Association Between Automotive Assembly Plant Closures and Opioid Overdose Mortality in the United States: A Difference-in-Differences Analysis.

Importance: Fading economic opportunity has been hypothesized to be an important factor associated with the US opioid overdose crisis. Automotive assembly plant closures are culturally significant events that substantially erode local economic opportunities. Objective: To estimate the extent to which automotive assembly plant closures were associated with increasing opioid overdose mortality rates among working-age adults. Design, Setting, and Participants: A county-level difference-in-differences study was conducted among adults aged 18 to 65 years in 112 manufacturing counties located in 30 commuting zones (primarily in the US South and Midwest) with at least 1 operational automotive assembly plant as of 1999. The study analyzed county-level changes from January 1, 1999, to December 31, 2016, in age-adjusted, county-level opioid overdose mortality rates before vs after automotive assembly plant closures in manufacturing counties affected by plant closures compared with changes in manufacturing counties unaffected by plant closures. Data analyses were performed between April 1, 2018, and July 20, 2019. Exposure: Closure of automotive assembly plants in the commuting zone of residence. Main Outcomes and Measures: The primary outcome was the county-level age-adjusted opioid overdose mortality rate. Secondary outcomes included the overall drug overdose mortality rate and prescription vs illicit drug overdose mortality rates. Results: During the study period, 29 manufacturing counties in 10 commuting zones were exposed to an automotive assembly plant closure, while 83 manufacturing counties in 20 commuting zones remained unexposed. Mean (SD) baseline opioid overdose rates per 100 000 were similar in exposed (0.9 [1.4]) and unexposed (1.0 [2.1]) counties. Automotive assembly plant closures were associated with statistically significant increases in opioid overdose mortality. Five years after a plant closure, mortality rates had increased by 8.6 opioid overdose deaths per 100 000 individuals (95% CI, 2.6-14.6; P = .006) in exposed counties compared with unexposed counties, an 85% higher increase relative to the mortality rate that would have been expected had exposed counties followed the same outcome trends as unexposed counties. In analyses stratified by age, sex, and race/ethnicity, the largest increases in opioid overdose mortality were observed among non-Hispanic white men aged 18 to 34 years (20.1 deaths per 100 000; 95% CI, 8.8-31.3; P = .001) and aged 35 to 65 years (12.8 deaths per 100 000; 95% CI, 5.7-20.0; P = .001). We observed similar patterns of prescription vs illicit drug overdose mortality. Estimates for opioid overdose mortality in nonmanufacturing counties were not statistically significant. Conclusions and Relevance: From 1999 to 2016, automotive assembly plant closures were associated with increases in opioid overdose mortality. These findings highlight the potential importance of eroding economic opportunity as a factor in the US opioid overdose crisis.

College affirmative action bans and smoking and alcohol use among underrepresented minority adolescents in the United States: A difference-in-differences study.

BACKGROUND: College affirmative action programs seek to expand socioeconomic opportunities for underrepresented minorities. Between 1996 and 2013, 9 US states-including California, Texas, and Michigan-banned race-based affirmative action in college admissions. Because economic opportunity is known to motivate health behavior, banning affirmative action policies may have important adverse spillover effects on health risk behaviors. We used a quasi-experimental research design to evaluate the association between college affirmative action bans and health risk behaviors among underrepresented minority (Black, Hispanic, and Native American) adolescents. METHODS AND FINDINGS: We conducted a difference-in-differences analysis using data from the 1991-2015 US national Youth Risk Behavior Survey (YRBS). We compared changes in self-reported cigarette smoking and alcohol use in the 30 days prior to survey among underrepresented minority 11th and 12th graders in states implementing college affirmative action bans (Arizona, California, Florida, Michigan, Nebraska, New Hampshire, Oklahoma, Texas, and Washington) versus outcomes among those residing in states not implementing bans (n = 35 control states). We also assessed whether underrepresented minority adults surveyed in the 1992-2015 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) who were exposed to affirmative action bans during their late high school years continued to smoke cigarettes between the ages of 19 and 30 years. Models adjusted for individual demographic characteristics, state and year fixed effects, and state-specific secular trends. In the YRBS (n = 34,988 to 36,268, depending on the outcome), cigarette smoking in the past 30 days among underrepresented minority 11th-12th graders increased by 3.8 percentage points after exposure to an affirmative action ban (95% CI: 2.0, 5.7; p < 0.001). In addition, there were also apparent increases in past-30-day alcohol use, by 5.9 percentage points (95% CI: 0.3, 12.2; p = 0.041), and past-30-day binge drinking, by 3.5 percentage points (95% CI: -0.1, 7.2, p = 0.058), among underrepresented minority 11th-12th graders, though in both cases adjustment for multiple comparisons resulted in failure to reject the null hypothesis (adjusted p = 0.083 for both outcomes). Underrepresented minority adults in the TUS-CPS (n = 71,575) exposed to bans during their late high school years were also 1.8 percentage points more likely to report current smoking (95% CI: 0.1, 3.6; p = 0.037). Event study analyses revealed a discrete break for all health behaviors timed with policy discussion and implementation. No substantive or statistically significant effects were found for non-Hispanic White adolescents, and the findings were robust to a number of additional specification checks. The limitations of the study include the continued potential for residual confounding from unmeasured time-varying factors and the potential for recall bias due to the self-reported nature of the health risk behavior outcomes. CONCLUSIONS: In this study, we found evidence that some health risk behaviors increased among underrepresented minority adolescents after exposure to state-level college affirmative action bans. These findings suggest that social policies that shift socioeconomic opportunities could have meaningful population health consequences.

