Use case
Investigating the Causal Effect of Cannabis Use on Cognitive Function with a Quasi-Experimental Co-Twin Design
Megan Ross et al.
Drug and Alcohol Dependence, forthcoming
Background: It is unclear whether cannabis use causes cognitive decline; several studies show an association between cannabis use and cognitive decline, but quasi-experimental twin studies have found little support for a causal effect. Here, we evaluate the association of cannabis use with general cognitive ability and executive functions (EFs) while controlling for genetic and shared environmental confounds in a longitudinal twin study.
Methods: We first examined the phenotypic associations between cannabis initiation, frequency, and use disorder with cognitive abilities, while also controlling for pre-use general cognitive ability and other substance involvement. We tested the concurrent association between the cannabis use variables and cognitive abilities in late adolescence and young adulthood and the longitudinal association between cannabis use variables during adolescence and young adulthood cognitive abilities. Next, we used multilevel models to test whether these relations reflect between- and/or within-twin pair associations.
Results: Phenotypically, cannabis use was related to poorer cognitive functioning, although most associations were negligible after accounting for other substance use. Nevertheless, there were few significant within-family twin-specific associations, except that age 17 cannabis frequency was associated with worse age 23 Common EF and general cognitive ability.
Conclusions: We found little support for a potential causal effect of cannabis use on cognition, consistent with previous twin studies. Results suggest that cannabis use may not cause decline in cognitive ability among a normative sample of cannabis users.
The Cannabis Effect on Crime: Time-Series Analysis of Crime in Colorado and Washington State
Ruibin Lu et al.
Justice Quarterly, forthcoming
Abstract:
Previous studies based on relatively weak analytical designs lacking contextualization and appropriate comparisons have reported that the legalization of marijuana has either increased or decreased crime. Recognizing the importance for public policy making of more robust research designs in this area during a period of continuing reform of state marijuana laws, this study uses a quasi-experimental, multi-group interrupted time-series design to determine if, and how, UCR crime rates in Colorado and Washington, the first two states to legalize marijuana, were influenced by it. Our results suggest that marijuana legalization and sales have had minimal to no effect on major crimes in Colorado or Washington. We observed no statistically significant long-term effects of recreational cannabis laws or the initiation of retail sales on violent or property crime rates in these states.
A Trend Analysis of Age of First Marijuana Use Among High School Students in the United States From 1991 to 2017
Sunday Azagba, Lingpeng Shan & Keely Latham
Health Education & Behavior, forthcoming
Method. Data were drawn from the 1991 to 2017 Youth Risk Behavior Survey. We used linear regression for age of first use as a continuous variable, and logistic regression for marijuana use before the age of 15 years as a dichotomous variable. Joinpoint regression analysis identified where significant changes in trend occurred.
Results: Results showed that the mean age of first marijuana use increased significantly between 1991 and 2017. Males had a younger age of first use than females. Between 1991 and 1997, there was an increasing trend in the prevalence of marijuana use before the age of 15 years in all adolescents and in subgroups for males, females, all races, and 9th and 10th grades. After 1997, a significant downward trend was found in all adolescents.
Medicaid expansion and opioid deaths
Susan Averett, Julie Smith & Yang Wang
Health Economics, December 2019, Pages 1491-1496
Abstract:
The United States is in the midst of an opioid epidemic, and drug overdose deaths are becoming a leading cause of death. Meanwhile, in 2010, the United States passed comprehensive health care reform providing access to care for millions of individuals who previously lacked care. Part of the new access came from expanding Medicaid, the insurance program for low‐income individuals. Expanding Medicaid was optional for states. Those individuals living in expansion states gained prescription drug coverage and hence more access to opioid pain‐relievers that are known to be addictive. However, they also gained access to medication‐assisted treatment for addiction. This paper uses a difference‐in‐differences approach and state‐level data from 2010 to 2017 to compare opioid death rates in expansion and non‐expansion states to determine if Medicaid expansion was a potential cause of rising opioid deaths. We find no evidence that Medicaid expansion is related to opioid deaths.
Do Ridesharing Services Increase Alcohol Consumption?
