Disease Vector

Kevin Lewis

November 04, 2020

Opting Out: Individualism and Vaccine Refusal in Pockets of Socioeconomic Homogeneity
Kevin Estep & Pierce Greenberg
American Sociological Review, forthcoming


Cases of measles and other highly contagious diseases are rising in the United States. Public health experts blame the rise partly on the spatial concentration of parents declining to vaccinate their children, but researchers have given little attention to theorizing why this clustering occurs in particular communities. We argue that residential and school selection processes create “pockets of homogeneity” attracting parents inclined to opt out of vaccines. Structural features of these enclaves reduce the likelihood of harsh criticism for vaccine refusal and foster a false sense of protection from disease, making the choice to opt out seem both safe and socially acceptable. Examination of quantitative data on personal belief exemptions (PBEs) from school-based vaccination requirements in California schools and districts, as well as findings from parent interviews, provide empirical support for the theory. We discuss substantive implications for lawmakers and public health officials, as well as broader sociological contributions concerning neighborhood effects and residential sorting.

The Effects of Fluoride in the Drinking Water
Linuz Aggeborn & Mattias Öhman
Journal of Political Economy, forthcoming


Water fluoridation is a common, but debated, public policy. In this paper, we use Swedish registry data to study the causal effects of fluoride in the drinking water. We exploit exogenous variation in natural fluoride, stemming from variation in geological characteristics at water sources, to identify its effects. First, we reconfirm the long-established positive effect of fluoride on dental health. Second, we estimate a zero-effect on cognitive ability – in contrast to several recent epidemiological studies. Third, fluoride is found to increase labor income. This effect is foremost driven by individuals from a lower socioeconomic background.

Don’t dumb it down: The effects of jargon in COVID-19 crisis communication
Hillary Shulman & Olivia Bullock
PLoS ONE, October 2020


Experts are typically advised to avoid jargon when communicating with the general public, but previous research has not established whether avoiding jargon is necessary in a crisis. Using the ongoing COVID-19 pandemic as a backdrop, this online survey experiment (N = 393) examined the effect of jargon use across three different topics that varied in situational urgency: COVID-19 (high urgency), flood risk (low urgency), and federal emergency policy (control). Results revealed that although the use of jargon led to more difficult processing and reduced persuasion for the two less-urgent topics (flood risk, emergency policy), there was no effect of jargon in the COVID-19 condition. Theoretically, these findings suggest that the motivation to process information is an important moderator for crisis communication in particular and science communication in general. Practically, these findings suggest that science communicators, during times of crisis, do not need to "dumb down" their language in the same way they should during non-crises.

Nursing Home Quality, COVID-19 Deaths, and Excess Mortality
Christopher Cronin & William Evans
NBER Working Paper, October 2020


The COVID-19 pandemic in the US has been particularly devastating for nursing home residents. A key question is how have some nursing homes been able to effectively protect their residents, while others have not? Using data on the universe of US nursing homes, we examine whether establishment quality is predictive of COVID-19 mortality. Higher-quality nursing homes, as measured by inspection ratings, have substantially lower COVID-19 mortality. Quality does not predict the ability to prevent any COVID-19 resident or staff cases, but higher-quality establishments prevent the spread of resident infections conditional on having one. Preventing COVID-19 cases and deaths may come at some cost, as high-quality homes have substantially higher non-COVID deaths, a result consistent with high excess non-COVID mortality among the elderly since March. The positive correlation between establishment quality and non-COVID mortality is driven entirely by nursing homes located in counties with below-median COVID-19 case rates. As a result, high-quality homes in these counties have significantly more total deaths than their low-quality counterparts. The concentration of excess death in low-risk areas suggests that future suffering could be avoided with more nuanced guidelines, such as those recently suggested by CMS that outline a role for in-person visits in lower-risk areas.

Health benefits of social insurance
Hamid Noghanibehambari & Mahmoud Salari
Health Economics, forthcoming


This paper studies the potential positive externality of unemployment insurance (UI) on infant birth outcomes. Taking advantage of variations of UI benefits across states and over time, we find that UI improves birth outcomes, including mean birth weight, full‐term birth weight, low birth weight, fetal growth, and preterm birth. If all states apply the UI schedule of the most generous state (Massachusetts), the average birth weight increases by roughly 19 g.

