Kevin Lewis

January 12, 2022

Taking the Pulse of Nations: A Biometric Measure of Well-being
David Blanchflower & Alex Bryson
NBER Working Paper, December 2021

A growing literature identifies associations between subjective and biometric indicators of wellbeing. These associations, together with the ability of subjective wellbeing (SWB) metrics to predict health and behavioral outcomes, have spawned increasing interest in SWB as an important concept in its own right. However, some social scientists continue to question the usefulness of SWB metrics. We contribute to this literature in three ways. First, we introduce a biometric measure of wellbeing – pulse – which has been largely overlooked. Using nationally representative data on 165,000 individuals from the Health Survey for England (HSE) and Scottish Health Surveys (SHeS) we show that its correlates are similar in a number of ways to those for SWB, and that it is highly correlated with SWB metrics, as well as self-assessed health. Second, we examine the determinants of pulse rates in mid-life (age 42) among the 9,000 members of the National Child Development Study (NCDS), a birth cohort born in a single week in 1958 in Britain. Third, we track the impact of pulse measured in mid-life (age 42) on health and labor market outcomes at age 50 in 2008 and age 55 in 2013. The probability of working at age 55 is negatively impacted by pulse rate a decade earlier. The pulse rate has an impact over and above chronic pain measured at age 42. General health at 55 is lower the higher the pulse rate at age 42, while those with higher pulse rates at 42 also express lower life satisfaction and more pessimism about the future at age 50. Taken together, these results suggest social scientists can learn a great deal by adding pulse rates to the metrics they use when evaluating people’s wellbeing. 

Prenatal choline supplementation improves child sustained attention: A 7-year follow-up of a randomized controlled feeding trial
Charlotte Bahnfleth et al.
FASEB Journal, January 2022

Numerous rodent studies demonstrate developmental programming of offspring cognition by maternal choline intake, with prenatal choline deprivation causing lasting adverse effects and supplemental choline producing lasting benefits. Few human studies have evaluated the effect of maternal choline supplementation on offspring cognition, with none following children to school age. Here, we report results from a controlled feeding study in which pregnant women were randomized to consume 480 mg choline/d (approximately the Adequate Intake [AI]) or 930 mg choline/d during the 3rd trimester. Sustained attention was assessed in the offspring at age 7 years (n = 20) using a signal detection task that showed benefits of maternal choline supplementation in a murine model. Children in the 930 mg/d group showed superior performance (vs. 480 mg/d group) on the primary endpoint (SAT score, p = .02) and a superior ability to maintain correct signal detections (hits) across the 12-min session (p = .02), indicative of improved sustained attention. This group difference in vigilance decrement varied by signal duration (p = .04). For the briefest (17 ms) signals, the 480 mg/d group showed a 22.9% decline in hits across the session compared to a 1.5% increase in hits for the 930 mg/d group (p = .04). The groups did not differ in vigilance decrement for 29 or 50 ms signals. This pattern suggests an enhanced ability to sustain perceptual amplification of a brief low-contrast visual signal by children in the 930 mg/d group. This inference of improved sustained attention by the 930 mg/d group is strengthened by the absence of group differences for false alarms, omissions, and off-task behaviors. This pattern of results indicates that maternal 3rd trimester consumption of the choline AI for pregnancy (vs. double the AI) produces offspring with a poorer ability to sustain attention — reinforcing concerns that, on average, choline consumption by pregnant women is approximately 70% of the AI. 

A Descriptive Analysis of 2020 California Occupational Safety and Health Administration Covid-19-related Complaints
Marilyn Thomas et al.
SSM - Population Health, forthcoming

