Vulnerability,Risk Perception,and Health Profile of Marginalized People Exposed to Multiple Built‐Environment Stressors in Worcester,Massachusetts: A Pilot Project

Millions of low‐income people of diverse ethnicities inhabit stressful old urban industrial neighborhoods. Yet we know little about the health impacts of built‐environment stressors and risk perceptions in such settings; we lack even basic health profiles. Difficult access is one reason (it took us 30 months to survey 80 households); the lack of multifaceted survey tools is another. We designed and implemented a pilot vulnerability assessment tool in Worcester, Massachusetts. We answer: (1) How can we assess vulnerability to multiple stressors? (2) What is the nature of complex vulnerability—including risk perceptions and health profiles? (3) How can findings be used by our wider community, and what lessons did we learn? (4) What implications arise for science and policy? We sought a holistic picture of neighborhood life. A reasonably representative sample of 80 respondents captured data for 254 people about: demographics, community concerns and resources, time‐activity patterns, health information, risk/stress perceptions, and resources/capacities for coping. Our key findings derive partly from the survey data and partly from our experience in obtaining those data. Data strongly suggest complex vulnerability dominated by psychosocial stress. Unexpected significant gender and ethnic disease disparities emerged: notably, females have twice the disease burden of males, and white females twice the burden of females of color (p < 0.01). Self‐reported depression differentiated by gender and age is illustrative. Community based participatory research (CBPR) approaches require active engagement with marginalized populations, including representatives as funded partners. Complex vulnerability necessitates holistic, participatory approaches to improve scientific understanding and societal responses.     

An update on the Kevorkian-Reding 93 physician-assisted deaths in Michigan: is Kevorkian a savior,serial-killer or suicidal martyr?

This report presents an update of the Kevorkian-Reding physician-assisted (or physician-aided) deaths to include the ninety-three publicly acknowledged cases as of November 25, 1998. These deaths are divided into ten distinct time phases. The following trends emerge. Over two-thirds of the decedents are women, the ratio of females to males varying widely with phase. The proportion of women seems to be the highest when Kevorkian is free to act as he wants and lowest when he seems to be acting under legal or political restraints. Based on autopsy results, only 29.0 percent of the cases are terminal, this percentage being higher among men (37.9%) than among women (25.4%). However, 66.7% of the decedents were disabled, no significant difference emerging between men and women. Further, five out of the six decedents showing no apparent anatomical sign of disease at autopsy were women. Over 80 percent of the physician-assisted deaths are cremated, approximately twice as high a proportion as that emerging for suicides in Michigan and four times as high as cremations occurring with regard to overall deaths. Finally, death by carbon monoxide decreases dramatically with time phase while the use of the contraption dubbed the "suicide machine" increases, suggesting an increasing routinization over time. Finally, during the ninth and tenth phases, Kevorkian's aims and his own suicidality emerge more clearly involving 1) harvesting organs and 2) threat of starving himself in prison if he is convicted. Phase 10 can be seen as an escalation from assisted death to overt euthanasia, repeating the same need for a demonstration (Thomas Youk) that was first exhibited in Phase I (Janet Adkins).     

Maternal Hurricane Exposure and Fetal Distress Risk

Logistic regression and spatial analytic techniques are used to model fetal distress risk as a function of maternal exposure to Hurricane Andrew. First, monthly time series compare the proportion of infants born distressed in hurricane affected and unaffected areas. Second, resident births are analyzed in Miami‐Dade and Broward counties, before, during, and after Hurricane Andrew. Third, resident births are analyzed in all Florida locales with 100,000 or more persons, comparing exposed and unexposed gravid females. Fourth, resident births are analyzed along Hurricane Andrew's path from southern Florida to northeast Mississippi. Results show that fetal distress risk increases significantly with maternal exposure to Hurricane Andrew in second and third trimesters, adjusting for known risk factors. Distress risk also correlates with the destructive path of Hurricane Andrew, with higher incidences of fetal distress found in areas of highest exposure intensity. Hurricane exposed African‐American mothers were more likely to birth distressed infants. The policy implications of in utero costs of natural disaster exposure are discussed.     

