Personal Health

Kevin Lewis

August 01, 2022

Prevalence of Psychological Distress Among Working-Age Adults in the United States, 1999–2018
Michael Daly
American Journal of Public Health, July 2022, Pages 1045-1049

I examined psychological distress in the past 30 days using the Kessler-6 Distress Scale, completed by 403 223 participants aged 25 to 64 years across 20 annual waves of the National Health Interview Study conducted from 1999 to 2018. I examined overall and demographic-specific trends.

The prevalence of psychological distress in the past 30 days increased from 16.1% in 1999-2000 to 22.6% in 2017-2018, an increase of 6.5 percentage points (95% confidence interval [CI] = 5.6, 7.3) or 40% from 1999-2000 levels. Statistically significant increases in the prevalence of distress were observed across all age, gender, race/ethnicity, and educational attainment subgroups examined. Rates of serious psychological distress increased from 2.7% in 1999-2000 to 4% in 2017-2018, an increase of 1.3 percentage points (95% CI = 0.9, 1.6).

Shifts in lifestyle and socioeconomic circumstances predict change -- for better or worse -- in speed of epigenetic aging: A study of middle-aged black women
Ronald Simons et al.
Social Science & Medicine, August 2022

Investigate over an 11-year period the extent to which changes in socioeconomic stress and lifestyle predict changes in speed of epigenetic aging among a sample of
middle-aged African American women.

Using data from the Family and Community Health Study, we investigated whether changes in socioeconomic stress, diet, smoking, exercise, alcohol consumption, and relationship status predict changes in speed of biological aging assessed with 3 s-generation epigenetic clocks: AccelGrimAge, DunedinPoAm, and AccelPhenoAge. The study was able to avoid the challenges associated with self-reports of diet and smoking by employing recently developed epigenetic measures.

Changes in socioeconomic stress and diet were associated with changes in speed of biological aging as assessed by all three epigenetic clocks, and changes in smoking was related to changes in AccelGrimAge and DunedinPoAm. Analyses controlling for cell-type indicated that in large measure diet exerts its effect on aging through its impact on the immune system.

Local Public Resources and Innovation: Evidence from the Opioid Crisis
Kimberly Cornaggia et al.
University of Kansas Working Paper, May 2022

Local opioid abuse reduces net worker inflows, taxable income, high skilled labor, corporate and aggregate innovation, new business creation, and job growth from start-ups in affected areas, holding socioeconomic conditions constant. Changes in house prices, parks and recreation expenditures, and dollar store establishments indicate a decline in local resources and amenities as a channel for these negative effects of opioid abuse on human capital and innovation. Our results are robust across diff-in-diff and IV identification strategies. We conclude that local public health problems drain local resources, drive out talent, and lead to long-term reductions in innovative capacity in affected communities. 

Misinformation, Consumer Risk Perceptions, and Markets: The Impact of an Information Shock on Vaping and Smoking Cessation
Lawrence Jin et al.
NBER Working Paper, July 2022

Smoking is the leading preventable cause of death in the U.S. Because e-cigarettes do not involve the combustion of tobacco, vaping offers the potential to prevent most of the health consequences of smoking. We study the impact of an information shock created by an outbreak of lung injuries apparently related to e-cigarettes. We use data from multiple sources: surveys of risk perceptions conducted before, during, and after the outbreak; an in-depth survey we conducted on risk perceptions and vaping and smoking behavior; and national aggregate time-series sales data. We find that after the outbreak, consumer perceptions of the riskiness of e-cigarettes sharply increased, so that in contrast to almost all experts, the majority of consumers perceive e-cigarettes to be relatively and absolutely riskier than cigarettes. From our estimated e-cigarette demand models, we conclude that the information shock reduced e-cigarette demand by about 30 percent. We also estimate that the information shock decreased the use of e-cigarettes for smoking cessation, again by about 30 percent. Over time, the reduced smoking cessation due to the information shock will in turn increase smoking-related illness and death. 

E-Cigarette Flavors, Devices, and Brands Used by Youths Before and After Partial Flavor Restrictions in the United States: Canada, England, and the United States, 2017‒2020
David Hammond et al.
American Journal of Public Health, July 2022, Pages 1014-1024

We analyzed 5 cross-sectional waves of the International Tobacco Control Policy Evaluation Project Youth Tobacco and Vaping Surveys, conducted online with youths aged 16 to 19 years in the United States, Canada, and England, for differences in usual e-cigarette flavor, device, and brand reported by past-30-day vapers (n = 9512) before (2017, 2018, 2019), during (February 2020), and after (August 2020) implementation of US flavor restrictions.