Jacob Burgdorf, Conor Lennon & Keith Teltser
University of Louisville Working Paper, November 2019
Abstract:
Recent studies show ridesharing services, such as Uber and Lyft, reduce intoxicated driving. However, ridesharing may also have negative health effects by increasing alcohol consumption. In this paper, we directly examine the effect of ridesharing on drinking activity. Our approach leverages variation in the existence and entry timing of Uber's taxi-like service, UberX, across the United States. Using self-reported measures of alcohol consumption, we estimate that UberX is associated with a 3.1% increase in the average number of drinks consumed per day, a 2.8% increase in number of drinking days per month, a 4.9% increase in the maximum number of drinks consumed on one occasion, and a 9% increase in the prevalence of heavy drinking. When we focus on areas with relatively weaker public transit options, we estimate UberX is associated with a 17.5% to 21.8% increase in instances of binge drinking. Using administrative data, we support our findings by showing that UberX is associated with a 2.4% increase in employment and a 2.3% increase in total earnings at drinking establishments. Our results imply that the net social impact of ridesharing is more complicated than the existing literature and policy debates suggest.
Employment Shocks and Demand for Pain Medication
Isabel Musse
University of Illinois Working Paper, November 2019
Abstract:
Declining economic opportunity is often portrayed as one of the drivers of the opioid epidemic. Better employment conditions can, however, affect opioid use through two channels: increasing physical pain from working, or reducing mental distress that can contribute to substance abuse. I use a large dataset of opioid and over-the-counter (OTC) painkiller sales to measure the effect of employment shocks on demand for pain medication. To separate the channels, I contrast the effect of labor demand shocks on the use of opioids with the effect on the use of OTC painkillers — which address pain but not mental health — allowing for the effects to depend on the injury rate of local industries. I find that a 1 percent increase in the employment-to-population ratio decreases the per-capita demand for opioids by 0.20 percent, while it increases the per-capita demand for OTC painkillers by 0.14 percent. To decompose the effect of employment on opioid use in the two channels, I calculate the substitution rate between these pain medications, exploring the introduction of a policy that increased requirements to prescribe opioids. My findings show that during local economic expansions, the decline in opioid abuse is 40 percent larger than the total effect on use while, at the same time, the demand for pain relief medication increases and is related to jobs in high injury industries.
Twenty-first birthday drinking: Extreme-drinking episodes and white matter microstructural changes in the fornix and corpus callosum
Cassandra Boness et al.
Experimental and Clinical Psychopharmacology, forthcoming
Abstract:
The 21st birthday celebration is characterized by extreme alcohol consumption. Accumulating evidence suggests that high-dose bingeing is related to structural brain changes and cognitive deficits. This is particularly problematic in the transition from adolescence to adulthood when the brain is still maturing, elevating the brain’s sensitivity to the acute effects of alcohol intoxication. Heavy drinking is associated with reduced structural integrity in the hippocampus and corpus callosum and is accompanied by cognitive deficits. However, there is little research examining changes in the human brain related to discrete heavy-drinking episodes. The present study investigated whether alcohol exposure during a 21st birthday celebration would result in changes to white matter microstructure by utilizing diffusion tensor imaging measures and a quasi-experimental design. By examining structural changes in the brain from pre- to postcelebration within subjects (N = 49) prospectively, we were able to more directly observe brain changes following an extreme-drinking episode. Region of interest analyses demonstrated increased fractional anisotropy in the posterior fornix (p < .0001) and in the body of the corpus callosum (p = .0029) from pre- to postbirthday celebration. These results suggest acute white matter damage to the fornix and corpus callosum following an extreme-drinking episode, which is especially problematic during continued neurodevelopment. Therefore, 21st birthday drinking may be considered an important target event for preventing acute brain injury in young adults.
