Kevin Lewis

March 06, 2023

Long Covid in the United States
David Blanchflower & Alex Bryson
NBER Working Paper, February 2023 


Although yet to be clearly identified as a clinical condition, there is immense concern at the health and wellbeing consequences of long COVID. Using data collected from nearly half a million Americans in the period June 2022-December 2022 in the US Census Bureau’s Household Pulse Survey (HPS), we find 14 percent reported suffering long COVID at some point, half of whom reported it at the time of the survey. It peaks in midlife in the same way as negative affect. Ever having had long COVID is strongly associated with negative affect (anxiety, depression, worry and a lack of interest in things). The effect is larger among those who currently report long COVID, especially if they report severe symptoms. In contrast, those who report having had short COVID report higher wellbeing than those who report never having had COVID. Long COVID is also strongly associated with physical mobility problems, and with problems dressing and bathing. It is also associated with mental problems as indicated by recall and understanding difficulties. Again, the associations are strongest among those who currently report long COVID, while those who said they had had short COVID have fewer physical and mental problems than those who report never having had COVID. Vaccination is associated with lower negative affect, including among those who reported having had long COVID.

The Paradox of Wealthy Nations’ Low Adolescent Life Satisfaction
Robert Rudolf & Dirk Bethmann
Journal of Happiness Studies, January 2023, Pages 79–105 


Using PISA 2018 data from nearly half a million 15-year-olds across 72 middle- and high-income countries, this study investigates the relationship between economic development and adolescent subjective well-being. Findings indicate a negative log-linear relationship between per-capita GDP and adolescent life satisfaction. The negative nexus stands in stark contrast to the otherwise positive relationship found between GDP per capita and adult life satisfaction for the same countries. Results are robust to various model specifications and both macro and micro approaches. Moreover, our analysis suggests that this apparent paradox can largely be attributed to higher learning intensity in advanced countries. Effects are found to be more pronounced for girls than for boys.

Mass gatherings contributed to early COVID-19 mortality: Evidence from US sports
Alexander Ahammer, Martin Halla & Mario Lackner
Contemporary Economic Policy, forthcoming 


Social distancing is important to slow the community spread of infectious disease, but it creates enormous economic and social cost. Thus, it is important to quantify the benefits of different measures. We study the ban of mass gatherings, an intervention with comparably low cost. We exploit exogenous variation in the number of National Basketball Association and National Hockey League games, which arises due to the leagues' predetermined schedules, and the sudden suspension of the 2019–2020 seasons. We find that, among clusters of counties that are adjacent to sports venues, each additional mass gathering increased the cumulative number of COVID-19 deaths by 10.3%.

Prevalence of Multidrug-Resistant Organisms in Healthy Adults in Shenzhen, China
Ding Liu et al.
Health Security, forthcoming 


Public health problems caused by the high transmission of multidrug-resistant organisms (MDROs) have attracted widespread international attention. However, studies on healthy adults in this field are scarce. In this article, we report the microbiological screening results of 180 healthy adults recruited from 1,222 participants between 2019 and 2022 in Shenzhen, China. Findings show a high MDRO carriage rate of 26.7% in those individuals who did not use any antibiotics in the past 6 months and had not been hospitalized within the past year. MDROs were mainly extended-spectrum β-lactamase-producing Escherichia coli with high resistance to cephalosporin. With the assistance of metagenomic sequencing technology, we also performed long-term observations of several participants and found that drug-resistant gene fragments were prevalent even when MDROs were not detected by drug sensitivity testing. Based on our findings, we suggest that healthcare regulators limit the medical overuse of antibiotics and enact measures to limit its nonmedical use.

