Living It Down

Kevin Lewis

June 21, 2021

Evidence against risk as a motivating driver of COVID-19 preventive behaviors in the United States
Mae Fullerton et al.
Journal of Health Psychology, forthcoming


Does an individual’s risk profile predict their social distancing and mask wearing in the U.S. during the COVID-19 pandemic? Common sense and some health behavior theories suggest that as a perceived threat increases, an individual should be more likely to take preventive measures. We explore this hypothesis using survey responses collected from 1114 U.S. adults during April and October 2020, and find that neither perceived nor actual risk predicted these preventive behaviors. Instead, being an essential worker, partisanship, and believing compliance was important were more reliable predictors. These results provide guidance for better pandemic response policies and challenge models of health behavior.

Statewide Reopening During Mass Vaccination: Evidence on Mobility, Public Health and Economic Activity from Texas
Dhaval Dave, Joseph Sabia & Samuel Safford
NBER Working Paper, May 2021


During the first four months of 2021, the United States distributed approximately 250 million doses of COVID-19 vaccinations, which resulted in the complete vaccination of nearly 45 percent of the adult population. In the midst of this mass vaccination effort, Texas became the first state to abolish its statewide mask mandate and fully lift capacity constraints for all businesses. Governor Greg Abbott’s order was met with (i) concern by public health officials that an early reopening would lead to a resurgence of COVID-19, and (ii) assertions by Texas politicians that a reopening would generate short-run employment growth. This study provides the first empirical evidence on these claims. First, using daily anonymized smartphone data on social mobility from SafeGraph, Inc. — and synthetic control and difference-in-differences approaches — we find no evidence that the Texas reopening led to substantial changes in social mobility, including foot traffic at a wide set of business establishments in Texas. Second, using daily data on new COVID-19 cases from the New York Times, we find no evidence that the Texas reopening affected the rate of new COVID-19 cases during the five weeks following the reopening. Our null results persist across more urbanized and less urbanized counties, as well as across counties that supported Donald Trump and Joe Biden in the 2020 presidential election. Finally, we find no evidence that the Texas reopening order impacted short-run employment. Together, our null findings underscore the limits of late-pandemic era COVID-19 reopening policies to alter private behavior.

Curse of Democracy: Evidence from 2020
Yusuke Narita & Ayumi Sudo
Yale Working Paper, April 2021


Countries with more democratic political regimes experienced greater GDP loss and more deaths from COVID-19 in 2020. Using five different instrumental variable strategies, we find that democracy is a major cause of the wealth and health losses. This impact is global and is not driven by China and the US alone. A key channel for democracy’s negative impact is weaker and narrower containment policies at the beginning of the outbreak, not the speed of introducing policies.

Effects of Political versus Expert Messaging on Vaccination Intentions of Trump Voters
Christopher Robertson et al.
Boston University Working Paper, May 2021


To increase COVID-19 vaccine uptake in resistant populations, such as Republicans, focus groups suggest that it is best to de-politicize the issue by sharing five facts from a public health expert. Yet polls suggest that Trump voters trust former President Donald Trump for medical advice more than they trust experts. We sought to test the efficacy of these alternative approaches for effective vaccine communication – facts delivered by an expert versus political claims delivered by President Trump endorsing the vaccine. We conducted an online, randomized, national experiment among 387 non-vaccinated Trump voters, using two brief audiovisual artifacts from Spring 2021. Relative to the control group, Trump voters who viewed the video of Trump endorsing the vaccine were 85% more likely to answer “yes” as opposed to “no” in their intention to get fully vaccinated (RRR = 1.85, 95% CI 1.01 to 3.40; P = .048). There were no significant differences between those hearing the public health expert excerpt and the control group (for “yes” relative to “no” RRR = 1.14, 95% CI 0.61 to 2.12; P = .68). These findings suggest that a political speaker’s endorsement of the COVID-19 vaccine may increase uptake among those who identify with that speaker. Contrary to highly-publicized focus group findings, our randomized experiment found that an expert’s factually accurate message may not be effectual to increase vaccination intentions.

Vaccine Hesitancy and Betrayal Aversion
Abdelaziz Alsharawy et al.
Virginia Tech Working Paper, May 2021


Current measures of vaccine hesitancy capture overall beliefs about the safety of vaccines without disassociating the source of the assumed risks. Betrayal aversion occurs when an individual is hesitant to risk being betrayed in an environment involving trust. In this pre-registered experimental study, we document the importance of betrayal aversion in vaccination decisions and show that it is not captured by current vaccine hesitancy measures. We find that over a third of participants have betrayal averse preferences, resulting in an 8-26% decline in vaccine acceptance, depending on the betrayal source. Moreover, we show that betrayal aversion is amplified in situations where the betrayal risk can be attributed to scientists or government. We explore an exogenous message intervention and show that an otherwise effective message acts narrowly and fails to reduce betrayal aversion. Our results demonstrate the importance of betrayal aversion as a preference construct in the decision to vaccinate.

