course material

1. Analysis of Biostatistical Article Discussion Paper
Analysis of Biostatistical Article Discussion PaperIntroductionVujicic, Yarbrough and
Nasseh (2014) presented the results of a quantitative study that intended to review how the
Affordable Care Act affects dependent coverage policy regarding utilization and barriers to
use of private coverage. This is informed by the fact that the Act’s coverage policy was
reviewed thereby creating an opportunity for employers to expand their dental cover even
as they expanded their medical cover. The study concedes that oral health is a source of
concern since it is linked to general health such that adequate dental care is anticipated to
avert higher medical costs and needs. The authors call to attention the fact that the public’s
access to dental services has reduced since the beginning of the 21st century owing to a
reduction in coverage benefits, making it difficult for dependents to access dental services
since they are not included in the plan. This effect has been evidenced by the increasing
number of people who visit emergency services owing to dental needs, citing reduced
benefits as being responsible for their condition. The authors anticipate that the current
study will provide an objective review of the Act, showing that the increased dependency
coverage will make the public more inclined to access dental services since they will be
cheaper (Vujicic, Yarbrough & Nasseh, 2014)Analysis of Biostatistical Article Discussion
Paper.ORDER YOUR PAPER HERELiterature reviewThe article presents a literature review
at its beginning. It is directed by the intention and purpose of the study with a focus on
rlevance and publication recency. In fact, it is directed by reliable, peer-reviewed and valid
literature sources and publications that present informaton and data that is relevant to the
study objective. In this case, 37 publications were sources to direct the literature review.
These publications included books, official agency commniques, websites and journal
articles. Besides that, the publications included quantitative and qualitative studies offer
relevant information to explain the concept of the Affordable Care Act, the changes intended
for the Act, and how they affected access to care as well as coverage. In addition, the
literature sources were published within four years of the article’s publication (except for
five literature sources that were published in 2000, 2002, 2005, 2007 and 2009
respectively. These publication dates are indicative that at the time of the article’s
publication, the information that was used in the literature review wvs current and included
up-to-date information and data on the present study objective thus improving the article’s
relevance within the medical care environment. Although there was no evaluation to
determine the weaknesses and strengths of the publications used in the literature review, it
can be accepted that they were relevant, valid and reliable to the study since they

2. contributed to discussions about the same subject as the article (Vujicic, Yarbrough &
Nasseh, 2014)Analysis of Biostatistical Article Discussion Paper.Theoretical framework and
hypothesesAlthough the theoretical framework was not explicitly desribed in the article, it
was implied. In this case, the article’s introduction acted as the theoretical framework
where the authors’ offer the basis for the research. It aquired perceptions from past
publications then amalgamated these perceptions into a rational context (Treiman, 2015).
Vujicic, Yarbrough and Nasseh (2014) identified a unique viewpoint from which the
discussions were developed. In this case, it was designed from the perspective of a research
study that reviewed the spillover effects of the Affordable Care Act, particularly how it has
affected private dental benefits coverage. For that matter, the authors were keen to offer an
objective opinion regarding the changes that have been experienced in the form of
increased coverage by private dental services managed by employers, and how this effect
can be credited to the policy changes in the Act. In line with this understanding was the
hypothesis that the private dental benefits coverage was expanded to include more
dependents so as to match the Act. Of course, the theoretical framework identified the Act
as the most likely source of the change since it is the only variable that has changed. In
addition, the framework identified the National Health Interview Survey (NHIS) as a unique
platform from which to collect secondary data regarding changes in dental benefits
coverage, particularly the position that cost plays in visits and access to dental services, and
how these figures have changed over time. It is apparent that the authors applied grounded
theory in the study since the theoretical framework was advanced under the supposition
that changes to the Act accounted for the increased access to dental services and coverage
noted in private institutions (Vujicic, Yarbrough & Nasseh, 2014).MethodologyVujicic,
Yarbrough and Nasseh (2014) applied a retrospective approach that used differences-in-
difference model to determine the relationship between the study variables. In this case, the
independent variable was the subjects’ ages while the dependent variable was the coverage
of private dental benefits, utilization of dental care, and financial barriers that would limit
access to dental care. For that matter, the subjects were divided into two age groups, one
age group was between 19 and 25 years of age while the second age group was between 26
and 34 years of age. Using secondary data collected from NHIS, the research intended to
show that private dental coverage reduced owing to changes in the Act, even as utilization
of dental services increased since financial barriers had been eliminated. Towards this end,
annual medical summary data was collected for the periods from 2008 to 2012. It was
noted 92,171 observations contained the dental benefits coverage data, 38,204
observations had dental care utilization data, while 38,331 observations had financial
