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Millions of Kids in U.S. Have Inadequate Health Care Coverage

Inadequate health coverage is a particular problem for commercially insured children, according to a new study released by Columbia University Mailman School of Public Health. The research shows that coverage gaps are affecting publicly insured children as well. Until now, prior research had focused on documenting rates and trends in insurance consistency for children covered by all insurance types. The findings are published in JAMA Health Forum.
“While uninsurance among children has generally been declining in the U.S., our results highlight the need for a renewed focus on making sure that children’s coverage is affordable for families and provides the benefits that children need” said Jamie Daw, PhD, assistant professor of health policy and management at Columbia Mailman School of Public Health.
Using representative data from the 2016-2021 National Survey of Children’s Health, the researchers analyzed parent- or caregiver-reported information on health insurance data for children from age 0-17 and also compared changes during COVID-19, identifying inconsistent and inadequate coverage within each insurance type. 
Inadequate insurance was defined by failure to meet three criteria: benefits were sufficient to meet a child’s needs; coverage allows a child to see needed health care providers; and a lack of reasonable annual out-of-pocket payments for child’s health care. 
Inconsistent coverage was three times higher among publicly compared to commercially-insured children. However, inadequate insurance was more prevalent overall, affecting nearly 1 in 5 U.S. children (16.5 million annually), with particularly high rates among the commercially-insured. The researchers also found that the child and family characteristics associated with higher rates of inconsistent and inadequate coverage differed by insurance type.
Of the sample of 203,691 insured children,34.5% were publicly-insured and 65.5 percent were commercially-insured. Compared to commercially-insured children, publicly-insured children had higher rates of inconsistent coverage (4.2 vs. 1.4 percent,) and lower rates of inadequate coverage (12 vs 33 percent). Relative to 2016-19, inconsistent insurance decreased by 42 percent for publicly-insured children and inadequate insurance decreased by 6 percent, for commercially-insured children during COVID. 
In summary, the findings indicate: 
– 1 in 5 children in the U.S. have inadequate health insurance, i.e. insurance that either has unreasonable out-of-pocket costs or doesn’t have benefits that meet the child’s medical needs. (
– Inadequate coverage is particularly high among kids with commercial insurance (approximately 1 in 3 commercially insured vs. 1 in 10 publicly insured kids).
– Insurance gaps (i.e. periods without coverage) are more common for publicly insured children.
– Both commercial insurance adequacy and public insurance gaps decreased significantly during the COVID-19 pandemic when there were additional subsidies for commercial insurance and requirements for states to keep Medicaid beneficiaries enrolled. 
-With protections winding down in 2023 following COVID, many publicly insured children are losing coverage which will reverse the gains in consistent coverage that were seen during the pandemic. 
-More needs to be done to protect commercially insured families against high out-of-pocket costs for child’s health care and make sure that benefits/provider networks are sufficient to meet children’s needs. 
Also, Daw and colleagues note there is a particular need for state Medicaid programs to conduct targeted outreach and linguistically and culturally competent navigation assistance for immigrant families.
“Federal COVID-19 relief policies prevented states from disenrolling children on Medicaid and instituted enhanced subsidies for private Marketplace coverage. Our study findings suggest these policies made an important difference for families during the pandemic: publicly insured children had fewer coverage gaps and coverage was more affordable for commercially insured children. Policymakers should be actively considering how to maintain and build on these gains,” noted Daw.
Co-authors are Sarra Yekta, Columbia Mailman School of Public Health; Faelan Jacobson-Davies and Lindsay Admon University of Michigan; and Stephen Patrick, Vanderbilt University Medical Center
The study was funded by the Agency for Healthcare Research and Quality (R01HS029159). 

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Ned Blackhawk, Winner of the 2023 National Book Award for Nonfiction, Speaks at Columbia

Ned Blackhawk spoke about Native American scholarship and archives on November 17 at an event sponsored by Columbia’s Lehman Center for American History. Two days earlier, he had won the National Book Award for Nonfiction for The Rediscovery of America: Native Peoples and the Unmaking of U.S. History.

“Was it earlier this week, or earlier this morning?” joked Blackhawk, the Howard R. Lamar Professor of History and American Studies at Yale University. He remained visibly moved by the accolade. “That happened less than 48 hours ago, and I still can’t process it. It’s been a pretty eventful week.”

A member of the Te-Moak Tribe of Western Shoshone Indians of Nevada, Blackhawk said that he hopes excitement around the prize will encourage more people to engage with Indigenous stories. “I know it’s a lot easier to just do other things,” he said. “Native American history is not familiar; it’s a little discomforting. But it’s a beautiful field, if you come to see it, because the insights can be quite generative, and often challenging. They make us think differently about things like citizenship, freedom, liberty.” 

