The Effect of the Earned Income Tax Credit on Physical and Mental health-Results from the Atlanta Paycheck Plus Experiment.

Policy Points The Paycheck Plus randomized controlled trial tested a fourfold increase in the Earned Income Tax Credit (EITC) for single adults without dependent children over 3 years in New York and Atlanta. In New York, the intervention improved economic, mental, and physical health outcomes. In Atlanta, it had no economic benefit or impact on physical health and may have worsened mental health. In Atlanta, tax filing and bonus receipt were lower than in the New York arm of the trial, which may explain the lack of economic benefits. Lower mental health scores in the treatment group were driven by disadvantaged men, and the study sample was in good mental health. CONTEXT: The Paycheck Plus experiment examined the effects of an enhanced Earned Income Tax Credit (EITC) for single adults on economic and health outcomes in Atlanta, GA and New York City (NYC). The NYC study was completed two years prior to the Atlanta study and found mental and physical benefits for the subgroups that responded best to the economic incentives provided. In this article, we present the findings from the Atlanta study, in which the uptake of the treatment (tax filings and EITC bonus) were lower and economic and health benefits were not observed. METHODS: Paycheck Plus Atlanta was an unblinded randomized controlled trial that assigned n = 3,971 participants to either the standard federal EITC (control group) or an EITC supplement of up to $2,000 (treatment group) for three tax years (2017-2019). Administrative data on employment and earnings were obtained from the Georgia Department of Labor and survey data were used to examine validated measures of health and well-being. FINDINGS: In Atlanta, the treatment group had significantly higher earnings in the first project year but did not have significantly higher cumulative earnings than the control group overall (mean difference = $1,812, 95% CI = -150, 3,774, p = 0.07). The treatment group also had significantly lower scores on two measures of mental health after the intervention was complete: the Patient Health Questionnaire 8 (mean difference = 0.19, 95% CI = 0.06, 0.32, p = 0.005) and the Kessler 6 (mean difference = 0.15, 95% CI = 0.03, 0.27, p = 0.012). Secondary analyses suggested these results were driven by disadvantaged men, but the study sample was in good mental health. CONCLUSIONS: The EITC experiment in Atlanta was not associated with gains in earnings or improvements in physical or mental health.

A Look at the First Quarantined Community in the USA: Response of Religious Communal Organizations and Implications for Public Health During the COVID-19 Pandemic.

The current study examined anxiety and distress among members of the first community to be quarantined in the USA due to the COVID-19 pandemic. In addition to being historically significant, the current sample was unusual in that those quarantined were all members of a Modern Orthodox Jewish community and were connected via religious institutions at which exposure may have occurred. We sought to explore the community and religious factors unique to this sample, as they relate to the psychological and public health impact of quarantine. Community organizations were trusted more than any other source of COVID-19-related information, including federal, state and other government agencies, including the CDC, WHO and media news sources. This was supported qualitatively with open-ended responses in which participants described the range of supports organized by community organizations. These included tangible needs (i.e., food delivery), social support, virtual religious services, and dissemination of COVID-19-related information. The overall levels of distress and anxiety were elevated and directly associated with what was reported to be largely inadequate and inconsistent health-related information received from local departments of health. In addition, the majority of participants felt that perception of or concern about future stigma related to a COVID-19 diagnosis or association of COVID-19 with the Jewish community was high and also significantly predicted distress and anxiety. The current study demonstrates the ways in which religious institutions can play a vital role in promoting the well-being of their constituents. During this unprecedented pandemic, public health authorities have an opportunity to form partnerships with religious institutions in the common interests of promoting health, relaying accurate information and supporting the psychosocial needs of community members, as well as protecting communities against stigma and discrimination.

The impact of urban speed reduction programmes on health system cost and utilities.

