Under the Influences
Janet Rosenbaum
Journal of Adolescent Health, February 2012, Page S75
Purpose: This research quantifies the impact of high school suspension on the alcohol and drug use of young adults at ages 25-31. Zero-tolerance high school disciplinary policies have been criticized by the American Academy of Pediatrics, but little research has assessed long-term impacts of high school suspension. The research tests hypotheses generated by the theory of secondary deviance, which predicts that school suspension for minor deviance will induce more severe deviance.
Methods: The research analyzed National Longitudinal Study of Adolescent Health data from in-home interview at waves 1-4 and the school administrator survey. The sample comprised 14,738 students who had never been suspended as of wave 1, of whom 1,572 were suspended between waves 1 and 2. Rubin Causal Inference Model methods were used to infer the impact of high school suspension on the 1,572 suspended students, including Coarsened Exact Matching and Full Matching. We used matching methods to construct a comparison group of non-suspended students similar to the 1,572 suspended students on pre-suspension (wave 1) characteristics. Imbalance between suspended and non-suspended youth is measured as a unitless quantity from 0 to 1, with 0 representing perfect balance, a successful match. Incidence rate ratios were obtained from Poisson regressions within the matched sample that controlled for socioeconomic and educational characteristics. Results were stratified by tertiles of parents' income and test score.
Results: The initial analysis used exact matching on 10 characteristics. The initial results evaluated high school graduation at ages 18-24 and BA attainment at ages 25-31. Exact matching on 10 characteristics reduced imbalance from 0.63 to 0 (perfect match) by restricting analysis to a sub-sample of 1,338 of the 1,572 suspended students. The similar comparison group was 7,835 non-suspended students. School suspension decreased the likelihood of high school graduation by 37% and BA attainment by 77% among low-income youth with high test scores. School suspension decreased the likelihood of BA attainment among nearly all levels of parent income and test scores, an average of reduction of 60%. Subsequent analyses will compare alcohol and drug use between suspended and non-suspended youth, and matching will use a larger set of control variables.
Conclusions: Twelve years later, school suspension may decrease BA attainment among all nearly all groups of youth. Low income youth with high test scores have the potential for socioeconomic mobility but seem particularly at risk for bad outcomes of school suspension. Subsequent analyses will evaluate whether suspended youth are also more likely to engage in alcohol and drug use.
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The Animal House effect: How university-themed comedy films affect students' attitudes
Louise Wasylkiw & Michael Currie
Social Psychology of Education, March 2012, Pages 25-40
Abstract:
Drawing from learning and attitude theories, the current investigation explores the effect of media on students' attitudes. Study 1 was a content analysis of 34 films classified as university-themed comedies and showed that such films highlighted risk-taking (e.g., alcohol consumption) and minimized the importance of academics (e.g., studying). The purpose of Study 2 was to demonstrate the impact of these films on the attitudes university students hold. One hundred and twenty-four undergraduates viewed a segment of either Animal House or a neutral film and results showed that viewing Animal House brought about positive attitudes towards substance use and negative attitudes towards academics even when controlling for past substance use and movie viewing frequency. The discussion focuses on future directions.
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Brian Primack et al.
Journal of Adolescent Health, February 2012, Page S13
Purpose: While smoking is associated with multiple sociodemographic, personal and environmental factors, evidence indicates that exposure to smoking depicted in movies is a strong risk factor for smoking outcomes among adolescents. However, it is not known whether exposure to smoking depicted in movies carries greater influence during early or late adolescence. We aimed to quantify the independent relative contribution to established smoking of exposure to smoking depicted in movies during both early and late adolescence.