All Children Left Behind: Drug Adherence and the COVID-19 Pandemic
Josh Feng, Matthew Higgins & Elena Patel
NBER Working Paper, February 2023 


We study the effect of the COVID-19 pandemic on chronic disease drug adherence. Focusing on asthma, we use a database that tracks the vast majority of prescription drug claims in the U.S. from 2018 to 2020. Using a difference-in-differences empirical specification, we compare monthly drug adherence in 2019 and 2020 for the set of chronic patients taking asthma medication before the onset of the pandemic. We find that the pandemic increased adherence for asthmatic adults by 10 percent. However, we find a sustained decrease in pediatric drug adherence that is most severe for the youngest children. By the end of 2020, drug adherence fell by 30 percent for children aged 0 to 5, by 12 percent for children aged 6 to 12, and 5 percent for children aged 13 to 18. These negative effects are persistent regardless of changes in medical need, socioeconomic factors, insurance coverage and access to health services. We provide suggestive evidence that the observed pediatric changes are likely driven by parental inattention.

Changes in Body Mass Index Among School-Aged Youths Following Implementation of the Healthy, Hunger-Free Kids Act of 2010
Aruna Chandran et al.
JAMA Pediatrics, forthcoming 

Main Outcomes and Measures: The main outcome was annual BMI z-score (BMIz) trends before (January 2005 to August 2016) and after (September 2016 to March 2020) implementation of the HHFKA, adjusted for self-reported race, ethnicity, maternal education, and cohort group. An interrupted time-series analysis design was used to fit generalized estimating equation regression models.

Results: A total of 14 121 school-aged youths (7237 [51.3%] male; mean [SD] age at first measurement, 8.8 [3.6] years) contributing 26 205 BMI measurements were included in the study. Overall, a significant decrease was observed in the annual BMIz in the period following implementation of the HHFKA compared with prior to implementation (−0.041; 95% CI, −0.066 to −0.016). In interaction models to evaluate subgroup associations, similar trends were observed among youths 12 to 18 years of age (−0.045; 95% CI, −0.071 to −0.018) and among youths living in households with a lower annual income (−0.038; 95% CI, −0.063 to −0.013).

Societal Disruptions And Child Mental Health: Evidence From ADHD Diagnosis During The COVID-19 Pandemic
Seth Freedman et al.
NBER Working Paper, February 2023 


We study how the societal disruptions of the COVID-19 pandemic impacted diagnosis of a prevalent childhood mental health condition, Attention Deficit Hyperactivity Disorder (ADHD). Using both nationwide private health insurance claims and a single state’s comprehensive electronic health records, we compare children exposed to the pandemic to same aged children prior to the pandemic. We find the pandemic reduced new ADHD diagnoses by 8.6% among boys and 11.0% among girls nationwide through February 2021. We further show that higher levels of in-person schooling in Fall 2020 dampened the decline for girls but had no moderating effect for boys.

Recreational cannabis and opioid distribution
Shyam Raman et al.
Health Economics, April 2023, Pages 747-754 


Twenty-one U.S. states have passed recreational cannabis laws as of November 2022. Cannabis may be a substitute for prescription opioids in the treatment of chronic pain. Previous studies have assessed recreational cannabis laws' effects on opioid prescriptions financed by specific private or public payers or dispensed to a unique endpoint. Our study adds to the literature in three important ways: by (1) examining these laws' impacts on prescription opioid dispensing across all payers and endpoints, (2) adjusting for important opioid-related policies such as opioid prescribing limits, and (3) modeling opioids separately by type. We implement two-way fixed-effects regressions and leverage variation from eleven U.S. states that adopted a recreational cannabis law (RCL) between 2010 and 2019. We find that RCLs lead to a reduction in codeine dispensed at retail pharmacies. Among prescription opioids, codeine is particularly likely to be used non-medically. Thus, the finding that RCLs appear to reduce codeine dispensing is potentially promising from a public health perspective.