Car Occupant Life Expectancy: Car Mass and Seat Belt Effects

Average human life expectancies for the U.S. resident population are calculated using tabulated population and survival rate data. These life expectancies are recalculated assuming elimination of various types of motor vehicle fatalities using Fatal Accident Reporting System (FARS) data. The differences between the original and recalculated values provide estimates of life expectancy reductions due to the motor vehicle fatalities. These estimates are combined with prior work relating the likelihood of an occupant fatality to car mass, so that reductions in life expectancy are determined as a function of car mass. The estimates of life expectancy reductions are also used to determine the effect of seat belt use on life expectancy. The estimates, which are based on data for 1978, assume that survival rates remain unchanged. Estimates of the changes in life expectancy associated with switching from a large (1800 kg) car to a small (900 kg) car, and switching from not using to using a seat belt are presented as functions of the age at which an individual makes the switch.     

MORE MISSING WOMEN,FEWER DYING GIRLS: THE IMPACT OF SEX‐SELECTIVE ABORTION ON SEX AT BIRTH AND RELATIVE FEMALE MORTALITY IN TAIWAN

This study finds that the introduction of sex‐selective abortion in Taiwan due to the legalization of abortion when prenatal sex‐detection technology was already available increased the fraction of males born at higher parities and changed the composition of mothers choosing to give birth. Controlling for compositional changes, we find that access to sex‐selective abortion reduced relative neonatal female mortality rates for higher‐parity births.     

THE IMPACT OF INCOME SHOCKS ON HEALTH: EVIDENCE FROM COHORT DATA

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. (JEL: I10, D31)     

Equitable Taxation and the Provision of Health Insurance Subsidies

Current U.S. income tax laws allow many taxpayers to exclude from taxable income part or all of the cost of acquiring health insurance through an employer‐sponsored benefit plan. This favorable tax treatment generally applies regardless of whether the employer or employee actually pays the health insurance premiums. We describe the effects of this tax policy on the U.S. tax system's horizontal and vertical equity. We also explain how taxpayers covered by employer‐sponsored plans are significantly subsidized by the government in acquiring health insurance, whereas taxpayers who acquire health insurance by other means or who are not covered by health insurance at all receive no such government assistance. We conclude that any prospective health‐care policy initiatives, including modifications to the 2010 health‐care reforms, should contemplate both the horizontal and vertical equity of the tax treatment of health insurance premiums.     

Concern About Petrochemical Health Risk Before and After a Refinery Explosion

On March 23, 2005, a large explosion at an oil refinery in Texas City, Texas caused 15 deaths and approximately 170 injuries. Little is known about how such an industrial accident influences concern about environmental health risks. We used measures of environmental health concern about nearby petrochemical production with a sample of Texas City residents to understand patterns of concern and change in concern after an industrial accident, as well as individual and contextual factors associated with those patterns. Survey interviews with residents of Texas City, Texas ( N = 315) both pre- and postexplosion using a brief Concern About Petrochemical Health Risk Scale (CAPHRS) and other questions were used to collect pertinent predictor information. CAPHRS baseline, postexplosion, and change scores were compared and modeled using ordinary least squares (OLS) regression and a mixed model. Higher preexplosion CAPHRS scores were predicted by younger adults, foreign-born Hispanics, non-Hispanic blacks, lower- and middle-income groups, and those who live with someone who has worked at the petrochemical plants. Higher CAPHRS change scores are predicted by the same variables (except income), as well as proximity to, or perception of, the explosion, and reports of neighborhood damage. Findings suggest these groups' concern scores could indicate a greater vulnerability to psychological and physical harm generated by concern and stress arising from local petrochemical activities. A clearer understanding of concern about actual environmental health risks in exposed populations may enhance the evolving theory of stress and coping and eventually enable public health professionals to develop appropriate mitigation strategies.     

Voting Technology,Political Responsiveness,and Infant Health: Evidence From Brazil

This paper studies the introduction of electronic voting technology in Brazilian elections. Estimates exploiting a regression discontinuity design indicate that electronic voting reduced residual (error‐ridden and uncounted) votes and promoted a large de facto enfranchisement of mainly less educated citizens. Estimates exploiting the unique pattern of the technology's phase‐in across states over time suggest that, as predicted by political economy models, it shifted government spending toward health care, which is particularly beneficial to the poor. Positive effects on both the utilization of health services (prenatal visits) and newborn health (low‐weight births) are also found for less educated mothers, but not for the more educated.     

