Users
Smoking Response to Health and Medical Spending Changes and the Role of Insurance
Joachim Marti & Michael Richards
Health Economics, forthcoming
Abstract:
Severe health shocks provide new information about one's personal health and have been shown to influence smoking behaviors. In this paper, we suggest that they may also convey information about the hard to predict financial consequences of illnesses. Relevant financial risk information is idiosyncratic and unavailable to the consumer preceding illness, and the information search costs are high. However, new and salient information about the health as well as financial consequences of smoking after a health shock may impact smoking responses. Using variation in the timing of health shocks and two features of the US health care system (uninsured spells and aging into the Medicare program at 65), we test for heterogeneity in the post-shock smoking decision according to plausibly exogenous changes in financial risk exposure to medical spending. We also explore the relationship between smoking and the evolution of out-of-pocket costs. Individuals experiencing a cardiovascular health shock during an uninsured spell have more than twice the cessation effect of those receiving the illness while insured. For those uninsured prior to age 65 years, experiencing a cardiovascular shock post Medicare eligibility completely offsets the cessation effect. We also find that older adults' medical spending changes separate from health shocks influence their smoking behavior.
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Impact of adolescent marijuana use on intelligence: Results from two longitudinal twin studies
Nicholas Jackson et al.
Proceedings of the National Academy of Sciences, 2 February 2016, Pages E500–E508
Abstract:
Marijuana is one of the most commonly used drugs in the United States, and use during adolescence — when the brain is still developing — has been proposed as a cause of poorer neurocognitive outcome. Nonetheless, research on this topic is scarce and often shows conflicting results, with some studies showing detrimental effects of marijuana use on cognitive functioning and others showing no significant long-term effects. The purpose of the present study was to examine the associations of marijuana use with changes in intellectual performance in two longitudinal studies of adolescent twins (n = 789 and n = 2,277). We used a quasiexperimental approach to adjust for participants’ family background characteristics and genetic propensities, helping us to assess the causal nature of any potential associations. Standardized measures of intelligence were administered at ages 9–12 y, before marijuana involvement, and again at ages 17–20 y. Marijuana use was self-reported at the time of each cognitive assessment as well as during the intervening period. Marijuana users had lower test scores relative to nonusers and showed a significant decline in crystallized intelligence between preadolescence and late adolescence. However, there was no evidence of a dose–response relationship between frequency of use and intelligence quotient (IQ) change. Furthermore, marijuana-using twins failed to show significantly greater IQ decline relative to their abstinent siblings. Evidence from these two samples suggests that observed declines in measured IQ may not be a direct result of marijuana exposure but rather attributable to familial factors that underlie both marijuana initiation and low intellectual attainment.
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Combat Exposure, Cigarette Consumption, and Substance Use
Resul Cesur, Alexander Chesney & Joseph Sabia
Economic Inquiry, forthcoming
Abstract:
This study estimates the relationship between combat exposure and several risky health behaviors: cigarette consumption, binge drinking, and drug use. We find that the U.S. active duty military personnel deployed to combat zones with enemy firefight are more likely to subsequently smoke cigarettes, consume alcohol, and use illicit drugs than their counterparts deployed to noncombat operations. Our results suggest that the mental health effects of combat can explain up to two-thirds of the estimated association between combat exposure and risky health behaviors.
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Sarah Boyle et al.
Addictive Behaviors, June 2016, Pages 21–29
Abstract:
Despite speculation that peers' alcohol-related content on social media sites (SMS) may influence the alcohol use behaviors of SMS frequenting college students, this relationship has not been investigated longitudinally. The current prospective study assesses the relationship between exposure to peers' alcohol-related SMS content and later-drinking among first-year college students. Among 408 first-year students, total exposure to peers' alcohol-related content on Facebook, Instagram, and Snapchat during the initial 6 weeks of college predicted alcohol consumption 6 months later. The rather robust relationship persisted even after students' and close friends drinking were accounted for, indicating that alcohol references on SMS do not simply reflect alcohol use behaviors that would otherwise be observed in the absence of SMS and be predictive of later alcohol use. Findings also illuminate important gender differences in the degree to which peers' alcohol-related SMS content influenced later drinking behavior as well as psychological mediators of this relationship. Among females, enhancement drinking motives and beliefs about the role of alcohol in the college experience fully mediated the relationship between SMS alcohol exposure and later drinking. Males, however, evidenced a much stronger predictive relationship between SMS alcohol exposure and second semester drinking, with this relationship only partially explained by perceptions of drinking norms, enhancement drinking motives, and beliefs about the role of alcohol in the college experience. Implications of these findings for college drinking prevention efforts and directions for future research are discussed.
