An examination of health care efficiency in Canada: a two-stage semi-parametric approach.

Using data envelopment analysis, we examine the efficiency of Canada's universal health care system by considering a set of labour (physicians) and capital (beds) inputs, which produce a level of care (measured in terms of health quality and quantity) in a given region. Data from 2013-2015 were collected from the Canadian Institute for Health Information regarding inputs and from the Canadian Community Health Survey and Statistics Canada regarding our output variables, health utility (quality) and life expectancy (quantity). We posit that variation in efficiency scores across Canada is the result of regional heterogeneity regarding socioeconomic and demographic disparities. Regressing efficiency scores on such covariates suggests that regional unemployment and an older population are quite impactful and associated with less efficient health care production. Moreover, regional variation indicates the Atlantic provinces (Newfoundland, Prince Edward Island, Nova Scotia, New Brunswick) are quite inefficient, have poorer economic prospects, and tend to have an older population than the rest of Canada. Oaxaca-Blinder decompositions suggest that the latter two factors explain about one-third of this efficiency gap. Based on our two-stage semi-parametric analysis, we recommend Canada adjust their transfer payments to reflect these disparities, thereby potentially reducing inequality in regional efficiency.

The little intervention that could: creative aging implies healthy aging among Canadian seniors.

OBJECTIVES: Through a process of 'creative ageing', there is increased interest in how active participation in the arts can help promote health and well-being among seniors. However, few studies have quantitatively examined the benefits of a foray into artistic expression, and even fewer employ rigorous identification strategies. Addressing this knowledge gap, we use a series of quantitative techniques (ordinary least squares and quantile regression) to analyze the impact of an arts-based intervention targeting the elderly. METHODS: Recruited from Saint John, New Brunswick (a city of about 125,000 people in Eastern Canada), 130 seniors were randomly assigned to the programme, with the remaining 122 serving as the control. This intervention consisted of weekly 2-h art sessions (i.e. drawing, painting, collage, clay-work, performance, sculpting, and mixed media), taking place from January 2020 until April 2021. RESULTS: Relative to the control group, the intervention tended to reduce participant loneliness and depression, and improve their mental health. Outcomes were more evident toward the latter part of the programme, were increasing in attendance, and most efficacious among those with initially low levels of well-being. CONCLUSION: These findings imply that creative ageing promotes healthy ageing, which is especially noteworthy given COVID-19 likely attenuated our results.

The prototype willingness model: An application to adolescent driver speeding.

INTRODUCTION: Many young drivers are involved in crashes due to speeding. Some studies have used the Prototype Willingness Model (PWM) to explain the risky driving behavior of young people. However, many have measured PWM constructs in a manner inconsistent with its formulation. The PWM asserts that the social reaction pathway is underpinned by a heuristic comparison of oneself with a cognitive prototype of someone who engages in a risky behavior. This proposition has not been comprehensively examined and few PWM studies specifically examine social comparison. The current study investigates intentions, expectations, and willingness to speed by teen drivers using operationalizations of PWM constructs more aligned with their original conceptualizations. Additionally, the influence of dispositional social comparison tendency on the social reaction pathway is examined to further test the original propositions underpinning the PWM. METHOD: Two hundred and eleven independently driving adolescents completed an online survey including items measuring PWM constructs and social comparison tendency. Hierarchical multiple regression was used to investigate the influence of perceived vulnerability, descriptive and injunctive norms, and prototypes on speeding intentions, expectations, and willingness. A moderation analysis examined the effect of social comparison tendency on the association between prototype perceptions and willingness. RESULTS: The regression models explained substantial amounts of variance in intentions (39%), expectations (49%), and willingness (30%) to speed. There was no evidence that social comparison tendency influences the relationship between prototypes and willingness. CONCLUSIONS: The PWM is useful for predicting teenage risky driving. More studies should confirm that social comparison tendency does not moderate the social reaction pathway. However, there may be need for further theoretical development of the PWM. PRACTICAL APPLICATIONS: The study suggests that it may be possible to develop interventions to reduce adolescent driver speeding based on manipulation of PWM constructs such as speeding driver prototypes.

