Video of the day

OMG just awesome.  Time-lapse Earth.  Images from the International Space Station.

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Pre-K in NC

Great Op-Ed in the N&O about the Republicans’ plan to limit eligibility for pre-K in NC (and you know what a bad idea that is).  But just in case you didn’t:

Children who participate in these programs are more likely to graduate from high school, hold a job considered semi-skilled or higher, attain a four-year degree and earn more as adults. And that is good for our businesses and our state’s economy.

Key to these economic outcomes are two critical factors: the quality of the programs and access to the programs.

•  Quality: Some policymakers have been led to believe that improvements in school performance for children in early learning programs diminish as they get into elementary school. Some call it “fade-out.”

But decades of data and longitudinal studies do not support this conclusion when early learning programs are high-quality.

A 2012 Duke University study of our state’s early learning programs shows North Carolina third-graders have higher standardized reading and math scores and lower special education placement rates in those counties with more funding for those programs. In fact, researchers found that the expected savings in reduced special education and instructional costs for children in these programs is at least equal to the cost of the programs – a break-even or savings of taxpayer money.

This study is not alone. A quantitative statistical analysis of 123 studies across four decades of early education research – a meta analysis – found that by third grade, one-third of the achievement gap can be closed by early education.

North Carolina is already a national model for high-quality early learning programs, being the second state to enact a Quality Rating and Improvement System. North Carolina’s programs have the quality components that get the results businesses want: appropriate teacher-to-child ratios, teachers educated in early childhood development, strong parental involvement and coaching, and screening and referral services to catch problems early.

North Carolina also leads the country in tying subsidies for child care to the quality of the programs. Programs receiving subsidies must have a star rating of three or higher.

Today, 70 percent of all young children in North Carolina’s regulated early learning programs attend high-quality programs rated with four or five stars.

Sadly, the latest proposal it to make it much harder for poor NC residents to get their children into one of these programs.  John F. spelled it out quite nicely on FB in response to this:

Living below the federal poverty level (FPL) means that a family has “insufficient income to provide the food, shelter and clothing needed to preserve health.” Child care was never a part of this equation so setting the eligibility requirements at 100% of the FPL is essentially asking working parents to decide between child care, food, shelter, and clothing for their children.

Yep.  But it’s okay, because we can use the savings to give tax cuts to wealthy North Carolinians!  That will surely have more long-term benefit for this state than investing in programs that have been proven to increase school performance and life success for at-risk kids.

Guns and 5-year olds

Perhaps you heard the story of the 5-year old who accidentally shot his 2-year old sister to death last week with his gun.  I loved Paul Waldman’s response:

Let’s be clear about one thing: The horrifying story of Caroline Sparks’ death tells us, if nothing else, that certain corners of gun culture in America are f-ing nuts. Anyone who has known a five-year-old understands that giving one of them a functioning firearm is utterly insane. Don’t give me any line about instilling proper respect for guns in children; at an age when a child doesn’t have the dexterity to tie his own shoes, and lacks the impulse control to conclude that putting Krazy Glue on his lips might not be such a great idea, he shouldn’t be allowed within 20 feet of a gun, supervised or not. Stories like this one may not be common, but they aren’t all that unusual either. According to data from the Centers for Disease Control, in 2010, 62 American children aged 14 and under were killed by accidental discharge of firearms; 25 of those were under age 5. Two hundred and nineteen kids 14 and younger were intentionally murdered with guns, including 54 younger than 5. So Caroline Sparks wasn’t the first, and she won’t be the last.

Today’s Times ran a story about the backlash in the Kentucky town against all these damn liberals coming down hard on them:

The death has convulsed this rural community of 1,800 in south-central Kentucky, where everyone seems to know the extended Sparks family, which is now riven by grief. But as mourners gathered for Caroline’s funeral on Saturday, there were equally strong emotions directed at the outside world, which has been quick to pass judgment on the parents and a way of life in which many see nothing unusual about introducing children to firearms while they are still in kindergarten…

The county coroner, Gary White, said Kristian’s gun, a .22-caliber single-shot Crickett rifle designed for children and sold in pink and blue, had been stored in a corner, and his parents did not realize it was loaded.

I’m sorry, designing actual working guns for 5-year olds is nuts.  Instead, there’s a lot of sentiment like this:

April Anderson, a cashier, said that she, too, owned a gun at age 5. “We went deer hunting,” she said. “I had a .22. You have to teach them at an early age [emphasis mine],” she noted, adding that she and her husband own more than 20 guns, but that they keep them secure. “Our guns are put up,” she said.

Ummm, no, you don’t actually.  I’m sure if you wait until they have some basic common sense (12?  13?) it will still be okay.

Hidden tattoos

I don’t like tattoos– never have, never will.  And neither does “Dear Prudence” advise columnist Emily Yoffe.  Anyway, she had a question about tattoos in an on-line chat today and it inspired me to wonder just what percentage of the public has a tattoo.  Fortunately, NCSU has a subscription to Roper Ipoll so I could easily look up the data and found it in a 2010 Pew Survey.  They give a number of demographic breakdowns as options, but surprisingly, not age.  Anyway, the overall figure is 24% and here’s the PID breakdown:

pew3

Now, what actually surprised me most, is the fact that there’s way more tattood people out there than you realize– unless you have x-ray vision, that is.  Check this out:

Pew2

Anyway, some day when I’ve really got nothing better to do (so much to grade!) I’m going to download this dataset and run some models with this variable.

 

 

More Medicaid Power

Drum actually posted an explanation of power analysis last night and how it relates to the Medicaid study:

There are several things to say about the Oregon study, but I think the most important one is this: not that the study didn’t find statistically significant improvements in various measures of health, but that the study couldn’t have found statistically significant improvements. It was impossible from the beginning.

