The Effect of the Earned Income Tax Credit on Physical and Mental health-Results from the Atlanta Paycheck Plus Experiment.

Policy Points The Paycheck Plus randomized controlled trial tested a fourfold increase in the Earned Income Tax Credit (EITC) for single adults without dependent children over 3 years in New York and Atlanta. In New York, the intervention improved economic, mental, and physical health outcomes. In Atlanta, it had no economic benefit or impact on physical health and may have worsened mental health. In Atlanta, tax filing and bonus receipt were lower than in the New York arm of the trial, which may explain the lack of economic benefits. Lower mental health scores in the treatment group were driven by disadvantaged men, and the study sample was in good mental health. CONTEXT: The Paycheck Plus experiment examined the effects of an enhanced Earned Income Tax Credit (EITC) for single adults on economic and health outcomes in Atlanta, GA and New York City (NYC). The NYC study was completed two years prior to the Atlanta study and found mental and physical benefits for the subgroups that responded best to the economic incentives provided. In this article, we present the findings from the Atlanta study, in which the uptake of the treatment (tax filings and EITC bonus) were lower and economic and health benefits were not observed. METHODS: Paycheck Plus Atlanta was an unblinded randomized controlled trial that assigned n = 3,971 participants to either the standard federal EITC (control group) or an EITC supplement of up to $2,000 (treatment group) for three tax years (2017-2019). Administrative data on employment and earnings were obtained from the Georgia Department of Labor and survey data were used to examine validated measures of health and well-being. FINDINGS: In Atlanta, the treatment group had significantly higher earnings in the first project year but did not have significantly higher cumulative earnings than the control group overall (mean difference = $1,812, 95% CI = -150, 3,774, p = 0.07). The treatment group also had significantly lower scores on two measures of mental health after the intervention was complete: the Patient Health Questionnaire 8 (mean difference = 0.19, 95% CI = 0.06, 0.32, p = 0.005) and the Kessler 6 (mean difference = 0.15, 95% CI = 0.03, 0.27, p = 0.012). Secondary analyses suggested these results were driven by disadvantaged men, but the study sample was in good mental health. CONCLUSIONS: The EITC experiment in Atlanta was not associated with gains in earnings or improvements in physical or mental health.

Did people really drink bleach to prevent COVID-19? A guide for protecting survey data against problematic respondents.

Survey respondents who are non-attentive, respond randomly, or misrepresent who they are can impact the outcomes of surveys. Prior findings reported by the CDC have suggested that people engaged in highly dangerous cleaning practices during the COVID-19 pandemic, including ingesting household cleaners such as bleach. In our attempts to replicate the CDC's results, we found that 100% of reported ingestion of household cleaners are made by problematic respondents. Once inattentive, acquiescent, and careless respondents are removed from the sample, we find no evidence that people ingested cleaning products to prevent a COVID-19 infection. These findings have important implications for public health and medical survey research, as well as for best practices for avoiding problematic respondents in all survey research conducted online.

Effect of a First Clinical Experience on Physical Therapy Students' Perception of the Importance of Obtaining and Assessing Blood Pressure.

AIMS: The purpose of this mixed-methods study was to investigate the effect of a first clinical experience on student perception of the importance of obtaining and assessing blood pressure (BP). METHODS: Fifty-eight students preparing for their first clinical experiences were recruited from three New York State physical therapy programs. Student experience obtaining BP during a first clinical experience was investigated using online anonymous surveys and focus groups. The pre survey was administered at 2 weeks before the first clinical experience, and a post survey and focus group were complete 3 weeks after. RESULTS: Statistically significant decline was found in student perceptions of the importance and likelihood of obtaining and assessing BP following a first clinical experience. Qualitatively, three themes emerged (1) Being a student and agency including reluctance to independently initiate practices; (2) influence of clinic norms such as availability of equipment and consistency of BP monitoring; and (3) personal confidence obtaining, assessing, and interpreting BP influenced by exposure to obtaining, assessing, and interpreting BP. CONCLUSION: Clinical education appears to have significant influence on students' perception of the importance of BP assessment. If students encounter and adopt practices deviating from didactic instruction reflecting professional standards, it can expose patients and practitioners to unnecessary risk. Faculty can use these results to better appreciate students' first clinical experiences and foster agency by discussing practice norms.

Examining the social origins and young adult life trajectories of high traditional masculinity (HTM) males: A group at elevated suicide risk.

