Aaron Kofner

Bio: Aaron Kofner is an academic researcher from RAND Corporation. The author has contributed to research in topics: Medicaid & Mental health. The author has an hindex of 13, co-authored 58 publications receiving 762 citations.

Growth and Distribution of Child Psychiatrists in the United States: 2007-2016.

Abstract: BACKGROUND: Historically, there has been a shortage of child psychiatrists in the United States, undermining access to care. This study updated trends in the growth and distribution of child psychiatrists over the past decade. METHODS: Data from the Area Health Resource Files were used to compare the number of child psychiatrists per 100 000 children ages 0 to 19 between 2007 and 2016 by state and county. We also examined sociodemographic characteristics associated with the density of child psychiatrists at the county level over this period using negative binomial multivariable models. RESULTS: From 2007 to 2016, the number of child psychiatrists in the United States increased from 6590 to 7991, a 21.3% gain. The number of child psychiatrists per 100 000 children also grew from 8.01 to 9.75, connoting a 21.7% increase. County- and state-level growth varied widely, with 6 states observing a decline in the ratio of child psychiatrists (ID, IN, KS, ND, SC, and SD) and 6 states increasing by >50% (AK, AR, NH, NV, OK, and RI). Seventy percent of counties had no child psychiatrists in both 2007 and 2016. Child psychiatrists were significantly more likely to practice in high-income counties (P CONCLUSIONS: Despite the increased ratio of child psychiatrists per 100 000 children in the United States over the past decade, there remains a dearth of child psychiatrists, particularly in parts of the United States with lower levels of income and education.

How Much Does “How Much” Matter? Assessing the Relationship Between Children’s Lifetime Exposure to Violence and Trauma Symptoms, Behavior Problems, and Parenting Stress

Abstract: The study explores whether and how lifetime violence exposure is related to a set of negative symptoms: child internalizing and externalizing behavior problems, child trauma symptoms, and parenting stress. Using a large sample of violence-exposed children recruited to participate in intervention research, the study employs different methods of measuring that exposure. These include total frequency of all lifetime exposure, total frequency of lifetime exposure by broad category (i.e., assault, maltreatment, sexual abuse, and witnessing violence), and polyvictimization defined as exposure to multiple violence categories. The results indicate that only polyvictimization, constructed as a dichotomous variable indicating two or more categories of lifetime exposure, emerged as a consistent predictor of negative symptoms. The total lifetime frequency of all violence exposure was not associated with negative symptoms, after controlling for the influence of polyvictimization. Likewise, in the presence of a dichoto...

Federally Qualified Health Center Clinicians And Staff Increasingly Dissatisfied With Workplace Conditions

Abstract: Better working conditions for clinicians and staff could help primary care practices implement delivery system innovations and help sustain the US primary care workforce. Using longitudinal surveys, we assessed the experience of clinicians and staff in 296 clinical sites that participated in the Centers for Medicare and Medicaid Services (CMS) Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration. Participating FQHCs were expected to achieve, within three years, patient-centered medical home recognition at level 3—the highest level possible. During 2013–14, clinicians and staff in these FQHCs reported statistically significant declines in multiple measures of professional satisfaction, work environment, and practice culture. There were no significant improvements on any surveyed measure. These findings suggest that working conditions in FQHCs have deteriorated recently. Whether findings would be similar in other primary care practices is unknown. Although we did not identif...

Neighborhood effects on crime and youth violence : the role of business improvement districts in Los Angeles

Abstract: Business improvement districts (BIDs) collect assessments and invest in local service provisions and activities, such as place promotion, street cleaning, and public safety. Such activities can help reduce crime and youth violence by increasing informal social control, reducing signs of disorder and blight, improving order maintenance, and enriching job opportunities. This report examines BIDs' impact on crime and youth violence in Los Angeles.

Autonomous Vehicle Technology: A Guide for Policymakers

Abstract: Autonomous vehicles may change the transportation landscape and policymakers must find the best course to maximize social benefits while minimizing drawbacks. This report weighs the potential advantages, including safety, mobility and fuel consumption, and disadvantages, including travel demand. Current legislation in Nevada, Florida, California, and Washington, DC, and in other states, and the standards and regulations that apply to such vehicles, are outlined. The report provides a brief history of autonomous vehicles and a summary of the role of telematics and communications, and discusses liability for drivers, insurers and manufacturers. It contains guidance for policymakers and risks to be considered as policies are formulated.

