The effect of combat deployments on veteran opioid abuse.

Grim national statistics about the U.S. opioid crisis are increasingly well known to the American public. Far less well known is that U.S. servicemembers are at ground zero of the epidemic, with veterans facing an overdose death rate of up to twice that of civilians. Exploiting a quasi-experiment in overseas deployment assignment, this study estimates the causal impact of combat exposure among the deployed in the Global War on Terrorism on opioid abuse. We find that exposure to war theater substantially increased the risk of prescription painkiller abuse and illicit heroin use among active duty servicemen. The magnitudes of our estimates imply lower-bound combat exposure-induced healthcare costs of $1.04 billion per year for prescription painkiller abuse and $470 million per year for heroin use.

Recreational Marijuana Legalization and Workplace Injuries Among Younger Workers.

This case-control study uses state-by-year workplace injury data to assess recreational marijuana legalization adoption and workplace injuries among younger workers aged 20 to 34 years.

Do tobacco 21 laws work?

Tobacco 21 (T-21) laws raise the minimum legal purchasing age for all tobacco products to 21. This study is the first to examine the impact of statewide T21 laws on teenage and young adult cigarette and electronic cigarette (e-cigarette) use. Using survey data from the Behavioral Risk Factor Surveillance System (BRFSS) and a difference-in-differences approach, we find that statewide adoption of a T-21 law is associated with a 2-to-4 percentage-point decline in smoking participation among 18-to-20-year-olds. Supplemental analyses using the State Youth Risk Behavior Surveys (YRBS) show that frequent e-cigarette use among 18-year-olds also fell following the adoption of T21 laws, though this effect was partially because teens turned to informal social sources to obtain e-cigarettes (i.e., borrowing or bumming). Finally, we find that T-21 laws generate spillover effects, including (2) reductions in cigarette use among 16-to-17-year-olds, a group that relies heavily on informal social markets in high school, and (2) reductions in marijuana use and days of alcohol use among some teens.

Have recreational marijuana laws undermined public health progress on adult tobacco use?

Public health experts caution that legalization of recreational marijuana may normalize smoking and undermine the decades-long achievements of tobacco control policy. However, very little is known about the impact of recreational marijuana laws (RMLs) on adult tobacco use. Using newly available data from the Population Assessment of Tobacco and Health (PATH) and dynamic difference-in-differences and discrete-time hazard approaches, we find that RML adoption increases prior-month marijuana use among adults ages 18-and-older by 2-percentage-points, driven by an increase in marijuana initiation among prior non-users. However, this increase in adult marijuana use does not extend to tobacco use. Rather, we find that RML adoption is associated with a lagged reduction in electronic nicotine delivery systems (ENDS) use, consistent with the hypothesis that ENDS and marijuana are substitutes. Moreover, auxiliary analyses from the National Survey on Drug Use and Health (NSDUH) show that RML adoption is associated with a reduction in adult cigarette smoking. We conclude that RMLs may generate tobacco-related health benefits.

Association Between State Antibullying Policies and Suicidal Behaviors Among Lesbian, Gay, Bisexual, and Questioning Youth.

This case-control study uses data from the 2009-2017 Youth Risk Behavior Survey to explore the association between antibullying law adoption and changes in suicidal behaviors among lesbian, gay, bisexual, and questioning youth.

Intended and unintended effects of e-cigarette taxes on youth tobacco use.

Over the past decade, rising youth use of e-cigarettes and other electronic nicotine delivery systems (ENDS) has contributed to aggressive regulation by state and local governments. Between 2010 and mid-2019, ten states and two large counties adopted ENDS taxes. We use two large national surveys (Monitoring the Future and the Youth Risk Behavior Surveillance System) to estimate the impact of ENDS taxes on youth tobacco use. We find that ENDS taxes reduce youth ENDS consumption, with estimated ENDS tax elasticities of -0.06 to -0.21. However, we estimate sizable positive cigarette cross-tax effects, suggesting economic substitution between cigarettes and ENDS for youth. These substitution effects are particularly large for frequent cigarette smoking. We conclude that the unintended effects of ENDS taxation may considerably undercut or even outweigh any public health gains.

Political violence, risk aversion, and population health: Evidence from the US Capitol riot.

This study is the first to explore the impact of the January 6, 2021 Capitol riot on risk avoidance behavior and the spread of COVID-19. First, using anonymized smartphone data from SafeGraph, Inc., and an event-study approach, we document a substantial increase on January 6 in non-resident smartphone pings at the sites of the protest: the Ellipse, the National Mall, and the US Capitol Building. Then, using data from the same source and a synthetic control approach, we find that the Capitol riot led to an increase in stay-at-home behavior among District of Columbia residents, consistent with risk avoidance behavior and post-riot policies designed to limit large in-person gatherings. Finally, while we find no evidence that the Capitol riot substantially increased the spread of COVID-19 in the District of Columbia, we do find that counties with the highest inflows of out-of-town protesters experienced a 0.004 to 0.010 increase in the rate of daily cumulative COVID-19 case growth during the month following the event. These findings are exacerbated in counties without COVID-19 mitigation policies in place. Supplementary Information: The online version contains supplementary material available at 10.1007/s00148-022-00914-0.

