Hurtful
Christmas and New Year as risk factors for death
David Phillips, Gwendolyn Barker & Kimberly Brewer
Social Science & Medicine, October 2010, Pages 1463-1471
Abstract:
This paper poses three questions: (1) Does mortality from natural causes spike around Christmas and New Year? (2) If so, does this spike exist for all major disease groups or only specialized groups? (3) If twin holiday spikes exist, need this imply that Christmas and New Year are risk factors for death? To answer these questions, we used all official U.S. death certificates, 1979-2004 (n = 57,451,944) in various hospital settings to examine daily mortality levels around Christmas and New Year. We measured the Christmas increase by comparing observed deaths with expected deaths in the week starting on Christmas. The New Year increase was measured similarly. The expected number of deaths was determined by locally weighted regression, given the null hypothesis that mortality is affected by seasons and trend but not by holidays. On Christmas and New Year, mortality from natural causes spikes in dead-on-arrival (DOA) and emergency department (ED) settings. There are more DOA/ED deaths on 12/25, 12/26, and 1/1 than on any other day. In contrast, deaths in non-DOA/ED settings display no holiday spikes. For DOA/ED settings, there are holiday spikes for each of the top five disease groups (circulatory diseases; neoplasms; respiratory diseases; endocrine/nutritional/metabolic diseases; digestive diseases). For all settings combined, there are holiday spikes for most major disease groups and for all demographic groups, except children. In the two weeks starting with Christmas, there is an excess of 42,325 deaths from natural causes above and beyond the normal winter increase. Christmas and New Year appear to be risk factors for deaths from many diseases. We tested nine possible explanations for these risk factors, but further research is needed.
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The Dengue Threat to the United States
Crystal Franco, Noreen Hynes, Nidhi Bouri & D.A. Henderson
Biosecurity and Bioterrorism, September 2010, Pages 273-276
Abstract:
Over the past 3 decades, dengue has spread rapidly and has emerged as one of the world's most common mosquitoborne viral diseases. Although often found in tropical and semitropical areas, dengue is capable of being transmitted in temperate climates as well. Dengue is currently endemic to Mexico, most other Latin American countries, and parts of the Caribbean, and it has the potential to become reestablished as an endemic disease in the United States. In fact, sustained transmission of dengue has occurred in Florida within the past year. Conditions exist in the U.S. that could facilitate sustained dengue transmission, including environmental factors, competent mosquito vectors, limited vector and dengue surveillance, increased domestic outdoor daytime activities in warmer months, and low public awareness of the disease. If dengue were to be reestablished in the U.S., it could have significant medical, public health, and economic consequences for the country. The impact of dengue as a public health threat could be lessened through enhanced awareness and reporting of cases, increased support for vector surveillance and control programs, and a greater focus on vaccine development.
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Short on Shots: Are Calls for Cooperative Restraint Effective in Managing a Flu Vaccines Shortage?
Alain de Janvry, Elisabeth Sadoulet & Sofia Villas-Boas
Journal of Economic Behavior & Organization, forthcoming
Abstract:
We conducted a randomized experiment at the time of the 2004 flu vaccine shortage, providing information about the sharply reduced number of clinics and their schedule, and an appeal on cooperative restraint to a campus population. This strategy was intended to reduce demand for vaccination among non-priority individuals and to free available supplies for the priority population. It failed to achieve its purpose. Information induced a net increase in vaccines distributed and, perversely, the net increase originated entirely in non-priority individuals. The surprising finding is that calls on cooperative restraint induced an uncalled for positive response among priority individuals, while they induced an increase in cheating among non-priority individuals. Age as a qualifying factor was in particular widely abused, with the number of "65 years old" more than twice the predicted value, while about half of the predicted 61-64 years old were missing.
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Do Gun Buybacks Save Lives? Evidence from Panel Data
Andrew Leigh & Christine Neill
American Law and Economics Review, forthcoming
Abstract:
In 1997, Australia implemented a gun buyback program that reduced the stock of firearms by around one-fifth (and nearly halved the number of gun-owning households). Using differences across states, we test whether the reduction in firearms availability affected homicide and suicide rates. We find that the buyback led to a drop in the firearm suicide rates of almost 80%, with no significant effect on non-firearm death rates. The effect on firearm homicides is of similar magnitude but is less precise. The results are robust to a variety of specification checks and to instrumenting the state-level buyback rate.
