Survivors
Self-Employment and Health: Barriers Or Benefits?
Cornelius Rietveld, Hans van Kippersluis & Roy Thurik
Health Economics, forthcoming
Abstract:
The self-employed are often reported to be healthier than wageworkers; however, the cause of this health difference is largely unknown. The longitudinal nature of the US Health and Retirement Study allows us to gauge the plausibility of two competing explanations for this difference: a contextual effect of self-employment on health (benefit effect), or a health-related selection of individuals into self-employment (barrier effect). Our main finding is that the selection of comparatively healthier individuals into self-employment accounts for the positive cross-sectional difference. The results rule out a positive contextual effect of self-employment on health, and we present tentative evidence that, if anything, engaging in self-employment is bad for one's health. Given the importance of the self-employed in the economy, these findings contribute to our understanding of the vitality of the labor force.
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Changing Trends of Childhood Disability, 2001–2011
Amy Houtrow et al.
Pediatrics, September 2014, Pages 530-538
Background: Over the past half century the prevalence of childhood disability increased dramatically, coupled with notable increases in the prevalence of mental health and neurodevelopmental conditions. This study provides a detailed assessment of recent trends in childhood disability in relation to health conditions and sociodemographic factors.
Methods: Secondary data analysis of National Health Interview Survey (NHIS) datasets 2001–2002, 2004–2005, 2007–2008, and 2010–2011 (N = 198 888) was conducted to calculate the prevalence, rate of change, severity, and sociodemographic disparities of parent-reported childhood disability.
Results: The prevalence of childhood disability has continued to increase, growing by 15.6% between 2001–2002 and 2010–2011. Nearly 6 million children were considered disabled in 2010–2011. Children living in poverty experienced the highest rates of disability, 102.6 cases per 1000 population in 2010–2011, but unexpectedly, children living in households with incomes ≥400% above the federal poverty level experienced the largest increase (28.4%) over this 10-year period. The percentage of disability cases related to any physical health condition declined 11.8% during the decade, whereas cases related to any neurodevelopmental or mental health condition increased by 20.9%.
Conclusions: Over the past decade, parent-reported childhood disability steadily increased. As childhood disability due to physical conditions declined, there was a large increase in disabilities due to neurodevelopmental or mental health problems. For the first time since the NHIS began tracking childhood disability in 1957, the rise in reported prevalence is disproportionately occurring among socially advantaged families. This unexpected finding highlights the need to better understand the social, medical, and environmental factors influencing parent reports of childhood disability.
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Does giving to charity lead to better health? Evidence from tax subsidies for charitable giving
Barış Yörük
Journal of Economic Psychology, forthcoming
Abstract:
In the United States, charitable contributions can be deducted from taxable income making the price of giving inversely related to the marginal tax rate. The existing literature documents that charitable giving is very responsive to tax subsidies, but often ignores the spillover effects of such policies. On the other hand, a growing body of literature documents that giving to others reduces stress and strengthens the immune system, which results in better health and longer life expectancy. These findings imply that tax subsidies for charitable giving may have positive spillover effects on health. This paper investigates this hypothesis using data from Center on Philanthropy Panel Study (COPPS), the philanthropy module of the Panel Study Income Dynamics (PSID). Understanding the spillover effects of charitable subsidies on health is quite important given the existing literature that links health status to several important economic outcomes. The results show that charitable subsidies have positive spillover effects on health. In particular, the implied cross-price elasticity of health index with respect to giving is -0.13. These results are robust to potential endogeneity of income and highlight the positive externalities created by tax subsidies for charitable giving.
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Emily Kroshus et al.
