It pains me
Social Capital, Ideology, and Health in the United States
Mitchel Herian et al.
Social Science & Medicine, March 2014, Pages 30–37
Abstract:
Research from across disciplines has demonstrated that social and political contextual factors at the national and subnational levels can impact the health and health behavior risks of individuals. This paper examines the impact of state-level social capital and ideology on individual-level health outcomes in the U.S. Leveraging the variation that exists across states in the U.S., the results reveal that individuals report better health in states with higher levels of governmental liberalism and in states with higher levels of social capital. Critically, however, the effect of social capital was moderated by liberalism such that social capital was a stronger predictor of health in states with low levels of liberalism. We interpret this finding to mean that social capital within a political unit — as indicated by measures of interpersonal trust — can serve as a substitute for the beneficial impacts that might result from an active governmental structure.
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Anatomy of a Municipal Triumph: New York City's Upsurge in Life Expectancy
Samuel Preston & Irma Elo
Population and Development Review, forthcoming
Abstract:
Over the period 1990–2010, the increase in life expectancy for males in New York City was 6.0 years greater than for males in the United States. The female relative gain was 3.9 years. Male relative gains were larger because of extremely rapid reductions in mortality from HIV/AIDS and homicide, declines that reflect effective municipal policies and programs. Declines in drug- and alcohol-related deaths also played a significant role in New York City's advance, but every major cause of death contributed to its relative improvement. By 2010, New York City had a life expectancy that was 1.9 years greater than that of the US. This difference is attributable to the high representation of immigrants in New York's population. Immigrants to New York City, and to the United States, have life expectancies that are among the highest in the world. The fact that 38 percent of New York's population consists of immigrants, compared to only 14 percent in the United States, accounts for New York's exceptional standing in life expectancy in 2010. In fact, US-born New Yorkers have a life expectancy below that of the United States itself.
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The Health Consequences of Retirement
Michael Insler
Journal of Human Resources, Winter 2014, Pages 195-233
Abstract:
This paper examines the impact of retirement on individuals’ health. Declines in health commonly compel workers to retire, so the challenge is to disentangle the simultaneous causal effects. The estimation strategy employs an instrumental variables specification. The instrument is based on workers’ self-reported probabilities of working past ages 62 and 65, taken from the first period in which they are observed. Results indicate that the retirement effect on health is beneficial and significant. Investigation into behavioral data, such as smoking and exercise, suggests that retirement may affect health through such channels. With additional leisure time, many retirees practice healthier habits.
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Declines in Elevated Blood Lead Levels Among Children, 1997−2011
Byron Kennedy et al.
American Journal of Preventive Medicine, March 2014, Pages 259–264
Objective: To assess temporal trends in childhood elevated blood lead level (EBLL) rates.
Methods: Laboratory surveillance data were collected from 1997 to 2011 and analyzed in 2013 using linear regression to assess trends in confirmed EBLL rates among children aged <6 years in the U.S., New York State ([NYS], excluding New York City), and Monroe County NY. Monroe County was also examined as a case study of local public health efforts to reduce childhood lead exposures. Blood lead screening and home lead hazard inspection data were collected from 1990 to 2012 and analyzed in 2013.
Results: The prevalence of EBLL≥10 μg/dL per 100 tested children decreased from 13.4 to 1.1 in Monroe County, 6.3 to 1.0 in NYS, and 7.6 to 0.6 in the U.S. between 1997 and 2011. The absolute yearly rate of decline in Monroe County (slope=−0.0083, p<0.001) occurred 2.4-fold faster than that in NYS (slope=−0.0034, p<0.001) and 1.8-fold faster than that in the U.S. (slope=−0.0046, p<0.001). The childhood blood lead testing rate was consistently higher in Monroe County than in NYS and the U.S.; however, testing increased for all three areas (all slopes>0, p<0.05), with greater improvements observed for U.S. children overall (slope=0.0075, p<0.001).
Conclusions: In addition to national and statewide policies, local efforts may be important drivers of population-based declines in childhood EBLL rates.
