroit’s method of land disposition has been less successful. Cleveland integrates its approach into the mayor’s agenda for housing development and supports redevelopment with many complementary efforts. Clevelanďs land bank conveys land with clear title, has an accurate property inventory, ‘banks’ property, and sells for predictable, low prices.”

“Year-Round Vacancy Rates for the 75 Largest Metropolitan Statistical Areas: 2015 to 2017”
U.S. Census Bureau report, 2018.

Summary: This spreadsheet from the U.S. Census provides data on the percentage of housing that was left vacant all year in the nation’s top 75 largest areas between 2015 and 2017. Year-round vacancy rates ranged from 3.9 percent in Fresno, California to 11.8 percent in the Baltimore region to 20.2 percent in the Cape Coral-Fort Myers area of Florida.

Impacts on crime

“Urban Blight Remediation as a Cost-Beneficial Solution to Firearm Violence”
Branas, Charles C.; et al. American Journal of Public Health, 2016. DOI: 10.2105/AJPH.2016.303434.

Conclusions: “Abandoned buildings and vacant lots are blighted structures seen daily by urban residents that may create physical opportunities for violence by sheltering illegal activity and illegal firearms. Urban blight remediation programs can be cost-beneficial strategies that significantly and sustainably reduce firearm violence.”

“A Difference-In-Differences Study of the Effects of a New Abandoned Building Remediation Strategy on Safety”
Kondo, Michelle C.; et al. PLOS ONE, 2015. DOI: 10.1371/journal.pone.0129582.

Abstract: “Vacant and abandoned buildings pose significant challenges to the health and safety of communities. In 2011 the City of Philadelphia began enforcing a Doors and Windows Ordinance that required property owners of abandoned buildings to install working doors and windows in all structural openings or face significant fines. We tested the effects of the new ordinance on the occurrence of crime surrounding abandoned buildings from January 2011 to April 2013 using a difference-in-differences approach. We used Poisson regression models to compare differences in pre- and post-treatment measures of crime for buildings that were remediated as a result of the ordinance (n = 676) or permitted for renovation (n = 241), and randomly-matched control buildings that were not remediated (n = 676) or permitted for renovation (n = 964), while also controlling for sociodemographic and other confounders measured around each building. Building remediations were significantly associated with citywide reductions in overall crimes, total assaults, gun assaults and nuisance crimes (p <0.001). Building remediations were also significantly associated with reductions in violent gun crimes in one city section (p <0.01). At the same time, some significant increases were seen in narcotics sales and possession and property crimes around remediated buildings (p <0.001). Building renovation permits were significantly associated with reductions in all crime classifications across multiple city sections (p <0.001). We found no significant spatial displacement effects. Doors and windows remediation offers a relatively low-cost method of reducing certain crimes in and around abandoned buildings. Cities with an abundance of decaying and abandoned housing stock might consider some form of this structural change to their built environments as one strategy to enhance public safety.”

“Foreclosure, Vacancy and Crime”
Cui, Lin; Walsh, Randall. Journal of Urban Economics, 2015. DOI: 10.1016/j.jue.2015.01.001.

Abstract: “This paper examines the impact of residential foreclosures and vacancies on violent and property crime. To overcome confounding factors, a difference-in-difference research design is applied to a unique data set containing geocoded foreclosure and crime data from Pittsburgh, Pennsylvania. Results indicate that while foreclosure alone has no effect on crime, violent crime rates increase by roughly 19 percent once the foreclosed home becomes vacant — an effect that increases with length of vacancy. We find weak evidence suggesting a potential vacancy effect for property crime that is much lower in magnitude.”

“Addressing Foreclosed and Abandoned Properties”
Pais, Roxann; Wolf, Robert V. U.S. Bureau of Justice Assistance report, 2010. NCJ Number: 230184.

Abstract: “With nearly 3.2 million foreclosures in the United States in 2008, it is understandable that much of the public’s attention has been focused on the economic repercussions of the Nation’s housing crisis. However, the repercussions for law enforcement have been as significant. The increased foreclosures and abandoned properties has generated many interrelated problems from unsafe structures and higher crime rates to homelessness and strains on municipal services. This guide offers ideas and potential responses to help policymakers, law enforcement agencies, and community partners address the challenges presented by foreclosed and abandoned properties. Ideas are offered in the areas of prevention (i.e., create housing resource center, develop process to clear legal title for heirs, offer temporary and/or extended financial assistance, establish emergency loan program), enforcement (i.e., require vacancy license and liability insurance, impose a tax on abandoned property, make ‘nuisance’ crimes a felony, expedite tax foreclosures, create an enforcement task force, use inspection warrant), and reuse (i.e., consider demolition, create a land bank, create a side-yard program, broaden receivership laws, build greater special financing for property in troubled neighborhoods).”

Impacts on surrounding environment

“Testing the Temporal Nature of Social Disorder through Abandoned Buildings and Interstitial Spaces”
Wallace, Danielle; Schalliol, David. Social Science Research, 2015. DOI: 10.1016/j.ssresearch.2015.06.013.

