Health

This paper studies the role of information on the evolution of beliefs and smoking in the United States in the 20th and early 21st centuries. We develop a dynamic and dynastic model of smoking, mortality and beliefs. The information about the harmfulness of smoking comes from three different sources: (i) medical information or public health messages, including obfuscation from the tobacco industry, (ii) learning from individual health shocks,  and (iii) social learning, understood as the diffusion of information and beliefs within and across social groups over time. We estimate the model using data on smoking behavior, health information and data on beliefs on the effect of smoking on health that cover several decades and different social groups. The estimated model shows that each of these mechanisms played an important role in the formation of beliefs about the harmfulness of smoking and that social learning was particularly important for low-educated individuals.

We develop a joint model of disease diffusion and mental health, with endogenous mobility decisions and where individuals update their trust in the efficiency of public containment policies. Mental health and trust determine preferences for mobility and hence how successful current and future policies are. We estimate the model using high-frequency and geolocalised data on mobility and psychotropic drugs consumption, allowing for a large degree of heterogeneity at an individual level. We show that containment policies lead gradually to poorer mental health, driven by the accumulation of reduced mobility periods and a progressive distrust in the efficiency of the policy, undermining future ones. 

Clinical research should conform to high standards of ethical and scientific integrity, given that human lives are at stake. However, economic incentives can generate conflicts of interest for investigators, who may be inclined to withhold unfavorable results or even tamper with data in order to achieve desired outcomes. To shed light on the integrity of clinical trial results, this paper systematically analyzes the distribution of p-values of primary outcomes for phase II and phase III drug trials reported to the ClinicalTrials.gov registry. First, we detect no bunching of results just above the classical 5% threshold for statistical significance. Second, a density discontinuity test reveals an upward jump at the 5% threshold for phase III results by small industry sponsors. Third, we document a larger fraction of significant results in phase III compared to phase II. Linking trials across phases, we find that early favorable results increase the likelihood of continuing into the next phase. Once we take into account this selective continuation, we can explain almost completely the excess of significant results in phase III for trials conducted by large industry sponsors. For small industry sponsors, instead, part of the excess remains unexplained.

This paper studies the spread of antibiotic resistance and its determinants, relying on unique data at state, year, bacteria and drug level, covering all US states. I relate antibiotic resistance to the use of antibiotics in human prescription and in animal production in a triple difference in difference design to control for confounders. Despite that animal production absorbs most of the antibiotic production, the results show that the main determinant of resistance is in fact human prescriptions, emphasising the role of policies targeting hospitals and ambulatory care. Resistance is particularly sensitive to antibiotic use for newer drugs.

This paper assesses the effect of import competition on the labor market and health outcomes of US workers. We first show that import shocks affect employment and income, but only in areas where jobs are more intense in routine tasks.  Exploiting over 40 million individual observations on health and mortality, we find that import had a detrimental effect on physical and mental health that is concentrated in those areas and exhibits strong persistence. It worsened health behaviour, decreased health care utilisation and  increased hospitalisation for a large set of conditions, more difficult to treat. The mortality hazard of workers in manufacturing increased by up to 6  percent per billion dollar import increase.

This paper evaluates the effect of increased trade on the mortality of workers in the manufacturing sector. We exploit the large increase of Chinese exports in the last two decades to assess its effect in two different countries, Italy and the US. Exploiting longitudinal individual data, we find that trade leads to an increased mortality rate among these populations, the effect being higher in Italy than in the US. A one billion dollar increase in imports leads to a 4 percent mortality increase in the US and up to 7 percent in Italy. We show that mortality patterns are different across occupational groups, with a more pronounced effect on blue collar workers in the US and in Italy, a marked effect on managers of small firms. We show that there are important spatial inequalities in the mortality burden of trade.

Viruses are a major threat to human health, and—given that they spread through social interactions—represent a costly externality. This article addresses three main questions: (i) what are the unintended consequences of economic activity on the spread of infections; (ii) how efficient are measures that limit interpersonal contacts; (iii) how do we allocate our scarce resources to limit the spread of infections? To answer these questions, we use novel high frequency data from France on the incidence of a number of viral diseases across space, for different age groups, over a quarter of a century. We use quasi-experimental variation to evaluate the importance of policies reducing interpersonal contacts such as school closures or the closure of public transpor- tation networks. While these policies significantly reduce disease prevalence, we find that they are not cost-effective. We find that expansions of transporta- tion networks have significant health costs in increasing the spread of viruses, and that propagation rates are pro-cyclically sensitive to economic conditions and increase with inter-regional trade. 

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This paper shows that smoking intensity, i.e. the amount of nicotine extracted per cigarette smoked, responds to changes in excise taxes and tobacco prices. We exploit NHANES data covering the period 1988 to 2006 across many US states. Moreover, using panel data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, we provide new evidence on the importance of cotinine measures in explaining long-run smoking behavior. We show the importance of smoking intensity as a long-run determinant of smoking cessation. We also investigate the sensitivity of smoking cessation to changes in excise taxes and their interaction with smoking intensity.

We show that individuals who are in poorer health, independently from smoking, are more likely to start smoking and to smoke more cigarettes than those with better non‐smoking‐related health. We present evidence of selection, relying on extensive data on morbidity and mortality. We show that health‐based selection into smoking has increased over the last 50 years with knowledge of its health effects. We show that the effect of smoking on mortality is greater for more highly educated individuals and for individuals in good non‐smoking‐related health.