BACKGROUND: Vehicle speed changes impact the probability of injuring a pedestrian in ways that differ from the way that it impacts the probability of a collision or of death. Therefore, return on investment in speed reduction programmes has complex and unpredictable manifests. The objective of this study is to analyse the impact of motor vehicle speed reduction on the collision-related morbidity and mortality rates of urban pedestrians. METHODS AND FINDINGS: We created a simple way to estimate the public health impacts of traffic speed changes using a Markov model. Our outcome measures include the cost of injury, quality-adjusted life years (QALYs) gained and probability of death and injury due to a road traffic collision. Our two-way sensitivity analysis of speed, both before the implementation of a speed reduction programme and after, shows that, due to key differences in the probability of injury compared with the probability of death, speed reduction programmes may decrease the probability of death while leaving the probability of injury unchanged. The net result of this difference may lead to an increase in injury costs due to the implementation of a speed reduction programme. We find that even small investments in speed reductions have the potential to produce gains in QALYs. CONCLUSIONS: Our reported costs, effects and incremental cost-effectiveness ratios may assist urban governments and stakeholders to rethink the value of local traffic calming programmes and to implement speed limits that would shift the trade-off to become between minor injuries and no injuries, rather than severe injuries and fatalities.

Examining longer-term effects of parental death in adolescents and young adults: Evidence from the national longitudinal survey of adolescent to adult health.

Using longitudinal data spanning a 7-year period, we investigated the behavioral and psycho-social effects resulting from a parent's death during early childhood or teenage years on adolescent and early adulthood functioning. Findings confirmed previous work demonstrating various behavioral problems and social-psychological adjustment deficits during adolescence. Results suggested that most detrimental adjustment behaviors among parentally bereaved youth fade as they entered into young adulthood. Yet, premature school withdrawals and diminished interests in college attendance at Wave 1 left many of these young adults with diminished academic accomplishments, lingering economic disadvantages and for females a hesitancy to marry as their lives progressed into adulthood.

More money, fewer lives: the cost effectiveness of welfare reform in the United States.

OBJECTIVES: We evaluated the economic benefits of Temporary Assistance to Needy Families (TANF) relative to the previous program, Aid to Families with Dependent Children (AFDC). METHODS: We used pooled mortality hazard ratios from 2 randomized controlled trials-Connecticut Jobs First and the Florida Transition Program, which had follow-up from the early and mid-1990s through December 2011-and previous estimates of health and economic benefits of TANF and AFDC. We entered them into a Markov model to evaluate TANF's economic benefits relative to AFDC and weigh them against the potential health threats of TANF. RESULTS: Over the working life of the average cash assistance recipient, AFDC would cost approximately $28000 more than TANF from the societal perspective. However, it would also bring 0.44 additional years of life. The incremental cost effectiveness of AFDC would be approximately $64000 per life-year saved relative to TANF. CONCLUSIONS: AFDC may provide more value as a health investment than TANF. Additional attention given to the neediest US families denied cash assistance could improve the value of TANF.

Mobile Exercise Apps and Increased Leisure Time Exercise Activity: A Moderated Mediation Analysis of the Role of Self-Efficacy and Barriers.

BACKGROUND: There are currently over 1000 exercise apps for mobile devices on the market. These apps employ a range of features, from tracking exercise activity to providing motivational messages. However, virtually nothing is known about whether exercise apps improve exercise levels and health outcomes and, if so, the mechanisms of these effects. OBJECTIVE: Our aim was to examine whether the use of exercise apps is associated with increased levels of exercise and improved health outcomes. We also develop a framework within which to understand how exercise apps may affect health and test multiple models of possible mechanisms of action and boundary conditions of these relationships. Within this framework, app use may increase physical activity by influencing variables such as self-efficacy and may help to overcome exercise barriers, leading to improved health outcomes such as lower body mass index (BMI). METHODS: In this study, 726 participants with one of three backgrounds were surveyed about their use of exercise apps and health: (1) those who never used exercise apps, (2) those who used exercise apps but discontinued use, and (3) those who are currently using exercise apps. Participants were asked about their long-term levels of exercise and about their levels of exercise during the previous week with the International Physical Activity Questionnaire (IPAQ). RESULTS: Nearly three-quarters of current app users reported being more active compared to under half of non-users and past users. The IPAQ showed that current users had higher total leisure time metabolic equivalent of task (MET) expenditures (1169 METs), including walking and vigorous exercise, compared to those who stopped using their apps (612 METs) or who never used apps (577 METs). Importantly, physical activity levels in domains other than leisure time activity were similar across the groups. The results also showed that current users had lower BMI (25.16) than past users (26.8) and non-users (26.9) and that this association was mediated by exercise levels and self-efficacy. That relationship was also moderated by perceived barriers to exercise. Multiple serial mediation models were tested, which revealed that the association between app use and BMI is mediated by increased self-efficacy and increased exercise. CONCLUSIONS: Exercise app users are more likely to exercise during their leisure time, compared to those who do not use exercise apps, essentially fulfilling the role that many of these apps were designed to accomplish. Data also suggest that one way that exercise apps may increase exercise levels and health outcomes such as BMI is by making it easier for users to overcome barriers to exercise, leading to increased self-efficacy. We discuss ways of improving the effectiveness of apps by incorporating theory-driven approaches. We conclude that exercise apps can be viewed as intervention delivery systems consisting of features that help users overcome specific barriers.