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Jodi Ford & Christopher Browning
Journal of Urban Health, February 2014, Pages 136-150
Abstract:
Adolescents and young adults have the highest rates of sexually transmitted infections (STIs) in the USA despite national priority goals targeting their reduction. Research on the role of neighborhoods in shaping STI risk among youth has increased in recent years, but few studies have explored the longitudinal effects of neighborhoods on STI acquisition during the adolescent to young adult transition. The aims of this study were to examine: (1) the longitudinal relationships between the neighborhood context (poverty, residential instability, and racial/ethnic concentration) of exposure during adolescence and young adults’ acquisition of chlamydia, and (2) the extent to which sexual risk behaviors and depression over the transition from adolescence to young adulthood mediate the relationship between the neighborhood context of exposure during adolescence and young adults’ acquisition of chlamydia. A longitudinal observational design was employed using data from the National Longitudinal Study of Adolescent Health (Add Health), waves 1–3 (1994–2002). The sample was composed of 11,460 young adults aged 18 to 27 years. Neighborhood measures during adolescence were derived from the 1990 US Census appended to adolescents’ interview data. Chlamydia infection was measured via urine assay at wave 3 and 4.6 % of the young adults in the sample tested positive for chlamydia. Multilevel logistic regression analyses were conducted adjusting for numerous neighborhood and individual risk factors. Multivariate findings indicated exposure to neighborhood poverty during adolescence increased the likelihood of a positive urine test for chlamydia during young adulthood (AOR = 1.23, 95 % CI = 1.06, 1.42), and the association was not mediated by sexual risk behaviors or depression. Further research is needed to better understand the pathways through which exposure to neighborhood poverty contributes to chlamydia over the life course as are comprehensive STI prevention strategies addressing neighborhood poverty.
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Michael Berlemann & Andreas Matthes
Journal of Policy Modeling, forthcoming
Abstract:
Policymakers around the globe have opted for high levels of regulation of the market for vehicle safety and declared many vehicle safety systems as mandatory for new cars. In this paper we argue that the delivered justifications for these policies are at least questionable. We add a completely new argument to the discussion and show in a simple theoretical model that vehicle safety systems might cause positive externalities. Based on a large dataset of traffic accidents in Germany we show that the these externalities in fact occur. Based on our estimation results we show that for anti-lock-brakes (ABS) and electronic stability programmes (ESP) the average expected externality exceeds the price of these systems. Thus, the obligation to equip any new car with both ABS and ESP is adequate from an allocative point of view although the official justification for the introduction of these regulations are flawed.
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Intake of Long-Chain ω-3 Fatty Acids From Diet and Supplements in Relation to Mortality
Griffith Bell et al.
American Journal of Epidemiology, forthcoming
Abstract:
Evidence from experimental studies suggests that the long-chain ω-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid have beneficial effects that may lead to reduced mortality from chronic diseases, but epidemiologic evidence is mixed. Our objective was to evaluate whether intake of long-chain ω-3 fatty acids from diet and supplements is associated with cause-specific and total mortality. Study participants (n = 70,495) were members of a cohort study (the Vitamins and Lifestyle Study) who were residents of Washington State aged 50–76 years at the start of the study (2000–2002). Participants were followed for mortality through 2006 (n = 3,051 deaths). Higher combined intake of eicosapentaenoic acid and docosahexaenoic acid from diet and supplements was associated with a decreased risk of total mortality (hazard ratio (HR) = 0.82, 95% confidence interval (CI): 0.73, 0.93) and mortality from cancer (HR = 0.77, 95% CI: 0.64, 0.92) but only a small reduction in risk of death from cardiovascular disease (HR = 0.87, 95% CI: 0.68, 1.10). These results suggest that intake of long-chain ω-3 fatty acids may reduce risk of total and cancer-specific mortality.
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Macroeconomic fluctuations and motorcycle fatalities in the U.S.
