Hit-and-run or hit-and-stay? Unintended effects of a stricter BAC limit.

Although they comprise a relatively small subset of all traffic deaths, hit-and-run (HR) fatalities are both contemptible and preventable. We analyze longitudinal data from 1982 to 2008 to examine the effects of blood alcohol concentration (BAC) laws on HR traffic fatalities. Our results suggest that lower BAC limits may have an unintended consequence of increasing HR fatalities, whereas a similar effect is absent for non-HR fatalities. Specifically, we find that the adoption of a 0.08 BAC limit is associated to an 8.3% increase in HR fatalities. This unintended effect is more pronounced in urban areas and during weekends, which are typical settings for HR incidents.

Societal Costs and Outcomes of Medical and Recreational Marijuana Policies in the United States: A Systematic Review.

Significant support exists in the United States for legalization of marijuana/cannabis. As of 2021, 36 states and four territories approved the legalization of medical cannabis via medical marijuana laws (MMLs), and 15 states and District of Columbia (DC) have adopted recreational marijuana laws (RMLs). We performed structured and systematic searches of articles published from 2010 through September 2021. We assess the literature pertaining to adolescent marijuana use; opioid use and opioid-related outcomes; alcohol use; tobacco use; illicit and other drug use; marijuana growing and cultivation; employment, earnings, and other workplace outcomes; academic achievement and performance; criminal activity; perceived harmfulness; traffic and road safety; and suicide and sexual activity. Overall, 113 articles satisfied our inclusion criteria. Except for opioids, studies on use of other substances (illicit drugs, tobacco, and alcohol) were inconclusive. MMLs and RMLs do not generate negative outcomes in the labor market, lead to greater criminal activity, or reduce traffic and road safety.

The Application of a Hospital Medical Surge Preparedness Index to Assess National Pandemic and Other Mass Casualty Readiness.

EXECUTIVE SUMMARY: This article describes the use and findings of the Hospital Medical Surge Preparedness Index (HMSPI) tool to improve the understanding of hospitals' ability to respond to mass casualty events such as the COVID-19 pandemic. For this investigation, data from the U.S. Census Bureau, the Dartmouth Atlas Project, and the 2005 to 2014 annual surveys of the American Hospital Association (AHA) were analyzed. The HMSPI tool uses variables from the AHA survey and the other two sources to allow facility, county, and referral area index calculations. Using the three data sets, the HMSPI also allows for an index calculation for per capita ratios and by political (state or county) boundaries. In this use case, the results demonstrated increases in county and state HMSPI scores through the period of analysis; however, no statistically significant difference was found in HMSPI scores between 2013 and 2014. The HMSPI builds on the limited scientific foundation of medical surge preparedness and could serve as an objective and standardized measure to assess the nation's medical readiness for crises such as the COVID-19 pandemic and other large-scale emergencies such as mass shootings. Future studies are encouraged to refine the score, assess the validity of the HMSPI, and evaluate its relevance in response to future legislative and executive policies that affect preparedness measures.

Trends in Health Care Utilization and Expenditures in the United States Across 5 Decades: 1977-2017.

BACKGROUND: Health care expenditures in the United States are high and rising, with significant increases over the decades. The delivery, organization, and financing of the health care system has evolved over time due to technological innovation, policy changes, patient preferences, altering payment mechanisms, shifting demographics, and other factors. OBJECTIVE: The objective of this study was to examine trends over time in health care utilization and expenditures in the United States. RESEARCH DESIGN: This analysis employs descriptive statistics to examine 5 decades of health care utilization and expenditure data from the Agency for Healthcare Research and Quality (AHRQ) for 1977-2017. MEASURES: Measures include utilization and expenditures (not charges) for inpatient, emergency department, outpatient physician, outpatient nonphysician, office-based physician, dental, and out-of-pocket retail prescription drugs. RESULTS: We demonstrate that while health care expenditures have increased significantly overall and by type of care, utilization trends are less pronounced. The population of the United States grew 53% between 1977 and 2017, while annual total expenditures on health care increased by 208%. Amidst attention to out-of-pocket exposure for unexpected medical care bills, out-of-pocket payments for care have declined from 32% in 1977 to 12% in 2017 but increased in amount. CONCLUSIONS: This article provides the first extended snapshot of the dynamics of health care utilization and expenditures in the United States. Aspects of health care are much different today than in previous decades, yet the inpatient setting still dominates the expenditures.