Abstract: “With the recent housing crisis, studying abandoned buildings has once again become important. However, it has been some time since abandoned buildings were the subject of direct study, leaving scholars with scant knowledge about the characteristics of abandoned buildings, how they change, and their relationship to neighborhood processes. To fill this gap, we employed longitudinal photographic and SSO evaluations of 36 abandoned buildings and their immediate surroundings in Chicago for one year (n = 587). Results demonstrate the presence and severity of social disorder cues vary across time points and the time of day of observation. There is a relationship between abandoned buildings and social disorder, though the relationship is not a trend. Also, social disorder is diminished around extremely decayed buildings. Lastly, we find that our results are driven by the measurement of places ignored by most SSO studies, including alleys and the rear side of buildings.”

“The Impact of Abandoned Properties on Nearby Property Values”
Han, Hye-Sung. Housing Policy Debate, 2014. DOI: 10.1080/10511482.2013.832350.

Abstract: “Previous research has shown that housing abandonment contributes to neighborhood decline by depressing nearby property values. However, most past research estimated the impact of abandonment through cross-sectional analysis without controlling for nearby foreclosures or local housing market trends. Therefore, it remains unclear whether abandoned properties reduce nearby property values or whether abandonment is more common in areas with already lower-valued properties. Prior research also has not explored how the duration of abandonment influences nearby property values. Therefore, to extend the current level of understanding of the impact of abandonment, this research examines the impact of abandoned properties on nearby property values in Baltimore, Maryland, from 1991 to 2010 using longitudinal data sets while simultaneously controlling for both nearby foreclosures and local housing market trends. This research finds that as properties are abandoned for longer periods of time, the impact on nearby property values not only increases in magnitude but also is seen increasingly farther away.”

“Proximity to Vacant Buildings is Associated with Increased Fire Risk in Baltimore, Maryland, Homes”
Schachterle, Stephen E.; et al. Injury Prevention, 2012. DOI: 10.1136/injuryprev-2011-040022.

Results: “On average, a 10 percent increase in the proportion of vacancies in a census tract was associated with a 9.9 percent increase in fires.”

Impact on health, wellbeing

“More Than Just An Eyesore: Local Insights and Solutions on Vacant Land And Urban Health”
Garvin, Eugenia. Journal of Urban Health, 2013. DOI: 10.1007/s11524-012-9782-7.

Abstract: “Vacant land is a significant economic problem for many cities, but also may affect the health and safety of residents. In order for community-based solutions to vacant land to be accepted by target populations, community members should be engaged in identifying local health impacts and generating solutions. We conducted 50 in-depth semi-structured interviews with people living in Philadelphia, Pennsylvania, a city with high vacancy, about the impact of vacant land on community and individual health and safety, as well as ideas for solutions to vacant land. Participants described a neighborhood physical environment dominated by decaying abandoned homes and overgrown vacant lots which affected community well-being, physical health, and mental health. Vacant land was thought to affect community well-being by overshadowing positive aspects of the community, contributing to fractures between neighbors, attracting crime, and making residents fearful. Vacant land was described as impacting physical health through injury, the buildup of trash, and attraction of rodents, as well as mental health through anxiety and stigma. Participants had several ideas for solutions to vacant land in their community, including transformation of vacant lots into small park spaces for the elderly and playgrounds for youth, and the use of abandoned homes for subsidized housing and homeless shelters. A few participants took pride in maintaining vacant lots on their block, and others expressed interest in performing maintenance but lacked the resources to do so. Public health researchers and practitioners, and urban planners should engage local residents in the design and implementation of vacant land strategies. Furthermore, municipalities should ensure that the health and safety impact of vacant land helps drive policy decisions around vacant land.”

“Neighborhood Social Conditions Mediate the Association Between Physical Deterioration and Mental Health”
Kruger, Daniel J.; Reischl, Thomas M.; Gee, Gilbert C. American Journal of Community Psychology, 2007. DOI: 10.1007/s10464-007-9139-7.

Abstract: “This study investigates how neighborhood deterioration is associated with stress and depressive symptoms and the mediating effects of perceived neighborhood social conditions. Data come from a community survey of 801 respondents geocoded and linked to a systematic on‐site assessment of the physical characteristics of nearly all residential and commercial structures around respondents’ homes. Structural equation models controlling for demographic effects indicate that the association between neighborhood deterioration and well‐being appear to be mediated through social contact, social capital, and perceptions of crime, but not through neighborhood satisfaction. Specifically, residential deterioration was mediated by social contact, then, social capital and fear of crime. Commercial deterioration, on the other hand, was mediated only through fear of crime. Additionally, data indicate that the functional definition of a ‘neighborhood’ depends on the characteristics measured. These findings suggest that upstream interventions designed to improve neighborhood conditions as well as proximal interventions focused on social relationships, may promote well‐being.”

Interested in more housing research? Check out The Journalist’s Resource’s other write-ups on housing affordability, eviction and low-income housing tax credits.

This photo by slworking2 was obtained from Flickr and used under a Creative Commons license.

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On Sept. 5, 2017, the U.S. Department of Homeland Security began phasing out a program that gives undocumented immigrants who came to the United States as children a two-year reprieve from deportation. The federal government immediately stopped accepting new requests for DACA, or Deferred Action for Childhood Arrivals. Meanwhile, President Donald Trump challenged Congress to make immigration reforms within the next six months, before work permits begin to expire for those who were granted DACA. Between 2012 and early 2017, the federal government approved nearly 800,000 DACA requests as well as hundreds of thousands of requests to renew a DACA upon its expiration.

