Health of the Republic
The Impact of Experiences with COVID-19 on the 2020 Presidential Election and Support for Health Reform
Nolan Kavanagh & Anil Menon
Public Opinion Quarterly, forthcoming
Abstract:
Health shocks may drive the public to support policies and candidates that protect health and well-being. Did the COVID-19 pandemic, as one such shock, shift preferences for health reform in the United States? Using nationally representative surveys of over 70,000 US adults between 2019 and 2020, we find that experiences with COVID-19 -- measured at both the individual and community levels -- increased support for Medicare for All by multiple percentage points. Consistent with partisan entrenchment on health issues, independents and weak partisans drove the association at the individual level; these subgroup differences were not observed for community-level experiences. To reduce concerns about confounding, we use data from multiple points in time to establish the expected temporal relationship between experiences with COVID-19 and support for health reform. Finally, consistent with the importance of health issues in the 2020 presidential race, we find that changes in support for health reform were mirrored by a comparable shift in support away from the incumbent, President Trump, in the weeks leading up to the election. Even if short lived, these shifts may have influenced both the discourse and outcome of the election.
The Impact of the Out-of-Pocket Housing Expense Inflation on Household Alcohol and Tobacco Purchases
Virat Agrawal et al.
NBER Working Paper, February 2025
Abstract:
Housing expense inflation has historically averaged an annual growth rate of 3.0 percent. However, starting in early 2021 housing expense inflation surged, peaking at 8.2 percent by March 2023. Substance use also increased concurrently. This study investigates the impact of rising housing expenses on household purchases of alcohol and tobacco. The relationship is ambiguous: higher housing costs could reduce spending on these items due to constrained disposable income or increase them as a coping mechanism for financial stress. To identify the effects of housing expense inflation we utilize exogenous variation in county-level housing regulations and exposure to housing expense inflation, which affects renters and homeowners differently as homeowners with fixed-rate mortgages are less impacted. In particular, we employ a difference-in-difference-in-difference (DDD) approach, comparing changes in alcohol and tobacco purchases between renters and homeowners, before and after the housing expense surge, across counties with varying housing regulation levels. Our findings reveal that a 1-unit increase in our housing regulation index -- equivalent to moving from the 10th to the 90th percentile -- correlates with an additional $28.70 (about 15.6 percent) monthly increase in out-of-pocket housing expenses per household member for renters relative to homeowners between 2019 and 2022. This increase is also associated with a 26 to 38 percent rise in financial difficulties among renters compared to homeowners. Furthermore, the same regulatory increase corresponds to a 15.2 percent rise in monthly beer purchases per member among renters relative to homeowners in 2022 compared to 2019, driven largely by low-cost beer. However, we find no significant effect on monthly household purchases of liquor, wine, or cigarettes.
Once-Weekly Semaglutide in Adults With Alcohol Use Disorder: A Randomized Clinical Trial
Christian Hendershot et al.
JAMA Psychiatry, forthcoming
Design, Setting, and Participants: This was a phase 2, double-blind, randomized, parallel-arm trial involving 9 weeks of outpatient treatment. Enrollment occurred at an academic medical center in the US from September 2022 to February 2024. Of 504 potential participants assessed, 48 non–treatment-seeking participants with AUD were randomized.
Results: Forty-eight participants (34 [71%] female; mean [SD] age, 39.9 [10.6] years) were randomized. Low-dose semaglutide reduced the amount of alcohol consumed during a posttreatment laboratory self-administration task, with evidence of medium to large effect sizes for grams of alcohol consumed (β, −0.48; 95% CI, −0.85 to −0.11; P = .01) and peak breath alcohol concentration (β, −0.46; 95% CI, −0.87 to −0.06; P = .03). Semaglutide treatment did not affect average drinks per calendar day or number of drinking days, but significantly reduced drinks per drinking day (β, −0.41; 95% CI, −0.73 to −0.09; P = .04) and weekly alcohol craving (β, −0.39; 95% CI, −0.73 to −0.06; P = .01), also predicting greater reductions in heavy drinking over time relative to placebo (β, 0.84; 95% CI, 0.71 to 0.99; P = .04). A significant treatment-by-time interaction indicated that semaglutide treatment predicted greater relative reductions in cigarettes per day in a subsample of individuals with current cigarette use (β, −0.10; 95% CI, −0.16 to −0.03; P = .005).
Behavioral Food Subsidies
Andy Brownback, Alex Imas & Michael Kuhn
Review of Economics and Statistics, forthcoming
Abstract:
We conduct a field experiment with low-income shoppers to study how behavioral interventions can improve the effectiveness of healthy food subsidies. Our unique design enables us to deliver subsidies both before and during grocery shopping. We examine the effects of two nonrestrictive changes to the choice environment: giving shoppers agency over the subsidy they receive and introducing a waiting period before a subsidized shopping trip to prompt deliberation about upcoming purchases. These interventions increase healthy food spending by 61% more than a healthy food subsidy alone, resulting in 199% greater healthy spending than in our unsubsidized control group.
What Can Trends in Emergency Department Visits Tell Us About Child Mental Health?
Han Choi et al.
NBER Working Paper, March 2025
Abstract:
Increases in mental health diagnoses and suicidal behaviors in Emergency Departments are often cited as evidence of an accelerating child mental health crisis. We ask whether trends in ED visits provide an accurate picture of changes in U.S. child mental health. These measures have been profoundly affected by changing conventions about screening, defining, and coding of mental illness. We conclude that child mental health has been deteriorating, but not by the startling magnitudes suggested by jumps and trends in some measures. Although reported suicidal behaviors rose 233% from 2006-2021, the true rise in mental health disorders is less than 30-50%.
Predicting the replicability of social and behavioural science claims in COVID-19 preprints
Alexandru Marcoci et al.
Nature Human Behaviour, February 2025, Pages 287-304
Abstract:
Replications are important for assessing the reliability of published findings. However, they are costly, and it is infeasible to replicate everything. Accurate, fast, lower-cost alternatives such as eliciting predictions could accelerate assessment for rapid policy implementation in a crisis and help guide a more efficient allocation of scarce replication resources. We elicited judgements from participants on 100 claims from preprints about an emerging area of research (COVID-19 pandemic) using an interactive structured elicitation protocol, and we conducted 29 new high-powered replications. After interacting with their peers, participant groups with lower task expertise (‘beginners’) updated their estimates and confidence in their judgements significantly more than groups with greater task expertise (‘experienced’). For experienced individuals, the average accuracy was 0.57 (95% CI: [0.53, 0.61]) after interaction, and they correctly classified 61% of claims; beginners’ average accuracy was 0.58 (95% CI: [0.54, 0.62]), correctly classifying 69% of claims. The difference in accuracy between groups was not statistically significant and their judgements on the full set of claims were correlated (r(98) = 0.48, P < 0.001). These results suggest that both beginners and more-experienced participants using a structured process have some ability to make better-than-chance predictions about the reliability of ‘fast science’ under conditions of high uncertainty. However, given the importance of such assessments for making evidence-based critical decisions in a crisis, more research is required to understand who the right experts in forecasting replicability are and how their judgements ought to be elicited.