A New Overview of U.S. History 

The Rediscovery of America offers an overview of U.S. history, from first contact to the 21st century, with Indigenous figures at the center. Among those he examines are Laura Cornelius Kellogg, an Oneida woman and one-time Barnard College student, who helped found the Society of American Indians, and Ada Deer, a graduate of Columbia’s School of Social Work, who served as assistant secretary of the Interior for Indian Affairs. 

The Lehman Center for American History, which is a collaboration between the Rare Book and Manuscript Library and the Department of History, invited Blackhawk as part of an ongoing conversation on Native American history. Previous events in the series have included a book talk by Columbia History Professor Michael Witgen, and a panel discussion on Black and Native Citizenship: The Making of American Identity Past and Present.

Despite years of study in Indigenous histories, there is an acute need for further research, particularly in the New York area. “There is an intense interest,” said Blackhawk. “A lot of people are asking me what I know about the Lenape communities that were in these spaces. But given the lack of sources, or scholarly studies, it’s hard to make sense of it all. You can’t just Google it.”

Going Back to the Archival Sources

To pursue this information, scholars are looking again at archival sources, including documents held by the RBML. From early audio recordings and printed books, to ethnographic records collected by Columbia anthropologists, the RBML serves as a custodian for a wide variety of Native American materials.

These collections were acquired by Columbia’s libraries decades—and sometimes more than a century—ago. They were often improperly identified and misinterpreted, and in the years since, have frequently served to reinforce colonial perspectives. Recent initiatives have begun correcting some of these historical legacies, and library staff now emphasize collaboration with creator communities. “Archivists have an ethical duty of stewardship to collections that reflect Indigenous people,” said Kevin Schlottmann, RBML head of archives processing. “This means making sure the existence of these records is known to tribes, that sustained community consultation takes place, that requests for restrictions on traditional or sacred knowledge are taken seriously, and that, when appropriate and desired, original records or digital reproductions are repatriated.”

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Soccer Heading Linked to Measurable Decline of Brain Structure and Function Over Two Years

A new study at Columbia University Irving Medical Center links soccer heading—where players hit the ball with their heads to direct it during play—to a decline in brain structure and function over a two-year period. The research is being presented for the first time at the annual meeting of the Radiological Society of North America (RSNA) in Chicago this week.
While previous research has examined adverse effects on the brain related to soccer heading at a single point in time, then ew findings are the first to show brain changes over two years.
“There is enormous worldwide concern for brain injury in general and the potential for soccer heading to cause long-term adverse brain effects in particular,” said senior author Michael L. Lipton, MD, PhD, professor of radiology at Columbia University’s Vagelos College of Physicians and Surgeons and affiliate professor of biomedical engineering at Columbia University.
“A large part of this concern relates to the potential for changes in young adulthood to confer risk for neurodegeneration and dementia later in life.”

Soccer heading linked with decline in brain structure and function

Study design
The study included 148 young adult amateur soccer players, with a mean age of 27. Participants were assessed for verbal learning and memory and underwent magnetic resonance imaging (MRI) at the time of enrollment and again two years later. 
Participants also filled out a specialized questionnaire, developed by the research team, to determine how many headers they performed. Two-year heading exposure was categorized as low, medium, and high.
The researchers used an MRI technique called diffusion tensor imaging (DTI) and a newer technique called neurite orientation dispersion density imaging (NODDI), which characterize the microstructure of the brain by tracking the movement of water molecules through the tissue. “By measuring how uniform the movement of water is through brain tissue, we can assess whether brain tissue structure is normal or abnormal,” says Lipton, “and we can see the effects on brain structure with increasing numbers of head impacts.”
Study results
Compared to the baseline test results, the high-heading group (over 1,500 headers in two years) demonstrated measureable changes in brain microstructure similar to findings seen in mild traumatic brain injuries.
“This is the first study to show a change of brain structure over the long term related to sub-concussive head impacts in soccer,” Lipton says.
High levels of heading were also associated with a decline in verbal learning performance on a memory test. In contrast, participants who engaged in low or no heading demonstrated an improvement in verbal learning performance over a two year period.
“These findings add to the ongoing conversation and contentious debate as to whether soccer heading is benign or confers significant risk.”
Related findings
Dr. Lipton and colleagues also presented a second study in which they analyzed heading over 12 months prior to assessment with DTI and testing verbal learning performance. The study looked at 353 amateur soccer players between the ages of 18 and 53.
Unlike previous research that has focused on deep white matter regions, this study employed a new approach assessing change of DTI parameters to evaluate the integrity of the interface between the brain’s gray and white matter closer to the skull. 
The researchers found that the normally sharp gray matter – white matter interface was blurred in proportion to high repetitive head impact exposure, consistent with injury at the gray matter – white matter interface. Further analysis showed that the change in brain structure at the gray matter – white matter interface plays a causal role in the association of greater heading with worse cognitive performance.