What contributes to drug driving? An exploratory investigation into the influence of problematic substance use, roadside testing and alternative transport options.

Despite a strong reliance on enforcement approaches to prevent drug driving in Australia, this behaviour is still prevalent. The objective of this study was to investigate the influence of problematic drug use (i.e., showing indications of addiction), exposure to roadside drug testing, the use of detection avoidance strategies, and perceptions relating to alternative transport options on drug driving among illicit drug users. A total of 1,541 licensed drivers from the states of Queensland, New South Wales, and Victoria completed an online survey. The survey collected demographic and problematic substance use information, as well as items assessing drug driving behaviour. Cannabis was reported to be the most commonly used drug (36.0%); the most common drug of problematic use (27.9%), and the drug most often taken prior to driving (43.5%). Observing police operating Roadside Drug Tests (RDT) was more common among the participants than being tested by RDT (35.7% vs 23%). The results indicated a significant association between being a drug driver and observing or being tested by RDT. The drug drivers were significantly more likely to report using a range of strategies to avoid police detection than the non-drug drivers. Similarly, the drug drivers reported that it was more difficult for them to use various alternative transport options than the non-drug drivers. Decision tree analyses found that significant predictors of self-reported drug driving were problematic drug use, holding a provisional or probationary licence, earning a low- or middle-income, and using detection avoidance strategies like remaining watchful for police vehicles and taking back streets. The findings of this study suggest that ongoing improvements to drug driving enforcement will need to be complemented by health-based approaches designed to reduce drug abuse and dependence, and improvements to public transport, in order to achieve a sustainable reduction in drug driving.

A systematic review of factors associated with illegal drug driving.

Drug driving is a serious problem worldwide that can increase the risk of road crashes. This systematic review seeks to identify factors associated with drug driving (i.e., driving after consuming drugs other than alcohol) to highlight gaps in existing knowledge and inform the design of more effective countermeasures. A search of the literature was conducted for the period January 1, 2005 to July 31, 2021 using six different databases. The search protocol followed PRISMA guidelines and was registered in PROSPERO (#CRD42021234616). Studies that met inclusion criteria compared drug drivers with either non-drug drivers, alcohol-only drivers or drug drivers from an earlier time period, to identify factors specifically associated with drug driving, rather than common to all drivers. Two hundred and nineteen publications met the inclusion criteria and were included within the review. Based on the findings, a logic model was developed that presents the factors associated with drug driving. Various sociodemographic, psychosocial and legal factors emerged as the main factors associated with illegal drug driving. At the sociodemographic and psychological levels, drug drivers were more likely to be single, young males who often drive after using cannabis and who score high on sensation-seeking and impulsivity scales. The key social factor found to be associated with drug driving was peer acceptance/disapproval of the behaviour. At the legal level, the review suggested that the effectiveness of current enforcement approaches to drug driving vary among jurisdictions around the world due to differences in the level of perceived certainty of apprehension and the chances of punishment avoidance. Future research into the anticipated and actual rewards for drug driving is needed to inform the development of more effective countermeasures.

Are Populists Insecure About Themselves or About Their Country? Political Attitudes and Economic Perceptions.

We investigate whether greater economic insecurity increases distrust in government and fosters authoritarian politics. Using the 2016 American National Election Studies dataset, we build on the literature regarding "egotropic" and "sociotropic" economic concerns to distinguish between "micro" insecurity (perceived insecurity regarding the individual's own personal economic well-being), and "macro" insecurity (negative expectations concerning the macro economy). Our results suggest micro insecurity is not significantly correlated with attitudinal differences, but macro-level insecurity is associated with increased levels of political distrust, accompanied by greater authoritarianism. Greater macro-level insecurity is also associated with more negative feelings toward "out-groups" (e.g. Muslims, the LGBTQ+ community, feminists, immigrants) and was a key predictor in reduced affinity for Hillary Clinton and the rise in support for Donald Trump. Results are robust to controls for political affiliation and aggregate macroeconomic indicators, suggesting that rising levels of income inequality and weakening social safety nets increase political polarization and encourage xenophobia, racism, and homophobia.

