Skip to main content
eScholarship
Open Access Publications from the University of California

This series is automatically populated with publications deposited by UCLA Luskin School of Public Affairs Department of Public Policy researchers in accordance with the University of California’s open access policies. For more information see Open Access Policy Deposits and the UC Publication Management System.

Women's well-being during a pandemic and its containment.

(2022)

The COVID-19 pandemic brought the dual crises of disease and the containment policies designed to mitigate it. Yet, there is little evidence on the impacts of these policies on women in lower-income countries, where there may be limited social safety nets to absorb these shocks. We conduct a large phone survey and leverage India's geographically varied containment policies to estimate the association between the pandemic and containment policies and measures of women's well-being, including mental health and food security. On aggregate, the pandemic resulted in dramatic income losses, increases in food insecurity, and declines in female mental health. While potentially crucial to stem the spread of COVID-19, the greater prevalence of containment policies is associated with increased food insecurity, particularly for women, and reduced female mental health. For surveyed women, moving from zero to average containment levels is associated with a 38% increase in the likelihood of reporting more depression, a 73% increase in reporting more exhaustion, and a 44% increase in reporting more anxiety. Women whose social position may make them more vulnerable - those with daughters and those living in female-headed households - experience even larger declines in mental health.

Bridging the Gap Between Pilot and Scale-Up: A Model of Antenatal Testing for Curable Sexually Transmitted Infections From Botswana.

(2022)

Background

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are common sexually transmitted infections (STIs) associated with adverse outcomes, yet most countries do not test and conduct syndromic management, which lacks sensitivity and specificity. Innovations allow for expanded STI testing; however, cost is a barrier.

Methods

Using inputs from a pilot program in Botswana, we developed a model among a hypothetical population of 50,000 pregnant women to compare 1-year costs and outcomes associated with 3 antenatal STI testing strategies: (1) point-of-care, (2) centralized laboratory, and (3) a mixed approach (point of care at high-volume sites, and hubs elsewhere), and syndromic management.

Results

Syndromic management had the lowest delivery cost but was associated with the most infections at delivery, uninfected women treated, CT/NG-related low-birth-weight infants, disability-adjusted life years, and low birth weight hospitalization costs. Point-of-care CT/NG testing would treat and cure the most infections but had the highest delivery cost. Among the testing scenarios, the mixed scenario had the most favorable cost per woman treated and cured ($534/cure). Compared with syndromic management, the mixed approach resulted in a mean incremental cost-effectiveness ratio of $953 per disability-adjusted life years averted, which is cost-effective under World Health Organization's one-time per-capita gross domestic product willingness-to-pay threshold.

Conclusions

As countries consider new technologies to strengthen health services, there is an opportunity to determine how to best deploy resources. Compared with point-of-care, centralized laboratory, and syndromic management, the mixed approach offered the lowest cost per infection averted and is cost-effective if policy makers' willingness to pay is informed by the World Health Organization's gross domestic product/capita threshold.

Cover page of COVID-19 and Children's Well-Being: A Rapid Research Agenda.

COVID-19 and Children's Well-Being: A Rapid Research Agenda.

(2021)

Purpose

Understanding the full impact of COVID-19 on U.S. children, families, and communities is critical to (a) document the scope of the problem, (b) identify solutions to mitigate harm, and (c) build more resilient response systems. We sought to develop a research agenda to understand the short- and long-term mechanisms and impacts of the COVID-19 pandemic on children's healthy development, with the goal of devising and ultimately testing interventions to respond to urgent needs and prepare for future pandemics.

Description

The Life Course Intervention Research Network facilitated a series of virtual meetings that included members of 10 Maternal and Child Health (MCH) research programs, their research and implementation partners, as well as family and community representatives, to develop an MCH COVID-19 Research Agenda. Stakeholders from academia, clinical practice, nonprofit organizations, and family advocates participated in four meetings, with 30-35 participants at each meeting.

Assessment

Investigating the impacts of COVID-19 on children's mental health and ways to address them emerged as the highest research priority, followed by studying resilience at individual and community levels; identifying and mitigating the disparate negative effects of the pandemic on children and families of color, prioritizing community-based research partnerships, and strengthening local, state and national measurement systems to monitor children's well-being during a national crisis.

Conclusion

Enacting this research agenda will require engaging the community, especially youth, as equal partners in research co-design processes; centering anti-racist perspectives; adopting a "strengths-based" approach; and integrating young researchers who identify as Black, Indigenous, and People of Color (BIPOC). New collaborative funding models and investments in data infrastructure are also needed.

Cover page of Analyzing voter support for California’s local option sales taxes for transportation

Analyzing voter support for California’s local option sales taxes for transportation

(2021)

Local and regional governments in the U.S. rely increasingly on voter-approved local option sales taxes (LOSTs) to fund transportation capital investments, maintenance, and operations. LOSTs typically present voters with lists of local transportation projects and programs to be funded by a ¼ to 1 percent sales tax increase. Most research on LOSTs are case studies, which make generalizations about LOSTs difficult. We conducted a comprehensive, multi-jurisdictional analysis of LOST measures in California, the U.S. state with the greatest number of LOST measures. We examined 76 LOST measures put to voters between 1976 and 2016 to assess factors associated with voter support. LOSTs in California are enacted by counties, which we examined in addition to smaller intra-county geographies using both regression models and case studies. We tested several explanatory variables for association with voter support including macroeconomic and political context, planned measure expenditures, voter characteristics, and spatial distribution of proposed projects. We found that funding dedicated to public transit and returned to local jurisdictions predicts support at the county level, and that LOSTs that create new taxes—as opposed to extending or renewing existing taxes—are less popular with voters, all else equal. Our analyses of sub-county geographies revealed that political party affiliation is the strongest predictor of local voter support for LOSTs and that voters living adjacent to funded projects tended to be more supportive of LOSTs.

