Standardising the measurement of e-cigarette taxes in the USA, 2010-2020.

INTRODUCTION: E-cigarette taxes have been enacted by 30 states through April 2020. E-cigarette tax schemas vary, in contrast to cigarette taxes in the USA that are levied almost exclusively as excise taxes per pack. Some states use excise taxes on liquid and containers, others ad valorem taxes on wholesale prices and others sales taxes. It is therefore difficult to understand the relative magnitudes of these e-cigarette taxes and the overall e-cigarette tax size relative to the cigarette tax size. OBJECTIVE: To create and publish a database of state and local quarterly e-cigarette taxes from 2010 to 2020, standardised as the rate per millilitre of fluid. METHODS: Using Universal Product Code-level e-cigarette sales from the NielsenIQ Retail Scanner Data along with e-cigarette product characteristics collected from internet searches and visits to e-cigarette retailers, we develop a method to standardise e-cigarette taxes as an equivalent average excise tax rate measured per millilitre of fluid. RESULTS: In 2020, the average American resided in a location with $3.08 in cigarette taxes and $0.34 in e-cigarette taxes (assuming 1 pack=0.7 fluid mL). CONCLUSIONS: The public availability of this state and local standardised e-cigarette tax data will allow tobacco control researchers to study the relationship between e-cigarette taxes and tobacco and related outcomes more effectively.

Innovations in Evaluating Statin Benefit and Efficacy in Staphylococcus aureus Intracellular Infection Management.

An emerging therapeutic approach in the treatment of infectious disease is to augment the host response through repurposing of well-tolerated, non-antibiotic, host-directed therapeutics. Earlier retrospective studies identify a positive association between statin use and a decreased risk of death due to sepsis or bacteremia. However, more recent randomized control trials fail to detect a therapeutic benefit in these complex infection settings. It is postulated that unrecognized biases in certain observational studies may have led to an overestimation of benefit and that statin use is instead a marker for health status, wealth, and demographic characteristics which may separately affect death due to infection. What remains unresolved is that in vitro and in vivo evidence reproducibly indicates that statin pharmacology limits infection and augments immunomodulatory responses, suggesting that therapeutic benefits may be attainable in certain infection settings, such as intracellular infection by S. aureus. Carefully considering the biological mechanisms capable of driving the relationship between statins and infections and constructing a methodology to avoid potential biases in observational studies would enable the examination of protective effects against infection and limit the risk of underestimating statin efficacy. Such an approach would rely on the examination of statin use in defined infection settings based on an underlying mode-of-action and pharmacology, where the inhibition of HMG-CoA-reductase at the rate-limiting step in cholesterol biosynthesis diminishes not only cholesterol levels but also isoprenoid intermediates central to host cell invasion by S. aureus. Therapeutic benefit in such settings, if existent, may be of clinical importance.

The effects of e-cigarette taxes on e-cigarette prices and tobacco product sales: Evidence from retail panel data.

We estimate the effect of e-cigarette tax rates on e-cigarette prices, e-cigarette sales, and sales of other tobacco products using NielsenIQ Retail Scanner data from 2013 to 2019. We find that 90% of e-cigarette taxes are passed on to consumer retail prices. We then estimate reduced form and instrumental variables regressions to examine the effects of e-cigarette and cigarette taxes and prices on sales. We calculate an e-cigarette own-price elasticity of -2.2 and particularly large elasticity of demand for flavored e-cigarettes. Further, we document a cigarette own-price elasticity of -0.4 and positive cross-price elasticities of demand between e-cigarettes and cigarettes, suggesting economic substitution.

The effects of false identification laws on underage alcohol-related traffic fatalities.