The Economic Impact of Health Policy Interventions

The rapid aging of the U.S. population, increases in the absolute prevalence of chronic diseases, and the associated rise in the proportion of the GNP expended on medical care all indicate the need for methods to accurately forecast future health care expenditures for specific chronic diseases. Additionally, if these methods are biomedically realistic, they can be used to evaluate the economic implications of specific prevention strategies designed to reduce chronic disease incidence, prevalence, and mortality. Projection strategies that are not biomedically realistic, such as models that assume that risks for demographic subgroups do not change over time (e.g., "static component" models), though possibly accurate over the short run, are not suitable for assessing the long term effects of specific proposed health policy interventions which are designed to alter risks.
In this paper we present a strategy for forecasting health care costs which is based on a model that represents the natural history of a chronic disease in terms of a preclinical state, a clinical state, case fatality rates, cures, and the implications of exogenous medical factors. Using this model we project that the treatment costs associated with respiratory cancer in the white male population of the U.S. may undergo a two-thirds increase in real dollars over the period 1977 to 2000. About one-half of this increase is due to a demographic shift to an older population structure, with the remainder due to higher respiratory cancer incidence rates in younger cohorts. Alteration of certain parameters of the model to simulate various interventions suggests that about three-quarters of the cost of this disease could be eliminated, though realization of any significant part of this savings would require a lengthy phase-in period.     

Prioritizing Environmental Health Risks in the UAE

This article presents the results of a comparative environmental risk‐ranking exercise that was conducted in the United Arab Emirates (UAE) to inform a strategic planning process led by the Environment Agency‐Abu Dhabi (EAD). It represents the first national‐level application of a deliberative method for comparative risk ranking first published in this journal. The deliberative method involves a five‐stage process that includes quantitative risk assessment by experts and deliberations by groups of stakeholders. The project reported in this article considered 14 categories of environmental risks to health identified through discussions with EAD staff: ambient and indoor air pollution; drinking water contamination; coastal water pollution; soil and groundwater contamination; contamination of fruits, vegetables, and seafood; ambient noise; stratospheric ozone depletion; electromagnetic fields from power lines; health impacts from climate change; and exposure to hazardous substances in industrial, construction, and agricultural work environments. Results from workshops involving 73 stakeholders who met in five separate groups to rank these risks individually and collaboratively indicated strong consensus that outdoor and indoor air pollution are the highest priorities in the UAE. Each of the five groups rated these as being among the highest risks. All groups rated soil and groundwater contamination as being among the lowest risks. In surveys administered after the ranking exercises, participants indicated that the results of the process represented their concerns and approved of using the ranking results to inform policy decisions. The results ultimately shaped a strategic plan that is now being implemented.     

THE IMPACT OF POLLUTION CONTROL ON CONSUMER INCOME A METHODOLOGICAL STUDY

This paper develops a methodology for assessing the impact of a comprehensive pollution control program on income distribution. A regional input-output table is employed to determine the overall effect of pollution control costs on prices. These price changes, are then translated into changes in consumption expenditures by income groups, which serve as a measure of the impact on consumers. The validity of this methodology is tested on the metropolitan Philadelphia region. It was found that the EPA air quality standards would raise the spending of middle income groups by about 3 percent as compared to about 2 percent increase for the highest and the lowest income groups. The paper concludes with an examination of the advantages and limitations of the proposed methodology.     

Estimated Rate of Fatal Automobile Accidents Attributable to Acute Solvent Exposure at Low Inhaled Concentrations

Acute solvent exposures may contribute to automobile accidents because they increase reaction time and decrease attention, in addition to impairing other behaviors. These effects resemble those of ethanol consumption, both with respect to behavioral effects and neurological mechanisms. These observations, along with the extensive data on the relationship between ethanol consumption and fatal automobile accidents, suggested a way to estimate the probability of fatal automobile accidents from solvent inhalation. The problem can be approached using the logic of the algebraic transitive postulate of equality: if A=B and B=C, then A=C. We first calculated a function describing the internal doses of solvent vapors that cause the same magnitude of behavioral impairment as ingestion of ethanol (A=B). Next, we fit a function to data from the literature describing the probability of fatal car crashes for a given internal dose of ethanol (B=C). Finally, we used these two functions to generate a third function to estimate the probability of a fatal car crash for any internal dose of organic solvent vapor (A=C). This latter function showed quantitatively (1) that the likelihood of a fatal car crash is increased by acute exposure to organic solvent vapors at concentrations less than 1.0 ppm, and (2) that this likelihood is similar in magnitude to the probability of developing leukemia from exposure to benzene. This approach could also be applied to other potentially adverse consequences of acute exposure to solvents (e.g., nonfatal car crashes, property damage, and workplace accidents), if appropriate data were available.     

