Whose Health

Kevin Lewis

August 26, 2020

Does Partisanship Affect Compliance with Government Recommendations?
Masha Krupenkin
Political Behavior, forthcoming


This article studies the role of partisanship in American’s willingness to follow government recommendations. I combine survey and behavioral data to examine partisans’ vaccination rates during the Bush and Obama administrations. I find that presidential co-partisans are more likely to believe that vaccines are safe and more likely to vaccinate themselves and their children than presidential out-partisans. Depending on the vaccine, presidential co-partisans are 4–10 percentage points more likely to vaccinate than presidential out-partisans. Using causal mediation analysis, I find that this effect is the result of partisans’ differing levels of trust in government. This finding sheds light on the far-reaching role of partisanship in Americans’ interactions with the federal government.

Algorithms and Health Misinformation: A Case Study of Vaccine Books on Amazon
Jieun Shin & Thomas Valente
Journal of Health Communication, June 2020, Pages 394-401


This study examines how vaccine-related books appear on Amazon, focusing on search and recommendation algorithms. We collected vaccine related books that appeared on the first 10 search result pages by Amazon for seven consecutive days and content coded each book. We also collected Amazon’s recommendations for each vaccine book and mapped the network of recommendation among these books. First, we found that the number of vaccine-hesitant books outnumbered vaccine-supportive books two to one. Of these vaccine-hesitant books, 21% were written by physicians and medical experts. Second, although we did not find evidence that their search algorithm systematically favored any particular type of book, the three top ranked books across the seven days were all vaccine-hesitant ones. Lastly, using a network model, we found that books sharing similar views of vaccines were recommended together such that when a user views a vaccine-hesitant book, many other vaccine-hesitant books are further recommended for the user. The three most frequently recommended books were vaccine-hesitant ones. The potential consequences of blindly applying commercial algorithms to a complicated health messages such as vaccines are discussed.

Who Doesn’t Trust Fauci? The Public’s Belief in the Expertise and Shared Values of Scientists in the COVID-19 Pandemic
John Evans & Eszter Hargittai
Socius: Sociological Research for a Dynamic World, August 2020


The primary tension in public discourse about the U.S. government’s response to the coronavirus pandemic has been President Trump’s disagreement with scientists. The authors analyze a national survey of 1,593 Americans to examine which social groups agree with scientists’ ability to understand the novel coronavirus (COVID-19) and which agree that COVID-19 scientists share their values. Republicans and independents are less trusting than Democrats on both measures, as are African Americans. The authors find conservative Protestants and Catholics to be skeptical of scientists’ knowledge but not their values. Working-class men and those who live outside cities believe in scientists’ knowledge but do not think they share scientists’ values. There is little evidence for a direct effect of President Trump’s criticism of scientists. The authors discuss the pragmatic implications for scientists trying to remain influential in COVID-19 policy.

When Guidance Changes: Government Inconsistency and Public Beliefs
Charlie Rafkin, Advik Shreekumar & Pierre-Luc Vautrey
MIT Working Paper, July 2020


Governments often provide inconsistent guidance to the public. Does inconsistency affect how much people believe the latest recommendations? Using an incentivized online experiment with 1,900 US respondents in early April 2020, we present all participants with the latest official projection about coronavirus death counts. We randomize exposure to information that highlights the government’s inconsistency about the coronavirus threat. When inconsistency is salient, participants have reduced propensity to revise prior beliefs about death counts and lower self-reported trust in the government. These results align with a simple model of signal extraction from government communication, and have implications for the design of changing guidelines in other settings.

Did President Trump's Tulsa Rally Reignite COVID-19? Indoor Events and Offsetting Community Effects
Dhaval Dave et al.
NBER Working Paper, July 2020


On June 20, 2020, President Donald J. Trump held his first mass campaign rally following the outbreak of COVID-19. Held in Tulsa, Oklahoma, the political gathering attracted 6,000 to 12,000 individuals to the indoor Bank of Oklahoma (BOK) arena. This study is the first to explore the impact of this event on the spread of COVID-19. First, using data from Safegraph Inc, we show that while non-resident visits to census block groups hosting the Trump event grew by approximately 25 percent, there was no decline in net stay-at-home behavior in Tulsa county, reflecting important offsetting behavioral effects. Then, using data on coronavirus cases from the Centers for Disease Control and Prevention (CDC) and a synthetic control design, we find little evidence that COVID-19 case growth grew more rapidly in Tulsa County, its border counties, or in the state of Oklahoma than each’s estimated counterfactual in the three weeks following the campaign rally. Difference-in-differences estimates further provide no evidence that COVID-19 case rates grew faster in counties that drew relatively larger shares of residents to the event. We conclude that offsetting behavioral responses to the rally — including voluntary closures of restaurants and bars in downtown Tulsa, increases in stay-at-home behavior, displacement of usual activities of weekend inflows, and smaller-than-expected crowd attendance — may be important mechanisms.