We examine the effects of policies aimed at restricting the use of false identification to purchase alcohol on traffic fatalities involving alcohol-impaired underage drivers. We find that the implementation of policies that incentivize alcohol retailers to adopt ID scanners reduces traffic fatalities from accidents involving 16-18 year old drivers with a BAC >0, but we do not find that similar policies like vertical ID laws lead to statistically significant changes in traffic fatalities involving underage impaired drivers. A back-of-the-envelope calculation suggests that if all remaining states passed ID scanner laws, the reduction in underage alcohol-related fatal accidents would generate over $400 million in annual economic benefits.

The relationship between in-person voting and COVID-19: Evidence from the Wisconsin primary.

On April 7, 2020, Wisconsin held its presidential primary election, and news reports showed long lines of voters due to fewer polling locations. We use county-level variation in voting patterns and weekly county-level COVID test data to examine whether in-person voting increased COVID-19 cases. We find a statistically significant association between in-person voting density and the spread of COVID-19 2-3 weeks after the election. In our main results, a 10% increase in in-person voters per polling location is associated with an 18.4% increase in the COVID-19 positive test rate 2-3 weeks later.

On the measurement of health and its effect on the measurement of health inequality.

We examine the extent to which self-reported health measures suffer from income-related reporting heterogeneity and then characterize how this reporting heterogeneity affects the estimation of income-related health inequality. We run a comprehensive set of tests of reporting heterogeneity using several self-reported health measures and several clinical measures of health from the National Health and Nutritional Examination Surveys. We propose the use of a multidimensional measure using clinical indicators of health in the context of measuring income-related health inequality, and we examine the extent of income-related health inequality, as measured by the concentration index, using both self-reported measures of health and the multidimensional clinical measure. Our results confirm the existence of significant, positive, income-related reporting heterogeneity and also suggest that higher income individuals react more strongly to a change in clinical health measures. Using self-assessed health suggests that income-related health inequality is about three times larger than when using more objective, self-reported health measures and ten times larger than when using the multidimensional clinical measure of health.

The effects of employment on influenza rates.

The seasonal influenza virus afflicts millions of people in the U.S. population each year, imposing significant costs on those who fall ill, their families, employers, and the health care system. The flu is transmitted via droplet spread or close contact, and certain environments, such as schools or offices, promote transmission. In this paper, we examine whether increases in employment are associated with increased incidence of the flu. We use state-level data on the prevalence of the flu from the Centers for Disease Control and Prevention. In our preferred specification, we find that a one percentage point increase in the employment rate increases the number of influenza related outpatient health care visits by 19%, and these effects are highly pronounced in the retail sector and healthcare sector, the sectors with the highest levels of interpersonal contact.

Impacts of the ACA Medicaid expansion on health behaviors: Evidence from household panel data.

A motivation for increasing health insurance coverage is to improve health outcomes for impacted populations. However, health insurance coverage may alternatively increase risky health behaviors due to ex ante moral hazard, and past research on this issue has led to mixed conclusions. This paper uses a panel of household purchases to estimate the effects of the recent state-level Medicaid expansions resulting from the Affordable Care Act (ACA) on consumption goods that present adverse health risks. We utilize within-household variation to identify whether increases in Medicaid availability impacted household purchase patterns of alcohol, nicotine-related, snack food, and carbonated beverage products. Overall, we find little evidence that the ACA Medicaid expansion led to ex ante moral hazard across any of these products, but we find compelling evidence that the Medicaid expansions reduced cigarette consumption and increased smoking cessation product use among the Medicaid-eligible population.

The relationship between cigarettes and electronic cigarettes: Evidence from household panel data.

We use the Nielsen Consumer Panel to investigate the impact of tobacco control policies on purchases of electronic cigarettes (e-cigarettes), cigarettes, and smoking cessation products. We measure product quantity, product type, nicotine content, and liquid volume of e-cigarettes, and product quantity and nicotine content of cigarettes. Higher cigarette excise taxes decrease both cigarette and e-cigarette purchases, suggesting that cigarettes and e-cigarettes are complements, and higher cigarette excise taxes reduce the aggregate amount of nicotine purchased from cigarettes and e-cigarettes. Cigarette smoke-free air laws decrease cigarette purchases, while e-cigarette smoke-free air laws do not affect cigarette or e-cigarette purchases.

