Kimberly Narain - Academia.edu (original) (raw)

Papers by Kimberly Narain

Journal of General Internal Medicine, Nov 13, 2023

BMC Women's Health, Jul 23, 2022

Background: Compared with wage and salary work, self-employment has been linked to more favorable... more Background: Compared with wage and salary work, self-employment has been linked to more favorable cardiovascular health outcomes within the general population. Women comprise a significant proportion of the self-employed workforce and are disproportionately affected by cardiovascular disease. Self-employed women represent a unique population in that their cardiovascular health outcomes may be related to gender-specific advantages of non-traditional employment. To date, no studies have comprehensively explored the association between self-employment and risk factors for cardiovascular disease among women. Methods: We conducted a weighted cross-sectional analysis using data from the University of Michigan Health and Retirement Study (HRS). Our study sample consisted of 4624 working women (employed for wages and selfemployed) enrolled in the 2016 HRS cohort. Multivariable linear and logistic regression were used to examine the relationship between self-employment and several self-reported physical and mental health risk factors for cardiovascular disease, controlling for healthcare access. Results: Among working women, self-employment was associated with a 34% decrease in the odds of reporting obesity, a 43% decrease in the odds of reporting hypertension, a 30% decrease in the odds of reporting diabetes, and a 68% increase in the odds of reporting participation in at least twice-weekly physical activity (p < 0.05). BMI for selfemployed women was on average 1.79 units lower than it was for women working for wages (p < 0.01). Conclusions: Employment structure may have important implications for cardiovascular health among women, and future studies should explore the causal relationship between self-employment and cardiovascular health outcomes in this population. Trial Registration: Not applicable.

Journal of Pharmacy Practice

Objective Examine the impact of a primary care-embedded clinical pharmacist-led intervention (UCM... more Objective Examine the impact of a primary care-embedded clinical pharmacist-led intervention (UCMyRx) on hemoglobin A1C and blood pressure control, relative to usual care, among patients with Type 2 diabetes (TD2) and Medicaid, in a large healthcare system. Methods We used data extracted from the Electronic Health Records system and a Difference-In-Differences study design with a 2:1 propensity-matched comparison group to evaluate the impact of UCMyRx on HbA1c and systolic blood pressure among patients with TD2 and Medicaid, relative to usual care. Results Having at least one UCMyRx clinical pharmacist visit was associated with a significant reduction in HbA1c; (−.27%, P-value= .03) but no impact on SBP. We do not find differential UCMyRx effects on HbA1c or SBP among the subpopulations with baseline HbA1C ≥9% or SBP ≥150 mmHg, respectively. In Charlson Comorbidity Index (CCI)-stratified analyses we found stronger UCMyRx effects on HbA1C (−.47%, P-value< .02) among the CCI tercil...

Objective: This dissertation explores the relationship between welfare reform and the health of s... more Objective: This dissertation explores the relationship between welfare reform and the health of single mothers with less than a high school diploma or GED (LESMS) by addressing six research questions: (1) what impact did welfare reform have on the health insurance coverage of LESMS, (2) what impact did welfare reform have on the annual medical provider contact of LESMS, (3) what impact did welfare reform have on the health outcomes of LESMS, (4) what impact did welfare reform have on the federal disability receipt of LESMS, (5) how has the relationship between welfare reform and these outcomes changed over time, and (6) does state-level variation in welfare reform policy stringency impact the relationships between welfare reform and these outcomes? Data: The data source was the Survey of Income and Program Participation, 1992, 1993, 1996, 2004 and 2008 panels. Methods: A difference-in-differences study design that exploited differences in welfare eligibility by marital status was us...

AIDS and Behavior

We investigated the impact of State-level Earned Income Tax Credit (SEITC) generosity on HIV risk... more We investigated the impact of State-level Earned Income Tax Credit (SEITC) generosity on HIV risk behavior among single mothers with low education. We merged individual-level data from the Behavioral Risk Factor Surveillance System (2002–2018) with state-level data from the University of Kentucky Center for Poverty Research and conducted a multi-state, multi-year difference-in-differences (DID) analysis. We found that a refundable SEITC ≥ 10% of the Federal Earned Income Tax Credit was associated with 21% relative risk reduction in reporting any high-risk behavior for HIV in the last year, relative to no SEITC. We also found that a 10-percentage point increase in SEITC generosity was associated with 38% relative risk reduction in reporting any high-risk HIV behavior in the last year. SEITC policy may be an important strategy to reduce the burden of HIV infections among women with low socioeconomic status, particularly single mothers.

