Addressing rural and non-rural substance use disorder stigma: Evidence from a national randomized controlled trial.

Background: Individuals with substance use disorder (SUD) and recovery support services often face significant social stigma, especially in rural areas. One method of addressing stigma is through education and personal recovery stories. It is unclear if such messages will work similarly across rural and non-rural areas. Methods: We conduct an exploratory analysis of data from a national randomized controlled trial (N = 2,721) to determine if there are differences in the effectiveness of messages at reducing stigma across rurality. Specifically, we test four interventions to reduce stigma: education about the effectiveness of recovery housing and three versions of a personal recovery story that varied social distance and delivery medium (identified written story, anonymous written story, and video). Results: We find that messages may not have the same effect across rurality, with non-rural participants in the identified and anonymous written recovery story groups having lower stigma scores and only rural participants exposed to the anonymous written story having lower stigma scores compared to their counterparts in the control group. Further, non-rural participants exposed to both written story treatments had higher positive feelings towards those in recovery compared to the control group, but only rural participants in the anonymous written story group had higher positive feelings compared to the control group. Conclusion: Our results suggest that messages may have different effects on stigma across rurality and that rural participants' beliefs may be particularly hard to change. Future research should examine what types of stigma reduction interventions are most effective in rural areas.

Create a culture of experiments in environmental programs.

Organizations need a better "learning by doing" approach.

Physical distancing versus testing with self-isolation for controlling an emerging epidemic.

Two distinct strategies for controlling an emerging epidemic are physical distancing and regular testing with self-isolation. These strategies are especially important before effective vaccines or treatments become widely available. The testing strategy has been promoted frequently but used less often than physical distancing to mitigate COVID-19. We compared the performance of these strategies in an integrated epidemiological and economic model that includes a simple representation of transmission by "superspreading," wherein a relatively small fraction of infected individuals cause a large share of infections. We examined the economic benefits of distancing and testing over a wide range of conditions, including variations in the transmissibility and lethality of the disease meant to encompass the most prominent variants of COVID-19 encountered so far. In a head-to-head comparison using our primary parameter values, both with and without superspreading and a declining marginal value of mortality risk reductions, an optimized testing strategy outperformed an optimized distancing strategy. In a Monte Carlo uncertainty analysis, an optimized policy that combined the two strategies performed better than either one alone in more than 25% of random parameter draws. Insofar as diagnostic tests are sensitive to viral loads, and individuals with high viral loads are more likely to contribute to superspreading events, superspreading enhances the relative performance of testing over distancing in our model. Both strategies performed best at moderate levels of transmissibility, somewhat lower than the transmissibility of the ancestral strain of SARS-CoV-2.

COVID-19 health practices and attitudes in the United States: the role of trust in healthcare.

Aim: Individual-level COVID-19 vaccination and related preventive health behaviors is politically polarized in the United States. We examined whether the current polarization in COVID-19 health behavior may be explained by differences in trust in healthcare, locus of control, or insurance status. Subject and methods: Our sample includes 553 US adults recruited on Amazon MTurk. We assessed odds ratios of currently vaccinated, or willing to be vaccinated if unvaccinated using logistic regression. We assessed count of routine changes and positive attitudes toward facemasks using negative binomial regression. Results: Trust in healthcare was found to be an important determinant of all COVID-19 related health behavior measured in our study. Further, the effects on COVID-related attitudes/behavior from trust in healthcare are large in magnitude. For instance, our results suggest that individuals at or above the upper quartile of trust in healthcare are around 20 percentage points more likely to be vaccinated than those at or below the lower quartile. Further, we find that the effect of trust in healthcare on adherence or endorsement of COVID-19 mitigation strategies is distinct from political affiliation, i.e., the effect on COVID-19 related health behavior is independent of the polarization across political party lines. Locus of control was not associated with adherence/attitude toward COVID-19 mitigation strategies. Insurance status was only found to be positively associated with odds of being vaccinated. Conclusion: Our study highlights the importance of increasing trust in healthcare as a means to protect public health in the wake of major public health crises. Supplementary Information: The online version contains supplementary material available at 10.1007/s10389-022-01737-9.