Exploring Prospective Predictors of Illicit Drug-Toxicity Deaths: Evidence From the General Social Survey.

BACKGROUND: This study was based on over 30,000 U.S. respondents who completed General Social Surveys between 1978 and 2002. AIMS: We approached these respondents prospectively, comparing and contrasting the responses of those who subsequently died from drug-poisonings (N = 135) with all respondents who were still living, N = 23,559. METHOD: We employed cross-tabulation and logistic regression analyses to test for statistically significant differences between drug-poisoning death casualties and all living respondents. RESULTS: Consistent with past research findings, younger males were over-represented among drug death casualties. Also consistent with past studies, drug casualties showed evidence of perceiving themselves as socially marginalized in comparison to living respondents: More reported themselves in poorer health, as having been sexual minority members during the last 5 years, as having spent their younger years in homes where parents' marriages disrupted, with fewer owning homes and feeling less satisfied about their financial situations. CONCLUSIONS: These exploratory findings obtained from a general population survey reinforce findings from clinical studies and help advance clinical assessments of potential at-risk individuals who might be identified sooner, lest they succumb to future fatal drug poisonings.

Impact of welfare reform on mortality: an evaluation of the Connecticut jobs first program, a randomized controlled trial.

OBJECTIVES: We examined whether Jobs First, a multicenter randomized trial of a welfare reform program conducted in Connecticut, demonstrated increases in employment, income, and health insurance relative to traditional welfare (Aid to Families with Dependent Children). We also investigated if higher earnings and employment improved mortality of the participants. METHODS: We revisited the Jobs First randomized trial, successfully linking 4612 participant identifiers to 15 years of prospective mortality follow-up data through 2010, producing 240 deaths. The analysis was powered to detect a 20% change in mortality hazards. RESULTS: Significant employment and income benefits were realized among Jobs First recipients relative to traditional welfare recipients, particularly for the most disadvantaged groups. However, although none of these reached statistical significance, all participants in Jobs First (overall, across centers, and all subgroups) experienced higher mortality hazards than traditional welfare recipients. CONCLUSIONS: Increases in income and employment produced by Jobs First relative to traditional welfare improved socioeconomic status but did not improve survival.

Effect of a First Clinical Experience on Physical Therapy Students' Perception of the Importance of Obtaining and Assessing Blood Pressure.

AIMS: The purpose of this mixed-methods study was to investigate the effect of a first clinical experience on student perception of the importance of obtaining and assessing blood pressure (BP). METHODS: Fifty-eight students preparing for their first clinical experiences were recruited from three New York State physical therapy programs. Student experience obtaining BP during a first clinical experience was investigated using online anonymous surveys and focus groups. The pre survey was administered at 2 weeks before the first clinical experience, and a post survey and focus group were complete 3 weeks after. RESULTS: Statistically significant decline was found in student perceptions of the importance and likelihood of obtaining and assessing BP following a first clinical experience. Qualitatively, three themes emerged (1) Being a student and agency including reluctance to independently initiate practices; (2) influence of clinic norms such as availability of equipment and consistency of BP monitoring; and (3) personal confidence obtaining, assessing, and interpreting BP influenced by exposure to obtaining, assessing, and interpreting BP. CONCLUSION: Clinical education appears to have significant influence on students' perception of the importance of BP assessment. If students encounter and adopt practices deviating from didactic instruction reflecting professional standards, it can expose patients and practitioners to unnecessary risk. Faculty can use these results to better appreciate students' first clinical experiences and foster agency by discussing practice norms.

