Professor Laura Abrams, chair of Social Welfare, recently co-authored an article in Academic Pediatrics investigating the relationship between child incarceration and subsequent adult health outcomes. The United States is the world leader in youth incarceration, and research by Abrams and co-principal investigator Elizabeth Barnert, an assistant professor of pediatrics at the David Geffen School of Medicine at UCLA, aimed to bridge the data gap on repercussions from child incarceration. The study used data from the National Longitudinal Study of Adolescent to Adult Health to compare adult health outcomes in individuals grouped by age of first incarceration. The study compared individuals first incarcerated before age 14 with those first incarcerated at 15-17 years old, 18-20 years old and 21-24 years old. Among the adult health outcomes analyzed were physical health, such as mobility limitations, and mental health, including depressive symptoms and suicidal thoughts. After controlling for sociodemographic and ecological factors, the study found that “child incarceration independently predicted adult mobility limitations, adult depression and adult suicidal thoughts,” confirming the link between younger age at first incarceration and worse adult health. The research also identified sociodemographic disparities in child incarceration, finding that “individuals first incarcerated as children were disproportionately of color, more likely to be from lower socioeconomic backgrounds, and more likely to have been raised in a single-parent household.” The findings will likely have repercussions in the health arena. The report concluded, “Child incarceration displays even wider sociodemographic disparities than incarceration generally and is associated with even worse adult physical and mental health outcomes.”
Social Welfare Professor David Cohen’s comments on the side effects of coming off antidepressants were featured in a recent article in TheBody. A 60% increase in long-term antidepressant use between 2010 and 2018 has prompted research on “discontinuation syndrome,” or the intense side effects that make it difficult for patients to taper off. According to Cohen, “Coming off anything that alters how your brain functions, even coffee or tea, will provoke some kind of reaction. The brain is no longer getting that feedback from the drug, and it reacts to the removal.” After patients of one study rated their withdrawal experience, Cohen explained that “those who rated [their withdrawal] as most severe were coming off the fastest.” Experts recommend careful planning for coming off antidepressants, including a tapering plan, flexibility and a strong support system. “Go slow, and stay in your comfort zone. Feel it out as you go,” Cohen recommended.
Public Policy Professor Mark Peterson was interviewed by Roll Call about the increased presence of a single-payer healthcare plan in the 2020 presidential election discourse, especially among Democrats. What began as a fringe issue seen as something discussed only by radically far-left politicians, the idea of a single-payer healthcare plan was proposed by Sen. Bernie Sanders during his 2016 presidential run and is now supported by many Democratic candidates. Most of the debate surrounding the issue involves funding and how it would affect current healthcare systems. Peterson said much of the challenge of implementing the plan would lie in the general public’s understanding of it: “To the extent that what progressives are doing will stimulate that kind of action at the public level to really create that wave, a groundswell of support the way Social Security had, that can make an enormous political difference,” he said.
In a GQ article, associate professor of social welfare Ian Holloway commented on oppressive male beauty standards that are detrimental to body image, particularly within the gay community. The article highlighted the absurdity of societal expectations for six-pack abs, which have become a barometer for male attractiveness. As a result, even the fittest men struggle with body image. Holloway, who runs a private practice in West Hollywood working with gay individuals and couples, explained, “The vast majority of my clients, despite what their external appearance might be, whether they have a six-pack or not, wrestle with this ideal image of themselves. Body-image issues are at the top of the list of things they struggle with.” Holloway recommends, “It’s important for guys to get a clear idea of what’s attainable and realistic and work towards that, as opposed to trying to achieve the impossible ideal we’re bombarded with.”