In August 2020, 78.7% of vapers in the United States reported using a flavor prohibited in cartridges or pods, versus 86.3% in Canada (adjusted odds ratio [AOR] = 1.73; 95% CI = 1.25, 1.40) and 79.8% in England (AOR = 1.10; 95% CI = 0.78, 1.55). Disposable e-cigarettes (exempt from flavor restrictions) increased to a greater extent among vapers in the United States (13.2% to 36.8%) versus Canada (7.7% to 14.2%; AOR = 2.01; 95% CI = 1.33, 3.04) and England (10.8% to 16.4%; AOR = 2.33; 95% CI = 1.52, 3.57). Puff Bar (disposable) emerged as the most popular brand in the United States. 

Are Menthol Smokers Different? An Economic Perspective
Yu-Chun Cheng et al.
NBER Working Paper, July 2022

Of the 45.7 million current smokers in the U.S. age 12 and over, more than 18.5 million usually smoke menthol cigarettes. The Food and Drug Administration (FDA) recently proposed a tobacco product standard that would prohibit menthol as a characterizing flavor in cigarettes (FDA 2022b). Although menthol is not harmful per se, the FDA concludes that the prohibition of menthol in cigarettes is appropriate for public health, meeting the criterion established by the 2009 Tobacco Control Act for FDA regulation of tobacco products. In this paper we explore whether menthol smokers are different in ways that provide an applied welfare economics rationale to prohibit menthol. In national data from the 2018-2019 Tobacco Use Supplement to the Current Population Survey (TUS-CPS), after controlling for socio-demographics, we mainly find small associations between menthol use and smoking behaviors, many quitting behaviors, and cigarette purchase behaviors. Although menthol use is much more common among Black smokers, Blacks are less likely to be current smokers, and conditional on current smoking Blacks are less likely to be daily smokers, are less likely to have started smoking before age 18, smoke fewer cigarettes per day, and are less likely to be addicted. In data from a 2021 Cornell Online Survey, we find no evidence that menthol smokers are less informed or are more likely to experience smoking-related internalities. Our analysis of stated preference data suggests that menthol and non-menthol smokers have similar preferences over tobacco product attributes, except that menthol smokers have a stronger preference for flavored e-cigarettes. In a potentially important exception to the patterns just described, in the 2018-2019 TUS-CPS data we find evidence that among ever smokers, menthol smokers and Black smokers are less likely to be lifetime quitters.

Do Opioid Prescriptions Lead to Fatal Car Crashes?
Michael Betz & Lauren Jones
American Journal of Health Economics, Summer 2022, Pages 359-386

Widespread opioid misuse suggests a potential for increased fatal car crashes. However, opioid use may not necessarily lead to additional crashes if drivers respond to opioid prevalence by substituting away from more inebriating intoxicants like alcohol. Combining data on local opioid prescription rates and car crashes from the Fatality Analysis Reporting System, we use two-way fixed-effects models to test the direction of the association between prescribing intensity and crash fatalities between 2007 and 2016. We estimate that a 10 percent increase in the local prescription rate is associated with a 1 percent increase in the number of driver deaths in motor vehicle accidents. The association is robust to several model specifications, and isolated to drivers most affected by the opioid crisis: males and 25- to 34-year-olds.

Cannabis Adaptation During and After Alcohol Ignition Interlock Device Installation: A Longitudinal Study 
Michael Scherer et al.
Journal of Studies on Alcohol and Drugs, July 2022, Pages 486–493 

The data are from the Managing Heavy Drinking (MHD) study of drivers in New York State. The MHD is a comprehensive three-wave study of drivers convicted of driving under the influence from 2015 to 2020. Participants (N = 189) completed all waves, and provided oral fluid/blood and hair samples to measure cannabis and alcohol use, respectively. Mixed between-within analysis of variance was conducted to assess cannabis use at IID installation (Time 1), removal (Time 2), and at 6-month follow-up (Time 3). 

In aggregate, participants increased their cannabis use over the course of the study. Drivers who decreased their alcohol use while the IID was installed on their car significantly increased their cannabis use while the IID was in place and further increased cannabis use after the device's removal.

Recalls, Availability, and Content of Dietary Supplements Following FDA Warning Letters
Pieter Cohen et al.
Journal of the American Medical Association, 26 July 2022, Pages 393-395

Dietary supplement products were included if they had previously been the subject of a warning letter from the FDA regarding the presence of the amphetamine analogue β-methylphenethylamine (BMPEA), the ephedrine analogue methylsynephrine, or the dimethylamylamine analogue octodrine (DMHA). The FDA issued warning letters for these stimulants in 2015, 2016, and 2019, respectively. The warning letters mandate that manufacturers inform the FDA of the steps the firm will take to correct the violation and prevent similar violations in the future. The Google search engine, manufacturers’ websites, and the FDA’s website were searched for evidence of recalls of the implicated products. Products that remained available for sale using the Google search engine in January 2022 were purchased online. Powder from the dietary supplement products was reconstituted in methanol and analyzed for the presence and quantity of FDA-prohibited ingredients by liquid chromatography quadrupole time-of-flight mass spectrometry using a previously described method.

