Quantile treatment effects of job loss on health

Gendered Impact of Layoffs on Body Weight Trajectories in Transitional China: A Life Course Perspective 1993-2015

Layoffs can have lasting effects on the bodyweight trajectories of both genders. However, prior studies usually overlook the nuanced gender differences in health impacts. This study investigates the differential impact of layoffs from State-Owned Enterprises in China on body mass index (BMI) trajectories in men and women over a span of two decades. Our results indicate that being laid-off was associated with higher BMI at mid-age and accelerated BMI growth in women, contrasting with a slower BMI growth in men as they aged. The diverging trends were primarily driven by women and men who were back on the job market and re-employed. Women with post-layoff childcare responsibilities had the least healthy mid-life BMI, and a faster BMI growth compared to their job retainer counterparts. This study emphasizes the importance of considering gendered life course perspectives to understand the health impacts of job loss.

What remains after the money ends? Evidence on whether admission reductions continued following the largest health and social care integration programme in England

We study the long-term effects on hospital activity of a three-year national integration programme. We use administrative data spanning from 24 months before to 22 months after the programme, to estimate the effect of programme discontinuation using difference-in-differences method. Our results show that after programme discontinuation, emergency admissions were slower to increase in Vanguard compared to non-Vanguard sites. These effects were heterogeneous across sites, with greater reductions in care home Vanguard sites and concentrated among the older population. Care home Vanguards showed significant reductions beginning early in the programme but falling away more rapidly after programme discontinuation. Moreover, there were greater reductions for sites performing poorly before the programme. Overall, this suggests the effects of the integration programme might have been lagged but transitory, and more reliant on continued programme support.

COVID-19 employment shocks and safety net expansion: Health effects on displaced workers

COVID-19 precipitated sharp job losses, concentrated in the service sector. Prior research suggests that such shocks would negatively affect health and wellbeing. However, the nature of the pandemic crisis was distinct in ways that may have mitigated any such negative effects, and historic expansions in unemployment insurance (UI) may have buffered workers from negative health consequences. We draw on employer-employee linked cross-sectional (N = 15,219) and panel (N = 3307) data from service sector workers to estimate the effects of job loss on health and wellbeing during COVID-19. Using employer fixed-effects, lagged dependent variables, and models that focus on job loss due to establishment closure to minimize confounding, we find negative effects of unemployment on health and wellbeing. However, in periods when UI was most generous or in cases where UI fully replaced pre-job loss wages, unemployed workers who received UI were no worse off than those who remained employed. Although UI protected against worsening health, receiving generous UI benefits did not confer a health advantage relative to working at the height of the pandemic.

A concept analysis of routines for improving health behaviors

Objective

Chronic disease patients often have unhealthy routines, especially when away from health care professionals. These patients need clear guidance about establishing and maintaining routines. This study aimed to synthesize a definition of the concept of routines for improving health behaviors based on its uses in the literature.

Methods

We searched CINAHL, Medline, Scopus, and Google Scholar from January to May, 2022 for articles that included definitions of routines in the context of improving health behavior. We applied no date restriction. The systematic analytic method and Rodgers' evolutionary concept analysis method were used. We charted the attributes, antecedents, and consequences of routines for improving health behaviors, analyzed their uses in the literature, and synthesized the results in a definition of the concept.

Result

At total of 24 articles were included. Attributes of the concept were repeated patterns, controllable by the patient, goal-oriented health, and integration into an overarching lifestyle. Antecedents were individual characteristics and environmental factors. Consequences were psychological, physical, and social well-being at individual and environmental levels.

Conclusion

This clarified definition of routines for improving health behaviors will provide a starting point for future research and, eventually, a basis for clinical nursing interventions to support patients in developing and maintaining healthy routines to promote better patient outcomes.

Multidimensional housing insecurity and psychological health: how do gender and initial psychological health differentiate the association?

OBJECTIVES

Despite compelling evidence for housing-health associations, it is still unclear (1) whether gender differentiates psychological responses to housing insecurity and (2) the extent to which initial psychological health influences the association between housing insecurity and psychological health. The present study aims to reduce these knowledge gaps.

STUDY DESIGN

We used data from over 13 waves (155,114 observations) of the Korea Welfare Panel Study.

