THE HEALTH OF YOUNG ADULTS WITH DISABILITIES IN THE UNITED STATES: THE COLLECTIVE ROLES OF RISK FACTORS IN SOCIAL ECOLOGIC FRAMEWORK

Background: Over the last few decades, the prevalence of young adults with disabilities (YAD) has steadily risen as a result of advances in medicine, clinical treatment, and biomedical technologythat enhanced their survival into adulthood. Despite investments in services, family supports, and insurance, they experience poor health status and barriers to successful transition into adulthood. Objectives: We investigated the collective roles of multi-faceted factors at intrapersonal, interpersonal and community levels within the social ecological framework on health related outcome including self-rated health (SRH) of YAD. The three specific aims are: 1) to examine sociodemographic differences and health insurance coverage in adolescence; 2) to investigate the role of social skills in relationships with family and peers developed in adolescence; and 3) to collectively explore the association of sociodemographic characteristics, social skills, and community participation in adolescence on SRH. Methods: Using longitudinal data (N=5,020) from the National Longitudinal Transition Study (NLTS2), we conducted multivariate logistic regression analyses to understand the association between insurance status as well as social skills in adolescence and YAD’s health related outcomes. Structural equation modeling (SEM) assessed the confluence of multi-faceted factors from the social ecological model that link to health in early adulthood. Results: Compared with YAD who had private insurance, YAD who had public health insurance in adolescence are at higher odds of experiencing poorer health related outcomes in self-rated health [adjusted odds ratio (aOR=2.89, 95% confidence interval (CI): 1.16, 7.23), problems with health (aOR=2.60, 95%CI: 1.26, 5.35), and missing social activities due to health problems (aOR=2.86, 95%CI: 1.39, 5.85). At the interpersonal level, overall social skills developed through relationship with family and peers in adolescence do not appear to have association with health related outcomes in early adulthood. Finally, at the community level, community participation in adolescence does not have an association with SRH in early adulthood. Conclusions: Having public health insurance coverage does not equate to good health. YAD need additional supports to achieve positive health outcomes. The findings in social skills and community participation suggest other potential factors may be at play for health related outcomes for YAD and the need for further investigation.

ESSAYS ON THE WTO ACCESSION, HOUSEHOLD INCOME AND MULTIDIMENSIONAL POVERTY: EVIDENCE FROM CHINA

In the course of integrating into the global market, especially since China’s WTO accession, China has achieved remarkable GDP growth and has become the second largest economy in the world. These economic achievements have substantially increased Chinese incomes and have generated more government revenue for social progress. However, China’s economic progress, in itself, is neither sufficient for achieving desirable development outcomes nor a guarantee for expanding peoples’ capabilities. In fact, a narrow emphasis on GDP growth proves to be unsustainable, and may eventually harm the life quality of Chinese citizens. Without the right set of policies, a deepening trade-openness policy in China may enlarge social disparities and some people may further be deprived of basic public services and opportunities. To address these concerns, this dissertation, a set of three essays in Chapters 2-4, examines the impact of China's WTO accession on income distribution, compares China’s income and multidimensional poverty reduction and investigates the factors, including the WTO accession, that predict multidimensional poverty. By exploiting the exogenous variation in exposure to tariff changes across provinces and over time, Chapter 2 (Essay 1) estimates the causal effects of trade shocks and finds that China’s WTO accession has led to an increase in average household income, but its impacts are not evenly distributed. Households in urban areas have benefited more significantly than those in rural areas. Households with members working in the private sector have benefited more significantly than those in the public sector. However, the WTO accession has contributed to reducing income inequality between higher and lower income groups. Chapter 3 (Essay 2) explains and applies the Alkire and Foster Method (AF Method), examines multidimensional poverty in China and compares it with income poverty. It finds that China’s multidimensional poverty has declined dramatically during the period from 1989-2011. Reduction rates and patterns, however, vary by dimensions: multidimensional poverty reduction exhibits unbalanced regional progress as well as varies by province and between rural and urban areas. In comparison with income poverty, multidimensional poverty reduction does not always coincide with economic growth. Moreover, if one applies a single measure ─ either that of income or multidimensional poverty ─ a certain proportion of those who are poor remain unrecognized. By applying a logistic regression model, Chapter 4 (Essay 3) examines factors that predict multidimensional poverty and finds that the major factors predicting multidimensional poverty in China include household size, education level of the household head, health insurance coverage, geographic location, and the openness of the local economy. In order to alleviate multidimensional poverty, efforts should be targeted to (i) expand education opportunities for the household heads with low levels of education, (ii) develop appropriate geographic policies to narrow regional gaps and (iii) make macroeconomic policies work for the poor.

Essays on the Effects of Social Insurance for Disability

This dissertation examines how social insurance, family support and work capacity enhance individuals' economic well-being following significant health and income shocks. I first examine the extent to which the liquidity-enhancing effects of Worker's Compensation (WC) benefits outweigh the moral hazard costs. Analyzing administrative data from Oregon, I estimate a hazard model exploiting variation in the timing and size of a retroactive lump-sum WC payment to decompose the elasticity of claim duration with respect to benefits into the elasticity with respect to an increase in cash on hand, and a decrease in the opportunity cost of missing work. I find that the liquidity effect accounts for 60 to 65 percent of the increase in claim duration among lower-wage workers, but less than half of the increase for higher earners. Using the framework from Chetty (2008), I conclude that the insurance value of WC exceeds the distortionary cost, and increasing the benefit level could increase social welfare. Next, I investigate how government-provided disability insurance (DI) interacts with private transfers to disabled individuals from their grown children. Using the Health and Retirement Study, I estimate a fixed effects, difference in differences regression to compare transfers between DI recipients and two control groups: rejected applicants and a reweighted sample of disabled non-applicants. I find that DI reduces the probability of receiving a transfer by no more than 3 percentage points, or 10 percent. Additional analysis reveals that DI could increase the probability of receiving a transfer in cases where children had limited prior information about the disability, suggesting that DI could send a welfare-improving information signal. Finally, Zachary Morris and I examine how a functional assessment could complement medical evaluations in determining eligibility for disability benefits and in targeting return to work interventions. We analyze claimants' self-reported functional capacity in a survey of current DI beneficiaries to estimate the share of disability claimants able to do work-related activity. We estimate that 13 percent of current DI beneficiaries are capable of work-related activity. Furthermore, other characteristics of these higher-functioning beneficiaries are positively correlated with employment, making them an appropriate target for return to work interventions.