Debt Collection Pressure and Mental Health: Evidence from a Cohort of U.S. Young Adults.

The debt collection industry in the United States has grown in tandem with rising indebtedness. Prior research on debt and mental health mainly treats debt as a resource and liability rather than a power relationship between creditors and debtors. We study the mental health consequences of debt collection pressure using data from the National Longitudinal Survey of Youth-1997 Cohort (N = 7,236). Drawing on stress theory and health power resources theory, we posit collection pressure as a relational stressor that undermines well-being through negative interactions with debt collectors, financial strain, role strain, and stigma. We find that one of every four young adults in this cohort faced debt collection pressure by around age 40, with higher rates among low-income and Black young adults. Individual fixed-effects and lagged dependent variable regression models indicate that debt collection pressure is associated with increased psychological distress, with more severe consequences among low-income young adults.

An AUA Workforce Report: Data From the AUA Census Regarding Workplace Experiences Based on Gender.

INTRODUCTION: The AUA Workforce Workgroup contributes workforce-related questions to the annual AUA Census to better understand factors impacting the urologic community. This study aims to highlight pertinent gender differences potentially impacting career satisfaction and identify areas in which intervention could improve gender discrepancies. We hypothesize significant differences between males and females exist regarding responses to gender-related AUA Census questions. METHODS: The 2016 to 2021 AUA Censuses were examined to collate gender-specific data between self-identified male and female urologists. Up until 2021, the words male and female were used to define gender. The language was changed in the 2022 Census. Answers to AUA Census questions on topics with potential gender differences were grouped into major categories of workplace treatment and job satisfaction. RESULTS: Females were more likely than males to report negative differential treatment in primary practices (66.3% vs 2.7%, P < .001), felt they had limitations in seeing certain patients due to their gender (25.9% vs 2.4%, P = .021), experience gender bias in their practice (39.3% vs 1.2%, P < .001), and experience conflict regarding work and personal responsibility (95.4% vs 75%, P < .001). Females felt more barriers to professional success (93% vs 75%, P < .001) and felt a lack of control over staffing decisions or scheduling to be the greatest barriers (46.2%, P < .001). In contrast, males felt lack of time (33.7%, P = .060) to be the most significant barrier. Females were less likely than males to report feeling satisfied or very satisfied with their work-life balance (39.9% vs 57.7%, P < .001) and more likely to feel they do not have enough time for personal/family life (57.7% vs 33.6, P < .001). Females were also more likely than males to feel burnout (49.2% vs 35.3%, P < .001), which increased notably between 2016 and 2021. Females were also more likely to carry substantial education debt (18% vs 9%) and feel this contributed to burnout (38% vs 21.6%, P < .001). Notably, males and females demonstrated little difference in average worked hours (h) per week (mean 45.7 h for males, 43.7 h for females) and choosing medicine again as a career (88% males, 83.3% females; P= .143) and urology again as a specialty (93.3% males, 90.8% females; P = .307). CONCLUSIONS: Significant differences exist in career perceptions based on gender. Females report unique challenges in the workplace, and these factors contribute to less job satisfaction. Future work is needed to help characterize and address these differential workplace experiences.

Voices of the accelerated: key themes when considering implementation of an accelerated medical school program.

In this rapid communication, accelerated undergraduate medical education is examined using prior literature as well as experiences of those who have completed or are in the process of completing accelerated medical curricula. The Consortium of Accelerated Medical Pathway Programs (CAMPP) hosts an annual multi-institutional conference for all its members. During the meeting in July 2023, a virtual panel was convened from multiple constituent programs (N = 4) including medical students (N = 2), resident physicians (N = 4), and faculty (N = 2). Panel participants represented current learners or graduates from accelerated pathways of varying specialties (N = 5) to share firsthand experiences about acceleration to an audience representing over 25 medical schools. Five key themes were identified for accelerated students and trainees: Reduced debt as motivating factor to accelerate, Feeling prepared for residency, Ideal accelerated students are driven, Ability to form early professional relationships, and Less time for additional clinical experiences. Discourse from the CAMPP panel can inform current and developing accelerated programs at institutions looking to create or improve accelerated learning.

Transitions from Aerobic to Anaerobic Metabolism and Oxygen Debt during Elective Major and Emergency Non-Cardiac Surgery.