The limits of reopening policy to alter economic behavior: New evidence from Texas.

In the midst of mass COVID-19 vaccination distribution efforts in the U.S. Texas became the first state to abolish its mask mandate and fully lift capacity constraints for all businesses, effective on March 10, 2021. Proponents claimed that the reopening would generate short-run employment growth and signal a return to normal while opponents argued that it would cause a resurgence of COVID-19 and kill Texans. This study finds that each side was largely incorrect. First, using daily anonymized smartphone data - and synthetic control and difference-in-differences approaches - we find no evidence that the Texas reopening led to substantial changes in mobility, including foot traffic at a wide set of business establishments. Second, we find no evidence that the Texas reopening affected the rate of new COVID-19 cases or deaths during the five weeks following the reopening. Our null results persist across more urbanized and less urbanized counties, as well as across counties that supported Donald Trump and Joe Biden in the 2020 presidential election. Finally, we find no evidence that the Texas reopening impacted short-run employment, including in industries most affected by the reopening. Together, these findings underscore the persistence of late-pandemic era private behavior and stickiness in individuals' risk-related beliefs, and suggest that reopening policies may have impacts that are more muted than policymakers expect. Supplementary information: The online version contains supplementary material available at 10.1007/s11166-022-09379-8.

JUE Insight: Were urban cowboys enough to control COVID-19? Local shelter-in-place orders and coronavirus case growth.

One of the most common policy prescriptions to reduce the spread of COVID-19 has been to legally enforce social distancing through shelter-in-place orders (SIPOs). This study examines the role of localized urban SIPO policy in curbing COVID-19 cases. Specifically, we explore (i) the comparative effectiveness of county-level SIPOs in urbanized as compared to non-urbanized areas, (ii) the mechanisms through which SIPO adoption in urban counties yields COVID-related health benefits, and (iii) whether late adoption of a statewide SIPO yields health benefits beyond those achieved from early adopting counties. We exploit the unique laboratory of Texas, a state in which the early adoption of local SIPOs by densely populated counties covered almost two-thirds of the state's population prior to adoption of a statewide SIPO on April 2, 2020. Using an event study framework, we document that countywide SIPO adoption is associated with an 8 percent increase in the percent of residents who remain at home full-time and between a 13 to 19 percent decrease in foot-traffic at venues that may contribute to the spread of COVID-19 such as restaurants, bars, hotels, and entertainment venues. These social distancing effects are largest in urbanized and densely populated counties. Then, we find that in early adopting urban counties, COVID-19 case growth fell by 21 to 26 percentage points two-and-a-half weeks following adoption of a SIPO, a result robust to controls for county-level heterogeneity in COVID-19 outbreak timing, coronavirus testing, the age distribution, and political preferences. We find that approximately 90 percent of the curbed growth in COVID-19 cases in Texas came from the early adoption of SIPOs by urbanized counties, suggesting that the later statewide shelter-in-place mandate yielded relatively few health benefits.

Child Access Prevention Laws and Juvenile Firearm-Related Homicides.

Debate over safe-storage gun regulations has captured public attention in the aftermath of several high-profile shootings committed by minors. To date, the existing literature provides no evidence that these laws are effective at deterring gun crime, a conclusion that has prompted the National Rifle Association to assert that such regulations are "unnecessary" and "ineffective." Using data from the FBI's Supplementary Homicide Reports for the period 1985-2013, we find that child access prevention (CAP) laws are associated with a 17 percent reduction in firearm-related homicides committed by juveniles. The estimated effect is stronger among whites than nonwhites and is driven by states enforcing the strictest safe-storage standard. We find no evidence that CAP laws are associated with firearm-related homicides committed by adults or with non-firearm-related homicides committed by juveniles, suggesting that the observed relationship between CAP laws and juvenile firearm-related homicides is causal.

Risk avoidance, offsetting community effects, and COVID-19: Evidence from an indoor political rally.