barriers to dental care data. The collected data was subjected to statistical analysis in which
differences between the periods before and after the change in the Act were noted. The
statistical analysis uses STATA version 12 software to compute the relevant statistics and
present the results. The differences in the two periods were attributed to the change,
particularly its effects in the 19 to 25 years age group, with the 26 to 34 years age group
used as the control group to show that any differences noted were the result of the changes
to the Act (Vujicic, Yarbrough & Nasseh, 2014)Analysis of Biostatistical Article Discussion
Paper.It is evident that the study applied a secondary research approach that used

3. quantitative data. This was the best approach for collecting the required data. Although a
qualitative approach could have collected similarly useful data, it would have been more
cumbersome and expensive to carry out (Babbie, 2016). Besides that, a qualitative approach
would have made it difficult to generalize the results since it would have used a smaller
sample of participants, unlike the present approach that had a larger number of participants
that improve the results generalizability (Creswell, 2013).The reliability and validity of the
data collection approach was not determined. This is clear from the absence of reliability
and validity test controls. Still, the statistical approach shows that the study population
were strongly linked. This indicates that the sample was from the same population (Mackey
& Gass, 2015). It is notable that the study relied on retrospective data collected through
reliable tools. The tools used interval level of measurement that used numerical measures
with statistical significance. It must be mentioned that it would be difficult to question the
reliability of official government statistics (particularly those linked to health care) since
they are the standard approaches that are applied to direct government policies and
practices (Bryman & Bell, 2015; Howell, 2013). As a result, it can be assumed that the data
collection approach applied in the study presented reliable and valid data.ORDER YOUR
PAPER HERESampleThe study sample comprised of a population divided into two groups.
In this case, the first group consisted of persons between 19 and 25 years of age while the
control group was comprised of persons between 26 and 34 years of age. The inclusion
criteria was participations in the NHIS, since the data used in the research was from
secondary sources. Any individual who provided data to the NHIS but had some missing
values was excluded from the study since the information they provided was considered
incomplete. As earlier indicated, 92,171 observations contained the dental benefits
coverage data, 38,204 observations had dental care utilization data, while 38,331
observations had financial barriers to dental care data. These numbers were considered
adequate for the study since they were the whole population of subjects that qualified for
the study. Still, there may be a need to look for a larger sample since the population of
interest is very large and the observations only cover a small fraction of that population
(Vujicic, Yarbrough & Nasseh, 2014) Analysis of Biostatistical Article Discussion Paper.Data
analysisData analysis was conducted using STATA software version 12. STATA is a
specialized data analysis software that has the capacity to analyze data, determine trends,
develop codebooks, offer statistically significant models, and present the outcomes of the
analysis in the forms of tables, charts and graphs. In the present case, the software analysis
presenting an understanding of data trends and determining its main characteristics. For
that matter, the analysis was conducted while controlling for research variables that
included region, marital status, gender, race/ethnicity, employment status, and educational
attainment, as well as coverage of dental benefits, financial barriers, and utilization of dental
care. In addition, the analysis included models for linear and quadratic time trends, along
with computations for complex sampling designs (Monette, Sullivan & DeJong, 2013; Vujicic,
Yarbrough & Nasseh, 2014). Data analysis made use of difference-in-differences analysis
that evaluated the study variables. In addition, it included quadratic and linear time trends
that were adjusted for pre-existing coverage trends. Also, the analysis used linear
probability modelling and t statistics. The study applied percentage as the statistical

4. procedure with the findings intended to compare the sample as a proportion of the
population (Vujicic, Yarbrough & Nasseh, 2014).The data analysis approach is appropriate
since it recognized that suitable instruments must be complemented with suitable
procedures and scales to make certain that the study meets its intentions. This is an
indication that the correct data would be collected to address the study objectives. This is
clarified through the study focus on care statistics as the dependent variable and the
Affordable Care Act as the independent variable. In addition, it indicates that the required
information was availed in terms of the dependent and independent variables (Rowe,
2015)Analysis of Biostatistical Article Discussion Paper.ResultsThe study determined that
following the introduction of the Act, private dental benefits coverage for persons between
19 and 25 years of age reported a higher increase when compared to persons between 26
and 34 years of age. A 5.6% (p<0.001) increase was reported in 2011 and an increase of
6.9% (p<0.001) was reported in 2012. In addition, dental care utilization for persons
between 19 and 25 years of age reported a higher increase when compared to persons
between 26 and 34 years of age. A 2.8% (p=0.062) increase was reported in 2011 and an
increase of 3.3% (p=0.038) was reported in 2012. With regards to financial barriers to
dental care, mixed results were reported for the two years. In 2011, persons between 19
and 25 years of age reported a 2.1% (p=0.068) decrease when compared to persons
between 26 and 34 years of age, although a 2.0% (p=0.087) increase was reported in 2012.