INTRODUCTION: Intraoperative hemodynamic and metabolic optimization of both the high-risk surgical patients and critically ill patients remains challenging. Reductions in oxygen delivery or increases in oxygen consumption can initiate complex cellular processes precipitating oxygen debt (OXD). METHODS: This study tested the hypothesis that intraoperative changes in sublingual microcirculatory flow reflect clinically relevant transitions from aerobic to anaerobic metabolism (TRANAM). We included patients undergoing elective major and emergency non-cardiac surgery. Macro- and microcirculatory variables, oxygen extraction, and transitions of metabolism were assessed in both cohorts. RESULTS: In the elective group, OXD was progressively increased over time, with an estimated 2.24 unit increase every 30 min (adjusted p < 0.001). Also, OXD was negatively correlated with central venous pressure (ρ = -0.247, adjusted p = 0.006) and positively correlated with stroke volume variation (ρ = 0.185, adjusted p = 0.041). However, it was not significantly correlated with sublingual microcirculation variables. In the emergency surgery group, OXD increased during the first two intraoperative hours and then gradually decreased until the end of surgery. In that cohort, OXD was positively correlated with diastolic arterial pressure (ρ = 0.338, adjpatients and the critically ill patients remains challengingsted p = 0.015). Also, OXD was negatively correlated with cardiac index (ρ = -0.352, adjusted p = 0.003), Consensus Proportion of Perfused Vessels (PPV) (ρ = -0.438, adjusted p < 0.001), and Consensus PPV (small) (ρ = -0.434, adjusted p < 0.001). CONCLUSIONS: TRANAM were evident in both the elective major and emergency non-cardiac surgery cohorts independent of underlying alterations in the sublingual microcirculation.

Economic Fragility of Older Adults: Factors Contributing to a Continuing Crisis.

With rapid population aging in the U.S. a greater number of older adults now experience economic insecurity, a situation disproportionately affecting older people of color. The COVID pandemic, rising inflation, and increasing economic inequality have reduced the purchasing power of both wages and fixed incomes. Compared with prior cohorts, the current cohort of adults at or nearing retirement age faces higher levels of secured and unsecured debt burden from mortgages, home equity loans, student loans, credit cards, and out-of-pocket medical costs. Long-standing disparities in opportunities and generational wealth have resulted in more outstanding debt for Black older adults than their white counterparts. This "financial fragility" may result in older people foregoing proper nutrition, doctor's visits, needed medications, or home or car repairs, while stress about finances may contribute to chronic health and mental health conditions. Along with programs to educate and advise older adults on their pressing financial concerns, practitioners who interact with older people in many settings should incorporate needed financial assessment and referrals into their work with this population. Professional and continuing education should ensure financial literacy and awareness of financial fragility for those working with older adults.

Medical students in distress: a mixed methods approach to understanding the impact of debt on well-being.

BACKGROUND: Nearly three in four U.S. medical students graduate with debt in six-figure dollar amounts which impairs students emotionally and academically and impacts their career choices and lives long after graduation. Schools have yet to develop systems-level solutions to address the impact of debt on students' well-being. The objectives of this study were to identify students at highest risk for debt-related stress, define the impact on medical students' well-being, and to identify opportunities for intervention. METHODS: This was a mixed methods, cross-sectional study that used quantitative survey analysis and human-centered design (HCD). We performed a secondary analysis on a national multi-institutional survey on medical student wellbeing, including univariate and multivariate logistic regression, a comparison of logistic regression models with interaction terms, and analysis of free text responses. We also conducted semi-structured interviews with a sample of medical student respondents and non-student stakeholders to develop insights and design opportunities. RESULTS: Independent risk factors for high debt-related stress included pre-clinical year (OR 1.75), underrepresented minority (OR 1.40), debt $20-100 K (OR 4.85), debt >$100K (OR 13.22), private school (OR 1.45), West Coast region (OR 1.57), and consideration of a leave of absence for wellbeing (OR 1.48). Mental health resource utilization (p = 0.968) and counselors (p = 0.640) were not protective factors against debt-related stress. HCD analysis produced 6 key insights providing additional context to the quantitative findings, and associated opportunities for intervention. CONCLUSIONS: We used an innovative combination of quantitative survey analysis and in-depth HCD exploration to develop a multi-dimensional understanding of debt-related stress among medical students. This approach allowed us to identify significant risk factors impacting medical students experiencing debt-related stress, while providing context through stakeholder voices to identify opportunities for system-level solutions.