Dread and Risk Elimination Premium for the Value of a Statistical Life

The value of a statistical life (VSL) is a widely used measure for the value of mortality risk reduction. As VSL should reflect preferences and attitudes to risk, there are reasons to believe that it varies depending on the type of risk involved. It has been argued that cancer should be considered a “dread disease,” which supports the use of a “cancer premium.” The objective of this study is to investigate the existence of a cancer premium (for pancreatic cancer and multiple myeloma) in relation to road traffic accidents, sudden cardiac arrest, and amyotrophic lateral sclerosis (ALS). Data were collected from 500 individuals in the Swedish general population of 50–74‐year olds using a web‐based questionnaire. Preferences were elicited using the contingent valuation method, and a split‐sample design was applied to test scale sensitivity. VSL differs significantly between contexts, being highest for ALS and lowest for road traffic accidents. A premium (92–113%) for cancer was found in relation to road traffic accidents. The premium was higher for cancer with a shorter time from diagnosis to death. A premium was also found for sudden cardiac arrest (73%) and ALS (118%) in relation to road traffic accidents. Eliminating risk was associated with a premium of around 20%. This study provides additional evidence that there exist a dread premium and risk elimination premium. These factors should be considered when searching for an appropriate value for economic evaluation and health technology assessment.     

Air Toxics and Health Risks in California: The Public Health Implications of Outdoor Concentrations

Of the 188 hazardous air pollutants (HAPs) listed in the Clean Air Act, only a handful have information on human health effects, derived primarily from animal and occupational studies. Lack of consistent monitoring data on ambient air toxics makes it difficult to assess the extent of low-level, chronic, ambient exposures to HAPs that could affect human health, and limits attempts to prioritize and evaluate policy initiatives for emissions reduction. Modeled outdoor HAP concentration estimates from the U.S. Environmental Protection Agency's Cumulative Exposure Project were used to characterize the extent of the air toxics problem in California for the base year of 1990. These air toxics concentration estimates were used with chronic toxicity data to estimate cancer and noncancer hazards for individual HAPs and the risks posed by multiple pollutants. Although hazardous air pollutants are ubiquitous in the environment, potential cancer and noncancer health hazards posed by ambient exposures are geographically concentrated in three urbanized areas and in a few rural counties. This analysis estimated a median excess individual cancer risk of 2.7E-4 for all air toxics concentrations and 8600 excess lifetime cancer cases, 70% of which were attributable to four pollutants: polycyclic organic matter, 1,3 butadiene, formaldehyde, and benzene. For noncancer effects, the analysis estimated a total hazard index representing the combined effect of all HAPs considered. Each pollutant contributes to the index a ratio of estimated concentration to reference concentration. The median value of the index across census tracts was 17, due primarily to acrolein and chromium concentration estimates. On average, HAP concentrations and cancer and noncancer health risks originate mostly from area and mobile source emissions, although there are several locations in the state where point sources account for a large portion of estimated concentrations and health risks. Risk estimates from this study can provide guidance for prioritizing research, monitoring, and regulatory intervention activities to reduce potential hazards to the general population. Improved ambient monitoring efforts can help clarify uncertainties inherent in this analysis.     

Rating Threat Mitigators: Faith in Experts,Governments, and Individuals Themselves to Create a Safer World

This research explores public judgments about the threat-reducing potential of experts, individual behavior, and government spending. The data are responses of a national sample of 1225 to mail surveys that include measures of several dimensions of public judgments about violent crime, automobile accidents, hazardous chemical waste, air pollution, water pollution, global warming, AIDS, heart disease, and cancer. Beliefs about who can best mitigate threats are specific to classes of threats. In general, there is little faith that experts can do much about violent crime and automobile accidents, moderate faith in their ability to address problems of global warming, and greater expectations for expert solutions to the remaining threats. People judge individual behavior as effective in reducing the threats of violent crime, AIDS, heart disease, and automobile accidents but less so for the remaining threats. Faith in more government spending is highest for AIDS and the other two health items, lowest for the trio of violent crime, automobile accidents, and global warming, and moderate for the remaining threats. For most threats, people are not distributed at the extremes in judging mitigators. Strong attitudinal and demographic cleavages are also lacking, although some interesting relationships occur. This relative lack of sharp cleavages and the generally moderate opinion indicate ample opportunity for public education and risk communication.     