Methods: We prospectively assessed 2,049 non-smoking students recruited from 14 randomly selected public schools in New Hampshire and Vermont. At baseline enrollment, students ages 10-14 completed a written survey capturing personal, family, and sociodemographic characteristics and exposure to depictions of smoking in the movies (early exposure). Seven years later, we conducted follow-up telephone interviews to ascertain follow-up exposure to movie smoking (late exposure) and smoking behavior. We used multiple regression models to assess associations between early and late exposure and development of established smoking, defined as having smoked 100 or more cigarettes in one's lifetime. We included in these models potential confounders that demonstrated a bivariable association of P<.20 with established smoking. These multivariable analyses also controlled for clustering of participants within schools by robust sandwich estimator of variance. We estimated covariate-adjusted attributable risk by calculating the reduced probability of established smoking realized by decreasing each participant's exposure from his or her reported level to the first quartile.
Results: Of the final sample of 2049 participants, 1886 (92.0%) were non-Hispanic white and 1092 (53.3%) were female. At baseline, the participants' mean age was 12.1 years (SD=1.1). At follow-up, ages ranged from 16 to 22 years, with a mean of 18.7 years (SD=1.1), One-sixth (17.3%) of the sample progressed to established smoking. In analyses that controlled for covariates and included early and late exposure in the same model, we found that students in the highest quartile for early exposure, compared to those in the lowest, had 73% greater risk of established smoking (relative risk, 1.73; 95% confidence interval, 1.14-2.62). However, risk did not differ for those in the highest and lowest quartiles of late exposure (relative risk for Q4 vs. Q1, 1.13; 95% CI, 0.89-1.44). According to attributable risk models, early exposure was responsible for 31.6% (95% CI, 10.1-53.2) of established smoking in these adolescents. However, only an additional 5.3% (95% CI, -7.0-17.5) of established smoking was attributable to late exposure.
Conclusions: Being in the highest quartile of early exposure was associated with a 73% increase in the relative risk of becoming an established smoker. This suggests that early exposure to smoking depicted in movies is a stronger risk factor than many other factors previously assumed to be highly potent, including parent, sibling, and peer smoking, which had relative risks of 1.36, 1.29, and 1.64, respectively in this study. Educational and policy-related interventions should focus on minimizing early exposure to smoking depicted in movies.
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The Effect of Alcohol Availability on Marijuana Use: Evidence from the Minimum Legal Drinking Age
Benjamin Crost & Santiago Guerrero
Journal of Health Economics, forthcoming
Abstract:
This paper exploits the discontinuity created by the Minimum Legal Drinking Age of 21 years to estimate the causal effect of increased alcohol availability on marijuana use. We find that consumption of marijuana decreases sharply at age 21, while consumption of alcohol increases, suggesting that marijuana and alcohol are substitutes. We further find that the substitution effect between alcohol and marijuana is stronger for women than for men. Our results suggest that policies designed to limit alcohol use have the unintended consequence of increasing marijuana use.
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The Effectiveness of Mandatory-Random Student Drug Testing: A Cluster Randomized Trial
Susanne James-Burdumy et al.
Journal of Adolescent Health, February 2012, Pages 172-178
Purpose: This article presents findings from the largest experimental evaluation to date of school-based mandatory-random student drug testing (MRSDT). The study tested the effectiveness of MRSDT in reducing substance use among high school students.
Methods: Cluster randomized trial included 36 high schools and more than 4,700 9th through 12th grade students. After baseline data collection in spring 2007, about half the schools were randomly assigned to a treatment group that was permitted to implement MRSDT immediately, and the remaining half were assigned to a control group that delayed MRSDT until after follow-up data collection was completed 1 year later, in spring 2008. Data from self-administered student questionnaires were used to compare rates of substance use in treatment and control schools at follow-up.
Results: Students subject to MRSDT by their districts reported less substances use in past 30 days compared with students in schools without MRSDT. The program had no detectable spillover effects on the substance use of students not subject to testing. We found no evidence of unintentional negative effects on students' future intentions to use substances, the proportion of students who participated in activities subject to drug testing, or on students' attitudes toward school and perceived consequences of substance use.