OBJECTIVE: We investigated whether male high school students displaying high traditional masculinity (HTM), defined briefly as overacting male roles, possessed distinctive social origins and adult lifestyle trajectories differentiating them from others. METHOD: Based upon four survey waves of the National Longitudinal Study of Adolescent to Adult Health cross-linked to the National Death Index, we contrasted surveys 1 and 2 respondents reporting HTM, n = 3138, 31%, with the remaining 69% (n = 6849) on various sociodemographic characteristics, problem behaviors, suicides, and other premature mortalities. RESULTS: High traditional masculinity males showed higher suicide rates, but no other differences in premature mortalities, compared with non-HTM peers. More likely to be White, younger, less close to their fathers, they were more likely to run away from home, get into fights, act delinquently, and engage in problem drinking and drug use. At survey wave 3, more had been arrested. By wave 4, when approaching their early thirties, HTM males showed higher drug uses, more delinquency, completed less schooling, and were less likely to marry. CONCLUSIONS: These data not only suggest higher suicide risks among this population after high school, but judging from the durability of HTM characteristics, but also they appear at risk of "deaths of despair" during later life.

Psychological Distress Among the First Quarantined Community in the United States: Initial Observations From the Early Days of the COVID-19 Crisis.

This study assesses distress and anxiety symptoms associated with quarantine due to COVID-19 exposure among the first quarantined community in the United States and identifies potential areas of intervention. All participants were directly or peripherally related to "patient 1,"-the first confirmed community-acquired case of COVID-19 in the New York Area. As such, this is a historically significant sample whose experiences highlight a transitional moment from a pre-pandemic to a pandemic period in the United States. In March 2020, an anonymous survey was distributed to 1,250 members of a NYC area community that was under community-wide quarantine orders due to the COVID-19 outbreak. Distress was measured using the Subjective Units of Distress Scale (SUDS) and symptoms of anxiety were measured using the Beck Anxiety Inventory (BAI). A variety of psychosocial predictors relevant to the current crisis were explored. Three hundred and three individuals responded within forty-eight hours of survey distribution. Mean levels of distress in the sample were heightened and sustained, with 69% reporting moderate to severe distress on the SUDS and 53% of the sample reported mild, moderate, or severe anxiety symptoms on the BAI. The greatest percentage of variance of distress and anxiety symptoms was accounted for by modifiable factors amenable to behavioral and psychological interventions.

A Look at the First Quarantined Community in the USA: Response of Religious Communal Organizations and Implications for Public Health During the COVID-19 Pandemic.

The current study examined anxiety and distress among members of the first community to be quarantined in the USA due to the COVID-19 pandemic. In addition to being historically significant, the current sample was unusual in that those quarantined were all members of a Modern Orthodox Jewish community and were connected via religious institutions at which exposure may have occurred. We sought to explore the community and religious factors unique to this sample, as they relate to the psychological and public health impact of quarantine. Community organizations were trusted more than any other source of COVID-19-related information, including federal, state and other government agencies, including the CDC, WHO and media news sources. This was supported qualitatively with open-ended responses in which participants described the range of supports organized by community organizations. These included tangible needs (i.e., food delivery), social support, virtual religious services, and dissemination of COVID-19-related information. The overall levels of distress and anxiety were elevated and directly associated with what was reported to be largely inadequate and inconsistent health-related information received from local departments of health. In addition, the majority of participants felt that perception of or concern about future stigma related to a COVID-19 diagnosis or association of COVID-19 with the Jewish community was high and also significantly predicted distress and anxiety. The current study demonstrates the ways in which religious institutions can play a vital role in promoting the well-being of their constituents. During this unprecedented pandemic, public health authorities have an opportunity to form partnerships with religious institutions in the common interests of promoting health, relaying accurate information and supporting the psychosocial needs of community members, as well as protecting communities against stigma and discrimination.

The persistence of pay inequality: The gender pay gap in an anonymous online labor market.