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Susan Averett & Yang Wang
Southern Economic Journal, January 2016, Pages 697–724
Abstract:
Intimate partner violence (IPV) is widespread and has substantial negative consequences. Researchers have documented a strong positive correlation between alcohol abuse and IPV. However, alcohol abuse is potentially endogenous to IPV. We deal with this problem by exploring a unique instrumental variable — the September 11 terrorist attack — in Wave III of the National Longitudinal Study of Adolescent Health. Ordinary least squares results confirm a strong positive correlation between alcohol abuse and IPV. However, our two-stage least squares results are statistically insignificant. These results indicate that alcohol abuse might not have a causal effect on IPV and, therefore, have important policy implications.
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James Cunningham, Teshia Solomon & Myra Muramoto
Drug and Alcohol Dependence, forthcoming
Background: This study uses national survey data to examine the veracity of the longstanding belief that, compared to whites, Native Americans (NA) have elevated alcohol consumption.
Methods: The primary data source was the National Survey on Drug Use and Health (NSDUH) from 2009-2013: whites (n = 171,858) and NA (n = 4,201). Analyses using logistic regression with demographic covariate adjustment were conducted to assess differences in the odds of NA and whites being alcohol abstinent, light/moderate drinkers (no binge/heavy consumption), binge drinkers (5+ drinks on an occasion 1–4 days), or heavy drinkers (5+ drinks on an occasion 5+ days) in the past month. Complementary alcohol abstinence, light/moderate drinking and excessive drinking analyses were conducted using Behavioral Risk Factor Surveillance System (BRFSS) data from 2011-2013: whites (n = 1,130,658) and NA (n = 21,589).
Results: In the NSDUH analyses, the majority of NA, 59.9% (95% CI: 56.7–63.1), abstained, whereas a minority of whites, 43.1% (CI: 42.6–43.6), abstained—adjusted odds ratio (AOR): 0.64 (CI: 0.56–0.73). Approximately 14.5% (CI: 12.0-17.4) of NA were light/moderate-only drinkers, versus 32.7% (CI: 32.2–33.2) of whites (AOR: 1.90; CI: 1.51–2.39). NA and white binge drinking estimates were similar—17.3% (CI: 15.0-19.8) and 16.7% (CI: 16.4–17.0), respectively (AOR: 1.00; CI: 0.83–1.20). The two populations' heavy drinking estimates were also similar—8.3% (CI: 6.7–10.2) and 7.5% (CI: 7.3–7.7), respectively (AOR: 1.06; CI: 0.85–1.32). Results from the BRFSS analyses generally corroborated those from NSDUH.
Conclusions: In contrast to the ‘Native American elevated alcohol consumption’ belief, Native Americans compared to whites had lower or comparable rates across the range of alcohol measures examined.
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Alcohol and tobacco consumption alter hypothalamic pituitary adrenal axis DNA methylation
Meeshanthini Dogan et al.
Psychoneuroendocrinology, April 2016, Pages 176–184
Abstract:
Alcohol and cigarette consumption have profound effects on genome wide DNA methylation and are common, often cryptic, comorbid features of many psychiatric disorders. This cryptic consumption is a possible impediment to understanding the biology of certain psychiatric disorders because if the effects of substance use are not taken into account, their presence may confound efforts to identify effects of other behavioral disorders. Since the hypothalamic pituitary adrenal (HPA) axis is known to be dysregulated in these disorders, we examined the potential for confounding effects of alcohol and cigarette consumption by examining their effects on peripheral DNA methylation at two key HPA axis genes, NR3C1 and FKBP5. We found that the influence of alcohol and smoke exposure is more prominent at the FKBP5 gene than the NR3C1 gene. Furthermore, in both genes, loci that were consistently significantly associated with smoking and alcohol consumption demethylated with increasing exposure. We conclude that epigenetic studies of complex disorders involving the HPA axis need to carefully control for the effects of substance use in order to minimize the possibility of type I and type II errors.
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Neal Goldstein et al.
International Journal of Drug Policy, forthcoming
Background: Men who have sex with men (MSM) report drug use more frequently than non-MSM, however data are lacking that examine the disparity within racial and ethnic groups.
Methods: Using a nationally representative sample of men in the US stratified by race and ethnicity, we present prevalence estimates of self-reported drug use comparing MSM to non-MSM.
