Keeping Healthy
The Exodus Of State And Local Public Health Employees: Separations Started Before And Continued Throughout COVID-19
Jonathon Leider et al.
Health Affairs, March 2023, Pages 338-348
Abstract:
Understanding the size and composition of the state and local governmental public health workforce in the United States is critical for promoting and protecting the health of the public. Using pandemic-era data from the Public Health Workforce Interests and Needs Survey fielded in 2017 and 2021, this study compared intent to leave or retire in 2017 with actual separations through 2021 among state and local public health agency staff. We also examined how employee age, region, and intent to leave correlated with separations and considered the effect on the workforce if trends were to continue. In our analytic sample, nearly half of all employees in state and local public health agencies left between 2017 and 2021, a proportion that rose to three-quarters for those ages thirty-five and younger or with shorter tenures. If separation trends continue, by 2025 this would represent more than 100,000 staff leaving their organizations, or as much as half of the governmental public health workforce in total. Given the likelihood of increasing outbreaks and future global pandemics, strategies to improve recruitment and retention must be prioritized.
How to avoid a local epidemic becoming a global pandemic
Nils Chr. Stenseth et al.
Proceedings of the National Academy of Sciences, 7 March 2023
Abstract:
Here, we combine international air travel passenger data with a standard epidemiological model of the initial 3 mo of the COVID-19 pandemic (January through March 2020; toward the end of which the entire world locked down). Using the information available during this initial phase of the pandemic, our model accurately describes the main features of the actual global development of the pandemic demonstrated by the high degree of coherence between the model and global data. The validated model allows for an exploration of alternative policy efficacies (reducing air travel and/or introducing different degrees of compulsory immigration quarantine upon arrival to a country) in delaying the global spread of SARS-CoV-2 and thus is suggestive of similar efficacy in anticipating the spread of future global disease outbreaks. We show that a lesson from the recent pandemic is that reducing air travel globally is more effective in reducing the global spread than adopting immigration quarantine. Reducing air travel out of a source country has the most important effect regarding the spreading of the disease to the rest of the world. Based upon our results, we propose a digital twin as a further developed tool to inform future pandemic decision-making to inform measures intended to control the spread of disease agents of potential future pandemics. We discuss the design criteria for such a digital twin model as well as the feasibility of obtaining access to the necessary online data on international air travel.
COVID-19 Stay-at-home Orders and Secondhand Smoke in Public Housing
Sarah Gehlert et al.
American Journal of Preventive Medicine, forthcoming
Methods: PM2.5 was measured in six public housing buildings in Norfolk, VA from 2018 – 2022. Multi-level regression was used to compare the seven-week period of the Virginia stay-at-home order in 2020 with that period in other years.
Results: Indoor PM2.5 was 10.29 μg/m3 higher in 2020 (95% CI [8.51, 12.07]) relative to the same period in 2019, a 72% increase. While PM2.5 improved in 2021 and 2022, it remained elevated relative to 2019.
Opioid death projections with AI-based forecasts using social media language
Matthew Matero et al.
npj Digital Medicine, March 2023
Abstract:
Targeting of location-specific aid for the U.S. opioid epidemic is difficult due to our inability to accurately predict changes in opioid mortality across heterogeneous communities. AI-based language analyses, having recently shown promise in cross-sectional (between-community) well-being assessments, may offer a way to more accurately longitudinally predict community-level overdose mortality. Here, we develop and evaluate, TROP (Transformer for Opiod Prediction), a model for community-specific trend projection that uses community-specific social media language along with past opioid-related mortality data to predict future changes in opioid-related deaths. TROP builds on recent advances in sequence modeling, namely transformer networks, to use changes in yearly language on Twitter and past mortality to project the following year’s mortality rates by county. Trained over five years and evaluated over the next two years TROP demonstrated state-of-the-art accuracy in predicting future county-specific opioid trends. A model built using linear auto-regression and traditional socioeconomic data gave 7% error (MAPE) or within 2.93 deaths per 100,000 people on average; our proposed architecture was able to forecast yearly death rates with less than half that error: 3% MAPE and within 1.15 per 100,000 people.
Prolonged Exposure Therapy for PTSD in Individuals with Opioid Use Disorder: A Randomized Pilot Study
Kelly Peck et al.
