Background Social welfare policies such as the minimum wage can affect population health, though the impact may differ by the level of unemployment experienced by society at a given time. Methods We ran difference-in-differences models using monthly data from all 50 states and Washington, DC from 1990 to 2015. We used educational attainment to define treatment and control groups. The exposure was the difference between state and federal minimum wage in US$2015, defined both by the date the state law became effective and lagged by 1 year. Models included state and year fixed effects, and additional state-level covariates to account for state-specific time-varying confounding. We assessed effect modification by the state-level unemployment rate, and estimated predicted suicide counts under different minimum wage scenarios. Results The effect of a US$1 increase in the minimum wage ranged from a 3.4% decrease (95% CI 0.4 to 6.4) to a 5.9% decrease (95% CI 1.4 to 10.2) in the suicide rate among adults aged 18–64 years with a high school education or less. We detected significant effect modification by unemployment rate, with the largest effects of minimum wage on reducing suicides observed at higher unemployment levels. Conclusion Minimum wage increases appear to reduce the suicide rate among those with a high school education or less, and may reduce disparities between socioeconomic groups. Effects appear greatest during periods of high unemployment.

Healthcare quality and safety span multiple topics across the spectrum of academic and clinical disciplines. Keeping abreast of the rapidly growing body of work can be challenging. In this series, we provide succinct summaries of selected relevant studies published in the last several months. Some articles will focus on a particular theme, while others will highlight unique publications from high-impact medical journals.

Rationale: Most U.S. residents who develop tuberculosis (TB) were born abroad, and U.S. TB incidence is increasingly driven by infection risks in other countries. Objectives: To estimate the potential impact of effective global TB control on health and economic outcomes in the United States. Methods: We estimated outcomes using linked mathematical models of TB epidemiology in the United States and migrants' birth countries. A base-case scenario extrapolated country-specific TB incidence trends. We compared this with scenarios in which countries achieve 90% TB incidence reductions between 2015 and 2035, as targeted by the World Health Organization's End TB Strategy (“effective global TB control”). We also considered pessimistic scenarios of flat TB incidence trends in individual countries. Measurements and Main Results: We estimated TB cases, deaths, and costs and the total economic burden of TB in the United States. Compared with the base-case scenario, effective global TB control would avert 40,000 (95% uncertainty interval, 29,000-55,000) TB cases in the United States in 2020-2035. TB incidence rates in 2035 would be 43% (95% uncertainty interval, 34-54%) lower than in the base-case scenario, and 49% (95% uncertainty interval, 44-55%) lower than in 2020. Summed over 2020-2035, this represents 0.8 billion dollars (95% uncertainty interval, 0.6-1.0 billion dollars) in averted healthcare costs and $2.5 billion dollars (95% uncertainty interval, 1.7-3.6 billion dollars) in productivity gains. The total U.S. economic burden of TB (including the value of averted TB deaths) would be 21% (95% uncertainty interval, 16-28%) lower (18 billion dollars [95% uncertainty level, 8-32 billion dollars]). Conclusions: In addition to producing major health benefits for high-burden countries, strengthened efforts to achieve effective global TB control could produce substantial health and economic benefits for the United States.

A key feature of Information and Communication Technologies (ICT) is that they increase the size of the market – or the “scale of operation” – for workers in some occupations. We model the scale of operation as the limit up to which the production technology displays increasing returns to scale. We then explore the implications of this feature of ICT for the income distribution within affected occupations, as well as for individuals' occupational choices. Within occupations, an increase in the scale of operation intensifies competition between workers and increases inequality. It also drives the lowest-ability workers out of the occupation while reducing the earnings of the next lowest-ability workers when the substitutability between the output of the affected occupations and that of the rest of the economy is low.

Cases of measles and other highly contagious diseases are rising in the United States. Public health experts blame the rise partly on the spatial concentration of parents declining to vaccinate their children, but researchers have given little attention to theorizing why this clustering occurs in particular communities. We argue that residential and school selection processes create “pockets of homogeneity” attracting parents inclined to opt out of vaccines. Structural features of these enclaves reduce the likelihood of harsh criticism for vaccine refusal and foster a false sense of protection from disease, making the choice to opt out seem both safe and socially acceptable. Examination of quantitative data on personal belief exemptions (PBEs) from school-based vaccination requirements in California schools and districts, as well as findings from parent interviews, provide empirical support for the theory. We discuss substantive implications for lawmakers and public health officials, as well as broader sociological contributions concerning neighborhood effects and residential sorting.

