Public Health Commons^™

Promoting Sustainable Responses To The Us Opioid Epidemic With Community-Academic Partnerships: Qualitative Outcomes From A Statewide Program, David L. Driscoll, Alison Evans Cuellar, Vinod Agarwal, Debra Jones, Kathy Hosig, Mary Beth Dunkenberger

Economics Faculty Publications

Background: Drug overdose deaths in the United States have continued to increase at an alarming rate. The United States is facing two devastating public health crises– the opioid epidemic and the COVID-19 pandemic. Within this context, one of the most ambitious implementation studies in addiction research is moving forward. Launched in May 2019, the HEALing Communities Study (HCS) was developed by the National Institutes of Health (NIH) and the Substance Abuse and Mental Health Services Administration (SAMHSA) as part of the Helping to End Addiction Long-termSM Initiative (National Institutes of Health, 2020). The goal for this research was to reduce …

The Drug Overdose Epidemic Seen Through Different Lenses, Barbara Blake Gonzalez, Richard Cebula, James V. Koch

Economics Faculty Publications

The age-adjusted death rate from drug overdoses in the United States per 100,000 individuals rose from 6.8 in 2010 to 17.1 in 2018. The most common explanation offered is the deaths of despair hypothesis. We identify additional factors that have contributed to the rise in drug overdose deaths in cities and counties. Methods: We utilize a period fixed effects model with a multi-variate panel data set for 94 independent cities and counties in Virginia for the period 2008 through 2017. Results: The drug overdose mortality rate is: (a) an increasing function (prob.

Drug-Overdose Death Rates: The Economic Misery Explanation And Its Alternatives, Barbara Blake Gonzalez, Richard Cebula, James V. Koch

Economics Faculty Publications

‘Deaths of despair’ is the most commonly cited explanation for the 151% increase in drug-overdose deaths that occurred in the USA between 2010 and 2018. We use panel data describing 84 Virginia cities and counties to assess the validity of the deaths of despair hypothesis and alternate explanations that focus on disability rates, travel time to work, urban vs. rural location, educational attainment, racial and ethnic characteristics, the influence of other health conditions such as obesity, and supply-side factors that include pill availability and pharmacy market shares. We find deaths of despair to be only a partial explanation for the …

Congenital Chagas Disease In The United States: The Effect Of Commercially Priced Benznidazole On Costs And Benefits Of Maternal Screening, Victoria Perez-Zetune, Stephanie R. Bialek, Susan P. Montgomery, Eileen Stillwaggon

Economics Faculty Publications

Chagas disease, caused by Trypanosoma cruzi, is transmitted by insect vectors, and through transfusions, transplants, insect feces in food, and mother to child during gestation. An estimated 30% of infected persons will develop lifelong, potentially fatal cardiac or digestive complications. Treatment of infants with benznidazole is highly efficacious in eliminating infection. This work evaluates the costs of maternal screening and infant testing and treatment for Chagas disease in the United States, including the cost of commercially available benznidazole. We compare costs of testing and treatment for mothers and infants with the lifetime societal costs without testing and consequent morbidity and …

The Cost-Effectiveness Of Neonatal Versus Prenatal Screening For Congenital Toxoplasmosis, Christine Binquet, Catherine Lejeune, Valérie Seror, François Peyron, Anne-Claire Bertaux, Olivier Scemama, Catherine Quantin, Sophie Béjean, Eileen Stillwaggon, Martine Wallon

Economics Faculty Publications

Congenital Toxoplasmosis (CT) can have severe consequences. France, Austria, and Slovenia have prenatal screening programs whereas some other countries are considering universal screening to reduce congenital transmission and severity of infection in children. The efficiency of such programs is debated increasingly as seroprevalence among pregnant women and incidence of congenital toxoplasmosis show a steady decrease. In addition, uncertainty remains regarding the effectiveness of pre- and postnatal treatments.

Maternal Work Hours And Childhood Obesity: Evidence Using Instrumental Variables Related To Sibling School Eligibility, Charles J. Courtemanche, Rusty Tchernis, Xilin Zhou

Economics Faculty Publications

This study exploits plausibly exogenous variation derived from the youngest sibling’s school eligibility to estimate the effects of maternal work on the weight outcomes of older children. We first show that mothers’ work hours increase gradually along both the extensive and intensive margins as the age of the youngest child rises, whereas mothers’ spouses’ work hours do not appear to be responsive. We develop an instrumental-variables model that shows that mothers’ work hours lead to larger increases in children’s body mass index z-scores and probabilities of being overweight/obese than those identified in previous studies. Subsample analyses find that the …