Socioeconomic Correlates of Suicidal Ideation in Military Veterans: Examining the Interaction Between Homelessness and Financial Debt.

Studies in veterans have yet to examine interconnections between homelessness, financial debt, and suicidal ideation. We analyzed data from a nationally-representative study conducted in 2021 of low-income U.S. veterans (N = 1,004). Analyses revealed veterans who were younger, male, had a history of criminal arrests, met criteria for posttraumatic stress disorder (PTSD), reported greater loneliness, or had both a history of homelessness and higher debt were more likely to endorse suicidal ideation. We found an interaction between a history of homelessness and current debt: 40% of veterans with both past homelessness and higher debt reported suicidal ideation, whereas only 10% of veterans with either past homelessness or higher debt reported suicidal ideation. As past homelessness and current debt interacted to increase the odds of suicidal ideation in a national sample of veterans, these results inform policy and clinical decision-making for suicide prevention and in programs serving veterans experiencing homelessness.

Negative effects of high public debt on health systems facing pandemic crisis: Lessons from COVID-19 in Europe to prepare for future emergencies.

The investigation goal here was to analyze how the level of public debt affects preparedness of health systems to face emergencies. In particular, this study examined the negative effects of high public debt on health systems of European countries in the presence of the COVID-19 pandemic crisis. Empirical evidence revealed that European countries with a lower level of government debt as a percentage of GDP both in 2009 and 2019 (the period before the arrival of the pandemic) had lower COVID-19 fatality rates compared to countries with higher levels of public debt. The explanation is that high levels of public debt in countries trigger budget constraints that limit their ability to allocate resources to healthcare systems (e.g., health expenditures and investments), weakening health system performance and causing systemic vulnerability and lower preparedness during emergencies, such as with the COVID-19 pandemic. Implications of health policies are suggested to improve strategies of crisis management.

How does the data element-driven industry affect corporate cash holdings? Evidence from Chinese listed companies.

The data element-driven industry (DEDI) generates large amounts of data, thereby mitigating information asymmetry. Does this affect corporate cash holdings? On the basis of theoretical analysis, this study empirically analyzes the impact of DEDI on enterprises' cash holdings and its transmission path using data of Chinese cities and A-share listed enterprises from 2008 to 2020. First, the results indicate that the DEDI reduces corporate cash holdings. As the development level of the DEDI improves, the corporate cash holdings gradually decrease. Second, the DEDI indirectly affects corporate cash holdings by influencing debt-financing and external credit supply capacities. Specifically, the DEDI increases the upstream corporate debt-financing and downstream corporate external credit supply capacities. Improvements in debt-financing and the external credit supply capacities can reduce corporate cash holdings. Third, the DEDI has a heterogeneous impact. For enterprise with CEO duality, small and medium-sized, and information technology enterprises, the impact of DEDI in reducing cash holdings is greater.

Why companies have low debt? An empirical evidence in Korea.

The aim of this study is to examine the reasons why companies have been borrowing less, which has become increasingly popular recently. The study uses the method developed by Agrawal and Nagarajan (1990) [13] to select unlevered and levered companies for comparison to identify the causes of low leverage. The results of empirical analysis indicate that first, companies with low debt levels are relatively profitable, have high internal reserves, and possess future growth opportunities. Second, unlevered companies exhibit higher economic value compared to levered companies. Debt does not improve company value through low cost of capital or higher cash flow via tax shield. Third, family ownership tends to prefer low debt levels. Finally, unlevered companies have higher cash holding compared to levered companies, and this trend is maintained over long period of time. The preference for higher cash among unlevered companies has a historical basis. The companies are maintaining low debt levels for future growth opportunities and their management preference for high level of cash has remained consistent over time.

The impact of China's carbon emissions trading policy on corporate investment expenditures: Evidence from carbon-intensive industries.