Agroecosystems, including peri-urban systems, are important providers of a range of services. However, management of these systems has generally been based on the market value of crops, neglecting to capture the broader public goods that ecosystem services provide to stakeholders. While the ecosystem service framework (Millennium Ecosystem Assessment [MEA], 2005) has been adopted to measure the market and nonmarket values associated with these services, knowledge gaps persist, particularly with respect to the quantification and valuation of cultural ecosystem services (CES). In this paper, the determination of CES values assigned to agroecosystems by residents of two communities along the Wasatch Front, Utah are explored through a randomly administrated survey designed to characterize and quantify CES. Descriptive statistics indicate that participants are motivated to visit farmland or rangeland because of their associated CES values. A principal component analysis is used to categorize specific CES values into factors representing ‘multifunctional’ cultural amenities and ‘traditional’ rural amenities. The clustering of CES values corroborates findings from other studies concerning multifunctional and traditional agricultural land-use preferences. OLS regression models subsequently reveal statistically significant relationships between multifunctional cultural amenities and religious affiliation and farming history. The regression models also uncover statistically significant relationships between traditional rural amenities and household income and community classification. Finally, our survey instrument demonstrates that while we are able to evaluate the range of commonly recognized CES categories, additional research is needed on lesser-studied CES (e.g. spiritual and inspirational values) and synergies among different CES (e.g. interconnected relationships between aesthetics and recreation) before their quantification can be standardized. However, this research demonstrates that CES values are ever-present in agroecosystems and can be integrated in peri-urban and agricultural land management and planning with existing CES knowledge.

We study the relationship between the composition of the political class and the size of government. First, we use a citizen-candidate model to show that the extension of suffrage is inconsequential for government spending when stricter eligibility requirements are in place. The removal of eligibility requirements, on the other hand, leads to the election of less wealthy politicians and the enactment of more redistributive policies. We test these predictions empirically using data from the 13 U.S. original states. We find no robust correlation between the extension of the franchise and government spending or the composition of the political class. However, the subsequent elimination of eligibility restrictions is associated with an increase in government spending and the election of state senators with a less elite background.

Importance Federal policy changes in 2002 and 2009 led some states to expand public health insurance coverage to non–US-born children and pregnant women who are lawful permanent residents during their first 5 years of residency in the United States. In other states, there were concerns that insurance expansion could attract immigrants to relocate to gain free health insurance coverage. Objective To examine whether expansion of public health insurance to non–US-born, lawful permanent resident children and pregnant women during their first 5 years of residency is associated with increased interstate migration among these groups. Design, Setting, and Participants This difference-in-differences analysis included data on 208 060 immigrants from the American Community Survey from 2000 through 2016, with analysis including all 50 states and the District of Columbia. The study sample included 2 treatment groups that became eligible under the expanded coverage: lawful permanent resident adults with at least 1 non–US-born child younger than 18 years (n = 36 438) and lawful permanent resident women of reproductive age (n = 87 418). Control groups that remained ineligible under the expanded coverage included lawful permanent resident adults without non–US-born children (n = 171 622), lawful permanent resident single men (n = 56 142), and lawful permanent resident postreproductive women (n = 15 129). A difference-in-differences design compared migration rates between eligible and ineligible immigrant groups before and after insurance coverage expansions. Data analysis was performed from November 3, 2018, to May 31, 2019. Exposures Public health insurance coverage for immigrant women and children who were lawful permanent residents within 5 years of residency. Main Outcomes and Measures Migration to a health expansion state from any other state and from a neighboring state. Results Of 208 060 immigrants (47% women in the weighted sample; mean [SD] age, 32.97 [12.94] years; 63% Hispanic), the mean (SD) annual move rate across the entire sample was 3% (17%). Expansion of public health insurance to non–US-born children or pregnant women within their first 5 years of residency was not associated with interstate movement for health care benefits. Coverage expansion for non–US-born children of lawful permanent residents was not associated with a change in the rate of in-migration higher than 1.78 percentage points or lower than –1.28 percentage points. The corresponding estimate for coverage expansion of lawful permanent resident pregnant women was a change higher than 1.38 percentage points and lower than –1.20 percentage points. Conclusions and Relevance The results suggest that states considering expanding health care benefits coverage to recently arrived immigrant children and pregnant women may be unlikely to experience in-migration of these persons from other states, which has important implications for understanding short- and long-term program costs.

Not every student has access to the technology needed to continue their education at home amidst at-home learning. In Louisiana, many of our rural and low-income students are students of color who are already more likely to attend a poorly funded K12 public school. This piece explores the technology divide that is further exacerbating the racial achievement gap.