As journalists cover this topic, they should understand what DACA is, what the research says about it and how it differs from the DREAM Act, formally known as the Development, Relief and Education for Alien Minors Act. Below, we offer some guidance.

What is DACA?

President Barack Obama created the DACA program through executive order in June 2012. This program overview from U.S. Citizenship and Immigration Services offers details about who qualifies, what protections are offered and work authorization. It’s worth noting that receiving DACA does not confer lawful immigration status or provide a path to conditional or permanent residency or citizenship.

Here are some helpful resources:

• This report from U.S. Citizenship and Immigration Services shows the number of people who requested and were granted or denied DACA between 2012 and 2017.
• This Q&A from the Department of Homeland Security provides a breakdown of how many work permits will expire in 2017, 2018 and 2019 for individuals with DACA.
• This 2017 letter from Attorney General Jeff Sessions explains his reasons for recommending the DACA program be phased out.
• This Q&A from the U.S. Department of Education offers information about financial aid for undocumented students. A number of DACA recipients are college students or want to remain in the country to attend college or a trade school.

What is the DREAM Act?

The Development, Relief, and Education for Alien Minors Act was first introduced in the U.S. Senate in 2001. Despite revisions, it has repeatedly failed to make it through Congress. This legislation would create a process through which undocumented immigrants who came to the U.S. as children and meet certain other criteria could become conditional residents and, eventually, permanent residents.

The most recent version of the bill, filed in July 2017, has nine co-sponsors — six Democrats and three Republicans.

What does the research say?

In recent years, scholars have examined the DACA program’s impact on local communities as well as undocumented immigrants and their families. Below, we have gathered a sampling of published academic research on the subject. We also have included research related to DACA and political and social activism.

Short-term benefits to undocumented adults

“Becoming DACAmented: Assessing the Short-Term Benefits of Deferred Action for Childhood Arrivals (DACA)”
Gonzales, Roberto G.; Terriquez, Veronica; Ruszczyk, Stephen P. American Behavioral Scientist, 2014. DOI: 10.1177/0002764214550288.

Abstract: “In response to political pressure, President Obama authorized the Deferred Action for Childhood Arrivals (DACA) program in 2012, giving qualified undocumented young people access to relief from deportation, renewable work permits, and temporary Social Security numbers. This policy opened up access to new jobs, higher earnings, driver’s licenses, health care, and banking. Using data from a national sample of DACA beneficiaries (N = 2,381), this article investigates variations in how undocumented young adults benefit from DACA. Our findings suggest that, at least in the short term, DACA has reduced some of the challenges that undocumented young adults must overcome to achieve economic and social incorporation. However, those with higher levels of education and access to greater family and community resources appear to have benefited the most. As such, our study provides new insights into how social policy interacts with other stratification processes to shape diverging pathways of incorporation among the general pool of undocumented immigrants.”

Health impacts 

“Health Consequences of the U.S. Deferred Action for Childhood Arrivals (DACA) Immigration Program: A Quasi-Experimental Study”
Venkataramani, Atheendar S.; et al. The Lancet, 2017. DOI: 10.1016/S2468-2667(17)30047-6.

Summary: “In this quasi-experimental study of Hispanic adults in the U.S.A., we found that exposure to the DACA program led to meaningful reductions in symptoms of psychological distress among DACA-eligible individuals. The effects on mental health were large and clinically significant, with the DACA program significantly reducing the odds of individuals reporting moderate or worse psychological distress. We did not find any improvements in self-reported overall health, which was consistent with the fact that the population was relatively young (mean age <40 years in all groups) and therefore generally in good physical health.”

“Coming of Age on the Margins: Mental Health and Wellbeing among Latino Immigrant Young Adults Eligible for Deferred Action for Childhood Arrivals (DACA)”
Siemons, Rachel; et al. Journal of Immigrant and Minority Health, 2017. DOI 10.1007/s10903-016-0354-x.

Abstract: “Undocumented immigrant young adults growing up in the United States face significant challenges. For those qualified, the Deferred Action for Childhood Arrivals (DACA) program’s protections may alleviate stressors, with implications for their mental health and wellbeing (MHWB). We conducted nine focus groups with 61 DACA-eligible Latinos (ages 18–31) in California to investigate their health needs. Participants reported MHWB as their greatest health concern and viewed DACA as beneficial through increasing access to opportunities and promoting belonging and peer support. Participants found that DACA also introduced unanticipated challenges, including greater adult responsibilities and a new precarious identity. Thus, immigration policies such as DACA may influence undocumented young adults’ MHWB in expected and unexpected ways. Research into the impacts of policy changes on young immigrants’ MHWB can guide stakeholders to better address this population’s health needs. MHWB implications include the need to reduce fear of deportation and increase access to services.”

Economic impact

“Do Human Capital Decisions Respond to the Returns to Education? Evidence from DACA”
Kuka, Elira; Shenhav, Na’ama; Shih, Kevin. National Bureau of Economic Research working paper No. 24315, February 2018.

