Possible side effects
Health insurance and opioid deaths: Evidence from the Affordable Care Act young adult provision
Gal Wettstein
Health Economics, forthcoming
Abstract:
The concurrence of health insurance expansion under the Affordable Care Act (ACA) and increasing opioid‐related mortality has led to debate whether insurance increases or decreases opioid deaths. I use the introduction of the ACA young adult (YA) provision as a quasi‐experiment and utilize the resulting policy‐induced variation across states over time in YA access to insurance to study the effect of coverage on opioid‐related mortality. I rely on the share of state populations which stood to gain insurance before the ACA to perform a dose–response analysis, and find that the YA provision reduced opioid‐related mortality. The analysis suggests that 1 percentage point more coverage reduced opioid mortality among YA by 2.5/100,000 or 19.8%.
Public Intoxication: Sobering Centers as an Alternative to Incarceration, Houston, 2010–2017
Suzanne Jarvis et al.
American Journal of Public Health, April 2019, Pages 597-599
Abstract:
In 2010, the Houston police department admitted 20 508 publicly intoxicated individuals into its jail. To address jail overcrowding, the city created a jail diversion policy that allowed law enforcement to admit publicly intoxicated individuals into a new sobering center. By 2017, public intoxication jail admissions had decreased by 95%, freeing valuable resources. A promising public health intervention, sobering centers offer an alternative to incarceration and relieve overuse of emergency services while assisting individuals with substance use issues.
A quasi-experimental evaluation of marijuana policies and youth marijuana use
Rebekah Levine Coley et al.
American Journal of Drug and Alcohol Abuse, forthcoming
Objectives: This study sought to delineate associations between state-level shifts in decriminalization and medical marijuana laws (MML) and adolescent marijuana use.
Methods: Using data on 861,082 adolescents (14 to 18+ years; 51% female) drawn from 1999 to 2015 state Youth Risk Behavior Surveys (YRBS), difference-in-differences models assessed how decriminalization and MML policy enactment were associated with adolescent marijuana use, controlling for tobacco and alcohol policy shifts, adolescent characteristics, and state and year trends.
Results: MML enactment was associated with small significant reductions (OR = 0.911, 95% CI [0.850, 0.975]) of 1.1 percentage points in current marijuana use, with larger significant declines for male, Black, and Hispanic (2.7–3.9 percentage points) adolescents. Effects of MML increased significantly with each year of exposure (OR = 0.980, 95% CI [0.968, 0.992]). In contrast, decriminalization was not associated with significant shifts in use for the sample as a whole, but predicted significant declines in marijuana use among 14-year olds and those of Hispanic and other ancestry (1.7–4.4 percentage points), and significant increases among white adolescents (1.6 percentage points). Neither policy was significantly associated with heavy marijuana use or the frequency of use, suggesting that heavy users may be impervious to such policy signals.
When are fakers also drinkers? A self-control view of emotional labor and alcohol consumption among U.S. service workers
Alicia Grandey et al.
Journal of Occupational Health Psychology, forthcoming
Abstract:
Some employees tend to drink more alcohol than other employees, with costs to personal and organizational well-being. Based on a self-control framework, we propose that emotional labor with customers — effortfully amplifying, faking, and suppressing emotional expressions (i.e., surface acting) — predicts alcohol consumption, and that this relationship varies depending on job expectations for self-control (i.e., autonomy) and personal self-control traits (i.e., impulsivity). We test these predictions with data drawn from a national probability sample of U.S. workers, focusing on employees with daily contact with outsiders (N = 1,592). The alcohol outcomes included heavy drinking and drinking after work. Overall, surface acting was robustly related to heavy drinking, even after controlling for demographics, job demands, and negative affectivity, consistent with an explanation of impaired self-control. Surface acting predicted drinking after work only for employees with low self-control jobs or traits; this effect was exacerbated for those with service encounters (i.e., customers and the public) and buffered for those with service relationships (i.e., patients, students, and clients). We discuss what these results mean for emotional labor and propose directions for helping the large segment of U.S. employees in public facing occupations.
State-Level Beer Excise Tax and Firearm Homicide in Adolescents and Young Adults
Robert Tessler et al.
American Journal of Preventive Medicine, forthcoming
Methods: A time series analysis with synthetic controls was conducted for the years 2003–2015. Exposed states changed the beer excise tax during the study period. Synthetic controls were weighted mimics that combined portions of unexposed states using state–year specific demographic and firearm covariates. Average annual incidence rate differences were calculated between each exposed state and its synthetic control. Alcohol taxes were available through the National Institute of Alcohol Abuse and Alcoholism and firearm homicide rates were obtained from the Centers for Disease Control and Prevention. States that changed the beer excise tax but for which <2years of pre-exposure data were available were excluded. Data were collected in 2017 and analyzed in 2018.
Results: Five states met inclusion criteria, and all raised the beer excise tax: Illinois (2009), New York (2009), North Carolina (2009), Connecticut (2011), and Rhode Island (2013). The percentage increase in beer excise tax ranged from 10% to 27%. Differences in pre-exposure firearm homicide rates between exposed states and synthetic controls were minimal. The increase in beer excise tax was associated with a lower average annual firearm homicide rate in all states except Illinois (Rhode Island: incidence rate difference= –2.48, Connecticut: incidence rate difference= –2.57, New York: incidence rate difference= –1.45, North Carolina: incidence rate difference= –0.45, and Illinois: incidence rate difference=1.54 per 100,000 population).
