Objective: Antipsychotic drug polypharmacy, the practice of using more than one antipsychotic drug to manage psychotic disorders, is an increasing practice, although controversial. This study examined current prescribing trends in antipsychotic drug polypharmacy. Methods: The study combined 2002 through 2004 data from the National Ambulatory Medical Care Survey to investigate the proportion of patients that were prescribed multiple compared to single antipsychotics. Patterns of use for conventional relative to atypical antipsychotic drugs were also examined. Logistic regression was used to explore relationships among patient and provider characteristics and the prescription of multiple antipsychotic drugs.

Results: Antipsychotic monotherapy was prescribed for 91.8% (N=762) of patients meeting study criteria, compared to 8.2% (N=68) of patients who were prescribed multiple antipsychotic drugs. Patients who were non-White

were more likely to receive multiple antipsychotic drugs compared to White individuals. Patients whose method of payment was reported as Medicare were up to twice as likely to receive multiple antipsychotic drugs compared to those with private insurance. Likewise, the Medicaid payment status was associated with an increased likelihood of antipsychotic polypharmacy, with those covered by Medicaid found to be three times as likely to be prescribed multiple antipsychotic drugs. The patient’s age and gender, and the physician specialty demonstrated no association with antipsychotic polypharmacy in an ambulatory care setting.

Conclusions: The influence of patient race and payment source on antipsychotic prescribing patterns is worrisome and warrants further investigation.

Enifome Ojareno Ogbru (2009)

Over the past decade, education policy in America has received considerable media, academic, and political attention. This renewed attention has been brought on by the growing economic and social importance of education. With this increasing importance came closer scrutiny into how well students, teachers, and the system at large are performing. In this series of essays, I examine three questions in K-12 and higher education that inform this overarching concern.

In the first essay, I explore whether the sanctions outlined in the most important piece of federal education legislation in the past quarter decade, NCLB (No Child Left Behind), improve students' academic performance. Using panel data on Maryland schools, I exploit the manner in which schools are flagged as failures to estimate the achievement impacts of a few specific consequences of failure. While I find that failure and the sanctions tied to poor performance have no or negative impacts on future school-level performance, the threat of possible failure derived from almost but not quite failing may motivate increased performance in passing schools.

Second, I turn to educational inputs and examine the role of teacher absences in student performance as well as racial/ethnic achievement gaps at the high school level. I explore the learning impacts of both the marginal missed day as well as of higher levels of teacher absence. I also characterize the magnitudes of current gaps in math and reading performance across student racial/ethnic subgroups. I find evidence across schools that more teacher absences lead to lower student performance; yet, controlling for school quality severely diminishes these negative impacts.

In the final essay, describe the substantial increases in college tuition costs that took place over the past decade and a half. I then examine student enrollment response to exceptionally large year-to-year tuition increases. While I find some evidence that students respond in disproportionate ways to very large tuition increases, there is considerable heterogeneity across different types of public four-year institutions in this response. Finally, I use parameters estimated in this study to predict the short- and long-run revenue implications of large tuition hikes for the average institution.

Steven Hemelt (2009)

Background and significance: Lethal violence, including homicide and suicide, takes the lives of 45,000 Americans per year. Intimate partner (IP) homicide is a type of lethal violence that is classified as a form of homicide by policymakers, law enforcement personnel, healthcare providers, and others. It accounts for only 7% of all homicides, but nearly one-third of all homicides of women. The rates of all types of lethal violence have decreased since 1985, but the distribution of IP homicide has gone from nearly half male and half female victims to one-quarter male and three-quarters female victims during that time. Because of the relationship shared between the perpetrator and the victim, the nearly unlimited access the perpetrator has to the victim, and the sociodemographic distinctions between lP homicide and non-intimate homicide, the author hypothesizes that it is not a type of homicide per se, but instead a separate entity deserving distinctively different approaches to prevent it.

Design and Methods: The primary aim of this study is to determine if IP homicide is a type of homicide similar to non-intimate homicide in seasonal, regional, economic, and sociodemographic distributions, if it is more like suicide in those distributions, or if it a separate form of lethal violence with its own set of predictive criteria. The author of this study examines a comprehensive database consisting of homicide data from the Supplementary Homicide Reports, suicide data from the Mortality Multiple Cause of Death Reports, as well as Census, firearm, alcohol, and religiosity data from a variety of resources covering the entire United States from 1985-2004. To create a panel for evaluation, the author aggregated these data at the county level to create a dataset with 54,037 county months of observations.

Results: Intimate Partner Homicide does not correlate to regional, seasonal, economic, and sociodemographic variables in the same way as

non-intimate homicide or suicide. Instead, IP Homicide does not vary with season or region of county. It does not correlate with increases in population density nationally, but does in the Northeast and the Midwest, where it has opposite correlations. Its only economic response is to negatively correlate with unemployment. Further, it is higher in counties with higher numbers of churchgoers. It also higher in counties with higher proportions of single-parent households and with broader age gaps between male and female intimates. The finding most important to policymakers is that since the passage of the Violence Against Women Act, IP homicide incidence has significantly decreased, but that decrease is disproportionately in favor of male victims.

Discussion and Policy Implications: The results of this study support the post that Intimate Partner Homicide is a separate “Current of Lethal Violence”, which many say is the most preventable type of lethal violence. Since IP homicide is not like non-intimate (NI) homicide, it might not be amenable to the same prevention strategies applied to NI homicide. Examples of these strategies include an increased police presence in areas with higher IP homicide rates. Enhancements to the Violence Against Women Act that focuses on women not capable of taking risks to protect themselves, such as leaving the abuser, could prove very beneficial. These enhancements could include interventions focusing on education of mental health and emergency department healthcare providers, as well as improvements in law enforcement methods used to stop intimate violence. An approach that recognizes that IP homicide is unlike NI homicide; therefore, prevention should begin with recognition of the intimate dyad and its effect on the persons within it. Some couples might not want to be separated, but instead they might just want the violence to end.

Darryl Roberts (2009)

Scholars and practitioners have increasingly paid attention to the changing nature of American suburbs, with emphasis on the decline in the nation’s older suburbs near central cities. The existing body of literature has not focused on the variation of change within and among these suburbs. In this study, I investigate how Baltimore’s first-tier suburbs have changed since 1970. I rely on U.S. Census place and tract level data and direct observation to: 1) develop a definition of first tier suburbs; 2) examine how the first tier suburbs changed between 1970 and 2000; and 3) identify and explain patterns of differentiation among and within Baltimore’s first tier suburbs.

In this study, I developed a definition of first tier suburbs using spatial and temporal criteria.

Suburbs had to share a border with the central city, or they had to share a border with a suburb adjacent to the city and have a housing stock with at least 50 percent of the units built prior to 1970. A descriptive spatial statistical analysis found evidence of suburban change in all of Baltimore’s 21 first tier suburbs. The patterns of change demonstrate that first tier suburbs declined on multiple indicators from the 1970 status, although the extent of decline varied among and within these places. Principal components and cluster analyses in 1970 and 2000 demonstrated that the transformation of the economic status, race, age, and labor force characterized Baltimore’s suburban changes.

Thomas J. Vicino (2006)