Nursing Home Staff Networks and COVID-19
Keith Chen, Judith Chevalier & Elisa Long
NBER Working Paper, July 2020


Nursing homes and other long term-care facilities account for a disproportionate share of COVID-19 cases and fatalities worldwide. Outbreaks in U.S. nursing homes have persisted despite nationwide visitor restrictions beginning in mid-March. An early report issued by the Centers for Disease Control and Prevention identified staff members working in multiple nursing homes as a likely source of spread from the Life Care Center in Kirkland, Washington to other skilled nursing facilities. The full extent of staff connections between nursing homes -- and the crucial role these connections serve in spreading a highly contagious respiratory infection -- is currently unknown given the lack of centralized data on cross-facility nursing home employment. In this paper, we perform the first large-scale analysis of nursing home connections via shared staff using device-level geolocation data from 30 million smartphones, and find that 7 percent of smartphones appearing in a nursing home also appeared in at least one other facility -- even after visitor restrictions were imposed. We construct network measures of nursing home connectedness and estimate that nursing homes have, on average, connections with 15 other facilities. Controlling for demographic and other factors, a home's staff-network connections and its centrality within the greater network strongly predict COVID-19 cases. Traditional federal regulatory metrics of nursing home quality are unimportant in predicting outbreaks, consistent with recent research. Results suggest that eliminating staff linkages between nursing homes could reduce COVID-19 infections in nursing homes by 44 percent.

Trends in anxiety among adults in the United States, 2008-2018: Rapid increases among young adults
Renee Goodwin et al.
Journal of Psychiatric Research, forthcoming

Methods: Data from the National Survey on Drug Use and Health (NSDUH), which is an annual, cross-sectional survey on substance use and mental health in the US, were analyzed in 2020. Prevalence of past-month anxiety was estimated among those ages ≥18, by survey year from 2008 to 2018. Time trends were tested using logistic regression.

Results: Anxiety increased from 5.12% in 2008 to 6.68% in 2018 (p<.0001) among adult Americans. Stratification by age revealed the most notable increase from 7.97% to 14.66% among respondents 18-25 years old (p<.001), which was a more rapid increase than among 26-34 and 35-49 year olds (differential time trend p<.001). Anxiety did not significantly increase among those ages 50 and older. Anxiety increased more rapidly among those never married and with some college education, relative to their respective counterparts. Apart from age, marital status and education, anxiety increased consistently among sociodemographic groups.

Professional Sporting Events Increase Seasonal Influenza Mortality in US Cities
Alexander Cardazzi et al.
West Virginia University Working Paper, June 2020


The COVID-19 pandemic shut down sporting events worldwide. Local policy makers and league officials face important decisions about restarting play, especially in professional leagues that draw large numbers of spectators to games. We analyze the impact of professional sporting events on local seasonal influenza mortality to develop evidence that will help inform sports league reopening policy decisions. Results from a difference-in-differences model applied to data from a sample of US cities that gained new professional sports teams over the period 1962-2016 show that the presence of games in these cities increased local influenza mortality by between 4% and 24%, depending on sport, relative to cities with no professional sports teams and relative to mortality in those cities before a new team arrived. Influenza mortality fell in cities with teams in some years when work stoppages occurred in sports leagues. Sports league reopening policies should take into account the role played by sporting events in increasing local seasonal flu mortality.

The Effects of Education on Mortality: Evidence From Linked U.S. Census and Administrative Mortality Data
Andrew Halpern-Manners et al.
Demography, August 2020, Pages 1513–1541


Does education change people’s lives in a way that delays mortality? Or is education primarily a proxy for unobserved endowments that promote longevity? Most scholars conclude that the former is true, but recent evidence based on Danish twin data calls this conclusion into question. Unfortunately, these potentially field-changing findings — that obtaining additional schooling has no independent effect on survival net of other hard-to-observe characteristics — have not yet been subject to replication outside Scandinavia. In this article, we produce the first U.S.-based estimates of the effects of education on mortality using a representative panel of male twin pairs drawn from linked complete-count census and death records. For comparison purposes, and to shed additional light on the roles that neighborhood, family, and genetic factors play in confounding associations between education and mortality, we also produce parallel estimates of the education-mortality relationship using data on (1) unrelated males who lived in different neighborhoods during childhood, (2) unrelated males who shared the same neighborhood growing up, and (3) non-twin siblings who shared the same family environment but whose genetic endowments vary to a greater degree. We find robust associations between education and mortality across all four samples, although estimates are modestly attenuated among twins and non-twin siblings. These findings — coupled with several robustness checks and sensitivity analyses — support a causal interpretation of the association between education and mortality for cohorts of boys born in the United States in the first part of the twentieth century.