Vaccine hunters and jostlers may have hurt the COVID-19 vaccination effort.

We examine how salience of extreme actions to gain access to vaccines affect general vaccine preferences using a survey experiment conducted shortly after a limited supply of COVID-19 vaccines were made available to prioritized groups. We document that learning about people who jump the line (jostlers) or people who go through great lengths to secure left-over vaccine doses (hunters) is off-putting, and has a meaningful, negative effect on people's vaccine preferences. Most people, however, predict the opposite-that news about extreme behavior would help the vaccination effort. If policy makers or public health authorities share these incorrect beliefs, they run the risk of implementing information policies that backfire in their effort to signal desirability of the vaccine.

What we think prayers do: Americans' expectations and valuation of intercessory prayer.

Praying for others in the wake of a disasters is a common interpersonal and public response to tragedy in the United States. But these gestures are controversial. In a survey experiment, we elicit how people value receiving a prayer from a Christian stranger in support of a recent hardship and examine factors that affect the value of the prayer. We find that people who positively value receiving the prayer do so primarily because they believe it provides emotional support and will be answered by God. Many also value the prayer because they believe it will improve their health and wealth, although empirical support of such effects is lacking. People who negatively value receiving the prayer do so primarily because they believe praying is a waste of time. The negative value is particularly large if people are offended by religion. Finally, the hardship experienced by the prayer recipient matters to the intensity by which recipients like or dislike the gesture, suggesting the benefit of prayers varies not only across people, but also across contexts.

Frequent mandatory COVID-19 testing may increase risky behavior.

Mandatory surveillance testing programs are popular policies aimed to control SARS-CoV-2 and may be considered for future epidemics. However, if people believe that testing lowers their risk of infection, such policies could increase risky behavior and may even cause increased pathogen spread. Using data from two US universities, we find that frequent mandatory testing is associated with greater participation in events linked to COVID-19 spread. Women seem to be driving this association, and mediation analyses suggest this is partly due to women's higher perception of COVID-related health risks. Our results show the potential for adverse effects from epidemic control policies, both on average and across population subgroups. Undertaking mitigation measures to reduce such unintended consequences may therefore be important.

In search of an appropriate mix of taxes and subsidies on nutrients and food: A modelling study of the effectiveness on health-related consumption and mortality.

Taxes and subsidies on foods and nutrients have the potential to promote healthier diets and thereby reduce mortality. In this study, we examine the effects of such policy instruments on Swedish public health. Specifically, we estimate the effects of food and nutrient taxes and subsidies on mortality averted and postponed in Sweden, using both demand system estimations and simulation models. We evaluate different Value Added Tax (VAT) reforms. The VAT is raised on food products that are particularly rich in saturated fat or salt and lowered on fruit and vegetables. Our models predict that an increase in the current VAT of 12% on food, to 25% VAT on products rich in saturated fat plus a 0% VAT on fruits and vegetables would result in almost 1100 deaths (95% CI: -832; -1363) averted or postponed in a year in Sweden, while the combination of a 34.4% VAT on products rich in saturated fat and a -10.4% VAT (i.e. a subsidy) on fruits and vegetables would result in almost 2100 (95% CI: -1572; -2311) deaths averted or postponed corresponding to a 4.8% reduction in diet-related annual death. Most of the deaths averted or delayed from this reform would be deaths from coronary heart disease (-1,148, 95% CI: -728; -1586), followed by stroke -641 (95% CI: -408; -887) and diet-related cancer deaths (-288, 95% CI: -11; -435). We find that health-related food taxes and subsidies improve dietary habits as well as reduce the mortality of the Swedish population. However, the effect of these reforms on different socioeconomic classes and which reforms provide the best value for money, i.e., cost-effectiveness of these reforms needs to be established first before implementation.