Mark Peterson, professor of public policy and political science, spoke with Roll Call about a new single-payer “Medicare-for-all” bill being introduced by House Democrats. The bill, introduced by Rep. Pramila Jayapal of Washington, said 107 House Democrats are initially supporting the measure. Health care is a central campaign topic among 2020 Democratic presidential candidates, but there are risks for any politician who proposes dramatic change and uncertainty in a system that is central to Americans’ well-being, the article noted. Success of a single-payer system hinges on whether supporters will span the ideological spectrum within the Democratic Party, Peterson said. “The important symbolism of how it’s risen is how many Democratic presidential candidates are at least signing on thematically, even if it’s only because they support universal coverage,” he said. “But that’s where you have to start.”
By Mary Braswell
With California taking steps to revamp its health care system, research by the UCLA Luskin School of Public Affairs is guiding the conversation.
The report, published Feb. 1, details strategies to improve the affordability of Covered California, the state’s health insurance marketplace. It was co-authored by economist Wes Yin, associate professor of public policy at UCLA Luskin.
Affordability is “the top challenge for individuals who are insured as well as those who remain uninsured,” according to the report (PDF), which lays out a wide array of proposals to meet that challenge, including:
- capping out-of-pocket premiums for all eligible Californians;
- offering expanded cost-sharing benefits, which would lower deductibles and the cost of office visits; and
- creating a California-only penalty for those who opt out of coverage, to replace the penalty that was phased out by the federal government.
“This will help push the conversation forward, now with policy options that we know will improve affordability and market stability,” said Yin, who wrote the report with economist Nicholas Tilipman of the University of Illinois, Chicago, and Covered California’s policy and research division.
Commissioned under a state law, the report was presented to the governor’s office and state Legislature. It was developed amid a shifting landscape for health care in California.
On Jan. 30, Covered California reported mixed figures for 2019 enrollment. Although the number of Californians held steady from 2018 to 2019, the number of new enrollees dropped by 23.7 percent. In addition, on the first day of his term, Gov. Gavin Newsom unveiled his own far-reaching health care plan, calling for increased premium subsidies and Medicaid coverage for undocumented youths up to age 26, among other reforms.
“Our analysis gives policymakers a sense for how different approaches benefit Californians and at what cost,” Yin said. “So this report bolsters the governor’s effort to improve health care access.”
The dialogue, he said, will include a debate over the state’s funding priorities.
“From a wider lens, it’s helpful to think about how we can best spend that next public dollar,” Yin said. “It could be health care, it could be pre-K programs, it could be public education or parental leave benefits. These are all important. And there is a strong argument for improving the affordability of health care coverage and reducing cost-sharing burdens. Coverage improves health — especially mental health — it improves chronic disease management and it drastically reduces the risk of catastrophic spending and debt incurred by consumers.”
The report includes proposals to address the divisive issue of penalties for Californians who choose not to buy health insurance. Covered California attributes the decline in new enrollments to removal of the federal individual mandate penalty beginning this year. A statewide penalty would create a fresh incentive to opt in.
“The penalty appears to be quite impactful,” Yin said. “What we’re seeing in Covered California the past year shows that, and our modeling also shows that. Zeroing out the penalty has directly caused premiums to increase and enrollment to drop. Including a penalty while making plans more affordable can be both an effective and fair way of expanding coverage and lowering premiums.”
The report also notes that premium costs can vary widely for consumers based on their age and geographic location. “For consumers nearing retirement age living in high-cost regions, premium costs can exceed 30 percent of income for the most common benefit package,” it said.
To make health insurance more affordable for those consumers, California could use subsidies to cap all premium payments at 15 percent of annual income. Currently, subsidies are offered only to people who earn up to 400 percent of the federal poverty level, or $103,000 for a family of four. Consumers who earn just over the 400 percent threshold would not qualify for federal premium subsidies, Yin said. A 15 percent cap would also eliminate this so-called tax-credit cliff.
The report’s policy options are based on a model developed by Yin and Tilipman that shows the potential effects that various policy proposals would have on health care enrollment, consumer health spending and public spending.
As elected officials and consumers debate competing visions of health care reform — from repealing the federal Affordable Care Act to moving to a state-run single-payer system — Yin said the proposals are aimed at expanding coverage and increasing affordability as much as possible.
