Identifying Health

Kevin Lewis

June 26, 2024

Taking One for the (Other) Team: Does Political Diversity Lower Vaccination Uptake?
Sung Eun Kim & Krzysztof Pelc
Political Behavior, forthcoming

What implications might rising animosity towards political out-partisans have for public health? Vaccination has a significant social aspect, protecting not only the vaccinated, but also those around them. While political ideology in the United States was an important driver of individuals’ willingness to get vaccinated against COVID-19, with those on the political right displaying greater hesitancy, we examine the role that political diversity has on vaccine uptake across US states and commuting zones. Using data from the Cooperative Election Study fielded on over 20,000 respondents in November 2021, and controlling for individual partisanship, we find that those who are political outliers in their community are significantly less likely to get vaccinated. By contrast, we find no equivalent negative effect for ethnic diversity. In sum, the impact of affective polarization is not limited to encounters between non-partisans; it can lead to decreased pro-social behavior that harms political friends and foes alike. Yet these behavioral effects depend on how individuals relate to their community’s predominant political ideology.

Medical Cannabis Availability and Mental Health: Evidence From New York’s Medical Cannabis Program
Coleman Drake et al.
NBER Working Paper, May 2024

Evidence on cannabis legalization’s effects on mental health remains scarce, despite both rapid increases in cannabis use and an ongoing mental health crisis in the United States. We use granular geographic data to estimate medical cannabis dispensary availability’s effects on self-reported mental health in New York state from 2011 through 2021 using a two-stage difference-in-differences approach to minimize bias introduced from the staggered opening of dispensaries. Our findings rule out that medical cannabis availability had negative effects on mental health for the adult population overall. We also find that medical cannabis availability reduced past-month self-reported poor mental health days by nearly 10% -- 3.37 percentage points -- among adults 65 and above. These results suggest medical cannabis access has positive health impacts for older populations, likely through pain relief.

The effects of recreational marijuana laws on drug use and crime
Joseph Sabia et al.
Journal of Public Economics, June 2024

Recreational marijuana laws (RMLs), which legalize the sale and possession of small quantities of marijuana for recreational use, have been adopted by 24 states and the District of Columbia. Using a generalized difference-in-differences approach and data for the period 2000–2019 from a variety of sources (the National Survey of Drug Use and Health, the Uniform Crime Reports, the Treatment Episode Data Set, and the National Vital Statistics Mortality files), this study comprehensively examines the effects of legalizing recreational marijuana on drug use, crime, and admissions to substance use treatment facilities. Our analyses show that RML adoption increases the use of marijuana by adults and reduces marijuana-related arrests. However, we find little evidence that RMLs increase the use of harder drugs, admissions to substance use treatment facilities, or property and violent crime. In fact, our results are consistent with the hypothesis that marijuana and opioids are substitutes.

Recreational cannabis dispensary access effects on prescription opioid use and mortality
Jason Beasley & Steven Dundas
Regional Science and Urban Economics, September 2024

While opioid prescribing rates have fallen since 2012, opioid mortality in the United States (US) climbed to record highs in 2022, per CDC reports. In the last decade, evidence emerged that recreational cannabis legislation (RCL) may help mitigate adverse opioid-related outcomes. Yet, the empirical evidence on the relationship between RCL and opioid misuse as a whole is inconsistent and possibly spurious, given common estimation methods. Studies reporting beneficial associations between RCL and opioid mortality tend to avoid the mechanism of change, often assuming mortality benefits stem from substituting cannabis for opioids. We test this relationship using prescription opioid quantities and access to recreational cannabis in the US state of Oregon. Our approach uses within-state variation in distance to recreational dispensary access generated by RCL and prior volumes of legal opioid use to assess the impact of dispensary access on prescription opioids. Results suggest that communities located closer to recreational dispensaries are associated with lower rates of prescription opioids per capita. We also show that reasonable bounds to our primary specification suggest communities located within a mile from a recreational dispensary have prescription opioid rates per capita that are 1.0–3.9 percent lower than surrounding communities. Despite the reduction, we find no evidence that reducing barriers to cannabis access and subsequent declines in prescription opioids are associated with meaningful changes in opioid mortality.

Broadband Internet Access, Economic Growth, and Wellbeing
Kathryn Johnson & Claudia Persico
NBER Working Paper, May 2024

Between 2000 and 2008, access to high-speed, broadband internet grew significantly in the United States, but there is debate on whether access to high-speed internet improves or harms wellbeing. We find that a ten percent increase in the proportion of county residents with access to broadband internet leads to a 1.01 percent reduction in the number of suicides in a county, as well as improvements in self-reported mental and physical health. We further find that this reduction in suicide deaths is likely due to economic improvements in counties that have access to broadband internet. Counties with increased access to broadband internet see reductions in poverty rate and unemployment rate. In addition, zip codes that gain access to broadband internet see increases in the numbers of employees and establishments. In addition, heterogeneity analysis indicates that the positive effects are concentrated in the working age population, those between 25 and 64 years old. This pattern is precisely what is predicted by the literature linking economic conditions to suicide risk.

