Showing posts with label health risk behaviors. Show all posts
Showing posts with label health risk behaviors. Show all posts

Friday, December 30, 2011

Penalty points and road safety: is there really a link

According to the Irish Independent, drivers in Ireland face a raft of new penalty offences – to be introduced by the end of 2012. In the article the minister, Leo Varadkar justified the clampdown, saying: “Each measure we take to advance road safety increases the likelihood that lives will be saved.” The article also quotes Conor Faughnan of the AA as saying that the penalty points system had changed driver behaviour.

So it is true? Road safety is a big topic on which there is a fair of research internationally and there have been a few papers on the Irish experience – penalty points were introduced in 2002. Here is a quick summary of a few papers I found.

Hussain et al. (British Journal of Oral and Maxillofacial Surgery 2006) look at maxillofacial injuries. They simply compare the number of various injuries in the year before and after the 2002 reform. They assert that “The introduction of legislation led to a 61% reduction in the need for emergency maxillofacial operations.” Clearly the design does not support such an assertion and subsequently in the paper they seem to acknowledge that a causal link cannot be firmly established. Yes indeed. Just comparing means before and after tells you nothing. Maybe the series just goes up and down a lot. Maybe something else happened. Lots of the other outcomes they consider don’t change at all. And of course if you look at enough outcomes you are bound to find some differences (though the paper does not appear to contain a single p-value or confidence interval).

At least two other papers were generated by this reform.

Healy et al. (Injury 2004) look at spinal injuries. This paper follows a similar methodology as the previous one but at least does some inference “In the first 6 months of the new speed penalty system the number of RTA (road traffic accident) related spinal injuries was 17. This was significantly lower then the same period in the previous 4 years when on average of 33 admissions occurred (P < 0:05, Chi-sq=3:96, d:f: =1)”. The same issue arises ‘though: how can one attribute the change to the reform? Interestingly in the second 6-month period after the reform, the number of RTA related injuries rose again so it looks, to me at least, that any effect was shortlived. Looking at their Table 2 it is far from clear the reform had any effect. Again, simply comparing means before and after is uninformative.

Butler et al. (Irish Journal of Medical Science 2006) also looks at spinal injuries (the authorship of the two papers overlap) and seem to report much the same result: an initial fall in RTA related spinal injuries that were not sustained.

Based on these 3 papers (there are others which I haven’t looked at) the evidence that the introduction of penalty points in 2002 was effective seems pretty underwhelming although a casual reading of these papers would not leave you with that impression. As the system changed in 2003, with additional offences introduced, it would be difficult to estimate the long run effect of the reform.

The possibility that such a reform had a temporary effect with people regressing to their usual driving standards quite quickly is plausible to me. I came across a paper that looked at whether conviction for driving offences lowered risk of death subsequently (Redelmeier et al. The Lancet 2003). They find it reduces the risk of death sharply in the immediate aftermath of a conviction but the effect was much smaller after 2 months and not significant after 3-4 months.I wonder is this a general finding.

Road safety is an emotive topic and it is essential that policy is based not on anecdote or gut instinct but on good evidence. Inferring whether the points system improved road safety is probably difficult or impossible given the data available. That does not mean one shouldn’t consider such policies – my guess is that the loss function is asymmetric: introducing penalty points probably can’t do any harm. But exaggerated claims of efficacy are never justified.

Wednesday, January 12, 2011

Does Drinking in College Affect Students' Grades?

I recently discussed on the blog new evidence pointing towards a positive relationship between students' grades in college and their later-life health outcomes. A recent economics paper adds a new dimension in this area by producing findings on the effect of preceding health-risk behaviour on subsequent academic performance. The paper is by Scott E. Carrell, Mark Hoekstra, and James E. West; and is called "Does Drinking Impair College Performance? Evidence from a Regression Discontinuity Approach". Abstract: here. Paper: here. Discussion on the Freakonomics Blog: here.

The paper exploits a discontinuity in drinking at age 21 at a college in which the minimum legal drinking age is strictly enforced. A comparison is made between the grades of students who turned 21 before final exams to those who turned 21 just afterward. The authors find that drinking causes causes statistically and economically meaningful reductions in academic performance, particularly for the highest-performing students. The authors suggest that concern regarding the harmful effects of drinking in U.S. colleges is reflected by the Amethyst Initiative - in which 135 university presidents and chancellors argue that current policy has resulted in binge-drinking by students.

Friday, December 17, 2010

Mandatory Minimum Sentencing, Drug Purity and Overdose Rates

This is the title of an article in the current edition of the Economic and Social Review by Ronald Davies (UCD). Link here. Abstract below.
Abstract: As of 1987, the US’s Anti-Drug Abuse Act (ADAA) has imposed mandatory minimum sentences for drug traffickers based on the quantity of the drug involved irrespective of purity. Using the STRIDE dataset and a differences-in-differences approach, I find that this led to increases in cocaine and heroin purity of 52 per cent and 27 per cent respectively. It also affected the distribution of purity around its mean. Using data on emergency room visits, I show that changes in the distribution of purity had significant impacts on such visits. These results provide insights useful when considering Ireland’s drug policies which include the use of mandatory minimum sentences.