Conclusions: MRSDT shows promise in reducing illicit substance use among high school students. The impacts of this study were measured for a 1-year period and may not represent longer term effects.
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Jacky Jennings et al.
Social Science & Medicine, forthcoming
Abstract:
We hypothesized that neighborhoods with drug markets, as compared to those without, have a greater concentration of infected sex partners, i.e. core transmitters, and that in these areas, there is an increased risk environment for STIs. This study determined if neighborhood drug markets were associated with a high-risk sex partnership and, separately, with a current bacterial STI (chlamydia and/or gonorrhea) after controlling for individual demographic and sexual risk factors among a household sample of young people in Baltimore City, MD. Analyses also tested whether links were independent of neighborhood socioeconomic status. Data for this study were collected from a household study, systematic social observations and police arrest, public health STI surveillance and U.S. census data. Nonlinear multilevel models showed that living in neighborhoods with household survey-reported drug markets increased the likelihood of having a high-risk sex partnership after controlling for individual level demographic factors and illicit drug use and neighborhood socioeconomic status. Further, living in neighborhoods with survey-reported drug markets increased the likelihood of having a current bacterial STI after controlling for individual level demographic and sexual risk factors and neighborhood socioeconomic status. The results suggest that local conditions in neighborhoods with drug markets may play an important role in setting-up risk environments for high-risk sex partnerships and bacterial STIs. Patterns observed appeared dependent on the type of drug market indicator used. Future studies should explore how conditions in areas with local drug markets may alter sexual networks structures and whether specific types of drug markets are particularly important in determining STI risk.
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Sudip Chattopadhyay & David Pieper
Contemporary Economic Policy, forthcoming
Abstract:
This paper presents a benefit-cost analysis of the ongoing, state-level tobacco prevention and control programs in the United States. Using state-level panel data for the years 1991-2007, the study applies several variants of econometric modeling approaches to estimate the state-level tobacco demand. The paper finds a statistically significant evidence of a sustained and steadily increasing long-run impact of the tobacco control program spending on cigarette demand in states. The study also shows that, if individual states follow the Best Practices funding guidelines, potential future annual benefits of the tobacco control program can be as high as 14-20 times the cost of program implementation.
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The Return on Investment of a Medicaid Tobacco Cessation Program in Massachusetts
Patrick Richard, Kristina West & Leighton Ku
PLoS ONE, January 2012, e29665
Background and Objective: A high proportion of low-income people insured by the Medicaid program smoke. Earlier research concerning a comprehensive tobacco cessation program implemented by the state of Massachusetts indicated that it was successful in reducing smoking prevalence and those who received tobacco cessation benefits had lower rates of in-patient admissions for cardiovascular conditions, including acute myocardial infarction, coronary atherosclerosis and non-specific chest pain. This study estimates the costs of the tobacco cessation benefit and the short-term Medicaid savings attributable to the aversion of inpatient hospitalization for cardiovascular conditions.
Methods: A cost-benefit analysis approach was used to estimate the program's return on investment. Administrative data were used to compute annual cost per participant. Data from the 2002-2008 Medical Expenditure Panel Survey and from the Behavioral Risk Factor Surveillance Surveys were used to estimate the costs of hospital inpatient admissions by Medicaid smokers. These were combined with earlier estimates of the rate of reduction in cardiovascular hospital admissions attributable to the tobacco cessation program to calculate the return on investment.
Findings: Administrative data indicated that program costs including pharmacotherapy, counseling and outreach costs about $183 per program participant (2010 $). We estimated inpatient savings per participant of $571 (range $549 to $583). Every $1 in program costs was associated with $3.12 (range $3.00 to $3.25) in medical savings, for a $2.12 (range $2.00 to $2.25) return on investment to the Medicaid program for every dollar spent.
Conclusions: These results suggest that an investment in comprehensive tobacco cessation services may result in substantial savings for Medicaid programs. Further federal and state policy actions to promote and cover comprehensive tobacco cessation services in Medicaid may be a cost-effective approach to improve health outcomes for low-income populations.
