Personal traits, cohabitation, and marriage.

This study examines how personal traits affect the likelihood of entering into a cohabitating or marital relationship using a competing risk survival model with cohabitation and marriage as competing outcomes. The data are from Waves 1, 3, and 4 of the National Longitudinal Study of Adolescent Health, a rich dataset with a large sample of young adults (N=9835). A personal traits index is constructed from interviewer-assessed scores on the respondents' physical attractiveness, personality, and grooming. Having a higher score on the personal traits index is associated with a greater hazard of entering into a marital relationship for men and women, but the score does not have a significant influence on entering into a cohabitating relationship. Numerous sensitivity tests support the core findings.

Motorcycle fatalities among out-of-state riders and the role of universal helmet laws.

Several studies have demonstrated that universal helmet laws (UHLs) and other motor vehicle policies are effective in reducing fatal and non-fatal motorcycle injuries. Although state policies can improve traffic safety overall, very little is known about how they affect different segments of motorcycle riders. In this paper, we investigate the differential effectiveness of such policies by license state of the rider (i.e., in-state versus out-of-state). From a policy perspective, this information gap is noteworthy because variations in state regulations may influence where individuals choose to ride. We use state-level longitudinal (1988-2008) data on motorcycle fatalities in the United States from the fatality analysis reporting system (FARS). Our results reconfirm the effectiveness of UHLs and offer new evidence suggesting that states without such policies may attract more risky riders from out-of-state. In particular, not having a UHL increases out-of-state rider fatalities by 18 percent and this effect is more pronounced for out-of-state riders who reside in a UHL state. These findings have important implications regarding unintended spillover effects of state-specific motor vehicle policies.

Alcohol use and crime: findings from a longitudinal sample of U.S. adolescents and young adults.

BACKGROUND: A positive relationship between alcohol use and criminal activity has been well documented among adults, but fewer studies explore this relationship among adolescents. METHODS: Using data from 4 waves of the National Longitudinal Study of Adolescent Health (Add Health), we examine alcohol use patterns and criminal activity from adolescence to young adulthood. Fixed-effects models partially address the potential endogeneity of alcohol use, and, because numerous studies indicate that males are more likely than females to engage in drinking and criminal activity, the analyses are segmented by gender. RESULTS: We find a strong positive relationship between alcohol consumption, the commission of crimes, and criminal victimization for both genders. Various sensitivity analyses and robustness checks support this core finding. CONCLUSIONS: Our results have important policy implications, as public policy tools that aim to reduce drinking among adolescents could also reduce criminal activity. Moreover, effective alcohol abuse treatment may indirectly reduce delinquency and thus have greater long-term economic benefits than previously estimated.

Alcohol Use and Popularity: Social Payoffs from Conforming to Peers' Behavior.

Although many economic analyses of adolescents have examined the costs of risky behaviors, few have investigated the gains that young people derive from such actions, particularly in terms of social payoffs for complying with peer behavior. This paper studies the relationship between adolescents' use of alcohol (relative to that of their peers) and popularity at school. We use data from the National Longitudinal Study of Adolescent Health, a rich and nationally-representative survey with detailed information on social networks. Our findings suggest that adolescents are socially rewarded for conforming to their peers' alcohol use and penalized (to a lesser degree) for increasing their consumption above that of their peers. Male adolescents are rewarded for keeping up with their peers' drinking and for getting drunk. Female adolescents are rewarded for drinking per se, but not necessarily for keeping up with their peers. The results offer new information on peer influence and have implications for substance abuse interventions at school and in the community.

Is the United States ready to embrace concierge medicine?

Concierge medicine (also called retainer practices or consumer-focused care) represents a new approach to the delivery of primary care. This model involves more personalized attention and greater resources for individual patients, thus limiting the number of patients who can be served at each practice. All enrolled members must pay an annual membership fee or retainer. Given the short history and novelty of concierge medicine, this article explores the clinical, economic, marketing, ethical, and policy implications of this innovative approach to primary care.

The health effects of parental problem drinking on adult children.