Did people really drink bleach to prevent COVID-19? A guide for protecting survey data against problematic respondents.

Survey respondents who are non-attentive, respond randomly, or misrepresent who they are can impact the outcomes of surveys. Prior findings reported by the CDC have suggested that people engaged in highly dangerous cleaning practices during the COVID-19 pandemic, including ingesting household cleaners such as bleach. In our attempts to replicate the CDC's results, we found that 100% of reported ingestion of household cleaners are made by problematic respondents. Once inattentive, acquiescent, and careless respondents are removed from the sample, we find no evidence that people ingested cleaning products to prevent a COVID-19 infection. These findings have important implications for public health and medical survey research, as well as for best practices for avoiding problematic respondents in all survey research conducted online.

Examining the social origins and young adult life trajectories of high traditional masculinity (HTM) males: A group at elevated suicide risk.

OBJECTIVE: We investigated whether male high school students displaying high traditional masculinity (HTM), defined briefly as overacting male roles, possessed distinctive social origins and adult lifestyle trajectories differentiating them from others. METHOD: Based upon four survey waves of the National Longitudinal Study of Adolescent to Adult Health cross-linked to the National Death Index, we contrasted surveys 1 and 2 respondents reporting HTM, n = 3138, 31%, with the remaining 69% (n = 6849) on various sociodemographic characteristics, problem behaviors, suicides, and other premature mortalities. RESULTS: High traditional masculinity males showed higher suicide rates, but no other differences in premature mortalities, compared with non-HTM peers. More likely to be White, younger, less close to their fathers, they were more likely to run away from home, get into fights, act delinquently, and engage in problem drinking and drug use. At survey wave 3, more had been arrested. By wave 4, when approaching their early thirties, HTM males showed higher drug uses, more delinquency, completed less schooling, and were less likely to marry. CONCLUSIONS: These data not only suggest higher suicide risks among this population after high school, but judging from the durability of HTM characteristics, but also they appear at risk of "deaths of despair" during later life.

Psychological Distress Among the First Quarantined Community in the United States: Initial Observations From the Early Days of the COVID-19 Crisis.

This study assesses distress and anxiety symptoms associated with quarantine due to COVID-19 exposure among the first quarantined community in the United States and identifies potential areas of intervention. All participants were directly or peripherally related to "patient 1,"-the first confirmed community-acquired case of COVID-19 in the New York Area. As such, this is a historically significant sample whose experiences highlight a transitional moment from a pre-pandemic to a pandemic period in the United States. In March 2020, an anonymous survey was distributed to 1,250 members of a NYC area community that was under community-wide quarantine orders due to the COVID-19 outbreak. Distress was measured using the Subjective Units of Distress Scale (SUDS) and symptoms of anxiety were measured using the Beck Anxiety Inventory (BAI). A variety of psychosocial predictors relevant to the current crisis were explored. Three hundred and three individuals responded within forty-eight hours of survey distribution. Mean levels of distress in the sample were heightened and sustained, with 69% reporting moderate to severe distress on the SUDS and 53% of the sample reported mild, moderate, or severe anxiety symptoms on the BAI. The greatest percentage of variance of distress and anxiety symptoms was accounted for by modifiable factors amenable to behavioral and psychological interventions.

Unraveling the Complex Web of Associations Between Easy Access to Firearms and Premature Mortalities.

