The impact of COVID-19 on alcohol sales and consumption in the United States: A retrospective, observational analysis.

Understanding the COVID-19 pandemic's effect on alcohol sales and consumption is critical in mitigating alcohol abuse and morbidity. We sought to determine how the onset of the COVID-19 pandemic and changes in viral incidence affected alcohol sales and consumption in the United States. We conducted a retrospective observational analysis regressing National Institute on Alcohol Abuse and Alcoholism (NIAAA) alcohol sales data and Behavioral Risk Factor Surveillance System (BRFSS) survey data for 14 states for 2017 to 2020 with COVID-19 incidence in 2020 in the United States. The onset of the pandemic was associated with higher monthly alcohol sales per capita of 1.99 standard drinks (95% Confidence Interval: 0.63 to 3.34, p = 0.007). Increases of one COVID-19 case per 100 were associated with lower monthly alcohol sales per capita of 2.98 standard drinks (95% CI: -4.47 to -1.48, p = 0.001) as well as broad decreases in alcohol consumption, notably 0.17 fewer days per month with alcohol use (95% CI: -0.31 to -0.23, p = 0.008) and 0.14 fewer days per month of binge drinking (95% CI: -0.23 to -0.052, p < 0.001). The COVID-19 pandemic is associated with increased monthly average alcohol purchases, but higher viral incidence is linked to lower alcohol purchases and consumption. Continued monitoring is needed to mitigate the effects of higher population alcohol use during the pandemic.

Texas Senate Bill 8 significantly reduced travel to abortion clinics in Texas.

The Dobbs v. Jackson decision by the United States Supreme Court has rescinded the constitutional guarantee of abortion across the United States. As a result, at least 13 states have banned abortion access with unknown effects. Using "Texas" SB8 law that similarly restricted abortions in Texas, we provide insight into how individuals respond to these restrictions using aggregated and anonymized human mobility data. We find that "Texas" SB 8 law reduced mobility near abortion clinics in Texas by people who live in Texas and those who live outside the state. We also find that mobility from Texas to abortion clinics in other states increased, with notable increases in Missouri and Arkansas, two states that subsequently enacted post-Dobbs bans. These results highlight the importance of out-of-state abortion services for women living in highly restrictive states.

The 1982 Medicaid Funding Cessation for Circumcision in California and Circumcision Rates.

We investigated California's 1982 decision to stop funding Medicaid neonatal circumcision. We examined male neonatal circumcision rates for those born 1977-1981 and 1983-1987 by region, race, and insurance status. Overall, West-Medicaid circumcision rates decreased from 56.5% in 1979-81 to 26.7% in 1983-85. California's 1982 decision to defund Medicaid circumcision coverage was associated with a 25.0-30.8% point decrease in West-Medicaid circumcision rates compared other groups, p < 0.01. This provides the earliest data to support that funding coverage for neonatal circumcision affects circumcision rates and magnifies healthcare disparities. Other states have since defunded Medicaid male neonatal circumcision. Circumcision have been associated with lower rates of sexually transmitted infections including HIV, and urinary tract infections. Lawmakers should consider re-funding Medicaid male neonatal circumcision.

RESUMEN: La cesación de financiamiento por Medicaid en 1982 para la circuncisión y el impacto de su tasa en California.Aquí investigamos la decisión del gobierno de California en 1982 de dejar de financiar la circuncisión neonatal por Medicaid. Examinamos las tasas de circuncisión neonatal masculina para los nacidos entre 1977 a 1981 y entre 1983 a 1987 por región, raza y estatus de seguro médico. En general, las tasas de circuncisión de West-Medicaid disminuyeron 56.5% en 1979-81 a 26.7% en 1983-85. La decisión de California en 1982 de desfinanciar la cobertura de circuncisión por Medicaid se asoció con una disminución de 25.0 a 30.8 puntos porcentuales en las tasas de circuncisión de West-Medicaid en comparación con otros grupos, p < 0.01. Esto provee los primeros datos que demuestra la cobertura de financiamiento para la circuncisión neonatal afecta las tasas de circuncisión y aumenta las disparidades en cuidado médico. Desde entonces, otros estados han desfinanciado la circuncisión neonatal masculina por Medicaid. La circuncisión se ha asociado con tasas más bajas de infecciones de transmisión sexual, incluyendo el VIH, e infecciones del tracto urinario. Los legisladores deberían considerar refinanciar la circuncisión neonatal masculina por Medicaid.

Blood Lead Testing in Flint Before and After Water Contamination.