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The Impact of Casinos on Fatal Alcohol-Related Traffic Accidents in the United States
Chad Cotti & Douglas Walker
Journal of Health Economics, forthcoming
Abstract:
Casinos have been introduced throughout the U.S. to spur economic development and generate tax revenues. Yet, casinos may also be associated with a variety of social ills. One issue that has not been empirically tested in the literature is whether there is a link between casino expansion and alcohol-related fatal traffic accidents. We suspect a link may exist since casinos often serve alcohol to their patrons and, by their dispersed nature, could impact driving distances after drinking. Using the variation in the timing and location of casino openings over a ten year period, we isolate the impact of casino introduction on alcohol-related fatal accidents. Results indicate that there is a strong link between the presence of a casino in a county and the number of alcohol-related fatal traffic accidents. However, this relationship is negatively related to the local-area (county) population. Results prove durable, as we subject them to robustness checks.
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The Global Epidemic of Waterpipe Smoking
Wasim Maziak
Addictive Behaviors, forthcoming
Abstract:
In the past decade waterpipe (WP) smoking (a.k.a. hookah, shisha, narghile) has been steadily spreading among youth around the world. The allure of this tobacco use method for youth can stem from its pleasant smooth smoke, social ambience and the perception of reduced harm. The material in this review is based on detailed Medline search for articles appearing especially in past two years that are of relevance to WP epidemiology, health and addictive effects, and WP-related tobacco control policies. It shows that WP smoking is continuing to spread among youth worldwide, and perhaps represents the second global tobacco epidemic since the cigarette. Available evidence suggests that the prevalence of current (past month) WP smoking range from 6-34% among Middle Eastern adolescents, 5%-17% among American adolescents, and that WP use is increasing globally. Studies on the health effects of WP smoking are limited by methodological quality, as well as by the novelty of WP epidemic relative to the long latency of important smoking-related health outcomes. Still, research indicates substantial harmful effects similar to those of cigarettes, as well as to the potential of providing a bridge to cigarette smoking or relapse. Developing effective interventions to curb WP use among youth requires a detailed understanding of how dependence develops in WP users, and how it is shaped by WP's unique features such as; the predominantly intermittent use with prolonged sessions, preparation time, accessibility, potent sensory cues, convivial experience of group use. It also requires assessing effective policy options such as factual and visible health warnings on all its parts, as well as youth access and indoor smoking restrictions. WP smoking is currently showing all signs of a burgeoning global epidemic with serious implications for public health and tobacco control worldwide. Investment in research and policy initiatives to understand and curb WP use needs to become a public health priority.
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Health of entrepreneurs versus employees in a national representative sample
Ute Stephan & Ulrike Roesler
Journal of Occupational and Organizational Psychology, September 2010, Pages 717-738
Abstract:
Prior research has found entrepreneurs to experience significantly higher job control and job demands compared with employees. This suggests that entrepreneurs have so-called active jobs and thus may benefit from positive health consequences. The present research compared entrepreneurs' health with employees' health in a national representative sample with regard to the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) diagnoses of somatic diseases, the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnoses of mental disorders, blood pressure, well-being (life-satisfaction) as well as behavioural health indicators (sick days, physician visits). Entrepreneurs showed significantly lower overall somatic and mental morbidity, lower blood pressure, lower prevalence rates of hypertension, and somatoform disorders, as well as higher well-being and more favourable behavioural health indicators. The results are discussed with regard to the active job hypothesis and recommendations for future research are provided.
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Political ideology and health in Japan: A disaggregated analysis
S.V. Subramanian, Tsuyoshi Hamano, Jessica Perkins, Akio Koyabu & Yoshikazu Fujisawa
Journal of Epidemiology and Community Health, September 2010, Pages 838-840
Background: Recent studies from the USA and Europe suggest an association between an individual's political ideology and their health status, with those claiming to be conservatives reporting better health. The presence of this association is examined in Japan.
Methods: Individual-level data from the 2000-3, 2005 and 2006 Japan General Social Survey were analysed. The outcomes of interest were self-rated poor health and smoking status. The independent variable of interest was reported political beliefs on a 5-point ‘left'-to-‘right' scale. Covariates included age, sex, education, income, occupational status and fixed effects for survey periods. Logistic regression models were estimated.
Results: There was an inverse association between political ideology (left to right) and self-rated poor health as well as between ideology and smoking status even after adjusting for age, sex, socioeconomic status and fixed effects for survey periods. Compared with those who identified as ‘left', the OR for reporting poor health and smoking among those who identified as ‘right' was 0.86 (95% CI 0.74 to 0.99) and 0.80 (95% CI 0.70 to 0.91), respectively.