Addictive Behaviors, forthcoming
Objective: Nearly all individuals with opioid use disorder (OUD) report lifetime trauma exposure and one-third meet diagnostic criteria for posttraumatic stress disorder (PTSD). Although prolonged exposure (PE) therapy is a first-line treatment for PTSD, little is known about the effects of PE in individuals with co-occurring OUD. Furthermore, its efficacy is commonly undermined by poor therapy attendance. This pilot study evaluated the feasibility and initial efficacy of a novel PE protocol for improving PE attendance and PTSD symptoms among buprenorphine- or methadone-maintained adults with PTSD.
Method: Thirty participants with co-occurring PTSD and OUD were randomized to receive either: (a) continued medications for OUD treatment as usual (TAU), (b) Prolonged Exposure therapy (PE), or (c) PE with financial incentives delivered contingent upon PE session attendance (PE+). Primary outcomes included PE session attendance, PTSD symptom severity, and use of opioids other than prescribed MOUD.
Results: PE+ participants attended significantly more therapy sessions vs. PE (87% vs. 35%; p<.0001). PTSD symptom reductions were also significantly greater in the PE+ vs. TAU group (p=.046). Participants in the two PE conditions submitted significantly fewer urine samples that tested positive for opioids than TAU participants (0% vs. 22%; p=.007).
Short-term effect of retirement on health: Evidence from nonparametric fuzzy regression discontinuity design
Mohamed Ebeid & Umut Oguzoglu
Health Economics, forthcoming
Abstract:
We estimate the short-term effect of retirement on health in the US using the Health and Retirement Study survey. We use the nonparametric fuzzy regression discontinuity design to avoid assuming any functional form on the age-health profile and minimize potential bias in identifying the causal effect of retirement on health status in the short term. Estimates indicate an 8% decline in the cognitive functioning score of retirees and a 28% increase in the CESD depression scale. The likelihood of being in good health status declined by 16%. The transition from working to retirement has more significant negative impacts on males than females. In addition, retirement has more considerable adverse effects on less-educated individuals compared to high-educated individuals. The short-term effects of retirement on health are consistent and robust across different bandwidths, weighting kernel functions, and age-profile specifications. Moreover, the Treatment Effect Derivative test results highly support the external validity of the nonparametric estimates of the retirement effect on health.
Is Grass Greener in the Gray Zone? Legalization and Innovation in the Cannabis Market
Lucy Xiaolu Wang & Nathan Chan
University of Massachusetts Working Paper, February 2023
Abstract:
This paper studies the impact of legalization on the rate and direction of innovation in the cannabis market. We construct novel data on cannabis-related innovation in clinical trials and patent applications. Using staggered difference-in-differences models utilizing the variation in state legalization of medical and adult-use cannabis, we find no evidence that medical cannabis laws affect innovation. Adult-use cannabis laws increase trials and patenting, especially patenting in downstream products and methods rather than upstream chemical or treatment innovation. These results suggest that legalization increases innovation in the cannabis market, but not naturally and not enough for where innovation matters the most.
Intergenerational Correlations in Longevity
Sandra Black et al.
NBER Working Paper, March 2023
Abstract:
While there is substantial research on the intergenerational persistence of economic outcomes such as income and wealth, much less is known about intergenerational persistence in health. We examine the correlation in longevity (an overall measure of health) across generations using a unique dataset containing information about more than 26 million families obtained from the Family Search Family Tree. We find that the intergenerational correlation in longevity is 0.09 and rises to 0.14 if we consider the correlation between children and the average of their parents' longevity. This intergenerational persistence in longevity is much smaller than that of persistence in socio-economic status and lower than existing correlations in health. Moreover, this correlation remained low throughout the 19th and early 20th centuries despite dramatic changes in longevity and its determinants. We also document that the correlations in longevity and in education are largely independent of each other. These patterns are likely explained by the fact that stochastic factors play a large role in the determination of longevity, larger than for other outcomes.
Feeling too isolated to be vaccinated? The contributing role of subjective interpersonal isolation factors towards COVID-19 vaccine hesitancy and resistance
Madhwa Galgali, Peter Helm & Jamie Arndt
Social Science & Medicine, April 2023
Methods: Study 1 (n = 695), conducted before COVID-19 vaccines were available, tested if different forms of subjective isolation predicted lower trust in potential COVID-19 vaccines. Study 2 (n = 674), conducted almost a year after COVID-19 vaccines were available, tested if different forms of subjective isolation predicted not being vaccinated.
Results: In Study 1, existential isolation and alienation predicted lower trust in potential COVID-19 vaccines, while loneliness did not. In Study 2, existential isolation and alienation, but not loneliness, predicted not getting vaccinated.