Here’s why. The first thing the researchers should have done, before the study was even conducted, was estimate what a clinically significant result would be. For example, based on past experience, they might have decided that if access to Medicaid produced a 20 percent reduction in the share of the population with elevated levels of glycated hemoglobin (a common marker for diabetes), that would be a pretty successful intervention.

Then the researchers would move on to step two: suppose they found the clinically significant reduction they were hoping for? Is their study designed in such a way that a clinically significant result would also be statistically significant? Obviously it should be…

So here’s the question: if the researchers ended up finding the result they hoped for (i.e., a reduction of 16 people with elevated GH levels), is there any chance that this result would be statistically significant? I can’t say for sure without access to more data, but the answer is almost certainly no. It’s just too small a number. Ditto for the other markers they looked at. In other words, even if they got the results they were hoping for, they were almost foreordained not to be statistically significant. And if they’re not statistically significant, that means the headline result is “no effect.”

Now, they didn’t design the Oregon program or they would have insisted upon more numbers for this very reason.  That said, how they probably should have been much more thoughtful about how they brought these findings too light given the inherent problems.

Photo of the day

Recent National Geographic photo of the day.  I fine the postscript fascinating.

Picture of an owl striking a mouse in Minnesota

Owl and Mouse, Minnesota

Photograph by Tom Samuelson, My Shot

Great gray owls come south from Canada into Minnesota during the winter to find food. This owl was on the north shore of Lake Superior, just south of Two Harbors, Minnesota. We happened to find him as the sun was setting, and in the evening light, we were able to be in a position to see an owl that was hunting when a mouse came out, and the owl was quick to pounce and pick up an evening meal.

(Editor’s Note, April 18, 2013: Since first posting this picture, we’ve received additional information. The mouse was placed in position to attract the owl.)

Staged or not, that’s one awesome photo.

Medicaid, statistical power, and health vs. wealth

The big news for policy wonks last week was a new study of Oregon Medicaid recipients that used a natural experiment to assess the impact of Medicaid.  Short version: No statistically significant” improvement on measured physical health outcomes over two years, but significant improvements in mental health and financial health.  Conservatives have been crowing about how it is therefore pointles to expand Medicaid, as Obama care does.  A lot of really smart responses.  Let’s start with Jon Cohn:

The big news is that Medicaid virtually wiped out crippling medical expenses among the poor: The percentage of people who faced catastrophic out-of-pocket medical expenditures (that is, greater than 30 percent of annual income) declined from 5.5 percent to about 1 percent. In addition, the people on Medicaid were about half as likely to experience other forms of financial strain—like borrowing money or delaying payments on other bills because of medical expenses.

That may sound obvious—of course people with insurance are less likely to struggle with medical bills. But it’s also the most under-appreciated accomplishment of health insurance: Whatever its effects on health, it promotes economic security. “The primary purpose of health insurance is to protect you financially in event of a catastrophic medical shock,” [emphasis mine] Finkelstein told me in an interview, “in the same way that the primary purpose of auto insurance or fire insurance is to provide you money in case you’ve lost something of value.” And while only a small portion of people will experience financial shock in any given year, over time many more will—which means many more will benefit from the protection that Medicaid provides.

Damn straight.  Yes, medical insurance keeps my family healthier, but mostly it keeps me out of the poorhouse.

Meanwhile, Chait takes this on as only Chait can:

Okay: The case for Medicaid expansion is not as strong as I had thought. Now for the caveats: The case for Medicaid expansion is overwhelmingly strong. If a study found that puppies survive steep falls at a higher rate than expected, then you could say the case for throwing puppies out of skyscraper windows has marginally weakened, but would remain extremely strong. Indeed, data notwithstanding, either throwing puppies out of skyscrapers or throwing people off Medicaid are both acts of sadism…

We know that Medicaid makes people happier and less poor. We have trouble proving its impact on their physical well-being because proof of the benefits of medicine remain elusive. Unless we want to stop thinking of basic medical care as a life necessity, and we don’t, the case for Medicaid remains unimpeachable.

Meanwhile, Drum and the Incidental Economist take an important look at why Medicaid did not seem to improve outcomes.  Drum:

In fact, the study showed fairly substantial improvements in the percentage of patients with depression, high blood pressure, high cholesterol, and high glycated hemoglobin levels (a marker of diabetes). The problem is that the sample size of the study was fairly small, so the results weren’t statistically significant at the 95 percent level.

However, that is far, far different from saying that Medicaid coverage had no effect. It’s true that we can’t say with high confidence that it had an effect, but the most likely result is that it did indeed have an effect. The table below shows the point estimates. Note also that in all cases, the use of prescribed medication went up, in some cases by a lot.

Here’s the thing, if you are finding 17 and 18% differences but they are not statistically significant at the p<.05 level, it means you just did not have enough statistical power to properly test your hypotheses.  Now, there’s nothing that can be done about that in this case– there were just only so many people– but it does mean that you need to think about this in full context and realize, exactly as Drum suggests, that in all likelihoood Medicaid did improve health outcomes, we’re just not 95% confident.  Kind of like if you gave one treatment to 10 people and 8 improved but only 5 improved in the control group.  Yeah, the treatment probably worked, but there’s just not enough people to give you statistical confidence.  Now, change those numbers to 800 of 1000 and 500 of 1000 and you can be pretty damn sure.  There just weren’t enough people in this study to be pretty damn sure, but in context, the results certainly are suggestive.  And as Chait and Cohn point out, even if there was not any physical improvement (in a narrow two year period), it sure means something to not go bankrupt and to have better mental health.

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