Conclusions: Health differences by political ideology have typically been interpreted as reflecting socioeconomic differences. The results from Japan corroborate the previous findings from the USA and Europe that socioeconomic differences do not account for health differences by political ideologies. Political ideology is likely to be a marker of several latent values and attitudes (eg, religiosity, individual responsibility and/or community participation) that might be beneficial for health at the individual level.
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Child care setting affects salivary cortisol and antibody secretion in young children
Sarah Enos Watamura, Christopher Coe, Mark Laudenslager & Steven Robertson
Psychoneuroendocrinology, September 2010, Pages 1156-1166
Abstract:
Elevated afternoon levels of cortisol have been found repeatedly in children during child care. However, it is unclear whether these elevations have any consequences. Because physiologic stress systems and the immune system are functionally linked, we examined the relationship between salivary cortisol concentration and antibody secretion across the day at home and in child care, and their relationships with parent-reported illnesses. Salivary antibody provides a critical line of defense against pathogens entering via the mouth, but little is known about its diurnal rhythm in young children or the effect of different environmental contexts. Saliva samples were taken at approximately 10:30 a.m., 3:30 p.m. and 8:00 p.m. on two child care and two home days in a sample of 65 3-5-year-old children attending very high quality, full time child care centers. Results indicated that (1) a rising cortisol profile at child care, driven by higher afternoon levels, predicted lower antibody levels on the subsequent weekend, (2) higher cortisol on weekend days was related to greater parent-reported illness, and (3) a declining daily pattern in sIgA was evident on weekend and child care days for older preschoolers, but only on weekend days for younger preschoolers. The results suggest that elevated cortisol in children during child care may be related to both lowered antibody levels and greater illness frequency.
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Chloe Bird et al.
Journal of Epidemiology and Community Health, October 2010, Pages 860-865
Objective: To assess whether neighborhood socioeconomic status (NSES) is independently associated with disparities in biological "wear and tear"-measured by allostatic load (AL)-in a nationally representative sample of U.S. adults.
Design: Cross-sectional study.
Setting: Population-based U.S. survey, the Third National Health and Nutrition Examination Survey (NHANES III), merged with U.S. Census data describing respondents' neighborhoods.
Participants: 13,184 adults from 83 counties and 1,805 census tracts who completed NHANES III interviews and medical examinations and whose residential addresses could be reliably geocoded to census tracts.
Main outcome measures: A summary measure of biological risk, incorporating nine biomarkers that together represent AL across metabolic, cardiovascular, and inflammatory subindices.
Results: Being male, older, having lower income, less education, being Mexican-American, and being both Black and female were all independently associated with worse AL. After adjusting for these characteristics, living in a lower SES neighborhood was associated with worse AL (coeff. = -0.46; CI -0.079,-0.012). The relationship between NSES and AL did not vary significantly by gender or race/ethnicity.
Conclusions: Living in a lower SES neighborhood in the United States is associated with significantly greater biological wear and tear as measured by AL, and this relationship is independent of individual SES characteristics. Our findings demonstrate that where one lives is independently associated with AL, thereby suggesting that policies that improve NSES may also yield health returns.
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Rubie Sue Maybury et al.
Surgery, August 2010, Pages 202-208
Background: Pedestrian trauma is the most lethal blunt trauma mechanism, and the rate of mortality in African Americans and Hispanics is twice that compared with whites. Whether insurance status and differential survival contribute to this disparity is unknown.
Methods: This study is a review of vehicle-struck pedestrians in the National Trauma Data Bank, v7.0. Patients <16 years and ≥65 years, as well as patients with Injury Severity Score (ISS) <9, were excluded. Patients were categorized as white, African American, or Hispanic, and as privately insured, government insured, or uninsured. With white and privately insured patients as reference, logistic regression was used to evaluate mortality by race and insurance status after adjusting for patient and injury characteristics.
Results: In all, 26,404 patients met inclusion criteria. On logistic regression, African Americans had 22% greater odds of mortality (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.06-1.41) and Hispanics had 33% greater odds of mortality (OR, 1.33; 95% CI, 1.14-1.54) compared with whites. Uninsured patients had 77% greater odds of mortality (OR, 1.77; 95% CI, 1.52-2.06) compared with privately insured patients.
