Nationwide Sample Research Articles

Navigating fairness and boundaries: parental rule strategies and indicators of adolescents’ media overuse

ABSTRACT Balancing adolescents’ growing desire for independence with the establishment of effective media-related rules presents a complex challenge for many parents. Our study, utilising a diverse nationwide sample of 1,480 adolescents aged 13-17, investigates how adolescents’ perceptions of rule restrictiveness might explain the relationship between parental rule strategies and adolescents’ overuse of media. Indicators of overuse include dysregulated media engagement, interference of media use with other activities, and media-related physical symptoms. Structural equation modelling reveals that a higher number of rules and more frequent enforcement are associated with increased perceptions of restrictiveness among adolescents. However, adolescents tend to view rules as more reasonable when parents consistently adhere to these rules themselves, particularly in situations with numerous rules and strict enforcement. Notably, a curvilinear relationship emerges between adolescents’ perceptions of rule restrictiveness and media overuse indicators. Adolescents who perceive rules as reasonable, rather than overly restrictive or lenient, report lower levels of media overuse indicators. Our findings highlight the importance of parents establishing media use expectations that are balanced, reasonable, and that they themselves are committed to following.

Traumatic brain injury and long-term associations with work, divorce and academic achievement

ObjectiveTraumatic brain injuries (TBI), irrespective of severity, may have long-term social implications. This study explores the relationships between TBI severity and outcomes related to work stability, divorce, and academic achievement. MethodsUsing a Danish nationwide sample of persons with and without TBI, we employed case-control and longitudinal cohort designs. The case-control design utilized individuals aged 18 to 60 years and examined work stability. Each case, employed at time of TBI, was compared with 10 matched controls. The cohort design utilized individuals alive from 1980 to 2016 with and without TBI and assessed the likelihood of 1) divorce and 2) higher-level education. TBI exposures included concussion, skull fractures, or confirmed TBI. ResultsTBI cases exhibited higher odds ratios (OR) for work instability at all follow-ups compared to controls. Increased TBI severity was associated with a higher risk of work instability at 2-year follow-up (concussion: OR = 1.83; skull fracture: OR = 2.22; confirmed TBI: OR = 4.55), and with a higher risk of not working at 10-year follow-up (confirmed TBI: OR = 2.82; concussion: OR = 1.63). The divorce incidence rate ratio (IRR) was elevated in individuals with TBI (males: IRR = 1.52; females: IRR = 1.48) compared to those without TBI. Individuals with childhood TBI had reduced chances of attaining high school degree or higher (males: IRR = 0.79; females: IRR = 0.85) compared to those without TBI. ConclusionTBI is associated with an increased long-term risk of social consequences, including work instability, divorce, and diminished chances of higher education, even in cases with concussion.

Zoning’s treatment of housing: Analysis from a nationwide sample of places

ABSTRACT Advocates of increased housing supply and affordability in the United States have targeted zoning regulations as drivers of housing cost growth, but they lack an understanding of the prevalence and geographical distribution of different types of zoning regulations because few efforts exist to compile zoning data across localities. This study measures the amount of land allocated to different housing types in a random, stratified sample of 90 places of over 10,000 residents across the U.S. Despite our exclusion of smaller communities, we find that variations of single-family zoning are more than three times as common as zoning for three or more units per lot. We also analyze socio-demographic, built environment, and political characteristics of the sampled places in relation to their zoning practices, finding few relationships between place-level characteristics and the shares of land dedicated to different housing types. Our results from a national sample suggest significant variation in zoning practices relative to local demographic characteristics and point to the importance of understanding zoning practices and paths for reform in their local and regional contexts.