Health Education & Behavior, forthcoming
Abstract:
Many states and sports leagues are instituting concussion policies aimed at reducing risk of morbidity and mortality; many include mandates about the provision of concussion education to youth athletes. However, there is limited evidence if educational materials provided under these typically vague mandates are in fact effective in changing concussion risk-related behavior or any cognition predictive of risk-related behavior. The purpose of this pilot randomized controlled study was to conduct a theory-driven evaluation of three publically available concussion education materials: two videos and one informational handout. Participants were 256 late adolescent males from 12 teams in a single league of ice hockey competition in the United States. Randomization of educational condition occurred at the team level. Written surveys assessing postimpact symptom reporting behavior, concussion knowledge, and concussion reporting cognitions were completed by participants immediately before receiving their educational intervention, 1 day after, and 1 month after. Results indicated no change in any measure over any time interval, with the exception of perceived underreporting norms. In one of the video conditions, perceived underreporting norms increased significantly 1 day after viewing the video. Possible content and viewing environment-related reasons for this increase are discussed. Across all conditions, perceived underreporting norms increased 1 month after intervention receipt, raising the possibility that late in the competitive season underreporting may be perceived as normative. The need for the development of theory-driven concussion education materials, drawing on best practices from health behavior scholars, is discussed.
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Identifying Moral Hazard in Car Insurance Contracts
Sarit Weisburd
Review of Economics and Statistics, forthcoming
Abstract:
This paper capitalizes on a unique situation in Israel where car insurance coverage is often distributed as a benefit by employers. In our sample, employer-determined coverage resulted in an average $235 discount in accident costs. Using instrumental variable analysis on data provided by an insurance firm in Israel (2001-2008), we find that each $100 reduction in accident costs results in a 1.7 percentage point increase in the probability of an accident. At an average accident rate of 16.3 percent, this 10 percent increase in auto accidents can be interpreted as the effect of moral hazard on car accidents.
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Félice Lê-Scherban et al.
American Journal of Epidemiology, 1 September 2014, Pages 469-481
Abstract:
Despite persistent schooling-related health disparities in the United States, little is known about the multigenerational effects of schooling on adult health. As expected lifespans increase, direct influences of grandparental schooling on grandchildren's health may become increasingly important. We used multigenerational data spanning 41 years from a national sample of US families to investigate associations of grandparents’ educational attainment with global health status, smoking, and obesity in their grandchildren who were aged 25–55 years in 2009. We estimated total effects of grandparental schooling and, by using marginal structural models, we estimated controlled direct effects that were independent of parents’ and participants’ schooling. Among whites, lower levels of grandparental schooling were monotonically associated with poor health status, current smoking, and obesity in adult grandchildren. There was also evidence suggesting direct effects, which was stronger for poor health status among participants whose highest-educated grandparent lived in the same state. Among blacks, the only association suggesting a total or direct effect of grandparental schooling was for smoking. Despite the relative imprecision of our estimates and possible residual bias, these results suggest that higher levels of grandparental schooling may benefit the health of grandchildren in adulthood, especially among whites. Furthermore, part of those apparent effects, especially for obesity, may not be mediated by parents’ and grandchildren's schooling.
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Vikesh Amin, Jere Behrman & Hans-Peter Kohler
Social Science & Medicine, forthcoming
Abstract:
Numerous theoretical reasons have been posited about why more schooling might improve health. Adult health outcomes and behaviors generally are significantly associated with schooling. However, such associations do not necessarily imply that schooling has causal effects on health outcomes and behaviors. Causal estimates based on schooling variation from policies and from within-MZ (monozygotic) twins have reached mixed conclusions. This study contributed new estimates of cross-sectional associations and within-MZ causal effects using three relatively large US twins samples. The estimates suggested that schooling was significantly associated with numerous health outcomes and behaviors. However, with within-MZ twins control for unobserved factors, schooling was no longer associated with most indicators of better health (with the exception of self-reported health), while it continued to be associated with outcomes such as fertility and spousal schooling. Similar patterns were observed for spousal schooling.
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Dhaval Dave & Jose Fernandez
Economic Inquiry, forthcoming
Abstract:
Autism is a development disorder that has increased in prevalence from 0.5 to 14.7 per 1,000 children over 1970–2010. Using annual wages and provider counts from the American Community Survey and information from 21 regional development centers in California, we estimate the labor demand for auxiliary health providers. We focus on this subset of providers because, unlike physicians and psychologists who can diagnose autism, these workers cannot induce their own demand. If the incidence of autism is increasing independently of other mental disorders, then the demand for auxiliary health providers should increase, leading to higher wages and labor supply. Otherwise, the increase in autism diagnosis is merely displacing other mental disorders. We find that a 100% increase in autism cases increases the wages of auxiliary health workers over non-autism health occupations by 8–11% and the number of providers by 9–14%. Furthermore, we find that one of every three new autism diagnoses is merely supplanting mental retardation diagnoses, but does not displace other mental disorders. These estimates suggest that at least part of the increase in autism diagnoses, about 50–65%, reflects an increase in the true prevalence of the disorder.
