Body Problems

Kevin Lewis

April 17, 2024

Promoting Public Health with Blunt Instruments: Evidence from Vaccine Mandates
Rahi Abouk et al.
NBER Working Paper, March 2024

We study the effect of mandates requiring COVID-19 vaccination among healthcare industry workers adopted in 2021 in the United States. There are long-standing worker shortages in the U.S. healthcare industry, pre-dating the COVID-19 pandemic. The impact of COVID-19 vaccine mandates on shortages is ex ante ambiguous. If mandates increase perceived safety of the healthcare industry, marginal workers may be drawn to healthcare, relaxing shortages. On the other hand, if marginal workers are vaccine hesitant or averse, then mandates may push workers away from the industry and exacerbate shortages. We combine monthly data from the Current Population Survey 2021 to 2022 with difference-in-differences methods to study the effects of state vaccine mandates on the probability of working in healthcare, and of employment transitions into and out of the industry. Our findings suggest that vaccine mandates may have worsened healthcare workforce shortages: following adoption of a state-level mandate, the probability of working in the healthcare industry declines by 6%. Effects are larger among workers in healthcare-specific occupations, who leave the industry at higher rates in response to mandates and are slower to be replaced than workers in non-healthcare occupations. Findings suggest trade-offs faced by health policymakers seeking to achieve multiple health objectives.

Reevaluating the “deaths of despair” narrative: Racial/ethnic heterogeneity in the trend of psychological distress-related death
Hui Zheng & Yoonyoung Choi
Proceedings of the National Academy of Sciences, 20 February 2024

Despite the significant scientific advancement in deciphering the “deaths of despair” narrative, most relevant studies have focused on drug-, alcohol-, and suicide-related (DAS) deaths. This study directly investigated despair as a determinant of death and the temporal variation and racial heterogeneity among individuals. We used psychological distress (PD) as a proxy for despair and drew data from the US National Health Interview Survey-Linked Mortality Files 1997 to 2014, CDC (Centers for Disease Control and Prevention) Multiple Cause of Death database 1997 to 2014, CDC bridged-race population files 1997 to 2014, Current Population Survey 1997 to 1999, and the American Community Survey 2000 to 2014. We used Cox proportional hazards models to estimate mortality hazard ratios of PD and compared age-standardized PD- and DAS-related mortality rates by race/ethnicity and over time. We found that while Whites had a lower prevalence of PD than Blacks and Hispanics throughout the whole period, they underwent distinctive increases in PD-related death and have had a higher PD-related mortality rate than Blacks and Hispanics since the early 2000s. This was predominantly due to Whites’ relatively high and increasing vulnerability to PD less the prevalence of PD. Furthermore, PD induced a more pervasive mortality consequence than DAS combined for Whites and Blacks. In addition, PD- and DAS-related deaths displayed a concordant trend among Whites but divergent patterns for Blacks and Hispanics. These findings suggest that 1) DAS-related deaths underestimated the mortality consequence of despair for Whites and Blacks but overestimated it for Hispanics; and 2) despair partially contributed to the DAS trend among Whites but probably not for Blacks and Hispanics.

Perinatal Mood And Anxiety Disorders Rose Among Privately Insured People, 2008–20
Kara Zivin et al.
Health Affairs, April 2024, Pages 496-503

Nationwide, perinatal mood and anxiety disorder (PMAD) diagnoses among privately insured people increased by 93.3 percent from 2008 to 2020, growing faster in 2015–20 than in 2008–14. Most states and demographic subgroups experienced increases, suggesting worsening morbidity in maternal mental health nationwide. PMAD-associated suicidality and psychotherapy rates also increased nationwide from 2008 to 2020. Relative to 2008–14, psychotherapy rates continued to rise in 2015–20, whereas suicidality rates declined.

