In excess

Kevin Lewis

October 23, 2014

The Impact of Large Container Beer Purchases on Alcohol-Related Fatal Vehicle Accidents

Omer Hoke & Chad Cotti
Contemporary Economic Policy, forthcoming

Using a fixed effect weighted least square model, we examine how changes in the share of beer purchases from large containers (>12 oz.) impact alcohol-related fatal accidents. We find that, after holding beer purchases and overall alcohol-consumption constant, an increase in total beer purchases from containers greater than the standard size of 12 oz. increases alcohol-related fatal accidents. We confirm our results persist across several investigations of robustness, as well as the use of instrument variables methods. Outcomes suggest that policy makers should consider differential excise taxes for the purchase of larger than standard size beer containers. Such a policy would likely reduce the number of alcohol-related fatal vehicle crashes and help to internalize the negative externalities associated with drunk driving. At the very minimum, these results suggest that individuals prone to dangerous levels of drunk driving are the consumers that most prefer large container size consumption. This is consistent with the idea that binge drinkers and beer drinkers are much more likely to drive while legally intoxicated.


Distance to Cannabis Shops and Age of Onset of Cannabis Use

Ali Palali & Jan van Ours
Health Economics, forthcoming

In the Netherlands, cannabis use is quasi-legalized. Small quantities of cannabis can be bought in cannabis shops. We investigate how the distance to the nearest cannabis shop affects the age of onset of cannabis use. We use a mixed proportional hazard rate framework to take account of observable as well as unobservable characteristics that influence the uptake of cannabis. We find that distance matters. Individuals who grow up within 20km of a cannabis shop have a lower age of onset.


Cannabis and creativity: Highly potent cannabis impairs divergent thinking in regular cannabis users

Mikael Kowal et al.
Psychopharmacology, forthcoming

Objective: The aim of this study was to investigate the acute effects of cannabis on creativity.

Methods: We examined the effects of administering a low (5.5 mg delta-9-tetrahydrocannabinol [THC]) or high (22 mg THC) dose of vaporized cannabis vs. placebo on creativity tasks tapping into divergent (Alternate Uses Task) and convergent (Remote Associates Task) thinking, in a population of regular cannabis users. The study used a randomized, double-blind, between-groups design.

Results: Participants in the high-dose group (n = 18) displayed significantly worse performance on the divergent thinking task, compared to individuals in both the low-dose (n = 18) and placebo (n = 18) groups.

Conclusions: The findings suggest that cannabis with low potency does not have any impact on creativity, while highly potent cannabis actually impairs divergent thinking.


Seatbelt Use among Drunk Drivers in Different Legislative Settings

Scott Adams, Chad Cotti & Nathan Tefft
Economic Inquiry, forthcoming

We present evidence from the Fatality Analysis Reporting System and Behavioral Risk Factor Surveillance System that shows increased seatbelt use following the concurrent presence of stricter blood alcohol content thresholds and primarily enforced seatbelt laws. This suggests that inebriated drivers may use their seat belts more judiciously to avoid being identified as a drunk driver by law enforcement. The interactive effect of stricter drunk driving laws and primary seatbelt laws are also shown to be more effective than either law passed in isolation in terms of reducing traffic fatalities.


Assessing the Effects of Medical Marijuana Laws on Marijuana Use: The Devil is in the Details

Rosalie Pacula et al.
Journal of Policy Analysis and Management, forthcoming

This paper sheds light on previous inconsistencies identified in the literature regarding the relationship between medical marijuana laws (MMLs) and recreational marijuana use by closely examining the importance of policy dimensions (registration requirements, home cultivation, dispensaries) and the timing of when particular policy dimensions are enacted. Using data from our own legal analysis of state MMLs, we evaluate which features are associated with adult and youth recreational and heavy use by linking these policy variables to data from the Treatment Episode Data Set (TEDS) and National Longitudinal Survey of Youth (NLSY97). We employ differences-in-differences techniques, controlling for state and year fixed effects, allowing us to exploit within-state policy changes. We find that while simple dichotomous indicators of MML laws are not positively associated with marijuana use or abuse, such measures hide the positive influence legal dispensaries have on adult and youth use, particularly heavy use. Sensitivity analyses that help address issues of policy endogeneity and actual implementation of dispensaries support our main conclusion that not all MML laws are the same. Dimensions of these policies, in particular legal protection of dispensaries, can lead to greater recreational marijuana use and abuse among adults and those under the legal age of 21 relative to MMLs without this supply source.