Michael French & Gulcin Gumus
Social Science & Medicine, March 2014, Pages 187–193
Abstract:
The effects of business cycles on health outcomes in general, and on traffic fatalities in particular, have received much attention recently. In this paper, we focus on motorcycle safety and examine the impact of changing levels of economic activity on fatal crashes by motorcyclists in the United States. We analyze state-level longitudinal data with 1,104 state/year observations from the 1988-2010 Fatality Analysis Reporting System (FARS). Using the extensive motorcycle crash characteristics available in FARS, we examine not only total fatality rates but also rates decomposed by crash type, day, time, and the level of the motorcycle operator’s blood alcohol content. Our results are consistent with much of the existing literature showing that traffic fatality rates are pro-cyclical. The estimates suggest that a 10% increase in real income per capita is associated with a 10.4% rise in the total motorcycle fatality rate. Along with potential mechanisms, policymakers and public health officials should consider the effects of business cycles on motorcycle safety.
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Population Health Concerns During the United States’ Great Recession
Benjamin Althouse et al.
American Journal of Preventive Medicine, February 2014, Pages 166–170
Background: Associations between economic conditions and health are usually derived from cost-intensive surveys that are intermittently collected with nonspecific measures (i.e., self-rated health).
Purpose: This study identified how precise health concerns changed during the U.S. Great Recession analyzing Google search queries to identify the concern by the query content and their prevalence by the query volume.
Methods: Excess health concerns were estimated during the Great Recession (December 2008 through 2011) by comparing the cumulative difference between observed and expected (based on linear projections from pre-existing trends) query volume for hundreds of individual terms. As performed in 2013, the 100 queries with the greatest excess were ranked and then clustered into themes based on query content.
Results: The specific queries with the greatest relative excess were stomach ulcer symptoms and headache symptoms, respectively, 228% (95% CI¼35, 363) and 193% (95% CI¼60, 275) greater than expected. Queries typically involved symptomology (i.e., gas symptoms) and diagnostics (i.e., heart monitor) naturally coalescing into themes. Among top themes, headache queries were 41% (95% CI¼3, 148); hernia 37% (95% CI¼16, 142); chest pain 35% (95% CI¼6, 313); and arrhythmia 32% (95% CI¼3, 149) greater than expected. Pain was common with back, gastric, joint, and tooth foci, with the latter 19% (95% CI¼4, 46) higher. Among just the top 100, there were roughly 205 million excess health concern queries during the Great Recession.
Conclusions: Google queries indicate that the Great Recession coincided with substantial increases in health concerns, hinting at how population health specifically changed during that time.
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Association Between Birthplace and Current Asthma: The Role of Environment and Acculturation
Shahed Iqbal et al.
American Journal of Public Health, February 2014, Pages S175-S182
Objectives: We evaluated associations between current asthma and birthplace among major racial/ethnic groups in the United States.
Methods: We used multivariate logistic regression methods to analyze data on 102 524 children and adolescents and 255 156 adults in the National Health Interview Survey (2001–2009).
Results: We found significantly higher prevalence (P < .05) of current asthma among children and adolescents (9.3% vs 5.1%) and adults (7.6% vs 4.7%) born in the 50 states and Washington, DC (US-born), than among those born elsewhere. These differences were among all age groups of non-Hispanic Whites, non-Hispanic Blacks, and Hispanics (excluding Puerto Ricans) and among Chinese adults. Non–US-born adults with 10 or more years of residency in the United States had higher odds of current asthma (odds ratio = 1.55; 95% confidence interval = 1.25, 1.93) than did those who arrived more recently. Findings suggested a similar trend among non–US-born children.
Conclusions: Current asthma status was positively associated with being born in the United States and with duration of residency in the United States. Among other contributing factors, changes in environment and acculturation may explain some of the differences in asthma prevalence.
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Disparities in Age-Appropriate Child Passenger Restraint Use Among Children Aged 1 to 12 Years
Michelle Macy et al.
Pediatrics, February 2014, Pages 262 -271
Objective: Observed racial disparities in child safety seat use have not accounted for socioeconomic factors. We hypothesized that racial differences in age-appropriate restraint use would be modified by socioeconomic status and child passenger safety information sources.