Mendelian randomization evidence for the causal effect of mental well-being on healthy aging
Chao-Jie Ye et al.
Nature Human Behaviour, forthcoming

Mental well-being relates to multitudinous lifestyle behaviours and morbidities and underpins healthy aging. Thus far, causal evidence on whether and in what pattern mental well-being impacts healthy aging and the underlying mediating pathways is unknown. Applying genetic instruments of the well-being spectrum and its four dimensions including life satisfaction, positive affect, neuroticism and depressive symptoms (n = 80,852 to 2,370,390), we performed two-sample Mendelian randomization analyses to estimate the causal effect of mental well-being on the genetically independent phenotype of aging (aging-GIP), a robust and representative aging phenotype, and its components including resilience, self-rated health, healthspan, parental lifespan and longevity (n = 36,745 to 1,012,240). Analyses were adjusted for income, education and occupation. All the data were from the largest available genome-wide association studies in populations of European descent. Better mental well-being spectrum (each one Z-score higher) was causally associated with a higher aging-GIP (β [95% confidence interval (CI)] in different models ranging from 1.00 [0.82–1.18] to 1.07 [0.91–1.24] standard deviations (s.d.)) independent of socioeconomic indicators. Similar association patterns were seen for resilience (β [95% CI] ranging from 0.97 [0.82–1.12] to 1.04 [0.91–1.17] s.d.), self-rated health (0.61 [0.43–0.79] to 0.76 [0.59–0.93] points), healthspan (odds ratio [95% CI] ranging from 1.23 [1.02–1.48] to 1.35 [1.11–1.65]) and parental lifespan (1.77 [0.010–3.54] to 2.95 [1.13–4.76] years). Two-step Mendelian randomization mediation analyses identified 33 out of 106 candidates as mediators between the well-being spectrum and the aging-GIP: mainly lifestyles (for example, TV watching and smoking), behaviours (for example, medication use) and diseases (for example, heart failure, attention-deficit hyperactivity disorder, stroke, coronary atherosclerosis and ischaemic heart disease), each exhibiting a mediation proportion of >5%. These findings underscore the importance of mental well-being in promoting healthy aging and inform preventive targets for bridging aging disparities attributable to suboptimal mental health.

Understanding the Educational Attainment Polygenic Index and its Interactions with SES in Determining Health in Young Adulthood
Atticus Bolyard & Peter Savelyev
Harvard Working Paper, June 2024

Based on the sample of The National Longitudinal Study of Adolescent to Adult Health (Add Health), we investigate the formation of health capital and the role played by genetic endowments, parental SES, and education. To measure genetic endowments we take advantage of the new availability of quality polygenic indexes (PGIs), which are optimally-weighted summaries of individual molecular genetic data. Our main focus is on the Educational Attainment Polygenic Index (EA PGI), which is designed to predict the highest level of education achieved in life. We find that the EA PGI demonstrates stronger effects on health and health behaviors for subjects with high parental socioeconomic status (SES). These effects are only partially explained by education as a mechanism. We provide suggestive evidence for the mechanisms behind estimated relationships, including early health, skills, and the parents' and child's own attitudes towards education, as well as outcomes related to occupation and wealth. We also show that a strong association between education and health survives controlling for a large set of PGIs that proxy health, skills, and home environment, with only a modest reduction in regression coefficients despite controlling for major expected confounders. This result informs the ongoing debate about the causal relationship between education and health and the confounders behind the education-health gradient.

The Effects of Tobacco 21 Laws on Smoking and Vaping: Evidence from Panel Data and Biomarkers
Chad Cotti, Philip DeCicca & Erik Nesson
NBER Working Paper, May 2024

We use data from the Population Assessment of Tobacco Use and Health (PATH), a longitudinal data set including self-reported and biomarker measures of tobacco use, to examine the effects of state-level tobacco 21 (T21) laws on smoking and vaping. T21 laws reduce self-reported cigarette smoking among 18-to-20 year olds, concentrated in males. Initial non-users who “age-out” of treatment are less likely to subsequently initiate self-reported smoking or vaping. Treated smokers are less likely to buy their own cigarettes and more likely to buy cigarettes in a different state. Biomarker results are mixed, and we find some evidence of a reduction in nicotine exposure but less evidence for a reduction in exposure to tobacco. Finally, we test for non-classical measurement error. T21 laws reduce the probability that clinically identified likely cigarette smokers self-report as smokers, which may increase the apparent effect of T21 laws on cigarette smoking as measured by self-reports.