The Meth Project and Teen Meth Use: New Estimates from the National and State Youth Risk Behavior Surveys

Mark Anderson & David Elsea
Health Economics, forthcoming

In this note, we use data from the national and state Youth Risk Behavior Surveys for the period 1999 through 2011 to estimate the relationship between the Meth Project, an anti-methamphetamine advertising campaign, and meth use among high school students. During this period, a total of eight states adopted anti-meth advertising campaigns. After accounting for pre-existing downward trends in meth use, we find little evidence that the campaign curbed meth use in the full sample. We do find, however, some evidence that the Meth Project may have decreased meth use among White high school students.


Effects of State Cigarette Excise Taxes and Smoke-Free Air Policies on State Per Capita Alcohol Consumption in the United States, 1980 to 2009

Melissa Krauss et al.
Alcoholism, forthcoming

Background: Increasing state cigarette excise taxes and strengthening smoke-free air (SFA) laws are known to reduce smoking prevalence. Some studies suggest that such policies may also reduce alcohol use, but results for cigarette taxes have been mixed, and associations with smoke-free air policies have been limited to some demographic subgroups. To shed further light on the potential secondary effects of tobacco control policy, we examined whether increases in cigarette taxes and strengthening of SFA laws were associated with reductions of per capita alcohol consumption and whether any reductions were specific to certain beverage types.

Methods: State per capita alcohol consumption from 1980 to 2009 was modeled as a function of state price per pack of cigarettes and SFA policy scores while controlling for secular trends and salient state covariates. Both policy measures also accounted for local policies. Total alcohol, beer, wine, and spirits consumption per capita were modeled separately. For each type of beverage, we used a nested models approach to determine whether the 2 policies together were associated with reduced consumption.

Results: For total alcohol consumption, and for beer or spirits (but not wine), one or both tobacco policies were associated with reductions in consumption. A 1% increase in cigarette price per pack was associated with a 0.083% decrease in per capita total alcohol consumption (95% confidence interval [CI] 0.0002 to 0.166, p = 0.0495), and a 1-point increase in SFA policy score, measured on a 6-point scale, was associated with a 1.1% decrease in per capita total alcohol consumption (95% CI 0.4 to 1.7, p = 0.001; p < 0.001 for the hypothesis that the 2 policies are jointly associated with reduced alcohol consumption).

Conclusions: The public health benefits of increasing cigarette taxes and smoke-free policies may go beyond the reduction of smoking and extend to alcohol consumption, specifically beer and spirits.


Variation among states in prescribing of opioid pain relievers and benzodiazepines — United States, 2012

Leonard Paulozzi, Karin Mack & Jason Hockenberry
Journal of Safety Research, forthcoming

Introduction: Overprescribing of opioid pain relievers (OPR) can result in multiple adverse health outcomes, including fatal overdoses. Interstate variation in rates of prescribing OPR and other prescription drugs prone to abuse, such as benzodiazepines, might indicate areas where prescribing patterns need further evaluation.

Methods: CDC analyzed a commercial database (IMS Health) to assess the potential for improved prescribing of OPR and other drugs. CDC calculated state rates and measures of variation for OPR, long-acting/extended-release (LA/ER) OPR, high-dose OPR, and benzodiazepines.

Results: In 2012, prescribers wrote 82.5 OPR and 37.6 benzodiazepine prescriptions per 100 persons in the United States. State rates varied 2.7-fold for OPR and 3.7-fold for benzodiazepines. For both OPR and benzodiazepines, rates were higher in the South census region, and three Southern states were two or more standard deviations above the mean. Rates for LA/ER and high-dose OPR were highest in the Northeast. Rates varied 22-fold for one type of OPR, oxymorphone.