This paper aims to assess the effects of industrial pollution on infant mortality between the years 1850-1940 using full count decennial censuses. In this period, US economy experienced a tremendous rise in industrial activity with significant variation among different counties in absorbing manufacturing industries. Since manufacturing industries are shown to be the main source of pollution, we use the share of employment at the county level in this industry to proxy for space-time variation in industrial pollution. Since male embryos are more vulnerable to external stressors like pollution during prenatal development, they will face higher likelihood of fetal death. Therefore, we proxy infant mortality with different measures of gender ratio. We show that the upswing in industrial pollution during late nineteenth century and early twentieth century has led to an increase in infant mortality. The results are consistent and robust across different scenarios, measures for our proxies, and aggregation levels. We find that infants and more specifically male infants had paid the price of pollution during upswing in industrial growth at the dawn of the 20th century. Contemporary datasets are used to verify the validity of the proxies. Some policy implications are discussed.

The contemporary practice of homeownership in the United States was born out of government programs adopted during the New Deal. The Home Owners Loan Corporation (HOLC)—and later the Federal Housing Administration and GI Bill—expanded home buying opportunity, although in segregationist fashion. Through mechanisms such as redlining, these policies fueled white suburbanization and black ghettoization, while laying the foundation for the racial wealth gap. This is the first article to investigate the long-term consequences of these policies on the segregation of cities. I combine a full century of census data with archival data to show that cities HOLC appraised became more segregated than those it ignored. The gap emerged between 1930 and 1950 and remains significant: in 2010, the black-white dissimilarity, black isolation, and white-black information theory indices are 12, 16, and 8 points higher in appraised cities, respectively. Results are consistent across a range of robustness checks, including exploitation of imperfect implementation of appraisal guidelines and geographic spillover. These results contribute to current theoretical discussions about the persistence of segregation. The long-term impact of these policies is a reminder of the intentionality that shaped racial geography in the United States, and the scale of intervention that will be required to disrupt the persistence of segregation.

Fourteen states and Washington DC allow unauthorized immigrants to obtain driver’s licenses. These policies are called Unauthorized Immigrant License Policies (UILP). The justification for such policies is that doing so may encourage those who are already driving to also get car insurance. For example, New Jersey’s Motor Vehicle Commission argues that allowing undocumented immigrants to obtain licenses encourages them to also get car insurance. Previous studies show that UILP’s are associated with fewer hit-and-run incidents. Others have argued the policies will increase the number of uninsured drivers because immigrants will use their licenses to drive but not obtain insurance. The authors of this paper extend previous research by examining the effects of UILPs on insurance rates. They find that UILP’s are associated with a one percent increase in auto insurance coverage. The study shows that both the number of drivers on the road increases as does the number of insured drivers. This likely means that those unauthorized drivers are receiving licenses and purchasing car insurance. The authors also document increases in the number of insurance claims and an increase in the number of collisions. However, these findings do not translate into more fatalities from car crashes, more severe insurance claims, or higher insurance premiums. Even though the study finds that there are more car crashes, there is not an increase in severe crashes. UILP’s are effective policies that create no unique driving risks. Overall, this study suggests that there is little risk in allowing unauthorized immigrants to obtain driver’s licenses. It finds that unauthorized drivers who are allowed to obtain licenses are more likely to be insured and that additional crashes are generally not severe. Although all driving involves some risk, policies that encourage drivers to get insurance by making it legal for them to obtain a driver’s license are likely to benefit the larger community.

Racial disparities in cancer incidence and outcomes have been well documented1,2 and may be due in part to lack of physician cultural competency. A cancer diagnosis and discussions of prognosis and treatments can have widely different implications across different cultural contexts. Highlighting the importance of high-quality care for diverse cultures, the American Society of Clinical Oncology recently outlined goals for improving cultural competency within its policy statement on cancer disparities.3,4 However, nationally representative data on cultural competency among physicians is limited.We therefore examined patient–reported physician cultural competency among cancer survivors in the United States using data from a contemporary population-based survey.

We provide an overview of the integration of refugees into the labor markets of a number of high-income countries. Discussing the ways in which refugees and economic migrants are differently selected and so might be expected to perform differently in a host country's labor market, we examine employment and wages for these groups over time after arrival. There is significant heterogeneity between host countries, but in general, refugees experience persistently worse outcomes than other migrants. While the gaps between the groups can be seen to decrease on a timescale of a decade or two, this is more pronounced in employment rates than it is in wages. We also discuss how refugees are distinct in terms of other factors affecting integration, including health, language skills, and social networks. We provide a discussion of insights for public policy in receiving countries, concluding that supporting refugees in early labor market attachment is crucial.

This paper examines the prevalence of scheduling uncertainty and the degree of work hour volatility among young adults with disabilities from 2008 through 2018, using data from the Current Population Survey and the National Longitudinal Youth Survey. First, the paper documents the magnitude of several features of irregular schedules among workers with disabilities in recent years. Second, it examines differences in irregular schedules between workers with and without disabilities. Third, it describes the trends in these features over the past decade. A key limitation of the study is that it cannot directly measure whether workers are employed in gig jobs.

