Healthy Status
Using Donald Trump’s COVID-19 Vaccine Endorsement to Give Public Health a Shot in the Arm: A Large-Scale Ad Experiment
Bradley Larsen et al.
NBER Working Paper, April 2022
Abstract:
We report a large-scale randomized controlled trial designed to assess whether the partisan cue of a provaccine message from Donald Trump would induce Americans to get COVID-19 vaccines. Our study involved presenting a 27-second advertisement to millions of U.S. YouTube users in October 2021. Results indicate that the campaign increased the number of vaccines in the average treated county by 103. Spread across 1,014 treated counties, the total effect of the campaign was an estimated increase of 104,036 vaccines. The campaign was cost-effective: with an overall budget of about $100,000, the cost to obtain an additional vaccine was about $1 or less.
Highlighting COVID-19 racial disparities can reduce support for safety precautions among White U.S. residents
Allison Skinner-Dorkenoo et al.
Social Science & Medicine, forthcoming
Abstract:
U.S. media has extensively covered racial disparities in COVID-19 infections and deaths, which may ironically reduce public concern about COVID-19. In two preregistered studies (conducted in the fall of 2020), we examined whether perceptions of COVID-19 racial disparities predict White U.S. residents’ attitudes toward COVID-19. Utilizing a correlational design (N = 498), we found that those who perceived COVID-19 racial disparities to be greater reported reduced fear of COVID-19, which predicted reduced support for COVID-19 safety precautions. In Study 2, we manipulated exposure to information about COVID-19 racial disparities (N = 1,505). Reading about the persistent inequalities that produced COVID-19 racial disparities reduced fear of COVID-19, empathy for those vulnerable to COVID-19, and support for safety precautions. These findings suggest that publicizing racial health disparities has the potential to create a vicious cycle wherein raising awareness reduces support for the very policies that could protect public health and reduce disparities.
Recreational cannabis legalizations associated with reductions in prescription drug utilization among Medicaid enrollees
Shyam Raman & Ashley Bradford
Health Economics, forthcoming
Abstract:
The potential substitution of cannabis for prescription medication has attracted a substantial amount of attention within the context of medical cannabis laws (MCLs). However, much less is known about the association between recreational cannabis laws (RCLs) and prescription drug use. With recent evidence supporting substitution of cannabis for prescription drugs following MCLs, it is reasonable to ask what effect RCLs may have on those outcomes. We use quarterly data for all Medicaid prescriptions from 2011 to 2019 to investigate the effect of state-level RCLs on prescription drug utilization. We estimate this effect with a series of two-way fixed effects event study models. We find significant reductions in the volume of prescriptions within the drug classes that align with the medical indications for pain, depression, anxiety, sleep, psychosis, and seizures. Our results suggest substitution away from prescription drugs and potential cost savings for state Medicaid programs.
The US Midlife Mortality Crisis Continues: Excess Cause-Specific Mortality During 2020
Dana Glei
American Journal of Epidemiology, forthcoming
Abstract:
This analysis investigates whether monthly excess mortality in the United States during 2020 varied by age and cause of death. Based on national-level death counts and population estimates for 1999-2020, sex-specific negative binomial regression models were used to estimate monthly cause-specific excess mortality by age group during 2020. Among males, 71% non-COVID excess deaths occurred at working ages (25-64), but those ages accounted for only 36% of non-COVID excess deaths in females. The results revealed substantial numbers of excess deaths from external causes (particularly among males), heart disease, diabetes, Alzheimer’s disease (particularly among women), and cerebrovascular disease. For males, the largest share of non-COVID excess deaths resulted from external causes, nearly 80% of which occurred at working ages. Although incorrectly classified COVID-19 deaths may explain some excess non-COVID mortality, misclassification is unlikely to explain the increase in external causes of mortality. Auxiliary analyses suggested that drug-related mortality may be driving the rise in external mortality, but drug overdoses were already increasing for a full year prior to the pandemic. The oldest Americans bore the brunt of COVID-19 mortality, but working-age Americans, particularly men, suffered substantial numbers of excess non-COVID deaths, most commonly from external causes and heart disease.
Can Policy Responses to Pandemics Reduce Mass Fear?
Michael Bechtel, William O’Brochta & Margit Tavits
Journal of Experimental Political Science, forthcoming
Abstract:
To successfully address large-scale public health threats such as the novel coronavirus outbreak, policymakers need to limit feelings of fear that threaten social order and political stability. We study how policy responses to an infectious disease affect mass fear using data from a survey experiment conducted on a representative sample of the adult population in the USA (N = 5,461). We find that fear is affected strongly by the final policy outcome, mildly by the severity of the initial outbreak, and minimally by policy response type and rapidity. These results hold across alternative measures of fear and various subgroups of individuals regardless of their level of exposure to coronavirus, knowledge of the virus, and several other theoretically relevant characteristics. Remarkably, despite accumulating evidence of intense partisan conflict over pandemic-related attitudes and behaviors, we show that effective government policy reduces fear among Democrats, Republicans, and Independents alike.
Structural sexism and Women's alcohol use in the United States, 1988–2016
Sarah McKetta et al.