Rethinking Depression in Cities: Evidence and Theory for Lower Rates in Larger Urban Areas
Andrew Stier et al.
University of Chicago Working Paper, August 2020


It is commonly assumed that cities are detrimental to mental health. However, the evidence remains inconsistent and, at most, makes the case for differences between rural and urban environments as a whole. Here, we propose a model of depression driven by an individual’s accumulated experience mediated by social networks. The connection between observed systematic variations in socioeconomic networks and built environments with city size provides a link be- tween urbanization and mental health. Surprisingly, this model predicts lower depression rates in larger cities. We confirm this prediction for US cities using three independent datasets. These results are consistent with other behaviors associated with denser socioeconomic networks and suggest that larger cities provide a buffer against depression. This approach introduces a systematic framework for conceptualizing and modeling mental health in complex physical and social networks, producing testable predictions for environmental and social determinants of mental health also applicable to other psychopathologies.

Socioeconomic Status and Well-Being During COVID-19: A Resource-Based Examination
Connie Wanberg et al.
Journal of Applied Psychology, forthcoming


The authors assess levels and within-person changes in psychological well-being (i.e., depressive symptoms and life satisfaction) from before to during the COVID-19 pandemic for individuals in the United States, in general and by socioeconomic status (SES). The data is from 2 surveys of 1,143 adults from RAND Corporation’s nationally representative American Life Panel, the first administered between April–June, 2019 and the second during the initial peak of the pandemic in the United States in April, 2020. Depressive symptoms during the pandemic were higher than population norms before the pandemic. Depressive symptoms increased from before to during COVID-19 and life satisfaction decreased. Individuals with higher education experienced a greater increase in depressive symptoms and a greater decrease in life satisfaction from before to during COVID-19 in comparison to those with lower education. Supplemental analysis illustrates that income had a curvilinear relationship with changes in well-being, such that individuals at the highest levels of income experienced a greater decrease in life satisfaction from before to during COVID-19 than individuals with lower levels of income. We draw on conservation of resources theory and the theory of fundamental social causes to examine four key mechanisms (perceived financial resources, perceived control, interpersonal resources, and COVID-19-related knowledge/news consumption) underlying the relationship between SES and well-being during COVID-19. These resources explained changes in well-being for the sample as a whole but did not provide insight into why individuals of higher education experienced a greater decline in well-being from before to during COVID-19.

Geographies of insecure water access and the housing-water nexus in US cities
Katie Meehan et al.
Proceedings of the National Academy of Sciences, forthcoming


Safe, reliable, and equitable water access is critical to human health and livelihoods. In the United States, an estimated 471,000 households or 1.1 million individuals lack a piped water connection and 73% of households are located in cities, close to networked supply. In this study, we undertake a nationwide analysis of urban water access in the United States, with the aim of explaining the drivers of infrastructural inequality in the 50 largest metropolitan areas. Drawing on statistical analysis and regression modeling of census microdata at the household scale, our analysis reveals spatial and sociodemographic patterns of racialized, class-based, and housing disparities that characterize plumbing poverty. Among unplumbed households, we show that households headed by people of color are almost 35% more likely to lack piped water as compared to white, non-Hispanic households. Precarious housing conditions are an equally strong predictor: Renter-occupied households in the 50 largest US metros were 1.61 times more likely than owner-occupied households to lack piped water. We argue that insecure domestic water access in the United States should be understood as a housing issue that reflects structural inequalities of race and class, particularly in cities with widening wealth gaps. The article concludes with a call for research and action at the intersection of water provision, housing, and social inequality — a paradigm we call the housing-water nexus.

Socioeconomic Status and the Experience of Pain: An Example from Knees
David Cutler, Ellen Meara & Susan Stewart
NBER Working Paper, October 2020


Reports of pain differ markedly across socioeconomic groups and are correlated with outcomes such as functional limitations and disability insurance receipt. This paper examines the differential experience of pain by education. We focus on knee pain, the most common musculoskeletal complaint. Comparing clinical interpretation of knee x-rays of people with and without pain, there are few differences in presence or clinical severity of arthritis across education groups. In contrast, less educated people report more pain for any given objective measure of arthritis. After confirming that reported pain maps to objective measures like walking speed and range of motion, we test four theories for differential experience of pain: differences in obesity, physically demanding occupations, psychological factors, and medical treatment differences. We find that physical demands on the job and obesity each explain about one-third of the education gradient in knee pain. There is an interaction between the two; physical requirements on the job are associated with knee pain primarily in those who are obese. In contrast, psychological traits and access to medical care explain little of the difference in reported pain by education level. These findings imply that educational gradients in pain are likely to persist or even widen as the need for physically demanding occupations — like home health aides and personal service workers — grows in importance with the aging population, and the working population continues to be obese.

