Influenced
Smoke Gets in Your Eyes: Medical Marijuana Laws and Tobacco Cigarette Use
Anna Choi, Dhaval Dave & Joseph Sabia
American Journal of Health Economics, forthcoming
Abstract:
The public health costs of tobacco consumption have been documented to be substantially larger than those of marijuana use. This study is the first to investigate the impact of medical marijuana laws (MMLs) on tobacco cigarette consumption. First, using data from the National Survey of Drug Use and Health (NSDUH), we establish that MMLs induce a 2 to 3 percentage-point increase in adult marijuana consumption, likely for both recreational and medicinal purposes. Then, using data from the NSDUH, the Behavioral Risk Factor Surveillance System (BRFSS), and the Current Population Survey Tobacco Use Supplements (CPS-TUS), we find that the enactment of MMLs leads to a 1 to 1.5 percentage-point reduction in adult cigarette smoking. We also find that MMLs reduce the number of cigarettes consumed by smokers, suggesting effects on both the cessation and intensive margins of cigarette use. Our estimated effect sizes imply substantial MML-induced tobacco-related healthcare cost savings, ranging from $4.6 to $6.9 billion per year.
Can cigarette taxes during pregnancy mitigate the intergenerational transmission of socioeconomic status?
Sonja Settele & Reyn van Ewijk
Labour Economics, forthcoming
Abstract:
Smoking during pregnancy is most prevalent among women with a low socioeconomic status and is negatively associated with important infant health measures such as birth weight. Cigarette taxes decrease smoking among pregnant women and lead to improved birth outcomes, especially among those with a low socioeconomic status. In this paper we investigate whether increasing cigarette taxes also translates into improved educational attainment of offspring from a low socioeconomic background. In order to answer this question, we exploit variation in cigarette taxes across U.S. states over time and analyze tax effects on grade retention and school enrollment among a large sample of adolescents representative of the population. We find that higher cigarette taxes during pregnancy are strongly associated with improved educational outcomes of children from a low socioeconomic background, but seem to have no effect on children from a higher socioeconomic background. Our findings therefore suggest that cigarette taxes can be an effective policy instrument for mitigating the propagation of a low socioeconomic status from one generation to the next.
Wage and Employment Growth in America’s Drug Epidemic: Is All Growth Created Equal?
Michael Betz & Lauren Jones
American Journal of Agricultural Economics, forthcoming
Abstract:
The rise in drug overdose deaths in the United States since the turn of the millennium has been extraordinary. A popular narrative paints a picture whereby opioid overdoses among white, male, less-educated, rural workers have been caused by reduced economic opportunities borne by such people. In this article, we causally test the validity of this theory by using Bartik-type variables to explore the relationship between local economic conditions and county opioid overdose death rates. We add to the literature by exploring how both employment and wage growth in different types of industries are related to opioid overdose deaths for the population as a whole, as well as for rural (vs. urban), male (vs. female) and white (vs. black) populations. We find mixed evidence. Our results confirm that wage and employment growth in industries more likely to employ low-skill workers are important protective factors for rural, white males. However, we also find evidence that economic improvements in low-skill industries are just as important in protecting blacks and women against opioid overdoses, and for workers in metro counties. We also find evidence that employment growth in high-paying industries has led to increases in opioid overdoes rates.
Illegal Drugs and Public Corruption: Crack Based Evidence from California
Alessandro Flamini, Babak Jahanshahi & Kamiar Mohaddes
University of Southern California Working Paper, August 2018
Abstract:
Do illegal drugs foster public corruption? To estimate the causal effect of drugs on public corruption in California, we adopt the synthetic control method and exploit the fact that crack cocaine markets emerged asynchronously across the United States. We focus on California because crack arrived here in 1981, before reaching any other state. Our results show that public corruption more than tripled in California in the first three years following the arrival of crack cocaine. We argue that this resulted from the particular characteristics of illegal drugs: a large trade-off between profits and law enforcement, due to a cheap technology and rigid demand. Such a trade-off fosters a convergence of interests between criminals and corrupted public officials resulting in a positive causal impact of illegal drugs on corruption.
Joint culpability: The effects of medical marijuana laws on crime
Yu-Wei LukeChu & Wilbur Townsend
Journal of Economic Behavior & Organization, forthcoming
Abstract:
Most U.S. states have passed medical marijuana laws. In this paper, we study the effects of these laws on violent and property crime. We first estimate models that control for city fixed effects and flexible city-specific time trends. To supplement this regression analysis, we use the synthetic control method which can relax the parallel trend assumption and better account for heterogeneous policy effects. Both the regression analysis and the synthetic control method suggest no causal effects of medical marijuana laws on violent or property crime at the national level. We also find no strong effects within individual states, except for in California where the medical marijuana law reduced both violent and property crime by 20%.
