Good or Bad for You
"Despair" and Death in the United States
Christopher Ruhm
NBER Working Paper, September 2024
Abstract:
Increases in “deaths of despair” have been hypothesized to provide an important source of the adverse mortality experiences of some groups at the beginning of the 21st century. This study examines this possibility and uncovers the following primary findings. First, mental health deteriorated between 1993 and 2019 for all population subgroups examined. Second, these declines raised death rates and contributed to the adverse mortality trends experienced by prime-age non-Hispanic Whites and, to a lesser extent, Blacks from 1999-2019. However, worsening mental health is not the predominant explanation for them. Third, to extent these relationships support the general idea of “deaths of despair”, the specific causes comprising it should be both broader and different than previously recognized: still including drug mortality and possibly alcohol deaths but replacing suicides with fatalities from heart disease, lower respiratory causes, homicides, and conceivably cancer. Fourth, heterogeneity in the consequences of a given increase of poor mental health are generally more important than the sizes of the changes in poor mental health in explaining Black-White differences in the overall effects of mental health on mortality.
The Association between the Volatility of Income and Life Expectancy in the U.S.
Joseph Hotz, Anna Ziff & Emily Wiemers
Journal of Labor Economics, forthcoming
Abstract:
We examine the relationship between income volatility and life expectancy in mid-sized U.S. commuting zones between 2006 and 2014. We use a commercial dataset, InfoUSA, to measure income volatility which we link to estimates of life expectancy by gender, county, race, and income. We find that higher income volatility in a county is associated with lower life expectancy, but only at the bottom of the income distribution and primarily for non-Hispanic Whites. Though we cannot extrapolate our findings to individual-level relationships, we do link them to existing literatures on place-based differences in mortality and the relationship between volatility and health.
What’s in the water? Long-run effects of fluoridation on health and economic self-sufficiency
Adam Roberts
Journal of Health Economics, forthcoming
Abstract:
Community water fluoridation has been named one of the 10 greatest public health achievements of the 20th century for its role in improving dental health. Fluoride has large negative effects at high doses, clear benefits at low levels, and an unclear optimal dosage level. I leverage county-level variation in the timing of fluoride adoption, combined with restricted U.S. Census data that link over 29 million individuals to their county of birth, to estimate the causal effects of childhood fluoride exposure. Children exposed to community water fluoridation from age zero to five are worse off as adults on indices of economic self-sufficiency (−1.9% of a SD) and physical ability and health (−1.2% of a SD). They are also significantly less likely to graduate high school (−1.5 percentage points) or serve in the military (−1.0 percentage points). These findings challenge existing conclusions about safe levels of fluoride exposure.
Do E-Cigarette Retail Licensure Laws Reduce Youth Tobacco Use?
Charles Courtemanche et al.
Journal of Health Economics, December 2024
Abstract:
E-cigarette licensure laws (ELLs) require retailers to obtain a state license to sell e-cigarettes over the counter. This study is the first to comprehensively explore the effect of ELL adoption on youth tobacco product use. Using data from the State Youth Risk Behavior Survey (YRBS) and a difference-in-differences approach, we find no evidence that ELL adoption reduces youth ENDS use. The precision of our estimates allows us to rule out, with 95 percent confidence, ELL-induced declines in prior-month, frequent, and everyday youth ENDS use of more than 0.7, 0.3, and 0.4 percentage points, respectively. The pattern of null findings persists when we examine ELLs that impose higher penalties for retailer non-compliance, higher renewable licensure fees, and criminal in addition to civil penalties. We conclude that ELLs have only limited success in curbing access to ENDS among youths.
