Health supplements
Incentivizing organ donation through a nonmonetary posthumous award
Mascia Bedendo & Linus Siming
Health Economics, forthcoming
Abstract:
Since 2013, The Order of St John Award for Organ Donation has been offered to the families of deceased solid organ donors in the United Kingdom to honor the donors and inspire others to donate. We evaluate the effects of this award using a difference‐in‐differences approach that builds on the fact that solid organ donors are eligible for the award, whereas cornea‐only donors are not. We find that the introduction of the award led to an increase in the number of deceased solid organ donors.
Effective strategies for rebutting science denialism in public discussions
Philipp Schmid & Cornelia Betsch
Nature Human Behaviour, September 2019, Pages 931–939
Abstract:
Science deniers question scientific milestones and spread misinformation, contradicting decades of scientific endeavour. Advocates for science need effective rebuttal strategies and are concerned about backfire effects in public debates. We conducted six experiments to assess how to mitigate the influence of a denier on the audience. An internal meta-analysis across all the experiments revealed that not responding to science deniers has a negative effect on attitudes towards behaviours favoured by science (for example, vaccination) and intentions to perform these behaviours. Providing the facts about the topic or uncovering the rhetorical techniques typical for denialism had positive effects. We found no evidence that complex combinations of topic and technique rebuttals are more effective than single strategies, nor that rebutting science denialism in public discussions backfires, not even in vulnerable groups (for example, US conservatives). As science deniers use the same rhetoric across domains, uncovering their rhetorical techniques is an effective and economic addition to the advocates’ toolbox.
Oakland's Sugar-Sweetened Beverage Tax: Impacts on Prices, Purchases and Consumption by Adults and Children
John Cawley et al.
NBER Working Paper, September 2019
Abstract:
Several cities in the U.S. have implemented taxes on sugar-sweetened beverages (SSBs) in an attempt to improve public health and raise revenue. On July 1, 2017, Oakland California introduced a tax of one cent per ounce on SSBs. In this paper, we estimate the impact of the tax on retail prices, product availability, purchases, and child and adult consumption of taxed beverages in Oakland, as well as of potential substitute beverages. We collected data from Oakland stores and their customers and a matched group of stores in surrounding counties and their customers. We collected information in the months prior to the implementation of the tax and again a year later on: (1) prices, (2) purchase information from customers exiting the stores, and (3) a follow-up household survey of adults and child beverage purchases and consumption. We use a difference-in-differences identification strategy to estimate the impact of the tax on prices, purchases, and consumption of taxed beverages. We find that roughly 60 percent of the tax was passed on to consumers in the form of higher prices. There was a slight decrease in the volume of SSBs purchased per shopping trip in Oakland and a small increase in purchases at stores outside of the city, and we find some evidence of increased shopping by Oakland residents at stores outside of the city. We do not find evidence of substantial changes in the overall consumption of SSBs or of added sugars consumed through beverages for either adults or children after the tax.
An Analysis of Beverage Size Restrictions
Brian Bourquard & Steven Wu
American Journal of Agricultural Economics, forthcoming
Abstract:
Due to high levels of obesity, various government interventions have been proposed to curb the consumption of sugar-sweetened beverages (SSBs). The New York City “soda ban,” which proposed to limit the size of SSBs is among the most well-known and controversial. While public debates about beverage-size-restrictions tend to focus on how consumers are impacted, we use a nonlinear pricing model to show that, for all but extremely tight restrictions, consumer welfare would be unaffected by an enforceable restriction. However, sellers’ profit would decline. While consumption is predicted to decline overall, the magnitude of the decline will vary by consumer segment.
Screening and Selection: The Case of Mammograms
Liran Einav et al.
NBER Working Paper, August 2019
Abstract:
Debates over whether and when to recommend screening for a potential disease focus on the causal impact of screening for a typical individual covered by the recommendation, who may differ from the typical individual who responds to the recommendation. We explore this distinction in the context of recommendations that breast cancer screening start at age 40. The raw data suggest that responders to the age 40 recommendation have less cancer than do women who self-select into screening at earlier ages. Combining these patterns with a clinical oncology model allows us to infer that responders to the age 40 recommendation also have less cancer than women who never screen, suggesting that the benefits of recommending early screening are smaller than if responders were representative of covered individuals. For example, we estimate that shifting the recommendation from age 40 to age 45 results in over three times as many deaths if responders were randomly drawn from the population than under the estimated patterns of selection. These results highlight the importance of considering the characteristics of responders when making and designing recommendations.