The carbon emissions trading (CET) policy internalises the cost of carbon emission reductions borne by companies, which will affect the companies' investment and management decisions. From a micro perspective, this paper analyzes the impact on company investment expenditure and its transmission mechanism by implementing the CET policy. Based on panel data of China's A-share listed companies from eight carbon-intensive industries spanning 2010 to 2020, the time-varying difference-in-difference model and its extended model are used to evaluate the impact of the policy in the pilot areas. The results show that: first, based on the cost effect and legality theories, CET policy can reduce the investment expenditure of the companies by 71.95%. Second, CET policy reduces corporate investment expenditures by increasing corporate debt financing costs. When debt financing costs increase by 120.25%, the investment expenditures will reduce by 2.56% indirectly while the intermediary effect of equity financing costs is not significant. Finally, with the implementation of CET policy, the inhibitory effect on corporate investment expenditures has gradually increased. CET policy has a more significant inhibitory effect on investment expenditures of nonstate-owned companies and small-scale companies. The results have passed the robustness test and provide evidence for the policy-maker to balance microeconomic entity development and carbon reduction, and for companies to make optimization investment and financing decisions in response to policy shocks effectively.

Changing epidemic patterns of infectious diseases during and after COVID-19 pandemic in Taiwan.

Mitigation measures aimed at curbing the transmission of the severe acute respiratory syndrome coronavirus 2 effectively suppressed the occurrence of many respiratory infections other than coronavirus disease 2019. Several infections experienced a resurgence following the relaxation of non-pharmaceutical interventions, surpassing pre-pandemic levels in Taiwan. This phenomenon, known as immune debt, primarily affected respiratory infections in young children, including respiratory syncytial virus (RSV) infection. Infections transmitted by means other than droplets or contact did not exhibit significant changes in their epidemic patterns, such as varicella and Japanese encephalitis. Alterations in seasonality were noted for RSV infection and influenza, and these changes are also linked to immune debt. The recent emergence of severe pediatric pneumonia in northern China may be associated with immune debt and the rise of macrolide-resistant Mycoplasma pneumoniae associated with severe illness.

Regional invasion history and land use shape the prevalence of non-native species in local assemblages.

The ecological impact of non-native species arises from their establishment in local assemblages. However, the rates of non-native spread in new regions and their determinants have not been comprehensively studied. Here, we combined global databases documenting the occurrence of non-native species and residence of non-native birds, mammals, and vascular plants at regional and local scales to describe how the likelihood of non-native occurrence and their proportion in local assemblages relate with their residence time and levels of human usage in different ecosystems. Our findings reveal that local non-native occurrence generally increases with residence time. Colonization is most rapid in croplands and urban areas, while it is slower and variable in natural or semi-natural ecosystems. Notably, non-native occurrence continues to rise even 200 years after introduction, especially for birds and vascular plants, and in other land-use types rather than croplands and urban areas. The impact of residence time on non-native proportions is significant only for mammals. We conclude that the continental exchange of biotas requires considerable time for effects to manifest at the local scale across taxa and land-use types. The unpredictability of future impacts, implied by the slow spread of non-native species, strengthens the call for stronger regulations on the exchange of non-native species to reduce the long-lasting invasion debt looming on ecosystems' future.

Educational Debt and Income Among Pharmacists and Other Health Professionals.

OBJECTIVE: Given the substantial increases in student educational loan debt in recent years, the objective was to assess trends in educational debt-to-income ratios for graduates of pharmacy, medicine, dentistry, optometry, and veterinary medicine programs in the United States in the 2017-2022 period. METHODS: A retrospective analysis of 2017-2022 data for educational debt and income for select health professions was conducted. Annual income data were collected from the American Community Survey, and educational debt data were collected from health professions organizations. Educational debt-to-income ratios for each health profession were calculated, as was the mean change per year in debt-to-income ratio. RESULTS: With the exception of medicine, educational debt consistently exceeded income across the selected health professions in the 2017-2022 period. Debt-to-income ratios of pharmacists and the remaining health professionals decreased on average per year between 2017 and 2022. Physicians had the lowest debt-to-income ratios and dentists had the highest debt-to-income ratios in the study period. CONCLUSION: Debt-to-income ratios fell below the 2017 levels for the health professions of interest, suggesting that average growth in income outpaced that of debt for the study period. Regardless, debt remains high and may influence health care professionals' postgraduate training and career decisions, and in turn affect access to health care. Therefore, a call to action is proposed to address educational debt burden. Several strategies are suggested, including federal policy changes, implementing tuition reductions or minimal increases, facilitating financial aid options, and reducing underlying costs of health professions programs.

