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Analyzing whether physicians use cesarean sections (c-sections) as defensive medicine (DM) has proven difficult. Using natural experiments arising out of Oregon court decisions overturning a state legislative cap on non-economic damages in tort cases, we analyze the impact of patient conditions on estimates of DM. Consistent with theory, we find heterogeneous impacts of tort laws across patient conditions. When medical exigencies dictate a c-section, tort laws have no impact on physician decisions. When physicians have latitude in their decision making, we find evidence of DM. When we estimate a model combining all women and not accounting for patient conditions (such as models estimated in previous studies) we obtain a result which is the opposite of DM, which we call offensive medicine (OM). The OM result appears to arise out of a bias in the difference-in-differences estimator associated with changes in the marginal distributions of patient conditions in control and treatment groups. The changes in the marginal distributions appear to arise from the impact of tort law on the market for midwives (substitutes for physicians for low-risk women). Our analysis suggests that not accounting for theoretically expected heterogeneity in physician reactions to changes in tort laws may produce biased estimates of DM. [ABSTRACT FROM AUTHOR]

Climate change and mitigation policies adopted by a locality indelibly impact urban form, landscape, and economy. The Cities for Climate Protection (CCP) has become a dominant movement organizing the localities to proactively address climate change. This study examines metropolitan area commitment to the CCP. Geographic information systems (GIS) and statistical techniques are used to analyze metros on dimensions of climate change risk, stress, and civic capacity. 'Climate change risk' measures a metro area's coastal proximity, ecosystem sensitivity, and susceptibility to extreme weather events. 'Climate change stress' summarizes transportation, energy, and production practices that adversely affect climate systems. 'Civic capacity' estimates human capital and environmental concern variables that constitute a metro area's ability to commit to policy initiatives. Statistical results indicate that high stressor areas are significantly less likely to participate in the CCP campaign, and metros high in civic capacity are significantly more likely to commit to the CCP campaign. Keywords: Climate change risk: stress; civic capacity; Cities for Climate Protection

Although there is a growing body of research examining public perceptions of global climate change, little work has focused on the role of place and proximity in shaping these perceptions. This study extends previous conceptual models explaining risk perception associated with global climate change by adding a spatial dimension. Specifically, Geographic Information Systems and spatial analytical techniques are used to map and measure survey respondents' physical risk associated with expected climate change. Using existing spatial data, multiple measures of climate change vulnerability are analyzed along with demographic, attitudinal, and social contextual variables derived from a representative national survey to predict variation in risk perception. Bivariate correlation and multivariate regression analyses are used to identify and explain the most important indicators shaping individual risk perception. Analysis of the data suggests that the relationship between actual and perceived risk is driven by specific types of physical conditions and experiences. Keywords: climate change; vulnerability; public perceptions

This article attempts to respond to Ostrom's call for a behavioral model of collective action by generalizing the collective interest model of mass political action to explain citizen policy support and personal behavioral intentions in the context of air quality policy. The collective action problems inherent in air quality policy provide a critical research setting for testing hypotheses of the collective interest model. Key elements of the collective interest model--perceived risk, trust in policy elites, knowledge of the policy problem, and efficacy--are found to be directly, and positively, related to support of government policies and intentions to engage in personal behaviors that might improve air quality. The article discusses the implications for using the collective interest model as general behavioral theory of collective action.

An increasing number of scholars and activists have begun to tackle a variety of issues relevant to environmental justice studies. This study attempts to address the role of criminologists in this domain. The authors examine 425 environmental justice articles in 204 academic journals, representing 18 programs/departments between 1970 and 2003. First, they measure the environmental justice contributions in the literature by academic department or activist affiliation. Second, they identify the major themes in the literature as they have developed and reveal the current and future directions of environmental justice studies. Such themes include the spatial distribution of hazards, social movements, law and public policy, and environmental discrimination. Finally, the authors seek to call attention to the evident linkages between accepted areas of criminological scholarship and environmental justice. From this latter objective, the authors seek to demonstrate how criminology and criminal justice can advance this dialogue and social movement. Keywords: environmental justice; environmental crime; eco-criminology; green criminology; environmental racism