The FDA issued warning letters targeting the presence of BMPEA, methylsynephrine, or DMHA in 31 supplement products. Of these 31 products, 1 (3%) was recalled by the manufacturer. Nine of the 31 products (29%) remained available for purchase online a mean of 6 years after the FDA issued warning letters. Four of the 9 available products (44%) listed the presence of at least 1 prohibited ingredient on the label: 1 product label declared the same prohibited ingredient that prompted the FDA warning letter and 3 product labels declared other FDA-prohibited ingredients. After chemical analysis, 5 of the 9 products (56%) were found to contain at least 1 FDA-prohibited ingredient. Four products contained 1 prohibited ingredient and 1 product contained 3 different prohibited ingredients. Two products contained the same prohibited ingredient for which the FDA issued the warning letter.

Sperm count is increased by diet-induced weight loss and maintained by exercise or GLP-1 analogue treatment: A randomized controlled trial
Emil Andersen et al.
Human Reproduction, July 2022, Pages 1414–1422

Study design, size, duration:
This is a substudy of men with obesity enrolled in a randomized, controlled, double-blinded trial (the S-LITE trial). The trial was conducted between August 2016 and November 2019. A total of 56 men were included in the study and assigned to an initial 8-week low-calorie diet (800 kcal/day) followed by randomization to 52 weeks of either: placebo and habitual activity (placebo), exercise training and placebo (exercise), the Glucagon Like Peptide 1 (GLP-1) analogue liraglutide and habitual activity (liraglutide) or liraglutide in combination with exercise training (combination).

Participants/materials, setting, methods:
Inclusion criteria were men who delivered semen samples, 18 to 65 years of age, and a body mass index between 32 and 43 kg/m2, but otherwise healthy. The study was carried out at Hvidovre Hospital and at the University of Copenhagen, and the participants were from the Greater Copenhagen Area. We assessed semen parameters and anthropometrics and collected blood samples before (T0), after the 8-week low-calorie dietary intervention (T1), and after 52 weeks (T2). 

Main results and the role of chance:
The men lost on average 16.5 kg (95% CI: 15.2–17.8) body weight during the low-calorie diet, which increased sperm concentration 1.49-fold (95% CI: 1.18–1.88, P < 0.01) and sperm count 1.41-fold (95% CI: 1.07–1.87, P < 0.01). These improvements were maintained for 52 weeks in men who maintained the weight loss, but not in men who regained weight. Semen volume, sperm motility and motile sperm count did not change.

Smoking, selection, and medical care expenditures
Michael Darden & Robert Kaestner
Journal of Risk and Uncertainty, June 2022, Pages 251–285

The contribution of cigarette smoking to national health expenditures is thought to be large, but our current understanding of the effect of smoking on annual medical expenditures is limited to studies that use cross-sectional data to make comparisons of medical care expenditures between smokers and never smokers at a particular age. We develop a dynamic economic model of smoking and medical care use that highlights two forms of selection: selective mortality and non-random cessation. To test predictions from our model, we construct novel longitudinal profiles of medical expenditures of smokers and never smokers from merged National Health Interview Survey and Medicare claims information. Consistent with our theory, we find that, from a given age, smokers generate higher expenditures prospectively, because of a higher incidence in inpatient usage, and lower expenditures retrospectively, because of lower outpatient usage. Between ages 65 and 84, we find that the expected value of the discounted sum of total expenditures is lower for smokers, mainly because of excess mortality. We find no evidence that cigarette smoking is a burden on Medicare.

The munchies: Marijuana legalization and food sales in Washington
Timothy Hodge & Cooper Hazel
Southern Economic Journal, July 2022, Pages 112-137

This paper uses the differential timing and varying degree of recreational marijuana access across Washington counties to estimate the relationship between recreational marijuana sales and food sales. Using panel event study design methods over a period that covers the emergence of Washington's retail marijuana industry, we find a statistically significant increase in taxable food sales without evidence of an increase in or substitution away from other food categories. Specifically, the introduction of recreational marijuana sales increases per capita taxable food sales by 5% to 6% and a 1% increase in marijuana sales increases per capita taxable food sales by 0.018%. These findings imply there may be additional tax revenue and health costs that need to be included in the recreational marijuana debate.


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