Association Between Maternal Fluoride Exposure During Pregnancy and IQ Scores in Offspring in Canada
Rivka Green et al.
JAMA Pediatrics, forthcoming
Design, Setting, and Participants: This prospective, multicenter birth cohort study used information from the Maternal-Infant Research on Environmental Chemicals cohort. Children were born between 2008 and 2012; 41% lived in communities supplied with fluoridated municipal water. The study sample included 601 mother-child pairs recruited from 6 major cities in Canada; children were between ages 3 and 4 years at testing. Data were analyzed between March 2017 and January 2019.
Exposures: Maternal urinary fluoride (MUFSG), adjusted for specific gravity and averaged across 3 trimesters available for 512 pregnant women, as well as self-reported maternal daily fluoride intake from water and beverage consumption available for 400 pregnant women.
Results: Of 512 mother-child pairs, the mean (SD) age for enrollment for mothers was 32.3 (5.1) years, 463 (90%) were white, and 264 children (52%) were female. Data on MUFSG concentrations, IQ scores, and complete covariates were available for 512 mother-child pairs; data on maternal fluoride intake and children’s IQ were available for 400 of 601 mother-child pairs. Women living in areas with fluoridated tap water (n = 141) compared with nonfluoridated water (n = 228) had significantly higher mean (SD) MUFSG concentrations (0.69 [0.42] mg/L vs 0.40 [0.27] mg/L; P = .001; to convert to millimoles per liter, multiply by 0.05263) and fluoride intake levels (0.93 [0.43] vs 0.30 [0.26] mg of fluoride per day; P = .001). Children had mean (SD) Full Scale IQ scores of 107.16 (13.26), range 52-143, with girls showing significantly higher mean (SD) scores than boys: 109.56 (11.96) vs 104.61 (14.09); P = .001. There was a significant interaction (P = .02) between child sex and MUFSG (6.89; 95% CI, 0.96-12.82) indicating a differential association between boys and girls. A 1-mg/L increase in MUFSG was associated with a 4.49-point lower IQ score (95% CI, −8.38 to −0.60) in boys, but there was no statistically significant association with IQ scores in girls (B = 2.40; 95% CI, −2.53 to 7.33). A 1-mg higher daily intake of fluoride among pregnant women was associated with a 3.66 lower IQ score (95% CI, −7.16 to −0.14) in boys and girls.
Conclusions and Relevance: In this study, maternal exposure to higher levels of fluoride during pregnancy was associated with lower IQ scores in children aged 3 to 4 years. These findings indicate the possible need to reduce fluoride intake during pregnancy.
Changes in the Prevalence of Chronic Hypertension in Pregnancy, United States, 1970 to 2010
Cande Ananth et al.
Hypertension, forthcoming
Abstract:
We estimated changes in the prevalence of chronic hypertension among pregnant women and evaluated the extent to which changes in obesity and smoking were associated with these trends. We designed a population-based cross-sectional analysis of over 151 million women with delivery-related hospitalizations in the United States, 1970 to 2010. Maternal age, year of delivery (period), and maternal year of birth (birth cohort), as well as race, were examined as risk factors for chronic hypertension. Prevalence rates and rate ratios with 95% CIs of chronic hypertension in relation to age, period, and birth cohort were derived through age-period-cohort models. We also examined how changes in obesity and smoking rates influenced age-period-cohort effects. The overall prevalence of chronic hypertension was 0.63%, with black women (1.24%) having more than a 2-fold higher rate than white women (0.53%; rate ratio, 2.31; 95% CI, 2.30–2.32). In the age-period-cohort analysis, the rate of chronic hypertension increased sharply with advancing age and period from 0.11% in 1970 to 1.52% in 2010 (rate ratio, 13.41; 95% CI, 13.22–13.61). The rate of hypertension increased, on average, by 6% (95% CI, 5–6) per year, with the increase being slightly higher among white (7%; 95% CI, 6%–7%) than black (4%; 95% CI, 3%–4%) women. Adjustments for changes in rates of obesity and smoking were not associated with age and period effects. We observed a substantial increase in chronic hypertension rates by age and period and an over 2-fold race disparity in chronic hypertension rates.
External Societal Costs of Antimicrobial Resistance in Humans Attributable to Antimicrobial Use in Livestock
Gabriel Innes et al.
