Mark Stehr

The Effect of Sunday Sales of Alcohol on Highway Crash Fatalities

A large body of evidence indicates that increased alcohol availability leads to increased consumption of alcohol. From 1995 to 2008, fourteen states relaxed or repealed their bans on the Sunday sale of packaged alcohol. This paper leverages these repeals to provide quasi-experimental evidence on the effect of Sunday sales bans on alcohol related crash fatalities. Previous published studies in this area have found conflicting results regarding the effect of Sunday sales on traffic accidents and fatalities, but these studies have focused on repeals in single states, cities, or provinces; are outdated; or have failed to control for underlying changes in traffic fatalities that may be correlated with repeals but are due to other factors affecting traffic safety. Drawing upon data from the lower 48 states from the Fatality Analysis Reporting System (FARS), this paper finds that only the repeal in New Mexico led to an increase in fatalities. The effect is evident only in New Mexico because this repeal led to larger increases in drinking in New Mexico than in other states, residents of New Mexico drive more than residents of the other repeal states, and there is a greater fraction of traffic fatalities involving alcohol in New Mexico than in the other repeal states.

Intended and Unintended Consequences of Youth Bicycle Helmet Laws

More than 20 states have adopted laws requiring youths to wear a helmet when riding a bicycle. We confirm previous research indicating that these laws reduced fatalities and increased helmet use, but we also show that the laws significantly reduced youth bicycling. We find this result in standard two-way fixed-effects models of parental reports of youth bicycling and in triple-difference models of self-reported bicycling among high school youths that explicitly account for bicycling by youths just above the age threshold of the helmet law. Our results highlight important intended and unintended consequences of a well-intentioned public policy.

Healthy and Unhealthy Food Prices across Neighborhoods and Their Association with Neighborhood Socioeconomic Status and Proportion Black/Hispanic

This paper evaluates variation in food prices within and between neighborhoods to improve our understanding of access to healthy foods in urbanized areas and potential economic incentives and barriers to consuming a higher-quality diet. Prices of a selection of healthier foods (dairy, fruit juice, and frozen vegetables) and unhealthy foods (soda, sweets, and salty snacks) were obtained from 1953 supermarkets across the USA during 2009–2012 and were linked to census block group socio-demographics. Analyses evaluated associations between neighborhood SES and proportion Black/Hispanic and the prices of healthier and unhealthy foods, and the relative price of healthier foods compared with unhealthy foods (healthy-to-unhealthy price ratio). Linear hierarchical regression models were used to explore geospatial variation and adjust for confounders. Overall, the price of healthier foods was nearly twice as high as the price of unhealthy foods (

Longitudinal associations of local cigarette prices and smoking bans with smoking behavior in the multi-ethnic study of atherosclerosis

0.590 vs

Neighborhood Prices of Healthier and Unhealthier Foods and Associations with Diet Quality: Evidence from the Multi-Ethnic Study of Atherosclerosis

0.298 per serving; healthy-to-unhealthy price ratio of 1.99). This trend was consistent across all neighborhood characteristics. After adjusting for covariates, no association was found between food prices (healthy, unhealthy, or the healthy-to-unhealthy ratio) and neighborhood SES. Similarly, there was no association between the proportion Black/Hispanic and healthier food price, a very small positive association with unhealthy price, and a modest negative association with the healthy-to-unhealthy ratio. No major differences were seen in food prices across levels of neighborhood SES and proportion Black/Hispanic; however, the price of healthier food was twice as expensive as unhealthy food per serving on average.

Neighborhood price of healthier food relative to unhealthy food and its association with type 2 diabetes and insulin resistance: The multi-ethnic study of atherosclerosis

Background: Few studies have examined associations of geographically proximal cigarette prices with within-person changes in smoking outcomes or assessed interactions between cigarette prices and smoking bans. Methods: We linked neighborhood cigarette prices (inflation-adjusted) at chain supermarkets and drug stores and bar/restaurant smoking ban policies to cohort participants (632 smokers from the Multi-Ethnic Study of Atherosclerosis, 2001–2012, baseline mean age 58 years) using geocoded retailer and participant addresses. We used fixed-effects models to investigate associations of within-person changes in price and ban exposures with within-person changes in five smoking outcomes: current smoking, heavy (≥10 cigarettes) smoking, cessation, relapse, and intensity (average number of cigarettes smoked per day, natural log transformed). We assessed intensity associations among all smokers, and heavy (≥10 cigarettes per day) and light (<10) baseline smokers. Finally, we tested interactions between cigarette price and bans. Results: A

The Limits of Simple Implementation Intentions: Evidence from a Field Experiment on Making Plans to Exercise

1 increase in price was associated with a 3% reduction in risk of current smoking (adjusted risk ratio [aRR]: 0.97; 95% confidence interval [CI] = 0.93, 1.0), a 7% reduction in risk of heavy smoking (aRR: 0.93; CI = 0.87, 0.99), a 20% increase in risk of smoking cessation (aRR: 1.2; CI = 0.99, 1.4), and a 35% reduction in the average number of cigarettes smoked per day by heavy baseline smokers (ratio of geometric means: 0.65; CI = 0.45, 0.93). We found no association between smoking bans and outcomes, and no evidence that price effects were modified by the presence of bans. Conclusions: Results underscore the importance of local prices, but not hospitality smoking bans, in influencing older adults’ smoking behaviors.