Sent Home Versus Being Arrested: The Relative Influence of School and Police Intervention on Drug Use
Beidi Dong & Marvin Krohn
Justice Quarterly, forthcoming
Abstract:
Prior research has demonstrated that school disciplinary practices lead to juvenile justice intervention or the “school-to-prison pipeline” and that juvenile justice intervention leads to adversities, including drug-using behavior, in adolescence and adult life. Yet, it is not clear which form of official intervention, school suspension, and expulsion or police arrest, is more predictive of drug use among young people. Using data from the Rochester Youth Developmental Study, we examined both the immediate, concurrent influence of school and police intervention on drug use during adolescence and the long-term, cumulative impact of school and police intervention during adolescence on subsequent drug use in young established adulthood. The results indicate that school exclusionary practices appeared to be more predictive of drug use than police arrest during both adolescence and young adulthood. Additionally, such negative effects mainly exhibited among minority subjects, and the effects by gender appeared contingent on developmental stages.
Trends in Fentanyl and Fentanyl Analogue-Related Overdose Deaths – Montgomery County, Ohio, 2015-2017
Raminta Daniulaityte et al.
Drug and Alcohol Dependence, May 2019, Pages 116-120
Introduction: There is a lack of information on illicitly manufactured fentanyl and fentanyl analogue-related (IMF) unintentional overdose death trends over time. The study analyzes IMF-related unintentional overdose fatalities that occurred between July 2015 and June 2017 in Montgomery County, Ohio, an area with the highest rates of unintentional overdose mortality in Ohio.
Methods: LC-MS/MS-based method was used to identify fentanyl analogs and metabolites in 724 unintentional overdose death cases. The Chi-square statistic was used to assess differences over time in demographic and drug-related characteristics.
Results: The number of unintentional overdose death cases testing positive for IMFs increased by 377% between second half of 2015 and first half of 2017. The majority of decedents were white (82.5%) and male (67.8%). The proportion of fentanyl-only (no other analogs) cases declined from 89.2% to 24.6% (p < 0.001), while proportion of fentanyl analogue-containing cases increased from 9.8% to 70.3% (p < 0.001) between the second half of 2015 and first half of 2017. The most commonly identified fentanyl analogs were carfentanil (29.7%), furanyl fentanyl (14.1%) and acryl fentanyl (10.2%). Proportion of IMF cases also testing positive for heroin declined from 21.6% to 5.4% (p < 0.001), while methamphetamine positive cases increased from 1.4% to 17.8% (p < 0.001) over the same time period
An African-specific haplotype in MRGPRX4 is associated with menthol cigarette smoking
Julia Kozlitina et al.
PLoS Genetics, February 2019
Abstract:
In the U.S., more than 80% of African-American smokers use mentholated cigarettes, compared to less than 30% of Caucasian smokers. The reasons for these differences are not well understood. To determine if genetic variation contributes to mentholated cigarette smoking, we performed an exome-wide association analysis in a multiethnic population-based sample from Dallas, TX (N = 561). Findings were replicated in an independent cohort of African Americans from Washington, DC (N = 741). We identified a haplotype of MRGPRX4 (composed of rs7102322[G], encoding N245S, and rs61733596[G], T43T), that was associated with a 5-to-8 fold increase in the odds of menthol cigarette smoking. The variants are present solely in persons of African ancestry. Functional studies indicated that the variant G protein-coupled receptor encoded by MRGPRX4 displays reduced agonism in both arrestin-based and G protein-based assays, and alteration of agonism by menthol. These data indicate that genetic variation in MRGPRX4 contributes to inter-individual and inter-ethnic differences in the preference for mentholated cigarettes, and that the existence of genetic factors predisposing vulnerable populations to mentholated cigarette smoking can inform tobacco control and public health policies.
Hospitals and substance use disorder services in the time of the opioid epidemic
Cory Cronin et al.
Health Services Research, April 2019, Pages 399-406
Objective: To test whether the opioid epidemic increased hospitals’ offerings of substance use services.
Data Sources/Study Setting: This study employs data from the 2010 and 2015 American Hospital Association Annual Survey.
Study Design: A multilevel, cross‐sectional design was utilized to examine associations between county‐level overdose rates and hospital substance use services.
Data Collection/Extraction Methods: The analytic sample consisted of 3365 acute care hospitals that answered pertinent survey questions.
Principal Findings: In 2010, 334 hospitals offered inpatient opioid services and 588 hospitals offered outpatient services, compared to 327 and 577, respectively, in 2015, indicating that more hospitals dropped services than added them as overdose rates increased. Factors other than growing need weigh more heavily in hospitals’ determination to offer substance use services, including resources, mission, and the presence of psychiatric facilities within their communities. Importantly, hospitals that employ medical home models had greater odds of offering outpatient substance abuse services in 2015 OR, 95 percent CI (1.54; 1.23‐1.93; P < 0.0001).
Conclusions: Hospitals are either not willing or equipped to increase substance use services in response to growing need.
Tobacco Marketing at SNAP- and WIC-Authorized Retail Food Stores in the United States
Shauna Rust et al.
Health Education & Behavior, forthcoming
Method: A nationally representative sample of tobacco retailers in the contiguous United States (N = 2,054) were audited for tobacco marketing in 2015. Using generalized estimating equations, we examined the association between WIC and SNAP authorization and presence of tobacco marketing, adjusted for store type and neighborhood demographics.
Results: Both WIC-authorized (odds ratio [OR] 1.7, 95% confidence interval [CI] [1.1, 2.4]) and SNAP-authorized retailers (OR 2.3, 95% CI [1.7, 3.1]) had greater odds of displaying interior tobacco price promotions, compared with stores that were not WIC/SNAP authorized. SNAP-authorized stores (compared with nonauthorized) had almost 3 times greater odds of displaying interior tobacco advertisements (OR 2.9, 95% CI [1.9, 4.5]), while WIC-authorized retailers had 80% lower odds of displaying exterior tobacco advertisements (OR 0.2, 95% CI [0.1, 0.3]).