Results: Prevalence of self-reported drug use was greater among MSM compared to non-MSM, with the exception of heroin. White MSM reported greatest drug use overall, with amphetamine use representing the greatest disparity compared to black or Hispanic MSM. Hispanic MSM reported the greatest crack/cocaine and heroin use. Men who reported using drugs were younger then men who did not report using drugs; there were no age patterns of reported drug use among MSM.
Conclusions: Drug use is a public health concern among MSM, compounding a racial and ethnic disparity. Intersectionality is a useful framework for identifying subgroups with highest reported rates of drug use.
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Casey Roulette et al.
American Journal of Human Biology, January/February 2016, Pages 5–15
Objectives: Little is known about cannabis use in hunter-gatherers. Therefore, we investigated cannabis use in the Aka, a population of foragers of the Congo Basin. Because cannabis contains anthelminthic compounds, and the Aka have a high prevalence of helminthiasis, we also tested the hypothesis that cannabis use might be an unconscious form of self-medication against helminths.
Methods: We collected self- and peer-reports of cannabis use from all adult Aka in the Lobaye district of the Central African Republic (n = 379). Because female cannabis use was low, we restricted sample collection to men. Using an immunoassay for Δ9-tetrahydrocannabinol-11-oic acid (THCA), a urinary biomarker of recent cannabis consumption, we validated cannabis use in men currently residing in camps near a logging road (n = 62). We also collected stool samples to assay worm burden. A longitudinal reinfection study was conducted among a subsample of the male participants (n = 23) who had been treated with a commercial anthelmintic 1 year ago.
Results: The prevalence of self- and peer-reported cannabis use was 70.9% among men and 6.1% among women, for a total prevalence of 38.6%. Using a 50 ng/ml threshold for THCA, 67.7% of men used cannabis. Cannabis users were significantly younger and had less material wealth than the non-cannabis users. There were significant negative associations between THCA levels and worm burden, and reinfection with helminths 1 year after treatment with a commercial anthelmintic.
Conclusions: The prevalence of cannabis use among adult Aka men was high when compared to most global populations. THCA levels were negatively correlated with parasite infection and reinfection, supporting the self-medication hypothesis.
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Understanding Patterns Of High-Cost Health Care Use Across Different Substance User Groups
Jan Gryczynski et al.
Health Affairs, January 2016, Pages 12-19
Abstract:
Substance use contributes to significant societal burdens, including high-cost health care use. However, these burdens may vary by type of substance and level of involvement. Using the 2009–13 National Surveys on Drug Use and Health, we examined all-cause hospitalizations and estimated costs across substance use profiles for alcohol, marijuana, and other illicit drugs. For each substance, we characterized differences between abstainers, nondiagnostic users (people who used the substance but did not meet diagnostic criteria for substance use disorder), and people with substance use disorders. In a multivariate analysis, we found that the odds of hospitalization were 16 percent lower for nondiagnostic marijuana users and 11 percent lower for nondiagnostic alcohol users, compared to abstainers. Neither alcohol- nor marijuana-specific substance use disorders were associated with hospitalization. In contrast, substance use disorders for other illicit drugs were strongly associated with hospitalization: People with those disorders had 2.2 times higher odds of hospitalization relative to abstainers. A more detailed understanding of health care use in different substance user groups could inform the ongoing expansion of substance use services in the United States.
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Splendide Mendax: False Label Claims About High and Rising Alcohol Content of Wine
Julian Alston et al.
Journal of Wine Economics, December 2015, Pages 275-313
Abstract:
Are wine alcohol labels accurate? If not, why? We explore the high and rising alcohol content of wine and examine incentives for false labeling, including the roles of climate, evolving consumer preferences, and expert ratings. We draw on international time-series data from a large number of countries that experienced different patterns of climate change and influences of policy and demand shifts. We find systematic patterns that suggest that rising wine alcohol content may be a nuisance by-product of producer responses to perceived market preferences for wines having more-intense flavours, possibly in conjunction with evolving climate.
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Clayton Velicer & Stanton Glantz
PLoS ONE, December 2015
Background: In 1996 Massachusetts proposed regulations that would require tobacco companies to disclose information about the ingredients in their products on a by-brand basis. This paper examines the strategies employed by Philip Morris to stop these regulations from being implemented.
Methods and Finding: We used previously secret tobacco industry documents and published literature to examine the activities of the tobacco companies after the regulations were proposed. Philip Morris hired a public relations firm to establish a coalition that was instructed to oppose the regulations by linking them to other industrial sectors (the slippery slope) and stating they would damage the state's economy. Philip Morris also retained a polling firm to test the popularity of specific arguments against ingredient disclosure and developed a strategic plan for opposing similar regulations in Vermont.
