Thursday, September 27, 2012

African-American Youth are More Exposed to Alcohol Ads

In a new study released today from the Johns Hopkins School of Public Health, researchers found that African-American youth are exposed to more alcohol advertisements than youth of other races. The director of the Center on Alcohol Marketing and Youth at Johns Hopkins, David Jernigan, PhD said this outcome is a result of two key phenomena: 1) brands are specifically targeting African-American audiences and 2) African-American media habits make them more vulnerable to alcohol advertising in general because of higher levels of media consumption. Because of the devastating effects that underage drinking can cause, it is important for policymakers to protect youth from excessive exposure to alcohol and to prevent youth from developing an alcohol-related substance use disorder.

The study found that certain brands, channels and formats overexpose African-American youth to alcohol ads.
  • In magazines, they saw 32% more alcohol ads than all youth.
  • On television, they were exposed to 17% more ads per capita than all youth, including 20% more exposure to distilled spirits ads.
  • On the radio, they heard 32% more advertising for distilled spirits.

Alcohol is the most widely used drug among African-American youth; more than tobacco and far more than marijuana. This study is significant because it is well established in research that the more young people are exposed to alcohol advertising and marketing, the more likely they are to start drinking. If they are already drinking, they are more likely to drink more heavily.

Despite their disproportionate exposure to alcohol ads, African-American youth actually drink less than youths of other racial groups, which researchers attribute to factors such as poverty, social norms and religion. However, this research is still significant because African-Americans who do drink suffer more serious consequences because they tend to have less access to health care, substance abuse treatment, live in poorer neighborhoods and are incarcerated more frequently. Alcohol consumption is also linked to the three leading causes of death among African-American youth-homicide, suicide and accidental injury.

Although the study could name specific magazines, alcohol brands, and television stations that overexposed African-American youth, the study could not prove the intent of the alcohol industry to target African-American youth.

Dr. Jernigan recommends that alcohol marketers commit to cutting exposure to this high-risk population, but there is also a role for policymakers to play. The Prevention Resource Center outlines a number of measures policymakers can take to create policies aimed at retailers, adult providers, youth, and alcohol availability in general. A number of states have already implemented limits to the public’s exposure to alcohol ads. For example, New Hampshire bans alcohol billboards as well as any advertising of alcohol events, such as happy hours. Some states ban ads in alcohol outlets that are visible from the street.

Sign up on for updates on results-based public policy strategies for preventing and treating youth substance abuse – coming soon!

Friday, September 21, 2012

Alzheimer’s Disease and the Link with Junk Food

It is already well-known that a diet high in junk food can lead to obesity, diabetes and other diseases, but there is a growing body evidence that junk food can have another effect, and this one even more debilitating: Alzheimer’s disease. With 5.4 million Americans currently affected by Alzheimer’s, unless something is done this prevalence will climb higher as Americans live longer. There is a role that policymakers can play in helping to abate this growing public health crisis, and that is by putting an emphasis on prevention: creating policies that expand children and families’ access to healthy, affordable food.
Prompted by New Scientist’s September 1 cover story on the issue, The Guardian summarized the latest research suggesting that Alzheimer’s is primarily a metabolic disease. It has long been established that people with type 2 diabetes are two to three times more likely to develop Alzheimer’s than the general population. There are also associations between Alzheimer’s and obesity and metabolic syndrome. Now some scientists are strengthening the link and have even renamed Alzheimer’s disease “type 3 diabetes” because they believe that Alzheimer’s is caused largely by the brain’s impaired response to insulin. Insulin in the brain has functions beyond glucose metabolism—it also regulates the transmission of signals between nerve cells, and affects their growth, plasticity and survival.
Anyone who has cared for a family member with Alzheimer’s can affirm how disabling this disease can be, and the stresses it can put on families. In fact, more than 15 million Americans provide unpaid care valued at $210 billion for persons with Alzheimer's and other dementias.
The cost of Alzheimer’s treatment to the state and federal government is also enormous. Average per person Medicare payments for an older person with Alzheimer’s or other dementias are nearly 3 times higher than for an older person without these conditions. Medicaid payments are 19 times higher.
Research has not reached the point where scientists can unequivocally say that poor diet is a leading cause of Alzheimer’s disease, but there is enough evidence to underscore the public health message of healthy diet. Furthermore, this becomes a policy issue because low-income communities and communities that are predominately people of color have a disproportionately low access to healthy food. To possibly prevent our children of today from developing Alzheimer’s later in their lives, it will be important to invest in widening their access to healthy, affordable foods.
For policymakers, see the Policy For Results brief on increasing access to healthy affordable foods.