Does the rise of robotic technology make people healthier?
Christian Gunadi & Hanbyul Ryu
Health Economics, forthcoming


Technological advancements bring changes to our life, altering our behaviors as well as our role in the economy. In this paper, we examine the potential effect of the rise of robotic technology on health. Using the variation in the initial distribution of industrial employment in US cities and the difference in robot adoption across industries over time to predict robot exposure at the local labor market, we find evidence that higher penetration of industrial robots in the local economy is positively related to the health of the low-skilled population. A 10% increase in robots per 1000 workers is associated with an approximately 10% reduction in the share of low-skilled individuals reporting poor health. Further analysis suggests that the reallocation of tasks partly explains this finding. A 10% increase in robots per 1000 workers is associated with an approximately 1.5% reduction in physical tasks supplied by low-skilled workers.

A phase 2 trial of inhaled nitrous oxide for treatment-resistant major depression
Peter Nagele et al.
Science Translational Medicine, 9 June 2021


Nitrous oxide at 50% inhaled concentration has been shown to improve depressive symptoms in patients with treatment-resistant major depression (TRMD). Whether a lower concentration of 25% nitrous oxide provides similar efficacy and persistence of antidepressant effects while reducing the risk of adverse side effects is unknown. In this phase 2 clinical trial (NCT03283670), 24 patients with severe TRMD were randomly assigned in a crossover fashion to three treatments consisting of a single 1-hour inhalation with (i) 50% nitrous oxide, (ii) 25% nitrous oxide, or (iii) placebo (air/oxygen). The primary outcome was the change on the Hamilton Depression Rating Scale (HDRS-21). Whereas nitrous oxide significantly improved depressive symptoms versus placebo (P = 0.01), there was no difference between 25 and 50% nitrous oxide (P = 0.58). The estimated differences between 25% and placebo were −0.75 points on the HDRS-21 at 2 hours (P = 0.73), −1.41 points at 24 hours (P = 0.52), −4.35 points at week 1 (P = 0.05), and −5.19 points at week 2 (P = 0.02), and the estimated differences between 50% and placebo were −0.87 points at 2 hours (P = 0.69), −1.93 points at 24 hours (P = 0.37), −2.44 points at week 1 (P = 0.25), and −7.00 points at week 2 (P = 0.001). Adverse events declined substantially with dose (P < 0.001). These results suggest that 25% nitrous oxide has comparable efficacy to 50% nitrous oxide in improving TRMD but with a markedly lower rate of adverse effects.

The impact of minimum wage increases on cigarette smoking
Chen Huang, Feng Liu & Shijun You
Health Economics, forthcoming


Recent debate about raising federal minimum wage to $15 per hour receives substantial public attention. Yet the minimum wage literature has been focusing on the labor market outcomes, with the health implications rarely being discussed. This paper investigates the impact of minimum wage increases on multiple dimensions of cigarette smoking behaviors for the low-skilled population using the Current Population Survey-Tobacco Use Supplement over a long time period (1998–2015). Results show that a $1 increase in the minimum wage raises the prevalence of smoking by about 2.3% and reduces cessation by about 13.7% among the low-skilled workers. With further examinations, we find evidence of an income effect as one potential mechanism that leads to more smoking. The impacts on all low-skilled adults, however, are somewhat smaller, which are most likely driven by the null effects among those who are out of the labor force. We additionally conduct a series of sensitivity tests and confirm the robustness of these results.

Tackling the Substance Abuse Crisis: The Role of Access to Treatment Facilities
Adriana Corredor-Waldron & Janet Currie
NBER Working Paper, May 2021


The continuing drug overdose crisis in the U.S. has highlighted the urgent need for greater access to treatment. This paper examines the impact of openings and closings of substance abuse treatment facilities in New Jersey on emergency room visits for substance abuse issues among nearby residents. We find that drug-related ER visits increase by 16.6% after a facility closure and decrease by 9.5% after an opening. The effects are largest in relatively under-served areas, among Black residents, and among males. They are smaller for the middle aged than for either younger or older people. The results suggest that expanding access to treatment results in significant reductions in morbidity related to drug abuse.

The continued rise of methamphetamine use among people who use heroin in the United States
Justin Strickland et al.
Drug and Alcohol Dependence, forthcoming

Methods: Data from the 2015–2019 National Surveys on Drug Use and Health (NSDUH) were analyzed. Data from the 2006–2014 NSDUH were summarized for historical trends. Past month and past year methamphetamine use prevalence was determined within populations using heroin as well as those using other drugs (e.g., cocaine, cannabis). Multivariable logistic models accounting for complex survey design evaluated predictors of methamphetamine use among people using heroin.