In search of causality: a systematic review of the relationship between the built environment and physical activity among adults.

Abstract: Empirical evidence suggests that an association between the built environment and physical activity exists. This evidence is mostly derived from cross-sectional studies that do not account for other causal explanations such as neighborhood self-selection. Experimental and quasi-experimental designs can be used to isolate the effect of the built environment on physical activity, but in their absence, statistical techniques that adjust for neighborhood self-selection can be used with cross-sectional data. Previous reviews examining the built environment-physical activity relationship have not differentiated among findings based on study design. To deal with self-selection, we synthesized evidence regarding the relationship between objective measures of the built environment and physical activity by including in our review: 1) cross-sectional studies that adjust for neighborhood self-selection and 2) quasi-experiments. In September 2010, we searched for English-language studies on built environments and physical activity from all available years in health, leisure, transportation, social sciences, and geographical databases. Twenty cross-sectional and 13 quasi-experimental studies published between 1996 and 2010 were included in the review. Most associations between the built environment and physical activity were in the expected direction or null. Land use mix, connectivity and population density and overall neighborhood design were however, important determinants of physical activity. The built environment was more likely to be associated with transportation walking compared with other types of physical activity including recreational walking. Three studies found an attenuation in associations between built environment characteristics and physical activity after accounting for neighborhood self-selection. More quasi-experiments that examine a broader range of environmental attributes in relation to context-specific physical activity and that measure changes in the built environment, neighborhood preferences and their effect on physical activity are needed.

Women in Academic Science: A Changing Landscape

Abstract: Summary Much has been written in the past two decades about women in academic science careers, but this literature is contradictory. Many analyses have revealed a level playing field, with men and women faring equally, whereas other analyses have suggested numerous areas in which the playing field is not level. The only widely-agreed-upon conclusion is that women are underrepresented in college majors, graduate school programs, and the professoriate in those fields that are the most mathematically intensive, such as geoscience, engineering, economics, mathematics/ computer science, and the physical sciences. In other scientific fields (psychology, life science, social science), women are found in much higher percentages. In this monograph, we undertake extensive life-course analyses comparing the trajectories of women and men in math-intensive fields with those of their counterparts in non-math-intensive fields in which women are close to parity with or even exceed the number of men. We begin by examining early-childhood differences in spatial processing and follow this through quantitative performance in middle childhood and adolescence, including high school coursework. We then focus on the transition of the sexes from high school to college major, then to graduate school, and, finally, to careers in academic science. The results of our myriad analyses reveal that early sex differences in spatial and mathematical reasoning need not stem from biological bases, that the gap between average female and male math ability is narrowing (suggesting strong environmental influences), and that sex differences in math ability at the right tail show variation over time and across nationalities, ethnicities, and other factors, indicating that the ratio of males to females at the right tail can and does change. We find that gender differences in attitudes toward and expectations about math careers and ability (controlling for actual ability) are evident by kindergarten and increase thereafter, leading to lower female propensities to major in math-intensive subjects in college but higher female propensities to major in non-math-intensive sciences, with overall science, technology, engineering, and mathematics (STEM) majors at 50% female for more than a decade. Post-college, although men with majors in math-intensive subjects have historically chosen and completed PhDs in these fields more often than women, the gap has recently narrowed by two thirds; among non-math-intensive STEM majors, women are more likely than men to go into health and other people-related occupations instead of pursuing PhDs. Importantly, of those who obtain doctorates in math-intensive fields, men and women entering the professoriate have equivalent access to tenure-track academic jobs in science, and they persist and are remunerated at comparable rates—with some caveats that we discuss. The transition from graduate programs to assistant professorships shows more pipeline leakage in the fields in which women are already very prevalent (psychology, life science, social science) than in the math-intensive fields in which they are underrepresented but in which the number of females holding assistant professorships is at least commensurate with (if not greater than) that of males. That is, invitations to interview for tenure-track positions in math-intensive fields—as well as actual employment offers—reveal that female PhD applicants fare at least as well as their male counterparts in math-intensive fields.