Additional analysis of the results shows that for private dental benefits coverage for the
treatment and control age group whereby it was noted that there was a general increase in
the proportion of adults’ age between 19 and 25 years of age who benefited from private
dental coverage in the period after the change in the Act. In contrast, it was noted that there
was a lower proportion of adults between 26 and 34 years of age who benefited from
private dental coverage in the period after the change in the Act. The results attributed the
changes to the implementation of the revision of the dependent coverage policy for the Act
whereby younger adults could now be covered by their guardians and parents’ health
insurance, a change that took effect in September 2010. In addition, the researchers noted
that there was a general increase in the utilization of dental services even as the financial
barriers to dental care reduced following the change to the Act (Vujicic, Yarbrough &
Nasseh, 2014)Analysis of Biostatistical Article Discussion Paper.Discussion and
conclusionFollowing the results of the research, the authors noted that the new policy
applied within the Act had a spillover effect in making dental care more affordable and
accessible to the population. It noted that before the Act, young people found it increasingly
difficult to access dental services thereby identifying them as the group most likely forego
dental services until an emergency arises. This explained why young people made the
principal proportion of patients who visited the emergency room seeking dental services,
and accounted for the lowest utilization rate for any age group. In essence, the researchers
noted that after the changes to the Act, more people had their dependents included in their
private dental cover. The implication is that the Act’s dependent coverage policy was
instrumental in influencing private insurance managers to include young adults into the
dependents population. Still, there are concerns that whatever improvements have been
noted in making dental care more accessible and affordable for young people has done very

5. little to address the issue of large numbers of young people seeking emergency dental care.
Rather than looking at the effects as being unintentional and spillover, there is need to
review the Affordable Care Act with the express intention of making dental care more
affordable and acceptable to young people thereby reducing their need for emergency
services since they access care when and if they need it (Vujicic, Yarbrough & Nasseh,
2014).Research utilization implicationsAlthough the research study presented in Vujicic,
Yarbrough and Nasseh (2014) included only a small proportion of the study population of
interest, it explores a novel concept that raises some pertinent questions that should be
explored by policy makers. The use of credible data sources in the form of NHIS and use of
STATA to analyze the data shows that it has applied scientific methods thereby making its
results credible enough to cause the industry to explore the issue further. The study is of
interest to both the public and government since it explores an avenue that would make
medical care more accessible and affordable even as it addresses the problem of young
people increasingly accessing and using emergency dental services. The results clearly
show that while the policy change to the Act had a different primary objective, it had a
secondary effect in the form of making dental care services more affordable and accessible
to young people by increasing dependent coverage ages. Based on the research results, the
government and policy makers can develop strategies for reviewing the Affordable Care Act
with the primary intention of allowing young people to easily and cheaply access such
services (Vujicic, Yarbrough & Nasseh, 2014). Therefore, the study under review has the
benefit of showing that greater coverage allows dependent to enjoy better health and
reduces their need for emergency services by making care more affordable and accessible
Analysis of Biostatistical Article Discussion Paper.Week 5 ProjectAnalysis of Biostatistical
ArticleIdentify a peer-reviewed article from the Online Library that presents statistical
analysis of a pertinent topic of public health interest or importance. Provide a link to this
article and give a brief summary of the article, including hypotheses, methods, and findings.