Understanding the Demand-Side of an Illegal Market: Prohibition of Menthol Cigarettes
Donald Kenkel et al.
NBER Working Paper, February 2024

The Food and Drug Administration has proposed to prohibit menthol cigarettes, which are smoked by almost 19 million people in the U.S. Illegal markets for menthol cigarettes could not only blunt the prohibition’s intended consequence to reduce smoking but could also lead to unintended consequences. We use data from a discrete choice experiment to estimate a mixed logit model which predicts that the prohibition of menthol cigarettes would substantially increase the fraction of menthol smokers who attempt to quit. However, our model also predicts a substantial potential consumer demand for illegal menthol cigarettes. Depending on the impact of illegality on product prices, our model predicts the potential demand-side of an illegal market for menthol cigarettes could be 59-92 percent the size of the status quo market if menthol e-cigarettes are legal, and 69-100 percent the size of the status quo market if menthol e-cigarettes are also illegal. Our mixed logit model estimated in willingness to pay space implies that the mean WTP to avoid an illegal retail market is equivalent to a tax of $8.44 per pack. In our partial cost-benefit analysis, the opportunity costs of prohibition exceed the value of the reduction in mortality risks from secondhand smoke by $15.4 billion annually.

The long-run impacts of adolescent drinking: Evidence from Zero Tolerance Laws
Tatiana Abboud, Andriana Bellou & Joshua Lewis
Journal of Public Economics, March 2024

This paper provides the first long-run assessment of adolescent alcohol control policies on later-life health and labor market outcomes. Our analysis exploits cross-state variation in the rollout of “Zero Tolerance” (ZT) Laws, which set strict alcohol limits for drivers under age 21 and led to sharp reductions in youth binge drinking. We adopt a difference-in-differences approach that combines information on state and year of birth to identify individuals exposed to the laws during adolescence and tracks the evolving impacts into middle age. We find that ZT Laws led to significant improvements in later-life health. Individuals exposed to the laws during adolescence were substantially less likely to suffer from cognitive and physical limitations in their 40s. The health effects are mirrored by improved labor market outcomes. These patterns cannot be attributed to changes in educational attainment or marriage. Instead, we find that affected cohorts were significantly less likely to drink heavily by middle age, suggesting an important role for adolescent initiation and habit-formation in affecting long-term substance use.

The Effect of E-cigarette Taxes on Substance Use
Dhaval Dave et al.
NBER Working Paper, April 2024

Public health advocates warn that the rapid growth of legal markets for electronic nicotine delivery systems (ENDS) may generate a “gateway” to marijuana and harder drug consumption, particularly among teenagers. This study is the first to explore the effects of ENDS taxes on substance use. We find that a one-dollar increase in ENDS taxes (2019$) is associated with a 1-to-2 percentage point decline in teen marijuana use and a 0.8 percentage point reduction in adult marijuana use. This result is consistent with e-cigarettes and marijuana being economic complements. We find no evidence that ENDS taxes affect drug treatment admissions or consumption of illicit drugs other than marijuana such as cocaine, methamphetamine, or opioids over this sample period.

Ridesharing and External-Cause Mortality
Conor Lennon, Christian Saenz & Keith Teltser
Georgia State University Working Paper, March 2024

Existing research suggests ridesharing affects transportation access, substance use, and exposure to crime. Ridesharing may therefore also have meaningful effects on mortality related to these underlying factors. To address this question, we use restricted-access data from the National Vital Statistics System to study how UberX, Uber's taxi-like service, affects mortality from external causes. Our identification strategy relies on spatial and temporal variation in UberX entry across U.S. counties. Among those aged 18 to 45, we find that UberX entry into an area is associated with 2.01 additional deaths per quarter per 100,000 population (roughly a 10% increase). We find that these deaths are primarily related to alcohol and drug use. We support a causal interpretation for our findings by presenting event studies, placebo analyses, sensitivity and heterogeneity analyses, and a variety of robustness checks, including differences-in-differences estimators that are robust to heterogeneous treatment effects. Our work contributes to the literature by addressing both the benefits and costs of ridesharing, and by informing stakeholders who are interested in the cumulative impact of ridesharing on public health and well-being.