National mixed methods evaluation of Adult and Youth Mental Health First Aid

ObjectiveMental Health First Aid (MHFA) is an international, early intervention, public education program that teaches participants to identify, understand, and respond to signs of mental health and substance use challenges. Until now, all evaluations on MHFA courses in the United States have been performed externally, which have limits in generalizability and the ability to address insights in a timely manner. Additionally, few evaluations have assessed the newest versions of MHFA courses. Therefore, this evaluation aimed to understand key outcomes and participant responses to Adult and Youth MHFA courses in a nationwide sample, spanning nearly a year of real-world implementation. MethodsAn internal, mixed methods program evaluation was performed on the second edition of the in-person versions of Adult and Youth MHFA. Pre- and post-course evaluation data from 3,586 Adult and 2,314 Youth MHFA participants trained between October 2022 and July 2023 were used in this evaluation. Key quantitative constructs, such as mental health literacy, intentions to perform MHFA skills, and confidence to use MHFA skills, were analyzed using paired sample t tests. Rapid thematic analysis methods were used to analyze participants' qualitative responses to the course. ResultsSignificant increases in mental health literacy, intentions, and confidence were observed in both Adult and Youth MHFA participants from pre- to post-course. Qualitative analyses revealed key themes in participant responses, including the helpfulness of the activities, materials, and the MHFA action plan. Adjustments to materials, the length or pace of the course, and other specifics were noted as opportunities for improvement. These findings will be used to inform the future practice, implementation, and revisions of MHFA. ConclusionCompletion of Adult or Youth MHFA by adults in the United States led to improvements in mental health literacy and intentions and confidence to assist someone in need. Both programs may benefit from implementation and content-related changes to enhance participant experience.

Comparing Medical-Surgical, Psychiatric–Mental Health, and Addiction Specialty Nurses’ Personal Attitudes, Professional Attitudes, and Motivation Toward Working With Individuals With Alcohol and Opioid Use Problems: Implications for the Nursing Workforce Using a Nationwide Sample

Comparing Medical-Surgical, Psychiatric–Mental Health, and Addiction Specialty Nurses’ Personal Attitudes, Professional Attitudes, and Motivation Toward Working With Individuals With Alcohol and Opioid Use Problems: Implications for the Nursing Workforce Using a Nationwide Sample

The Association between Exposure to Fine Particulate Matter and MRI-Assessed Locus Coeruleus Integrity in the Vietnam Era Twin Study of Aging (VETSA).

Increased exposure to ambient air pollution, especially fine particulate matter () is associated with poorer brain health and increased risk for Alzheimer's disease (AD) and related dementias. The locus coeruleus (LC), located in the brainstem, is one of the earliest regions affected by tau pathology seen in AD. Its diffuse projections throughout the brain include afferents to olfactory areas that are hypothesized conduits of cerebral particle deposition. Additionally, extensive contact of the LC with the cerebrovascular system may present an additional route of exposure to environmental toxicants. Our aim was to investigate if exposure to was associated with LC integrity in a nationwide sample of men in early old age, potentially representing one pathway through which air pollution can contribute to increased risk for AD dementia. We examined the relationship between and invivo magnetic resonance imaging (MRI) estimates of LC structural integrity indexed by contrast to noise ratio () in 381 men [; standard deviation ] from the Vietnam Era Twin Study of Aging (VETSA). Exposure to was taken as a 3-year average over the most recent period for which data were available (average of 5.6 years prior to the MRI scan). We focused on in the rostral-middle portion of LC due to its stronger associations with aging and AD than the caudal LC. Associations between exposures and LC integrity were tested using linear mixed effects models adjusted for age, scanner, education, household income, and interval between exposure and MRI. A co-twin control analysis was also performed to investigate whether associations remained after controlling for genetic confounding and rearing environment. Multiple linear regressions revealed a significant association between and rostral-middle (; ), whereby higher exposure to was associated with lower . A co-twin control analysis found that, within monozygotic pairs, individuals with higher exposure showed lower (; ), indicating associations were not driven by genetic or shared environmental confounds. There were no associations between and caudal or hippocampal volume, suggesting a degree of specificity to the rostral-middle portion of the LC. Given previous findings that loss of LC integrity is associated with increased accumulation of AD-related amyloid and tau pathology, impacts on LC integrity may represent a potential pathway through which exposure to air pollution increases AD risk. https://doi.org/10.1289/EHP14344.

Testing predictions from the memory and identity theory of ICD-11 complex posttraumatic stress disorder: Measurement development and initial findings

BackgroundThe ‘Memory and Identity Theory’ of ICD-11 Complex Posttraumatic Stress Disorder (CPTSD) was recently published but has not yet been subjected to empirical testing. The objective of this study was to evaluate newly developed measures of memory and identity disturbances and test hypothesized structural relations between these constructs and CPTSD symptoms. MethodsSelf-report data were collected from a nationwide sample of adults living in Ukraine (N = 2050) in September 2023. Exploratory factor analysis was used to assess the latent structure of the newly developed measures, and structural equation modeling was used to test the associations between memory and identity disturbances and CPTSD symptoms. Results90 % of participants experienced a lifetime trauma, and 9.2 % screened positive for ICD-11 CPTSD. Results indicated that the newly developed measures of memory and identity problems possessed satisfactory psychometric properties, and all but one of the model-implied structural associations were observed. ConclusionThis study provides initial empirical support for the Memory and Identity theory of ICD-11 CPTSD, indicating that the basis of this disorder lies in distinct memory and identity processes. Several effects not predicted by the theory were observed, and these can provide the basis for further model testing and refinement.