“Let’s find ways to build on the successes of the Affordable Care Act and make it work better,” Yin said. “These are models for improvement.”
The U.S. Department of Health and Human Services has named UCLA Luskin Professor of Social Welfare Mark S. Kaplan to a board of experts on the prevention of violence and injuries. Kaplan will serve a four-year term on the Board of Scientific Counselors for the National Center for Injury Prevention and Control, a branch of the Centers for Disease Control and Prevention. The CDC reports that 214,000 people die from injury every year in the United States, and millions who survive an injury face lifelong mental, physical and financial problems. The board will advise the federal agencies on a variety of research areas to help set priorities and improve public health. “This is an incredible career achievement,” Social Welfare chair Laura Abrams said of the appointment. Kaplan’s research has focused on understanding suicide risk factors among veterans, seniors and other vulnerable populations. The CDC reports that suicide is one of just three leading causes of death that are on the rise. Members of the Board of Scientific Counselors represent several disciplines and include epidemiologists, statisticians, trauma surgeons, behavioral scientists, health economists, political scientists and criminologists.
New CDC figures documenting the growing rate of suicide may not reflect the full scope of the problem, said Mark S. Kaplan, professor of social welfare at UCLA Luskin. Many suicides are actually classified as ”accidental deaths,” Kaplan, a noted suicide prevention researcher, told WebMD. “Some are classified as unintentional self-injury when, in fact, if you take a closer look, they look more like suicide,” he said. “The true incidence of suicide is unknown.” Kaplan said the Great Recession from 2007 to 2009 contributed to what he terms ”deaths of despair” by suicide. Some people, he said, never recovered economically.
UCLA Luskin Social Welfare’s Ian Holloway has received word that another of his research proposals has been selected for funding. The study, “Tobacco and Cannabis Product Use Among Subgroups of Sexual and Gender Minority Emerging Adults,” will examine trajectories of tobacco and cannabis use among sexual and gender minority young people. Previous studies of tobacco products showed higher frequency of use within LGBT communities, but less is known about specific subgroups of LGBT people or their use of cannabis. Holloway, an associate professor, said the research is timely in the wake of California’s legalization of marijuana and other cannabis products in 2016, and he was happy to learn of the funding by the California Tobacco Related Disease Research Program during the month of June, which is Gay Pride month. “This funding will help us better understand tobacco and cannabis-related health disparities among LGBT young people, which is crucial to improve both short-term and long-term health in LGBT communities” Holloway said. The award amount of $400,000 will fund research in two phases, with initial results expected in about a year. Phase I will consist of qualitative interviews about tobacco and cannabis initiation and progression with LGBT tobacco users ages 18-29 in Los Angeles. In Phase II, 1,000 LGBT young people across California will participate in an online survey about their frequency and intensity of tobacco and cannabis product use. The research will be completed in partnership with the Los Angeles LGBT Center.
The UCLA Luskin School of Public Affairs and the UCLA Food Studies Graduate Certificate Program wrapped up its 10-week “Off the Table” series on urban agriculture, food security, and food policy with a moderated discussion on the sustainability of social enterprises within the food industry led by Evan Kleiman, chef and host of “Good Food” on KCRW. She was joined by panelists Anar Joshi of Everytable, Kaitlin Mogentale of Pulp Pantry, Nick Panepinto of L.A. Kitchen and Karla T. Vasquez of SalviSoul during a gathering on Nov. 30 at the L.A. Kitchen facility in Lincoln Heights near downtown Los Angeles. Among other topics, the speakers talked about their efforts to promote healthy eating among young people. “One of our most successful programs was cooking lessons for kids,” Vasquez said during the panel discussion. “We told them, ‘You can like something, love something, or hate it. But you have to make it. There’s so much food in the world, and you get to try it all!’” Afterward, attendees had a chance to do some cooking themselves, making a vegetarian ricotta carpaccio from scratch under Kleiman’s direction. Download the recipe. View a video of the panel discussion. Browse a Flickr album of images from the event below.