Effects Of The Affordable Care Act On Health Care Access And Self-Assessed Health After 3 Years, Charles J. Courtemanche, James Marton, Benjamin Ukert, Aaron Yelowitz, Daniela Zapata

Economics Faculty Publications

Using data from the Behavioral Risk Factor Surveillance System, we examine the causal impact of the Affordable Care Act on health-related outcomes after 3 years. We estimate difference-in-difference-in-differences models that exploit variation in treatment intensity from 2 sources: (1) local area prereform uninsured rates from 2013 and (2) state participation in the Medicaid expansion. Including the third postreform year leads to 2 important insights. First, gains in health insurance coverage and access to care from the policy continued to increase in the third year. Second, an improvement in the probability of reporting excellent health emerged in the third year, with …

Congenital Toxoplasmosis In Austria: Prenatal Screening For Prevention Is Cost-Saving, Andrea-Romana Prusa, David C. Kasper, Larry Sawers, Evelyn Walter, Michael Hayde, Eileen Stillwaggon

Economics Faculty Publications

Background:

Primary infection of Toxoplasma gondii during pregnancy can be transmitted to the unborn child and may have serious consequences, including retinochoroiditis, hydrocephaly, cerebral calcifications, encephalitis, splenomegaly, hearing loss, blindness, and death. Austria, a country with moderate seroprevalence, instituted mandatory prenatal screening for toxoplasma infection to minimize the effects of congenital transmission. This work compares the societal costs of congenital toxoplasmosis under the Austrian national prenatal screening program with the societal costs that would have occurred in a No-Screening scenario.

Methodology/Principal Findings:

We retrospectively investigated data from the Austrian Toxoplasmosis Register for birth cohorts from 1992 to 2008, including pediatric …

Point-Of-Care Testing For Toxoplasma Gondii Igg/Igm Using Toxoplasma Ict Igg-Igm Test With Sera From The United States And Implications For Developing Countries, Ian J. Begeman, Joseph Lykins, Ying Zhou, Bo Shiun Lai, Pauline Levinge, Kamal El Bissati, Kenneth Boyer, Shawn Withers, Fatima Clouser, A. Gwendolyn Noble, Peter Rabiah, Charles N. Swisher, Peter T. Heydemann, Depina G. Contopoulos-Ioannidis, Jose G. Montoya, Yvonne Maldonado, Raymund Ramirez, Cindy Press, Eileen Stillwaggon, François Peyron, Rima Mcleod

Economics Faculty Publications

Background

Congenital toxoplasmosis is a serious but preventable and treatable disease. Gestational screening facilitates early detection and treatment of primary acquisition. Thus, fetal infection can be promptly diagnosed and treated and outcomes can be improved.

Methods

We tested 180 sera with the Toxoplasma ICT IgG-IgM point-of-care (POC) test. Sera were from 116 chronically infected persons (48 serotype II; 14 serotype I-III; 25 serotype I-IIIa; 28 serotype Atypical, haplogroup 12; 1 not typed). These represent strains of parasites infecting mothers of congenitally infected children in the U.S. 51 seronegative samples and 13 samples from recently infected persons known to be IgG/IgM …

Goods-Time Elasticity Of Substitution In Health Production, Juan Du, Takeshi Yagihashi

Economics Faculty Publications

We examine how inputs for health production, in particular, medical care and health-enhancing time, are combined to improve health. The estimated elasticity of substitution from a constant elasticity of substitution production function is significantly less than one for the working-age population, rejecting the unit elasticity of substitution used in previous studies.

Economic Costs And Benefits Of A Community-Based Lymphedema Management Program For Lymphatic Filariasis In Odisha State, India, Eileen Stillwaggon, Larry Sawers, Jonathan Rout, David Addiss, Leanne Fox

Economics Faculty Publications

Lymphatic filariasis afflicts 68 million people in 73 countries, including 17 million persons living with chronic lymphedema. The Global Program to Eliminate Lymphatic Filariasis aims to stop new infections and to provide care for persons already affected, but morbidity management programs have been initiated in only 24 endemic countries. We examine the economic costs and benefits of alleviating chronic lymphedema and its effects through a simple limb-care program. For Khurda District, Odisha State, India, we estimated lifetime medical costs and earnings losses due to chronic lymphedema and acute dermatolymphangioadenitis (ADLA) with and without a community-based limb-care program. The program would …

Rush To Judgment: The Sti-Treatment Trials And Hiv In Sub-Saharan Africa, Eileen Stillwaggon, Larry Sawers

Economics Faculty Publications

Introduction: The extraordinarily high incidence of HIV in sub-Saharan Africa led to the search for cofactor infections that could explain the high rates of transmission in the region. Genital inflammation and lesions caused by sexually transmitted infections (STIs) were a probable mechanism, and numerous observational studies indicated several STI cofactors. Nine out of the ten randomized controlled trials (RCTs), however, failed to demonstrate that treating STIs could lower HIV incidence. We evaluate all 10 trials to determine if their design permits the conclusion, widely believed, that STI treatment is ineffective in reducing HIV incidence.