Prenatal exposure to air pollution and intergenerational economic mobility: Evidence from U.S. county birth cohorts.

New estimates reveal intergenerational economic mobility varies substantially across U.S. counties. The potential role of local environmental health exposures in structuring mobility outcomes has been thus far unexamined, despite mounting evidence that early life exposure to environmental pollutants has lasting impacts for individual human capital development and labor market performance. This study aims to fill this gap by estimating the impact of exposure to air pollution in the birth year on the average intergenerational mobility outcomes of children from low-income families as measured in adulthood. We do so by linking measures of intergenerational economic mobility for U.S. county-cohorts born between 1980 and 1986 to the county average concentration of total suspended particulates (TSP) in the birth year. We then estimate multivariate linear regression models that adjust for birth-cohort fixed effects, county-fixed effects and time-varying county-level covariates to address potential confounding. We find higher levels of TSP in birth year is associated with less upward economic mobility for children from low-income families: a one standard deviation increase in TSP levels is associated with a 0.14 point reduction in average income percentile ranking as measured in adulthood. Notably, we find no association for children from high income families. Our findings indicate early life exposure to air pollution may reduce the prospects children from low-income families will achieve upward economic mobility and suggest variation in environmental quality may help explain observed variation in mobility outcomes.

Early-life Medicaid Coverage and Intergenerational Economic Mobility.

New data reveal significant variation in economic mobility outcomes across U.S. localities. This suggests that social structures, institutions, and public policies-particularly those that influence critical early-life environments-play an important role in shaping mobility processes. Using new county-level estimates of intergenerational economic mobility for children born between 1980 and 1986, we exploit the uneven expansions of Medicaid eligibility across states to isolate the causal effect of this specific policy change on mobility outcomes. Instrumental-variable regression models reveal that increasing the proportion of low-income pregnant women eligible for Medicaid improved the mobility outcomes of their children in adulthood. We find no evidence that Medicaid coverage in later childhood years influences mobility outcomes. This study has implications for the normative evaluation of this policy intervention as well as our understanding of mobility processes in an era of rising inequality.

Redistribution and the New Fiscal Sociology: Race and the Progressivity of State and Local Taxes.

States redistribute wealth through two mechanisms: spending and taxation. Yet studies of the social determinants of redistribution typically focus exclusively on government spending. This article explores how one determinant of social spending-racial composition-influences preferences for, and the structure of, tax systems. First, analyses of state and local tax burden data indicate that an increasing proportion of Latinos within states is associated with more regressive tax systems. Second, evidence from a nationally representative survey experiment suggests that individual preferences for taxation may be influenced by changes in the racial composition of communities. Finally, analyses reveal that in-group solidarity is a key mechanism through which racial threat shapes preferences for taxation. In demonstrating a relationship between racial change, tax preferences, and tax structures, this article contributes to our under-standing of the determinants of redistribution as well as the broader project of the new fiscal sociology.

Leveraging Psychological Insights to Encourage the Responsible Use of Consumer Debt.

U.S. consumers currently hold $880 billion in revolving debt, with a mean household credit card balance of approximately $6,000. Although economic factors play a role in this societal issue, it is clear that psychological forces also affect consumers' decisions to take on and maintain unmanageable debt balances. We examine three psychological barriers to the responsible use of credit and debt. We discuss the tendency for consumers to (a) make erroneous predictions about future spending habits, (b) rely too heavily on values presented on billing statements, and (c) categorize debt and saving into separate mental accounts. To overcome these obstacles, we urge policymakers to implement methods that facilitate better budgeting of future expenses, modify existing credit card statement disclosures, and allow consumers to easily apply government transfers (such as tax credits) to debt repayment. In doing so, we highlight minimal and inexpensive ways to remedy the debt problem.

Monetizing illness: the influence of disability assistance priming on how we evaluate the health symptoms of others.

For low-income families in the United States disability assistance has emerged as a critical income support program in the post-welfare reform era. This article explores how this monetization of illness-tying receipt of government assistance to a physical or mental condition-influences how individuals evaluate the severity of another individual's health symptoms. Using data collected through a nationally representative survey experiment of adults in the United States (n = 1005) in May 2013, I find that respondents who are primed to consider the existence of disability assistance are less likely to rate the symptoms described in a hypothetical vignette as severe relative to the control group. I find evidence that this effect holds for both physical (back pain) and mental (depression) conditions for adults and behavioral conditions (ADHD) in children. Moreover, respondents in the experimental group were more likely to blame the individual for her health condition and this measure was found to partially mediate the effect of the disability assistance prime. These findings have important implications for researchers, policymakers and medical practitioners by illustrating how premising state assistance on a health condition may in turn shape how individuals evaluate the health symptoms of others.