The Interplay of Local- and State-Level Alcohol Policies in the United States.

Most research on alcohol control policies in the United States has focused on the state level. In this study, we assessed both local and state policy prevalence and restrictiveness in a nationwide sample of cities. We conducted original legal research to assess prevalence of local-level policies across 374 cities (48 states) in 2019 for the following seven policy areas: (a) drink specials; (b) beverage service training; (c) minimum age for on-premise servers and bartenders; (d) minimum age for off-premise sellers; (e) prohibitions against hosting underage drinking parties (i.e., social host provisions); (f) bans on off-premise Sunday sales; and (g) keg registration. We obtained parallel state-level policies from the Alcohol Policy Information System. We assessed the restrictiveness of existing policies and how these compared across local and state levels. We found that for six of the seven policy areas, the majority of cities (53% to 83%) had only a state-level policy. Few cities (0% to 8% across policy areas) had only a local-level policy. The percentage of cities that had an alcohol policy at both the local and state levels ranged from less than 1% to 19% across policy areas, and the policies were mostly equally restrictive at both levels. The lack of local policies may point to areas where these localities could strengthen their alcohol policy environments. Additional research is needed to understand how the prevalence and restrictiveness of local and state policies are associated with public health harms such as traffic crashes.

Perioperative Albumin Among Adults Undergoing Thoracic Surgery in the United States: Utilization, Associations With Clinical Outcomes, and Contribution to Hospital Costs

Objectives: To estimate the use of albumin among adults undergoing thoracic surgery in the United States, compare baseline characteristics, clinical and cost outcomes of recipients versus non-recipients, and determine albumin's contribution to total hospital costs. Design: Retrospective cohort study. Setting: Nationwide sample of US hospitals. Participants: Adults undergoing open and minimally invasive thoracic surgery between 2011 and 2017. Interventions: Albumin on the day of surgery (identified using itemized hospital billing logs). Measurements and Main Results: Albumin was used in 170 of 342 US hospitals, among 13% and 7% of 14672 and 22532 patients who respectively underwent open and minimally invasive thoracic surgery (median volume 500cc). Baseline comorbidities and organ supportive treatments were several-fold more prevalent among recipients (particularly vasopressors, mechanical ventilation, red cell transfusions). In standardized mortality ratio propensity score weighted analysis, albumin use was not associated with in-hospital mortality (adjusted RR 1.17 [0.72, 1.92] and 1.51 [0.97, 2.34], with open and minimally procedures), but was associated with morbidity and higher costs, more so with minimally invasive than open surgery. Total costs among recipients were higher by $4,744 [$3,591, $5,897] and $5,088 [$4,075, $6,100] for open and minimally invasive procedures respectively. Albumin accounted for 2.6% of this difference (median $124 [$83-$189] per patient). Conclusions: Albumin use varies widely across hospitals, and 9% of patients receive it (median 500cc). Use was not associated with in-hospital mortality and was associated with more morbidity and cost. The cost of albumin accounted for a trivial portion of hospital costs. Clinical trials must examine effects of albumin on complications and costs after thoracic surgery.

A framework for measuring electricity price literacy: Application to South Korea

Consumers’ knowledge of electricity prices and its effect on their behaviors have been widely studied, yet the comparison and generalization of these findings are challenging due to variations in definition and survey items. This paper proposes a comprehensive framework to assess Electricity Price Literacy by introducing a functional representation that encompasses various electricity pricing systems and categorizing into three knowledge domains to systematically organize previous literature's knowledge measures. To demonstrate the practicality of this framework, a survey was administered to a nationwide sample of 4214 electricity consumers in South Korea. The survey results highlight variations in electricity price literacy across different domains and reveal varying relationships between domain-specific knowledge and behaviors, thereby highlighting the need for a decomposed measure of price knowledge.

