Healthy Activity

Kevin Lewis

February 19, 2024

Lives vs. Livelihoods: The Impact of the Great Recession on Mortality and Welfare
Amy Finkelstein et al.
NBER Working Paper, February 2024


We leverage spatial variation in the severity of the Great Recession across the United States to examine its impact on mortality and to explore implications for the welfare consequences of recessions. We estimate that an increase in the unemployment rate of the magnitude of the Great Recession reduces the average, annual age-adjusted mortality rate by 2.3 percent, with effects persisting for at least 10 years. Mortality reductions appear across causes of death and are concentrated in the half of the population with a high school degree or less. We estimate similar percentage reductions in mortality at all ages, with declines in elderly mortality thus responsible for about three-quarters of the total mortality reduction. Recession-induced mortality declines are driven primarily by external effects of reduced aggregate economic activity on mortality, and recession-induced reductions in air pollution appear to be a quantitatively important mechanism. Incorporating our estimates of pro-cyclical mortality into a standard macroeconomics framework substantially reduces the welfare costs of recessions, particularly for people with less education, and at older ages where they may even be welfare-improving.

How does the use of evidence in policy narratives change during crises? A comparative study of New York City's pandemic school shutdowns
Nikolina Klatt & Sonja Blum
Review of Policy Research, forthcoming 


Narratives play an essential role in fast-paced policy making that occurs during crises. The COVID-19 pandemic brought numerous disruptions of normality, including school closures, which were intensely debated in narratives by many policy actors. Two shutdowns of New York City's public school system affected over 1.1 million students. This article investigates how scientific evidence was used in the narratives surrounding the school shutdowns in NYC by analyzing around 160 policy narratives with the Narrative Policy Framework. We ask whether and how the growing certainty of evidence on the new Coronavirus was reflected in the policy narratives in the second compared to the first shutdown. While there is increased use of scientific evidence in the second shutdown stage, this does not reflect an increased evidence base: The evolving use of evidence in policy narratives is mainly reflected in its strategic uses to support a certain policy solution within a blame-avoidance strategy.

Hindsight Bias and Trust in Government
Holger Herz et al.
Review of Economics and Statistics, forthcoming 


We empirically assess whether hindsight bias affects citizens' evaluation of their political actors. Using an incentivized elicitation technique, we demonstrate that people systematically misremember their past policy preferences regarding how to best fight the Covid-19 pandemic. At the peak of the first wave in the United States, the average respondent mistakenly believed that they supported significantly stricter restrictions at the onset of the first wave than they actually did. Exogenous variation in the extent of hindsight bias, induced through a randomized survey experiment, indicates that hindsight bias has a negative causal impact on the change in trust in government.

Thick Market Externalities and the Persistence of the Opioid Epidemic
David Cutler & Travis Donahoe
NBER Working Paper, January 2024 


Opioid overdose death rates in the United States have risen continuously for over three decades, increasing 2,142 percent in total from 1990 to 2020. This is surprising. One might expect drug epidemics to be self-limiting, as policy and individual behavior reacts to observed deaths. We study why opioid deaths have risen so greatly and for so long. We consider three reasons for a prolonged epidemic: exogenous and continuing changes in demand or supply, and spillovers in demand for opioids across users, which we term "thick market externalities." We show there is no evidence of sufficiently large exogenous changes in the demand or supply of opioids that could explain such a prolonged increase in death rates. We test for spillovers using county-level data on opioid deaths from 1991-2018 and opioid shipments from 2006-2009, combined with data on friendships and distance between counties. Estimating a model with addiction and spatial spillovers, we find large spillovers in opioid use and deaths across areas. A shock that increases opioid death rates by 1 in an index county causes 0.38 to 0.76 more deaths in other counties because of spillovers. Because opioids are addictive, this leads to even more deaths and spillovers in future years. In some specifications, these effects are large enough to generate a continuously increasing epidemic without any ongoing changes in demand or supply. We estimate spillovers explain 84 to 92 percent of opioid deaths from 1990 to 2018 and are the main reason deaths have increased for so long.

The Role of Friends in the Opioid Epidemic
Effrosyni Adamopoulou et al.
NBER Working Paper, January 2024 


The role of friends in the US opioid epidemic is examined. Using data from the National Longitudinal Survey of Adolescent Health (Add Health), adults aged 25-34 and their high school best friends are focused on. An instrumental variable technique is employed to estimate peer effects in opioid misuse. Severe injuries in the previous year are used as an instrument for opioid misuse in order to estimate the causal impact of someone misusing opioids on the probability that their best friends also misuse. The estimated peer effects are significant: Having a best friend with a reported serious injury in the previous year increases the probability of own opioid misuse by around 7 percentage points in a population where 17 percent ever misuses opioids. The effect is driven by individuals without a college degree and those who live in the same county as their best friends.

Cannabis Retailer Communication About Cannabis Products, Health Benefits, and Risks: A Mystery Shopper Study of Licensed Retailers in Five U.S. Cities
Katelyn Romm et al.
Journal of Studies on Alcohol and Drugs, January 2024, Pages 100-108 

Method: In Summer 2022, mystery shoppers audited 140 licensed cannabis retailers in 5 cities in states with established nonmedical (i.e., recreational) cannabis sales and diverse regulations (Denver, Colorado; Seattle, Washington; Portland, Oregon; Las Vegas, Nevada; Los Angeles, California). Descriptive and bivariate analyses characterized retail personnel communication overall and across cities.

Results: Common product recommendations for new users included edibles, pre-rolled joints, and bud/flower, and 8.6% offered free/inexpensive ways to sample products. Although Colorado, Washington, and Oregon explicitly prohibited health claims in advertising or labels, more than 90% of retailers there endorsed use for anxiety, insomnia, and/or pain. Whereas 54.3% endorsed use for pregnancy-related nausea (least common in Denver, 23.3%; most common in Seattle, 76.7%), 26.4% warned against use during pregnancy (most frequently in Denver, 46.7%; least frequently in Seattle and Portland, 13.3%). Overall, 52.1% warned against driving after use (most frequently in Denver, 80.0%; least frequently in Las Vegas, 20.0%). Almost all (?90%) sold cannabidiol (CBD) products and endorsed their health benefits and safety, but few (<10%) sold or endorsed delta-8 tetrahydrocannabinol (THC), etc. (all of which were in Los Angeles).

Estimating the Effects of Tobacco-21 on Youth Tobacco Use and Sales
Rahi Abouk, Prabal De & Michael Pesko
Journal of Health Economics, March 2024 


We examine the effect of raising the minimum legal sale age of tobacco to 21 (i.e., "T21"). We estimate difference-in-differences models using the Monitoring the Future (MTF) survey data and Nielsen Retail Scanner data from 2012 to 2019. Outcomes include cigarette and e-cigarette use and sales. We find sizable reductions in e-cigarette and cigarette use for 12th graders. T21 also reduced cigarette sales by 12.4% and e-cigarette sales by 69.3% in counties with the highest percent quartile of individuals under 21 years of age. In terms of mechanisms, we find that T21 increases ID checking and perceived risks of using both products.


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