Death on the job: The Great Recession and work-related traffic fatalities.

In light of recent discussions about shifting employees from traditional workplaces to virtual employment, we are motivated by the question of whether this phenomenon will end up saving lives even in the absence of an infectious disease outbreak. Motor vehicle incidents are the leading cause of work-related fatalities in the US, killing more than 1200 workers each year, which make up about a quarter of all work-related deaths. Not only are motor vehicle crashes the top killer at work, but economic expansions can further increase occupational and traffic deaths as they both tend to be procyclical. In this paper, we examine the effects of business cycles on traffic fatalities in the US with a special focus on work-related deaths. Specifically, we implement a longitudinal design across all 50 states by compiling quarterly data for 2004-2012 and consider macroeconomic fluctuations around the Great Recession. Our findings show that traffic deaths during prosperous times are not solely due to an increase in risky behaviors such as drunk driving, but directly related to work. Given the highly preventable nature of traffic crashes, policy makers, public health advocates, and employers can develop effective strategies, including remote work arrangements, to improve both occupational and traffic safety.

The relationships between marijuana use and exercise among young and middle-aged adults.

As decriminalization, increased access, and decreased perception of risk spurs the popularity of medical and recreational marijuana, more information is needed on possible links between marijuana use and social determinants of health. The goal of this study was to assess the relationships between marijuana use and exercise. Data sources included the two most recent waves of the National Longitudinal Study of Adolescent to Adult Health (Wave IV, 2008-2009; N = 14,784 and Wave V, 2016-2018; N = 12,043). The exercise variables included any form of exercise/sport during the past 7 days and the number of days participating in each of 7 types of exercise/sport. Marijuana-use variables comprised any current use and frequency of use during the past 30 days. Both fixed-effects and random-effects models were estimated with numerous control variables, along with binary and count measures of exercise. Results show that, particularly for fixed-effects models, marijuana use is not significantly related to exercise, counter to conventional wisdom that marijuana users are less likely to be active. Indeed, the only significant estimates suggest a positive relationship, even among heavier users during the past 30 days. These findings are at odds with much of the existing literature, which generally shows a negative relationship between marijuana use and exercise. As additional states legalize the medicinal and recreational use of marijuana, perhaps its impact on exercise, one of the leading social determinants of health, is not necessarily a primary concern.

The effect of genetic vs nongenetic parental care on adult children's income and wealth in later life: An evolutionary analysis.

OBJECTIVE: Using Wave IV of the National Longitudinal Study of Adolescent to Adult Health data set, this preregistered study set out to investigate the effect of parental care arrangements (eg, genetically related parents, adoptive, step/ foster, genetic nonparental relative, and no parental figure) on adult children's income and wealth in later life. METHODS: Consistent with the preregistration plan, multivariate analyses of covariance were first used to examine, separately, the effects of paternal and maternal care arrangements on children's income and wealth in later life. Further post hoc exploratory analyses were carried out to evaluate the robustness of the findings. RESULTS: The results indicate that individual earnings in later life are unrelated to paternal care arrangements, thus questioning a key tenet of kin selection theory. However, children raised by biological fathers and adoptive fathers still enjoy significant economic advantages over nongenetic father figures and homes without fathers in relation to household income and wealth. CONCLUSIONS: Prevailing theories suggest that children raised by relatives, nongenetically related parents, and no father or mother suffer from a lack of parental investment that should manifest itself in reduced earnings and assets in adulthood. These theories are only partially correct, with evidence pointing to no deleterious effect of variable parental arrangements on individual earnings.

Psychological Distress and Coronavirus Fears During the Initial Phase of the COVID-19 Pandemic in the United States.