Conclusion: African American and Hispanic race, as well as uninsured status, increase the risk of mortality after pedestrian crashes. Given the greater incidence of pedestrian crashes in minorities, this compounded burden of injury mandates pedestrian trauma prevention efforts in inner cities to decrease health disparities.
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M. Siahpush, P.R. Jones, G.K. Singh, L.R. Timsina & J. Martin
Public Health, September 2010, Pages 525-529
Objective: To examine the association of neighbourhood median income and racial/ethnic composition with the availability of tobacco products in Omaha Metropolitan Area, Nebraska, USA.
Methods: A total of 94 census tracts were selected at random. The outcome measures were the percentage of stores that sold tobacco and the number of stores that sold tobacco per square mile in each census tract.
Results: Median household income was negatively associated (P < 0.001), and percentage African American population (P < 0.001) and percentage Hispanic population (P = 0.049) were positively associated with the percentage of stores that sold tobacco. Median household income was negatively associated (P < 0.001) and percentage Hispanic population (P = 0.012) was positively associated with the number of stores that sold tobacco per square mile.
Conclusion: Policies that reduce the number of tobacco outlets might reduce social disparities in tobacco use.
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Feng Liu
Applied Economics, September 2010, Pages 2921-2939
Abstract:
I employ a large national representative dataset (Current Population Survey-Tobacco Use Supplements) to investigate how cigarette prices affect smoking decisions. A standard econometric approach is to estimate the relationship between cigarette prices and smoking participation at a point in time. I extend this approach to model past-year decisions to start, resume or quit smoking. Considering reverse causality, I apply an instrumental variable (excise taxes) for cigarette prices. I include an index of state-level anti-smoking sentiment to control for omitted variable bias. After estimating separate models for smoking initiation, relapse and cessation and for different age groups, I find no evidence that increasing taxes on cigarettes can prevent the onset of youth smoking. Neither does it effectively induce young smokers to quit. However, cigarette prices do play an important role to prevent relapse and encourage quitting at older ages.
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Do neighbourhoods matter? Neighbourhood disorder and long-term trends in serum cortisol levels
Akilah Dulin-Keita, Krista Casazza, Jose Fernandez, Michael Goran & Barbara Gower
Journal of Epidemiology and Community Health, forthcoming
Background: Characteristics associated with low socioeconomic status neighbourhoods may put children at risk for unique chronic stressors that affect cortisol levels. This research sought to explore whether neighbourhood stressor exposure affected serum cortisol levels among children.
Methods: A total of 148 African and European-American children with an average age of 8.28 years participated in a longitudinal study evaluating ethnic differences in body composition and disease risk. Five waves of data were included in analyses. Mixed modelling was used to explore neighbourhood stressors, which was a composite index of five items for zip code level poverty and physical disorder, and serum cortisol outcomes for the full sample, by race/ethnicity and gender. Adjustments were made for individual level correlates age, pubertal status, gender and total fat mass.
Results: Neighborhood disorder was predictive of lower serum cortisol levels among African-American children (p<0.05), such that higher neighbourhood stressor exposure resulted in lower serum cortisol over time compared with individuals in socially ordered neighbourhoods. Neighbourhood disorder was marginally significant and predictive of higher serum cortisol among European-American children (p<0.10). Transition to a higher pubertal status, nested in age was also predictive of lower serum cortisol levels (p<0.01) among European-American children.
Conclusion: Children who are exposed to negative socioenvironmental climates over time are more likely to have altered serum cortisol levels. This may be an adaptive mechanism to cope with stress; however, disrupted cortisol levels may have negative effects on general physical and mental health.
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Laurens Niëns, Alexandra Cameron, Ellen Van de Poel, Margaret Ewen, Werner Brouwer & Richard Laing
PLoS Medicine, August 2010, e1000333
Background: Increasing attention is being paid to the affordability of medicines in low- and middle-income countries (LICs and MICs) where medicines are often highly priced in relation to income levels. The impoverishing effect of medicine purchases can be estimated by determining pre- and postpayment incomes, which are then compared to a poverty line. Here we estimate the impoverishing effects of four medicines in 16 LICs and MICs using the impoverishment method as a metric of affordability.