Results: From 2015 to 2019, past month methamphetamine use increased from 9.0% to 44.0% within the population of people reporting past month heroin use. Similarly, past year methamphetamine use increased from 22.5% to 46.7% among those reporting past year heroin use. Risk factors for methamphetamine use among people using heroin included rurality, past year injection drug use, and serious mental illness.

Evidence and Lessons on the Health Impacts of Public Health Funding from the Fight against HIV/AIDS
Marcus Dillender
NBER Working Paper, May 2021


HIV/AIDS has been one of the largest public health crises in recent history, and the U.S. federal government has spent hundreds of billions of dollars fighting the disease. This study examines the impact of federal funding allocated to U.S. cities through the Ryan White CARE Act, which is the largest program for combating HIV/AIDS in the United States. The empirical approach identifies the impact of the funding by studying funding variation that comes from Ryan White policy features that resulted in large funding differences among cities that were originally on parallel HIV/AIDS trajectories and finds that Ryan White's city-level funding has improved HIV/AIDS outcomes in the cities receiving the funds. The estimates indicate that one HIV/AIDS death has been avoided for every $314,000 allocated through the program and that the program has saved approximately 60,000 lives through 2018. The estimates also indicate that funding differences across cities have contributed to the uneven progress in combating HIV/AIDS across the United States.

Innovation and Health Disparities During an Epidemic: The Case of HIV
Barton Hamilton et al.
NBER Working Paper, May 2021


We examine whether medical innovation can reinforce existing health disparities by disproportionately benefiting socioeconomically advantaged patients. The reason is that less advantaged patients often do not use new medications. This may be due to high costs of new drugs, but could also reflect differences in how side effects of new treatments interact with labor supply. To investigate, we develop a dynamic lifecycle model in which the effect of medical treatment on labor supply varies across sociodemographic groups. We estimate the model using rich data on treatment choices and employment decisions of men infected with HIV. In the model, treatments can improve long-run health, but can also cause immediate side effects that interact with the utility cost of work. Estimates indicate that HIV-infected men often forego medication to avoid side effects, in part to remain employed. This effect is stronger for people with fewer years of education, leading to lower use of treatment and worse health outcomes. As a result, while a breakthrough HIV treatment - known as HAART - improved lifetime utility for all patients, it disproportionately benefitted those with higher levels of completed education, thereby reinforcing existing inequality. A counterfactual subsidy that increases non-labor income reduces employment for all education groups, but only increases adoption of HAART and improves health among lower-education individuals, who face a starker health-work tradeoff.

Does the built environment have independent obesogenic power? Urban form and trajectories of weight gain
James Buszkiewicz et al.
International Journal of Obesity, forthcoming

Methods: Weight trajectories over a 5-year period were obtained from electronic health records for 115,260 insured patients aged 18–64 years in the Kaiser Permanente Washington health care system. Home addresses were geocoded using ArcGIS. Built environment variables were population, residential unit, and road intersection densities captured using Euclidean-based SmartMaps at 800-m buffers. Counts of area supermarkets and fast food restaurants were obtained using network-based SmartMaps at 1600, and 5000-m buffers. Property values were a measure of socioeconomic status. Linear mixed effects models tested whether built environment variables at baseline were associated with long-term weight gain, adjusting for sex, age, race/ethnicity, Medicaid insurance, body weight, and residential property values.

Results: Built environment variables at baseline were associated with differences in baseline obesity prevalence and body mass index but had limited impact on weight trajectories. Mean weight gain for the full cohort was 0.06 kg at 1 year (95% CI: 0.03, 0.10); 0.64 kg at 3 years (95% CI: 0.59, 0.68), and 0.95 kg at 5 years (95% CI: 0.90, 1.00). In adjusted regression models, the top tertile of density metrics and frequency counts were associated with lower weight gain at 5-years follow-up compared to the bottom tertiles, though the mean differences in weight change for each follow-up year (1, 3, and 5) did not exceed 0.5 kg.

Firearms Injuries Involving Young Children in the United States During the COVID-19 Pandemic
Joanna Cohen et al.
Pediatrics, June 2021

Methods: In this cross-sectional study with an interrupted time series analysis, we used multiyear data from the Gun Violence Archive. We compared trends in (1) firearm injuries in children younger than 12 years old and (2) firearm injuries inflicted by children younger than 12 years old during the pre-COVID-19 period (March to August in the years 2016–2019) and during the first 6 months of the COVID-19 pandemic (March 2020 to August 2020). Linear regression models were developed to evaluate the relationship between firearm injuries and new firearm acquisitions.

Results: There was an increased risk of (1) firearm injuries in young children (relative risk = 1.90; 95% confidence interval 1.58 to 2.29) and (2) firearm injuries inflicted by young children (relative risk = 1.43; 95% confidence interval 1.14 to 1.80) during the first 6 months of the COVID-19 pandemic as compared to the pre-COVID-19 study period. These increased incidents correlate with an increase in new firearm ownership (P < .03).


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