COVID-19 mortality has disproportionately affected specific occupations and industries. The Occupational Safety and Health Administration (OSHA) protects the health and safety of workers by setting and enforcing standards for working conditions. Workers may file OSHA complaints about unsafe conditions. Complaints may indicate poor workplace safety during the pandemic. We evaluated COVID-19-related complaints filed with California (Cal)/OSHA between January 1, 2020 and December 14, 2020 across seven industries. To assess whether workers in occupations with high COVID-19-related mortality were also most likely to file Cal/OSHA complaints, we compared industry-specific per-capita COVID-19 confirmed deaths from the California Department of Public Health with COVID-19-related complaints. Although 7820 COVID-19-related complaints were deemed valid by Cal/OSHA, only 627 onsite inspections occurred, and 32 citations were issued. Agricultural workers had the highest per-capita COVID-19 death rates (402 per 100,000 workers) but were least represented among workplace complaints (44 per 100,000 workers). Health Care workers had the highest complaint rates (81 per 100,000 workers) but the second lowest COVID-19 death rate (81 per 100,000 workers). Industries with the highest inspection rates also had high COVID-19 mortality. Our findings suggest complaints are not proportional to COVID-19 risk. Instead, higher complaint rates may reflect worker groups with greater empowerment, resources, or capacity to advocate for better protections. This capacity to advocate for safe workplaces may account for relatively low mortality rates in potentially high-risk occupations. Future research should examine factors determining worker complaints and complaint systems to promote participation of those with the greatest need of protection. 

The Impact of the COVID-19 Vaccine Distribution on Mental Health Outcomes
Virat Agrawal et al.
NBER Working Paper, December 2021

The COVID-19 pandemic has led to a “second pandemic” of anxiety and depression. While vaccines are primarily aimed at reducing COVID-19 transmission and mortality risks, they may have important secondary benefits. We use data from U.S. Census Bureau’s Household Pulse Survey merged to state-level COVID-19 vaccination eligibility data to estimate the secondary benefits of COVID-19 vaccination on mental health outcomes. To address endogenous COVID-19 vaccination, we leverage state-level variation in the timing of when age groups are eligible for vaccination. We estimate that COVID-19 vaccination reduces anxiety and depression symptoms by nearly 30%. Nearly all the benefits are private benefits, and we find little evidence of spillover effects, that is, increases in community vaccination rates are not associated with improved anxiety or depression symptoms among the unvaccinated. We find that COVID-19 vaccination is associated with larger reductions in anxiety or depression symptoms among individuals with lower education levels, who rent their housing, who are not able to telework, and who have children in their household. The economic benefit of reductions in anxiety and depression are approximately $350 billion. Our results highlight an important, but understudied, secondary benefit of COVID-19 vaccinations. 

Pandemic-related decline in injuries related to women wearing high-heeled shoes: Analysis of U.S. data for 2016-2020
Philip Cohen
University of Maryland Working Paper, December 2021

This study assessed the trend in high-heel related injuries among U.S. women, using 2016-2020 data from the U.S. Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS).

In 2020 there were an estimated 6,290 high-heel related emergency department visits involving women ages 15-69, down from 16,000 per year in 2016-2019. The 2020 decline began after the start of the COVID-19 shutdowns on March 15. There was no significant change in the percentage of fractures or hospital admissions. 

The Marginal Cost of Mortality Risk Reduction: Evidence from Housing Markets
Kelly Bishop et al.
NBER Working Paper, December 2021

We provide the first evidence that spatial variation in all-cause mortality risk is capitalized into US housing prices. Using a hedonic framework, we recover the annual implicit cost of a 0.1 percentage-point reduction in mortality risk among older Americans and find that this figure is both relatively low and decreasing in age, from $1,346 for a 67 year old to $246 for an 87 year old. These estimates are one-fifth of the size of comparable estimates found in the labor market, suggesting that the housing market provides an alternative, substantially cheaper channel to reducing mortality risk. 

The Epidemic of Despair and Infant Mortality: A Research Note
Matthew Forsstrom
Demography, forthcoming

This research note documents that progress against infant mortality in the United States has stalled in the twenty-first century among infants born to White non-Hispanic women without a bachelor's degree. In contrast, the mortality rate fell considerably among infants born to White non-Hispanic women with a bachelor's degree, Black non-Hispanic women across levels of education, and Hispanic women with a bachelor's degree. The decline in infant mortality for Hispanic women without a bachelor's degree was small, but still greater than the decline for White non-Hispanic women without a bachelor's after adjusting for changes in the distribution of maternal age within groups. I also document a marked difference in trends for sudden unexpected infant death (SUID) rates by maternal education. The SUID rate increased among those born to women without a bachelor's degree across racial and ethnic groups, while declining or staying constant for those born to women with a bachelor's degree. The lack of progress against infant mortality for White non-Hispanic women without a bachelor's degree was driven by a relatively large increase in SUID rates, coupled with relatively slow progress against other types of infant mortality. 