METHODS

This study tests fixed effects models that can take into account measured and unmeasured heterogeneity. Quantile regression with fixed effects was conducted to assess whether the observed association depends on the initial state of psychological health. All analyses are gender stratified.

RESULTS

Fixed effects estimates show that housing problems, such as being a renter (b = 0.159), housing cost burden (b = 0.173), and rental/or mortgage arrears (b = 1.194), are significantly associated with depressive symptoms. Similar patterns were observed for poor housing quality (b = 0.598) and a lack of essential facilities (b = 0.286). Although the association between the severity of housing insecurity and depressive symptoms was concentrated among men with initially higher levels of depressive symptoms, the observed association was consistently pronounced for women regardless of initial psychological health.

CONCLUSIONS

This study suggests that gender perspectives need to be incorporated into the development of housing intervention for vulnerable groups.

Late-career unemployment and cognitive abilities

We study the effect of unemployment on cognitive abilities among individuals aged between 50 and 65 in Europe. To this end, we exploit plant closures and use flexible event-study estimations together with an experimentally elicited measure of fluid intelligence, namely word recall. We find that, within a time period of around eight years after the event of unemployment, cognitive abilities only deteriorate marginally - the effects are insignificant both in statistical and economic terms. We do, however, find significant effects of late-career unemployment on the likelihood to leave the labor force, and short-term effects on mental health problems such as depression and sleep problems.

Economic shocks, health, and social protection: The effect of COVID-19 income shocks on health and mitigation through cash transfers in South Africa

COVID-19 caused an unprecedented health and economic crisis. Nation-wide lockdowns triggered major economic disruptions across the world. We provide evidence of the impact of these extreme economic shocks on health outcomes across wealth levels. We further identify if cash transfers can mitigate the negative health effects for the most economically vulnerable. The study focuses on South Africa, an Upper Middle-Income Country with high levels of inequality, a large informal labor market and with low levels of social welfare. Using difference-in-difference estimation (DD) on a longitudinal sample of 6437 South Africans, we find that the lockdown income shock significantly reduces health by 0.2 standard deviations (SD). We find no difference of the effect across wealth quartiles. Exposure to a cash transfer program mitigates the negative health effects for recipients in the lowest wealth quartile to 0.25 SD compared to 0.4 SD for non-recipients. Full mitigation occurs for individuals exposed to an on average higher scale-up of the cash transfer program. Our analysis shows that a lockdown induced income shock caused adverse health outcomes; however, a pro-poor cash transfer program protected the most economically vulnerable from these negative health effects.

Job loss and psychological distress during the COVID-19 pandemic: Longitudinal Analysis from residents in nine predominantly African American low-income neighborhoods

While psychological distress is a common sequelae of job loss, how that relationship continued during the COVID-19 pandemic is unclear, for example, given higher health risk to working due to disease exposure. This paper examines changes in psychological distress depending on job loss among a cohort of randomly selected residents living in nine predominantly African American low-income neighborhoods in Pittsburgh PA across four waves between 2013 and 2020. Between 2013 and 2016, we found an increase in psychological distress after job loss in line with the literature. In contrast, between 2018 and 2020 we found change in psychological distress did not differ by employment loss. However, residents who had financial concerns and lost their jobs had the largest increases in psychological distress, while residents who did not have serious financial concerns-potentially due to public assistance-but experienced job loss had no increase in distress, a better outcome even than those that retained their jobs. Using partial identification, we find job loss during the pandemic decreased psychological distress for those without serious financial concerns. This has important policy implications for how high-risk persons within low-income communities are identified and supported, as well as what type of public assistance may help.

Housing cost burden and material hardship among older adults: How do they influence psychological health?

OBJECTIVES

Despite a growing body of evidence for the association between housing cost burden and psychological health, few studies have focused on the potential mediators of this association and the extent to which housing cost burden poses a threat to older adults' psychological health. This study aims to assess (a) the link between housing cost burden and psychological health among older adults and (b) how the association is mediated by material hardship.

METHODS

Using thirteen waves of a nationally representative longitudinal study in Korea, this study assessed the association between housing cost burden and depressive symptoms among older adults aged 65 or over. Mediation tests were conducted to identify whether material hardship explains the link between housing cost burden and depressive symptoms. We used fixed-effects models to take into account individual-level heterogeneity.