Emphasize personal health benefits to boost COVID-19 vaccination rates.

The rapid development of COVID-19 vaccines is a tremendous scientific response to the current global pandemic. However, vaccines per se do not save lives and restart economies. Their success depends on the number of people getting vaccinated. We used a survey experiment to examine the impact on vaccine intentions of a variety of public health messages identified as particularly promising: three messages that emphasize different benefits from the vaccines (personal health, the health of others, and the recovery of local and national economies) and one message that emphasizes vaccine safety. Because people will likely be exposed to multiple messages in the real world, we also examined the effect of these messages in combination. Based on a nationally quota representative sample of 3,048 adults in the United States, our findings suggest that several forms of public messages can increase vaccine intentions, but messaging that emphasizes personal health benefits had the largest impact.

Hesitancy Toward a COVID-19 Vaccine.

The scientific community has come together in a mass mobilization to combat the public health risks of COVID-19, including efforts to develop a vaccine. However, the success of any vaccine depends on the share of the population that gets vaccinated. We designed a survey experiment in which a nationally representative sample of 3,133 adults in the USA stated their intentions to vaccinate themselves and their children for COVID-19. The factors that we varied across treatments were: the stated severity and infectiousness of COVID-19 and the stated source of the risk information (White House or the Centers for Disease Control). We find that 20% of people in the USA intend to decline the vaccine. We find no statistically significant effect on vaccine intentions from the severity of COVID-19. In contrast, we find that the degree of infectiousness of the coronavirus influences vaccine intentions and that inconsistent risk messages from public health experts and elected officials may reduce vaccine uptake. However, the most important determinants of COVID-19 vaccine hesitancy seem to be distrust of the vaccine safety (including uncertainty due to vaccine novelty), as well as general vaccine avoidance, as implied by not having had a flu shot in the last two years.

Effects of Physical Distancing to Control COVID-19 on Public Health, the Economy, and the Environment.

Physical distancing measures are important tools to control disease spread, especially in the absence of treatments and vaccines. While distancing measures can safeguard public health, they also can profoundly impact the economy and may have important indirect effects on the environment. The extent to which physical distancing measures should be applied therefore depends on the trade-offs between their health benefits and their economic costs. We develop an epidemiological-economic model to examine the optimal duration and intensity of physical distancing measures aimed to control the spread of COVID-19. In an application to the United States, our model considers the trade-off between the lives saved by physical distancing-both directly from stemming the spread of the virus and indirectly from reductions in air pollution during the period of physical distancing-and the short- and long-run economic costs that ensue from such measures. We examine the effect of air pollution co-benefits on the optimal physical distancing policy and conduct sensitivity analyses to gauge the influence of several key parameters and uncertain model assumptions. Using recent estimates of the association between airborne particulate matter and the virulence of COVID-19, we find that accounting for air pollution co-benefits can significantly increase the intensity and duration of the optimal physical distancing policy. To conclude, we broaden our discussion to consider the possibility of durable changes in peoples' behavior that could alter local markets, the global economy, and our relationship to nature for years to come.

Do parents counter-balance the carbon emissions of their children?

It is well understood that adding to the population increases CO2 emissions. At the same time, having children is a transformative experience, such that it might profoundly change adult (i.e., parents') preferences and consumption. How it might change is, however, unknown. Depending on if becoming a parent makes a person "greener" or "browner," parents may either balance or exacerbate the added CO2 emissions from their children. Parents might think more about the future, compared to childless adults, including risks posed to their children from environmental events like climate change. But parenthood also adds needs and more intensive competition on your scarce time. Carbon-intensive goods can add convenience and help save time, e.g., driving may facilitate being in more places in one day, compared to public transportation or biking. Pre-prepared food that contain red meat may save time and satisfy more household preferences, relative to vegetarian food. We provide the first rigorous test of whether parents are greener or browner than other adults. We create a unique dataset by combining detailed micro data on household expenditures of all expenditure groups particularly important for CO2 emissions (transportation, food, and heating/electricity) with CO2 emissions, and compare emissions from Swedish adults with and without children. We find that parents emit more CO2 than childless adults. Only a small fraction of adults permanently choose not to have children, which means any meaningful self-selection into parenthood based on green preferences is unlikely. Our findings suggest that having children might increase CO2 emissions both by adding to the population and by increasing CO2 emissions from those choosing to have children.