Soccer heading and the brain’s gray matter/white matter interface

“Our new approach addresses a brain region that is susceptible to injury but has been neglected due to limitations of existing methods,” Lipton says. “Application of this technique has the potential to disclose the extent of injury from repetitive heading, but also from concussion and traumatic brain injury, to an extent not previously possible.”
Next Steps
Research shows that changes in brain structure and function are associated with high levels of soccer heading. In a new study that is just underway, Lipton and colleagues will assess the competing effects of fitness and head impacts on the brain by looking at soccer players, athletes who never participated in contact sports, and nonathletes.
“Soccer players and their parents have been rightly warned about the potential risks of heading in soccer, but it leads to mixed messages about the wisdom of playing the sport,” says Lipton. “This grant will allow us to determine soccer’s tradeoffs with respect to brain health so that people can make informed decisions, and we can establish evidence-based guidelines for heading.”

What should soccer players do about heading?

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Remembering Cantor Charles Davidson (z”l)  

JTS mourns the passing of Cantor Charles Davidson, a revered composer, cantor, JTS alum, and H. L. Miller Cantorial School professor. One of the earliest graduates of JTS’s Cantors Institute, he later earned his doctorate in sacred music and then went on to serve on the faculty as the Nathan Cummings Professor.

Read more about Cantor Davidson’s life and reflections from those that knew him.

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Union’s 2023 Impact Report – Union Theological Seminary

Dear Friends,
I am pleased to share with you the 2023 Impact Report for Union Theological Seminary in the City of New York. It’s a first for us. While we are constantly communicating with our many stakeholders, we do not have a tradition of creating a single, comprehensive, public facing annual update. As a step towards improving our work and pursuing best practices in theological education, we have created this report! Great thanks go to the many people at Union who worked on this report and to those who appear in it. I hope you enjoy what you find in these pages – the stories are phenomenal but even more, the people that comprise Union are just downright amazing to behold!
As you will see in the pages ahead, Union is filled with vitality and vision as it continues to uphold its historic mission while also forging ahead, reaching toward ever-expanding horizons for the practice of theological education. This year’s Impact Report is organized around our present Strategic Plan, the central goal of which is to support and strengthen the Union of today so that 50 years from now, students will still be walking through our doors, zooming onto our screens, and joining the work of the Seminary via whatever new forms of communication and education await us in the future.
I am happy to say that Union has been making great strides towards creating foundations for that lively future. You will read about our extensive campus renovations, our new degree programs, our emerging platforms for public education, our incredible fundraising successes, and most importantly, the brilliance and passion of the students who continue to show up, seeking the unique education we offer. In a world where the horizons of many seminaries are constricting, Union is thriving as it reaches further and further out to communities and people who seek the fruits of theological study and formation. We know, as do you, that the education we offer here – justice-seeking, love-embracing, world-transforming, faith-inspiring – has never been so urgently needed.
Ahead, we share the incredible work of our amazing faculty, staff, students, and alums, all pulling together in the same exciting direction. We also share the incredible leadership journeys of some of our alums.
We have organized the report around the central pillars of Union’s Strategic Plan which I share here with you.

Shaping 21st Century Religious Scholarship
Innovation in Theological Education
Recruiting, Retaining, and Supporting Students
Cultivating Intentional Community
Reimagining Faith in the Public Square
Ensuring Union’s Future: Cultivating Partnerships
Ensuring Union’s Future: Campus Renewal & Climate Responsibility
Ensuring Union’s Future: Development & Alum Relations
Ensuring Union’s Future: Financial Sustainability

On behalf of the whole Union community – which reaches far and wide – I am happy to say thank you for your witness and your faithful labor in our broken and struggling yet resilient world. We remain committed to you and to keeping Union a place Where Faith and Scholarship Meet to Reimagine the Work of Justice. May it do so for many generations to come!
I hope you enjoy reading this inaugural issue of Union’s 2023 Impact Report!
Serene Jones
Johnston Family Professor for Religion and Democracy
Click Here to Read the 2023 Impact Report
The post Union’s 2023 Impact Report appeared first on Union Theological Seminary.
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