Pain Management and Work Capacity: Evidence from Workers’ Compensation and Marijuana Legalization
Rahi Abouk et al.
Journal of Policy Analysis and Management, forthcoming 


We study whether the work capacity of the older working population responds to improved pain management therapy access. We use the adoption of state recreational marijuana laws (RMLs) as a large policy shock to access to a non-pharmaceutical pain management option. We focus on workers’ compensation cash benefit receipt as a measure of work capacity, finding that receipt declines in response to RML adoption. Workers’ compensation cash benefits are awarded to workers who require time away from work to recover from an injury, which arguably captures a policy-relevant aspect of work capacity. We observe similar shifts in complementary proxies for work capacity, including work-limiting disability rates. After considering a range of alternative mechanisms, the evidence suggests that the primary driver of the reductions in workers’ compensation benefits is improvements in work capacity.

Can accurate demographic information about people who use prescription medications nonmedically be derived from Twitter?
Yuan-Chi Yang et al.
Proceedings of the National Academy of Sciences, 21 February 2023 


Traditional substance use (SU) surveillance methods, such as surveys, incur substantial lags. Due to the continuously evolving trends in SU, insights obtained via such methods are often outdated. Social media-based sources have been proposed for obtaining timely insights, but methods leveraging such data cannot typically provide fine-grained statistics about subpopulations, unlike traditional approaches. We address this gap by developing methods for automatically characterizing a large Twitter nonmedical prescription medication use (NPMU) cohort (n = 288,562) in terms of age-group, race, and gender. Our natural language processing and machine learning methods for automated cohort characterization achieved 0.88 precision (95% CI:0.84 to 0.92) for age-group, 0.90 (95% CI: 0.85 to 0.95) for race, and 94% accuracy (95% CI: 92 to 97) for gender, when evaluated against manually annotated gold-standard data. We compared automatically derived statistics for NPMU of tranquilizers, stimulants, and opioids from Twitter with statistics reported in the National Survey on Drug Use and Health (NSDUH) and the National Emergency Department Sample (NEDS). Distributions automatically estimated from Twitter were mostly consistent with the NSDUH [Spearman r: race: 0.98 (P < 0.005); age-group: 0.67 (P < 0.005); gender: 0.66 (P = 0.27)] and NEDS, with 34/65 (52.3%) of the Twitter-based estimates lying within 95% CIs of estimates from the traditional sources. Explainable differences (e.g., overrepresentation of younger people) were found for age-group-related statistics. Our study demonstrates that accurate subpopulation-specific estimates about SU, particularly NPMU, may be automatically derived from Twitter to obtain earlier insights about targeted subpopulations compared to traditional surveillance approaches.

Sales of Electronic Nicotine Delivery Systems (ENDS) and Cigarette Sales in the USA: A Trend Break Analysis
Arielle Selya et al.
Journal of Consumer Policy, March 2023, Pages 79–93 


Electronic nicotine delivery systems (ENDS) are a potentially lower-risk tobacco product which could help smokers switch completely away from cigarettes. However, the lack of strong evidence to date of a measurable, population-level effect on reducing smoking has generated skepticism about ENDS’ potential benefits. This study examines whether increased US ENDS sales have been associated with reduced cigarette sales. Retail data on weekly per-capita cigarette and ENDS purchases in the USA during 2014–2019 were obtained from a national sample of brick-and-mortar retail outlets. Trends in cigarette sales were modeled before (2014–2016) ENDS had a substantial market share, and, after adjusting for macroeconomic factors, projected into the post-period (2017–2019). Actual cigarette sales were lower than projected sales (by up to 16% across the post-period), indicating a substantial “cigarette shortfall” in the post-period. To explore whether general (i.e., inclusive of potentially many mechanisms) substitution by ENDS can explain the cigarette shortfall, its association with per-capita ENDS volume sales was examined. Higher ENDS sales were significantly associated with a greater cigarette shortfall: for every additional per-capita ENDS unit, cigarette sales were 1.4 packs-per-capita lower than expected (B = 1.4, p < .0001). Error correction models which account for spurious correlation yielded similar results. These findings support ENDS serving as a substitute for cigarettes (through potentially many mechanisms including cigarette price), causing cigarette consumption to decline. Since ENDS potentially pose lower risk than cigarettes, this general substitution effect suggests that risk-proportionate tobacco regulation could mitigate the tobacco-related health burden.


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