Sex differences in age-varying trends of depressive symptoms, substance use, and their associations among South Korean adults: A Time-Varying Effect Modeling (TVEM) analysis of a nationwide sample

BackgroundThis study investigated sex differences in the age-varying trends of depressive symptoms, substance use, and their relationships throughout the adult lifespan. Using a nationwide sample from South Korea, this study aimed to confirm existing patterns and identify unique characteristics specific to the South Korean context. MethodTime-Varying Effect Modeling (TVEM) was applied to data from 17,484 participants (9987 women and 7497 men) in the Korea National Health and Nutrition Examination Survey. ResultsConsistent with global trends, the results revealed a higher prevalence of depressive symptoms among women and a greater prevalence of substance use among men. However, the findings also illuminated unique patterns within the South Korean context. Substance use among South Korean men peaked during their 40s, whereas South Korean women consistently exhibited lower rates of substance use. Additionally, a stronger association between depressive symptoms and substance use was identified in women compared to men. LimitationsThe study used cross-sectional data, limiting the analysis of temporal dynamics between depressive symptoms and substance use. Additionally, TVEM cannot distinguish between aging and cohort effects. Furthermore, the assessments of depressive symptoms and substance use were based on self-report. Finally, the study did not include adolescents or sex and gender minorities in its sample. ConclusionsThese results emphasize the need for targeted interventions, particularly among women in their 20s and older adulthood, where there is a heightened co-occurrence of depressive symptoms and substance use. These findings also highlight the importance of sex- and culture-sensitive approaches tailored to the South Korean context.

Why People in Prison Disobey the Rules: The Influence of Legitimacy on Misconduct in South Korean Prisons

ABSTRACT Research has demonstrated that individuals with higher levels of perceived legitimacy toward police or legal institutions are less likely to engage in antisocial behavior. However, a limited number of empirical studies have directly examined the relationship between the perceived legitimacy of prison officers and misconduct in prisons. The goal of this study is to examine the role of legitimacy in misconduct among people incarcerated in South Korean prisons. Using a nationwide sample of adults in correctional facilities in South Korea, logistic regression models are used to examine whether the perceived legitimacy of prison officers is associated with verbal and physical aggression against officers and other incarcerated persons. The equality of regression coefficients test is employed to examine whether the independent variable has varying impacts on each measure of interpersonal aggression. The study found that perceived legitimacy was negatively related and varied with the target of misconduct, with a larger influence on interpersonal aggression toward prison officers than those toward other incarcerated individuals. The findings are consistent with the normative perspective and suggest the need for policies encouraging just and fair management of prison populations by prison officers to sustain order in prisons. Policy implications are discussed.

A 2024 nationwide cross-sectional survey to assess the prevalence of cigarette smoking, e-cigarette use and heated tobacco use in Poland.

Monitoring tobacco use is one of the most important tobacco control interventions recommended by the World Health Organization. This study aimed to assess the prevalence of cigarette smoking, e-cigarette use, and heated tobacco use in a nationwide sample of adults in Poland, as well as to identify factors associated with smoking, e-cigarette use, and heated tobacco use. This nationwide crosssectional survey was carried out in February 2-4, 2024 using the computer-assisted web interviewing method. The study questionnaire included 17 closed questions on smoking, e-cigarette use, and heated tobacco use. A sample of 1080 adults was selected using a non-probability quota sampling method. Data were collected from 1080 adults, age M±SD 48.4±15.5 years, 53% females. Past 30-day smoking was declared by 30.4% of adults in Poland, including 24.5% of daily smokers. Ever e-cigarette use was declared by 33% of respondents, and 20.6% had ever tried heated tobacco. Past 30-day e-cigarette use was declared by 15.2% of adults, wherein 5.9% were daily e-cigarette users. Past 30-day heated tobacco use was declared by 10.9% of respondents, wherein 4.9% were daily heated tobacco users. One-tenth of adults were dual users (cigarette and e-cigarette or heated tobacco), and 6.5% were past 30-day triple users. Age 40-59 years, having less than higher education, and bad economic status were significantly associated with daily smoking (p < 0.05). Age 18-39 years, having less than higher education, and active occupational status (employment/ self-employment) were associated with daily e-cigarette use (p < 0.05). Age 18-39 years and active occupational status were associated with daily heated tobacco use (p < 0.05). This study provides comprehensive epidemiological data on the current prevalence of smoking, e-cigarette use, and heated tobacco use. The introduction of e-cigarettes and heated tobacco products evoked changes in social behaviors related to nicotine use. Int J Occup Med Environ Health. 2024;37(3):271-86.