The value of thoughts and prayers.

A standard response of both policy makers and private citizens to hardships-from natural disasters to mass shootings-is to offer "thoughts and prayers." Critics argue that such gestures are meaningless and may obstruct structural reforms intended to mitigate catastrophes. In this study, we elicit the value of receiving thoughts and prayers from strangers following adversity. We find that Christians value thoughts and prayers from religious strangers and priests, while atheists and agnostics are "prayer averse"-willing to pay to avoid receiving prayers. Furthermore, while indifferent to receiving thoughts from other secular people, they negatively value thoughts from Christians.

The impact of price reductions on individuals' choice of healthy meals away from home.

Food high in energy but low in nutritional value is an important contributor to several serious illnesses, and one type of food that is particularly high in energy but low in nutrition is food consumed away from home. In this paper, we examine the demand and willingness to pay for healthy, Keyhole-labelled meals. A Keyhole-labelled meal is particularly low in energy, fat, sugar and salt, but particularly high in fibre. The results suggest that to get the majority of individuals to choose the healthy option regularly it would be necessary to alter the relative price between healthy and less healthy meals. Generally groups of individuals with a poor nutritional intake require a larger compensation (subsidy) before they choose the healthy alternative. About one third of respondents would choose the healthy option regularly if the prices for a healthy and less healthy meal were the same. In particular groups of individuals who already have a relatively good nutritional intake would select the healthy option. Groups with a generally poor nutritional intake (men and individuals with lower education and lower income) would gain health benefits from a subsidy of Keyhole-labelled meals.

Economic policies for healthier food intake: the impact on different household categories.

This paper simulates the impact across household types of fully funded tax reforms designed to increase consumers' fiber intake from grain consumption. Our results suggest that household types with the highest initial consumption share of fiber-rich products--i.e., households without children (seniors, couples without children, and single women without children)--experience the highest increase in fiber intake from these reforms. However, they also experience high increases in unhealthy nutrients from the reforms, making the net health effects difficult to evaluate. Seniors and couples without children also gain most financially, paying less food taxes and facing, depending on the reform, either a lower price level than before the reform or a lower increase in the price level than the average household. These household types also face the lowest initial price level. Households with the lowest initial consumption share of fiber-rich products--families with children--appear to gain the least financially from the reforms: they pay more food taxes and face relatively high increases in price levels. Further, in general they experience an increase in fiber intake smaller than that of the average household. However, they do generally see reductions in the intake of added sugar, and in many cases saturated fat, which positively affects the health of families with children, who often overconsume these nutrients.

The impact of tax reforms designed to encourage healthier grain consumption.

In this paper, we simulate the effects of tax reforms aimed at encouraging healthier grain consumption. We use a rich data set on household grain consumption in 2003 from the market research institute GfK Sweden, combined with information on the nutritional content of the consumption. We estimate behavioral parameters, which are used to simulate the impact on the average household of tax reforms entailing either a subsidy on commodities particularly rich in fiber or a subsidy of the fiber density in grain products. Our results suggest that to direct the fiber intake towards nutritional recommendations, reforms with a substantial impact on consumer prices are required. Regardless of the type of subsidy implemented, the increase in the intake of fiber is accompanied by unwanted increases in nutrients that are often overconsumed: fat, salt and sugar. Funding the subsidies by taxing these nutrients, or less healthy commodities, helps to counteract such developments.