Persistent Patterns of Behavior: Two Infectious Disease Outbreaks 350 Years Apart
Utteeyo Dasgupta, Chandan Kumar Jha & Sudipta Sarangi
Economic Inquiry, forthcoming


Outbreaks of infectious diseases bring behavior and policy responses into sharp focus since societies face acute constraints and uncertainties. This paper compares two infectious disease outbreaks: the Covid‐19 pandemic and the 1665 London plague outbreak described by Daniel Defoe in A Journal of the Year of the Plague published in 1722. We compare three aspects: individual behavior, social behavior, and governance and find striking similarities in behavior in spite of these events being separated by 350 years. We contend that the same models of behavior can be used to explain human responses during such outbreaks regardless of when they occur.

Teenage Driving, Mortality, and Risky Behaviors
Jason Huh & Julian Reif
NBER Working Paper, October 2020


We investigate the effect of teenage driving on mortality and risky behaviors in the United States using a regression discontinuity design. We estimate that motor vehicle fatalities rise by 40% at the minimum legal driving age cutoff, implying a mortality risk per additional mile driven 6-9 times higher than the risk faced by adult drivers. We also find a stark 80% increase in female deaths from drug overdoses and carbon monoxide poisoning at the cutoff, caused by changes in both suicides and accidental deaths. Our analysis suggests driving regulations could be an effective tool to improve teenage health.

The Distributional Impacts of Taxes on Health Products: Evidence from Diaper Sales Tax Exemptions
Chelsea Swete & Kye Lippold
University of California Working Paper, June 2020


Sales taxes that are uniform across products are traditionally seen as more efficient than good-specific taxes, but broad-based taxes can be regressive for low income households. We examine taxation of diapers, an inelastic health product, and find substantial income variation in responsiveness to taxes using retail scanner data. Exploiting changes to sales tax exemptions for diapers in New York State and Connecticut, we find that sales of diapers rise by 5.4% in low income areas when taxes are removed, accompanied by a 6.2% fall in spending on children's pain medications. These results imply that sales tax exemptions for diapers can have positive spillover effects on health and well-being.

Improvements in Neighborhood Socioeconomic Conditions May Improve Resident Diet
Andrea Richardson et al.
American Journal of Epidemiology, forthcoming


Neighborhood socioeconomic conditions (NSEC) are associated with resident diet, but most research has been cross-sectional. We capitalize on a natural experiment where one neighborhood experienced substantial investments, compared to a sociodemographically similar neighborhood that did not, in order to examine pathways from neighborhood investments to changed NSEC and changed dietary behavior. We examine differences between renters and homeowners. Data are from a random sample of households (n=831) in each of these low-income Pittsburgh neighborhoods who were surveyed in 2011 and 2014. Structural equation modeling tested direct and indirect pathways from neighborhood to resident dietary quality, adjusting for individual-level sociodemographics, with multi-group testing by homeowners versus renters. Neighborhood investments were directly associated with improved dietary quality for both renters (β, 95% confidence interval [CI]) =0.27, CI: 0.05, 0.50) and homeowners (β=0.51, CI: 0.10, 0.92). Among renters, investments were also associated with dietary quality through a positive association with commercial prices (β= 0.34, CI: 0.15, 0.54) and a negative association with residential prices (β=-0.30, CI: -0.59, -0.004). Among homeowners, we did not observe any indirect pathways from investments to dietary quality through tested mediators. Investing in neighborhoods may support resident diet, doing so through improvements in neighborhood commercial environments for renters, but mechanisms appear to differ for homeowners.

Lead in Drinking Water and Birth Outcomes: A Tale of Two Water Treatment Plants
Dhaval Dave & Muzhe Yang
NBER Working Paper, October 2020


The recent drinking water crisis in Newark, New Jersey's largest city, has renewed concerns about the lead-in-water crisis becoming a persistent and widespread problem owing to the nation's aging infrastructure. We exploit a unique natural experiment in Newark, which exogenously exposed some women in the city to higher levels of lead in tap water but not others, to identify a causal effect of prenatal lead exposure on fetal health. Using birth data that contain information on mothers' exact residential addresses, we find robust and consistent evidence that prenatal exposure to lead significantly raises the probability of low birth weight or preterm births by approximately 1.4 to 1.9 percentage points (14-22 percent), and the adverse effects are largely concentrated among mothers of lower socioeconomic status. Our findings have important policy implications in light of the long-term impact of compromised health at birth and the substantial number of lead water pipes that remain in use as part of our aging infrastructure.


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