Nation-scale primary prevention to reduce newly incident adolescent drug use: the issue of lag time

Estimating the effects of legalizing recreational cannabis on newly incident cannabis use

Liberalized state-level recreational cannabis policies in the United States (US) fostered important policy evaluations with a focus on epidemiological parameters such as proportions [e.g., active cannabis use prevalence; cannabis use disorder (CUD) prevalence]. This cannabis policy evaluation project adds novel evidence on a neglected parameter–namely, estimated occurrence of newly incident cannabis use for underage (<21 years) versus older adults. The project’s study populations were specified to yield nationally representative estimates for all 51 major US jurisdictions, with probability sample totals of 819,543 non-institutionalized US civilian residents between 2008 and 2019. Standardized items to measure cannabis onsets are from audio computer-assisted self-interviews. Policy effect estimates are from event study difference-in-difference (DiD) models that allow for causal inference when policy implementation is staggered. The evidence indicates no policy-associated changes in the occurrence of newly incident cannabis onsets for underage persons, but an increased occurrence of newly onset cannabis use among older adults (i.e., >21 years). We offer a tentative conclusion of public health importance: Legalized cannabis retail sales might be followed by the increased occurrence of cannabis onsets for older adults, but not for underage persons who cannot buy cannabis products in a retail outlet. Cannabis policy research does not yet qualify as a mature science. We argue that modeling newly incident cannabis use might be more informative than the modeling of prevalences when evaluating policy effects and provide evidence of the advantages of the event study model over regression methods that seek to adjust for confounding factors.

Trends and determinants of catastrophic health expenditure in China 2010-2018: a national panel data analysis

BACKGROUND

Catastrophic health expenditures (CHE) are out-of-pocket payments (OOP) that exceed a predefined percentage or threshold of a household's resources, usually 40 %, that can push households into poverty in China. We analyzed the trends in the incidence and intensity, and explored the determinants, of CHE, and proposed policy recommendation to address CHE.

METHODS

A unique 5-year national urban-rural panel database was constructed from the China Family Panel Studies (CFPS) surveys. CHE incidence was measured by calculating headcount (percentage of households incurring CHE to the total household sample) and intensity was measured by overshoot (degree by which an average out of pocket health expenditure exceeds the threshold of the total sample). A linear probability model was employed to assess the trend in the net effect of the determinants of CHE incidence and a random effect logit model was used to analyse the role of the characteristics of the household head, the household and household health utilization on CHE incidence.

RESULTS

CHE determinants vary across time and geographical location. From 2010 to 2018, the total, urban and rural CHE incidence all showed a decreasing tend, falling from 14.7 to 8.7 % for total households, 12.5-6.6 % in urban and 16.8-10.9 % in rural areas. CHE intensity decreased in rural (24.50-20.51 %) and urban (22.31-19.57 %) areas and for all households (23.61-20.15 %). Inpatient services were the most important determinant of the incidence of CHE. For urban households, the random effect logit model identified household head (age, education, self-rated health); household characteristics (members 65 + years, chronic diseases, family size and income status); and healthcare utilization (inpatient and outpatient usage) as determinants of CHE. For rural areas, the same variables were significant with the addition of household head's sex and health insurance.

CONCLUSIONS

The incidence and intensity of CHE in China displayed a downward trend, but was higher in rural than urban areas. Costs of inpatient service usage should be a key intervention strategy to address CHE. The policy implications include improving the economic level of poor households, reforming health insurance and reinforcing pre-payment hospital insurance methods.

Examining the Intended and Unintended Impacts of Raising a Minimum Legal Drinking Age on Primary and Secondary Societal Harm and Violence from a Contextual Policy Perspective: A Scoping Review

Raising a minimum legal drinking age (MLDA) has generated interest and debate in research and politics, but opposition persists. Up to now, the presentation of impacts focussed on effectiveness (i.e., intended impact); to our knowledge, no literature syntheses focussed on both intended and unintended impacts. A systematic scoping review was conducted in which a search strategy was developed iteratively and literature was obtained from experts in alcohol research and scientific and grey databases. Ninety-one studies were extracted and analysed using formative thematic content analysis. Intended impacts were reported in 119 units of information from the studies (68% positive), forming four paths: implementation, primary and (two) on secondary societal harm and violence. Unintended developments were reported in 43 units of information (30% positive), forming five themes. Only eight studies reported on implementation. Furthermore, a division between primary and secondary paths and the use of a bridging variable (drinking patterns in analyses or methodology) was discovered. These results provide an insight into how well legislation works and can be used to discover or implement new means of curbing underage drinking and alcohol-related violence and harm. They also offer valuable starting points for future research and underline the importance of considering unintended developments.