Spatial Spillover Effects of State-Level Policies Banning Electronic Nicotine Delivery Systems
Tengjiao Chen, Lanxin Jiang & Shivaani Prakash
American Journal of Health Economics, Fall 2024, Pages 539–567
Abstract:
After the outbreak of e-cigarette or vaping use-associated lung injury (EVALI) strongly linked to vitamin E acetate found in some tetrahydrocannabinol-containing vaping products in 2019, several states passed emergency bans on the sale of electronic nicotine delivery systems (ENDS) products. We use a fixed-effect panel regression model with an embedded difference-in-differences design to evaluate the unintended effects of state-level ENDS bans. Besides eliminating ENDS sales, our results indicate that a full ENDS ban is associated with a 94.5 percent increase in volume sales of ENDS refills in neighboring counties compared with the pre-ban average. We find similar but weaker spatial spillover impacts of flavor (non-tobacco) ENDS bans. As these flavor bans did not restrict tobacco-flavored ENDS sales, we observe an overall 55.4 percent decline in sales of ENDS refills but more-than-doubled sales of tobacco-flavored ENDS refills in the states subject to the flavor bans. Relative increases in cigarette sales can be observed when states implemented either full or flavor ENDS bans. This study improves our understanding of the unintended consequences of ENDS bans, as our results suggest significant spillover effects from cross-border purchasing behavior, switching across flavors of ENDS, and substitution between ENDS and cigarettes after states implemented such bans.
Cannabis Users’ and Non-Users’ Differential Responses to Two Anti-Cannabis Campaigns
Elise Stevens et al.
Health Education & Behavior, forthcoming
Abstract:
Even though multiple states have approved legal recreational use of cannabis, the expansion of recreational cannabis legalization has led to public health concerns in the United States. Young adults (18–25 years old) have the highest percentage of cannabis use disorder compared to all other age groups. The purpose of this study is to compare cognitive and emotional responses of young adults who use cannabis and non-users to two anti-cannabis media campaigns that employed different message strategies. In total, 50 people (25 people who use cannabis and 25 non-users) participated in the study -- a 2 (cannabis use status: people who currently use cannabis/non-users) × 2 (Public Service Advertising [PSA] campaign: Don’t be a Lab Rat-Informational/Stoner Sloth-Narrative) × 3 (message replication) experiment. Participants viewed six messages based on the combinations of each of the three message replications within two campaigns. Participants’ facial emotional responses were recorded during message exposure. Self-report questions were asked after viewing each message. Self-report indices showed no differences between the two campaigns for participants who use cannabis and non-users. However, after controlling for individual differences, participants who use cannabis displayed more negative emotional responses to the Don’t be a Lab Rat messages than to the Stoner Sloth messages. Conversely, cannabis users experienced more positive emotional responses to the Stoner Sloth messages than to the Don’t be a Lab Rat messages. The study provides insights for message design in public health campaigns addressing cannabis use, suggesting that psychophysiological measures can be helpful in providing insights into responses not detected by traditional self-report measures.
Are suicides underreported? The impact of coroners versus medical examiners on suicide reporting
Jose Manuel Fernandez & Jayani Jayawardhana
Health Services Research, forthcoming
Data Sources and Study Setting: We used restricted-access state mortality data from National Vital Statistics System between the years 1959 to 2016. These data were matched with state-level changes in death investigation systems reported by the Centers for Disease Control and Prevention database on the Public Health Law Program: Coroner/ME Laws.
Study Design: We used difference-in-differences and event study methods for the analysis. We estimated the relative per capita changes in suicides, accidental deaths, and homicides when comparing coroner-only states with other death investigation types. Sub-analyses estimated differences by sex, race, and if coroners were required to receive training.
Principal Findings: Coroners-only states underreported suicides by 17.4% (p < 0.05) and performed 20.4% (p < 0.05) fewer autopsies compared to states with county coroners and a state medical examiner. This pattern is consistent by sex and race. Required coroner training did not affect death determination significantly.
Conclusion: Coroners-only states underreported suicides compared to states with county coroners and a state medical examiner. The disparity in the use of autopsies is a potential mechanism for underreporting of suicides by coroners. If all coroners-only states adopted a state medical examiner, suicide reporting would increase by 2243–3100 deaths in the United States annually.