Abstract: “This paper studies the human capital responses to a large shock in the returns to education for undocumented youth. We obtain variation in the benefits of schooling from the enactment of the Deferred Action for Childhood Arrivals (DACA) policy in 2012, which provides work authorization and deferral from deportation for high school educated youth. We implement a difference-in-differences design by comparing DACA eligible to non-eligible individuals over time, and we find that DACA had a significant impact on the investment decisions of undocumented youth. High school graduation rates increased by 15 percent while teenage births declined by 45 percent. Further, we find that college attendance increased by 25 percent among women, suggesting that DACA raised aspirations for education above and beyond qualifying for legal status. We find that the same individuals who acquire more schooling also work more (at the same time), counter to the typical intuition that these behaviors are mutually exclusive, indicating that the program generated a large boost in productivity.”

“The Effects of DACAmentation: The Impact of Deferred Action for Childhood Arrivals on Unauthorized Immigrants”
Pope, Nolan G. Journal of Public Economics, November 2016. DOI: 10.1016/j.jpubeco.2016.08.014.

Abstract: “As the largest immigration policy in 25 years, Deferred Action for Childhood Arrivals (DACA) made deportation relief and work authorization available to 1.7 million unauthorized immigrants. This paper looks at how DACA affects DACA-eligible immigrants’ labor market outcomes. I use a difference-in-differences design for unauthorized immigrants near the criteria cutoffs for DACA eligibility. I find DACA increases the likelihood of working by increasing labor force participation and decreasing the unemployment rate for DACA-eligible immigrants. I also find DACA increases the income of unauthorized immigrants in the bottom of the income distribution. I find little evidence that DACA affects the likelihood of attending school. Using these estimates, DACA moved 50,000 to 75,000 unauthorized immigrants into employment. If the effects of Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA) are similar to DACA, then DAPA could potentially move over 250,000 unauthorized immigrants into employment.”

State responses 

“Navigating DACA in Hospitable and Hostile States: State Responses and Access to Membership in the Wake of Deferred Action for Childhood Arrivals”
Cebulko, Kara; Silver, Alexis. American Behavioral Scientist, 2016. DOI: 10.1177/0002764216664942.

Abstract: “This study examines the ways in which liminally legal young immigrants respond to shifting policies that either legitimize or delegitimize their presence within state and national boundaries. Borne out of two larger studies that rely on ethnographic and in-depth interview data in Massachusetts and North Carolina, we primarily focus on longitudinal interviews with individuals responding to Deferred Action for Childhood Arrivals (DACA). We examine the ways in which federal and state policies interact to affect access to membership for young adult immigrants in states with very different political climates. In Massachusetts, young adults felt more legitimacy and were more optimistic in their abilities to redirect their life pathways after DACA. In contrast, in the more hostile environment of North Carolina, state policies continued to impede mobility pathways and differentiate previously undocumented youth as outsiders even after the passage of DACA. Instead of characterizing the transition to adulthood for liminally legal youth as a unidirectional transition to exclusion, we emphasize the interactive influence of state- and federal-level policies and illustrate how incorporation can occur on multiple levels and even in opposite directions simultaneously. Moreover, we discuss how hostile policies in one state appear to reverberate outward, suggesting spillover effects for respondents in other states.”

DACA and civic engagement, activism

“Participation in Black Lives Matter and deferred action for childhood arrivals: Modern activism among Black and Latino college students”
Hope, Elan C.; Keels, Micere; Durkee, Myles I. Journal of Diversity in Higher Education, 2016. DOI: 10.1037/dhe0000032.

Abstract: “Political activism is one way racially/ethnically marginalized youth can combat institutional discrimination and seek legislative change toward equality and justice. In the current study, we examine participation in #BlackLivesMatter (BLM) and advocacy for Deferred Action for Childhood Arrivals (DACA) as political activism popular among youth. Participants were 533 Black and Latino college students. We found that both Black and Latino students reported more involvement in BLM than DACA. There were no gender differences in participation for Black students, but Latina women reported greater participation in BLM and DACA than Latino men. We also tested whether demographic characteristics, racial/ethnic microaggressions, and political efficacy predict BLM and DACA involvement. For Black students, prior political activism predicted involvement in BLM and DACA and immigration status predicted DACA involvement. For Latino students, more experiences of racial/ethnic microaggressions predicted involvement in BLM and DACA and political efficacy predicted DACA involvement. Findings highlight rates of participation in modern sociopolitical movements and expand our understanding of how psychological factors may differentially promote activism for Black and Latino college students.”

“The Role of Campus Support, Undocumented Identity, and Deferred Action for Childhood Arrivals on Civic Engagement for Latinx Undocumented Undergraduates”
Katsiaficas, Dalal; Volpe, Vanessa; Raza, Syeda S.; Garcia, Yuliana. Child Development, 2017. DOI: 10.1111/cdev.12933.

Abstract: “This study examined civic engagement in a sample of 790 undocumented Latinx undergraduates (aged 18–30). The relations between social supports (campus safe spaces and peer support) and civic engagement and whether a strong sense of undocumented identity mediated this relation were examined. Competing statistical models examined the role of participants’ status (whether or not they received temporary protection from deportation with Deferred Action for Childhood Arrivals [DACA]) in this mediational process. Results revealed that having a strong identification with being undocumented mediated the role of social supports on civic engagement in the overall sample, and that this process was specifically important for those with DACA status. The intersection of policies such as DACA and the lived experiences of Latinx undocumented college students are discussed.” 