OBJECTIVE: We investigated whether high school students reporting easy access to guns were more likely to die prematurely from either suicide, homicide, or an accidental death. METHOD: Based upon the National Longitudinal Study of Adolescent to Adult Health, we contrasted those reporting easy access to guns, n = 5,185, 25%, with the remaining 75% (n = 15,589) on various sociodemographic characteristics, behaviors, and premature mortalities. RESULTS: We found higher rates of suicides, homicides, and accidental deaths among those reporting easy access to guns at Wave 1 or Wave 2. This was only true for males. Those with easy access to guns were more likely to share common sociodemographic characteristics, came from two-parent homes where children had strong and close relationships with parents, where children were more likely to get into fights, do delinquent misdeeds, and engage in other risk-taking behaviors such as increased drinking, drug use, and riding motorcycles. Logistic regression analysis showed easy access to guns remained a significant predictor of premature mortalities when sex, family income differences, risk-taking, and delinquency were used as covariates. CONCLUSIONS: This study supports previous research and carves out new ground showing easy access to guns acts synergistically with other lifestyle differences to diminish youth life chances.

Research Note on Whether Sexual Minority Individuals Are Over-Represented Among Suicide's Casualties.

Background: Past studies have repeatedly shown higher suicidal thoughts and attempts among sexual minority members, yet have remained opaque on whether these groups are more prone to taking their own lives. Aims: This short report focuses on suicide deaths among sexual minority members. Method: We utilized two large-scale surveys: one, among adults, the updated Cumulative General Social Surveys, and the other, among adolescents, The National Longitudinal Study of Adolescent Health (Add Health), where respondents' data were cross-linked to National Death Index death records. Results: Results confirmed pre-existent findings showing elevated suicide rates among sexual minority females but not among sexual minority males. Limitations: The shortfall of female adolescent suicides in the Add Health sample prevented us from examining the question of female sexual minority suicides within this population. Conclusion: Although ample evidence demonstrates higher suicidal thoughts and attempts among sexual minority males, three studies presently do not confirm their greater propensity to die by suicide, compared with heterosexual males; yet, for sexual minority females the evidence is steadily mounting showing their greater suicide risks.

The persistence of pay inequality: The gender pay gap in an anonymous online labor market.

Studies of the gender pay gap are seldom able to simultaneously account for the range of alternative putative mechanisms underlying it. Using CloudResearch, an online microtask platform connecting employers to workers who perform research-related tasks, we examine whether gender pay discrepancies are still evident in a labor market characterized by anonymity, relatively homogeneous work, and flexibility. For 22,271 Mechanical Turk workers who participated in nearly 5 million tasks, we analyze hourly earnings by gender, controlling for key covariates which have been shown previously to lead to differential pay for men and women. On average, women's hourly earnings were 10.5% lower than men's. Several factors contributed to the gender pay gap, including the tendency for women to select tasks that have a lower advertised hourly pay. This study provides evidence that gender pay gaps can arise despite the absence of overt discrimination, labor segregation, and inflexible work arrangements, even after experience, education, and other human capital factors are controlled for. Findings highlight the need to examine other possible causes of the gender pay gap. Potential strategies for reducing the pay gap on online labor markets are also discussed.

Racial Disparities in Cleanliness Attitudes Mediate Purchasing Attitudes Toward Cleaning Products: a Serial Mediation Model.

The present study has three objectives (1) to examine whether there are differences in cleanliness concerns between African Americans and European Americans toward kitchen items that are known to be vectors of disease, (2) to examine whether disparities in cleanliness attitudes have an impact on purchasing attitudes toward kitchen cleaning products, and (3) to explore the mechanisms that may account for these differences utilizing a serial mediation model. Five hundred participants, 50% African American and 50% European American were shown a picture of a sponge cleaning product and filled out multiple survey instruments relating to cleanliness attitudes. We found greater concern with cleanliness of kitchen items (d = .46) and a greater willingness to purchase cleaning products among African Americans compared to European Americans (17 vs 10%). A serial mediation analysis revealed that general cleanliness concerns account for the increased willingness to spend money on cleaning products among African Americans. These results suggest that African Americans are more sensitive to issues of cleanliness compared to European Americans and, in particular, are more sensitive to cleanliness of kitchen items such as sponges, which can be vectors of food-borne pathogens. Potential reasons for the observed racial disparities in cleanliness attitudes and the implications of these results for public health are discussed.