RESULTS

Housing cost burden was significantly associated with depressive symptoms among older adults, regardless of their housing tenure status. Different types of material hardship partially mediated the association between housing cost burden and depressive symptoms in older adults. Older adults with severe housing cost burden are more susceptible to all types of material hardship compared to those with a moderate burden.

CONCLUSIONS

To contribute further to the social causation discussions, future studies should seek to identify protective factors of depressive symptoms among older adults and other potential mechanisms of the association between older adults' socioeconomic conditions and their psychological health.

Quantile Treatment Effect of Zinc Lozenges on Common Cold Duration: A Novel Approach to Analyze the Effect of Treatment on Illness Duration

Calculation of the difference of means is the most common approach when analyzing treatment effects on continuous outcomes. Nevertheless, it is possible that the treatment has a different effect on patients who have a lower value of the outcome compared with patients who have a greater value of the outcome. The estimation of quantile treatment effects (QTEs) allows the analysis of treatment effects over the entire distribution of a continuous outcome, such as the duration of illness or the duration of hospital stay. Furthermore, most of these outcomes have asymmetric distributions with fat tails, and censored observations are not uncommon. These features can be accounted for in the analysis of the QTE. In this paper, we use the QTE approach to analyze the effect of zinc lozenges on common cold duration. We use the data set of the Mossad (1996) trial with zinc gluconate lozenges, and three data sets of trials with zinc acetate lozenges. In the Mossad (1996) trial, zinc gluconate lozenges shortened common cold duration on average by 4.0 days (95% CI 2.3-5.7 days). However, the QTE analysis indicates that 15- to 17-day colds were shortened by 8 days, and 2-day colds by just 1 day, for the group taking zinc lozenges. Thus, the overall 4.0-day average effect of zinc gluconate lozenges in the Mossad (1996) trial is inconsistent with our QTE findings for both short and long colds. Similar results were found in our QTE analysis of the pooled data sets of the three zinc acetate lozenge trials. The average effect of 2.7 days (95% CI 1.8-3.3 days) was inconsistent with the effects on short and long colds. The QTE approach may have broad usefulness for examining treatment effects on the duration of illness and hospital stay, and on other similar outcomes.

The impact of late-career job loss and genetic risk on body mass index: Evidence from variance polygenic scores

Unemployment shocks from the COVID-19 pandemic have reignited concerns over the long-term effects of job loss on population health. Past research has highlighted the corrosive effects of unemployment on health and health behaviors. This study examines whether the effects of job loss on changes in body mass index (BMI) are moderated by genetic predisposition using data from the U.S. Health and Retirement Study (HRS). To improve detection of gene-by-environment (G × E) interplay, we interacted layoffs from business closures-a plausibly exogenous environmental exposure-with whole-genome polygenic scores (PGSs) that capture genetic contributions to both the population mean (mPGS) and variance (vPGS) of BMI. Results show evidence of genetic moderation using a vPGS (as opposed to an mPGS) and indicate genome-wide summary measures of phenotypic plasticity may further our understanding of how environmental stimuli modify the distribution of complex traits in a population.

A distributional regression approach to income-related inequality of health in Australia

Background

Several studies have confirmed the existence of a significant positive relationship between income and health. Conventional regression techniques such as Ordinary Least Squares only help identify the effect of the covariates on the mean of the health variable. In this way, important information of the income-health relationship could be overlooked. As an alternative, we apply and compare unconventional regression techniques.

Methods

We adopt a distributional approach because we want to allow the effect of income on health to vary according to people’s health status. We start by analysing the income-health relationship using a distributional regression model that falls into the GAMLSS (Generalized Additive Models for Location, Scale and Shape) framework. We assume a gamma distribution to model the health variable and specify the parameters of this distribution as linear functions of a set of explanatory variables. For comparison, we also adopt a quantile regression analysis. Based on predicted health quantiles, we use both a parametric and a non-parametric approach to estimate the lower tail of the health distribution.