Associations of Bar and Restaurant Smoking Bans With Smoking Behavior in the CARDIA Study: A 25-Year Study

It is known that the price of food influences the purchasing and consumption decisions of individuals; however, little work has examined if the price of healthier food relative to unhealthier food in an individual’s neighborhood is associated with overall dietary quality while using data from multiple regions in the United States. Cross-sectional person-level data came from The Multi-Ethnic Study of Atherosclerosis (exam 5, 2010–2012, n = 2765); a food frequency questionnaire assessed diet. Supermarket food/beverage prices came from Information Resources Inc. (n = 794 supermarkets). For each individual, the average price of select indicators of healthier foods (vegetables, fruits, dairy) and unhealthier foods (soda, sweets, salty snacks), as well as their ratio, was computed for supermarkets within three miles of the person’s residential address. Logistic regression estimated odds ratios of a high-quality diet (top quintile of Healthy Eating Index 2010) associated with healthy-to-unhealthy price ratio, adjusted for individual and neighborhood characteristics. Sensitivity analyses used an instrumental variable (IV) approach. Healthier foods cost nearly twice as much as unhealthier foods per serving on average (mean healthy-to-unhealthy ratio = 1.97 [SD 0.14]). A larger healthy-to-unhealthy price ratio was associated with lower odds of a high-quality diet (OR = 0.76 per SD increase in the ratio, 95% CI = [0.64–0.9]). IV analyses largely confirmed these findings although—as expected with IV adjustment—confidence intervals were wide (OR = 0.82 [0.57–1.19]). Policies to address the large price differences between healthier and unhealthy foods may help improve diet quality in the United States.

The Effects of Mandatory Seatbelt Laws on Seatbelt Use, Motor Vehicle Fatalities, and Crash-Related Injuries Among Youths

This study examined the association between the price of healthier food relative to unhealthy food and type 2 diabetes prevalence, incidence and insulin resistance (IR). Data came from the Multi-Ethnic Study of Atherosclerosis exam 5 administered 2010-2012 (exam 4, five years prior, was used only for diabetes incidence) and supermarket food/beverage prices derived from Information Resources Inc. For each individual, average price of a selection of healthier foods, unhealthy foods and their ratio was computed for supermarkets within 3miles of the persons residential address. Diabetes status was confirmed at each exam and IR was assessed via the homeostasis model assessment index. Multivariable-adjusted logistic, modified Poisson and linear regression models were used to model diabetes prevalence, incidence and IR, respectively as a function of price and covariates; 2353 to 3408 participants were included in analyses (depending on the outcome). A higher ratio of healthy-to-unhealthy neighborhood food price was associated with greater IR (4.8% higher HOMA-IR score for each standard deviation higher price ratio [95% CI -0.2% to 10.1%]) after adjusting for region, age, gender, race/ethnicity, family history of diabetes, income/wealth index, education, smoking status, physical activity, and neighborhood socioeconomic status. No association with diabetes incidence (relative risk=1.11, 95% CI 0.85 to 1.44) or prevalence (odds ratio=0.95, 95% CI 0.81 to 1.11) was observed. Higher neighborhood prices of healthier food relative to unhealthy food were positively associated with IR, but not with either diabetes outcome. This study provides new insight into the relationship between food prices with IR and diabetes.

Relationship between HIV risk perception and condom use: Evidence from a population-based survey in Mozambique.

Recent large-scale randomized experiments find that helping people form implementation intentions by asking when and where they plan to act increases one-time actions, such as vaccinations, preventative screenings and voting. We investigate the effect of a simple scalable planning intervention on a repeated behavior using a randomized design involving 877 subjects at a private gym. Subjects were randomized into i) a treatment group who selected the days and times they intended to attend the gym over the next two weeks or ii) a control group who instead recorded their days of exercise in the prior two weeks. In contrast to recent studies, we find that the planning intervention did not have a positive effect on behavior. We observe a tightly estimated null effect even though the majority of subjects believed that planning is helpful and despite clear evidence that they engaged with the planning process.