The perceived impact of a post-Dobbs landscape on U.S. adolescents and young adults

Objective(s)To capture the perspectives and knowledge of adolescents and young adults on abortion-related topics following the Dobbs decision. Study designQualitative content analysis of an open-ended, five-question survey fielded on October 28, 2022 via the MyVoice project, a nationwide weekly text message poll of 14–24-year-olds. ResultsWe found the respondents (N = 565, response rate 71%) had a mean age of 20.0 years and resided in 47 states. Many described pro- or anti-abortion changes to abortion access in their state, though expressed mixed emotions about the changes (negative, positive, or mixed/neutral). Most often, they had conversations about abortion with peers (28%), followed by parents or family (20%); nearly 20% stated they have never had a conversation about abortion. The majority of respondents (55%) believed they and their peers should have access to abortion care without required parental consent/notification, frequently citing individual rights/autonomy (31%) followed by harms of parental involvement (12%). Most (79%) provided a technique for how to determine if online information about abortion was trustworthy. Conclusion(s)Four months after the Dobbs decision, this national sample of adolescents and young adults were aware of changes to abortion access, had conversations about abortion, shared diverse opinions on parental consent or notification laws, and could determine trustworthiness of online abortion resources. Abortion-related policy and practice can be improved by understanding adolescents’ and young adults’ needs and preferences, trusting and supporting their autonomy, and reducing barriers to care. ImplicationsThis study highlights the timely perspectives and experiences of a diverse, nationwide sample of adolescents and young adults on abortion-related topics. Findings can support centering adolescents and young adults in practice and policy changes to improve their knowledge about abortion and streamline access to essential reproductive health services post-Dobbs.

A ‘Thank You’ really would be nice: Perceived gratitude in family relationships

ABSTRACT The current study investigated perceived gratitude in multiple family relationships (i.e. couple, parent-older child, parent-younger child) and their unique associations with couple, parenting, and individual outcomes. Study hypotheses were executed from a nationwide sample of 593 parents that were married or in a romantic relationship. Results indicated perceived gratitude from romantic partners was associated with couple relationship satisfaction but was not associated with parenting stress; conversely, perceived gratitude from children was associated with parenting stress but was not associated with couple relationship satisfaction. Perceived gratitude from romantic partners and from older children, but not younger children, were associated with less psychological distress. Some moderation effects by sex were also observed. Additionally, women were found to report lower levels of perceived gratitude from romantic partners and from older children than men. Findings highlight the unique benefits of perceived gratitude from different family relationships for improving various domains of family well-being.

Own or public? Later livelihoods of Ukrainian war migrant households in Poland

AbstractThis paper presents empirical research on the livelihood resources of Ukrainian households that fled to Poland due to the Russian invasion and reside there long term. Using a nationwide sample of these households and an accurate econometric framework, we investigate the factors influencing the role of income from work, other private resources and public assistance in covering their living costs in exile. Our findings confirm the importance of public assistance addressed to professional activation and childcare for households' self‐reliance. Assistance from employers, housing conditions, intentions to settle permanently in Poland and financial responsibility for relatives in Ukraine are also among the decisive factors. However, sufficient monetary aid hinders households' self‐reliance, along with health problems, language barriers and a lack of professional qualifications. Household composition is also significant, as those with children face the most adverse outcomes. Based on our results, we provide recommendations for public authorities responsible for migration policy.

Exploring heterogeneous relationships between multiscale built environment and overweight in urbanizing China

Overweight has emerged as a significant threat to people's health. Although a handful of studies have evaluated the neighborhood built environment (BE) and overweight connection, there is little knowledge about how urbanization moderates the connection. The present study seeks to assess whether there are differences in the BE and overweight connection between urban and rural settings, and how the connection varies across different urbanization rates. Based on a nationwide sample of 7883 individuals in China, we consider both scales of BE elements and examine their heterogeneous associations with overweight. The findings show that both scales of BE elements are essential determinants of overweight. Significant differences in the connection between urban and rural settings are observed. Most BE elements are shown to be significant contributors in urban settings, whereas only residential density, metro, and public transit supply play significant roles in rural settings. Additionally, the BE and overweight connection also varies across urbanization rates. The BE elements are more influential to overweight in more urbanized areas. Our findings indicate that planning efforts at both neighborhood and city scales are essential and targeted planning strategies should be made according to local contexts.