Studies of the gender pay gap are seldom able to simultaneously account for the range of alternative putative mechanisms underlying it. Using CloudResearch, an online microtask platform connecting employers to workers who perform research-related tasks, we examine whether gender pay discrepancies are still evident in a labor market characterized by anonymity, relatively homogeneous work, and flexibility. For 22,271 Mechanical Turk workers who participated in nearly 5 million tasks, we analyze hourly earnings by gender, controlling for key covariates which have been shown previously to lead to differential pay for men and women. On average, women's hourly earnings were 10.5% lower than men's. Several factors contributed to the gender pay gap, including the tendency for women to select tasks that have a lower advertised hourly pay. This study provides evidence that gender pay gaps can arise despite the absence of overt discrimination, labor segregation, and inflexible work arrangements, even after experience, education, and other human capital factors are controlled for. Findings highlight the need to examine other possible causes of the gender pay gap. Potential strategies for reducing the pay gap on online labor markets are also discussed.

Unraveling the Complex Web of Associations Between Easy Access to Firearms and Premature Mortalities.

OBJECTIVE: We investigated whether high school students reporting easy access to guns were more likely to die prematurely from either suicide, homicide, or an accidental death. METHOD: Based upon the National Longitudinal Study of Adolescent to Adult Health, we contrasted those reporting easy access to guns, n = 5,185, 25%, with the remaining 75% (n = 15,589) on various sociodemographic characteristics, behaviors, and premature mortalities. RESULTS: We found higher rates of suicides, homicides, and accidental deaths among those reporting easy access to guns at Wave 1 or Wave 2. This was only true for males. Those with easy access to guns were more likely to share common sociodemographic characteristics, came from two-parent homes where children had strong and close relationships with parents, where children were more likely to get into fights, do delinquent misdeeds, and engage in other risk-taking behaviors such as increased drinking, drug use, and riding motorcycles. Logistic regression analysis showed easy access to guns remained a significant predictor of premature mortalities when sex, family income differences, risk-taking, and delinquency were used as covariates. CONCLUSIONS: This study supports previous research and carves out new ground showing easy access to guns acts synergistically with other lifestyle differences to diminish youth life chances.

Research Note on Whether Sexual Minority Individuals Are Over-Represented Among Suicide's Casualties.

Background: Past studies have repeatedly shown higher suicidal thoughts and attempts among sexual minority members, yet have remained opaque on whether these groups are more prone to taking their own lives. Aims: This short report focuses on suicide deaths among sexual minority members. Method: We utilized two large-scale surveys: one, among adults, the updated Cumulative General Social Surveys, and the other, among adolescents, The National Longitudinal Study of Adolescent Health (Add Health), where respondents' data were cross-linked to National Death Index death records. Results: Results confirmed pre-existent findings showing elevated suicide rates among sexual minority females but not among sexual minority males. Limitations: The shortfall of female adolescent suicides in the Add Health sample prevented us from examining the question of female sexual minority suicides within this population. Conclusion: Although ample evidence demonstrates higher suicidal thoughts and attempts among sexual minority males, three studies presently do not confirm their greater propensity to die by suicide, compared with heterosexual males; yet, for sexual minority females the evidence is steadily mounting showing their greater suicide risks.

The cost-effectiveness analysis of the New Rural Cooperative Medical Scheme in China.

OBJECTIVE: The New Rural Cooperative Medical Scheme (NCMS) is a universal healthcare coverage plan now covering over 98% of rural residents in China, first implemented in 2003. Rising costs in the face of modest gains in health and financial protections have raised questions about the cost-effectiveness of the NCMS. METHODS: Using the most recent estimates of the NCMS's health and economic consequences from a comprehensive review of the literature, we conducted a cost-effectiveness analysis using a Markov model for a hypothetical cohort between ages 20 and 100. We then did one-way sensitivity analyses and a probabilistic sensitivity analysis using Monte Carlo simulations to explore whether the incremental cost-effectiveness ratio (ICER) falls below 37,059 international dollars [Int$], the willingness-to-pay (WTP) threshold of three times per capita GDP of China in 2013. FINDINGS: The ICER of the NCMS over the lifetime of an average 20-year-old rural resident in China was about Int$71,480 per quality-adjusted life year (QALY) gained (95% confidence interval: cost-saving, Int$845,659/QALY). There was less than a 33% chance that the system was cost-saving or met the WTP threshold. However, the NCMS did fall under the threshold when changes in the program costs, the risk of mortality and hypertension, and the likelihood of labor force participation were tested in one-way sensitivity analyses. CONCLUSION: The NCMS appears to be economically inefficient in its current form. Further cost-effectiveness analyses are warranted in designing insurance benefit packages to ensure that the NCMS fund goes toward health care that has a good value in improving survival and quality of life.