Wednesday, September 12, 2012

New Data from the U.S. Census on Poverty, Income and Health Insurance

Earlier today the Census Bureau released the 2011 data on income, poverty and health insurance coverage. The good news is after three consecutive years of increases, neither the official poverty rate nor the number of people in poverty were statistically different from the 2010 estimates. The bad news is there is still an unacceptable poverty rate, marked income disparities by race, and a continued shift of wealth to people in the top income percentiles.

Highlights from the Census data on poverty and income:
  • The 2011 official poverty rate for the nation was 15.0% and there were 46.2 million people in poverty, not statistically different from last year.
  • There still persists a large income disparity among racial groups, as Blacks had a poverty rate of 27.6%, Hispanics 25.3%, Asians 12.3% and Non-Hispanics Whites 9.8%.
  • Hispanics were the only ethnic group to see a change in poverty rate, which decreased from 26.5% in 2010 to 25.3% in 2011.
  • The percentage of people without health insurance coverage decreased in 2011 to 15.7% from 16.3% in 2010. The number of uninsured also decreased to 48.6 million in 2011 from 50.0 million in 2010.
  • There was a significant change in the share of aggregate income, as the top 5% of earners saw their share of aggregate income increase by 5.3%. Those in the second, middle, and fourth quintiles saw their share of aggregate income decrease by 1.6%, 1.9%, and 1.6%, respectively. Those in the lowest quintile saw no significant difference.
  • People in the lowest quintile of income increased their percentage of year-round, full-time workers by 17.3%, which was much higher than any other income quintile.
  • The percent of people in deep poverty (i.e. their income is 50% of their poverty threshold) was 6.6%--although this is not a significant change from 2010, it is important to note that 6.6% is a substantial increase from the 1967 level of 4.4%.
  • Unemployment insurance benefits saved 2.3 million people (600,000 of whom were children under 18) from being poverty
  • Social Security income saved 21.4 million people (1.1 million of whom were children under 18) from being in poverty
  • Although the Supplemental Nutrition Assistance Program (SNAP—food stamps) and the Earned Income Tax Credit (EITC) are not counted in the poverty measure, if they were: SNAP would have decreased the poverty number by 3.9 million people (1.7 million of whom were children) and the EITC would decreased the poverty number by 5.7 million people (3.1 million of whom were children).
On health insurance:
  • In 2011, the percentage of people without health insurance decreased to 15.7% from 16.3% in 2010. The number of uninsured people decreased to 48.6 million, down from 50.0 million in 2010. This is the first time in four years that the number fell.
  • However, coverage levels remain below levels prior to the Great Recession. The percentage of people without coverage remains higher than in 2007, when 14.7% of the population was uninsured.
  • Among adults aged 19-25, in 2011 27.7% were uninsured as compared to 29.8% in 2010. This is a decrease of 2.2%. There was not a significant change in insurance coverage for children under 19.

The poverty data released today tells us the percentage and demographic information of people in the United States that live in poverty.  However, the numbers indicate something else too: the impact that public policies have on poverty.  Public investment in policies that create jobs and support families significantly impacts whether or not people experience poverty.  In an earlier post, the Center on Budget and Policy Priorities connected the numbers on health insurance to related federal policies. They found that the decrease in the percentage of uninsured young people aged 19-26 can be explained in part because of the new provision under the Affordable Care Act that allow adult children to obtain coverage from their parents’ health insurance plan up to their 26th birthday. Similarly, in a recent piece by Half in 10, they outline the impact of public policy choices on poverty, including information on the tax programs that were included in the Recovery Act. Furthermore, CBPP found that it is possible to reduce poverty while reducing the deficit, as the three largest three largest deficit-reduction packages of the last two decades achieved both by increasing the EITC (in 1990 and 1993), increasing SNAP (in 1993) and creating the Children’s Health Insurance Program (CHIP) (in 1997).

The Take-Home Message
While the official poverty rate did not change from last year, it is important to note that the data shows the wealth gap between rich and poor continues to increase, and the rate of people in deep poverty remains staggeringly high.