INTRODUCTION: The COVID-19 pandemic is a significant health and economic crisis around the world. The U.S. saw a rapid escalation in laboratory-confirmed cases of COVID-19 and related deaths in March, 2020. The financial consequences of a virtual economic shutdown to curb the spread of the coronavirus are widespread and debilitating, with over 30 million Americans (about 20% of the labor force) filing for unemployment benefits since mid-March. During these unprecedented times, it is important to understand the impact of the COVID-19 pandemic on psychological distress and overall fear associated with the virus. DATA: To gain an understanding of the overall levels and predictors of psychological distress experienced in the first month of the COVID-19 pandemic in the U.S., a survey was administered online to over 2,000 individuals residing in the country. The survey instrument was administered between March 22-26, 2020, during which time the country was suffering through a period of exponential growth in COVID-19 cases and fatalities. It was administered via MTurk, a popular crowdsourcing platform increasingly used by social scientists to procure large samples over a brief period of time. A short, valid screening instrument to measure psychological distress in individuals, the Kessler 10 scale was developed in the U.S. in the 1990s as an easy-to-administer symptom assessment. The first dependent variable is the respondents' summated Kessler 10 score. The second dependent variable is a 7-category measure of how afraid the subject is about the novel coronavirus. The final dependent variable is also a 7-category scale, this time measuring self-reported likelihood of contracting the coronavirus. A variety of socio-demographic variables and health status were collected to analyze factors associated with psychological distress and mental health. METHODS: Ordinary Least Squares (OLS) multiple regression was employed to analyze these data. RESULTS: We find that protective factors against psychological distress include age, gender (male), and physical health. Factors exacerbating psychological distress include Hispanic ethnicity and a previous mental illness diagnosis. Similar factors are significantly related to fear of the virus and self-assessed likelihood of contracting it. DISCUSSION: The COVID-19 pandemic is associated with high levels of psychological distress in the U.S. The Kessler 10 mean value in our sample is 21.12, which falls in the likely to experience mild mental illness category, yet is considerably higher compared to one of the largest and earliest benchmark studies validating the scale. Psychological distress is one element of overall mental health status that could be influenced by the COVID-10 pandemic. Other mental health conditions such as depression, anxiety, and substance use disorders could also be affected by the pandemic. We encourage researchers to examine these and other mental health disorders in future research on the COVID-19 pandemic. CONCLUSION: The relatively high mean score (21.12) for psychological distress during early stages of the pandemic suggests government officials, policy-makers, and public health advocates should act quickly to address emerging mental health problems.

Hormone Therapy and Discrimination in the Labor Market: Emerging Experimental Evidence on the Economics of Endocrinology.

BACKGROUND: Gender transitioning is increasingly common, but little is known about the extent to which individuals in transition and fully transitioned suffer from wage discrimination. Methods: Managers in the United States (n=204) were shown photos of white and Asian male and female "employees" at different stages of simulated hormone therapy and were asked to estimate their actual hourly wages based on appearance. RESULTS: The results suggest that Asian men and women "in transition" and fully transitioned do not suffer from significant wage discrimination. However, among the white stimuli, gender atypical ("in transition" and fully transitioned) men and women are estimated to earn significantly less than their gender typical (sexually dimorphic) counterparts, with some gender-specific nuances. CONCLUSIONS: The effects of hormone therapy may have a deleterious impact on the wages of white transgender individuals.

Cost-effectiveness analysis of a large jail-based methadone maintenance treatment continuation program in New Mexico.

The U.S. has the second-highest incarceration rate in the world and spends more than $80 billion annually to house inmates. The clinical research literature suggests that methadone maintenance treatment (MMT) is an effective method to treat opioid use disorders (OUD) and that jails are a potentially valuable environment to implement MMT. Currently, jail-based MMT is rarely implemented in practice, due in part to resource limitations and other economic considerations. The primary goal of this study was to perform a cost-effectiveness analysis (CEA) of jail-based MMT using data from a unique MMT continuation program located in a large urban jail in New Mexico. Recidivism data were collected for a three-year period both before and after incarceration, and quasi-control groups were constructed from both substance-using and general populations within the jail. Base models show that inmates enrolled in jail-based MMT exhibited significantly fewer days of incarceration due to recidivism (29.33) than a group of inmates with OUDs who did not receive MMT. Economic estimates indicate that it cost significantly less ($23.49) to reduce an incarcerated day using jail-based MMT than incarceration per se ($116.49). To mitigate potential sample selection bias, we used both propensity-score-matching and difference-in-differences estimators, which provided comparable estimates when using the OUD non-MMT comparison group. Difference-in-differences models find that, on average, MMT reduced recidivism by 24.80 days and it cost $27.78 to reduce an incarcerated day using jail-based MMT. Assuming a willingness to pay threshold of the break-even cost of reducing one incarcerated day, we estimate a 93.3% probability that this MMT program is cost-effective. Results were not as strong or consistent when using other comparison groups (e.g., alcohol-detoxified and general-population inmates). Overall, results suggest that it costs substantially less to provide jail-based MMT than incarceration alone. Jail administrators and policymakers should consider incorporating MMT in other jail systems and settings.