The Effect of E-Cigarette Flavor Bans on Tobacco Use
Chad Cotti et al.
NBER Working Paper, June 2024

Advocates for sales restrictions on flavored e-cigarettes argue that flavors appeal to young people and lead them down a path to nicotine addiction. This study is among the first to examine the effect of state and local restrictions on the sale of flavored electronic nicotine delivery system (ENDS) products on youth and young adult tobacco use. Using data from the State and National Youth Risk Behavior Surveys, we find that the adoption of an ENDS flavor restriction reduces frequent and everyday youth ENDS use by 1.2 to 2.5 percentage points. Auxiliary analyses of the Behavioral Risk Factor Surveillance System show similar effects on ENDS use for young adults ages 18-20. However, we also detect evidence of an unintended effect of ENDS flavor restrictions that is especially clear among 18-20-year-olds: inducing substitution to combustible cigarette smoking. Finally, there is no evidence that ENDS flavor restrictions affect ENDS use among adults aged 21 and older or non-tobacco-related health behaviors such as binge drinking and illicit drug use.

Comprehensive E-cigarette Flavor Bans and Tobacco Use among Youth and Adults
Henry Saffer et al.
NBER Working Paper, June 2024

The vast majority of youth e-cigarette users consume flavored e-cigarettes, raising concerns from public health advocates that flavors may drive youth initiation into and continued use of e-cigarettes. Flavors drew further notice from the public health community following the sudden outbreak of lung injury among vapers in 2019, prompting several states to enact sweeping bans on flavored e-cigarettes. In this study, we examine the effects of these comprehensive bans on e-cigarette use and potential spillovers into other tobacco use by youth, young adults, and adults. We utilize both standard difference-in-differences (DID) and synthetic DID methods, in conjunction with four national data sets. We find evidence that young adults decrease their use of the banned flavored e-cigarettes as well as their overall e-cigarette use, by about two percentage points, while increasing cigarette use. For youth, there is some suggestive evidence of increasing cigarette use, though these results are contaminated by pre-trend differences between treatment and control units. The bans have no effect on e-cigarette and smoking participation among older adults (ages 25+). Our findings suggest that statewide comprehensive flavor bans may have generated an unintended consequence by encouraging substitution towards traditional smoking in some populations.

Spring Forward = Fall Back? the Effect of Daylight Saving Time Change on Consumers’ Unhealthy Behavior
Ramkumar Janakiraman et al.
Journal of Marketing, forthcoming

Prior research documents deleterious consequences of the annual clock change to daylight saving time in many contexts, but little is known about the effect the policy has on consumer behavior. While policy debates around ending seasonal clock changes continue, millions of consumers worldwide are potentially adversely affected by the time change. Drawing on the notions of sleepiness and self-control, the authors propose a framework of how the onset of daylight saving time increases unhealthy behavior. The hypotheses are tested via two studies cast in the difference-in-differences modeling framework capturing consumption before and after the time change and across consumers who experience the transition versus who do not. Results of the first study suggest that the onset of daylight saving time increases calorie consumption from packaged snacks that are largely unhealthy, specifically in the evening and on cloudy days. The effect of the end of daylight saving time is not significant, suggesting an overall asymmetric effect of the time change on unhealthy behavior. Study 2 reveals that the onset of daylight saving time decreases fitness center visits, particularly for consumers without healthy consumption habits and with high transaction costs. Analysis of social media data suggests that consumers find the time change disruptive. Overall, the findings imply that public policy makers and businesses should find ways to support consumers around the onset of daylight saving time.

Vaccination Invitations Sent by Warm and Competent Medical Professionals Disclosing Risks and Benefits Increase Trust and Booking Intention and Reduce Inequalities Between Ethnic Groups
Marie Juanchich et al.
Health Psychology, forthcoming

Method: In a preregistered 4 × 4 mixed-design experiment, we manipulated how much risk–benefit information the message included within-subjects and the message source between-subjects (N = 4,038 U.K. and U.S. participants, 50% ethnic minority). Participants read four vaccine invitations that varied in vaccination risk–benefit information (randomized order): control (no information), benefits only, risk and benefit, and risk and benefit that mentions vulnerable groups. The messages were sent by one of four sources (random allocation): control (health institution), medical professional (unnamed), warm and competent medical professional (unnamed), and named warm and competent medical professional (Sanjay/Lamar). Participants assessed how much they trusted the message and how likely they would be to book their vaccination appointment.

Results: Information about vaccination benefits and risks increased trust, especially among ethnic minority groups—for whom the effect replicated within each group. Trust also increased when the message was sent by a warm and competent medical professional relative to a health institution, but the importance of the source mattered less when more information was shared.


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