Unhealthy Lifestyles

Kevin Lewis

November 08, 2021

How Internet Access Drives Global Vaccine Skepticism
Kristin Lunz Trujillo & Matthew Motta
International Journal of Public Opinion Research, Autumn 2021, Pages 551–570

Counterintuitively, wealthier countries tend to be more vaccine skeptical than poorer countries. One possible explanation -- the Online Accessibility hypothesis -- posits that internet access facilitates the spread of antivaccine misinformation, particularly for those lower in scientific and medical expert trust. Another explanation -- the Out of Sight hypothesis -- is that some citizens in richer countries fail to consider the risks of vaccine-preventable diseases because they are rarely experienced directly. Merging country-level data with nationally representative survey data (N = 149,014) from 144 countries, we find evidence for the Online Accessibility hypothesis. These findings are robust to alternate measures of wealth and modeling strategies. 

Prevalence of Depression Among Adolescents in the U.S. From 2009 to 2019: Analysis of Trends by Sex, Race/Ethnicity, and Income
Michael Daly
Journal of Adolescent Health, forthcoming

This study drew on 11 years of the National Survey on Drug Use and Health (N = 167,783), a nationally representative survey of adolescents aged 12–17 years conducted between 2009 and 2019.

The prevalence of past-year major depressive episode (MDE) increased by 7.7 percentage points from 8.1% to 15.8% between 2009 and 2019. MDE increased by 12 percentage points from 11.4% to 23.4% among girls. The gender difference in the prevalence of MDE increased from 6.4% to 14.8% between 2009 and 2019. Black participants experienced a comparatively small increase in depression (4.1%). 

County health outcomes linkage to county spending on social services, building infrastructure, and law and order
Carolina Cardona et al.
SSM - Population Health, forthcoming

Will counties that reallocate money from law enforcement to social services improve subsequent markers of population wellbeing? In this study, we measure the association between county government spending across multiple sectors and Life Expectancy at Birth (LEB) in the U.S. using data from the U.S. Census Bureau. We constructed a Structural Equation Model to determine whether social expenditure, building infrastructure, and spending on law and order were positively or negatively associated with LEB three-years after initial spending. The analysis compared data between 2002-05 and 2007-10 and was stratified for urban and rural counties. In rural counties, a one-standard-deviation increase in social spending increased subsequent LEB by 0.58 (SE 0.16) and 0.36 (SE 0.16) years in 2005 and 2010, respectively. In urban counties, a one-standard-deviation increase in building infrastructure spending increased subsequent LEB by 1.14 (SE 0.51) and 1.05 (SE 0.49) years in 2005 and 2010, respectively. In 2002, a one-standard-deviation increase in law and order spending significantly decreased subsequent life expectancy, 2.2 (SE 1.27) and 0.46 (SE 0.13) years in urban and rural counties, respectively. Similarly, investments in building infrastructure for urban counties and social services for rural counties were associated with subsequently higher life expectancy three years later after initial investments. 

Subsidising the spread of COVID-19: Evidence from the UK’S Eat-Out-to-Help-Out Scheme
Thiemo Fetzer
Economic Journal, forthcoming

This paper documents that a large-scale government subsidy aimed at encouraging people to eat out in restaurants in the wake of the first 2020 COVID-19 wave in the United Kingdom has had a significant causal impact on new cases, accelerating the subsequent second COVID-19 wave. The scheme subsidised 50% off the cost of food and non-alcoholic drinks for an unlimited number of visits in participating restaurants on Mondays–Wednesdays from 3–31 August 2020. Areas with higher take-up saw both a notable increase in new COVID-19 infection clusters within a week of the scheme starting and a deceleration in infections within two weeks of the program ending. Similarly, areas that exhibited notable rainfall during the prime lunch and dinner hours on the days the scheme was active record lower infection incidence -- a pattern that is also measurable in mobility data -- and non-detectable on days during which the discount was not available or for rainfall outside the core lunch and dinner hours. 

Re-exploring the early relationship between teenage cigarette and e-cigarette use using price and tax changes
Michael Pesko & Casey Warman
Health Economics, forthcoming

In 2016, the Surgeon General used longitudinal cohort studies to conclude that youth e-cigarette use is strongly associated with cigarette use. We re-evaluate data from the period of time before the writing of the Surgeon General report, using quasi-experimental methods, and reach the opposite conclusion. We study contemporaneous and intertemporal effects of e-cigarette and cigarette price and tax changes. Our price variation comes from 35,000 retailers participating in the Nielsen Retail Scanner data system. We match price and tax variation to survey data on current use of e-cigarettes and cigarettes for over 94,000 students between grades 6 and 12 in the National Youth Tobacco Survey (NYTS) for years 2011–2015. We find evidence that e-cigarettes and cigarettes are same-period economic substitutes. Coefficient estimates (while imprecisely estimated) also suggest potentially large positive effects of past e-cigarette prices on current cigarette use, indicating intertemporal economic substitution. Our findings raise doubts about the conclusion of government-sponsored reports that e-cigarettes and cigarettes are strongly positively associated. We recommend revisiting and possibly amending this conclusion. 