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Ralph DiClemente et al.
JAMA Pediatrics, forthcoming
Objective: To evaluate the efficacy of a telephone counseling prevention maintenance intervention (PMI) to sustain STI/HIV-preventive behaviors and reduce incident STIs during a 36-month follow-up.
Design, Setting, and Participants: In a 2-arm randomized supplemental treatment trial at 3 clinics serving predominantly minority adolescents in Atlanta, Georgia, 701 African American adolescent girls aged 14 to 20 years received a primary treatment and subsequently received a different (supplemental) treatment (PMI) to enhance effects of the primary treatment.
Interventions: Participants in the experimental condition (n = 342) received an adapted evidence-based STI/HIV intervention (HORIZONS) and a PMI consisting of brief telephone contacts every 8 weeks over 36 months to reinforce and complement prevention messages. Comparison-condition participants (n = 359) received HORIZONS and a time- and dose-consistent PMI focused on general health.
Main Outcomes and Measures: The primary outcomes were percentage of participants with a laboratory-confirmed incident chlamydial infection and percentage of participants with a laboratory-confirmed gonococcal infection during the 36-month follow-up. Behavioral outcomes included the following: (1) proportion of condom-protected sexual acts in the 6 months and 90 days prior to assessments; (2) number of sexual episodes during the past 90 days in which participants engaged in sexual intercourse while high on drugs and/or alcohol; and (3) number of vaginal sex partners in the 6 months prior to assessments.
Results: During the 36-month follow-up, fewer participants in the experimental condition than in the comparison condition had incident chlamydial infections (94 vs 104 participants, respectively; risk ratio = 0.50; 95% CI, 0.28 to 0.88; P = .02) and gonococcal infections (48 vs 54 participants, respectively; risk ratio = 0.40; 95% CI, 0.15 to 1.02; P = .06). Participants completing more telephone contacts had a lower risk of chlamydial infection (risk ratio = 0.95; 95% CI, 0.90 to 1.00; P = .05). Participants in the experimental condition reported a higher proportion of condom-protected sexual acts in the 90 days (mean difference = 0.08; 95% CI, 0.06 to 0.11; P = .02) and 6 months (mean difference = 0.08; 95% CI, 0.06 to 0.10; P = .04) prior to assessments and fewer episodes of sexual acts while high on drugs and/or alcohol (mean difference = −0.61; 95% CI, −0.98 to −0.24; P < .001).
Conclusions and Relevance: Sustaining the long-term impact of an STI/HIV intervention is achievable with brief, tailored telephone counseling.
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Don't Take 'No' For An Answer: An Experiment With Actual Organ Donor Registrations
Judd Kessler & Alvin Roth
NBER Working Paper, August 2014
Abstract:
Over 10,000 people in the U.S. die each year while waiting for an organ. Attempts to increase organ transplantation have focused on changing the registration question from an opt-in frame to an active choice frame. We analyze this change in California and show it decreased registration rates. Similarly, a "field in the lab" experiment run on actual organ donor registration decisions finds no increase in registrations resulting from an active choice frame. In addition, individuals are more likely to support donating the organs of a deceased who did not opt-in than one who said "no" in an active choice frame.
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Perceived Extrinsic Mortality Risk and Reported Effort in Looking after Health
Gillian Pepper & Daniel Nettle
Human Nature, September 2014, Pages 378-392
Abstract:
Socioeconomic gradients in health behavior are pervasive and well documented. Yet, there is little consensus on their causes. Behavioral ecological theory predicts that, if people of lower socioeconomic position (SEP) perceive greater personal extrinsic mortality risk than those of higher SEP, they should disinvest in their future health. We surveyed North American adults for reported effort in looking after health, perceived extrinsic and intrinsic mortality risks, and measures of SEP. We examined the relationships between these variables and found that lower subjective SEP predicted lower reported health effort. Lower subjective SEP was also associated with higher perceived extrinsic mortality risk, which in turn predicted lower reported health effort. The effect of subjective SEP on reported health effort was completely mediated by perceived extrinsic mortality risk. Our findings indicate that perceived extrinsic mortality risk may be a key factor underlying SEP gradients in motivation to invest in future health.
