Journal of Health Economics and Development1220191001Diminished Returns of Income Against Cigarette Smoking Among Chinese Americans1897298ENShervin AssariDepartment of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CAJournal Article20190818<strong>Introduction:</strong> Although educational attainment and income are protective against tobacco use, Marginalization-related Diminished Returns (MDRs) theory posits that the protective effects of socioeconomic status (SES) indicators may be smaller for marginalized groups than mainstream social groups. We aimed to compare the effects of educational attainment and income on current smoking status of Chinese American and European American adults.
<strong>Methods:</strong> Data came from the National Health Interview Survey (NHIS - 2015). A total number of 28081 individuals entered our analysis. This included 420 Chinese Americans and 27661 European Americans. The independent variables were educational attainment (years of schooling) and annual income. The dependent variable was current established smoking status. Age, gender, region, and marital status were covariates. Ethnicity (Chinese American vs. European American) was the moderator.
<strong>Results:</strong> Overall, educational attainment and income were inversely associated with the odds of current established smoking. Ethnicity showed a significant interaction with income but not educational attainment. This finding suggested that the protective effect of income, but not educational attainment, on odds of current established smoking might be smaller for Chinese Americans than European Americans.
<strong>Conclusions:</strong> While educational attainment reduces the odds of current established smoking, high-income Chinese Americans remain at high risk of smoking due to a phenomenon called MDRs. In fact, high income is associated with greater smoking prevalence in Chinese Americans, rather than less. To reduce ethnic disparities in tobacco use, we need to go beyond SES inequalities by addressing structural causes of higher than expected risk of smoking in high SES ethnic minorities.https://www.hedjournal.com/article_97298_9086f17043c928f6d240d5b9c7ca97b5.pdfJournal of Health Economics and Development1220190920Race by Gender Differences in the Protective Effects of Education and Income Against Subsequent Changes in Self-rated Health, Physical Activity, and Body Mass Index Among Older Americans92197299ENShervin AssariDepartment of Family Medicine, University of California Los Angeles, Los Angeles, CA 90095, USASharon CobbDepartment of Family Medicine, Charles R. Drew University of Medicine and Sciences, Los Angeles, CA 90095, USAMohsen BazarganDepartment of Family Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA Department of Family Medicine, Charles R. Drew University of Medicine and Sciences, Los Angeles, CA 90095, USAJournal Article20190819<strong>Background: </strong>Educational attainment and income are central to maintenance of body mass index (BMI), physical activity, and self-rated health (SRH). However, less is known about how social groups differ in the role of educational attainment and income on subsequent changes in these health outcomes. This study compared race/ethnicity by gender groups of older Americans for the effects of baseline educational attainment and income on subsequent changes in BMI, physical activity, and SRH.
<strong>Methods: </strong>The Health and Retirement Study (HRS) followed 37,495 male and female White and African American people above age 50 for 6 years from 2004 to 2010. This number included 15,581 White women, 12,495 White men, 5,580 African American women, and 3,839 African American men. Physical activity, BMI, and SRH were measured every two years. Multi-group structural equation modeling (latent growth curve modeling) was used to compare race/ethnicity by gender groups for the protective effects of educational attainment and income in 2004 on a decline in physical activity, BMI, and SRH from 2004 to 2010.
<strong>Results: </strong>Major race/ethnicity by gender differences were observed in theeffects of baseline educational attainment and income on changes in BMI, physical activity, and SRH. Educational attainment and income showed more salient roles for White men and women than African American men and women. To give some examples, baseline education (years) was associated with changes in physical activity of White women and changes in BMI of White men, while baseline income was associated with changes in SRH of White Women. We did not find evidence suggesting that baseline income fully mediates the effect of baseline educational attainment on health outcomes, as in many instances, educational attainment but not income was associated with health changes over time.
<strong>Conclusion: </strong>The intersection of race/ethnicity and gender alters how educational attainment and income protects against subsequent changes in physical activity, BMI, and SRH. Social groups may vary in operant mechanisms by which social determinants of health prevent health decline in the United States.https://www.hedjournal.com/article_97299_f85dd6c65d894c582f2245b6073054d0.pdfJournal of Health Economics and Development1220190701Assessing the catastrophic health expenditure and impoverishment in Iran in 2012 and 2015 (before and after the implementation of HTP in Iran)223397300ENAli MaherAssistant Professor of Health Services Management, Department of Health Services Management, Tehran North Branch, Islamic Azad University, Tehran, IR Iran.Zahra FazelDepartment of Economic, Alzahra University, Tehran, IR Iran.Journal Article20191001Healthcare in many developing countries is predominantly funded through out-of-pocket spending by households. Providing financial protection from exorbitant out-of-pocket expenses is an important tool for a country’s health system to ensure equitable access to care. Although, Iran has made great achievements in Health Sector and health financing after the implementation of Health Sector Evolution Plan, there are still some provinces and expenditure groups which suffered from health payments and pushed them under poverty line. This study aimed to compare the rates of households with CHE and the effect of health spending on national poverty estimates before and after the implementation of HTP in Iran. To do that, statistical data were acquired from two surveys conducted by Iran statistic Center (2012 and 2015). CHE are defined an excess of out-of-pocket payments for health care at the various thresholds for household total expenditure (capacity to pay). For an estimate of the impoverishment effect, the national poverty line is used. It is necessary to mention that, about 10.476 and 3.122% of total households suffered from catastrophic health expenditures, when the threshold is 10% of the total household expenditure in 2012 and 2015, respectively. At the threshold of 40 % of capacity to pay, 1.249 (2012) and 0.283% (2015) of the total household incurred catastrophic health expenditures. About 611 and 5895 households were forced into poverty due to paying for health care in 2012 and 2015, respectively.https://www.hedjournal.com/article_97300_06abe0cc65f812be2fed35c9b4fa4de2.pdf