Development of a Hospital Medical Surge Preparedness Index using a national hospital survey.

To generate a Hospital Medical Surge Preparedness Index that can be used to evaluate hospitals across the United States in regard to their capacity to handle patient surges during mass casualty events. Data from the American Hospital Association's annual survey, conducted from 2005 to 2014. Our sample comprised 6239 hospitals across all 50 states, with an annual average of 5769 admissions. An extensive review of the American Hospital Association survey was conducted and relevant variables applicable to hospital inpatient services were extracted. Subject matter experts then categorized these items according to the following subdomains of the "Science of Surge" construct: staff, supplies, space, and system. The variables within these categories were then analyzed through exploratory and confirmatory factor analyses, concluding with the evaluation of internal reliability. Based on the combined results, we generated individual (by hospital) scores for each of the four metrics and an overall score. The exploratory factor analysis indicated a clustering of variables consistent with the "Science of Surge" subdomains, and this finding was in agreement with the statistics generated through the confirmatory factor analysis. We also found high internal reliability coefficients, with Cronbach's alpha values for all constructs exceeding 0.9. A novel Hospital Medical Surge Preparedness Index linked to hospital metrics has been developed to assess a health care facility's capacity to manage patients from mass casualty events. This index could be used by hospitals and emergency management planners to assess a facility's readiness to provide care during disasters.

Food insecurity, health care utilization, and health care expenditures.

OBJECTIVE: To disentangle the relationships among food insecurity, health care utilization, and health care expenditures. DATA SOURCES/STUDY SETTING: We use national data on 13 465 adults (age ≥ 18) from the 2016 Medical Expenditure Panel Survey (MEPS), the first year of the food insecurity measures. STUDY DESIGN: We employ two-stage empirical models (probit for any health care use/expenditure, ordinary least squares, and generalized linear models for amount of utilization/expenditure), controlling for demographics, health insurance, poverty status, chronic conditions, and other predictors. PRINCIPAL FINDINGS: Our results show that the likelihood of any health care expenditure (total, inpatient, emergency department, outpatient, and pharmaceutical) is higher for marginal, low, and very low food secure individuals. Relative to food secure households, very low food secure households are 5.1 percentage points (P < .001) more likely to have any health care expenditure, and have total health care expenditures that are 24.8 percent higher (P = .011). However, once we include chronic conditions in the models (ie, high blood pressure, heart disease, stroke, emphysema, high cholesterol, cancer, diabetes, arthritis, and asthma), these underlying health conditions mitigate the differences in expenditures by food insecurity status (only the likelihood of any having any health care expenditure for very low food secure households remains statistically significant). CONCLUSIONS: Policy makers and government agencies are focused on addressing deficiencies in social determinants of health and the resulting impacts on health status and health care utilization. Our results indicate that chronic conditions are strongly associated with food insecurity and higher health care spending. Efforts to alleviate food insecurity should consider the dual burden of chronic conditions. Finally, future research can address specific mechanisms underlying the relationships between food security, health, and health care.

Are tattoos associated with negative health-related outcomes and risky behaviors?

BACKGROUND: Tattoos have reached broadening mainstream acceptance. Medical professional societies have noted that tattoos may co-occur with high risk behaviors. METHODS: Using a variety of statistical models applied to a sample of 2,008 adults residing in the United States via Amazon's Mechanical Turk, we estimate the associations between tattoo characteristics, three health-related outcomes (overall health status, ever diagnosed with a mental health issue, sleep problems), and three risky behaviors (current smoking, ever spent time in jail or prison, and number of sex partners). RESULTS: We find that the presence, number, and specific features of tattoos are positively correlated with two of the health-related outcomes (ever diagnosed with a mental health issue and trouble sleeping) and all three of the risky behaviors (P < .05). Magnitudes are larger for those with multiple, visible, and offensive tattoos. CONCLUSIONS: Our results suggest that individuals with tattoos are more likely to engage in risky behaviors relative to their non-tattooed counterparts, which may lead to health consequences. Dermatologists, healthcare providers, and public health advocates should recognize that having a tattoo(s) is a potential marker for mental health issues and risky behaviors.