Adjustment factors for all state-year combinations (1993-2014). (XLS 46 kb)

BMC Health Services Research, 2021

Background To determine if requiring Dual Eligible Special Need Plans (D-SNPs) to receive approva... more Background To determine if requiring Dual Eligible Special Need Plans (D-SNPs) to receive approval from the National Committee of Quality Assurance and contract with state Medicaid agencies impacts healthcare utilization. Methods We use a Multiple Interrupted Time Series to examine the association of D-SNP regulations with dichotomized measures of emergency room (ER) and hospital utilization. Our treatment group is elderly D-SNP enrollees. Our comparison group is near-elderly (ages 60–64) beneficiaries enrolled in Medicaid Managed Care plans ( N = 360,405). We use segmented regression models to estimate changes in the time-trend and slope of the outcomes associated with D-SNP regulations, during the post-implementation (2012–2015) period, relative to the pre-implementation (2010–2011) period. Models include a treatment-status indicator, a monthly time-trend, indicators and splines for the post-period and the interactions between these variables. We conduct the following sensitivity...

Journal of General Internal Medicine, 2020

Health Equity, 2020

There is some evidence that self-employment may improve measures of cardiovascular and general he... more There is some evidence that self-employment may improve measures of cardiovascular and general health among the general population; however, no studies have examined this relationship among Non-Hispanic Blacks (NHBs). Studying the health implications of self-employment among NHBs is important because of the disparities that persist in both cardiovascular health and self-employment rates between NHBs and other racial/ethnic subgroups. Methods: A pooled cross-sectional analysis of data from the Behavioral Risk Factor Surveillance System (2000 to 2014) was used to explore the association between self-employment and the following self-reported outcomes: ''no exercise,'' fruit consumption, vegetable consumption, days of alcohol consumption, fair or poor health, hypertension, poor mental health days, and poor physical health days among the total population of NHBs and across gender/income subgroups. Results: We find favorable associations between self-employment and several measures of cardiovascular health (increased fruit and vegetable consumption, reduced reports of ''no exercise,'' and reduced reports of hypertension) and positive associations between self-employment, poor mental health days, and days of alcohol consumption among the total population. The nature of these associations varies across gender/ income subgroup. Conclusions: Given the disparities between racial/ethnic subgroups with respect to adverse cardiovascular outcomes and the well-documented roles of exercise and blood pressure control in limiting cardiovascular disease, it is important to probe the relationship between self-employment and health among NHBs further.

American Journal of Public Health, 2018

Journal of Public Health Management and Practice, 2019

Objective: To improve the understanding of local health departments' (LHDs') capacity for and per... more Objective: To improve the understanding of local health departments' (LHDs') capacity for and perceived barriers to using quantitative/economic modeling information to inform policy and program decisions. Design: We developed, tested, and deployed a novel survey to examine this topic. Setting: The study's sample frame included the 200 largest LHDs in terms of size of population served plus all other accredited LHDs (n = 67). The survey was e-mailed to 267 LHDs; respondents completed the survey online using SurveyMonkey. Participants: Survey instructions requested that the survey be completed from the perspective of the entire health department by LHD's top executive or designate. A total of 63 unique LHDs responded (response rate: 39%). Main Outcome Measure(s): Capacity for quantitative and economic modeling was measured in 5 categories (routinely use information from models we create ourselves; routinely use information from models created by others; sometimes use information from models we create ourselves; sometimes use information from models created by others; never use information from modeling). Experience with modeling was measured in 4 categories (very, somewhat, not so, not at all). Results: Few (9.5%) respondents reported routinely using information from models, and most who did used information from models created by others. By contrast, respondents reported high levels of interest in using models and in gaining training in their use and the communication of model results. The most commonly reported barriers to modeling were funding and technical skills. Nearly all types of training topics listed were of interest. Conclusions: Across a sample of large and/or accredited LHDs, we found modest levels of use of modeling coupled with strong interest in capacity for modeling and therefore highlight an opportunity for LHD growth and support. Both funding constraints and a lack of knowledge of how to develop and/or use modeling are barriers to desired progress around modeling. Educational or funding opportunities to promote capacity for and use of quantitative and economic modeling may catalyze use of modeling by public health practitioners.