Social Science & Medicine, forthcoming
Methods:
We examined associations between structural sexism (state-level sex inequality in political/economic status), and alcohol outcomes among women in Monitoring the Future (N = 20,859) from 1988 to 2016 (ages 27–45 in 2016). We controlled for state and individual confounders and tested three mediators: depressive symptoms, restrictive alcohol norms, and college completion.
Results:
Increased structural sexism was associated with decreased alcohol consumption frequency (RR: 0.974, 95% CI: 0.971, 0.976) and binge drinking probability (OR: 0.917, 95% CI: 0.909, 0.926). Norms and education but not depressive symptoms partially mediated these relationships.
The Effect of Maternal United States Nativity on Racial/Ethnic Differences in Fetal Growth
Melanie Jacobson et al.
American Journal of Epidemiology, forthcoming
Abstract:
While racial/ethnic differences in fetal growth have been documented, few studies have examined whether they vary by exogenous factors, which could elucidate underlying causes. The purpose of this study was to characterize longitudinal fetal growth patterns by maternal sociodemographic, behavioral, and clinical factors and examine whether associations with maternal race/ethnicity varied by these other predictors. Between 2016-2019, pregnant women receiving prenatal care at NYU Langone were invited to participate in a birth cohort study. Women completed questionnaires and clinical data were abstracted from ultrasound examinations. Maternal characteristics were assessed in relation to fetal biometric measures throughout pregnancy using linear mixed models. Maternal race/ethnicity was consistently associated with fetal biometry: Black, Hispanic, and Asian women had fetuses with smaller head circumference, abdominal circumference, and biparietal diameter than White women. The associations between race/ethnicity and fetal growth varied by nativity for Asian women, such that the disparity between Asian and White women was much greater for US-born than foreign-born women. However, associations for Black and Hispanic women did not vary by nativity. While racial/ethnic-specific fetal growth standards have been proposed, work is needed to elucidate what could be driving these differences, including factors that occur in parallel and differentially affect fetal growth.
Saving lives: The 2006 expansion of daylight saving in Indiana
Adam Cook
Journal of Population Economics, July 2022, Pages 861–891
Abstract:
Using data provided by the Indiana State Department of Vital Statistics, this study examines the mortality effects of daylight saving time observance using the April 2006 expansion of daylight saving time in Indiana as a natural experiment. The expansion of daylight saving time to all Indiana counties lowered the average mortality rate in the treatment counties during the months in which daylight saving time was observed. Stratified demographic analyses indicate that daylight saving time reduced mortality among males, females, and whites, but only among those aged 65 years and older. Specific-cause analysis indicates that daylight saving time lowered mortality primarily via reduced cancer mortality. The results of this study suggest a novel solar UVB-vitamin D mechanism could be responsible for the reduction in treatment county mortality following the expansion of daylight saving time in Indiana.
Selection Bias Analysis Supports Dose-Response Relationship between Level of American Football Play and Chronic Traumatic Encephalopathy Diagnosis
Jessica LeClair et al.
American Journal of Epidemiology, forthcoming
Abstract:
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with exposure to repetitive head impacts (RHI) such as those from American football. Our understanding of this association is based on research in autopsied brains since CTE can only be diagnosed postmortem. Such studies are susceptible to selection bias, which needs to be accounted for to ensure a generalizable estimate of the association between RHI and CTE. We evaluated the relationship between level of American football play and CTE diagnosis after adjusting for selection bias. The sample included 290 deceased male former American football players who donated their brain to the Veterans Affairs-Boston University-Concussion Legacy Foundation Brain Bank (VA-BU-CLF) between 2008 and 2019. After adjusting for selection bias, college and professional football players have 2.38 (95% simulation interval (SI): 1.16,5.94) and 2.47 (95% SI: 1.46,4.79) times the risk of being diagnosed with CTE relative to high school players, respectively, which are larger than estimates with no selection bias adjustment. Since CTE is currently diagnosed only post-mortem, we additionally provide plausible scenarios for the risk ratios of these populations where we consider the outcome affecting former players during their lifetime. In conclusion, this study provides further evidence to support a dose-response relationship between football play and CTE.
Investigation of a UK biobank cohort reveals causal associations of self-reported walking pace with telomere length
Paddy Dempsey et al.
Communications Biology, April 2022
Abstract:
Walking pace is a simple and functional form of movement and a strong predictor of health status, but the nature of its association with leucocyte telomere length (LTL) is unclear. Here we investigate whether walking pace is associated with LTL, which is causally associated with several chronic diseases and has been proposed as a marker of biological age. Analyses were conducted in 405,981 UK Biobank participants. We show that steady/average and brisk walkers had significantly longer LTL compared with slow walkers, with accelerometer-assessed measures of physical activity further supporting this through an association between LTL and habitual activity intensity, but not with total amount of activity. Bi-directional mendelian randomisation analyses suggest a causal link between walking pace and LTL, but not the other way around. A faster walking pace may be causally associated with longer LTL, which could help explain some of the beneficial effects of brisk walking on health status. Given its simple measurement and low heritability, self-reported walking pace may be a pragmatic target for interventions.