Intergenerational Benefits of Childhood Health Intervention: Evidence from Measles Vaccination
Hamid Noghanibehambari
American Journal of Health Economics, Fall 2024, Pages 670–698
Abstract:
Previous literature suggested that promoting childhood health could have intergenerational benefits. While several studies have pointed to the life-cycle benefits of mass vaccinations and disease elimination, fewer studies have explored their long-run intergenerational aspects. This paper joins the ongoing literature by exploring the intergenerational health benefits of mothers’ childhood exposure to the measles vaccination for their infants’ birth outcomes. Our identification strategy takes advantage of cross-cohort exposure to the introduction of the measles vaccine in 1963 and cross-state variations in pre-vaccine measles rates. Using the universe of birth records in the US over the years 1970–2004, we show that mothers who were exposed to the measles vaccine reveal improved birth outcomes. For mothers in states with an average pre-vaccine measles rate, full exposure to the vaccine during childhood is associated with roughly 5.4 and 5.7 percent reduction in the incidence of low-birth-weight and preterm-birth newborns. A series of event study analyses suggest that these findings are not driven by preexisting trends in outcomes. Further analyses suggest that improvements in educational outcomes, increases in prenatal care utilization, reductions in smoking, and increases in several measures of socioeconomic status are potential mechanisms.
The burden of natural gas leaks on public sector emergency response in the United States
Casey Brodsky et al.
Energy Policy, September 2024
Abstract:
Fire departments play a critical role in responding to potential hazards generated by natural gas and propane leaks, yet the costs of providing these services is unknown. Here, we analyzed 15 years of gas leak-coded incidents from the National Fire Incident Reporting System (NFIRS) and estimated associated costs using fire department operating budgets. From 2003 to 2018, a total of 2.4 million gas leak-coded incidents required fire department responses, accounting for ∼0.8% of all nationwide incidents. Reported gas leak incidents have steadily increased nationwide, nearly quadrupling from 2003 to 2018. In 2018, New York City (NYC) experienced 22,090 gas leak incidents -- more than the next 25 cities combined—conservatively costing NYC $70 million annually. With a median national response cost of $2609 (S.D. $1734), uncombusted gas leaks conservatively cost U.S. fire departments $564 million in 2018 -- at least 10x greater than for gas leak-caused fires. City-level natural gas systems entail an underappreciated and increasing public cost burden on emergency response services. Findings herein raise the salience of gas leak-associated emergency response costs and support improved gas leak response coordination between emergency services and gas utility providers. Decision-makers are encouraged to incorporate these costs into cost-benefit analyses and consider the intended and unintended effects on emergency response systems in managing energy transitions.
Microbial richness and air chemistry in aerosols above the PBL confirm 2,000-km long-distance transport of potential human pathogens
Xavier Rodó et al.
Proceedings of the National Academy of Sciences, 17 September 2024
Abstract:
The existence of viable human pathogens in bioaerosols which can cause infection or affect human health has been the subject of little research. In this study, data provided by 10 tropospheric aircraft surveys over Japan in 2014 confirm the existence of a vast diversity of microbial species up to 3,000 m height, which can be dispersed above the planetary boundary layer over distances of up to 2,000 km, thanks to strong winds from an area covered with massive cereal croplands in Northeast (NE) Asia. Microbes attached to aerosols reveal the presence of diverse bacterial and fungal taxa, including potential human pathogens, originating from sewage, pesticides, or fertilizers. Over 266 different fungal and 305 bacterial genera appeared in the 10 aircraft transects. Actinobacteria, Bacillota, Proteobacteria, and Bacteroidetes phyla dominated the bacteria composition and, for fungi, Ascomycota prevailed over Basidiomycota. Among the pathogenic species identified, human pathogens include bacteria such as Escherichia coli, Serratia marcescens, Prevotella melaninogenica, Staphylococcus epidermidis, Staphylococcus haemolyticus, Staphylococcus saprophyticus, Cutibacterium acnes, Clostridium difficile, Clostridium botulinum, Stenotrophomonas maltophilia, Shigella sonnei, Haemophillus parainfluenzae and Acinetobacter baumannii and health-relevant fungi such as Malassezia restricta, Malassezia globosa, Candida parapsilosis and Candida zeylanoides, Sarocladium kiliense, Cladosporium halotolerans, and Cladosporium herbarum. Diversity estimates were similar at heights and surface when entrainment of air from high altitudes occurred. Natural antimicrobial-resistant bacteria (ARB) cultured from air samples were found indicating long-distance spread of ARB and microbial viability. This would represent a novel way to disperse both viable human pathogens and resistance genes among distant geographical regions.