A New Look at Cohort Trend and Underlying Mechanisms in Cognitive Functioning
Hui Zheng
Journals of Gerontology: Series B, forthcoming

Method: Data come from 30,191 participants of the 1996-2014 Health and Retirement Study. CF is measured as a summary score on a 35-point cognitive battery of items. We use generalized linear models to examine the trends in CF and explanatory variables across birth cohorts. Then Karlson-Holm-Breen decomposition method is used to evaluate the contribution of each explanatory variable to the trend of CF.

Results: CF has been improving from the Greatest Generation to Late Children of Depression and War Babies, but then significantly declines since the Early-Baby Boomers and continues into Mid-Baby Boomers. This pattern is observed universally across genders, race/ethnicities, education groups, occupations, income and wealth quartiles. The worsening CF among Baby Boomers does not originate from childhood conditions, adult education, or occupation. It can be attributed to lower household wealth, lower likelihood of marriage, higher levels of loneliness, depression and psychiatric problems, and more cardiovascular risk factors (e.g., obesity, physical inactivity, hypertension, stroke, diabetes, and heart disease).

Geographic Patterns of Implicit Age Bias and Associations with State‐level Health Outcomes across the United States
Hannah Giasson & William Chopik
European Journal of Social Psychology, forthcoming


Negative attitudes toward aging are pervasive in society and may be detrimental to people’s health as they become older. Older people tend to report feeling significantly younger than their chronological age, often as a way of psychologically distancing themselves from the stigma of old age. However, attitudes and behaviors toward aging may differ across regional contexts. We examined associations among state‐level patterns of bias against older adults and state‐level health outcomes across the United States. Data from 803,009 respondents (ages: 15‐94) across 50 U.S. states (and the District of Columbia) revealed geographic variation in implicit age bias. Higher state‐level implicit age bias was associated with poorer state‐level health outcomes among adults ages 65+. Older adults living in states high in implicit age bias showed greater age‐group dissociation compared to older adults living in states low in implicit age bias. Findings highlight potential consequences of implicit age bias and invite further research on the long‐term health implications of individual age‐group dissociation in response to regional age bias.

Insurance Design and Pharmaceutical Innovation
Leila Agha, Soomi Kim & Danielle Li
NBER Working Paper, July 2020


This paper studies how insurance coverage policies affect incentives for pharmaceutical innovation. In the United States, the majority of drugs are sold to Pharmacy Benefit Managers (PBMs), which administer prescription drug plans on behalf of insurers. Beginning in 2012, PBMs began adopting “closed formularies”, excluding coverage for certain drugs, including many newly approved drugs, when adequate substitutes were available. We show that this policy reshaped upstream R&D activity and led pharmaceutical firms to shift investment away from therapeutic classes at greater risk of facing coverage exclusions. This move translated into a relative decline in the number of drug candidates that appear more incremental in their therapeutic contribution: that is, those in drug classes with more pre-existing therapies and less scientifically novel research.

The effects of soda taxes on adolescent sugar intake and blood sugar
Brandon Restrepo & Jonathan Cantor
Health Economics, forthcoming


Intake of added sugars is high in the US adolescent population, with sugar‐sweetened beverages being the primary source. We contribute to the literature by providing the first estimates of the impacts of soda sales taxes, which are commonly levied in the US states, on the total daily sugar intake and blood sugar of adolescents aged 12–19 years. Using a restricted‐use version of the 1999–2014 National Health and Nutrition Examination Survey (NHANES) and exploiting within‐state variation in soda sales tax rates over time, our results indicate that adolescent soft drink demand is tax‐sensitive. Consistent with prior research using NHANES data, we find that adolescents reduce calories consumed from soft drinks when faced with a rise in soda sales taxes, but they offset this reduction with an increase in calorie intake from milk drinks. In accordance with this substitution behavior, we find that soda sales taxes cause small and insignificant changes in the total daily calorie intake, total daily sugar intake, or blood sugar levels of adolescents.


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