The Relationship between Cigarettes and Electronic Cigarettes: Evidence from Household Panel Data
Chad Cotti, Erik Nesson & Nathan Tefft
Journal of Health Economics, September 2018, Pages 205-219
Abstract:
We use the Nielsen Consumer Panel to investigate the impact of tobacco control policies on purchases of electronic cigarettes (e-cigarettes), cigarettes, and smoking cessation products. We measure product quantity, product type, nicotine content, and liquid volume of e-cigarettes, and product quantity and nicotine content of cigarettes. Higher cigarette excise taxes decrease both cigarette and e-cigarette purchases, suggesting that cigarettes and e-cigarettes are complements, and higher cigarette excise taxes reduce the aggregate amount of nicotine purchased from cigarettes and e-cigarettes. Cigarette smoke-free air laws decrease cigarette purchases, while e-cigarette smoke-free air laws do not affect cigarette or e-cigarette purchases.
High Times: The Effect of Medical Marijuana Laws on Student Time Use
Yu-Wei Luke Chu & Seth Gershenson
Economics of Education Review, October 2018, Pages 142-153
Abstract:
Medical marijuana laws (MMLs) represent a major change of marijuana policy in the U.S. Previous research shows that these laws increase marijuana use among adults. In this paper, we estimate the effects of MMLs on secondary and post-secondary students’ time use using data from the American Time Use Survey. We apply a difference-in-differences research design and estimate flexible fixed effects models that condition on state fixed effects and state-specific time trends. We find no effect of MMLs on secondary students’ time use. However, we find that college students in MML states spend approximately 20% less time on education-related activities and 20% more time on leisure activities than their counterparts in non-MML states. These behavioral responses largely occur during weekends and summer when students have more spare time. Finally, the impacts of MMLs are heterogeneous and stronger among part-time college students, who are more likely to be first-generation college goers and to come from underrepresented racial and ethnic groups.
Modeling Health Benefits and Harms of Public Policy Responses to the US Opioid Epidemic
Allison Pitt, Keith Humphreys & Margaret Brandeau
American Journal of Public Health, October 2018, Pages 1394-1400
Methods: We used dynamic compartmental modeling of US adults, in various pain, opioid use, and opioid addiction health states, to project addiction-related deaths, life years, and quality-adjusted life years from 2016 to 2025 for 11 policy responses to the opioid epidemic.
Results: Over 5 years, increasing naloxone availability, promoting needle exchange, expanding medication-assisted addiction treatment, and increasing psychosocial treatment increased life years and quality-adjusted life years and reduced deaths. Other policies reduced opioid prescription supply and related deaths but led some addicted prescription users to switch to heroin use, which increased heroin-related deaths. Over a longer horizon, some such policies may avert enough new addiction to outweigh the harms. No single policy is likely to substantially reduce deaths over 5 to 10 years.
Academic Achievement and Drug Abuse Risk Assessed Using Instrumental Variable Analysis and Co-relative Designs
Kenneth Kendler et al.
JAMA Psychiatry, forthcoming
Importance: Low academic achievement (AA) in childhood and adolescence is associated with increased substance use. Empirical evidence, using longitudinal epidemiologic data, may provide support for interventions to improve AA as a means to reduce risk of drug abuse (DA).
Design, Setting, and Participants: This study, assessing nationwide data from individuals born in Sweden between 1971 and 1982, used instrumental variable and co-relative analyses of the association between AA and DA. The instrument was month of birth. Co-relative analyses were conducted in pairs of cousins (263 222 pairs), full siblings (154 295), and monozygotic twins (1623) discordant for AA, with raw results fitted to a genetic model. The AA-DA association was modeled using Cox regression. Data analysis was conducted from October 2017 to January 2018.
Exposures: Academic achievement assessed at 16 years of age (for instrumental variable analyses), and estimated discordance in AA in pairs of monozygotic twins (for co-relative analyses).
Main Outcomes and Measures: Drug abuse registration in national medical, criminal, or pharmacy registries.
Results: This instrumental variable analysis included 934 462 participants (478 341 males and 456 121 females) with a mean (SD) age of 34.7 (4.3) years at a mean follow-up of 19 years. Earlier month of birth was associated with a linear effect on AA, with the regression coefficient per month equaling −0.0225 SDs (95% CI, −0.0231 to −0.0219). Controlling for AA, month of birth had no association with risk of DA (hazard ratio [HR], 1.000; 95% CI, 0.997-1.004). Lower AA had a significant association with risk of subsequent DA registration (HR per SD, 2.33; 95% CI, 2.30-2.35). Instrumental variable analysis produced a substantial but modestly attenuated association (HR, 2.04; 95% CI, 1.75-2.33). Controlling for modest associations between month of birth and parental educational status and DA risk reduced the association to a HR of 1.92 (95% CI, 1.67-2.22). The genetic model applied to the results of co-relative analyses fitted the observed data well and estimated the AA-DA association in monozygotic twins discordant for AA to equal a HR of 1.79 (95% CI, 1.64-1.92).
Conclusions and Relevance: Two different methodological approaches with divergent assumptions both produced results consistent with the hypothesis that the significant association observed between AA at 16 years of age and risk of DA into middle adulthood may be causal. These results provide empirical support for efforts to improve AA as a means to reduce risk of DA.
