Cost-Effectiveness of 5 Public Health Approaches to Prevent Eating Disorders.

INTRODUCTION: Eating disorders cause suffering and a high risk of death. Accelerating the translation of research into implementation will require intervention cost-effectiveness estimates. The objective of this study was to estimate the cost-effectiveness of 5 public health approaches to preventing eating disorders among adolescents and young adults. METHODS: Using data from 2001 to 2017, the authors developed a microsimulation model of a closed cohort starting at the age of 10 years and ending at 40 years. In 2021, an analysis was conducted of 5 primary and secondary prevention strategies for eating disorders: school-based screening, primary care‒based screening, school-based universal prevention, excise tax on over-the-counter diet pills, and restriction on youth purchase of over-the-counter diet pills. The authors estimated the reduction in years lived with eating disorders and the increase in quality-adjusted life-years. Intervention costs and net monetary benefit were estimated using a threshold of $100,000/quality-adjusted life year. RESULTS: All the 5 interventions were estimated to be cost-saving compared with the current practice. Discounted per person cost savings (over the 30-year analytic time horizon) ranged from $63 (clinic screening) to $1,102 (school-based universal prevention). Excluding caregiver costs for binge eating disorder and otherwise specified feeding and eating disorders substantially reduced cost savings (e.g., from $1,102 to $149 for the school-based intervention). CONCLUSIONS: A range of public health strategies to reduce the societal burden of eating disorders are likely cost saving. Universal prevention interventions that promote healthy nutrition, physical activity, and media use behaviors without introducing weight stigma may prevent additional negative health outcomes, such as excess weight gain.

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 prevalence and excess mortality risk of driving with children.

INTRODUCTION: The presence of passengers can affect the driving behavior of motor-vehicle operators. Child passengers present unique motivations to drive more safely, as well as opportunities to distract drivers. Because motor-vehicle crashes are an important cause of premature childhood mortality, this study assesses whether adult drivers with child passengers are more or less likely to cause a fatal crash. METHOD: Data include fatal crashes involving one or two vehicles from 2007 to 2017 in the U.S. Fatality Analysis Reporting System. We apply methods developed by Levitt and Porter (2001) and Dunn and Tefft (2020) -the LPDT approach- to estimate the risk that adult drivers (21 years or older) with at least one child passenger (15 year or younger) cause a fatal crash relative to adults without child passengers. RESULTS: Childhood crash exposure when traveling with an adult driver is low: 0.78% of vehicle miles traveled by adults included a child passenger. Nevertheless, adult drivers with child passengers were significantly more likely to cause a fatal crash than adult drivers without child passengers. The estimated risk of causing a single-vehicle crash was 6.2 times higher among the full sample of adults, 7.2 times higher among female drivers, and 5.0 times higher among drivers 25-44 years old. CONCLUSIONS: Despite their relatively low crash exposure, child passengers are associated with much greater risk of causing a fatal crash. PRACTICAL APPLICATIONS: This study not only informs about the need to develop interventions to remind parents and adult drivers of the risks associated with driving children, but also reminds researchers about the enormous potential of the LPDT approach when applied to traffic safety issues.

Drinking-and-driving in the United States from 1983-2017: comparing survey and model-based estimates of prevalence.

Although several approaches to estimating prevalence and excess risk exist, each relies on behavioral assumptions that are subject to credible objections. In this article, we compare the assumptions of the most widely accepted approach over the past three decades-results from the National Roadside Survey (NRS)-with a recently revived model-based alternative that estimates these population parameters from the observed distribution of fatal motor vehicle crashes. Comparing estimates of prevalence covering the past four decades, we find that when driver non-response rates in NRS are small, estimates of the prevalence of alcohol-involved driving are nearly identical between methods, suggesting that the underlying behavior assumptions of both models approximately hold. For the past two decades, however, as the rate of driver refusal in the NRS has increased substantially, prevalence estimates between methods have diverged. A counterfactual analysis reveals that the estimates for drinking-and-driving from the model-based approach should be taken as at least as valid as those from the NRS. That is troubling as these methods yield markedly different conclusions about the continued effectiveness of existing traffic safety policy: the NRS finds that the prevalence of drinking-and-driving has fallen monotonically over time, while estimates from the model-based approach suggest that prevalence has plateaued at 15% for the past two decades. More unsettling however, is the conclusion that researchers and policy-makers may know very little about the extent of legally-impaired driving or how it has changed over time.

Has increased body weight made driving safer?

We develop a model of alcohol consumption that incorporates the negative biological relationship between body mass and inebriation conditional on total alcohol consumption. Our model predicts that the elasticity of inebriation with respect to weight is equal to the own-price elasticity of alcohol, consistent with body mass increasing the effective price of inebriation. Given that alcohol is generally considered price inelastic, this result implies that as individuals gain weight, they consume more alcohol but become less inebriated. We test this prediction and find that driver blood alcohol content (BAC) is negatively associated with driver weight. In fatal accidents with driver BAC above 0.10, the driver was 7.8 percentage points less likely to be obese than drivers in fatal accidents that did not involve alcohol. This relationship is not explained by driver attributes (age and sex), driver behaviors (speed and seatbelt use), vehicle attributes (weight class, model year, and number of occupants), or accident context (county of accident, time of day, and day of week).