Heterogeneity in Smokers' Responses to Tobacco Control Policies.

This paper uses unconditional quantile regression to estimate whether smokers' responses to tobacco control policies change across the distribution of smoking levels. I measure smoking behavior with the number of cigarettes smoked per day and also with serum cotinine levels, a continuous biomarker of nicotine exposure, using individual-level repeated cross-section data from the National Health and Nutrition Examination Surveys. I find that the cigarette taxes lead to reductions in both the number of cigarettes smoked per day and in smokers' cotinine levels. These reductions are most pronounced in the middle quantiles of both distributions in terms of marginal effects, but most pronounced in the lower quantiles in terms of tax elasticities. I do not find that higher cigarette taxes lead to statistically significant changes in the amount of nicotine smokers ingest from each cigarette. Copyright © 2015 John Wiley & Sons, Ltd.

Crystal Clear? The Relationship Between Methamphetamine Use and Sexually Transmitted Infections.

Public health officials have cited methamphetamine control as a tool with which to decrease HIV and other sexually transmitted infections, based on previous research that finds a strong positive correlation between methamphetamine use and risky sexual behavior. However, the observed correlation may not be causal, as both methamphetamine use and risky sexual behavior could be driven by a third factor, such as a preference for risky behavior. We estimate the effect of methamphetamine use on risky sexual behavior using monthly data on syphilis diagnoses in California and quarterly data on syphilis, gonorrhea, and chlamydia diagnoses across all states. To circumvent possible endogeneity, we use a large exogenous supply shock in the US methamphetamine market that occurred in May 1995 and a later shock stemming from the Methamphetamine Control Act, which went into effect in October 1997. While the supply shocks had large negative effects on methamphetamine use, we find no evidence that they decreased syphilis, gonorrhea, or chlamydia rates. Our results have broad implications for public policies designed to decrease sexually transmitted infection rates.

An information theory based framework for the measurement of population health.

This paper proposes a new framework for the measurement of population health and the ranking of the health of different geographies. Since population health is a latent variable, studies which measure and rank the health of different geographies must aggregate observable health attributes into one summary measure. We show that the methods used in nearly all the literature to date implicitly assume that all attributes are infinitely substitutable. Our method, based on the measurement of multidimensional welfare and inequality, minimizes the entropic distance between the summary measure of population health and the distribution of the underlying attributes. This summary function coincides with the constant elasticity of substitution and Cobb-Douglas production functions and naturally allows different assumptions regarding attribute substitutability or complementarity. To compare methodologies, we examine a well-known ranking of the population health of U.S. states, America's Health Rankings. We find that states' rankings are somewhat sensitive to changes in the weight given to each attribute, but very sensitive to changes in aggregation methodology. Our results have broad implications for well-known health rankings such as the 2000 World Health Report, as well as other measurements of population and individual health levels and the measurement and decomposition of health inequality.

Estimating the Relationship between Alcohol Policies and Criminal Violence and Victimization.

Violence is one of the leading social problems in the United States. The development of appropriate public policies to curtail violence is confounded by the relationship between alcohol and violence. In this paper, we estimate the propensity of alcohol control policies to reduce the perpetration and victimization of criminal violence. We measure violence with data on individual level victimizations from the National Crime Victimization Survey. We examine the effects of a host of alcohol control policies in reducing violent crime. These policies include the retail price of beer, drunk driving laws and penalties, keg laws, and serving and selling laws. We find some evidence of a negative relationship between alcohol prices and the probability of alcohol or drug related assault victimizations, particularly for assaults against young adults ages 18-29. However, we find no strong evidence that other alcohol policies are effective in reducing violent crimes. These results provide policy makers with guidance on potential approaches for reducing violence through alcohol beverage control.