Methods and Findings: Affordability was assessed in terms of the proportion of the population being pushed below US$1.25 or US$2 per day poverty levels because of the purchase of medicines. The prices of salbutamol 100 mcg/dose inhaler, glibenclamide 5 mg cap/tab, atenolol 50 mg cap/tab, and amoxicillin 250 mg cap/tab were obtained from facility-based surveys undertaken using a standard measurement methodology. The World Bank's World Development Indicators provided household expenditure data and information on income distributions. In the countries studied, purchasing these medicines would impoverish large portions of the population (up to 86%). Originator brand products were less affordable than the lowest-priced generic equivalents. In the Philippines, for example, originator brand atenolol would push an additional 22% of the population below US$1.25 per day, whereas for the lowest priced generic equivalent this demographic shift is 7%. Given related prevalence figures, substantial numbers of people are affected by the unaffordability of medicines.
Conclusions: Comparing medicine prices to available income in LICs and MICs shows that medicine purchases by individuals in those countries could lead to the impoverishment of large numbers of people. Action is needed to improve medicine affordability, such as promoting the use of quality assured, low-priced generics, and establishing health insurance systems.
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Mark Seery, Raphael Leo, Alison Holman & Roxane Cohen Silver
Pain, September 2010, Pages 507-515
Abstract:
Previous research has demonstrated an association between lifetime exposure to adverse events and chronic back pain (CBP), but the nature of this relationship has not been fully specified. Adversity exposure typically predicts undesirable outcomes, suggesting that lack of all adversity is optimal. However, we hypothesized that among individuals faced with CBP, a history of a low level of lifetime adversity would yield protective effects, manifested as lower impairment and healthcare utilization. Adult members of a national panel (N = 396) endorsed a history of CBP when reporting their physical health status in an online survey; they further reported their functional impairment and healthcare utilization. Respondents had previously completed a survey of lifetime exposure to adverse events. Significant U-shaped quadratic relationships emerged between adversity and self-rated functional impairment (p < 0.001), disabled employment status (p < 0.001), frequency of physician/clinic visits for CBP (p < 0.01), prescription (but not over-the-counter) analgesic use (p < 0.01), and comorbid depression treatment seeking (p < 0.01). Specifically, people with some lifetime adversity reported less impairment and healthcare utilization than people who had experienced either no adversity or a high level of adversity. Additional analyses failed to support alternative explanations of the findings. Implications for understanding and promoting resilience in the context of CBP are discussed.
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A Population-Based Study of Sexual Orientation Identity and Gender Differences in Adult Health
Kerith Conron, Matthew Mimiaga & Stewart Landers
American Journal of Public Health, October 2010, Pages 1953-1960
Objectives: We provide estimates of several leading US adult health indicators by sexual orientation identity and gender to fill gaps in the current literature.
Methods: We aggregated data from the 2001-2008 Massachusetts Behavioral Risk Factor Surveillance surveys (N=67359) to examine patterns in self-reported identity and gender, using multivariable logistic regression.
Results: Compared with heterosexuals, sexual minorities (i.e., gays/lesbians, 2% of sample; bisexuals, 1%) were more likely to report activity limitation, tension or worry, smoking, drug use, asthma, lifetime sexual victimization, and HIV testing, but did not differ on 3-year Papanicolaou tests, lifetime mammography, diabetes, or heart disease. Compared with heterosexuals, bisexuals reported more barriers to health care, current sadness, past-year suicidal ideation, and cardiovascular disease risk. Gay men were less likely to be overweight or obese and to obtain prostate-specific antigen tests, and lesbians were more likely to be obese and to report multiple risks for cardiovascular disease. Binge drinking and lifetime physical intimate partner victimization were more common among bisexual women.
Conclusions: Sexual orientation disparities in chronic disease risk, victimization, health care access, mental health, and smoking merit increased attention. More research on heterogeneity in health and health determinants among sexual minorities is needed.
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Public attitudes towards human life extension by intervening in ageing
Jayne Lucke, Helen Bartlett & Wayne Hall
Journal of Aging Studies, forthcoming
Abstract:
A number of biogerontologists have expressed an interest in intervening in the ageing process in order to extend the human life span. This study explored the attitudes of members of the Australian public towards the potential development and use of life-extension technologies and their attitudes towards the ethical, social and personal implications of life extension. Participants were presented with a vignette outlining the prospect of a "life-extension pharmaceutical" that could increase maximum life span by slowing the ageing process. While 65% supported such research, only 35% said that they would use a life-extension technology if one became available. Men were more supportive of research and more disposed to use life-extension technologies than women. Concerns about the potential ethical, social and personal implications predicted levels of overall support for, and intention to use, life-extension technologies. Our survey suggests that public attitudes towards life extension are neither overwhelmingly "pro" or "con" and in fact more nuanced than either proponents or opponents of life extension have often assumed.