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Wealth Shocks and Health Outcomes: Evidence from Stock Market Fluctuations
Hannes Schwandt
Princeton Working Paper, July 2014
Abstract:
Do wealth shocks affect the health of the elderly in developed countries? The economic literature is skeptical about such effects which have so far only been found for poor retirees in poor countries. In this paper I show that wealth shocks also matter for the health of wealthy retirees in the US. I exploit the booms and busts in the US stock market as a natural experiment that generated considerable gains and losses in the wealth of stock-holding retirees. Using data from the Health and Retirement Study I construct wealth shocks as the interaction of stock holdings with stock market changes. These constructed wealth shocks are highly predictive of changes in reported wealth. And they strongly affect health outcomes. A 10% wealth shock leads to an improvement of 2-3% of a standard deviation in physical health, mental health and survival rates. Effects are heterogeneous across physical health conditions, with most pronounced effects for the incidence of high blood pressure, smaller effects for heart problems and no effects for arthritis, diabetes, lung diseases and cancer. The comparison with the cross-sectional relationship of wealth and health suggests that the estimated effects of wealth shocks are larger than the long-run wealth elasticity of health.
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Income Receipt and Mortality: Evidence from Swedish Public Sector Employees
Elvira Andersson, Petter Lundborg & Johan Vikström
Lund University Working Paper, August 2014
Abstract:
In this paper, we study the short-run effect of salary receipt on mortality among Swedish public sector employees. By exploiting variation in pay-days across work-places, we completely control for mortality patterns related to, for example, public holidays and other special days or events coinciding with paydays and for general within-month and within-week mortality patterns. We find a dramatic increase in mortality on the day salaries arrive. The increase is especially pronounced for younger workers and for deaths due to activity-related causes such as heart conditions and strokes. Additionally, the effect is entirely driven by an increase in mortality among low income individuals, who are more likely to experience liquidity constraints. All things considered, our results suggest that an increase in general economic activity upon salary receipt is an important cause of the excess mortality.
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Pro-Cyclical Mortality Across Socioeconomic Groups and Health Status
Venke Furre Haaland & Kjetil Telle
Journal of Health Economics, forthcoming
Abstract:
Using variation across geographic regions, a number of studies from the U.S. and other developed countries have found more deaths in economic upturns and less deaths in economic downturns. We use data from regions in Norway for 1977-2008 and find the same pro-cyclical patterns. Using individual-level register data for the identical population, we find that disadvantaged socioeconomic groups are not hit harder by pro-cyclical mortality than advantaged groups. We also find that other indicators of deteriorated health (than death), like becoming disabled, are pro-cyclical. Overall, our analysis suggests that pro-cyclical mortality is rather related to deaths of people already in deteriorated health than to people of low socioeconomic status.
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What can genes tell us about the relationship between education and health?
Jason Boardman, Benjamin Domingue & Jonathan Daw
Social Science & Medicine, forthcoming
Abstract:
We use genome wide data from respondents of the Health and Retirement Study (HRS) to evaluate the possibility that common genetic influences are associated with education and three health outcomes: depression, self-rated health, and body mass index. We use a total of 1.7 million single nucleotide polymorphisms obtained from the Illumina HumanOmni2.5-4v1 chip from 4,233 non-Hispanic white respondents to characterize genetic similarities among unrelated persons in the HRS. We then used the Genome Wide Complex Trait Analysis (GCTA) toolkit, to estimate univariate and bivariate heritability. We provide evidence that education (h2 = .33), BMI (h2 = .43), depression (h2 = .19), and self-rated health (h2 = .18) are all moderately heritable phenotypes. We also provide evidence that some of the correlation between depression and education as well as self-rated health and education is due to common genetic factors associated with one or both traits. We find no evidence that the correlation between education and BMI is influenced by common genetic factors.