BACKGROUND: Much of the research on adult children of alcoholics has focused on the transmission of drinking patterns from parents to their children and the development of alcohol-related problems. Less is known about how exposure to parental problem drinking affects children as they progress into adulthood in terms of other mental health outcomes. This is crucial information, in part because the average age of onset for depression and other mental health disorders is during late adolescence or young adulthood. AIMS: The objective of this study was to rigorously assess the long-term impacts of parental problem drinking on adult children's mental and self-perceived overall health. The study improves on previous literature by analyzing a range of mental health markers and other predictors of morbidity, by focusing on a period of adulthood that only a limited number of studies have examined, and by using data from a highly regarded and nationally representative panel study. DATA: The analysis used data from the NLSY79, a nationally representative sample of 12,686 men and women. The NLSY79 collected detailed information about personal and family characteristics, including alcohol and other substance use, for a cohort of individuals who were between the ages of 14 and 22 when first surveyed in 1979. The survey was re-administered each year through 1994 and on a biennial basis since then. The dataset provides information on parental drinking and identifies problematic drinking behaviors both among mothers and fathers. Beginning with the 1998 survey, an extensive health module was administered to respondents over 40 years of age to provide a baseline health profile of the respondents before retirement. It includes a set of measures that assess the mental, physical, and behavioral health of the respondents when they reached the age of 40. METHODS: Estimation was conducted using propensity score matching (PSM) methods. Through the use of PSM methods, we control for a rich set of observed demographic, household, geographic, and economic characteristics, as well as unobserved features correlated with these variables, that predispose a parent to drink problematically, thereby reducing the possibility of estimation bias. In addition, PSM is superior to traditional multivariate regression in that it allows for the possibility of non-linear effects and the comparison of treatment and control individuals with similar characteristics. RESULTS: The results indicate that parental problem drinking is associated with significant mental health consequences for children that persist far into adulthood. Adult respondents with a problem-drinking father were more likely to have been diagnosed with mental health problems relative to other respondents, while those with a problem-drinking mother had poorer self-perceived health and mental health (SF-12) scores. Respondents with a problem-drinking mother were also more likely to have ever been diagnosed with a mental health problem. Outcomes were worse for daughters of problem drinkers than for sons. POLICY IMPLICATIONS: These long-lasting consequences of parental problem drinking on adult children's mental health should be considered when designing and financing interventions targeting problem drinkers and their families.

Public policies and motorcycle safety.

Numerous studies have examined the effectiveness of alcohol and traffic policies in reducing automobile crashes and fatalities, but only a few have analyzed the impact of state-specific policies on motorcycle safety. Given the growing popularity and inherent safety risks of motorcycle riding, this study provides a comprehensive investigation of both fatal and non-fatal injuries. State-level longitudinal data from 1990 to 2005 are analyzed to determine how various alcohol and traffic policies impact motorcycle safety and whether there are differential effects by type of injury. The results consistently show that universal helmet laws have the most significant effect on both non-fatal and fatal injuries. Mandatory rider education programs and speed limits on rural interstates significantly impact non-fatal injuries.

Substance use, education, employment, and criminal activity outcomes of adolescents in outpatient chemical dependency programs.

Although the primary outcome of interest in clinical evaluations of addiction treatment programs is usually abstinence, participation in these programs can have a wide range of consequences. This study evaluated the effects of treatment initiation on substance use, school attendance, employment, and involvement in criminal activity at 12 months post-admission for 419 adolescents (aged 12 to 18) enrolled in chemical dependency recovery programs in a large managed care health plan. Instrumental variables estimation methods were used to account for unobserved selection into treatment by jointly modeling the likelihood of participation in treatment and the odds of attaining a certain outcome or level of an outcome. Treatment initiation significantly increased the likelihood of attending school, promoted abstinence, and decreased the probability of adolescent employment, but it did not significantly affect participation in criminal activity at the 12-month follow-up. These findings highlight the need to address selection in a non-experimental study and demonstrate the importance of considering multiple outcomes when assessing the effectiveness of adolescent treatment.

Economic evaluation of adolescent addiction programs: methodologic challenges and recommendations.

This article identifies and describes several methodologic challenges encountered in economic evaluations of substance abuse interventions for adolescents. Topics include study design, the choice of perspective, the estimation of costs and outcomes, and the generalizability of results. Recommendations are offered for confronting these challenges using examples from research on adolescent substance abuse and dependency/addiction.

Alcohol consumption and health among elders.

PURPOSE: This article estimates the effects of alcohol consumption on self-reported overall health status, injuries, heart problems, emergency room use, and hospitalizations among persons older than the age of 65. DESIGN AND METHODS: We analyzed data from the first wave of the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative study. We used multivariate regression and instrumental variables methods to study the associations between alcohol consumption (current drinking, binge drinking, and average number of drinks consumed) and several indicators of health status and health care utilization. RESULTS: Alcohol consumption by women was associated with better self-perceived health status, improved cardiovascular health, and lower rates of hospitalizations. We detected no significant negative or positive associations for older men. IMPLICATIONS: These findings suggest that light to moderate alcohol use by older women may have beneficial health effects. Experimental trials, however, are needed to more rigorously assess the potential benefits of alcohol use by elders due to the inherent biases of observational studies.

Does America spend enough on addiction treatment? Results from public opinion surveys.

Addiction treatment is often misunderstood and underappreciated in the United States. Although a large body of literature clearly demonstrates the clinical and economic benefits of addiction treatment for many clients and in most settings, the general public has a somewhat ambivalent attitude toward treatment expansion and taxpayer financing. A potential reason for this disconnect between economic evidence and public opinion is a weak identification with the need for, or the success of, addiction treatment for those individuals without a substance abuse problem themselves or in members of their family. Alternatively, addiction treatment stakeholders may be delivering an ineffective or misdirected message about the social value of this industry. This article explores these and other potential explanations for the paradoxically low placement of the addiction treatment industry among other socially important institutions in the United States. Although none of the explanations advanced in this article has been scientifically tested or verified, it is hoped that the historical inquiry and information provided herein will offer practical strategies for the stability and growth of the addiction treatment industry.