Conclusion: Tobacco companies have historically used third parties to form coalitions to oppose ingredient disclosure regulations. These coalitions have had success preventing regulations from being implemented after they are initially proposed by creating the appearance of local opposition. With countries around the world currently implementing ingredient disclosure regulations in the WHO Framework Convention on Tobacco, governments and regulatory agencies should be aware of the political strategies that the tobacco companies have used to create the impression of popular opposition to these measures.
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Race, Ethnicity, and Exposure to Alcohol Outlets
Christopher Morrison, Paul Gruenewald & William Ponicki
Journal of Studies on Alcohol and Drugs, January 2016, Pages 68–76
Objective: Prior studies suggest that Black and Hispanic minority populations are exposed to greater concentrations of alcohol outlets, potentially contributing to health disparities between these populations and the White majority. We tested the alternative hypothesis that urban economic systems cause outlets to concentrate in low-income areas and, controlling for these effects, lower demand among minority populations leads to fewer outlets.
Method: Market potential for alcohol sales, a surrogate for demand, was estimated from survey and census data across census block groups for 50 California cities. Hierarchical Bayesian conditional autoregressive Poisson models then estimated relationships between observed geographic distributions of outlets and the market potential for alcohol, income, population size, and racial and ethnic composition.
Results: Market potentials were significantly smaller among lower income Black, Hispanic, and Asian populations. Block groups with greater market potential and lower income had greater concentrations of outlets. When we controlled for these effects, the racial and ethnic group composition of block groups was mostly unrelated to outlet concentrations.
Conclusions: Health disparities related to exposure to alcohol outlets are primarily driven by distributions of income and population density across neighborhoods.
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Effect of a “pill mill” law on opioid prescribing and utilization: The case of Texas
Tatyana Lyapustina et al.
Drug and Alcohol Dependence, February 2016, Pages 190–197
Background: States have attempted to reduce prescription opioid abuse through strengthening the regulation of pain management clinics; however, the effect of such measures remains unclear. We quantified the impact of Texas’s September 2010 “pill mill” law on opioid prescribing and utilization.
Methods: We used the IMS Health LRx LifeLink database to examine anonymized, patient-level pharmacy claims for a closed cohort of individuals filling prescription opioids in Texas between September 2009 and August 2011. Our primary outcomes were derived at a monthly level and included: (1) average morphine equivalent dose (MED) per transaction; (2) aggregate opioid volume; (3) number of opioid prescriptions; and (4) quantity of opioid pills dispensed. We compared observed values with the counterfactual, which we estimated from pre-intervention levels and trends.
Results: Texas’s pill mill law was associated with declines in average MED per transaction (−0.57 mg/month, 95% confidence interval [CI] −1.09, −0.057), monthly opioid volume (−9.99 kg/month, CI −12.86, −7.11), monthly number of opioid prescriptions (−12,200 prescriptions/month, CI −15,300, −9,150) and monthly quantity of opioid pills dispensed (−714,000 pills/month, CI −877,000, −550,000). These reductions reflected decreases of 8.1–24.3% across the outcomes at one year compared with the counterfactual, and they were concentrated among prescribers and patients with the highest opioid prescribing and utilization at baseline.
Conclusions: Following the implementation of Texas’s 2010 pill mill law, there were clinically significant reductions in opioid dose, volume, prescriptions and pills dispensed within the state, which were limited to individuals with higher levels of baseline opioid prescribing and utilization.
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Opioid Overdose Deaths and Florida’s Crackdown on Pill Mills
Alene Kennedy-Hendricks et al.
American Journal of Public Health, February 2016, Pages 291-297
Objectives: We examined the effect on opioid overdose mortality of Florida state laws and law enforcement operations targeting “pill mills.”
Methods: We collected 2003 to 2012 mortality data from the Florida Department of Health and the North Carolina State Center for Health Statistics (the comparison state) to estimate changes in the rates of death from prescription opioid, heroin, or any opioid overdose.
Results: Florida’s actions were associated with an estimated 1029 lives saved from prescription opioid overdose over a 34-month period. Estimated reductions in deaths grew over the intervention period, with rates per 100 000 population that were 0.6 lower in 2010, 1.8 lower in 2011, and 3.0 lower in 2012 than what would have been expected had the changes in mortality rate trends in Florida been the same as changes in trends in North Carolina. Florida’s mortality rates from heroin and total opioid overdose were also lower than anticipated relative to changes in trends in North Carolina.
Conclusions: Findings from this study indicate that laws regulating pain clinics and enforcement of these laws may, in combination, reduce opioid overdose deaths.