Variation in common laboratory test results caused by ambient temperature
Ziad Obermeyer & Devin Pope
Med, December 2021, Pages 1314-1326

In a sample of 4,877,039 individuals between 2009–2015, we model 215,234,179 test results as a function of temperature, controlling for individual and city-week fixed effects. This measures how day-to-day temperature fluctuations affect results over and above the individual’s mean values, and seasonal variation.

51 of 75 assays are significantly affected by temperature, including measures of kidney function (increased creatinine, urea nitrogen, and urine specific gravity), cellular blood components (decreased neutrophils, erythrocytes, and platelets), and lipids (increased high-density lipoprotein [HDL] and decreased total cholesterol, triglycerides, and low-density lipoprotein [LDL]). These small, day-to-day fluctuations are unlikely to correlate with long-term physiological trends; for example, lipid panels checked on cooler days look lower risk, but these short-term changes probably do not reflect stable changes in cardiovascular risk. Nonetheless, doctors appear to treat these individuals differently. We observe 9.7% fewer statin prescriptions for individuals checked on the coolest versus the warmest days (–0.42% versus baseline of 4.34%, p < 0.001). 

Bullying, cyberbullying, and youth health behaviors
Dimitrios Nikolaou
Kyklos, forthcoming

This paper examines the impact of bullying and cyberbullying victimization on youth health behaviors (smoking, drinking, drugs, sexual intercourse) since the literature has not evaluated within the same framework whether bullying on school grounds and cyberbullying have distinct effects on such behaviors. Using within law heterogeneity in anti-(cyber)bullying laws during 2011–2019, I jointly estimate the decision to adopt a health (dis)accumulating behavior along with a multivariate treatment into four victimization groups: no victimization, bullying only at school, only cyberbullying, both bullying and cyberbullying. Identification of students who face one of the four distinct victimization types reveals heterogeneous effects: cyberbullying has stronger deleterious effects than bullying, and students who experience both accumulate even less health capital. Interestingly, female students respond to victimization by increasing their participation in addictive health behaviors (smoking, excess drinking, marijuana, other illicit drugs), whereas male students are prone to engaging in riskier sexual behaviors (multiple sex partners, unprotected sex). These effects remain even after accounting for mediating effects of student depression and truancy suggesting that public policies should invest in strategies to educate the student's social environment (peers, teachers, parents) about their role in preventing (cyber)bullying and in providing effective counseling for victimized students. 

Origins of the Opioid Crisis and its Enduring Impacts
Abby Alpert et al.
Quarterly Journal of Economics, forthcoming

Overdose deaths involving opioids have increased dramatically since the 1990s, leading to the worst drug overdose epidemic in U.S. history, but there is limited empirical evidence about the initial causes. In this paper, we examine the role of the 1996 introduction and marketing of OxyContin as a potential leading cause of the opioid crisis. We leverage cross-state variation in exposure to OxyContin's introduction due to a state policy that substantially limited OxyContin's early entry and marketing in select states. Recently unsealed court documents involving Purdue Pharma show that state-based triplicate prescription programs posed a major obstacle to sales of OxyContin and suggest that less marketing was targeted to states with these programs. We find that OxyContin distribution was more than 50% lower in “triplicate states” in the years after OxyContin's launch. While triplicate states had higher rates of overdose deaths prior to 1996, this relationship flipped shortly after the launch and triplicate states saw substantially slower growth in overdose deaths, continuing even twenty years after OxyContin's introduction. Our results show that the introduction and marketing of OxyContin explain a substantial share of overdose deaths over the last two decades.

State-level regulations and opioid-related health outcomes
Joanna Jackson et al.
Drug and Alcohol Dependence, forthcoming

Due to the ongoing opioid use disorder crisis, improved access to opioid treatment programs (OTPs) is needed. However, OTPs operate in a complex regulatory environment which may limit their ability to positively affect health outcomes. The objective of this study was to examine how the number and type of state OTP regulations are associated with opioid-related deaths, hospitalizations, and emergency department visits.