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Impact of FDA Actions, DTCA, and Public Information on the Market for Pain Medication
David Bradford & Andrew Kleit
Health Economics, forthcoming
Abstract:
Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most important classes of prescription drugs used by primary care physicians to manage pain. The NSAID class of products has a somewhat controversial history, around which a complex regulatory and informational environment has developed. This history includes a boxed warning mandated by the Food and Drug Administration (FDA) for all NSAIDs in 2005. We investigate the impact that various information shocks have had on the use of prescription medications for pain in primary care in the USA. We accomplish this by extracting data on nearly 600 000 patients from a unique nationwide electronic medical record database and estimate the probability of any active prescription for the four types of pain medications as a function of FDA actions, advertising, media coverage, and patient characteristics. We find that even after accounting for multiple sources of information, the FDA label changes and boxed warnings had a significant effect on pain medication prescribing. The boxed warning did not have the same impact on the use of all NSAID inhibitors. We find that the boxed warning reduced the use of NSAID COX-2 inhibitor use, which was the focus of much of the press attention. In contrast, however, the warning actually increased the use of non-COX-2 NSAID inhibitors. Thus, the efficacy of the FDA's black box warning is clearly mixed.
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Sexual Functioning in Military Personnel: Preliminary Estimates and Predictors
Sherrie Wilcox, Sarah Redmond & Anthony Hassan
Journal of Sexual Medicine, forthcoming
Introduction: Although the military is a young and vigorous force, service members and veterans may experience sexual functioning problems (SFPs) as a result of military service. Sexual functioning can be impaired by physical, psychological, and social factors and can impact quality of life (QOL) and happiness.
Methods: This exploratory cross-sectional study was conducted using data from a larger nationwide study conducted between October 2013 and November 2013. This sample consists of 367 male active duty service members and recent veterans (military personnel) age 40 or younger.
Main Outcome Measures: Erectile dysfunction (ED) was determined using the five-item International Index of Erectile Function, sexual dysfunction (SD) was determined using the Arizona Sexual Experiences Scale, Male, and QOL was determined using the World Health Organization Quality of Life, Brief.
Results: SFPs were associated with various demographic, physical, and psychosocial risk factors. The rates of SD and ED were 8.45% and 33.24%, respectively, for male military personnel aged 21–40. Those who were 36–40, nonmarried, nonwhite, and of lower educational attainment reported the highest rates of SFPs. Male military personnel with poor physical and psychosocial health presented the greatest risk for ED and SD. SFPs were associated with reduced QOL and lower happiness, and barriers for treatment were generally related to social barriers.
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Community design, street networks, and public health
Wesley Marshall, Daniel Piatkowski & Norman Garrick
Journal of Transport & Health, forthcoming
Abstract:
What is the influence of street network design on public health? While the literature linking the built environment to health outcomes is vast, it glosses over the role that specific street network characteristics play. The three fundamental elements of street networks are: street network density, connectivity, and configuration. Without sufficient attention being paid to these individual elements of street network design, building a community for health remains a guessing game. Our previous study found more compact and connected street networks highly correlated with increased walking, biking, and transit usage; while these trends suggest a health benefit, this study seeks to strengthen that connection. Using a multilevel, hierarchical statistical model, this research seeks to fill this gap in the literature through a more robust accounting of street network design. Specifically, we ask the following: what is the influence of the three fundamental measures of street networks on obesity, diabetes, high blood pressure, heart disease, and asthma? We answer this question by examining 24 California cities exhibiting a range a street network typologies using health data from the California Health Interview Survey. We control for the food environment, land uses, commuting time, socioeconomic status, and street design. The results suggest that more compact and connected street networks with fewer lanes on the major roads are correlated with reduced rates of obesity, diabetes, high blood pressure, and heart disease among residents. Given the cross-sectional nature of our study, proving causation is not feasible but should be examined in future research. Nevertheless, the outcome is a novel assessment of streets networks and public health that has not yet been seen but will be of benefit to planners and policy-makers.