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Smoking bans and acute myocardial infarction incidence
Michael Marlow
Applied Economics Letters, forthcoming
Abstract:
This article examines the effect of statewide smoking bans on Acute Myocardial Infarction (AMI) incidence. After controlling for endogeneity between smoking ban status and AMI incidence, an econometric model indicates that smoking bans exerted no significant effect over 2005-2009 in the 50 states. The evidence thus suggests that findings from previous studies that bans lowered AMI incidence from 6% to 47% were the result of possible sampling bias and/or from examining periods too short with which to fully evaluate the longer term effects from bans.
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Jennifer Mitchell et al.
Science Translational Medicine, 11 January 2012, Page 116ra6
Abstract:
Excessive consumption of alcohol is among the leading causes of preventable death worldwide. Although ethanol modulates a variety of molecular targets, including several neurotransmitter receptors, the neural mechanisms that underlie its rewarding actions and lead to excessive consumption are unknown. Studies in animals suggest that release of endogenous opioids by ethanol promotes further consumption. To examine this issue in humans and to determine where in the brain endogenous opioids act to promote alcohol consumption, we measured displacement of a radiolabeled μ opioid receptor agonist, [11C]carfentanil, before and immediately after alcohol consumption in both heavy drinkers and control subjects. Drinking alcohol induced opioid release in the nucleus accumbens and orbitofrontal cortex, areas of the brain implicated in reward valuation. Opioid release in the orbitofrontal cortex and nucleus accumbens was significantly positively correlated. Furthermore, changes in orbitofrontal cortex binding correlated significantly with problem alcohol use and subjective high in heavy drinkers, suggesting that differences in endogenous opioid function in these regions contribute to excessive alcohol consumption. These results also suggest a possible mechanism by which opioid antagonists such as naltrexone act to treat alcohol abuse.
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Kayo Fujimoto, Jennifer Unger & Thomas Valente
Child Development, forthcoming
Abstract:
Using a network analytic framework, this study introduces a new method to measure peer influence based on adolescents' affiliations or 2-mode social network data. Exposure based on affiliations is referred to as the "affiliation exposure model." This study demonstrates the methodology using data on young adolescent smoking being influenced by joint participation in school-based organized sports activities with smokers. The analytic sample consisted of 1,260 American adolescents from ages 10 to 13 in middle schools, and the results of the longitudinal regression analyses showed that adolescents were more likely to smoke as they were increasingly exposed to teammates who smoke. This study illustrates the importance of peer influence via affiliation through team sports.
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Liesbeth Mercken et al.
Health Psychology, forthcoming
Objective: Similarity in smoking behavior among adolescent friends could be caused by selection of friends on the basis of behavioral similarity, or by influence processes, where behavior is changed to be similar to that of friends. The main aim of the present study is to disentangle selection and influence processes and study changes over time in these processes using new methods of longitudinal social network analysis.
Methods: The sample consists of 1716 adolescents (mean age at baseline = 12.17 years, SD = .38) in 11 British schools participating in the control group of the ASSIST (A Stop Smoking in School Trial) study. The design was longitudinal with three observations at one-year intervals. At each observation, participants were asked to report on their smoking behavior and friendship networks. An actor-based model of friendship network and smoking behavior coevolution (a statistical model for the simultaneously occurring changes in friendship nominations and smoking) was analyzed, capable of modeling possible changes occurring between observations, allowing alternative influence and selection mechanisms to be investigated, and avoiding the violation of assumptions of statistical independence of observed data.
Results: Adolescent's tendency to select friends based on similar smoking behavior was found to be a stronger predictor of smoking behavior than friends' influence. The proportion of smoking behavior similarity explained by smoking-based selection of friends increased over time, whereas the proportion explained by influence of friends decreased.