Student Debt Associated with Entry-level Athletic Training Education.

CONTEXT: Borrowers burdened by high student debt generally experience financial constraints that can impact them both personally and professionally. To date no published data exists that profiles the education-related debt accrued by entry-level certified athletic trainers. OBJECTIVE: To assess the scope and scale of student debt associated with the completion of an entry-level athletic training degree. DESIGN: Cross-sectional study. SETTING: Online web-based survey. PATIENTS OR OTHER PARTICIPANTS: Participants were recruited with assistance from the National Athletic Trainers' Association, who disseminated the survey to 18,689 certified athletic trainers who were members in good standing and who had earned their certification between 2004 and 2022. A total of 2,271 individuals accessed the survey. MAIN OUTCOME MEASURE(S): The overall amount of student debt incurred to complete an entry-level degree in athletic training and the initial monthly repayment amount were collected from survey respondents. Education-related debt-to-income ratio (DTIR) and monthly payment DTIR which are measures of financial health/stability were also calculated from the acquired survey data. RESULTS: Among athletic trainers who took out student loans, the average amount owed by entry-level athletic trainers for the period spanning 20042022 was $61,717, with an average initial monthly loan payment amount reported to be $453. The mean education related DTIR calculated from respondents was 169%, which exceeded the benchmark value of 100% recommended within the finance industry. Also, the average monthly payment DTIR calculated from study participants was .144, which approached the recommended acceptable upper-limit of .15. CONCLUSIONS: Education-related DTIR and monthly payment DTIR values reported by respondents suggests the potential for entry-level athletic trainers to experience financial challenges related to their student debt.

How does external debt and governance quality impact renewable energy consumption: novel policy insights from BRICS countries.

Amidst global environmental reforms, the role of energy systems is under scrutiny to promote ecological welfare through low-carbon alternatives. Amongst the solutions, the role of renewable energy as a clean source has become popular to mitigate climate change. However, the impact of debt on renewable energy consumption remains limited in the economic literature. The debt initiatives provide funding for environmental initiatives primarily, while it is also credited as a barrier to limiting the growth of clean energy programs. Within such discussion, the current study extended the dialogue by examining how external debt impacts energy transition in Brazil, Russia, India, China, and South Africa (BRICS) economies in the presence of institutional quality, education expenditures, and banking development. Using the novel CS-ARDL, AMG, and CCEMG tests, the study results showed that external debt decreases renewable energy consumption, while institutional quality, educational expenditures, banking developments, and economic growth are essential elements of green energy developments. Based on these conclusions, this study provides novel policy guidelines to align BRICS energy and economic agendas.

Carbon reduction through renewable energy and digitalization in emerging economies: Moderating role of public debt.

Utilizing renewable energy (RE) and embracing the digital economy (DIG) can significantly contribute to achieving economic, energy, and climate goals by promoting carbon reduction. In this regard, public debt (DEB) is particularly important since it provides the funds required to achieve these goals by investing in renewable energy and digital economy projects. This study examines the impact of public debt on the link between renewable energy and carbon emissions (CE), as well as the association between the digital economy and carbon emissions in emerging economies from 2003 to 2022. The study employed cross-sectional augmented autoregressive distributed lag (CS-ARDL) estimation to check the relationship between the variables. The findings of our study suggest that the integration of renewable energy sources and the growth of the digital economy have a positive impact on reducing carbon emissions. On the other hand, public debt has a positive effect on carbon emissions. In addition, the findings support the notion that interaction terms (RE × DEB) and (DIG × DEB) have a diminishing effect on carbon emissions. It can be concluded that the reduction of carbon emissions is contingent upon the utilization of public debt to promote the growth of renewable energy and the digital economy. Based on our study, it is recommended that emerging economies' needs focus on boosting renewable energy usage and digital economy initiatives. Additionally, it is necessary for these economies to maintain a sustainable level of debt.

SIR+ models: accounting for interaction-dependent disease susceptibility in the planning of public health interventions.