Conclusions: Factors accounting for the regional variation are unknown. Such wide variations are unlikely to be attributable to underlying differences in the health status of the population. High rates indicate the need to identify prescribing practices that might not appropriately balance pain relief and patient safety.


Correlation between Cocaine Prices and Purity with Trends in Emergency Department Visits in a Major Metropolitan Area

He Zhu et al.
Journal of Urban Health, October 2014, Pages 1009-1018

Illicit drug use not only causes acute and chronic adverse health outcomes but also results in a significant burden to health care providers. The objective of this study is to examine the relationship between cocaine prices and purity with emergency department (ED) visits for the Chicago-Naperville-Joliet metropolitan area. Our primary outcome was number of cocaine-related ED visits per quarter provided by the Drug Abuse Warning Network. The predictor variables of cocaine purity and price were provided by the System to Retrieve Information from Drug Evidence database. Autoregressive integrated moving average (ARIMA) regressions were used to estimate the effects of cocaine price and purity on cocaine-related ED visits. Although cocaine prices did not change substantially over time, cocaine purity decreased by over 30 % between 2006 and 2010. ARIMA regression results suggest that cocaine-related ED visits were not significantly associated with powder or crack cocaine prices; however, a decrease in powder cocaine purity was associated with 2,081 fewer ED visits overall from 2007 to 2010. The cocaine trade continues to be a major public health and law enforcement threat to large metropolitan cities like Chicago. Regular monitoring of cocaine purity levels may provide early warning of impending changes in cocaine-related ED visits for law enforcement and health care providers.


‘I think he is immune to all the smoke I gave him’: How women account for the harm of smoking during pregnancy

Britta Wigginton & Michelle Lafrance
Health, Risk & Society, Summer 2014, Pages 530-546

Despite women’s awareness of the risks of smoking in pregnancy to the developing foetus, a significant minority continue to smoke during pregnancy. In this article, we use a discourse analytic approach to analyse interviews with 12 Australian women who smoked during a recent pregnancy. We used these data to examine how women accounted for their smoking and identities in the light of the implicit but ever-present discourse that smoking in pregnancy harms babies. We found that the women in our study deployed two rhetorical devices in their talk, ‘stacking the facts’ and ‘smoking for health’, allowing them to situate their smoking within a discourse of risk or as a potential benefit to their health. Women ‘stacked the facts’ by citing personal observable evidence (such as birthweight) to draw conclusions about the risks of smoking in pregnancy to the baby. ‘Stacking the facts’ allowed women to show how they had evaded the risks and their babies were healthy. This device also allowed women to deny or cast doubt over the risks of smoking in pregnancy. Women’s accounts of ‘smoking for health’ involved positioning quitting as stressful and, as a result, more harmful than continuing to smoke a reduced amount. We found complex and counter-intuitive ways in which women dealt with the discourse that smoking in pregnancy harms babies and how these ways of accounting served to protect their identities. We argue that health promotion messages conveying the risks of smoking in pregnancy would benefit from contextualising these messages within women’s personal accounts (e.g. by ‘stacking the facts’ or ‘smoking for health’) and hence providing more ‘realistic’ health risk messages.


Alcohol and Emotional Contagion: An Examination of the Spreading of Smiles in Male and Female Drinking Groups

Catharine Fairbairn et al.
Clinical Psychological Science, forthcoming

Researchers have hypothesized that men gain greater reward from alcohol than do women. However, alcohol-administration studies in which participants were tested when they were drinking alone have offered weak support for this hypothesis. Research has suggested that social processes may be implicated in gender differences in drinking patterns. We examined the impact of gender and alcohol on “emotional contagion” — a social mechanism central to bonding and cohesion. Social drinkers (360 male, 360 female) consumed alcohol, placebo, or control beverages in groups of three. Social interactions were videotaped, and both Duchenne and non-Duchenne smiling were continuously coded using the Facial Action Coding System. Results revealed that Duchenne smiling (but not non-Duchenne smiling) contagion correlated with self-reported reward and typical drinking patterns. Importantly, Duchenne smiles were significantly less “infectious” among sober male groups versus female groups and that alcohol eliminated these gender differences in smiling contagion. Findings identify new directions for research that explores social-reward processes in the etiology of alcohol problems.