When citizens hold multiple values relevant to their policy opinions, they might experience value conflict, value reconciliation or make a value trade-off. Yet, it is unclear which individuals are able to manage their multiple values in these ways. We posit a sophistication-interaction theory of value pluralism where the most politically sophisticated individuals are able to reconcile the existence of multiple values, thus increasing the stability of their policy opinions. We test this hypothesis using a series of heteroskedastic graded item response theory models of public opinion toward policies related to climate change. We find that people structure their policy preferences toward climate change policies in values toward the environment and the economy, but only the most sophisticated citizens are able to reconcile the potential conflict between these values. [ABSTRACT FROM AUTHOR]

The establishment of interventions to maximize maternal health requires the identification of modifiable risk factors. Toward the identification of modifiable hospital‐based factors, we analyze over 2 million births from 2005 to 2010 in Texas, employing a series of quasi‐experimental tests involving hourly, daily, and monthly circumstances where medical service quality (or clinical capital) is known to vary exogenously. Motivated by a clinician's choice model, we investigate whether maternal delivery complications (1) vary by work shift, (2) increase by the hours worked within shifts, (3) increase on weekends and holidays when hospitals are typically understaffed, and (4) are higher in July when a new cohort of residents enter teaching hospitals. We find consistent evidence of a sizable statistical relationship between deliveries during nonstandard schedules and negative patient outcomes. Delivery complications are higher during night shifts (OR = 1.21, 95% CI: 1.18–1.25), and on weekends (OR = 1.09, 95% CI: 1.04–1.14) and holidays (OR = 1.29, 95% CI: 1.04–1.60), when hospitals are understaffed and less experienced doctors are more likely to work. Within shifts, we show deterioration of occupational performance per additional hour worked (OR = 1.02, 95% CI: 1.01–1.02). We observe substantial additional risk at teaching hospitals in July (OR = 1.28, 95% CI: 1.14–1.43), reflecting a cohort‐turnover effect. All results are robust to the exclusion of noninduced births and intuitively falsified with analyses of chromosomal disorders. Results from our multiple‐test strategy indicate that hospitals can meaningfully attenuate harm to maternal health through strategic scheduling of staff. [ABSTRACT FROM AUTHOR]

The 2014-2015 Legionnaire's disease (LD) outbreak in Genesee County, MI and the outbreak resolution in 2016 coincided with changes in the source of drinking water to Flint's municipal water system. Following the switch in water supply from Detroit to Flint River water, the odds of a Flint resident presenting with LD increased 6.3-fold (95% CI: 2.5, 14.0). This risk subsided following boil water advisories, likely due to residents avoiding water, and returned to historically normal levels with the switch back in water supply. During the crisis, as the concentration of free chlorine in water delivered to Flint residents decreased, their risk of acquiring LD increased. When the average weekly chlorine level in a census tract was <0.5 mg/L or <0.2 mg/L, the odds of an LD case presenting from a Flint neighborhood increased by a factor of 2.9 (95% CI: 1.4, 6.3) or 3.9 (95% CI: 1.8, 8.7), respectively. During the switch, the risk of a Flint neighborhood having a case of LD increased by 80% per 1 mg/L decrease in free chlorine, as calculated from the extensive variation in chlorine observed. In communities adjacent to Flint, the probability of LD occurring increased with the flow of commuters into Flint. Together, the results support the hypothesis that a system-wide proliferation of legionellae was responsible for the LD outbreak in Genesee County, MI. [ABSTRACT FROM AUTHOR]