Discussion: Examination of the …

El Mal De Chagas Y Su Potencial De Eliminación, Eileen Stillwaggon

Economics Faculty Publications

La Asamblea Mundial de la Salud ha elegido algunas enfermedades como blancos para la eliminación. Hay mucha esperanza y una alta probabilidad de que varias enfermedades, recientemente llamadas desatendidas, sean eliminadas en las próximas décadas. Vamos a presenciar el fin de la transmisión de la dracunculiasis, la filariosis linfática, la poliomielitis, y en las Américas por lo menos, la oncocercosis. Ya se ven éxitos significativos como la cuasi erradicación de la dracunculiasis y paso importantes en contra de otras aflicciones. [Original Spanish version]

The World Health Assembly has chosen some diseases as targets for elimination. There is much …

Power, Race, And The Neglect Of Science: The Hiv Epidemics In Sub-Saharan Africa, Eileen Stillwaggon, Larry Sawers

Economics Faculty Publications

This work addresses racial stereotyping and the effect it has in distorting AIDS policy for sub-Saharan Africa.

Are Low Wages Risk Factors For Hypertension?, J. Paul Leigh, Juan Du

Economics Faculty Publications

Objective: Socio-economic status (SES) is strongly correlated with hypertension. But SES has several components, including income and correlations in cross-sectional data need not imply SES is a risk factor. This study investigates whether wages-the largest category within income-are risk factors. Methods: We analysed longitudinal, nationally representative US data from four waves (1999, 2001, 2003 and 2005) of the Panel Study of Income Dynamics. The overall sample was restricted to employed persons age 25-65 years, n = 17 295. Separate subsamples were constructed of persons within two age groups (25-44 and 45-65 years) and genders. Hypertension incidence was self-reported based on …

Hiv And Concurrent Sexual Partnerships: Modelling The Role Of Coital Dilution, Larry Sawers, Alan G. Isaac, Eileen Stillwaggon

Economics Faculty Publications

Background: The concurrency hypothesis asserts that high prevalence of overlapping sexual partnerships explains extraordinarily high HIV levels in sub-Saharan Africa. Earlier simulation models show that the network effect of concurrency can increase HIV incidence, but those models do not account for the coital dilution effect (nonprimary partnerships have lower coital frequency than primary partnerships).

Methods: We modify the model of Eaton et al (AIDS and Behavior, September 2010) to incorporate coital dilution by assigning lower coital frequencies to non-primary partnerships. We parameterize coital dilution based on the empirical work of Morris et al (PLoS ONE, December …

Concurrent Sexual Partnerships Do Not Explain The Hiv Epidemics In Africa: A Systematic Review Of The Evidence, Larry Sawers, Eileen Stillwaggon

Economics Faculty Publications

The notion that concurrent sexual partnerships are especially common in sub-Saharan Africa and explain the region’s high HIV prevalence is accepted by many as conventional wisdom. In this paper, we evaluate the quantitative and qualitative evidence offered by the principal proponents of the concurrency hypothesis and analyze the mathematical model they use to establish the plausibility of the hypothesis.

We find that research seeking to establish a statistical correlation between concurrency and HIV prevalence either finds no correlation or has important limitations. Furthermore, in order to simulate rapid spread of HIV, mathematical models require unrealistic assumptions about frequency of sexual …

Complexity, Cofactors, And The Failure Of Aids Policy In Africa, Eileen Stillwaggon

Economics Faculty Publications

Global AIDS policy still treats HIV as an exceptional case, abstracting from the context in which infection occurs. Policy is based on a simplistic theory of HIV causation, and evaluated using outdated tools of health economics. Recent calls for a health systems strategy – preventing and treating HIV within a programme of comprehensive health care – have not yet influenced the silo approach of AIDS policy.

Evidence continues to accumulate, showing that multiple factors, such as malnutrition, malaria and helminthes, increase the risk of sexual and vertical transmission of HIV. Moreover, complementary interventions that reduce viral load, improve immune response, …