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Policymakers pay a lot of attention to the meals served in public schools. In the midst of a nationwide childhood obesity epidemic, lawmakers are working to improve the nutritional value of foods and beverages served on campus. Some research suggests healthier lunches lead to higher test scores and that many kids rely on school meals as their main source of food.

The federally funded National School Lunch Program helps education leaders gauge the needs of a school. Students who are most likely to eat meals prepared in school cafeterias are from lower-income households and qualify for free- or reduced-price breakfasts and lunches. The percentage of students receiving subsidized meals is often used to measure a community’s poverty. Some education funding is earmarked specifically for schools where a large proportion of students get free- or reduced-price meals.

Nationally, 51.3 percent of public school students were eligible for free- or reduced-price lunches in 2012-13 – up from 38.3 percent in 2000-01, according to the National Center for Education Statistics. The states with the largest proportion of students qualifying for free or reduced-price lunches in 2012-13 were Mississippi (71.7 percent), New Mexico (68.2 percent) and Louisiana (66.2 percent).

This collection of academic research on school meals looks at the link between lunch quality and academic performance, the effectiveness of efforts to improve school meals and the amount of food waste in campus cafeterias.

Other helpful resources include fact sheets on the National School Lunch Program and the School Breakfast Program. The U.S. Department of Agriculture releases annual reports on the amount the federal government pays for school meals. A 2016 survey by the School Nutrition Association (SNA) tracks trends related to school meals, including how schools handle students with cafeteria debts. SNA, a professional organization, released a statement in 2017 on “school lunch shaming.”

——

School meals and learning

“School Lunch Quality and Academic Performance”
Anderson, Michael L.; Gallagher, Justin; Ritchie, Elizabeth Ramirez. Working paper for the National Bureau of Economic Research, 2017. No. 23218.

Abstract: “Improving the nutritional content of public school meals is a topic of intense policy interest. A main motivation is the health of school children, and, in particular, the rising childhood obesity rate. Medical and nutrition literature has long argued that a healthy diet can have a second important impact: improved cognitive function. In this paper, we test whether offering healthier lunches affects student achievement as measured by test scores. Our sample includes all California (CA) public schools over a five-year period. We estimate difference-in-difference style regressions using variation that takes advantage of frequent lunch vendor contract turnover. Students at schools that contract with a healthy school lunch vendor score higher on CA state achievement tests, with larger test score increases for students who are eligible for reduced price or free school lunches. We do not find any evidence that healthier school lunches lead to a decrease in obesity rates.”

“Food for Thought: The Effects of School Accountability Plans on School Nutrition”
Figlio, David N.; Winicki, Joshua. Journal of Public Economics, 2005. DOI: 10.1016/j.jpubeco.2003.10.007.

Abstract: “With the passage of the No Child Left Behind Act of 2001, school accountability is now federal law, continuing the recent trend of states implementing significant accountability systems for schools. This paper studies an unusual yet powerful school response to accountability systems. Using disaggregated school lunch menus from a random sample of school districts in Virginia, we find that schools threatened with accountability sanctions increase the caloric content of their lunches on testing days in an apparent attempt to boost short-term student cognitive performance. Moreover, we find that the schools that responded the most along these dimensions experienced the greatest improvements in standardized test scores.”

“Not Just for Poor Kids: The Impact of Universal Free School Breakfast on Meal Participation and Student Outcomes”
Leos-Urbel, Jacob; Schwartz, Amy Ellen; Weinstein, Meryle; Corcoran, Sean. Economics of Education Review, 2013. DOI: 10.1016/j.econedurev.2013.06.007.

Abstract: “This paper examines the impact of the implementation of a universal free school breakfast policy on meals program participation, attendance, and academic achievement. In 2003, New York City made school breakfast free for all students regardless of income, while increasing the price of lunch for those ineligible for meal subsidies. Using a difference-in-difference estimation strategy, we derive plausibly causal estimates of the policy’s impact by exploiting within and between group variation in school meal pricing before and after the policy change. Our estimates suggest that the policy resulted in small increases in breakfast participation both for students who experienced a decrease in the price of breakfast and for free-lunch eligible students who experienced no price change. The latter suggests that universal provision may alter behavior through mechanisms other than price, highlighting the potential merits of universal provision over targeted services. We find limited evidence of policy impacts on academic outcomes.”

School food waste

“Nutritional, Economic, and Environmental Costs of Milk Waste in a Classroom School Breakfast Program”
Blondin, Stacy A.; et al. American Journal of Public Health, 2017. DOI: 10.2105/AJPH.2016.303647.

Results: “Of the total milk offered to School Breakfast Program participants, 45 percent was wasted. A considerably smaller portion of served milk was wasted (26 percent). The amount of milk wasted translated into 27 percent of vitamin D and 41 percent of calcium required of School Breakfast Program meals. The economic and environmental costs amounted to an estimated $274,782 (16 percent of the district’s total annual School Breakfast Program food expenditures) and 192,260,155 liters of water over the school year in the district.”

“Younger Elementary School Students Waste More School Lunch Foods than Older Elementary School Students”
Niaki, Shahrbanou F.; et al. Journal of the Academy of Nutrition and Dietetics, 2017. DOI: 10.1016/j.jand.2016.08.005.

Conclusions: “Overall, younger students in elementary schools (K-Gr-1) consumed less of the foods they selected for their lunch meals, and wasted more than older elementary school students. Future studies should investigate why younger children wasted more food and potential strategies to reduce food waste by younger students.”