What happens when the insurer can say no? Assessing prior authorization as a tool to prevent high-risk prescriptions and to lower costs
Marcus Dillender
Journal of Public Economics, September 2018, Pages 170-200
Abstract:
Insurers are increasingly requiring physicians to obtain prior authorization before prescribing drugs that are costly or have high abuse potential. These prior authorization requirements have the potential to reduce risky prescriptions and to lower prescription drug costs, but little is known about their ability to do either. This study estimates the effect of a prior authorization requirement for certain costly and abuse-prone drugs on prescription drug use and costs for work-related injuries in Texas. The findings indicate that the prior authorization requirement reduces the likelihood that claimants receive non-preferred drugs as well as insurers' spending on non-preferred drugs. While there is some substitution to preferred drugs, I do not find evidence of large increases in spending on preferred drugs. The estimated effects on average total pharmacy spending are imprecise, though there is suggestive evidence that the prior authorization requirement reduces the likelihood that a claim has high prescription drug costs. The results provide strong evidence that the prior authorization requirement drastically reduces the likelihood that patients receive combinations of drugs that have contributed disproportionately to the rise in prescription drug overdoses. Despite the success of prior authorization in lowering spending on non-preferred drugs and in reducing high-risk prescriptions, I find little evidence that prior authorization has disproportionately large effects on the most dangerous prescription drug use and only weak, suggestive evidence that it has larger effects on prescription drug use that likely arises because physicians are not fully informed, suggesting that prior authorization requirements do not necessarily target the riskiest drug use.
Does winning an experimental auction change people's behavior? An application to e-cigarettes
Richard O'Connor et al.
Journal of Economic Behavior & Organization, October 2018, Pages 281-285
Abstract:
Experimental auctions allow researchers to estimate demand for products like e-cigarettes in a non-hypothetical environment where participants face real and immediate consequences for their bids. However, because auction winners actually purchase the product they bid on, participants may be introduced to a product they otherwise would not have discovered. Based on an experimental auction where 432 participants bid to buy e-cigarettes, we found that auction winners are significantly more likely to be using e-cigarettes two weeks, six weeks, and six months after the study but are no less likely to be daily cigarette smokers. This result holds even after controlling for prior e-cigarette use, strength of participants’ initial demand for e-cigarettes, and demographic characteristics.
Effect of Cannabidiol on Medial Temporal, Midbrain, and Striatal Dysfunction in People at Clinical High Risk of Psychosis: A Randomized Clinical Trial
Sagnik Bhattacharyya et al.
JAMA Psychiatry, forthcoming
Importance: Cannabidiol (CBD) has antipsychotic effects in humans, but how these are mediated in the brain remains unclear.
Design, Setting, and Participants: In this parallel-group, double-blind, placebo-controlled randomized clinical trial conducted at the South London and Maudsley NHS Foundation Trust in London, United Kingdom, 33 antipsychotic medication–naive participants at clinical high risk (CHR) of psychosis and 19 healthy control participants were studied. Data were collected from July 2013 to October 2016 and analyzed from November 2016 to October 2017.
Interventions: A total of 16 participants at CHR of psychosis received a single oral dose of 600 mg of CBD, and 17 participants at CHR received a placebo. Control participants were not given any drug. All participants were then studied using functional magnetic resonance imaging (fMRI) while performing a verbal learning task.
Results: Of the 16 participants in the CBD group, 6 (38%) were female, and the mean (SD) age was 22.43 (4.95) years; of 17 in the placebo group, 10 (59%) were female, and the mean (SD) age was 25.35 (5.24) years; and of 19 in the control group, 8 (42%) were female, and the mean (SD) age was 23.89 (4.14) years. Brain activation (indexed using the median sum of squares ratio of the blood oxygen level–dependent hemodynamic response effects model component to the residual sum of squares) was analyzed in 15 participants in the CBD group, 16 in the placebo group, and 19 in the control group. Participants receiving placebo had reduced activation relative to controls in the right caudate during encoding (placebo: median, −0.027; interquartile range [IQR], −0.041 to −0.016; control: median, 0.020; IQR, −0.022 to 0.056; P < .001) and in the parahippocampal gyrus and midbrain during recall (placebo: median, 0.002; IQR, −0.016 to 0.010; control: median, 0.035; IQR, 0.015 to 0.039; P < .001). Within these 3 regions, activation in the CBD group was greater than in the placebo group but lower than in the control group (parahippocampal gyrus/midbrain: CBD: median, −0.013; IQR, −0.027 to 0.002; placebo: median, −0.007; IQR, −0.019 to 0.008; control: median, 0.034; IQR, 0.005 to 0.059); the level of activation in the CBD group was thus intermediate to that in the other 2 groups. There were no significant group differences in task performance.
Conclusions and Relevance: Cannabidiol may partially normalize alterations in parahippocampal, striatal, and midbrain function associated with the CHR state. As these regions are critical to the pathophysiology of psychosis, the influence of CBD at these sites could underlie its therapeutic effects on psychotic symptoms.