The Flint Water Crisis (FWC) is divisible into four phases of child water-lead exposure risk: Phase A) before the switch in water source to the Flint River (our baseline); Phase B) after the switch in water source, but before boil water advisories; Phase C) after boil water advisories, but before the switch back to the baseline water source of the Detroit Water and Sewerage Department (DWSD); and Phase D) after the switch back to DWSD. The objective of this work is to estimate water-lead attributable movements in child blood lead levels (BLLs) that correspond with the four phases in the FWC. With over 21,000 geo-referenced and time-stamped blood lead samples from children in Genesee County drawn from January 01, 2013 to July 19, 2016, we develop a series of quasi-experimental models to identify the causal effect of water-lead exposure on child BLLs in Flint. We find that the switch in water source (transitioning from phase A to B) caused mean BLLs to increase by about 0.5 μg/dL, and increased the likelihood of a child presenting with a BLL ≥ 5 μg/dL by a factor of 1.91–3.50, implying an additional 561 children exceeding 5 μg/dL. We conservatively estimate cohort social costs (through lost earnings alone) of this increase in water-lead exposed children at $65 million, contrasted with expected annual savings of $2 million from switching water source. On the switch from Phase B to C, we find BLLs decreased about 50% from their initial rise following boil water advisories and subsequent water avoidance behaviors by households. Finally, the return to the baseline source water (Phase D) returned child BLLs to pre-FWC levels further implicating water-lead exposure as a causal source of child BLLs throughout the FWC. [ABSTRACT FROM AUTHOR]

Arsenic, cadmium and lead in aerosols, dusts and surface soils from Australia's oldest continuous lead mining town of Broken Hill were compared to standardised national childhood developmental (year 1) and education performance measures (years 3,5,7,9). Contaminants close to mining operations were elevated with maximum lead levels in soil: 8900 mg/kg; dust wipe: 86,061 μg/m 2 ; dust deposition: 2950 μg/m 2 /day; aerosols: 0.707 μg/m 3 . The proportion of children from Broken Hill central, the area with the highest environmental contamination, presented with vulnerabilities in two or more developmental areas at 2.6 times the national average. Compared with other school catchments of Broken Hill, children in years 3 and 5 from the most contaminated school catchment returned consistently the lowest educational scores. By contrast, children living and attending schools associated with lower environmental contamination levels recorded higher school scores and lower developmental vulnerabilities. Similar results were identified in Australia's two other major lead mining and smelting cities of Port Pirie and Mount Isa. [ABSTRACT FROM AUTHOR]

ABSTRACT We examine the contribution to economic growth of entrepreneurial marketplace information within a regional endogenous growth framework. Entrepreneurs are posited to provide an input to economic growth through the information revealed by their successes and failures. We empirically identify this information source with the regional variation in establishment births and deaths. To account for the potential endogeneity caused by forward-looking entrepreneurs, we utilize instruments based on historic mining activity. We find that the information spillover component of local establishment birth and death rates have significant positive effects on subsequent entrepreneurship and employment growth for U.S. counties and metropolitan areas. [ABSTRACT FROM AUTHOR]

Washing and wet mopping is often advocated as a remedial treatment to limit exposure to lead dust. Here, surface and pre- and post-play wipes were measured to ascertain dust metal exposures (arsenic, cadmium, copper, lead and zinc) following play routines at four playgrounds in the smelter city of Port Pirie, South Australia, which are washed regularly. Although post-play hand wipe metals were 55.9% (95% CI: −0.78, −0.34) lower on wash days, loadings increased ∼5.1% (95% CI: 1.2, 11.7) per hour after washing. Despite washing, post-play hand lead exceeded a conservative value of 800 μg/m 2 within 24 h or sooner, with loadings increasing in proximity to the smelter. Post-play lead loadings were always >1000 μg/m 2 at the playground closest to smelter. Playground washing results in short-lived exposure reduction and effective treatment requires elimination of smelter emissions. [ABSTRACT FROM AUTHOR]

Disaster damage levels are matched to county-level nonprofit activity indicators. Using dynamic panel-data estimation, nonprofit net assets (and nonprofit revenue to a lesser extent) defined at this local level are found to be positively correlated with disaster event damage levels, consistent with a post-disaster giving mechanism. Magnitudes are relatively small, suggesting a distributed downstream flow of benefits to local nonprofits from larger national organizations. Furthermore, disaster damage at a lag is associated with only minor increases in the count of local nonprofit organizations at the county level. The relative impacts of assets and nonprofit counts in particular indicate that existing nonprofits have the established credibility and networks to be reliable conduits for post-disaster asset flows. If local nonprofits are an indicator of regional social capital, the findings suggest that disasters reveal the resilience of social capital structures in the face of crisis along the focal dimension of nonprofit activity. [ABSTRACT FROM AUTHOR]