Methods: A 2-site, cross-sectional tablet-based survey of parents seeking emergency care for their 1- to 12-year-old child was conducted between October 2011 and May 2012. Parents provided self-report of child passenger safety practices, demographic characteristics, and information sources. Direct observation of restraint use was conducted in a subset of children at emergency department discharge. Age-appropriate restraint use was defined by Michigan law.
Results: Of the 744 eligible parents, 669 agreed to participate and 601 provided complete responses to key variables. White parents reported higher use of car seats for 1- to 3-year-olds and booster seats for 4- to 7-year-olds compared with nonwhite parents. Regardless of race, <30% of 8- to 12-year-old children who were ≤4 feet, 9 inches tall used a booster seat. White parents had higher adjusted odds (3.86, 95% confidence interval 2.27–6.57) of reporting age-appropriate restraint use compared with nonwhite parents, controlling for education, income, information sources, and site. There was substantial agreement (82.6%, κ = 0.74) between parent report of their child’s usual restraint and the observed restraint at emergency department discharge.
Conclusions: Efforts should be directed at eliminating racial disparities in age-appropriate child passenger restraint use for children <8 years. Booster seat use, seat belt use, and rear seating represent opportunities to improve child passenger safety practices among older children.
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David Schwebel et al.
Health Education & Behavior, forthcoming
Abstract:
Firearms in the home are associated with increased injury risk, especially when loaded and unlocked. In this study, 5,010 fifth-graders and their caregivers in three U.S. metropolitan areas participated in the 2004-2006 Healthy Passages study on adolescent health. Firearm ownership and storage patterns were examined by four self-reported sociodemographic characteristics (child’s race/ethnicity, child’s gender, family socioeconomic status, and study site) and reasons for ownership. Eighteen percent (n = 880) of the families reported firearms in the home. Families with African American and Hispanic children had lower odds of owning firearms than families with non-Hispanic White children. The most common reasons for ownership were protection from crime and hunting. Six percent (n = 56) of the families with firearms stored at least one firearm unlocked, assembled, without a trigger lock, and with unlocked ammunition. Compared with families with non-Hispanic White children, families with African American children engaged in safer storage practices. Results can inform childhood firearm injury prevention activities.
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Lauren Renée Moore
Social Science & Medicine, March 2014, Pages 76–83
Abstract:
“Gluten free” exploded onto the American foodscape in recent years: as of January 2013, 30 percent of U.S. adults reported reducing or eliminating gluten in their diets. How do individuals participate in the expansion of gluten-free dieting, and what are the implications of that expansion? This article is based on 31 in-depth, semi-structured interviews conducted between May and October 2012 with gluten-free and -restricted persons. I identify three interrelated factors contributing to the expansion of gluten-free dieting among non-celiacs. Participants broaden the lay understanding of gluten-related disorders, undermine biomedical authority, and diagnose others. Such participant-driven change, termed self-ascriptive looping, is one factor in the diet’s rapid popularization. I show how participants question the doctor-patient relationship and increase social contestability for other dieters. My findings challenge previous work on contested illness and suggest food intolerances may require a reconceptualization of contested illness experience.
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Life expectancy and economic growth
Lars Kunze
Journal of Macroeconomics, forthcoming
Abstract:
This paper investigates the relationship between life expectancy and economic growth in an overlapping generations model with family altruism where private and public investments in human capital of children are the engine of endogenous growth. Consistent with recent empirical evidence, our model provides a theoretical case of a non-linear pattern between life expectancy and economic growth. However, it is also shown that the emergence of such a pattern critically depends on the existence of intergenerational transfers in form of bequests. Specifically, we find that rising life expectancy unambiguously decreases growth if bequests are operative, whereas there exists an inverted-U shape relationship in economies where bequests are inoperative.
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Healthcare Worker Contact Networks and the Prevention of Hospital-Acquired Infections
Donald Curtis et al.