The Center analyzed the relationship between public transit availability and employment in the entry-level job hubs. Using a Poisson model for the Youngstown origin-destination matrix, we found that a 10-minute decrease in rush-hour travel times by public transit is expected to increase employment by almost 7%. This means that 224 more residents of each low-income census tract will have access to the entry-level job hubs in Youngstown. As transit agencies are experiencing major disruptions to normal operating procedures because of the COVID-19 pandemic, our findings show that without access to public transportation many people lose prospective employment.

We examine the impact of the drug crisis that has unfolded over the last three decades in the United States on children’s living arrangements and environments. Because the current living arrangement could be a result of events that occurred at any point in a child’s life, we measure children’s exposure to the crisis with the cumulative drug-related mortality of likely parents. A potential omitted variables bias complicates the analysis, as the factors that may have led parents to abuse drugs could also have altered the living arrangements of their children. Within a 2SLS framework, we instrument for the cumulative mortality of likely parents with a child’s years of exposure to a non-triplicate prescription pad environment. Previous work by Alpert et al. (2019) demonstrates that pharmaceutical advertising was much more extensive in non-triplicate states and fostered the development of the drug crisis. Our results indicate that OLS and 2SLS estimates are nearly identical and the crisis increased both the fraction of children living away from a parent and in a household headed by a grandparent. We estimate that if drug abuse had remained at 1996 levels, 1.5 million fewer children aged 0-16 would have lived away from a parent in 2015

Over the last century, US agriculture greatly intensified and became industrialized, increasing in inputs and yields while decreasing in total cropland area. In the industrial sector, spatial agglomeration effects are typical, but such changes in the patterns of crop types and diversity would have major implications for the resilience of food systems to global change. Here, we investigate the extent to which agricultural industrialization in the United States was accompanied by agglomeration of crop types, not just overall cropland area, as well as declines in crop diversity. Based on county-level analyses of individual crop land cover area in the conterminous United States from 1840 to 2017, we found a strong and abrupt spatial concentration of most crop types in very recent years. For 13 of the 18 major crops, the widespread belts that characterized early 20th century US agriculture have collapsed, with spatial concentration increasing 15-fold after 2002. The number of counties producing each crop declined from 1940 to 2017 by up to 97%, and their total area declined by up to 98%, despite increasing total production. Concomitantly, the diversity of crop types within counties plummeted: in 1940, 88% of counties grew >10 crops, but only 2% did so in 2017, and combinations of crop types that once characterized entire agricultural regions are lost. Importantly, declining crop diversity with increasing cropland area is a recent phenomenon, suggesting that corresponding environmental effects in agriculturally dominated counties have fundamentally changed. For example, the spatial concentration of agriculture has important consequences for the spread of crop pests, agrochemical use, and climate change. Ultimately, the recent collapse of most agricultural belts and the loss of crop diversity suggest greater vulnerability of US food systems to environmental and economic change, but the spatial concentration of agriculture may also offer environmental benefits in areas that are no longer farmed.

For decades, escalating housing costs have outpaced income growth for middle- and lower-income earners. As a result, millions of American households have too little income leftover after paying rent to accumulate a savings buffer to cover other necessary expenses. When unexpected financial shocks occur, such as a drop in earnings or a surprise medical expense, many low-income households may not have sufficient savings and liquidity to pay their full rent at that time, leading many to the brink of eviction or a forced move. In this chapter, we document the costly externalities that such housing instability poses to renters and to society more broadly. To help low-income renters manage temporary shocks, we propose the creation of a Federal Emergency Rental Assistance Program to provide one-time, short-term financial help to low-income renters who face unexpected financial shocks. This short-term assistance would fill a critical gap in the current suite of federal housing programs which promote housing stability by subsidizing homeownership for middle- and higher-income households and providing long-term rental assistance to a small share of eligible, low-income households. Although we emphasize flexibility to allow states and localities to tailor the program to local conditions, we highlight key design features that would promote efficiency. Finally, while the proposed program is designed to address idiosyncratic financial shocks, it could be scaled up to address common shocks when such need arises.

The link between theory and quantitative empirical evidence is a longstanding hurdle in sociological research. Ambiguity about the role that statistical evidence plays in an argument may produce misleading conclusions and poor methodological practice. This ambiguity could be reduced if researchers would state the theoretical estimand— the central quantity at the core of a given paper—in precise language. Our approach envisions three choices in the research process: (1) choice of a theoretical estimand, which will be informative for theory, (2) choice of an empirical estimand, which is informative about the theoretical estimand under some identification assumptions, and (3) choice of an estimation strategy to learn the empirical estimand from data. Key advantages of this approach include improved clarity on the object of interest, transparency about how empirical evidence contributes to knowledge of that quantity, and the ability to easily plug in new statistical tools for estimation.