“‘It’s Just So Much Waste.’ A Qualitative Investigation of Food Waste in a Universal Free School Breakfast Program”
Blondin, Stacy A.; et al. Public Health Nutrition, 2015. DOI: 10.1017/S1368980014002948.

Results: “Stakeholders perceived food waste as a problem and expressed concern regarding the amount of food wasted. Explanations reported for food waste included food-related (palatability and accessibility), child-related (taste preferences and satiation) and program-related (duration, food service policies, and coordination) factors. Milk and fruit were perceived as foods particularly susceptible to waste. Several food waste mitigation strategies were identified by participants: saving food for later, actively encouraging children’s consumption, assisting children with foods during mealtime, increasing staff support, serving smaller portion sizes, and composting and donating uneaten food.”

“School Lunch Waste among Middle School Students: Implications for Nutrients Consumed and Food Waste Costs”
Cohen, Juliana F.W.; et al. American Journal of Preventive Medicine, 2013. DOI:  10.1016/j.amepre.2012.09.060.

Conclusions: “There is substantial food waste among middle school students in Boston. Overall, students’ nutrient consumption levels were below school meal standards, and foods served were not valid proxies for foods consumed. The costs associated with discarded foods are high; if translated nationally for school lunches, roughly $1,238,846,400 annually is wasted. Students might benefit if additional focus were given to the quality and palatability of school meals.”

Free and reduced-price meals

“Concentration of Public School Students Eligible for Free or Reduced-Price Lunch”
Report from the National Center for Education Statistics, Updated 2017.

Summary: “In school year 2014–15, nearly half of Hispanic and Black public school students, one-third of American Indian/Alaska Native students, and one-quarter of Pacific Islander students attended high-poverty schools. In contrast, 17 percent of students of two or more races, 15 percent of Asian students, and 8 percent of White students attended high-poverty schools.”

“Low-income Children’s Participation in the National School Lunch Program and Household Food Insufficiency”
Huang, Jin; Barnidge, Ellen. Social Science & Medicine, 2016. DOI: 10.1016/j.socscimed.2015.12.020.

Abstract: “Assessing the impact of the National School Lunch Program (NSLP) on household food insufficiency is critical to improve the implementation of public food assistance and to improve the nutrition intake of low-income children and their families. To examine the association of receiving free/reduced-price lunch from the NSLP with household food insufficiency among low-income children and their families in the United States, the study used data from four longitudinal panels of the Survey of Income and Program Participation (SIPP; 1996, 2001, 2004, and 2008), which collected information on household food insufficiency covering both summer and non-summer months. The sample included 15,241 households with at least one child (aged 5–18) receiving free/reduced-price lunch from the NSLP. A dichotomous measure describes whether households have sufficient food to eat in the observed months. Fixed-effects regression analysis suggests that the food insufficiency rate is .7 (95 percent CI: .1, 1.2) percentage points higher in summer months among NSLP recipients. Since low-income families cannot participate in the NSLP in summer when the school is not in session, the result indicates the NSLP participation is associated with a reduction of food insufficiency risk by nearly 14 percent. The NSLP plays a significant role to protect low-income children and their families from food insufficiency. It is important to increase access to school meal programs among children at risk of food insufficiency in order to ensure adequate nutrition and to mitigate the health problems associated with malnourishment among children.”

Moving to healthier options

“Healthier Standards for School Meals and Snacks: Impact on School Food Revenues and Lunch Participation Rates”
Cohen, Juliana F.W.; et al. American Journal of Preventive Medicine, 2016, Vol. 51. DOI: 10.1016/j.amepre.2016.02.031.

Conclusions: “Schools experienced initial revenue losses after implementation of the standards, yet longer-term school food revenues were not impacted and school meal participation increased among children eligible for reduced-price meals. Weakening the school meal or competitive food guidelines based on revenue concerns appears unwarranted.”

“Effect of the Healthy Hunger-Free Kids Act on the Nutritional Quality of Meals Selected by Students and School Lunch Participation Rates”
Johnson, Donna B.; Podrabsky, Mary; Rocha, Anita. JAMA Pediatrics, 2016. DOI: 10.1001/jamapediatrics.2015.3918.

Results: “After implementation of the Healthy Hunger-Free Kids Act, change was associated with significant improvement in the nutritional quality of foods chosen by students, as measured by increased mean adequacy ratio from a mean of 58.7 (range, 49.6-63.1) prior to policy implementation to 75.6 (range, 68.7-81.8) after policy implementation and decreased energy density from a mean of 1.65 (range, 1.53-1.82) to 1.44 (range, 1.29-1.61), respectively. There was negligible difference in student meal participation following implementation of the new meal standards with 47 percent meal participation (range, 40.4 percent-49.5 percent) meal participation prior to the implemented policy and 46 percent participation (range, 39.1 percent -48.2 percent) afterward.”

“Lunch, Recess and Nutrition: Responding to Time Incentives in the Cafeteria”
Price, Joseph; Just, David R. Preventive Medicine, 2015. DOI: 10.1016/j.ypmed.2014.11.016.

Conclusions: “Our results show the benefits of holding recess before lunch and suggest that if more schools implement this policy, there would be significant increases in fruit and vegetable consumption among students who eat school lunch as part of the National School Lunch Program.”