Racial Disparities in Cleanliness Attitudes Mediate Purchasing Attitudes Toward Cleaning Products: a Serial Mediation Model.

The present study has three objectives (1) to examine whether there are differences in cleanliness concerns between African Americans and European Americans toward kitchen items that are known to be vectors of disease, (2) to examine whether disparities in cleanliness attitudes have an impact on purchasing attitudes toward kitchen cleaning products, and (3) to explore the mechanisms that may account for these differences utilizing a serial mediation model. Five hundred participants, 50% African American and 50% European American were shown a picture of a sponge cleaning product and filled out multiple survey instruments relating to cleanliness attitudes. We found greater concern with cleanliness of kitchen items (d = .46) and a greater willingness to purchase cleaning products among African Americans compared to European Americans (17 vs 10%). A serial mediation analysis revealed that general cleanliness concerns account for the increased willingness to spend money on cleaning products among African Americans. These results suggest that African Americans are more sensitive to issues of cleanliness compared to European Americans and, in particular, are more sensitive to cleanliness of kitchen items such as sponges, which can be vectors of food-borne pathogens. Potential reasons for the observed racial disparities in cleanliness attitudes and the implications of these results for public health are discussed.

The impact of urban speed reduction programmes on health system cost and utilities.

BACKGROUND: Vehicle speed changes impact the probability of injuring a pedestrian in ways that differ from the way that it impacts the probability of a collision or of death. Therefore, return on investment in speed reduction programmes has complex and unpredictable manifests. The objective of this study is to analyse the impact of motor vehicle speed reduction on the collision-related morbidity and mortality rates of urban pedestrians. METHODS AND FINDINGS: We created a simple way to estimate the public health impacts of traffic speed changes using a Markov model. Our outcome measures include the cost of injury, quality-adjusted life years (QALYs) gained and probability of death and injury due to a road traffic collision. Our two-way sensitivity analysis of speed, both before the implementation of a speed reduction programme and after, shows that, due to key differences in the probability of injury compared with the probability of death, speed reduction programmes may decrease the probability of death while leaving the probability of injury unchanged. The net result of this difference may lead to an increase in injury costs due to the implementation of a speed reduction programme. We find that even small investments in speed reductions have the potential to produce gains in QALYs. CONCLUSIONS: Our reported costs, effects and incremental cost-effectiveness ratios may assist urban governments and stakeholders to rethink the value of local traffic calming programmes and to implement speed limits that would shift the trade-off to become between minor injuries and no injuries, rather than severe injuries and fatalities.

The Cost-effectiveness Analysis of Nurse-Family Partnership in the United States.

We evaluated whether Nurse-Family Partnership might serve as a cost-effective social policy for improving health. Using data from studies of randomized controlled trials as well as real-world data, we conducted a Monte Carlo simulation to estimate cost-effectiveness of Nurse-Family Partnership in a hypothetical cohort of first-born children in the United States. Analyses were conducted in 2015. Were all new mothers eligible for Nurse-Family Partnership, the program would produce 0.11 QALYs (95% confidence interval [CI]=0.06, 0.17) at an additional cost of $1,021 (95% CI=-$2,831, $4,414) per nurse-visited child's lifetime relative to the comparison-group children or $14,642 (95% CI = Savings, $71,877) per QALY gained. However, if applied to high-risk mothers, it would generate 0.19 QALYs (95% CI = 0.09, 0.44) and a net benefit of $2,764 (95% CI =-$1,210, $7,092) per nurse-visited child. Nurse-Family Partnership should be considered as a policy investment, particularly in an era of investments in the social determinants of health.

The cost-effectiveness of PHQ screening and collaborative care for depression in New York City.

BACKGROUND: Depression is under-diagnosed and under-treated in most areas of the US. New York City is currently looking to close gaps in identifying and treating depression through the adoption of a screening and collaborative care model deployed throughout the city. METHODS: We examine the cost-effectiveness of universal two-stage screening with the 2- and 9-item Patient Health Questionnaires (PHQ-2 and PHQ-9) in New York City followed by collaborative care for those who screen positive. We conducted microsimulations on hypothetical adult participants between ages 20 and 70. RESULTS: The incremental cost-effectiveness of the interventions over the average lifespan of a 20-year-old adult in NYC is approximately $1,726/QALY gained (95% plausible interval: cost-saving, $10,594/QALY gained). CONCLUSIONS: Two-stage screening coupled with collaborative care for depression in the clinical setting appears to be significantly less expensive than most clinical preventive interventions, such as HIV screening in high-risk patients. However, effectiveness is dependent on the city's ability to manage scale up of collaborative care models.

