Cigarette Smoking and All-Cause and Cause-Specific Adult Mortality in the United States

This study illuminates the association between cigarette smoking and adult mortality in the contemporary United States. Recent studies have estimated smoking-attributable mortality using indirect approaches or with sample data that are not nationally representative and that lack key confounders. We use the 1990–2011 National Health Interview Survey Linked Mortality Files to estimate relative risks of all-cause and cause-specific mortality for current and former smokers compared with never smokers. We examine causes of death established as attributable to smoking as well as additional causes that appear to be linked to smoking but have not yet been declared by the U.S. Surgeon General to be caused by smoking. Mortality risk is substantially elevated among smokers for established causes and moderately elevated for additional causes. We also decompose the mortality disadvantage among smokers by cause of death and estimate the number of smoking-attributable deaths for the U.S. adult population ages 35+, net of sociodemographic and behavioral confounders. The elevated risks translate to 481,887 excess deaths per year among current and former smokers compared with never smokers, 14 % to 15 % of which are due to the additional causes. The additional causes of death contribute to the health burden of smoking and should be considered in future studies of smoking-attributable mortality. This study demonstrates that smoking-attributable mortality must remain a top population health priority in the United States and makes several contributions to further underscore the human costs of this tragedy that has ravaged American society for more than a century.     

URBAN TRANSPORTATION MODE CHOICE AND TRIP COMPLEXITY: BICYCLISTS STICK TO THEIR GEARS

Commuters' lives have become more complicated with rising income. In my model, transportation mode choices are made simultaneously with the choice of whether to make multiple stops. Using travel behavior data, I estimate the model using an error components logit (ECL) specification to account for commuters' unobserved preferences for particular modes and find that omitting unobserved preferences underestimates value of travel time relative to the crossing‐components ECL. The estimated model predicts that increased trip complexity causes substitution away from public transit to automobiles, with the exception that bicyclists transition only to more complex trips and do not change transportation modes. (JEL R41, C25)     

Transparency tested: The influence of message features on public perceptions of organizational transparency

The concept of transparency has been promoted within the public relations and business literature as both ethical and advantageous; however, the effectiveness of transparency is seldom empirically put to the test. In particular, the use of clarity, disclosure, and accuracy in organizational messages needs to be empirically examined. To this end, we conducted an online experiment using a 2 (high vs. low message transparency) x 2 (news story placed before or after an organizational statement) between-subjects design. Participants (n?=?357) perceived organizations as more transparent and credible when exposed to messages exhibiting greater levels of clarity, disclosure, and accuracy as opposed to messages that did not. Placement of an information anchor in the form of an objective news story before the organizational message increased the perceived organizational transparency when messages employed transparent design features and decreased the perceived organizational transparency when messages did not use these features. These results provide significant implications for practitioners attempting to convey organizational transparency at the tactical level through message features.     

Relationship building and message planning: An exploration of media challenges and strategies used during school crises at the P-12 level

Schools at the P-12 level increasingly face crises related to school shootings, violence, and other tragedies. Understanding the communication challenges schools face is paramount to assisting schools with communication before, during, and after crisis events. The current study focuses on the challenges created by media interest in such crises and the strategies implemented to overcome these challenges and provide responsible information to stakeholders. Interviews conducted with 21 school crisis teams at the P-12 level revealed that sensationalism, seeking alternative routes to information, and framing were key challenges in working with the media. In light of these challenges, administrators focused on creating media plans, building relationships with the media, being accurate but guarded, and communicating reassurance and reunification. Implications are discussed for school districts nationally.     

Development of the Emergency Department Senior Abuse Identification (ED Senior AID) tool

Emergency departments (EDs) are an important health care setting for the identification of elder abuse (EA). Our objective was to develop an ED-based tool to identify EA. The initial tool included a brief cognitive assessment, questions to detect multiple domains of EA, and a physical examination. Refinement of the tool was based on input from clinical experts and nurse and patient feedback. The revised tool, which included 15 questions about EA, was then tested in an academic ED. We calculated the inter-rater reliability, sensitivity, and specificity of individual EA questions. Among ED patients age≥65 (N = 259), 17 (7%) screened positive for suspicion of EA. We identified a combination of six questions that cover the included domains of EA, demonstrated good or excellent inter-rater reliability, and had a sensitivity and specificity of 94% (95% confidence interval (CI) 71–100%) and 90% (95% CI 85–93%), respectively. These results inform a proposed screening tool for multisite validation testing.     

Knox meets Cox: Adapting epidemiological space-time statistics to demographic studies

Many important questions and theories in demography focus on changes over time, and on how those changes differ over geographic and social space. Space-time analysis has always been important in studying fertility transitions, for example. However, demographers have seldom used formal statistical methods to describe and analyze time series of maps. One formal method, used widely in epidemiology, criminology, and public health, is Knox’s space-time interaction test. In this article, we discuss the potential of the Knox test in demographic research and note some possible pitfalls. We demonstrate how to use familiar proportional hazards models to adapt the Knox test for demographic applications. These adaptations allow for nonrepeatable events and for the incorporation of structural variables that change in space and time. We apply the modified test to data on the onset of fertility decline in Brazil over 1960–2000 and show how the modified method can produce maps indicating where and when diffusion effects seem strongest, net of covariate effects.     

Government Capital,Intimate and Community Social Capital,and Food Security Status in Older Adults with Different Income Levels

Whether government‐based forms of food assistance such as the Supplemental Nutrition Assistance Program (SNAP), communal efforts including food pantries, aid from friends and family, or alternative means such as gardening are the appropriate means to reduce the prevalence of household food insecurity is a continuous source of policy contention. To inform this debate, we examine the relative importance of these forms of food assistance and acquisition to a sample of U.S. older adults from the 2010 Brazos Valley Health Assessment of central Texas households that have been stratified by income eligibility for SNAP, low‐income SNAP ineligibility, and above low income status. To identify how membership in these socioeconomic groups constrains household capacity to acquire sufficient food to maintain an adequate and healthy diet, we explore the varied associations of assets received from government; communal and intimate social networks; and alternative food sources such as gardening, hunting, and fishing with household food security across socioeconomic status, while examining the importance of place of residence on the use of capital assets. SNAP participation was the only specific capital asset associated with all levels of food insecurity for both SNAP‐eligible and ineligible low‐income groups, thus emphasizing the continued importance of food assistance among poverty‐level older adults.     

Benefits and costs associated with mutual-help community-based recovery homes: The Oxford House model

We used data from a randomized controlled study of Oxford House (OH), a self-run, self-supporting recovery home, to conduct a cost-benefit analysis of the program. Following substance abuse treatment, individuals that were assigned to an OH condition (n = 68) were compared to individuals assigned to a usual care condition (n = 61). Economic cost measures were derived from length of stay at an Oxford House residence, and derived from self-reported measures of inpatient and outpatient treatment utilization. Economic benefit measures were derived from self-reported information on monthly income, days participating in illegal activities, binary responses of alcohol and drug use, and incarceration. Results suggest that OH compared quite favorably to usual care: the net benefit of an OH stay was estimated to be roughly $29,000 per person on average. Bootstrapped standard errors suggested that the net benefit was statistically significant. Costs were incrementally higher under OH, but the benefits in terms of reduced illegal activity, incarceration and substance use substantially outweighed the costs. The positive net benefit for Oxford House is primarily driven by a large difference in illegal activity between OH and usual care participants. Using sensitivity analyses, under more conservative assumptions we still arrived at a net benefit favorable to OH of $17,830 per person.