Adolescent exposure to low-dose Δ9-tetrahydrocannabinol (THC) depletes the ovarian reserve in female mice
Jinhwan Lim et al.
Toxicological Sciences, forthcoming
Abstract:
Cannabis use by adolescents is widespread, but its effects on the ovaries remain largely unknown. Δ9-tetrahydrocannabinol (THC) exerts its pharmacological effects by activating, and in some conditions hijacking, cannabinoid receptors (CBRs). We hypothesized that adolescent exposure to THC affects ovarian function in adulthood. Peripubertal female C57BL/6N mice were given THC (5 mg/kg) or its vehicle, once daily by intraperitoneal injection. Mice either received THC from postnatal day (PND) 30-33 and ovaries were harvested PND34 or mice received THC from PND30-43, and ovaries were harvested PND70. Adolescent treatment with THC depleted ovarian primordial follicle numbers by 50% at PND70, 4 weeks after the last dose. The treatment produced primordial follicle activation which persisted until PND70. THC administration also caused DNA damage in primary follicles and increased PUMA protein expression in oocytes of primordial and primary follicles. Both CB1R and CB2R were expressed in oocytes and theca cells of ovarian follicles. Enzymes involved in the formation (N-acylphosphatidylethanolamine phospholipase D) or deactivation (fatty acid amide hydrolase) of the endocannabinoid anandamide were expressed in granulosa cells of ovarian follicles and interstitial cells. Levels of mRNA for CBR1 were significantly increased in ovaries after adolescent THC exposure, and upregulation persisted for at least 4 weeks. Our results support that adolescent exposure to THC may cause aberrant activation of the ovarian endocannabinoid system in female mice, resulting in substantial loss of ovarian reserve in adulthood. Relevance of these findings to women who frequently used cannabis during adolescence warrants investigation.
When we change the clock, does the clock change us?
Patrick Baylis, Severin Borenstein & Edward Rubin
NBER Working Paper, March 2023
Abstract:
The practice of standardizing the designation of time is a central device for coordinating activities and economic behaviors across individuals. However, there is nearly always conflict between an individual's goals of coordinating activities with others and engaging in those activities at their own preferred time. When time is standardized across large geographic areas, that tension is enhanced, because norms about the "clock times" of activities conflict with adapting to local environmental conditions created by natural or "solar" time. This tension is at the heart of current state and national debates about adopting daylight saving time or switching time zones. We study this conflict by examining how geographic and temporal variation in solar time within time zones affects the timing of a range of common behaviors in the United States. Specifically, we estimate the degree to which people shift their online behavior (through Twitter), their commute (using data from the Census), and their visits to businesses and other establishments (using foot traffic data). We find that, on average, a one-hour shift in the differential between solar time and clock time -- approximately the width of a time zone -- leads to shifting the clock time of behavior by between 9 and 26 minutes. This result shows that while adapting to local environmental factors significantly offsets the differential between solar time and clock time, the behavioral nudge and coordination value of clock time has the larger influence on activity. We also study how the trade-off differs across different activities and population demographics.
Changes in Dental Outcomes After Implementation of the Philadelphia Beverage Tax
Joshua Petimar et al.
American Journal of Preventive Medicine, forthcoming
Methods: Electronic dental record data were obtained on 83,260 patients living in Philadelphia and control areas from 2014 to 2019. Difference-in-differences analyses compared the number of new Decayed, Missing, and Filled Teeth with that of new Decayed, Missing, and Filled Surfaces before (January 2014–December 2016) and after (January 2019–December 2019) tax implementation in Philadelphia and control patients. Analyses were conducted in older children/adults (aged ≥15 years) and younger children (aged <15 years). Subgroup analyses stratified by Medicaid status. Analyses were conducted in 2022.
Results: The number of new Decayed, Missing, and Filled Teeth did not change after tax implementation in Philadelphia in panel analyses of older children/adults (difference-in-differences= –0.02, 95% CI= –0.08, 0.03) or younger children (difference-in-differences=0.07, 95% CI= –0.08, 0.23). There were similarly no post-tax changes in the number of new Decayed, Missing, and Filled Surfaces. However, in cross-sectional samples of patients on Medicaid, the number of new Decayed, Missing, and Filled Teeth was lower after tax implementation in older children/adults (difference-in-differences= –0.18, 95% CI= –0.34, –0.03; –20% decline) and younger children (difference-in-differences= –0.22, 95% CI= –0.46, 0.01; –30% decline), with similar results for number of new Decayed, Missing, and Filled Surfaces.