The Centers for Disease Control and Prevention (CDC) deem large indoor gatherings without social distancing the "highest risk" activity for COVID-19 contagion. On June 20, 2020, President Donald J. Trump held his first mass campaign rally following the US coronavirus outbreak at the indoor Bank of Oklahoma arena. In the weeks following the event, numerous high-profile national news outlets reported that the Trump rally was "more than likely" the cause of a coronavirus surge in Tulsa County based on time series data. This study is the first to rigorously explore the impacts of this event on social distancing and COVID-19 spread. First, using data from SafeGraph Inc, we show that while non-resident visits to census block groups hosting the Trump event grew by approximately 25 percent, there was no decline in net stay-at-home behavior in Tulsa County, reflecting important offsetting behavioral effects. Then, using data on COVID-19 cases from the CDC and a synthetic control design, we find little evidence that COVID-19 grew more rapidly in Tulsa County, its border counties, or in the state of Oklahoma than each's estimated counterfactual during the five-week post-treatment period we observe. Difference-in-differences estimates further provide no evidence that COVID-19 rates grew faster in counties that drew relatively larger shares of residents to the event. We conclude that offsetting risk-related behavioral responses to the rally-including voluntary closures of restaurants and bars in downtown Tulsa, increases in stay-at-home behavior, displacement of usual activities of weekend inflows, and smaller-than-expected crowd attendance-may be important mechanisms. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11166-021-09359-4.

The contagion externality of a superspreading event: The Sturgis Motorcycle Rally and COVID-19.

Large in-person gatherings of travelers who do not socially distance are classified as the "highest risk" for COVID-19 spread by the Centers for Disease Control and Prevention (CDC). From August 7-16, 2020, nearly 500,000 motorcycle enthusiasts converged on Sturgis, South Dakota for its annual rally in an environment without mask-wearing requirements or other mitigating policies. This study is the first to explore this event's public health impacts. First, using anonymized cell phone data, we document that foot traffic at restaurants/bars, retail establishments, and entertainment venues rose substantially at event locations. Stay-at-home behavior among local residents fell. Second, using a synthetic control approach, we find that the COVID-19 case rate increased substantially in Meade County and in the state of South Dakota in the month following the Rally. Finally, using a difference-in-differences model to assess nationwide spread, we find that following the Sturgis event, counties outside of South Dakota that contributed the highest inflows of rally attendees experienced a 6.4-12.5% increase in COVID-19 cases relative to counties without inflows. Our findings highlight that local policy decisions assessing the tradeoff between local economic benefits and COVID-19 health costs will not be socially optimal in the presence of large contagion externalities.

Association Between Statewide COVID-19 Lottery Announcements and Vaccinations.

This case-control study assesses if announcements of cash drawings in 19 states were associated with increased vaccine uptake by comparing vaccination trends in states that announced drawings with states that did not using a difference-in-differences framework.

WHEN DO SHELTER-IN-PLACE ORDERS FIGHT COVID-19 BEST? POLICY HETEROGENEITY ACROSS STATES AND ADOPTION TIME.

This study explores the impact of Shelter-in-Place Orders (SIPOs) on health, with attention to heterogeneity in their impacts. First, using daily state-level social distancing data, we document that adoption of a SIPO was associated with a 9%-10% increase in the rate at which state residents remained in their homes full-time. Using daily state-level coronavirus case data, we find that approximately 3 weeks following the adoption of a SIPO, cumulative COVID-19 cases fell by approximately 53.5%. However, this average effect masks important heterogeneity across states-early adopters and high population density states appear to reap larger benefits from their SIPOs. (JEL H75, I12, I18).

CIGARETTE TAXES AND TEEN MARIJUANA USE.

The spillover effect of cigarette taxes on youth marijuana use has been the subject of intense public debate. Opponents of cigarette taxes warn that tax hikes will cause youths to substitute toward marijuana. On the other hand, public health experts often claim that because tobacco is a "gateway" drug, higher cigarette taxes will deter youth marijuana use. Using data from the National and State Youth Risk Behavior Surveys (YRBS) for the period 1991-2017, we explore the relationship between state excise taxes on cigarettes and teen marijuana use. In general, our results fail to support either of the above hypotheses. Rather, we find little evidence to suggest that teen marijuana use is sensitive to changes in the state cigarette tax. This null result holds for the sample period where cigarette taxes are observed to have the largest effect on teen cigarette use and across a number of demographic groups in the data. Finally, we find preliminary evidence that the recent adoption of state e-cigarette taxes is associated with a reduction in youth marijuana use.

Sexual identity, same-same relationships, and health dynamics: New evidence from Australia.

Prior research has found that opposite-sex marital and cohabiting relationships are associated with improvements in health. However, studies examining the health dynamics of same-sex relationships are sparser because few nationally representative longitudinal datasets collect information on adults' sexual identity. Using newly available data on sexual minorities from the Household, Income and Labour Dynamics in Australia (HILDA) Survey, we estimate the effects of Lesbian/Gay/Bisexual (LGB) identification and same-sex relationships on health dynamics. We document two key findings. First, sexual minorities in Australia are more likely to engage in risky health behaviors and report worse health than their heterosexual counterparts. Second, after exploiting the longitudinal nature of the HILDA and accounting for selection into relationships using the dynamic panel approach of Kohn and Averett (2014), we find that while opposite-sex partnerships are associated with a 3 to 7 percentage-point decline in risky health behaviors and improved physical and mental health, the health benefits of same-sex relationships are weaker, particularly for men.