Research the topic and available data sources. On the basis of the biostatistical methods you
have learned about in this course, analyze the article and its findings.Here are some points
to consider in your analysis:What data are available on this topic?What data does the article
use?Discuss the level of measurement, assumptions that can be made, statistics that can be
calculated from these data, and the general quality of the data.What is the type of study or
study design used?Explain the type of biostatistical study design that the author has
used.Describe the hypothesis or hypotheses that the author intends to test.Explain the
statistics that the author uses to test these hypotheses.What are the article's statistical
findings?Describe the statistical results of the author's analysis.Provide a substantive
interpretation of these findings (What do the results mean in relation to the hypotheses and
the public health topic?).Describe the author's recommendations about this topic based on
his or her findings and hypotheses.If you had been the author, what changes, if any, would
you have made in the study you analyzed?Discuss whether the author made any statistical
errors.Were the correct data used for the questions asked?Were the correct data
available?Were the correct statistics used for the data available?What other data might you
want to collect and why?Do the statistical findings support the author's conclusions?Write a
9 page, double-spaced paper in Word format. Apply APA standards to citation of sources.

6. Utilize at least 8 scholarly sources in your research and be sure to include a references page.
Write in a clear, concise, and organized manner; demonstrate ethical scholarship in
accurate representation and attribution of sources; and display accurate spelling, grammar,
and punctuation.ReferencesBabbie, E. (2016). The basics of social research (7th ed.).
Boston, MA: Cengage Learning.Bryman, A. & Bell, E. (2015). Business research methods (4th
ed.). Oxford: Oxford University Press.Creswell, J. (2013). Research design: qualitative,
quantitative, and mixed method approaches. Thousand Oaks, CA: Sage Publications.Howell,
D. (2013). Fundamental statistics for the behavioral sciences. Belmont, CA:
Wadsworth.Mackey, A., & Gass, S. (2015). Second language research: methodology and
design. London: Routledge.Monette, D., Sullivan, T. & DeJong, C. (2013). Applied social
research: a tool for the human services. Boston, MA: Cengage Learning.Rowe, P. (2015).
Essential statistics for the pharmaceutical sciences. Hoboken, NJ: John Wiley &
Sons.Treiman, D. (2014). Quantitative data analysis: doing social research to test ideas.
Hoboken NJ: John Wiley & Sons.Vujicic, M., Yarbrough, C. & Nasseh, K. (2014). The effect of
the Affordable Care Act's Expanded Coverage Policy on access to dental care. Med Care,
52(8), 715-719.ORDER YOUR PAPER HEREWeek 5 Project Analysis of Biostatistical Article
Identify a peer-reviewed article from the Online Library that presents statistical analysis of
a pertinent topic of public health interest or importance. Provide a link to this article and
give a brief summary of the article, including hypotheses, methods, and findings. Research
the topic and available data sources. On the basis of the biostatistical methods you have
learned about in this course, analyze the article and its findings. Here are some points to
consider in your analysis: • What data are available on this topic? • What data does the
article use? o Discuss the level of measurement, assumptions that can be made, statistics
that can be calculated from these data, and the general quality of the data. • What is the type
of study or study design used? o Explain the type of biostatistical study design that the
author has used. o Describe the hypothesis or hypotheses that the author intends to test. o
Explain the statistics that the author uses to test these hypotheses. • What are the article's
statistical findings? o Describe the statistical results of the author's analysis. o Provide a
substantive interpretation of these findings (What do the results mean in relation to the
hypotheses and the public health topic?). o Describe the author's recommendations about
this topic based on his or her findings and hypotheses. • If you had been the author, what
changes, if any, would you have made in the study you analyzed? o Discuss whether the
author made any statistical errors. • Were the correct data used for the questions asked? •
Were the correct data available? • Were the correct statistics used for the data available? •
What other data might you want to collect and why? • Do the statistical findings support the
author's conclusions? Write a 9 page, double-spaced paper in Word format. Apply APA
standards to citation of sources. Utilize at least 8 scholarly sources in your research and be
sure to include a references page. Write in a clear, concise, and organized manner;
demonstrate ethical scholarship in accurate representation and attribution of sources; and
display accurate spelling, grammar, and punctuation. Analysis of Biostatistical Article
Discussion Paper