Multiple Health Risk Perception and Information Processing Among African Americans and Whites Living in Poverty

We investigated the risk‐information‐processing behaviors of people living at or near the poverty line. Because significant gaps in health and communication exist among high‐ and low‐income groups, increasing the information seeking and knowledge of poor individuals may help them better understand risks to their health and increase their engagement in health‐protective behaviors. Most earlier studies assessed only a single health risk selected by the researcher, whereas we listed 10 health risks and allowed the respondents to identify the one that they worried about most but took little action to prevent. Using this risk, we tested one pathway inspired by the risk information seeking and processing model to examine predictors of information insufficiency and of systematic processing and extended this pathway to include health‐protective action. A phone survey was conducted of African Americans and whites living in the southern United States with an annual income of ≤$35,000 (N= 431). The results supported the model pathway: worry partially mediated the relationship between perceived risk and information insufficiency, which, in turn, increased systematic processing. In addition, systematic processing increased health‐protective action. Compared with whites and better educated respondents, African Americans and respondents with little education had significantly higher levels of information insufficiency but higher levels of systematic processing and health‐protective action. That systematic processing and knowledge influenced health behavior suggests a potential strategy for reducing health disparities.     

Safety Impacts of SUVs, Vans, and Pickup Trucks in Two-Vehicle Crashes

Policy makers, vehicle manufacturers, and consumers have shown growing concern about the relative safety of sport utility vehicles (SUVs), vans, pickups, and cars. Empirical analysis of real-world crashes is complicated by the possibility that apparent relationships between vehicle type and safety may be confounded by other factors, such as driver behavior and crash circumstances. This study compares different vehicle types with respect to their crashworthiness (self-protection) and aggressivity (risk to others) in crashes between two passenger vehicles. The U.S. Crashworthiness Data System is used to analyze detailed information on 6,481 drivers involved in crashes during 1993-1999. Logistic regression analysis is used to model the risk of serious injury or death to a driver, conditional on a crash occurring. Covariates include the body type of each vehicle in the crash; the driver's age, gender, and restraint use; and the configuration of the crash. A unique feature of this study is the use of "delta-v" to represent the joint effects of vehicle mass and crash severity. While estimated effects are somewhat sensitive to the injury severity level used as the outcome variable, SUVs, vans, and pickups appear to be more aggressive and may be more crashworthy than cars. Effects of pickups are most pronounced. Drivers in pickups face less risk of serious injury than car drivers (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.20-0.60), and drivers who collide with pickups experience more than twice the risk than those who collide with a car (OR, 2.18; 95% CI, 1.03-4.62). While vehicle mass and crash severity contribute to the apparent crashworthiness and aggressivity of passenger vehicles, other vehicle characteristics associated with body type (e.g., the stiffness and height of the underlying structure of the vehicle) also influence safety risks.     

Are Female Executives Over‐represented in Precarious Leadership Positions?

We use a sample of CEO appointments at US corporations over the years 1992–2004 to test the 'glass cliff' hypothesis, which posits that females are appointed to leadership positions at firms that are in a precarious financial condition. Our analysis utilizes three measures of stock-price-based financial performance and two distinct control samples of appointments of males to the CEO position. We find that corporate performance preceding CEO appointments tends to favor females, implying that females (males) are appointed to the CEO position largely at times when the firm is in relatively better (worse) financial health. Disaggregating the data by appointments in up versus down markets, at high-risk versus low-risk firms, and by calendar time yield similar conclusions. There appears to be no glass cliff facing female CEOs at US firms. Our findings suggest a need for additional research to identify where and for what types of positions this phenomenon is prevalent.     

流动人口自雇的决定机制及收入差异

除工资雇佣外,自雇(包含有雇工自雇和无雇工自雇)是流动人口重要的劳动参与方式. 本文基于2016全国流动人口调查数据,采用多项logit模型考察了自雇的决定机制,并从平均和非线性维度分别运用倾向得分匹配和无条件分位数处理效应模型测度了不同劳动参与方式之间的收入差异. 实证分析结果表明：1)教育有利于流动人口有雇工自雇而无助于无雇工自雇,男性较女性更容易产生自雇,户籍并不会明显影响自雇;专业技术人员并不倾向于自雇,而服务业中的非技能劳动力自雇可能性更大. 2)流动人口有雇工自雇的平均收入水平最高,其后依次为无雇工自雇和工资雇佣;经济越发达的地区,流动人口自雇与其他劳动参与形式的收入差异越大. 3)相对于工资雇佣,流动人口两类自雇的收入均随收入水平上升而递增,且有雇工自雇引致的收入差异更大;不同劳动参与方式间的收入差异主要源于个体间的条件(禀赋)差别.