OBJECTIVE: Lead is a neurotoxicant that negatively affects health. Reducing lead exposure and early detection among children are important public health goals. Our objective with this study was to determine if the September 2015 lead advisory in Flint, Michigan affected lead testing among children when possible exposure was widely publicized. METHOD: This study included 206 001 children born in Michigan from 2013 to 2015 and enrolled in Medicaid, using 2013 to 2017 claims data to determine if and at what age an individual received a lead test. Difference-in-differences regression models were used to compare the receipt of lead tests among children in Flint with other cities in Michigan before and after September 2015, when a lead advisory was issued for the city warning about potential exposure to lead in publicly supplied water. RESULTS: Before the lead advisory, approximately 50% of children in Flint received a lead test by 12 months of age and nearly 75% received a lead test by 24 months of age. After the September 2015 advisory, the receipt of lead tests among children in Flint increased 10 percentage points by 12 months compared with other cities. Effects by 10-month cohorts, as of 2016, revealed a 20-percentage-point increase for children in Flint compared with other cities. CONCLUSIONS: Despite a highly publicized lead advisory, children in Flint enrolled in Medicaid received lead tests earlier, but the proportion of Medicaid-eligible children who were tested did not change. This suggests that increasing lead testing is a difficult policy goal to achieve and, therefore, supports recent efforts focusing on primary prevention to reduce lead exposure.

The Impact of Driving Time to Family Planning Facilities on Preventive Service Use in Ohio.

INTRODUCTION: Publicly funded family planning clinics provide preventive health services to low-income populations in the U.S. In recent years, several states, including Ohio, have restricted public funds for organizations that provide or refer patients to abortion care, often resulting in clinic closures. This research evaluates the effects of such closures on preventive service use and access to care among female adults in Ohio. METHODS: With data from the 2010 to 2015 Ohio Behavioral Risk Factor Surveillance System, trends in health service use were assessed for female respondents aged 18-45 years with household incomes <$50,000. Clinic locations were combined with restricted-access survey ZIP codes to compute respondents' driving times to the nearest family planning clinic. The association between changes in driving time and the use of routine preventive and unmet care owing to cost were assessed with linear probability models. Analyses took place from March 2019 to February 2020. RESULTS: Each additional 10 minutes of driving time was associated with an 8.9 percentage point increase in the likelihood of avoided care owing to cost (95% CI=1.7, 16.2), a 10.4 percentage point decrease in the likelihood of mammogram receipt during the past 12 months (95% CI= -22.3, 1.5), and a 12.5 percentage point decrease in the likelihood of ever receiving a clinical breast examination (95% CI= -18.7, -6.3). Driving time had insignificant associations with other utilization outcomes. Similar results were obtained when using driving distance. CONCLUSIONS: Reduced access to family planning clinics was associated with unmet care due to cost and a reduction in preventive service use among low-income, reproductive-aged females.

Sunlight and Protection Against Influenza.

Recent medical literature suggests that vitamin D supplementation protects against acute respiratory tract infection. Humans exposed to sunlight produce vitamin D directly. This paper investigates how differences in sunlight, as measured over several years across states and during the same calendar week, affect influenza incidence. We find that sunlight strongly protects against getting influenza. This relationship is driven almost entirely by the severe H1N1 epidemic in fall 2009. A 10% increase in relative sunlight decreases the influenza index in September or October by 1.1 points on a 10-point scale. A second, complementary study employs a separate data set to study flu incidence in counties in New York State. The results are strongly in accord.

The Impact of the Flint Water Crisis on Fertility.

Flint switched its public water source in April 2014, increasing exposure to lead and other contaminants. We compare the change in the fertility rate and in health at birth in Flint before and after the water switch to the changes in other cities in Michigan. We find that Flint fertility rates decreased by 12 % and that overall health at birth decreased. This effect on health at birth is a function of two countervailing mechanisms: (1) negative selection of less healthy embryos and fetuses not surviving (raising the average health of survivors), and (2) those who survived being scarred (decreasing average health). We untangle this to find a net of selection scarring effect of 5.4 % decrease in birth weight. Because of long-term effects of in utero exposure, these effects are likely lower bounds on the overall effects of this exposure.

Did UberX reduce ambulance volume?

Ambulances are a vital part of emergency medical services. However, they come in single, high intervention form, which is at times unnecessary, resulting in excessive costs for patients and insurers. In this paper, we ask whether UberX's entry into a city caused substitution away from traditional ambulances for low-risk patients, reducing overall volume. Using a city-panel over-time and leverage that UberX enter markets sporadically over multiple years, we find that UberX entry reduced the per capita ambulance volume by at least 6.7%. Our result is robust to numerous specifications.

Reproductive health care in Catholic-owned hospitals.

Mergers that affiliate a hospital with a Catholic owner, network, or system reduce the set of possible reproductive medical procedures since Catholic hospitals have strict prohibitions on contraception. Using changes in ownership of hospitals, we find that Catholic hospitals reduce the per bed rates of tubal ligations by 31%, whereas there is no significant change in related permitted procedures such as Caesarian sections. However, across a variety of measures, we find minimal overall welfare reductions. Still, fewer tubal ligations increase the risk of unintended pregnancies across the United States, imposing a potentially substantial cost for less reliable contraception on women and their partners.