Adoption of community monitoring improves common pool resource management across contexts.

(2021)

Pervasive overuse and degradation of common pool resources (CPRs) is a global concern. To sustainably manage CPRs, effective governance institutions are essential. A large literature has developed to describe the institutional design features employed by communities that successfully manage their CPRs. Yet, these designs remain far from universally adopted. We focus on one prominent institutional design feature, community monitoring, and ask whether nongovernmental organizations or governments can facilitate its adoption and whether adoption of monitoring affects CPR use. To answer these questions, we implemented randomized controlled trials in six countries. The harmonized trials randomly assigned the introduction of community monitoring to 400 communities, with data collection in an additional 347 control communities. Most of the 400 communities adopted regular monitoring practices over the course of a year. In a meta-analysis of the experimental results from the six sites, we find that the community monitoring reduced CPR use and increased user satisfaction and knowledge by modest amounts. Our findings demonstrate that community monitoring can improve CPR management in disparate contexts, even when monitoring is externally initiated rather than homegrown. These findings provide guidance for the design of future programs and policies intended to develop monitoring capabilities in communities. Furthermore, our harmonized, multisite trial provides sustainability science with a new way to study the complexity of socioecological systems and builds generalizable insights about how to improve CPR management.

A Tale of Two Cities: Exploring the Role of Race/Ethnicity and Geographic Setting on PrEP Use Among Adolescent Cisgender MSM.

(2021)

Although pre-exposure prophylaxis (PrEP) could substantially reduce the risk of HIV acquisition among adolescent cisgender men who have sex with men (cisMSM), various barriers faced by people of color, particularly within the southern region of the U.S., may lead to racial disparities in the utilization of PrEP. Few studies, however, have explored racial/ethnic differences in PrEP use by geographic setting among adolescent cisMSM. We conducted a cross-sectional analysis examining racial disparities in PrEP use among cisMSM ages 15-24 years in New Orleans, Louisiana, and Los Angeles, California recruited between May, 2017 and September, 2019. The odds of PrEP use among AA adolescents were considerably lower than White adolescents in New Orleans (OR (95% CI): 0.24 (0.10, 0.53)), although we did not find evidence of differences in Los Angeles. Our findings underscore the need for targeted interventions to promote PrEP use among adolescent MSM, particularly among AA adolescent cisMSM living in the southern region of U.S.

Cover page of Do Commodity Price Shocks Cause Armed Conflict? A Meta-Analysis of Natural Experiments

Do Commodity Price Shocks Cause Armed Conflict? A Meta-Analysis of Natural Experiments

(2020)

Scholars of the resource curse argue that reliance on primary commodities destabilizes governments: price fluctuations generate windfalls or periods of austerity that provoke or intensify civil conflict. Over 350 quantitative studies test this claim, but prominent results point in differentdirections, making it difficult to discern which results reliably hold across contexts. We conduct a meta-analysis of 46 natural experiments that use difference-in difference designs to estimate the causal effect of commodity price changes on armed civil conflict. We show that commodity pricechanges, on average, do not change the likelihood of conflict. However, there are cross-cutting effects by commodity type. In line with theory, we find price increases for labor-intensive agricultural commodities reduce conflict, while increases in the price of oil, a capital-intensive commodity, provoke conflict. We also find that price increases for lootable artisanal minerals provoke conflict. Our meta-analysis consolidates existing evidence, but also highlights opportunities for future research.

Cover page of Do Elections Improve Constituency Responsiveness? Evidence from US Cities.

Do Elections Improve Constituency Responsiveness? Evidence from US Cities.

(2020)

Do elections motivate incumbent politicians to serve their voters? In this paper, we use millions of service requests placed by residents in US cities to measure constituency responsiveness. We then test whether an unusual policy change in New York City, which enabled city councilors to run for three rather than two terms in office, improved constituency responsiveness in previously term-limited councilors' districts. Using difference-in-differences, we find robust evidence for this. Taking advantage of differential timing of local election races in New York City and San Francisco, we also find late-term improvements to responsiveness in districts represented by reelection-seeking incumbents. Elections improve municipal services, but also create cycles in constituency responsiveness. These findings have implications for theories of representative democracy.

Cover page of The Impact of Mental Health Conditions on Public Insurance Costs of Treating HIV/AIDS.

The Impact of Mental Health Conditions on Public Insurance Costs of Treating HIV/AIDS.

(2020)

Medicare and Medicaid insurance claims data for Californians living with HIV are analyzed in order to determine: (1)The prevalence of treatment for particular mental health diagnoses among people living with HIV (PLWH) with Medicare or Medicaid insurance in 2010; (2)The relationship between individual mental health conditions and total medical care expenditures; (3)The impact of individual mental health diagnoses on the cost of treating non-mental health conditions; and (4)The implications of the cost of mental health diagnoses for setting managed care capitation payments. We find that the prevalence of mental health conditions among PLWH is high (23% among Medicare and 28% among Medicaid enrollees). PLWH with mental health conditions have significantly higher treatment costs for both mental health and non-mental health conditions. Setting managed care capitations that account for these greater expenditures is necessary to preserve access to both mental health and physical health services for PLWH and mental health conditions.