2023
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Francis W. Graham, Sonja de New, Suzanne Nielsen and Dennis Petrie
2023-09
The proliferation of the high-dose prescription opioid product OxyContin has been identified as a major contributing factor to rising rates of opioid-involved harm throughout the early stages of the US opioid epidemic. Furthermore, after OxyContin was reformulated with abuse-deterrent properties in 2010, many people previously engaging in extramedical OxyContin use substituted to illicit substitutes, initiating a wave of heroin- and later synthetic opioid-involved deaths. Using event studies similar to those employed in previous OxyContin-related studies, we provide evidence that the OxyContin reformulation also induced substitution to another high-dose extended release (ER) prescription opioid product marketed under the brand name Opana ER. We show that the steady continued growth in prescription opioid-involved mortality after the OxyContin reformulation is nearly entirely explained by substitution from OxyContin to Opana ER. Furthermore, we show that when Opana ER itself was reformulated in February 2012, there was another wave of substitution to heroin previously attributed solely to OxyContin. Our estimates imply that if the Opana ER pathway were shut down at the time of the OxyContin reformulation, heroin-involved mortality from 2009 to 2016 in the US would have been as much as 33% lower, synthetic opioid-involved mortality as much as 38% lower, and total opioid-involved mortality as much as 44% lower. This study provides new evidence of the harms posed by high-dose prescription opioid products throughout the US opioid epidemic, as well as the unintended consequences of supply disruptions in the presence of both licit and illicit substitutes.
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Nicole Black, Lachlan Deer, David W. Johnston, and Johannes S. Kunz
2023-08
Peer-to-peer support is often a critical component of mental health programs, but evidence on the effect of peer-based support programs at scale is limited. Using quasi-experimental methods, we examine whether a prominent peer-based support campaign, “R U OK? Day”, affects short-term mental health outcomes in Australia. Using variation in daily records and differences in the campaign’s intensity over nine years, we find no evidence that “R U OK? Day” reduces suicides and suicidal behaviours in the month after the campaign. However, we find positive effects on mental wellbeing, particularly among middle-aged males, with improved social support the likely mechanism. Our results provide evidence that peer support campaigns may be a practical, low-cost approach to improve population mental wellbeing.
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Sundar Ponnusamy and Mohammad Abbas Hakeem
2023-07
We examine the association between ethnic inequality and various key health outcomes for a global set of developed and developing countries. Our results show that higher ethnic inequality is associated with a poor state of public health, such as higher child and maternal mortality, increased stillbirths and child stunting, and reduced life expectancy at birth. This set of effects is found to be predominant mainly in developing countries, and Sub-Saharan African countries. Results remain robust to the inclusion of various other measures of inequality, ethnic composition indices, geographic endowments, and other relevant controls. We argue that lower contraceptive usage and poor vaccination rates are potential mechanisms through which ethnic inequality affects health outcomes. Policies targeted at improving public health may need to focus more on these key intermediate channels in ethnic minority regions.
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Nicole Black, Danusha Jayawardana, and Gawain Heckley
2023-06
Children’s time investments in various activities may be important for reducing socioeconomic status (SES) gaps in educational and mental health outcomes. Using time use diaries of Australian children aged 4-14, we find children from low SES backgrounds spend more time on digital media and less time on cognitively stimulating out-of-school activities, organised or for leisure. This difference contributes about 4% to the observed SES gap in numeracy skills. The contribution is larger for males, older age groups, and when the cumulative effect on learning is considered. No clear results are found for literacy skills and mental health outcomes.
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Johannes Kunz and Anna Zhu
2023-05
We study the effect of reducing welfare assistance on migrants’ long-term integration in Australia. The policy postponed a migrant’s eligibility for benefits during their first two years in the country. It mainly affected mothers and was announced after their arrival. Using a regression discontinuity design and 21 years of administrative welfare data, we find significant reductions in welfare receipt, where the gap widened over time, and stabilized in the long run. Benefit receipt amounts reduced by 28%, and time-on-benefits by 19%, particularly in the unemployment and disability categories. We observe larger treatment effects for mothers from disadvantaged backgrounds.
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Sofia Amaral-Garcia, Mattia Nardotto, Carol Propper and Tommaso Valletti
2023-04
We study the effect of internet diffusion on the uptake of the measles, mumps and rubella (MMR) vaccine for children in England between 2000 and 2011. OLS estimates suggest that internet diffusion led to an increase in vaccinations but this result is reversed once we instrument for internet access. We find that the effect of internet diffusion on vaccination rates is sizable: a change of one standard deviation in internet take up determined an approximately 20% decrease in vaccination rate. We also find that areas with a higher proportion of high skilled individuals and lower deprivation levels are those with a higher response to internet diffusion in terms of the reduction in MMR vaccination rates. These findings are consistent with higher skilled and less deprived parents responding faster to false information circulated at the time that the vaccine could lead to autism. Even though this information has been proven to be wrong, these parents were those absorbing it more.
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Coen van de Kraats, Titus Galama and Maarten Lindeboom
2023-03
We provide evidence that the social norm (expectation) of work has a detrimental causal effect on the mental well-being of individuals not able to abide by it. Using SHARE data on men aged 50+ from 10 European countries, we identify the social norm of work effect in a difference-in-differences model that compares mental well-being scores of unemployed / disabled individuals (the treatment group) with those of employed / retired individuals (the control group) at varying levels of the fraction of retirees of comparable age. The initial mental well-being gap at age 50 is large, with unemployed / disabled men experiencing substantially lower levels of mental well-being, comparable to, e.g., the detriment of being widowed. Beyond age 50, the mental well-being of unemployed and disabled men improves as peers of comparable age retire, and full convergence occurs generally at an age that is slightly above the normal retirement age, when everyone has retired.
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Hai-Anh Dang, Trong-Anh Trinh and Paolo Verme
2023-02
Hardly any evidence exists on the effects of mental illness on refugee labor outcomes. We offer the first study on this topic in the context of Australia, one of the host countries with the largest number of refugees per capita in the world. Analyzing the Building a New Life in Australia longitudinal survey, we exploit the variations in traumatic experiences of refugees interacted with post-resettlement time periods to causally identify the impacts of refugee mental health. We find that worse mental health, as measured by a one-standard-deviation increase in the Kessler mental health score, reduces the probability of employment by 14.1% and labor income by 26.8%. We also find some evidence of adverse impacts of refugees’ mental illness on their children’s mental health and education performance. These effects appear more pronounced for refugees that newly arrive or are without social networks, but they may be ameliorated with government support.
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Johannes S. Kunz, Carol Propper, Kevin E. Staub and Rainer Winkelmann
2023-01
We examine variation in US hospital quality across ownership, chain membership, and market concentration. We use a new measure of quality derived from the penalties imposed on hospitals under the flagship Hospital Readmissions Reduction Program. We document a robust and sizable negative for-profit quality gap: for-profit hospitals are consistently of lower quality. We find that a substantial part of the gap is related to being located in less competitive markets. This reduction occurs most for hospitals that are part of large national chains. For such hospitals we find no quality gap in fully competitive markets.
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