Experimentation versus progression in adolescent drug use: A test of an emerging neurobehavioral imbalance model

Atika Khurana et al.
Development and Psychopathology, forthcoming

Based on an emerging neuroscience model of addiction, this study examines how an imbalance between two neurobehavioral systems (reward motivation and executive control) can distinguish between early adolescent progressive drug use and mere experimentation with drugs. Data from four annual assessments of a community cohort (N = 382) of 11- to 13-year-olds were analyzed to model heterogeneity in patterns of early drug use. Baseline assessments of working memory (an indicator of the functional integrity of the executive control system) and three dimensions of impulsivity (characterizing the balance between reward seeking and executive control systems) were used to predict heterogeneous latent classes of drug use trajectories from early to midadolescence. Findings revealed that an imbalance resulting from weak executive control and heightened reward seeking was predictive of early progression in drug use, while heightened reward seeking balanced by a strong control system was predictive of occasional experimentation only. Implications of these results are discussed in terms of preventive interventions that can target underlying weaknesses in executive control during younger years, and potentially enable at-risk adolescents to exercise greater self-restraint in the context of rewarding drug-related cues.


The Economic Value to Smokers of Graphic Warning Labels on Cigarettes: Evidence from Combining Market and Experimental Auction Data

Matthew Rousu et al.
Journal of Economic Behavior & Organization, forthcoming

Many countries now require prominent pictorial health warning labels (HWLs) on the front and back of cigarette packages. In the US, pictorial HWLs have been adopted, but tobacco industry litigation has delayed their implementation. This intervention could have value to smokers, if it increases their information and changes their smoking behavior. In this paper we estimate the value of two different health warning labels for cigarette packages relative to the current US labeling policy. Our methodology does not depend on the personal values of policy makers or other individuals, as the value of information estimates we derive are based solely on smokers’ own consumption choices, not any public health or other effects. We introduce an approach to valuing information with a surplus measure that couples willingness-to-pay from non-hypothetical experimental auctions with time-series revealed preference demand estimates. We find that a pictorial HWL has a large value to smokers, and a higher value than a label that only contains text, insofar as changing purchase behavior.


Effects of Regulation on Methadone and Buprenorphine Provision in the Wake of Hurricane Sandy

Bridget McClure et al.
Journal of Urban Health, October 2014, Pages 999-1008

Hurricane Sandy led to the closing of many major New York City public hospitals including their substance abuse clinics and methadone programs, and the displacement or relocation of thousands of opioid-dependent patients from treatment. The disaster provided a natural experiment that revealed the relative strengths and weaknesses of methadone treatment in comparison to physician office-based buprenorphine treatment for opioid dependence, two modalities of opioid maintenance with markedly different regulatory requirements and institutional procedures. To assess these two modalities of treatment under emergency conditions, semi-structured interviews about barriers to and facilitators of continuity of care for methadone and buprenorphine patients were conducted with 50 providers of opioid maintenance treatment. Major findings included that methadone programs presented more regulatory barriers for providers, difficulty with dose verification due to impaired communication, and an over reliance on emergency room dosing leading to unsafe or suboptimal dosing. Buprenorphine treatment presented fewer regulatory barriers, but buprenorphine providers had little to no cross-coverage options compared to methadone providers, who could refer to alternate methadone programs. The findings point to the need for well-defined emergency procedures with flexibility around regulations, the need for a central registry with patient dose information, as well as stronger professional networks and cross-coverage procedures. These interventions would improve day-to-day services for opioid-maintained patients as well as services under emergency conditions.


from the


A weekly newsletter with free essays from past issues of National Affairs and The Public Interest that shed light on the week's pressing issues.


to your National Affairs subscriber account.

Already a subscriber? Activate your account.


Unlimited access to intelligent essays on the nation’s affairs.

Subscribe to National Affairs.