Health Services Research, 2019

Objective: To document differences among racial/ethnic/gender groups in specialty behavioral heal... more Objective: To document differences among racial/ethnic/gender groups in specialty behavioral health care (BH) utilization/expenditures; examine whether these differences are driven by probability vs intensity of treatment; and identify whether differences are explained by socioeconomic status (SES). Data Source: The cohort consists of adults continuously enrolled in Optum plans with BH benefits during 2013. Study Design: We modeled each outcome using linear regressions among the entire sample stratified by race/ethnicity, language and gender. Then, we estimated logistic regressions of the probability that an enrollee had any spending/use in a given service category (service penetration) and linear regressions of spending/use among the user subpopulation (treatment intensity). Lastly, all analyses were rerun with SES controls. Data Collection: This study links administrative data from a managed BH organization to a commercial marketing database.

BMJ Open, 2018

ObjectivesWe sought the perspectives of lead public health officials working to improve health eq... more ObjectivesWe sought the perspectives of lead public health officials working to improve health equity in the USA regarding the drivers of scientific evidence use, the supply of scientific evidence and the gap between their evidentiary needs and the available scientific evidence.DesignWe conducted 25 semistructured qualitative interviews (April 2017 to June 2017) with lead public health officials and their designees. All interviews were transcribed and thematically analysed.SettingPublic health departments from all geographical regions in the USA.ParticipantsParticipants included lead public health officials (20) and their designees (5) from public health departments that were either accredited or part of the Big Cities Health Coalition.ResultsMany respondents were using scientific evidence in the context of grant writing. Professional organisations and government agencies, rather than specific researchers or research journals, were the primary sources of scientific evidence. Respond...

Journal of Epidemiology and Community Health, 2018

In January of 2018 the Centers for Medicare and Medicaid Services (CMS) announced that it would b... more In January of 2018 the Centers for Medicare and Medicaid Services (CMS) announced that it would be granting waivers to states to impose either work or community engagement requirements on non-disabled, working-age Medicaid beneficiaries, based on the idea that such requirements would ‘promote better mental, physical, and emotional health’ and help families ‘rise out of poverty and attain independence'.1 To date, four states have approved waivers (Arkansas, Indiana, Kentucky and New Hampshire) and seven states have pending waivers with CMS.2 These waivers typically require that individuals work anywhere from 20 to 30 hours per week or engage in some specified activity to maintain eligibility for Medicaid benefits, with exceptions made, in some cases, for the elderly, pregnant women, primary caregivers, students and those with substance-abuse disorders or serious physical illness. There are good reasons to fear that these waivers will not improve health or foster economic self-sufficiency among current Medicaid beneficiaries as CMS suggest but instead will lead to worse health outcomes and less economic security among individuals who lose access to healthcare as a consequence of these waivers. These concerns were one reason why implementation of the KY waiver was halted. In the case of Stewart v. Azar , the court found that in the approval of the waiver the Secretary of Health and Human Services failed to consider the waiver’s impact on providing affordable health coverage to the low-income populations identified by Congress …

Journal of General Internal Medicine, 2018

Journal of Public Health Management and Practice, 2018

OBJECTIVES We explored the definition of health equity being used by public health departments an... more OBJECTIVES We explored the definition of health equity being used by public health departments and the extent of engagement of public health departments in activities to improve health equity, as well as facilitators and barriers to this work. DESIGN We conducted 25 semistructured qualitative interviews with lead public health officials (n = 20) and their designees (n = 5). All interviews were transcribed and thematically analyzed. SETTING We conducted interviews with respondents from local public health departments in the United States (April 2017-June 2017). PARTICIPANTS Respondents were from local or state public health departments that were members of the Big Cities Health Coalition, accredited or both. RESULTS Many departments were using a definition of health equity that emphasized an equal opportunity to improve health for all, with a special emphasis on socially disadvantaged populations. Improving health equity was a high priority for most departments and targeting the social determinants of health was viewed as the optimal approach for improving health equity. Having the capacity to frame issues of health equity in ways that resonated with sectors outside of public health was seen as a particularly valuable skill for facilitating cross-sector collaborations and promoting work to improve health equity. Barriers to engaging in work to improve health equity included lack of flexible and sustainable funding sources as well as limited training and guidance on how to conduct this type of work. CONCLUSIONS Work to improve health equity among public health departments can be fostered and strengthened by building capacity among them to do more targeted framing of health equity issues and by providing more flexible and sustained funding sources. In addition, supporting peer networks that will allow for the exchange of resources, ideas, and best practices will likely build capacity among public health departments to effectively do this work.