PLoS ONE, December 2013
Abstract:
We present a comprehensive approach to using electronic medical records (EMR) for constructing contact networks of healthcare workers in a hospital. This approach is applied at the University of Iowa Hospitals and Clinics (UIHC) – a 3.2 million square foot facility with 700 beds and about 8,000 healthcare workers – by obtaining 19.8 million EMR data points, spread over more than 21 months. We use these data to construct 9,000 different healthcare worker contact networks, which serve as proxies for patterns of actual healthcare worker contacts. Unlike earlier approaches, our methods are based on large-scale data and do not make any a priori assumptions about edges (contacts) between healthcare workers, degree distributions of healthcare workers, their assignment to wards, etc. Preliminary validation using data gathered from a 10-day long deployment of a wireless sensor network in the Medical Intensive Care Unit suggests that EMR logins can serve as realistic proxies for hospital-wide healthcare worker movement and contact patterns. Despite spatial and job-related constraints on healthcare worker movement and interactions, analysis reveals a strong structural similarity between the healthcare worker contact networks we generate and social networks that arise in other (e.g., online) settings. Furthermore, our analysis shows that disease can spread much more rapidly within the constructed contact networks as compared to random networks of similar size and density. Using the generated contact networks, we evaluate several alternate vaccination policies and conclude that a simple policy that vaccinates the most mobile healthcare workers first, is robust and quite effective relative to a random vaccination policy.
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Compulsory Schooling Reforms, Education and Mortality in Twentieth Century Europe
Christina Gathmann, Hendrik Jürges & Steffen Reinhold
Social Science & Medicine, forthcoming
Abstract:
Education yields substantial non-monetary benefits, but the size of these gains is still debated. Previous studies report causal effects of education and compulsory schooling on mortality ranging anywhere from zero to large and negative. Using data from 18 compulsory schooling reforms implemented in Europe during the twentieth century, we quantify the average mortality gain and explore its dispersion across gender, time and countries. We find that more education yields small mortality reductions in the short- and long-run for men. In contrast, women seem to experience no mortality reductions from compulsory schooling reforms.
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Combat Exposure and Migraine Headache: Evidence from Exogenous Deployment Assignment
Resul Cesur, Joseph Sabia & Erdal Tekin
Economics & Human Biology, forthcoming
Abstract:
Migraine headache is a growing problem for U.S. servicemembers deployed to Iraq and Afghanistan and has been linked to substantial negative socioeconomic consequences. However, there has been no comprehensive examination of the relationship between combat exposure and migraine headache or its stress-related triggers. Analyzing data drawn from the National Longitudinal Study of Adolescent Health, we use exogenous variation in deployment assignment to estimate the effect of combat exposure on migraine headache. We find that those deployed to a combat zone with enemy firefight are at substantially increased risk for migraine headache relative to those deployed to non-combat zones outside the United States or to combat zones without enemy firefight. We find that combat-induced sleep disorders, stress-related psychological problems, and physical injuries in combat explain approximately 40 to 45 percent of the relationship between combat exposure and migraine headache.
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Frank Lichtenberg & Gisela Hostenkamp
Columbia University Working Paper, December 2013
Abstract:
There were no innovations in chemotherapy for myeloma patients during the period 1977-1997, but there have been several important innovations since 1997. We investigate the impact of recent chemotherapy innovation on the longevity of myeloma patients using both time-series U.S. data and longitudinal data on 26 countries. In the US, the average annual rate of increase of life expectancy of myeloma patients at time of diagnosis was over five times as large during 1997-2005 as it had been during 1975-1997. We estimate that almost two-thirds (0.99 years) of the 1997-2005 increase in life expectancy was due to the increase in the number of chemotherapy regimens now preferred by specialists, and that the cost per U.S. life-year gained from post-1997 chemotherapy innovation did not exceed $45,551. We also investigate the impact of chemotherapy innovation on the myeloma mortality rate using longitudinal country-level data on 26 countries during the period 2005-2009. Countries that had larger increases in the number of chemotherapy regimens had larger subsequent declines in myeloma mortality rates, controlling for other factors. The estimates imply that chemotherapy innovation reduced the age-adjusted myeloma cancer mortality rate by about 3.1% during the period 2005-2009.