The cost-effectiveness analysis of the New Rural Cooperative Medical Scheme in China.

OBJECTIVE: The New Rural Cooperative Medical Scheme (NCMS) is a universal healthcare coverage plan now covering over 98% of rural residents in China, first implemented in 2003. Rising costs in the face of modest gains in health and financial protections have raised questions about the cost-effectiveness of the NCMS. METHODS: Using the most recent estimates of the NCMS's health and economic consequences from a comprehensive review of the literature, we conducted a cost-effectiveness analysis using a Markov model for a hypothetical cohort between ages 20 and 100. We then did one-way sensitivity analyses and a probabilistic sensitivity analysis using Monte Carlo simulations to explore whether the incremental cost-effectiveness ratio (ICER) falls below 37,059 international dollars [Int$], the willingness-to-pay (WTP) threshold of three times per capita GDP of China in 2013. FINDINGS: The ICER of the NCMS over the lifetime of an average 20-year-old rural resident in China was about Int$71,480 per quality-adjusted life year (QALY) gained (95% confidence interval: cost-saving, Int$845,659/QALY). There was less than a 33% chance that the system was cost-saving or met the WTP threshold. However, the NCMS did fall under the threshold when changes in the program costs, the risk of mortality and hypertension, and the likelihood of labor force participation were tested in one-way sensitivity analyses. CONCLUSION: The NCMS appears to be economically inefficient in its current form. Further cost-effectiveness analyses are warranted in designing insurance benefit packages to ensure that the NCMS fund goes toward health care that has a good value in improving survival and quality of life.

Vision zero: a toolkit for road safety in the modern era.

Vision Zero (VZ) is a public program that aims to have zero fatalities or serious injuries from road traffic crashes. This article examines various major components of VZ: how VZ redefines road safety, how VZ principles and philosophies can be applied to modern car and road designs, and how VZ can be applied to traffic. Applications of these principles to real-world traffic infrastructure are explored in order to show policymakers the toolkits available to increase road safety while taking into consideration local contexts.

The cost-effectiveness of PHQ screening and collaborative care for depression in New York City.

BACKGROUND: Depression is under-diagnosed and under-treated in most areas of the US. New York City is currently looking to close gaps in identifying and treating depression through the adoption of a screening and collaborative care model deployed throughout the city. METHODS: We examine the cost-effectiveness of universal two-stage screening with the 2- and 9-item Patient Health Questionnaires (PHQ-2 and PHQ-9) in New York City followed by collaborative care for those who screen positive. We conducted microsimulations on hypothetical adult participants between ages 20 and 70. RESULTS: The incremental cost-effectiveness of the interventions over the average lifespan of a 20-year-old adult in NYC is approximately $1,726/QALY gained (95% plausible interval: cost-saving, $10,594/QALY gained). CONCLUSIONS: Two-stage screening coupled with collaborative care for depression in the clinical setting appears to be significantly less expensive than most clinical preventive interventions, such as HIV screening in high-risk patients. However, effectiveness is dependent on the city's ability to manage scale up of collaborative care models.

The Cost-effectiveness Analysis of Nurse-Family Partnership in the United States.

We evaluated whether Nurse-Family Partnership might serve as a cost-effective social policy for improving health. Using data from studies of randomized controlled trials as well as real-world data, we conducted a Monte Carlo simulation to estimate cost-effectiveness of Nurse-Family Partnership in a hypothetical cohort of first-born children in the United States. Analyses were conducted in 2015. Were all new mothers eligible for Nurse-Family Partnership, the program would produce 0.11 QALYs (95% confidence interval [CI]=0.06, 0.17) at an additional cost of $1,021 (95% CI=-$2,831, $4,414) per nurse-visited child's lifetime relative to the comparison-group children or $14,642 (95% CI = Savings, $71,877) per QALY gained. However, if applied to high-risk mothers, it would generate 0.19 QALYs (95% CI = 0.09, 0.44) and a net benefit of $2,764 (95% CI =-$1,210, $7,092) per nurse-visited child. Nurse-Family Partnership should be considered as a policy investment, particularly in an era of investments in the social determinants of health.