Why Money Alone Can't (Always) "Nudge" Physicians: The Role of Behavioral Economics in the Design of Physician Incentives.

Behavioral economics seeks to define how humans respond to incentives, how to maximize desired behavioral change, and how to avoid perverse negative impacts on work effort. Relatively new in their application to physician behavior, behavioral economic principles have primarily been used to construct optimized financial incentives. This review introduces and evaluates the essential components of building successful financial incentive programs for physicians, adhering to the principles of behavioral economics. Referencing conceptual publications, observational studies, and the relatively sparse controlled studies, the authors offer physician leaders, healthcare administrators, and practicing anesthesiologists the issues to consider when designing physician incentive programs to maximize effectiveness and minimize unintended consequences.

Watch for motorcycles! The effects of texting and handheld bans on motorcyclist fatalities.

Motorcyclists account for a much higher proportion of traffic fatalities relative to the share of motorcycles among all motor vehicles and vehicle miles driven in the U.S. In this paper, we posit that motorcyclists may be particularly vulnerable to the risks of distracted driving by others. Specifically, we examine whether state-specific texting/handheld bans significantly influence motorcyclist fatalities in the U.S. We use state-specific traffic fatality data in the U.S. (2005-2015, N = 550) from the Fatality Analysis Reporting System (FARS) merged with state-specific characteristics, texting/handheld device laws, and other traffic policies. Although research is mixed on the effectiveness of texting/handheld bans for overall traffic fatalities, our findings indicate that motorcyclists are at elevated risk of being a victim of distracted driving and thus could greatly benefit from these policies. This result is driven mainly by multiple-vehicle crashes (e.g., car hitting motorcycle) as opposed to single-vehicle crashes. Policy makers should consider strengthening texting/handheld bans along with their enforcement to improve safety and save lives, especially among motorcyclists. .

The economic costs of jail-based methadone maintenance treatment.

BACKGROUND: The US has the highest incarceration rate in the world and spends $40-$80 billion to house inmates per year. It is well-known that a significant correlation is present between substance use and crime, especially over recent years as opioid use disorder (OUD) has grown exponentially. To mitigate OUD, methadone maintenance treatment (MMT) has demonstrated effectiveness in numerous randomized and quasi-experimental studies. A potentially fruitful environment for MMT is correctional facilities, particularly short-term facilities, such as city and county jails. However, little is known about the economic implications of MMT within correctional facilities. OBJECTIVE: The aim of the present study was to estimate the economic costs of jail-based MMT using data from a novel, established MMT program located within a large urban jail in New Mexico. METHODS: Data were collected using administrative records and by interviewing program administrators using a modified version of the Drug Abuse Treatment Cost Analysis Program (DATCAP). Both sensitivity analysis and cost-structure analysis were conducted to gauge the robustness of the findings. RESULTS: The average (per patient) weekly cost of MMT is $115 and the total treatment cost for an average treatment episode is $689. These costs are generally in-line with non-jail-based MMT programs of similar size. Weekly cost estimates range from $86 to $185 depending on the size of the treatment facility, with larger programs exhibiting lower per-patient costs. CONCLUSION: Results provide a valuable economic benchmark to policy makers, criminal justice officials, and program administrators considering establishing and/or expanding MMT in jail settings.

Self-reported Health Status Differs for Amazon's Mechanical Turk Respondents Compared With Nationally Representative Surveys.