The Census data also showed a link between full time work and the leveling-off of the poverty level.  This has meaningful implications for policymakers. Continuing to focus on job creation will help to bring more people out of poverty and stable employment at a reasonable wage will ensure they stay there. However, the data also shows the immense value of safety net programs like SNAP, the EITC, unemployment insurance, and Social Security which are there to support those  who have a job but are still struggling to meet their basic needs, those who have lost their jobs and those who may be unable to work.

While budgets are tight and falling short, and while unemployment rates and poverty remain high, it is important for policymakers to continue to work on supporting the families in greatest need - all while considering the feasibility within the current economic climate. Understanding how communities are being most affected and why will help policymakers create safety-net programs that will meet family and community needs. Creating policy with a focus on results will help to do this in a way that also efficiently allocates scarce resources and improves the odds that problems will be addressed effectively.

To read CSSP's Statement on the New Poverty Data and Implications for Children and Families please click here.

More from our blog: a primer on poverty measurement and the Census instruments used.

Thursday, September 6, 2012

To Block Grant Medicaid—A Potentially Heavy Burden for States

Medicaid, the federal health insurance program that largely serves low-income children, seniors and certain disabled adults, has been a vital component of the public safety net since its inception in 1965. Because children under Medicaid tend to be in poorer health than children in private insurance (they have a higher prevalence of asthma, autism, dental and vision problems, ADHD, developmental delays, depression, and seizure disorders), Medicaid’s benefits package was designed to meet the complex needs of low-income children. Early and Periodic Screening, Diagnosis and Treatment (EPSDT) has been essential to ensuring that children continue to have a routine source of care and preventive screening for oral health, vision, mental health, developmental issues, and physical health.

In the last four years, people have enrolled into Medicaid at a higher rate than previous years as a direct result of the recession. With more people out of work, they lose access to their employer-based health insurance, their families become impoverished and they then become income-eligible for Medicaid. Furthermore, Medicaid’s enrollment has increased because of the aging population and because of the steady decrease in the number of employers who offer health plans to employees.

Since the federal government pays for the majority of the share of Medicaid spending, this increase in enrollment has led to an increase in the proportion of federal spending that goes to Medicaid. Although Medicaid costs less for the federal government than Medicare and Social Security, it often becomes the target of cuts because people with low-income are an easy target. Therefore, to control for the rising costs of Medicaid and to reduce the federal deficit, there are two very different opinions on the direction that Medicaid should now take: (A) expand Medicaid eligibility while creating cost-savings elsewhere or (B) block grant Medicaid.

Under the Affordable Care Act, Medicaid’s eligibility rules are set to expand in 2014 so that childless, non-disabled adults would be able to enroll if their income was up to 133% of the federal poverty level. The costs of this expansion are offset by revenues from the excise tax on high-premium insurance plans and net savings from other coverage-related effects, such that the Affordable Care Act produces a net reduction to the federal deficit of $124 billion.

On the opposite end of the spectrum is a proposal to change Medicaid from a defined entitlement program to a block grant. With a set amount of dollars and no mandates on coverage, states would have more autonomy and flexibility to design their Medicaid program to meet the specific needs of the state. Under this proposal, to encourage more enrollment into private insurance, premium supports or a refundable tax credit would help non-disabled adults and children to enter the private insurance market. States would be encouraged to use block grant dollars to pay for home-based care for the aged and disabled, rather than more costly institutional care.

As noted by First Focus in their analysis of the US House of Representative’s Budget Committee bill (which would block grant Medicaid), a Medicaid block grant would result in a loss of $810 billion over 10 years of federal investment in the program. About $162 billion of the total would come from investment in children’s services. While it would save money for the federal government, it would also shift the burden of costs to states, which would face a difficult decision in how to respond.

According to the non-partisan Congressional Budget Office, which also analyzed the bill, “states would face significant challenges in achieving sufficient cost savings through efficiencies to mitigate the loss of federal funding.” States could: (A) maintain current service levels, in which case they would need to reduce spending in other areas or raise revenues, or (B) reduce the size of their Medicaid program.

To adjust to the decrease in contribution from the federal government, states would likely have to tighten eligibility restrictions, ration care that children receive and lower payments to providers. Considering that Medicaid reimbursement rates are already lower than the reimbursement rates under Medicare and private insurance, this might discourage doctors from accepting Medicaid patients.

Whether Medicaid expands as an entitlement or is reduced via a block grant, states will have flexibility to design innovative programming to get services to their populations; it will be critical that state policymakers carefully consider their options (through state plans, waivers, demonstration programs, etc.) to provide quality, cost-effective care to children.For more on strategies to ensure that children are healthy, please visit