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Background and aims:Non-Hispanic African Americans (African Americans) smoke fewer cigarettes per day (CPD) and are more likely to be non-daily smokers than non-Hispanic whites (whites). Little is known about how changes in cigarette prices might contribute to these differences. This study aimed to measure the price-responsiveness of smoking participation, non-daily smoking among current smokers and smoking intensity among daily or non-daily smokers for African Americans and compare the price-responsiveness estimates with those for whites.Design:Analysis of data from the 2009-14 National Adult Tobacco Surveys and cigarette price data from the Tax Burden on Tobacco report.Setting:United States.Participants:A total of 19 232 African American and 197 939 white adults aged 18+.Measurements:We used a three-part econometric model of cigarette demand to estimate the price-responsiveness of smoking participation, daily versus non-daily smoking and smoking intensity. The model controlled for secular variation, state-level anti-smoking sentiment and smoke-free air laws and socio-demographics.Findings:In 2009-14, 20.2% of African Americans and 17.7% of whites identified as current smokers; 70.2% of African American smokers and 81.4% of white smokers smoked daily. The price elasticity of smoking participation was significant for whites at -0.16 [95% confidence interval (CI) = -0.23, -0.09], indicating that a 10% increase in prices would reduce smoking participation by 1.6%, but not statistically significant for African Americans, and this racial/ethnic differential price responsiveness was not statistically significant. The price elasticity of smoking intensity was statistically significant for African American daily smokers at -0.29 (95% CI = -0.42, -0.16), but not statistically significant for white daily smokers, and this racial/ethnic differential price-responsiveness was statistically significant. The price elasticity of daily versus non-daily smoking among current smokers, and the price elasticity of smoking intensity among non-daily smokers were not statistically significant for either racial/ethnic group.Conclusion:In the United States, cigarette price increases may have stronger effects on decreasing daily smokers' consumption among African Americans than among non-Hispanic whites.

Both clinical diagnoses and self-rated measures of mental illness are associated with a variety of outcomes, including physical well-being, health utilization, and expenditure. However, much of current literature primarily utilizes clinically diagnosed data. This cross-sectional study explores the impact of mental illness and health care expenditure using 2 self-rated measures: self-rated measured of perceived mental health status (SRMH) and Kessler Screening Scale for Psychological Distress (K6). Data from the 2011 Medical Expenditure Panel Survey Household Component, a nationally representative sample of noninstitutionalized individuals (n = 18,295), were analyzed using bivariate χ2 tests and a 2-part model (logistics regression and generalized linear model regression for the first and second stages, respectively). Although predictive of any health expenditure, SRMH alone was not highly predictive of the dollar value of that health expenditure conditional on any spending. By comparison, the K6 measure was significantly and positively associated with the probability of any health expenditure as well as the dollar value of that spending. Taken together, both the K6 and SRMH measures suggest a positive relationship between poor mental health and the probability of any health expenditure and total expenditure conditional on any spending, even when adjusting for other confounding factors such as race/ethnicity, sex, age, educational attainment, insurance status, and some regional characteristics. Our results suggest that psychological distress and SRMH may represent potential pathways linking poor mental health to increased health care expenditure. Further research exploring the nuances of these relationships may aid researchers, practitioners, and policy makers in addressing issues of inflated health care expenditure in populations at risk for poor mental health.

Using data from the National Longitudinal Study of Adolescent Health, this work examines the impact of individual substance use, peer substance use, and depression on risky sexual behaviors, rape victimization among women, and labor market outcomes. The data are nationally representative of American youth. Although Fagan (1993) hypothesized that substance use not only increases the probability of perpetrating violent crimes but also the probability of becoming a victim of violent crime, the impact of substance use and depression on rape victimization remains largely uninvestigated. Previous research often neglects the concurrent impact of depression and the role of peer substance use in shaping the outcomes of interest. I fill these gaps by controlling for individual and peer substance use as well as depression. I use zero-inflated negative binomial, linear probability, and two-part models to investigate these relationships. Given the endogeneity of depression and substance use, analyses incorporate instrumental variable approaches. The results suggest that neither substance use nor depression have a causal impact on the risky sexual behavior, rape, or labor market outcomes. The analyses do indicate, however, that peer substance use influences the observed health and employment outcomes. As a result, health providers may want to consider a patient's social environment when devising prevention and treatment plans.