“Nobody views it as a negative thing to smoke”: A qualitative study of the relationship between United States Air Force culture and tobacco use
Rebecca Krukowski et al.
Military Psychology, forthcoming

Tobacco use has long been a part of military culture, and rates of tobacco use remain higher among military personnel compared to civilians. The current study examines aspects of Air Force tobacco culture that encourage tobacco use. We conducted seven focus groups among Air Force Military Training Leaders (n = 48) and five focus groups among Technical Training Instructors (n = 33) from July 2018 to February 2019. Tobacco use was seen as a core part of Air Force culture and a low-risk behavior, in contrast to other potential activities. Three themes of Air Force culture that facilitate tobacco use emerged: 1) opportunity for work breaks; 2) finding common ground; and 3) stress management or stress relief during deployment. Smoke pits were seen as serving several functions that were not perceived to occur anywhere else: an opportunity for informal communication with leadership, a source of valuable information, and a space for problem-solving. Airmen viewed tobacco as serving a functional role, which outweighed its harm. Future programs might try to address the functions fulfilled by tobacco in order to enhance their impact. 

A Salient Sugar Tax Decreases Sugary-Drink Buying
Grant Donnelly et al.
Psychological Science, forthcoming

Many governments have introduced sugary-drink excise taxes to reduce purchasing and consumption of such drinks; however, they do not typically stipulate how such taxes should be communicated at the point of purchase. Historical, field, and experimental data consisting of more than 225,000 purchase decisions indicated that introducing a $0.01-per-ounce sugar-sweetened beverage (SSB) tax—without making it salient on price tags—had no significant effect on purchasing (−1.26%, p = .28). However, when the phrase “includes sugary drink tax” was added to tax-inclusive price tags, SSB purchasing was lower than (a) in the pretax period (−9.78%, p < .001), (b) in a posttax period when drinks did not bear price tags (−5.04%, p < .001), and (c) in a posttax period when drinks bore tax-inclusive price tags that did not mention the tax (−3.83%, p = .002). Making the tax’s beneficiary (student programs) salient on price tags had no added effect. Two follow-up studies suggested that tax salience was effective partly because consumers overestimated the tax amount, leading to reduced purchase intentions. 

Providing Vouchers and Value Information for Already Free Eye Exams Increases Uptake Among a Low-Income Minority Population: A Randomized Trial
Seema Kacker et al.
NBER Working Paper, October 2021

We study whether vouchers with and without value information encourage completion of already free follow-up appointments in a low-income minority population in Baltimore City referred for definitive evaluation of possible eye disease. Between May 2017 and September 2018, 821 individuals referred for free follow-up from 114 screening events received 1) standard referral, 2) a voucher redeemable for free follow-up and prescription glasses, or 3) a voucher including a statement of monetary value ($250). All referred individuals received patient education, counseling, and appointment reminders. We find that vouchers with and without value information increase follow-up appointments by 12.5 and 20.3 percentage points, respectively, corresponding to a 36%-58% increase compared to the standard referral with no voucher. We conclude that reframing free targeted health service offers by providing vouchers with value information is a promising, low-cost tool to increase uptake. 

Tobacco price and use following California Proposition 56 tobacco tax increase
Christian Gunadi et al.
PLoS ONE, October 2021

California Proposition 56 increased cigarette excise tax by $2 per pack with equivalent increases on non-cigarette tobacco products. We estimated the changes in cigarette price, cigarette use, and non-cigarette use following the implementation of Proposition 56 in California in 2017.

Seven waves of Tobacco Use Supplements to the Current Population Survey (TUS-CPS) 2011–2019 data were used to obtain state-level aggregate self-reported outcomes, including cigarette price per pack, current and daily cigarette use, cigarette consumption per day, and current and daily use of non-cigarette tobacco products (hookah, pipe, cigar, and smokeless tobacco). A modified version of a synthetic control method was used to create a “synthetic” California that best resembled pre-policy sociodemographic characteristics and outcome trends in California while correcting time-invariant pre-policy differences. Various sensitivity analyses were also conducted.

The implementation of Proposition 56 was associated with an increase in self-reported cigarette price per pack in California ($1.844, 95%CI: $0.153, $3.534; p = 0.032). No evidence suggested that Proposition 56 was associated with the changes in the prevalence of current or daily cigarette use, cigarette consumption per day, or the prevalence of current or daily use of non-cigarette tobacco products. 

Flavored cigar availability in Oakland after a partial ban
Kevin Schroth, Marin Kurti & Cristine Delnevo
Addictive Behaviors, forthcoming

We report the continued availability of flavored cigars based on our analysis of discarded cigar wrappers collected in February 2019, after a partial flavor ban in Oakland, CA.

We collected 1,501 discarded cigar wrappers in a stratified random sample of census tracts (n = 15). Collected packages were cleaned, photographed, and coded for product type, brand name, pack size, flavor descriptor, and pricing details.

More than half (58.5%, CI 95% = 50–67.1%) of the cigar wrappers collected were flavored. When controlling for product type, pack size, and brand, there were statistical differences in the presence of flavored tobacco products that align with census tract racial and ethnic demographics. The odds of finding flavored cigars in black/African American tracts census tracts were significantly higher (AOR = 2.13, p < .05) than in white (non-Hispanic) census tracts. We also found that wrappers for larger cigar packs (containing three or more cigars) (77.7%) were the most likely to be flavored. 

Bad Lighting: Effects of Youth Indoor Tanning Prohibitions
Christopher Carpenter, Brandyn Churchill & Michelle Marcus
NBER Working Paper, October 2021

Indoor tanning beds (ITBs) emit UV light at high intensity and have been classified as carcinogenic to humans by the World Health Organization since 2009. We are the first to study the role of state laws prohibiting youths from indoor tanning using a difference-in-differences research design. We find that youth ITB prohibitions reduced population search intensity for tanning-related information. Among white teen girls, ITB prohibitions reduced self-reported indoor tanning and increased sun protective behaviors. We also find that youth ITB prohibitions significantly reduced the size of the indoor tanning market by increasing tanning salon closures and reducing tanning salon sales.


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