Avoiding physical contact is regarded as one of the safest and most advisable strategies to follow to reduce pathogen spread. The flip side of this approach is that a lack of social interactions may negatively affect other dimensions of health, like induction of immunosuppressive anxiety and depression or preventing interactions of importance with a diversity of microbes, which may be necessary to train our immune system or to maintain its normal levels of activity. These may in turn negatively affect a population's susceptibility to infection and the incidence of severe disease. We suggest that future pandemic modelling may benefit from relying on 'SIR+ models': epidemiological models extended to account for the benefits of social interactions that affect immune resilience. We develop an SIR+ model and discuss which specific interventions may be more effective in balancing the trade-off between minimizing pathogen spread and maximizing other interaction-dependent health benefits. Our SIR+ model reflects the idea that health is not just the mere absence of disease, but rather a state of physical, mental and social well-being that can also be dependent on the same social connections that allow pathogen spread, and the modelling of public health interventions for future pandemics should account for this multidimensionality.

The Economic Context of Higher Education Expansion: Race, Gender, and Household Finances Across Cohorts and Generations.

This article assesses how the economic context of higher education expansion since the mid-20th century has shaped families' financial lives-in terms of income and wealth/debt-as well as how these trends have differed for Black and White women and men. We use data from the NLSY-79 (comprising trailing-edge Baby Boomers) and NLSY-97 (comprising early Millennials) to show how academically similar students in these two cohorts fared in terms of educational attainment, household income, household wealth, and total student debt accrued by age 35. While we discuss findings across race-gender groups, our results call attention to the education-related economic disadvantages faced by Black women that have accelerated across cohorts. Over time, Black women's educational attainment has increased substantially, and high-achieving Black women, in particular, have become uniquely likely to progress beyond the BA. But while high-achieving Black women have made many advances in higher education, they also have become more likely than similarly high-achieving White men, White women, and Black men to have zero or negative wealth at the household level, and to accrue student debt for themselves and for their children. Our findings demonstrate that the costs of expanded access to credit for higher education have not been borne equally across race, gender, and achievement, and that these patterns have multigenerational financial consequences for college attendees and their families.

A Geographical Approach to China's Local Government Debt.

Since the 2010s local government debt has boomed in China because the government relies on debt financing for infrastructure investment. The debt mainly consists of the issuance of Chengtou bonds and later local government bonds. Using data from more than 300 cities from 2009 to 2020, this article maps its spatial dynamics to further the understanding of intergovernmental relations in the studies on local government debt. We find that, from 2009 to 2014, most cities had large bond-issuing amounts. The dynamics were affected by the economic stimulus target set by the central government and the interjurisdictional competition in borrowing among local governments. After 2015 the cities with better economies issued more bonds because the central government tried to match local government debt with local fiscal capacity to maintain financial security. The spatial dynamics show the increasing intervention by the central government in local fiscal income and expenditure, reflecting fiscal centralization. Fiscal centralization did not effectively contain the financial risk in the less-developed cities. Motivated by the competition, the less-developed cities did not use bonds efficiently and had higher ratios of bond issuance to fiscal income, experiencing higher financial risk.

Desde el 2010, la deuda de los gobiernos locales en China se ha disparado debido a que las administraciones recurren a la financiación por medio de deuda para inversión en infraestructura. La deuda consiste primordialmente en la emisión de bonos Chengtou y, más tarde, bonos del gobierno local. Usando datos de más de 300 ciudades, entre 2009 y 2020, este artículo mapea la dinámica espacial para lograr un mayor entendimiento de las relaciones intergubernamentales en los estudios sobre deuda de los gobiernos locales. Encontramos que, de 2009 a 2014, la mayoría de las ciudades emitieron grandes volúmenes de bonos. Las dinámicas se afectaron por el objetivo del estímulo económico establecido por el gobierno central y por la competencia interjurisdiccional en el endeudamiento entre los gobiernos locales. Después de 2015, las ciudades con mejores economías emitieron más bonos debido a que el gobierno central trató de equiparar la deuda del gobierno local con la capacidad fiscal local para conservar la seguridad financiera. La dinámica espacial deja ver la creciente intervención del gobierno central en los ingresos y gastos fiscales locales, lo cual refleja la centralización fiscal. La centralización fiscal no contuvo eficazmente el riesgo financiero en las ciudades menos desarrolladas. Motivadas por la competencia, las ciudades menos desarrolladas no utilizaron eficientemente los bonos y tuvieron ratios más altas de emisión de bonos respecto a los ingresos fiscales, experimentando un riesgo financiero más alto.