Advertising and Demand for Addictive Goods: The Effects of E-Cigarette Advertising
Anna Tuchman
Marketing Science, November-December 2019, Pages 994–1022
Abstract:
Although TV advertising for traditional cigarettes has been banned since 1971, advertising for e-cigarettes remains unregulated. The effects of e-cigarette ads have been heavily debated, but empirical analysis of the market has been limited. Analyzing both individual and aggregate data, I present descriptive evidence showing that e-cigarette advertising reduces demand for traditional cigarettes and that individuals treat e-cigarettes and traditional cigarettes as substitutes. I then specify a structural model of demand for cigarettes that incorporates addiction and allows for heterogeneity across households. The model enables me to leverage the information content of both data sets to identify variation in tastes across markets and the state dependence induced on choice by addiction. Using the demand model estimates, I evaluate the impact of a proposed ban on e-cigarette television advertising. I find that in the absence of e-cigarette advertising, demand for traditional cigarettes would increase, suggesting that a ban on e-cigarette advertising may have unintended consequences.
Was Television Responsible for a New Generation of Smokers?
Michael Thomas
Journal of Consumer Research, December 2019, Pages 689–707
Abstract:
Consumers’ response to mass media can be difficult to assess because individuals choose for themselves the amount of media they consume, and that choice may be correlated with their other consumption decisions. To avoid this selection problem, this article examines the introduction of television to the US, during which some cities gained access to television years before others. This natural experiment makes it possible to estimate the causal impact of television on the decision to start smoking, a consumer behavior with important public health implications. Difference-in-differences analyses of television’s introduction indicate that (1) television did cause people to start smoking, (2) 16- to 21-year-olds were particularly affected by television, and (3) much of the response to television occurred within a couple of years of its introduction. Our preferred estimates suggest that television increased the share of smokers in the population by 5–15 percentage points, generating roughly 11 million additional smokers between 1946 and 1970. More broadly, these results offer causal evidence that (1) mass media can have a large influence on consumers, potentially affecting their health, (2) media exerts an especially strong influence on teens, and (3) mass media can influence consumers more than typical changes in prices.
The Opioid Hydra: Understanding Overdose Mortality Epidemics and Syndemics Across the Rural‐Urban Continuum
David Peters et al.
Rural Sociology, forthcoming
Abstract:
The rapid increase of fatal opioid overdoses over the past two decades is a major U.S. public health problem, especially in non‐metropolitan communities. The crisis has transitioned from pharmaceuticals to illicit synthetic opioids and street mixtures, especially in urban areas. Using latent profile analysis, we classify n = 3,079 counties into distinct classes using CDC fatal overdose rates for specific opioids in 2002–2004, 2008–2012, and 2014–2016. We identify three distinct epidemics (prescription opioids, heroin, and prescription‐synthetic opioid mixtures) and one syndemic involving all opioids. We find that prescription‐related epidemic counties, whether rural or urban, have been “left behind” the rest of the nation. These communities are less populated and more remote, older and mostly white, have a history of drug abuse, and are former farm and factory communities that have been in decline since the 1990s. Overdoses in these places exemplify the “deaths of despair” narrative. By contrast, heroin and opioid syndemic counties tend to be more urban, connected to interstates, ethnically diverse, and in general more economically secure. The urban opioid crisis follows the path of previous drug epidemics, affecting a disadvantaged subpopulation that has been left behind rather than the entire community. County data on opioid epidemic class membership are provided.
e-Cigarette Use Among Youth in the United States, 2019
Karen Cullen et al.
Journal of the American Medical Association, 3 December 2019, Pages 2095-2103
Design, Setting, and Participants: Cross-sectional analyses of a school-based nationally representative sample of 19 018 US students in grades 6 to 12 participating in the 2019 National Youth Tobacco Survey. The survey was conducted from February 15, 2019, to May 24, 2019.