Wednesday, March 24, 2010

Girls... don't want you to have fun: daughters & risk taking

Understanding risky behaviour in health and other domains is an important topic and researchers in Geary are active in looking at this. The paper below has a novel take on this:

The Effects of Daughters on Health Choices and Risk Behaviour
N Powdthavee, S Wu, A Oswald
Little is known about why some human beings make risky life-choices. This paper provides evidence that people's health decisions and addictive actions are influenced by the gender of their children. Having a daughter leads individuals -- in micro data from Great Britain and the United States -- to reduce their smoking, drinking, and drug-taking. The paper's results are consistent with the hypothesis that human beings 'self-medicate' when under stress.
http://d.repec.org/n?u=RePEc:yor:yorken:10/03&r=cbe

Monday, November 30, 2009

Longer school days

The amount of human capital a person is usually proxied by years of education. But of course one can vary the number of days of education per annum or the number of hours per day. The number of days in school in Ireland is comparatively low it appears. So what would be the effect of lengthening the school day? This paper, for Chile, shows that it keeps adolescent girls out of trouble - literally: an increase in full-day municipal enrollment of 20% reduces the likelihood of teen motherhood by 5%

Thursday, June 18, 2009

Rats play the odds in gambling task

Rats are able to play the odds in a "gambling task" designed by scientists to test the biology of addiction.

In the journal Neuropsychopharmacology, researchers describe how the rodents developed a "strategy" in a timed task where they make choices to earn treats. The rodents avoided high-reward options because these carried high risks of punishment - their sugar pellet supply being cut off for a period.

To further test their model, the team looked at how the rats' performance was affected by drugs that altered levels of two neurotransmitters, dopamine and serotonin.

These are signalling chemicals in the brain that are both thought to play an important role in addiction.

Roulette chips
Researchers hope to develop treatments for "pathological gambling"

The rats were given a drug that reduced the amount of serotonin circulating in their brains. This impaired their ability to make good decisions, and to successfully play the odds.

http://news.bbc.co.uk/2/hi/science/nature/8105963.stm

Thursday, October 09, 2008

Criminal Prosecution and HIV-related Risky Behavior

There has been a serious debate in the UK about whether the transmission of HIV should be a prosecutable offence. This is especially the case after a couple of high profile cases resulted in prosecution, in Scotland in '01 for 'reckless injury' and soon after in England and Wales for 'reckless transmission'. This has led to a lot of speculation in the UK about what the public health consequences of taking a stringent or lenient view of HIV transmission may be. The main concern being that taking a hard line may discourage both disclosure to partners and also people coming forward for testing or voicing their potential concerns to GP's and psychologists.

Delavande,Goldman and Sood (2008) are the first to empirically investigate the potential consequences of prosecutions for HIV transmission. They use U.S. inter-state variation in prosecution rate, from a limited sample of just 316 prosecutions for this crime and categorise states into those with 'strict' or 'non-strict' enforcement of laws which would permit prosecution. They then use a nationally representative survey of the sexual risk behaviours of 1,400 people with HIV to see is there a relationship between state type and risk behaviour. Interestingly, they find that in 'strict' states safe sex is practiced more often by those with HIV as is abstinence. They go on to claim that transmission rates should be 'responsive to agressive prosecution' and if the prosectution rate for HIV is doubled then the number of new infections will be reduced by a third in 10 years.

Looking at the figures I don't think it can control fully for the effects of the 'elephant in the room' in this paper which is that those in stict states are more likely to visit prostitutes and more than twice as likely not to disclose their HIV status to any of their last 5 partners. It is very difficult to know the extent of the knock on effects this can have on new infections and it may indeed wipe out the potential effects of more safe sex and more abstinence, the latter which probably shouldn't be the goal for a HIV intervention anyway. However, we have to be very careful before advocating criminalisation in the case of HIV transmission and framing the argument in term of a welfare enhancing 'tax on risky behaviour' could have some dangerous consequences down the line both in terms of the welfare of those with HIV and the number of new infections criminalisation may cause. Because criminalisation may disincentivise testing it is also difficult to separate this effect from the potential effect it may have on reducing new infections. More work on this is definitely needed but it is worth noting that WHO and European Commission guidelines going back three decades have stated that it is an ethical obligation on the part of those with HIV to disclose to potential or existing partners, but that this should not translate into a legal obligation as such legislation would be 'inappropriate ad impractical'.

Tuesday, October 09, 2007

Predicting Health Behaviors with an Experimental Measure of Risk Preference

Lisa R. Anderson (Department of Economics, College of William and Mary)
Jennifer M. Mellor (Department of Economics, College of William and Mary)

http://d.repec.org/n?u=RePEc:cwm:wpaper:59&r=cbe

We conduct a large-scale economics experiment paired with a survey to examine the association between individual risk preferences and health-related behaviors among adults aged 18 to 87 years. Risk preferences are measured by the Holt and Laury (2002) lottery choice experiment. Controlling for race, sex, and age, we find that risk preference is significantly associated with cigarette smoking, being overweight or obese, seat belt non-use, and driving over the speed limit. In additional specifications, we find that risk preference is significantly associated with heavy episodic drinking, and is a significant predictor of the number of risky behaviors.