BACKGROUND: Amazon's Mechanical Turk (MTurk) platform has become a data source for peer-reviewed academic research publications, with over 24,000 Google Scholar search results. Although well-developed and supportive in other disciplines, the literature in health and medicine comparing results from samples generated on MTurk to gold standard, nationally representative health and medical surveys is beginning to emerge. OBJECTIVE: To compare the demographic, socioeconomic, and self-reported health status variables in an MTurk sample to those from 2 prominent national probability surveys, including the Medical Expenditure Panel Survey (MEPS) and the Behavioral Risk Factor Surveillance System (BRFSS). RESEARCH DESIGN: We analyze weighted and unweighted tabulations of the MTurk, MEPS, and BRFSS. Wald tests identify statistical significance. MEASURES: Demographic, socioeconomic, and health status variables in an adult MTurk sample collected in 2016 (n=1916), the 2015 MEPS household survey component (n=21,210), and the 2015 BRFSS (n=283,502). RESULTS: Our findings indicate statistically significant differences in the demographic, socioeconomic, and self-perceived health status tabulations in the MTurk sample relative to the unweighted and weighted MEPS and BRFSS. The MTurk sample is more likely to be female (65.8% in MTurk, 50.9% in MEPS, 50.2% in BRFSS), white (80.1% in MTurk, 76.9% in MEPS, and 73.9% in BRFSS), non-Hispanic (91.1%, 82.4%, and 81.4%, respectively), younger, and less likely to report excellent health status (6.8% in MTurk, 28.3% in MEPS, and 20.2% in BRFSS). CONCLUSIONS: We find significant differences across variables that warrant hesitation in using MTurk data as a replacement for the gold standard datasets in health services research.

Monetary conversion factors for economic evaluations of substance use disorders.

AIMS: Estimating the economic consequences of substance use disorders (SUDs) is important for evaluating existing programs and new interventions. Policy makers in particular must weigh program effectiveness with scalability and sustainability considerations in deciding which programs to fund with limited resources. This study provides a comprehensive list of monetary conversion factors for a broad range of consequences, services, and outcomes, which can be used in economic evaluations of SUD interventions (primarily in the United States), including common co-occurring conditions such as HCV and HIV. METHODS: Economic measures were selected from standardized clinical assessment instruments that are used in randomized clinical trials and other research studies (e.g., quasi-experimental community-based projects) to evaluate the impact of SUD interventions. National datasets were also reviewed for additional SUD-related consequences, services, and outcomes. Monetary conversion factors were identified through a comprehensive literature review of published articles as well as targeted searches of other sources such as government reports. RESULTS: Eight service/consequence/outcome domains were identified containing more than sixty monetizable measures of medical and behavioral health services, laboratory services, SUD treatment, social services, productivity outcomes, disability outcomes, criminal activity and criminal justice services, and infectious diseases consequences. Unit-specific monetary conversion factors are reported, along with upper and lower bound estimates, whenever possible. CONCLUSIONS: Having an updated and standardized source of monetary conversion factors will facilitate and improve future economic evaluations of interventions targeting SUDs and other risky behaviors. This exercise should be repeated periodically as new sources of data become available to maintain the timeliness, comprehensiveness, and quality of these estimates.

Benefit-cost analysis of SBIRT interventions for substance using patients in emergency departments.

Screening, brief intervention, and referral to treatment (SBIRT) has been widely implemented as a method to address substance use disorders in general medical settings, and some evidence suggests that its use is associated with decreased societal costs. In this paper, we investigated the economic impact of SBIRT using data from Screening, Motivational Assessment, Referral, and Treatment in Emergency Departments (SMART-ED), a multisite, randomized controlled trial. Utilizing self-reported information on medical status, health services utilization, employment, and crime, we conduct a benefit-cost analysis. Findings indicate that neither of the SMART-ED interventions resulted in any significant changes to the main economic outcomes, nor had any significant impact on total economic benefit. Thus, while SBIRT interventions for substance abuse in Emergency Departments may be appealing from a clinical perspective, evidence from this economic study suggests resources could be better utilized supporting other health interventions.

The Role of Adolescent Friendship Group Integration and Cohesion in Weapon-Related Violent Crime as a Young Adult.

Weapon-related violent crime is a serious, complex, and multifaceted public health problem. The present study uses data from Waves I and III of Add Health (n = 10,482, 54% female) to examine how friendship group integration and cohesion in adolescence (ages 12-19) is associated with weapon-related criminal activity as a young adult (ages 18-26). Results indicate that greater cohesion in friendship groups is associated with significantly lower weapon-related criminal activity in young adulthood. In addition, for adolescent girls, a greater number of close friendship ties-an indicator of friendship group integration-is associated with less weapon-related criminal activity in young adulthood. These findings suggest that school-based initiatives to facilitate inclusive and cohesive adolescent peer communities may be an effective strategy to curb weapon-related criminal activity in young adulthood.