Public transportation means as seen by citizens: Approaching the case of the Dominican Republic

Especially in lowand middle-income countries, key constraints such as dense traffic flows, jams, and pollution constitute frequent issues that potentially explain many negative consequences in terms of (e.g.) efficiency, sustainability, and mobility safety. In this regard, recent evidence supports the idea that fostering public transportation is crucial to offering solutions for this difficult panorama. However, transport mode-related choices and shifts have been proven to depend highly on key perceptions and needs of potential users. The aim of this study was to analyze a set of key users’ perceptions, usage, and perceived quality of public transportation in the Dominican Republic, as well as to explore the most relevant features for Dominicans from the “desired quality” paradigm. For this research at a national level, data retrieved from a nationwide sample of 1254 inhabitants of the Dominican Republic was used, proportional to the ONE census in terms of sex, age, habitat, and region. Overall, the results show that the general quality of transportation is 6.70 points out of 10. The use of public transportation in the Dominican Republic has a medium-low rating and is very focused on urban buses (41 %) and public cars (27.1 %). Nonetheless, the metro remains the most highly rated means of transport (M = 8.75). Concerning the quality variables analyzed, the highest scores are for accessibility (M = 7.08) and frequency of service (M = 6.99). Further, Dominicans focus on improving comfort, vehicle conditions, and safety. This study constitutes a first approximation to the desired quality of public transportation for Dominican Citizens, which may help policymakers scope user-based needs in public transportation systems and encourage a more frequent (and friendlier) public transport use in the country.

Impact of cholangiocarcinoma on the severity of acute cholangitis: A nationwide sample analysis.

e16200 Background: Acute cholangitis (AC) is a clinical entity caused by bacterial infection of the hepatobiliary system, commonly secondary to obstruction of the bile duct or hepatic ducts. The outcomes are poor if not treated promptly. Cholangiocarcinoma (CC) is a group of heterogeneous cancers of the intrahepatic or extrahepatic bile ducts with a guarded prognosis. Our study aimed to evaluate the mortality and healthcare utilization of AC with and without CC in the United States. Methods: A retrospective cohort study of adult patients hospitalized in 2020 for AC in acute care hospitals across the USA. Patients were selected from the Nationwide Inpatient Sample (NIS) database. Our study population included all patients with a discharge diagnosis of AC with or without CC using the International Classification of Diseases (ICD-10). The primary outcome was in-hospital mortality, and secondary outcomes were the proportions of Endoscopic Retrograde Cholangiopancreatography (ERCP), early ERCP (within 24 hours), length of hospital stay (LOS), and total hospitalization charges. Analysis was performed using STATA version 18.0. Univariable logistic regression analysis was used to calculate the unadjusted odds ratio (ORs) for the primary and secondary outcomes. Multivariable logistic regression analysis was used to adjust for potential confounders. Results: Out of 32 million discharges included in the NIS database for 2020, our study included 38465 with AC including 2692 with CC and 35772 without CC. Comparing both cohorts, patients with AC, and CC were less likely to be female or white and had a higher Charlson comorbidity index. Furthermore, patients with AC and CC had lower adjusted in-hospital mortality (OR 0.66, 95% CI: 0.45-0.96), lower LOS(mean difference 1.102, CI: 0.31-1.88), lower total hospitalization charges $ (mean difference 22463, CI: 12115-32810). Patients with AC and CC had higher adjusted rate of in-hospital ERCP (OR 1.29, 95% CI: 1.07—1.56), and early ERCP within 24 hours (OR 1.29, 95% CI: 1.03-1.62). Total mortality in AC was found to be 6.8% (n = 2630, CI: 2374-2885), whereas mortality in CC from AC was 5.7%. Conclusions: Cholangiocarcinoma was observed to have an impact on the in-hospital mortality outcome of Acute cholangitis with increased utilization of resources, including ERCP. However, lower mortality from AC in CC is potentially contributed by early ERCP within 24 hours and a lower Charlson comorbidity index than AC without CC. [Table: see text] [Table: see text]

Firm Innovation in Hazy Days: Chinese Evidence

This paper estimates the causal effect of air pollution on firm innovation based on a nationwide sample of Chinese manufacturing firms. Using thermal inversion as instrument variable (IV), we demonstrate that air pollution significantly hurts firm innovation performance: a 1% increase in air pollution (PM2.5) in the past year, from its mean value, amounts to a 1.5% decrease in the number of invention patents compared to the average between 1999 and 2013. We also provide the casual estimate using regression discontinuity design (RDD) by exploiting the exogenous variation in pollution level caused by China’s Huai River policy: the decrease in firms’ invention patents is approximately 2.2% in the regions north of the Huai River Line. The underlying mechanism analyses reveal that poor air quality has detrimental effects on labor productivity, firms’ human capital accumulation, and financing ability. These findings highlight the substantial costs associated with air pollution, which are greater than previously thought, as it hinders innovation, a crucial driver of long-term economic growth.