This paper analyzes the effects on firms of a ban on smoking in public places. Our empirical strategy relies on comparing outcomes in Scotland before and after the Scottish smoking ban (introduced in March 2006) with those in northern England, where such a ban was not in place. Our analysis of survey data collected from public houses finds that the Scottish smoking ban reduced pub sales with no concomitant effect on prices. An event study analysis of the stock market performance of pub-holding companies corroborates the negative effect of the smoking ban on firm performance.

This paper evaluates the long-term consequences of parental death on children’s cognitive and noncognitive skills, as well as on labor market outcomes. We exploit a large administrative data set covering many Swedish cohorts. We develop new estimation methods to tackle the potential endogeneity of death at an early age, based on the idea that the amount of endogeneity is constant or decreasing during childhood. Our method also allows us to identify a set of death causes that are conditionally exogenous. We find that the loss of either a father or a mother on boys' earnings is no higher than 6-7 percent and slightly lower for girls. Our examination of the impact on cognitive skills (IQ and educational attainment) and on noncognitive skills (emotional stability, social skills) shows rather small effects on each type of skill. We find that both mothers and fathers are important, but mothers are somewhat more important for cognitive skills and fathers for noncognitive ones.

We evaluate the effect of smoking bans and excise taxes on the exposure to tobacco smoke of nonsmokers, and we show their unintended consequences on children. Smoking bans perversely increase non-smokers' exposure by displacing smokers to private places where they contaminate nonsmokers. We exploit data on bio-samples of cotinine, time use, and smoking cessation, as well as state and time variation in anti-smoking policies across US states. We find that higher taxes are an efficient way to decrease exposure to tobacco smoke. 

We study the effect of permanent income innovations on health for a prime-aged population. Using information on more than half a million individuals sampled over a 25-year period in three different cross-sectional surveys we aggregate data by date-of-birth cohort to construct a “synthetic cohort” data set with details of income, expenditure, socio-demographic factors, health outcomes, and selected risk factors. We then exploit structural and arguably exogenous changes in cohort incomes over the 1980s and 1990s to uncover causal effects of permanent income shocks on health. We find that such income innovations have little effect on a wide range of health measures, but do lead to increases in mortality and risky health behaviour.

The paper exploits the “Mad Cow” crisis as a natural experiment to gain knowledge on the behavioral effect of new health information. The analysis uses a detailed data set following a sample of households through the crisis. The paper disentangles the effect of non-separable preferences across time from the effect of previous exposure. It shows that new health information interacts in a non-monotonic way with disease susceptibility. Individuals at low or high risk of infection do not respond to new health information. The results show that individual behavior partly offsets the effect of new health information.

This paper analyses the compensatory behavior of smokers. Exploiting data on cotinine concentration—a metabolite of nicotine—measured in a large population of smokers over time, we show that smokers compensate for tax hikes by extracting more nicotine per cigarette. Our study makes two important contributions. First, as smoking a given cigarette more intensively is detrimental to health, our results question the usefulness of tax increases. Second, we develop a model of rational addiction where agents can also adjust their intensity of smoking, and we show that the previous empirical results suffer from estimation biases.

Background We estimated the short-run economic impacts of the Scottish smoking ban on public houses. Previous findings on the effect of smoking bans on the hospitality sector have mainly focused on the United States. These studies have mostly found no negative economic effects of such legislation on the hospitality sector in the long run. However, differences in the social use of public houses in Great Britain in comparison with the United States may lead to different findings.

Methods We used a quasi-experimental research design that compared the sales and number of customers in public houses located in Scotland before and after the Scottish smoking ban was introduced, relative to a control group of establishments across the English border where no ban was imposed. To perform this analysis, we collected data on 2724 pubs, 1590 in Scotland and 1134 in Northern England by phone interviews using quota sampling.

Results We found that the Scottish ban led to a 10% decrease in sales [P = 0.02, 95% confidence interval (CI) −19% to −2%] and a 14% decrease in customers (P = 0.02, 95% CI −26% to −2%).

Conclusion Our study suggests that the Scottish smoking ban had a negative economic impact on public houses, at least in the short run, due in part to a drop in the number of customers.

In this paper, the conclusions of Adams et al.(2002) are investigated further by replicating their methodology on two different panel data sets, the Whitehall II study in the UK and the ULF study in Sweden. Given the universal nature of health care coverage in these countries (both in terms of coverage for all age groups and types of illnesses), these data could provide an interesting comparison with the AHEAD results in the US. Futhermore, some of the assumptions and implications underlying the conclusions made by Adams et al.(2002) are discussed and their results and the results of this paper are reinterpreted in terms of pathways from SES to health and mortality.

Study objective: To determine whether measures of income and wealth are associated with poor self rated health and GHQ depression.

Design: Whitehall II study of London based civil servants re-interviewed between 1997–1999; 7162 participants.

Main results: A twofold age adjusted difference in morbidity was observed between the top and bottom of the personal income hierarchy for both sexes. For household income and particularly for wealth these associations are stronger. After adjusting for health at baseline the associations between personal income and both health outcomes are reduced by about 40%–60%. For household income the attenuation is somewhat smaller and for wealth is about 30%. Adjusting for other sociodemographic factors leads to further attenuation of the effects.

Conclusions: The associations between income, particularly personal income, and morbidity can be largely accounted for by pre-existing health and other measures of social position. The strong independent association between household wealth—a measure of income earned over decades and across generations—and morbidity are likely to be related to a set of early and current material and psychosocial benefits.