Parental economic insecurity and child health.

We explore the effects of parental economic insecurity on their children's hyperactivity and anxiety. Our central argument is that even after controlling for current family income and employment status, parents may have legitimate feelings of economic insecurity, and these may be detrimental for their children. Data from the National Longitudinal Survey of Children and Youth indicate that the health of 2- to 5-year-old children is worse when parents report themselves to be "worried about having enough money to support the family." In particular, boys are more hyperactive and girls are more anxious when parents feel less economically secure. Changes in parenting styles appear to be channels through which parental economic insecurity affects their children.

A unified deterrence-based model of legal and non-legal factors that influence young driver speeding behaviour.

Young driver speeding behaviour remains a large contributor to road trauma worldwide. In order to provide a more-in depth understanding of how to deter young drivers from this behaviour, this study developed and tested a model of the legal and non-legal factors that influence young driver's intentional speeding behaviour (exceeding the speed limit by more than 10 km/hr). A prospective survey design was conducted to measure the impact of perceptions of legal factors (including classical deterrence and reconceptualised deterrence variables) and non-legal factors (including the variables of fear of physical loss, material loss and perceived social sanctions, as well as the perception that it is safe to engage in the behaviour without being involved in a crash) at time 1, on engagement in speeding behaviour at time 2, which occurred 3 months later. A total of 200 participants aged 17-25 years completed both surveys (Mean age = 20.44 years). Using structural equation modelling, a unique model combining classical and extended deterrence theory, as well as prominent non-legal factors was created, and the variables were able to explain 41% of the variance in speeding behaviour. A high perceived severity of the punishment, experiencing direct punishment avoidance and perceiving that it is safe to speed were significant direct predictors. Meanwhile, there were also numerous significant partially mediated relationships found for both legal and non-legal variables. These findings provide important implications for both the application of deterrence-based theories in road safety and for improving countermeasures to deter young drivers more effectively from engagement in speeding.

A breath of fresh air: The effect of public smoking bans on Indigenous youth.

In general, past studies have estimated the average effect of public smoking bans on youth, ignoring differences across sub-populations. We extend the literature by considering Indigenous youth, who are a vulnerable and previously unexamined group (however, our analysis excludes First Nations youth who live on reserve). We also consider previously unexamined outcomes among youth: self-assessed health and subjective well-being. Our difference-in-differences estimates from Canada indicate that public bans reduced youth smoking and second-hand exposure in public places, on average. There was no displacement on the extensive margin, but the bans increased the number of people who smoke in the homes of youth, conditional on the presence of smokers in the household. Beyond average effects, however, we find that public bans reduced second-hand exposure in the homes of Indigenous youth (particularly Métis youth), on the extensive and intensive margins. The same youth experienced concurrent improvements in self-assessed health and life satisfaction. We conclude that public bans mitigate disparities in health and well-being between Indigenous and non-Indigenous youth, but the extent varies across Indigenous sub-populations, even within a particular country.

Racial/Ethnic Differences in Light of 100% Smoke-free State Laws: Evidence from Adults in the United States.