NBER Working Paper, August 2019
Abstract:
Antimicrobial use in animal agriculture contributes to antimicrobial resistance in humans, which imposes significant health and economic costs on society. These costs are negative externalities. We review the relevant literature and develop a model to quantify the external costs of antimicrobial use in animal agriculture on antimicrobial resistance in humans. Parameters required for this estimate include: 1) the health and economic burden of antimicrobial resistance in humans, 2) the impact of antimicrobial use in animal agriculture on antimicrobial resistance in animals, 3) the fraction of antimicrobial resistance in humans attributable to animal agriculture, and 4) antimicrobial use in animals. We use a well-documented historic case to estimate an externality cost of about $1500 per kilogram of fluoroquinolones administered in US broiler chicken production. Enhanced data collection, particularly on parameters 3) and 4), would be highly useful to quantify more fully the externalities of antimicrobial use in animal agriculture.
Randomized controlled trial of Family Connects: Effects on child emergency medical care from birth to 24 months
Benjamin Goodman et al.
Development and Psychopathology, forthcoming
Abstract:
One of Tom Dishion's most significant contributions to prevention science was the development of affordable, ecologically valid interventions, such as the Family Check-Up, that screen for child and family risk factors broadly, but concentrate family-specific interventions on those with greatest potential for population impact. In the spirit of this approach, investigators examined effects of a brief, universal postnatal home visiting program on child emergency medical care and billing costs from birth to age 24 months. Family Connects is a community-wide public health intervention that combines identification and alignment of community services and resources with brief, postpartum nurse home visits designed to assess risk, provide supportive guidance, and connect families with identified risk to community resources. Over 18 months, families of all 4,777 resident Durham County, North Carolina, births were randomly assigned based on even or odd birth date to receive a postnatal nurse home visiting intervention or services as usual (control). Independently, 549 of these families were randomly selected and participated in an impact evaluation study. Families, blind to study goals, provided written consent to access hospital administrative records. Results indicate that children randomly assigned to Family Connects had significantly less total emergency medical care (by 37%) through age 24 months, with results observed across almost all subgroups. Examination of billing records indicate a $3.17 decrease in total billing costs for each $1 in program costs. Overall, results suggest that community-wide postpartum support program can significantly reduce population rates of child emergency medical care through age 24 months while being cost-beneficial to communities.
Behavioral Food Subsidies
Andy Brownback, Alex Imas & Michael Kuhn
University of Arkansas Working Paper, July 2019
Abstract:
We conduct a pre-registered field experiment with low-income grocery shoppers to study how behavioral interventions can be leveraged to improve the effectiveness of subsidies for healthy food purchases. Our unique design enables us to elicit choices between subsidies and deliver subsidies both before and at the point of purchase. We examine the effect of two non-restrictive changes to the choice environment: giving shoppers greater agency over the choice of subsidies and introducing a waiting period before the shopping trip to prompt deliberation about the subsidy and food purchasing decision. When combined, these changes substantially increase the effectiveness of subsidies, increasing healthy purchases by 61% relative to a restricted healthy food subsidy and 199% relative to an un-subsidized control group. Given the low cost and potential scalability of our interventions, our findings have significant implications for policy and intervention design.
Antibiotics-Driven Gut Microbiome Perturbation Alters Immunity to Vaccines in Humans
Thomas Hagan et al.
Cell, 5 September 2019, Pages 1313-1328
Abstract:
Emerging evidence indicates a central role for the microbiome in immunity. However, causal evidence in humans is sparse. Here, we administered broad-spectrum antibiotics to healthy adults prior and subsequent to seasonal influenza vaccination. Despite a 10,000-fold reduction in gut bacterial load and long-lasting diminution in bacterial diversity, antibody responses were not significantly affected. However, in a second trial of subjects with low pre-existing antibody titers, there was significant impairment in H1N1-specific neutralization and binding IgG1 and IgA responses. In addition, in both studies antibiotics treatment resulted in (1) enhanced inflammatory signatures (including AP-1/NR4A expression), observed previously in the elderly, and increased dendritic cell activation; (2) divergent metabolic trajectories, with a 1,000-fold reduction in serum secondary bile acids, which was highly correlated with AP-1/NR4A signaling and inflammasome activation. Multi-omics integration revealed significant associations between bacterial species and metabolic phenotypes, highlighting a key role for the microbiome in modulating human immunity.