RAND Corporation

About: RAND Corporation is a nonprofit organization based out in Santa Monica, California, United States. It is known for research contribution in the topics: Population & Health care. The organization has 9602 authors who have published 18570 publications receiving 744658 citations.

WIC Eligibility and Participation

Abstract: The authors examine WIC eligibility and participation using the Current Population Survey (CPS), the Survey of Income and Program Participation (SIPP), and state-level administrative data.

Time of Day and the Decision to Prescribe Antibiotics

Abstract: Clinicians make many patient care decisions each day. The cumulative cognitive demand of these decisions may erode clinicians’ abilities to resist making potentially inappropriate choices. Psychologists, who refer to the erosion of self-control after making repeated decisions as decision fatigue,1,2 have found evidence that it affects nonmedical professionals. For example, as court sessions wear on, judges are more likely to deny parole, the “easier” or “safer” option.3

Geographic disparities in children's mental health care.

Abstract: Objective. It is widely believed that only a minority of vulnerable children and adolescents receive any mental health services. Although health care disparities associated with sociodemographic characteristics are well known, almost no information exists about another potentially important source of disparity for children: How does state of residence affect mental health service use? Methods. Observational analysis was conducted using the 1997 and 1999 waves of the National Survey of America’s Families (N 45 247 children aged 6–17), a population survey fielded in 13 states and a smaller geographically dispersed sample. We studied 4 dependent variables: 1) use of any mental health services and number of visits among users; 2) need for mental health care, based on 6 items from the Child Behavior Checklist; 3) unmet need (no services among children with identified need); and 4) need among users of mental health services. Results. Use of any mental health care differs >2-fold across states, ranging from 5% in California and Texas to >10% in Colorado and Massachusetts. The variation across states in service use and unmet need exceeds the differences across racial/ethnic groups or family income. For example, the odds ratio of unmet need in California versus Massachusetts is 3.04, compared with 2.33 between Hispanic and white children. Differences in population characteristics across states do not explain much of the observed geographic variation in mental health related outcomes for children. Perhaps the most disconcerting finding is that the differences in use are not paralleled by differences in need. Overall, there is no apparent relationship between levels of need and use of services across states. As a general rule, states with high rates of services do not have low levels of need or vice versa, although that situation exists. Alabama and Texas, for example, have higher rates of need and lower rates of use than the nation as a whole, whereas Washington state displays the opposite pattern. Even with the similar levels of need and service use, states differ in the effectiveness of their delivery system. Alabama and Mississippi have high rates of need and low levels of use, but rates of unmet need are not significantly higher in those 2 states than in the nation, whereas California, Florida, and Texas have the highest rates of unmet need. In California and Texas, children from high-income families are more likely to receive some mental health services than children from low-income families. In Alabama and Mississippi, as well as in the states with the lowest rates of unmet need (Colorado, Massachusetts, and Minnesota), the opposite is true: children from low-income families are much more likely to receive any mental health service than children from high-income families. Conclusions. Large differences from the national average across states in service use and unmet need are the rule, rather than the exception. National averages obscure large differences that can exceed the effects of race/ethnicity or income. The differences in the rates of use or unmet need are not driven by differences in the racial/ ethnic or socioeconomic makeup across states but more likely are the result of differences in state policies and health care market characteristics. These state policies and health care market characteristics can interact with sociodemographic characteristics and affect how effectively resources are used. For states such as California and Texas that have the lowest rates of mental health service use, it may be less important to raise the rates of service use than to deliver them to the children with the highest need, predominantly black and Hispanic children and children in low-income families. Pediatrics 2003;112:e308–e315. URL: http://www.pediatrics.org/cgi/ content/full/112/4/e308; unmet need, health disparities, behavioral health, state variations.

Using ordered attitudinal indicators in a latent variable choice model: a study of the impact of security on rail travel behaviour

Abstract: There is growing interest in the use of models that recognise the role of individuals’ attitudes and perceptions in choice behaviour. Rather than relying on simple linear approaches or a potentially bias-inducing deterministic approach based on incorporating stated attitudinal indicators directly in the choice model, researchers have recently recognised the latent nature of attitudes. The uptake of such latent attitude models in applied work has however been slow, while a number of overly simplistic assumptions are also commonly made. In this article, we present an application of jointly estimated attitudinal and choice models to a real-world transport study, looking at the role of latent attitudes in a rail travel context. Our results show the impact that concern with privacy, liberty and security, and distrust of business, technology and authority have on the desire for rail travel in the face of increased security measures, as well as for universal security checks. Alongside demonstrating the applicability of the model in applied work, we also address a number of theoretical issues. We first show the equivalence of two different normalisations discussed in the literature. Unlike many other latent attitude studies, we explicitly recognise the repeated choice nature of the data. Finally, the main methodological contribution comes in replacing the typically used continuous model for attitudinal response by an ordered logit structure which more correctly accounts for the ordinal nature of the indicators.

Alcohol and environmental justice: the density of liquor stores and bars in urban neighborhoods in the United States

Abstract: Objective: This study had two purposes: (1) to characterize the density of liquor stores and bars that individuals face according to race, economic status, and age in the urban United States and (2) to assess alternative measures of retailer density based on the road network and population. Method: We used census data on business counts and sociodemographic characteristics to compute the densities facing individuals in 9,361 urban zip codes. Results: Blacks face higher densities of liquor stores than do whites. The density of liquor stores is greater among nonwhites in lower-income areas than among whites in lower- and higher-income areas and nonwhites in higher-income areas. Nonwhite youths face higher densities of liquor stores than white youths. The density of liquor stores and bars is lower in higher-income areas, especially for nonwhites. Conclusions: Mismatches between alcohol demand and the supply of liquor stores within urban neighborhoods constitute an environmental injustice for minorities and l...