This study estimates racial/ethnic differences in the association between 100% smoke-free state laws and smoking, as well as self-reported health, to facilitate policy aimed at reducing disparities. Data pertain to adults aged 18 years and older, obtained from the public-use Behavioral Risk Factor Surveillance System (2002-2014). The authors exploit variation in the timing of 100% smoke-free state laws using a difference-in-differences model. Examining heterogeneity across racial/ethnic minority groups, the authors consider the association between smoke-free laws and the probability of being: a daily smoker (versus occasional); an occasional smoker (versus former); and at the top of the self-reported health scale (versus the bottom). The authors find that 100% smoke-free state laws were not correlated with smoking among women. Moreover, racial/ethnic minority men who smoked occasionally were less likely to quit than white men, and results suggest that smoke-free laws did not reduce these disparities. However, there is evidence that smoke-free laws reduced the probability of being a daily smoker for Asian and Hispanic/Latinx men, but not the probability of quitting or being at the top of the self-reported health scale. More generally, smoke-free laws were not associated with self-reported health, except that there may have been an improvement among nonsmoking American Indian/Alaska Native women. These findings underscore the importance of looking beyond average effects to consider how 100% smoke-free state laws impact racial/ethnic minorities. There is evidence that they reduced smoking and improved self-reported health for some groups, but a suite of tobacco control policies is necessary to reduce racial/ethnic disparities more broadly.

Are perceptions of penalties stable across time? The problem of causal ordering in deterrence applied to road safety.

This study addressed the causal ordering problem in deterrence research by examining the perceptual stability of deterrence variables over time and comparing the results via cross-sectional and longitudinal surveys. This research extends upon scant previous research by including three key classical deterrence variables (i.e., the perceived certainty of apprehension and the perceived severity and swiftness of punishment), as well as Homel's (1988) extra-legal deterrence-related variables of the fear of physical loss, material loss and social sanctions. A longitudinal survey design was utilised over a three month-time period (N = 200, Mage = 20.38 years, 71 males) that examined the stability of the deterrence-related variables for three road rule violations, consisting of 1) exceeding the speed limit by more than 10 km/hr, 2) reading a message on a phone while driving and 3) using the social media platform of Snapchat while driving. Overall, fluctuations were found in all the deterrence-related variables (both legal and extra-legal sanctions), with the largest difference being for the perceptions of the certainty of apprehension. Consequently, it can be suggested that: (a) longitudinal surveys are more reliable when measuring the impact of deterrence perceptions on engagement in offending behaviour and (b) the problem of causal ordering regarding utilising cross-sectional surveys is further illuminated. The results suggest that deterrence is a dynamic process, constantly changing based upon individual experiences, which reinforces the need for continued enforcement efforts (both legal and non-legal), within the road safety arena to maximise rule compliance.

Gender differences in the effectiveness of public education messages aimed at smartphone use among young drivers.

Objective: The main aim of this survey study was to evaluate the relative persuasiveness of three newly developed and piloted public education messages aimed at monitoring/reading social interactive technology on a smartphone among young male and female drivers. In accordance with the Step Approach to Message Design and Testing, the messages were evaluated on a number of outcome measures and also explored the influence of self-reported involvement in the target behavior.Methods: Participants (N = 152; 105 F) were aged 17 to 25 years (Mage = 20.14 years, SD = 2.35) and were randomly allocated to either an intervention (one of the three messages) or control (no message) condition. The messages in the intervention group were assessed on acceptance (i.e., behavioral intention and message effectiveness), rejection, and the third person effect (TPE) differential score (i.e., the message is perceived to be more effective for others than for themselves).Results: Hierarchical regression analyses found that, compared to males, females reported: a) lower intention to monitor/read social interactive technology on a smartphone while driving, b) lower rejection; and, c) lower TPE likelihood, irrespective of message.Conclusions: These findings suggest that young male drivers and young female drivers require different message content to be effective and support the importance of including multiple outcome measures to explain the messages' persuasive effects.

Can positive income anticipations reverse the mental health impacts of negative income anxieties?