Conclusions: Smoking prevention should not solely focus on social influence but also consider selection processes and changes in both processes over time during adolescence.
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Matthew Harding, Ephraim Leibtag & Michael Lovenheim
American Economic Journal: Economic Policy, forthcoming
Abstract:
This paper uses Nielsen Homescan data at the Universal Product Code-transaction level to identify how cigarette taxes are passed through to consumer prices in order to determine how the supply and demand-side split the excess burden of taxation. We find that these excise taxes are less than fully passed through to consumer prices. Using information on consumer location and the location of purchases, we show that the availability of lower-tax goods across uncontrolled borders creates significant differences in how consumer prices are affected by excise taxes. Close to lower-tax borders, about half of the cigarette tax is passed on to consumers through higher prices. Far from these borders, however, consumer prices are much more responsive to excise taxes. We also demonstrate that tax evasion opportunities have a sizable effect on purchasing behavior by altering consumer search, prices paid and quantities purchased. With the household demographic information contained in our data, we show that the incidence of cigarette taxes and the border effect varies across household income groups and race. These findings have important consequences for the distribution of the excess burden of cigarette taxes and thus for the social welfare costs and benefits of these taxes.
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The effects of family stressors on substance use initiation in adolescence
Jason Fletcher & Jody Sindelar
Review of Economics of the Household, March 2012, Pages 99-114
Abstract:
Smoking and drinking are critical problems in adolescence that have long-term adverse impacts on health and socio-economic factors. We examine the extent to which family stresses influence the timing of initiation of smoking and drinking. Using national panel data from the National Educational Longitudinal Study (NELS) we capitalize on the survey design and use school-level fixed effects that control for the local environments, including prices of cigarettes and alcohol. In addition, we narrow our control group to classmates who will experience a similar stressor in the future. We find that a composite measure of family stressors when young increases the likelihood of initiating tobacco and alcohol use, with much of the impact attributable to parental divorce. In our baseline estimates, the composite stress measure is associated with a 30% increase in the likelihood of smoking and a 20% increase in drinking. When we control for multiple sources of confounding, the impact shrinks and remains significant for smoking but not for drinking. We conclude that studies which do not control for confounding are likely to significantly overestimate the impact of family stress on substance use. Our approach helps to move the literature forward by separating causal results from spurious associations.
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A Search-Theoretic Model of the Retail Market for Illicit Drugs
Manolis Galenianos, Rosalie Liccardo Pacula & Nicola Persico
Review of Economic Studies, forthcoming
Abstract:
A search-theoretic model of the retail market for illegal drugs is developed. Trade occurs in bilateral, potentially long-lived matches between sellers and buyers. Buyers incur search costs when experimenting with a new seller. Moral hazard is present because buyers learn purity only after a trade is made. This model is consistent with some new stylized facts about the drugs market, and it is informative for policy design. The effectiveness of different enforcement strategies is evaluated, including some novel ones that leverage the moral hazard present in the market.
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Julia Dilley et al.
American Journal of Public Health, February 2012, Pages e22-e28
Objectives: We examined health effects associated with 3 tobacco control interventions in Washington State: a comprehensive state program, a state policy banning smoking in public places, and price increases.
Methods: We used linear regression models to predict changes in smoking prevalence and specific tobacco-related health conditions associated with the interventions. We estimated dollars saved over 10 years (2000-2009) by the value of hospitalizations prevented, discounting for national trends.
Results: Smoking declines in the state exceeded declines in the nation. Of the interventions, the state program had the most consistent and largest effect on trends for heart disease, cerebrovascular disease, respiratory disease, and cancer. Over 10 years, implementation of the program was associated with prevention of nearly 36 000 hospitalizations, at a value of about $1.5 billion. The return on investment for the state program was more than $5 to $1.
Conclusions: The combined program, policy, and price interventions resulted in reductions in smoking and related health effects, while saving money. Public health and other leaders should continue to invest in tobacco control, including comprehensive programs.