“Nutrient Content of School Meals Before and After Implementation of Nutrition Recommendations in Five School Districts Across Two U.S. Counties”
Cummings, Patricia L.; et al. Preventive Medicine, 2014. DOI: 10.1016/j.ypmed.2014.03.004.

Results: “School districts in both counties made district-wide changes in their school breakfast and lunch menus. Menu changes resulted in a net reduction of calories, sugar, and sodium content offered in the meals. Net fewer calories offered as a result of the nutrition interventions were estimated to be about 64,075 kcal per student per year for LAC [Los Angeles County, California] and 22,887 kcal per student per year for SCC [Cook County, Illinois].”

Farm-to-school efforts

“Daily Access to Local Foods for School Meals: Key Drivers”
Ralston, Katherine; et al. Report from the U.S. Department of Agriculture’s Economic Research Service, 2017. EIB-168.

Abstract: “Farm-to-school programs began in the 1990s and have been encouraged by the U.S. Department of Agriculture (USDA) through grant funding, technical assistance and changes to school meal procurement regulations. In 2012, USDA’s Farm to School Program was formally established to improve access to local foods in eligible schools. Today, more than 4 in 10 school districts report serving local foods or implementing other farm-to-school activities. To examine progress toward USDA’s goal of daily availability of locally produced foods for all students and to identify potential targets for technical assistance, this report uses data from the 2013 Farm to School Census to measure the prevalence of school districts that serve local food daily and the characteristics of those districts.”

School meals as a main source of food

“The Contribution of the USDA School Breakfast and Lunch Program Meals to Student Daily Dietary Intake”
Cullen, Karen Weber; Chen, Tzu-An. Preventive Medicine Reports, 2017. DOI: 10.1016/j.pmedr.2016.11.016.

Abstract: “In the United States, the National School Breakfast (SBP) and School Lunch Program (NSLP) meals are provided for free or at a reduced price to eligible children, and are a nutrition safety net for low income children. Consuming both meals could provide 58 percent of daily intake. This paper evaluates the contribution of SBP and NSLP meals to the dietary intakes of 5-18 year old children participating in the National Health and Nutrition Examination Surveys (NHANES) from 2007 through 2012. The participants completed 24-hour dietary recalls. Least-square means and standard errors of the mean for energy and food group intakes for the total day and by school meal, and the percent of daily energy and food groups contributed by school meals were computed by analysis of covariance, with BMI, ethnicity, sex, age and poverty level as covariates. Of the 7,800 participating children aged 5-18 years in the entire dataset, 448 consumed both SBP-NSLP meals on a weekday. Almost one-half (47 percent) of the day’s energy intake was provided by the two school meals. For the major food groups, the contribution of school meals ranged from between 40.6 percent for vegetables to 77.1 percent for milk. Overall, these results provide important information on contribution of the SBP and NSLP meals to low income children’s daily dietary intake.”

School breakfast

“Expanding the School Breakfast Program: Impacts on Children’s Consumption, Nutrition and Health”
Schanzenbach, Diane Whitmore; Zaki, Mary. Working paper for the National Bureau of Economic Research, 2014. No. 20308.

Abstract: “School meals programs are the front line of defense against childhood hunger, and while the school lunch program is nearly universally available in U.S. public schools, the school breakfast program has lagged behind in terms of availability and participation. In this paper we use experimental data collected by the USDA to measure the impact of two popular policy innovations aimed at increasing access to the school breakfast program. The first, universal free school breakfast, provides a hot breakfast before school (typically served in the school’s cafeteria) to all students regardless of their income eligibility for free or reduced-price meals. The second is the Breakfast in the Classroom (BIC) program that provides free school breakfast to all children to be eaten in the classroom during the first few minutes of the school day. We find both policies increase the take-up rate of school breakfast, though much of this reflects shifting breakfast consumption from home to school or consumption of multiple breakfasts and relatively little of the increase is from students gaining access to breakfast. We find little evidence of overall improvements in child 24-hour nutritional intake, health, behavior or achievement, with some evidence of health and behavior improvements among specific subpopulations.”

School meals vs. packed lunches

“Eating School Lunch Is Associated with Higher Diet Quality among Elementary School Students”
Au, Lauren E.; et al. Journal of the Academy of Nutrition and Dietetics, 2016. DOI: 10.1016/j.jand.2016.04.010.

Results: “Students who ate school breakfast had higher total fruit (P=0.01) and whole fruit (P=0.0008) scores compared with students who only ate breakfast obtained from home. Students who ate school foods had higher scores for dairy (P=0.007 for breakfast and P<0.0001 for lunch) and for empty calories from solid fats and added sugars (P=0.01 for breakfast and P=0.007 for lunch).”

“Nutritional Comparison of Packed and School Lunches in Pre-Kindergarten and Kindergarten Children Following the Implementation of the 2012–2013 National School Lunch Program Standards”
Farris, Alisha R.; et al. Journal of Nutrition Education and Behavior, 2014. DOI: 10.1016/j.jneb.2014.07.007.

Conclusions: “Packed lunches were of less nutritional quality than school lunches. Additional research is needed to explore factors related to choosing packed over school lunches.”