Prospect theory suggests losses are more influential than equivalent sized gains in individual level decision-making. Extending this literature, we use longitudinal National Population Health Survey data (2000-01 to 2010-11) to investigate whether experienced psychological distress impacts of greater economic insecurity for working age Canadians can be fully reversed by equal sized increases in security. Economic insecurity (security) is defined as the probability of an annual income decrease (increase) of 25 percent or more. Our identification strategy employs fixed effects estimation and a set of instruments to control for unobserved heterogeneity and reverse causality. Results suggest that an initial one standard deviation increase in economic insecurity predicts a rise in psychological distress of about 0.57 standard deviations for males and 0.54 standard deviations for females. Good economic news of a similar magnitude has considerably less impact, reducing psychological distress by 0.16 and 0.35 standard deviations for males and females respectively.

Healing and/or breaking? The mental health implications of repeated economic insecurity.

Current literature confirms the negative consequences of contemporaneous economic insecurity for mental health, but ignores possible implications of repeated insecurity. This paper asks how much a person's history of economic insecurity matters for psychological distress by contrasting the implications of two models. Consistent with the health capital literature, the Healing model suggests psychological distress is a stock variable affected by shocks from life events, with past events having less impact than more recent shocks. Alternatively, the Breaking Point model considers that high levels of distress represent a distinct shift in life state, which occurs if the accumulation of past life stresses exceeds some critical value. Using five cycles of Canadian National Population Health Survey data (2000-2009), we model the impact of past economic insecurity shocks on current psychological distress in a way that can distinguish between these hypotheses. In our sample of 1775 males and 1883 females aged 25 to 64, we find a robust healing effect for one-time economic insecurity shocks. For males, only a recent one-time occurrence of economic insecurity is predictive of higher current psychological distress (0.19 standard deviations). Moreover, working age adults tend to recover from past accumulated experiences of economic insecurity if they were recently economically secure. However, consistent with the Breaking Point hypothesis, males experiencing three or four cycles of recent insecurity are estimated to have a level of current psychological distress that is 0.26-0.29 standard deviations higher than those who were employed and job secure throughout the same time period. We also find, consistent with other literature, distinct gender differences - for working age females, all economic insecurity variables are statistically insignificant at conventional levels. Our results suggest that although Canadians are resilient to one-time insecurity shocks, males most vulnerable to repeated bouts suffer from elevated levels of psychological distress.

Steering Clear of Driving After Drinking: a Tailored e-Health Intervention for Reducing Repeat Offending and Modifying Alcohol Use in a High-Risk Cohort.

PURPOSE: Digital interventions to reduce risk behaviours are emerging as effective public health measures; however, few have been applied to drink driving and associated alcohol use based on a harm reduction perspective. This paper reports on the design, development, and pilot of a novel intervention which aims to reduce repeat offending by first-time convicted drink driving offenders. It explores whether an online program is acceptable and user friendly and contains useful and relevant content, with a sample of first-time drink driving offenders recruited at the time of conviction. METHOD: Building upon existing research into interventions to reduce drink driving recidivism and problem alcohol use, a tailored program was designed to provide content specifically concerned with drink driving and with an additional component related to alcohol use. Following stakeholder and internal review, the 'Steering Clear First Offender Drink Driving Program' was subsequently piloted with 15 first-time drink driving offenders. Evaluative data was analysed both quantitatively and qualitatively. RESULTS: The pilot results indicate that the participants found the program to be user friendly, as demonstrated by high scores in relation to navigation, online delivery, engagement, avatar usage and straightforwardness. They reported that they found the content to be useful and relevant and that the key learning area was in relation to the consequences of drink driving. CONCLUSION: Online interventions for reducing risky behaviour such as drink driving may be useful and cost effective from a public health perspective. Potentially, they can directly address risky behaviours associated with alcohol use in high-risk cohorts that may not ordinarily receive intervention.

Evaluating public education messages aimed at monitoring and responding to social interactive technology on smartphones among young drivers.