Vision zero: a toolkit for road safety in the modern era.

Vision Zero (VZ) is a public program that aims to have zero fatalities or serious injuries from road traffic crashes. This article examines various major components of VZ: how VZ redefines road safety, how VZ principles and philosophies can be applied to modern car and road designs, and how VZ can be applied to traffic. Applications of these principles to real-world traffic infrastructure are explored in order to show policymakers the toolkits available to increase road safety while taking into consideration local contexts.

Examining longer-term effects of parental death in adolescents and young adults: Evidence from the national longitudinal survey of adolescent to adult health.

Using longitudinal data spanning a 7-year period, we investigated the behavioral and psycho-social effects resulting from a parent's death during early childhood or teenage years on adolescent and early adulthood functioning. Findings confirmed previous work demonstrating various behavioral problems and social-psychological adjustment deficits during adolescence. Results suggested that most detrimental adjustment behaviors among parentally bereaved youth fade as they entered into young adulthood. Yet, premature school withdrawals and diminished interests in college attendance at Wave 1 left many of these young adults with diminished academic accomplishments, lingering economic disadvantages and for females a hesitancy to marry as their lives progressed into adulthood.

Cost Effectiveness of the Earned Income Tax Credit as a Health Policy Investment.

INTRODUCTION: Lower-income Americans are suffering from declines in income, health, and longevity over time. Income and employment policies have been proposed as a potential non-medical solution to this problem. METHODS: An interrupted time series analysis of state-level incremental supplements to the Earned Income Tax Credit (EITC) program was performed using data from 1993 to 2010 Behavioral Risk Factor Surveillance System surveys and state-level life expectancy. The cost effectiveness of state EITC supplements was estimated using a microsimulation model, which was run in 2015. RESULTS: Supplemental EITC programs increased health-related quality of life and longevity among the poor. The program costs about $7,786/quality-adjusted life-year gained (95% CI=$4,100, $13,400) for the average recipient. This ratio increases with larger family sizes, costing roughly $14,261 (95% CI=$8,735, $19,716) for a family of three. CONCLUSIONS: State supplements to EITC appear to be highly cost effective, but randomized trials are needed to confirm these findings.

Contrasts Between Young Males Dying by Suicide, Those Dying From Other Causes and Those Still Living: Observations From the National Longitudinal Survey of Adolescent to Adult Health.

UNLABELLED: Utilizing Add Health longitudinal data, we compared 21 male suicide casualties to 10,101 living respondents identifying suicide correlates. METHOD: 21 suicide decedents completed surveys in 1994/1995 (Wave 1) and 11 completed at Wave 3; responses were compared with Chi-square and oneway ANOVA tests. RESULTS: Suicide decedents were prone to higher delinquency and fighting at Wave 1, but not at Wave 3. At Wave 1 suicide decedents remained undistinguished from living respondents in depression, self-esteem, and drug uses. Yet, after Wave 3, the 11 respondents dying by suicide showed significantly higher depression, drug use and lower self-esteem. CONCLUSION: Delinquency trends can readily understood, but more complex causes are needed to account for unexpected changes in self-esteem, depression and drug uses.

Investigating Correlates of Suicide Among Male Youth: Questioning the Close Affinity Between Suicide Attempts and Deaths.

This study was based on a sample of male high school students who completed National Longitudinal Adolescent Health Surveys in 1994, 1995, and 2001. We studied these students prospectively, comparing those who later died by suicide (n = 21) with those who were still living (n = 10,101). We employed chi-square and analysis of variance tests for statistical significance between suicide decedents and living respondents. Results showed suicide decedents were more likely to have experienced the suicide loss of another family member, to have been expelled from school, to have engaged in more delinquent actions including fighting, and to have greater involvement with the criminal justice system. Although one might have expected suicide casualties to have exhibited a greater amount of suicidal thoughts, attempts, and higher incidences of suicidality among their friends, our analyses did not find that these factors were associated with actual suicides. Should these findings be replicated, this would point to a need to refine youth suicide risk assessments. Collecting life histories, as well as identifying patterns of delinquency and fighting, may serve as more potentially fruitful means for assessing genuine suicide risk than some traditional risk assessment methods.z.