Length of lunch break

“Amount of Time to Eat Lunch Is Associated with Children’s Selection and Consumption of School Meal Entrée, Fruits, Vegetables, and Milk”
Cohen; Juliana F.W.; et al. Journal of the Academy of Nutrition and Dietetics, 2016. 10.1016/j.jand.2015.07.019.

Conclusions: “During the school year, a substantial number of students had insufficient time to eat, which was associated with significantly decreased entrée, milk and vegetable consumption compared with students who had more time to eat. School policies that encourage lunches with at least 25 minutes of seated time might reduce food waste and improve dietary intake.”

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A new study suggests that laws allowing police to directly cite motorists for not wearing seat belts may be less effective than they once were at reducing accident deaths.

The issue: Seat belts save lives by drastically reducing the likelihood that drivers and passengers will die in a motor vehicle crash. An often-cited study published in 2003 by scholars from the National Bureau of Economic Research and Stanford University confirms that “mandatory seat belt laws unambiguously reduce traffic fatalities.” The study also estimates that for each 1 percentage point increase in the proportion of people using seat belts, 136 lives are saved annually.

Over the years, states have adopted what are referred to as “primary enforcement” or “secondary enforcement” seat belt laws. Primary-enforcement laws allow police to pull over motorists and ticket them (or their passengers) if seats belts are not in use. Secondary-enforcement laws permit officers to issue a ticket related to seat belts only if the officer already is citing someone for another traffic infraction. As of early 2017, 34 states and Washington DC have primary-enforcement laws for anyone riding in the front seat of a vehicle, according to the Governors Highway Safety Association, a group of state highway safety offices. Fifteen states have secondary laws for adults riding in front seats. New Hampshire is the only state without a seat belt law for adults.

Previous research has suggested that primary-enforcement laws improve traffic safety more than secondary-enforcement laws. A 2002 study published in Accident Analysis & Prevention, for example, demonstrated a reduction in motor vehicle injuries after California upgraded its seat belt law from secondary enforcement to primary enforcement. A 2006 study in the Journal of Policy Analysis and Management indicates that states with primary-enforcement laws have lower vehicle fatality rates than states with secondary-enforcement laws.

But Americans’ driving habits and other circumstances have changed since those studies were completed. Seat belt use alone has risen significantly – from about 71 percent nationally in 2000 to about 90 percent in 2016, according to the National Highway Traffic Safety Administration.

An academic study worth reading: “Primary Enforcement of Mandatory Seat Belt Laws and Motor Vehicle Crash Deaths,” published in the American Journal of Preventive Medicine, 2017.

Study summary: Sam Harper and Erin C. Strumpf of McGill University tested whether primary-enforcement laws still result in lower death rates among drivers and passengers in motor vehicles. The authors analyzed crash data from the Fatal Analysis Reporting System, a census for the National Highway Traffic Safety Administration, for the years 2000 to 2014. The Insurance Institute for Highway Safety provided data on seat-belt policies and the dates that some states upgraded from secondary-enforcement laws to primary-enforcement laws.

Harper and Strumpf considered, as part of their analysis, several factors they believed might influence traffic safety, including recent laws related to maximum speed limits, legal limits for blood alcohol concentration and graduated driver’s license programs.

Among the key findings:

• After controlling for certain factors, the authors find that switching from secondary enforcement to primary enforcement has almost no impact on traffic death rates. States that upgrade their laws are estimated to have 0.22 fewer deaths per 100,000 than states that keep their secondary-enforcement laws in place.
• These estimates “suggest that the impact of upgrading from secondary to primary enforcement on MVC [Motor Vehicle Crash] death rates may have waned in comparison to earlier studies.”
• The authors present several possible reasons why the impact of adopting primary-enforcement laws might have diminished in recent years. There is evidence that road improvements and changes in vehicle safety and design have contributed to lower crash death rates. The growing popularity of speed cameras and traffic roundabouts may have helped reduce deaths. Changes in the economy also may play a role as people tend to do less recreational driving when the economy contracts.

Other resources for journalists:

• The National Highway Traffic Safety Administration provides a variety of data on traffic crashes and deaths, including those involving motorcycles, pedestrians or impaired drivers.
• The U.S. Centers for Disease Control and Prevention offers state-specific fact sheets related to motor vehicle occupant deaths and seat belt use.
• The National Conference of State Legislators monitors legislation related to seat belts and child restraints.

Related research:

• A 2005 study from the Transportation Research Board, “Minorities and Primary Versus Secondary Belt Use Enforcement,” looks at how minority motorists were impacted when five states switched from secondary-enforcement laws to primary-enforcement laws for seat belts.
• A 2014 paper in the Journal of Policy Analysis and Management, “Do Traffic Tickets Reduce Motor Vehicle Accidents? Evidence from a Natural Experiment,” finds that tickets reduce car accidents and injuries.
• A 2015 study in the journal Traffic Injury Prevention, “The Effects of Vehicle Redesign on the Risk of Driver Death,” finds that “changes in vehicles, whether from government regulations and consumer testing that led to advanced safety designs or from other factors such as consumer demand for different sizes and types of vehicles, have been key contributors to the decline in U.S. motor vehicle occupant crash death rates since the mid-1990s.”
• Journalist’s Resource has featured academic research on the dangers of driving while texting and drowsy driving. We also have written about how devices that require speech activation can interfere with visual attention.
  

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