Young drivers are more likely than any other age group to access social interactive technology (e.g., Facebook, E-mail) on a smartphone while driving. The current study formed part of a larger investigation and was guided by The Step Approach to Message Design and Testing (SatMDT) to evaluate the relative effectiveness of three different public education messages aimed at reducing smartphone use among young drivers. The messages were each adapted to the specific behaviours of monitoring/reading and responding to social interactive technology on smartphones. Participants (n=288; 199F, 89M) were drivers aged 17-25 years who resided in the Australian state of Queensland. Message acceptance (i.e., intention and effectiveness) and message rejection were both assessed using a self-report survey. Multivariate analyses found that, overall, the messages targeting monitoring/reading behaviour were considered more effective than those targeting responding behaviour. The message that challenged the underlying motivation that believing you are a good driver makes it easier to monitor/read social interactive technology while driving was considered particularly effective by young male drivers.

Provisional drivers' perceptions of the impact of displaying P plates.

OBJECTIVE: P plates (or decals) identify a driver's license status to other road users. They are a compulsory part of the graduated driver licensing system in Queensland, Australia, for drivers on a P1 (provisional 1) or P2 (provisional 2) license. This study explored the perceptions of young drivers regarding the display of P plates (decals) in Queensland, Australia. METHODS: In this study, 226 young drivers with a provisional (intermediate/restricted) license completed a 30-min online survey between October 2013 and June 2014. t Tests were used to compare the opinions of people who displayed their plates nearly always with those who displayed them less frequently. RESULTS: Participants approved of the requirement to display P plates with 69% of those on a P1 license and 79% on a P2 license supporting the condition to display P1 (red) plates. Participants on a P1 license (62%) and a P2 license (68%) also approved the requirement to display P2 (green) plates. However, young drivers also perceived that the display of P plates (measured from 1 = never to 5 = nearly all the time) enabled newly licensed drivers to be targeted by police and other drivers (those who do not always display P plates: M = 3.72, SD = 0.94; those who nearly always display P plates: M = 3.43, SD = 1.09). CONCLUSIONS: The study findings suggest that participants who nearly always display their P plates are more likely to report that having to display their plates resulted in them driving more carefully.

Young drivers' engagement with social interactive technology on their smartphone: Critical beliefs to target in public education messages.

The current study forms part of a larger study based on the Step Approach to Message Design and Testing (SatMDT), a new and innovative framework designed to guide the development and evaluation of health communication messages, including road safety messages. This four step framework is based on several theories, including the Theory of Planned Behaviour. The current study followed steps one and two of the SatMDT framework and utilised a quantitative survey to validate salient beliefs (behavioural, normative, and control) about initiating, monitoring/reading, and responding to social interactive technology on smartphones by N=114 (88F, 26M) young drivers aged 17-25 years. These beliefs had been elicited in a prior in-depth qualitative study. A subsequent critical beliefs analysis identified seven beliefs as potential targets for public education messages, including, 'slow-moving traffic' (control belief - facilitator) for both monitoring/reading and responding behaviours; 'feeling at ease that you had received an expected communication' (behavioural belief -advantage) for monitoring/reading behaviour; and 'friends/peers more likely to approve' (normative belief) for responding behaviour. Potential message content targeting these seven critical beliefs is discussed in accordance with the SatMDT.

The influence of the elements of procedural justice and speed camera enforcement on young novice driver self-reported speeding.

Road policing is an important tool used to modify road user behaviour. While other theories, such as deterrence theory, are significant in road policing, there may be a role for using procedural justice as a framework to improve outcomes in common police citizen interactions such as traffic law enforcement. This study, using a sample of 237 young novice drivers, considered how the four elements of procedural justice (voice, neutrality, respect and trustworthiness) were perceived in relation to two forms of speed enforcement: point-to-point (or average) speed and mobile speed cameras. Only neutrality was related to both speed camera types suggesting that it may be possible to influence behaviour by emphasising one or more elements, rather than using all components of procedural justice. This study is important as it indicates that including at least some elements of procedural justice in more automated policing encounters can encourage citizen compliance.