Results: The survey included 10 097 high school students (mean [SD] age, 16.1 [3.0] years; 47.5% female) and 8837 middle school students (mean [SD] age, 12.7 [2.8] years; 48.7% female). The response rate was 66.3%. An estimated 27.5% (95% CI, 25.3%-29.7%) of high school students and 10.5% (95% CI, 9.4%-11.8%) of middle school students reported current e-cigarette use. Among current e-cigarette users, an estimated 34.2% (95% CI, 31.2%-37.3%) of high school students and 18.0% (95% CI, 15.2%-21.2%) of middle school students reported frequent use, and an estimated 63.6% (95% CI, 59.3%-67.8%) of high school students and 65.4% (95% CI, 60.6%-69.9%) of middle school students reported exclusive use of e-cigarettes. Among current e-cigarette users, an estimated 59.1% (95% CI, 54.8%-63.2%) of high school students and 54.1% (95% CI, 49.1%-59.0%) of middle school students reported JUUL as their usual e-cigarette brand in the past 30 days; among current e-cigarette users, 13.8% (95% CI, 12.0%-15.9%) of high school students and 16.8% (95% CI, 13.6%-20.7%) of middle school students reported not having a usual e-cigarette brand. Among current exclusive e-cigarette users, an estimated 72.2% (95% CI, 69.1%-75.1%) of high school students and 59.2% (95% CI, 54.8%-63.4%) of middle school students used flavored e-cigarettes, with fruit, menthol or mint, and candy, desserts, or other sweets being the most commonly reported flavors.
Trends in college students’ alcohol, nicotine, prescription opioid and other drug use after recreational marijuana legalization: 2008-2018
Zoe Alley, David Kerr & Harold Bae
Addictive Behaviors, forthcoming
Method: The cross-sectional National College Health Assessment-II survey was administered twice yearly from 2008-2018 at four-year colleges and universities. Participants were 18-26 year old undergraduates attending college in states that did (n=243,160) or did not (n=624,342) implement RML by 2018. Outcome variables were self-reported nicotine use, binge drinking, illicit drug use, and misuse of prescription stimulants, sedatives, and opioids. Other variables included individual and contextual covariates, and institution-reported institutional and community covariates. Publicly available information was used to code state RML status at each survey administration.
Results: Accounting for state differences and time trends, RML was associated with decreased binge drinking prevalence among college students age 21 and older [OR (95% CI) = .91 (.87 - .95), p < .0001] and increased sedative misuse among minors [OR (95% CI) = 1.20 (1.09 – 1.32), p = .0003]. RML did not disrupt secular trends in other substance use.
Individual Differences in Human Opioid Abuse Potential As Observed in a Human Laboratory Study
Kelly Dunn et al.
Drug and Alcohol Dependence, forthcoming
Methods: This within-subject (N = 16), double-blind, double-dummy, human laboratory study evaluated individual differences in response to dose (placebo, low, medium, high) following administration of heroin and hydromorphone through intravenous and subcutaneous routes, in opioid-experienced but non physically-dependent participants. Outcomes were self-reported visual analog scale (VAS) ratings (High, Liking, Drug Effect, Good Effect, Rush), pupil diameter change from baseline, and crossover point on the Drug vs. Money questionnaire. The degree to which results were consistent across measures within an individual was assessed using a mixed-effects model from which an intraclass correlation coefficient measure of between and within-subject variance was derived.
Results: The mixed effects model fit was significant (p < 0.0001) and revealed that 85.5% of the explainable variance was due to between-subject effects, suggesting the responses within an individual were highly consistent. Visual inspection reveals a myriad response pattern across participants, with some demonstrating classic dose-effect responses and others not differentiating any active doses from placebo.
Has the “M” word been framed? Marijuana, cannabis, and public opinion
Robert Mikos & Cindy Kam
PLoS ONE, October 2019
Abstract:
Over the past two decades, a growing cadre of US states has legalized the drug commonly known as “marijuana.” But even as more states legalize the drug, proponents of reform have begun to shun the term “marijuana” in favor of the term “cannabis.” Arguing that the “M” word has been tainted and may thus dampen public support for legalization, policy advocates have championed “cannabis” as an alternative and more neutral name for the drug. Importantly, however, no one has tested whether calling the drug “cannabis” as opposed to “marijuana” actually has any effect on public opinion. Using an original survey experiment, we examine whether framing the drug as “marijuana” as opposed to “cannabis” shapes public attitudes across a range of related topics: support for legalization of the drug, moral acceptance of its use, tolerance of activities involving the drug, perceptions of the drug’s harms, and stereotypes of its users. Throughout each of our tests, we find no evidence to suggest that the public distinguishes between the terms “marijuana” and “cannabis.” We conclude with implications of our findings for debates over marijuana/cannabis policy and for framing in policy discourse more generally.