Examination of the Effects of Cannabidiol on Menstrual-Related Symptoms
Morgan Ferretti et al.
Experimental and Clinical Psychopharmacology, forthcoming

Some individuals attempt to alleviate menstrual-related symptoms (MRS) by using cannabis and report having expectations that cannabis can improve MRS; however, no study has examined the effect of cannabinoids on MRS. The present study is a pre–post, randomized, open-label trial that aimed to examine the effects of oral cannabidiol (CBD) isolate for alleviating MRS. Participants were assigned randomly to one of two open-label dosing groups of CBD softgels (160 mg twice a day, BID, n = 17; 320 mg BID, n = 16) and completed a 1-month baseline period. Following baseline, participants were instructed to consume CBD starting the first day they believed they experienced symptoms each month and to take their assigned dose daily for 5 consecutive days for three CBD-consumption months. We examined differences in MRS and related outcomes between baseline and 3 months of CBD consumption. Results revealed reductions (in both dosing groups) in MRS, irritability, anxiety, global impression of change, stress, and subjective severity scores when comparing baseline to all 3 months of CBD consumption. Depression scores did not change in either dosing group. Findings suggest that CBD may have the potential for managing MRS. Importantly, changes in symptoms appeared in the first month of CBD consumption and persisted over the 3 consumption months. Further research is warranted comparing the effects of CBD to placebo (a limitation of the study) and examining the potential to optimize CBD consumption for reducing MRS (e.g., combining CBD with terpenes; varying routes and timing of administration).

The effects of physical activity on sleep architecture and mood in naturalistic environments
Kennedy Zapalac et al.
Scientific Reports, March 2024

Physical activity has been found to alter sleep architecture, but these effects have been studied predominantly in the laboratory and the generalizability of these findings to naturalistic environments and longer time intervals, as well as their psychological effects, have not been evaluated. Recent technological advancements in wearable devices have made it possible to capture detailed measures of sleep outside the lab, including timing of specific sleep stages. In the current study, we utilized photoplethysmography coupled with accelerometers and smartphone ambulatory assessment to collect daily measurements of sleep, physical activity and mood in a sample of N = 82 over multi-month data collection intervals. We found a robust inverse relationship between sedentary behavior and physical activity and sleep architecture: both low-intensity and moderate-to-vigorous physical activity were associated with increased NREM sleep and decreased REM sleep, as well as a longer REM latency, while higher levels of sedentary behavior showed the opposite pattern. A decreased REM/NREM ratio and increased REM latency were in turn associated with improved wellbeing, including increased energy, reduced stress and enhanced perceived restfulness of sleep. Our results suggest that physical activity and sleep account for unique variance in a person’s mood, suggesting that these effects are at least partially independent.

Smoke and Mirrors: Impact of E-cigarette Taxes on Underage Social Media Posting
Piyush Anand & Vrinda Kadiyali
Marketing Science, forthcoming

E-cigarette use, or vaping, is a public health concern, with particular worries about underage use. The U.S. government is expected to introduce federal taxation on vaping. The potential deterrent effect of such a tax on underage users is understudied because of the absence of underage use data. To cut through this data fog, we use Instagram images from 2016 to 2018 to estimate whether a tax change in California affected vaping-related posting by underage users. This posting behavior is a potential proxy for consumption behavior. We use image analysis (residual neural networks) and latent factor models for causal inference of tax effects. Compared with counterfactuals, we find a relative decline in the incidence of underage users (in effect a slower increase in postings) in vaping-related images in California for about six months, with no effects after. There is gender and race heterogeneity in these effects. Our proposed approach of using near real-time social media images can be helpful to regulators and managers, especially in the rapidly changing landscape expected in the coming months.


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