Results

Our data come from Wave 13 of the Household, Income and Labour Dynamics in Australia (HILDA) survey, collected in 2013-2014. According to GAMLSS, we find that the risk of ending up in poor, fair or average health is lower for those who have relatively high incomes ($80,000) than for those who have relatively low incomes ($20,000), for both smokers and non-smokers. In relative terms, the risk-lowering effect of income appears to be the largest for those who are in poor health, again for both smokers and non-smokers. The results obtained on the basis of quantile regression are to a large extent comparable to those obtained by means of GAMLSS regression.

Conclusions

Both distributional regression techniques point in the direction of a non-uniform effect of income on health, and are therefore promising complements to conventional regression techniques as far as the analysis of the income-health relationship is concerned.

The effect of unemployment on the smoking behavior of couples

Although unemployment likely entails various externalities, research examining its spillover effects on spouses is scarce. This is the first paper to estimate effects of unemployment on the smoking behavior of both spouses. Using German Socio-Economic Panel data, we combine matching and difference-in-differences estimation, employing the post-double-selection method for control variable selection via Lasso regressions. One spouse's unemployment increases both spouses' smoking probability and intensity. Smoking relapses and decreased smoking cessation drive the effects. Effects are stronger if the partner already smokes and if the male partner becomes unemployed. Of several mechanisms discussed, we identify smoking to cope with stress as relevant.

No evidence for a protective effect of education on mental health

This paper analyzes whether education has a protective effect on mental health. To estimate causal effects, we employ an instrumental variable (IV) technique that exploits a reform extending compulsory schooling by one year implemented between 1949 and 1969 in West Germany. We complement analyses on the Mental Component Summary (MCS) score as a generic measure of overall mental health with an MCS-based indicator for risk of developing symptoms of mental health disorder and a continuous measure of subjective well-being. Results support existing evidence of a positive relationship between completed years of secondary schooling and mental health in standard OLS estimations. In contrast, the IV estimations reveal no such causal protective effect and negative effects cannot be ruled out.

The shattered "Iron Rice Bowl": Intergenerational effects of Chinese State-Owned Enterprise reform

Reform of the Chinese State-Owned Enterprise (SOE) sector in the late 1990s triggered massive layoffs (34 million employees) and marked the end of the "Iron Rice Bowl" guarantee of employment security for the remaining 67 million workers. An expanding international literature has documented the adverse health impacts of economic insecurity on adults, but has typically neglected children. This paper uses the natural experiment of SOE reform to explore the causal relationship between increased parental economic insecurity and children's BMI Z-score. Using province-year-level layoff rates and income loss from the layoffs, we estimate a generalised difference-in-differences model with child fixed effects and year fixed effects. For a medium-build 10-year-old boy, a median treatment effect implies a gain of 1.8 kg and a 2.2-percentage-point increase in the overweight rate due to the reform. Anxiety about potential losses causes weight gain for boys whose SOE parents kept their jobs. Unconditional quantile regressions suggest that boys who are heavier are more likely to gain weight. Girls are not significantly affected. Intergenerational effects therefore increase the estimated public health costs of greater economic insecurity.

The effect of job loss on pharmaceutical prescriptions

We estimate the effect of job loss on the probability that long-tenured workers are prescribed anti-hypertensive and psychotropic drugs. We exploit two administrative data sources from the Veneto region in Italy and estimate an event-study model. Our results indicate that the probability of drug prescription increases among under-40 males but not among older males or female workers. We suggest that the effect on younger male workers is the combined result of their typical role as breadwinners, limited wealth buffers in case of layoff, and unfavourable employment legislative protection.

Reconsidering the income-health relationship using distributional regression

We reconsider the relationship between income and health taking a distributional perspective rather than one centered on conditional expectation. Using structured additive distributional regression, we find that the association between income and health is larger than generally estimated because aspects of the conditional health distribution that go beyond the expectation imply worse outcomes for those with lower incomes. Looking at German data from the Socio-Economic Panel, we find that the risk of bad health is roughly halved when doubling the net equivalent income from 15,000 to 30,000€. This is more than tenfold of the magnitude of change found when considering expected health measures. A distributional perspective thus highlights another dimension of the income-health relation-that the poor are in particular faced with greater health risk at the lower end of the health distribution. We therefore argue that when studying health outcomes, a distributional approach that considers stochastic variation among observationally equivalent individuals is warranted.