Cross-sectional data capturing information about OTP state-level regulations collected by Jackson et al. was combined with other secondary sources. OTP regulations were categorized based on the nature of their focus. Analyses include bivariate and multivariable regressions that controlled for region and other state laws that can affect opioid outcomes.

In bivariate analysis, a greater number of OTP regulations was positively correlated with both deaths and emergency visits. Moreover, a greater number of regulations in the Physical Facilities Management category (e.g., rules related to restrooms, lighting, and signage) was positively correlated with both deaths and hospitalizations. The number of regulations in the Staffing Requirement category was positively associated with emergency visits. In adjusted analysis, the number of regulations in the Physical Facilities Management category was positively associated with opioid-related deaths. 

Mortality disparities between Black and White Americans mediated by income and health behaviors
Juhua Luo, Michael Hendryx & Fennge Wang
SSM - Population Health, forthcoming

We analyzed public NHANES III data from 1988-1994 linked to mortality outcomes prospectively through 2015. Participants included 10,460 non-Hispanic Black (40.5%, n = 4233) and non-Hispanic White (59.5%, n = 6227) adults. Proportional hazards regression models examined mortality risk in association with race, demographics, income, and an index of risky health behaviors including smoking, poor diet and low physical activity. A mediation approach under the counterfactual framework was used to test effects of income and risky health behaviors as mediators between race and mortality risk.

Considering only race, age and sex, Black participants had significantly higher mortality risk than Whites (HR = 1.46, 95% CI 1.35–1.58). When income and education were added, the race effect was lower but remained significant (HR = 1.15, 95% CI 1.02–1.30). In the subsequent model that also included risky behaviors the association between race and mortality was no longer significant (HR = 1.05, 95% CI 0.92–1.20); both higher income and healthier behaviors contributed to lower mortality risk. There was a significant indirect effect of race on mortality mediated through income, and the direct effect of race on mortality was not significant when the mediating effect of income was considered. Likewise, the risky behavior score significantly mediated the association between race with mortality, and the direct effect of race was not significant. In the separate models, income mediated 62% of the association between race and mortality and lifestyle mediated 61% of the relationship. 

Higher educational attainment is associated with longer telomeres in midlife: Evidence from sibling comparisons in the UK Biobank
Vikesh Amin et al.
SSM - Population Health, forthcoming

Prior studies have established that higher educational attainment is associated with a longer telomere length (TL), a marker of cellular aging. However, it is unclear whether extant associations are causal, since they are likely confounded by unobserved genetic, early-life and family background factors that are correlated with education and TL. We leverage sibling differences in TL, education and measured genetics (polygenic scores for educational attainment and TL) to estimate associations between educational attainment and TL in midlife for European ancestry individuals in the UK Biobank, while controlling for unobserved confounders shared by siblings. After controlling for genetics and shared background between siblings, we find suggestive evidence that high school graduates have longer telomeres than high school dropouts, but we find no differences in TL between high school dropouts and college graduates. 

Declining violence and improving birth outcomes in the US: Evidence from birth certificate data
Nicholas Mark & Gerard Torrats-Espinosa
Social Science & Medicine, forthcoming

The decline in crime that occurred in the last decade of the 20th century was one of the most important societal changes in recent U.S. history. In this paper, we leverage the sharp decline in violence that began in the 1990's to estimate the relationship between county-level murder rates and individual-level birth outcomes for Black, Hispanic, and White mothers. Using the FBI's Uniform Crime Reporting data from 1992 to 2002 and individual-level data from more than 30,000,000 US birth certificates, we employ two-way fixed effects models with a rich set of controls to compare births to similar women in the same county who experienced different crime rates during their pregnancies. Elevated murder rates are associated with substantially higher risks of low birth weight for White mothers, low birth weight and small for gestational age among Black mothers, and small for gestational age among Hispanic mothers. Sensitivity analyses show that the existence of confounders that would invalidate these inferences is highly unlikely, suggesting that we have identified causal relationships, even if some uncertainty about the precision of our estimates remains. These findings have potential implications for prenatal and postpartum care, and they add to a growing body of evidence showing that the “Great American Crime Decline” was strongly linked to improved outcomes among groups that experienced the steepest declines in violence.


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