While a large body of literature investigates the bidirectional relationship between retirement and health, few have analyzed the mechanism through which retirement affects health which will provide important policy instrument insights. Using three waves of National Social Life, Health, and Aging Project, we examine the mediating role of the social network in the relationship between retirement and health in USA. We address the endogeneity and reverse causality through panel instrumental fixed-effect methods. We apply both single and parallel mediation analyses to identify the potential mechanism by which social network characteristics mediate the impact of retirement on health. Findings reveal that retirement adversely affects physical and mental health outcomes, and a considerable portion of these effects are explained by social network changes post-retirement. Specifically, 58% of reduction in the probability of reporting good physical health and 4.5% of increment in chances of having depression symptoms post-retirement can be explained by shrinkage in the size of social network in retirees. Using parallel mediation identification to account for dependencies among social network features, we find that social network size induces 79.5% reduction in probability of reporting good physical health and 18.6% increase in probability of having depression in retirees as compared to non-retirees. Findings in this paper suggest that investing in social network of the elderly can buffer the adverse health effect of retirement and can be an effective policy target for promoting healthy aging.
Iran has been experiencing slow growth for the past ten years. Using plant‐level information, we show that on average firm‐specific productivity in manufacturing sectors declined at the rate of 2.6% annually, while large top decile firms experienced a modest growth in productivity between 2005 and 2011. We decompose this trend and find that within‐plant variation is its main driving force while the between firms and industries component is insignificant. We test several alternative explanations that may contribute to these negative trends. We show that the subsidy reform had a negative effect, while privatization seems to have had no effect. Private management not affected productivity growth, while firm size is associated with higher productivity growth. Also, we find that productivity growth decreases with the energy intensity of the firm. We also find that R&D expenditures significantly increase productivity growth, while the R&D sales ratio is about 0.5% in manufacturing sectors, which is about one‐fifth of the world average. A one‐percent point increase in R&D expenditures increases productivity growth by 0.5%.
Objectives. To estimate county-level cigarette smoking prevalence in Virginia and examine cigarette use disparities by rurality, Appalachian status, and county-level social vulnerability. Methods. We used 2011–2019 Virginia Behavioral Risk Factor Surveillance System proprietary data with geographical information to estimate county-level cigarette smoking prevalence using small area estimation. We used the Centers for Disease Control and Prevention’s social vulnerability index to quantify social vulnerability. We used the 2-sample statistical t test to determine the differences in cigarette smoking prevalence and social vulnerability between counties by rurality and Appalachian status. Results. The absolute difference in smoking prevalence was 6.16 percentage points higher in rural versus urban counties and 7.52 percentage points higher in Appalachian versus non-Appalachian counties in Virginia (P < .001). Adjusting for county characteristics, a higher social vulnerability index is associated with increased cigarette use. Rural Appalachian counties had 7.41% higher cigarette use rates than did urban non-Appalachian areas. Tobacco agriculture and a shortage of health care providers were significantly associated with higher cigarette use prevalence. Conclusions. Rural Appalachia and socially vulnerable counties in Virginia have alarmingly high rates of cigarette use. Implementation of targeted intervention strategies could reduce cigarette use, ultimately reducing tobacco-related health disparities. (Am J Public Health. 2023;113(7):811–814. https://doi.org/10.2105/AJPH.2023.307298 )
Purpose Research has focused on cigarette use motives and have not included military personnel. The current study assessed tobacco use motives for different products, and differences within males and females and those with different racial identities given historical disparities in tobacco use. Design A cross-sectional survey about tobacco use was administered from October 2019 to February 2022. Setting Four Technical Training bases in the US. Sample Air Force Airmen who used tobacco (N = 3243). Measures Questions were about sociodemographic characteristics, tobacco use, and the Tobacco Motives Inventory (representing affect regulation, boredom, enhancement, and social motives). Analysis Linear regressions assessed associations between overall tobacco use and motives. Stratified analyses assessed associations between tobacco use and motives among males and females, and individuals from different racial backgrounds. Logistic regressions assessed differences in motives and use of different tobacco products between “some day” and “everyday” users. Results Overall, boredom ( B = .09, SE = .01) and affect regulation ( B = .05, SE = .00) motives were associated with higher tobacco use. Males and females and individuals from different racial backgrounds endorsed different motives, but all endorsed boredom as a motive for higher tobacco use. Individuals who used cigarettes, e-cigarettes, or smokeless tobacco “some days” endorsed higher social motives than everyday users, but everyday users endorsed different motives across products. Conclusion There are motives differentiating between “some day” and “everyday” users of tobacco products, which may need to be differentially targeted in intervention programs. Additionally, there are some overlapping motives (affect regulation, boredom) that may be beneficial to address with all tobacco users.
e13070 Background: This retrospective study addresses the question of whether real-world treatment with CDK4/6 inhibitors in combination with Endocrine Therapy (ET) for advanced hormone receptor positive (ER+) HER2 negative breast cancer yields similar benefits as reported by the major clinical trials: PALOMA-2 and MONALEESA-3. Methods: This study used the nationwide electronic health record-derived-Flatiron Health de-identified database to test the benefits demonstrated in major clinical trials on MBC patients under treatment with CDK4/6 + Letrozole (PALOMA-2) or CDK4/6 + Fulvestrant (MONALEESA-3). Regarding PALMOMA-2, a total of 1,774 patients with ≥ 3 months of follow-up received either CDK4/6 + Letrozole (n=1,277) or Letrozole alone (n=497) as the first line of treatment between February 3, 2015, and November 02, 2021. To test the benefits reported in MONALEESA-3, 1,187 patients are selected who were treated with either CDK4/6 + Fulvestrant (n=786) who received no or up to 1 line of prior ET or Fulvestrant alone (n=401). We conducted inverse probability weighting to balance the baseline demographic and clinical characteristics between patients in all subgroups. Kaplan-Meier method and Cox proportional hazards were used to test for the association of CDK4/6 treatment on rwPFS as the primary outcome and rwOS as the secondary outcome while adjusting for patient characteristics (e.g., age, race, ECOG PS value, health insurance, etc). Results: The real-world analysis of PALOMA-2 showed similar results as demonstrated in the clinical trials. The findings showed receiving CDK4/6 + Letrozole as the first-line treatment was associated with significantly longer median PFS compared to receiving Letrozole alone (28.3 vs 18 months; hazard ratio [HR], 0.57; 95% CI, 0.46–0.69; P < 0.0001). Median OS was 56.5 months for the group with first line CDK4/6 + Letrozole and 50.4 months for the group with Letrozole alone (HR=0.76, 95% CI, 0.61–0.93, P-value = 0.01). Analysis of real-world practices of MONALEESA-3 also endorsed the results reported from the trial. Median PFS was 17.5 months for the group treated with CDK4/6 + Fulvestrant who received no or up to 1 line of prior ET, while it was about 14.3 months for patients treated with only Fulvestrant (HR=0.64, 95% CI, 0.52–0.80, P-value < 0.0001). Consistent OS benefit was observed in patients treated with CDK4/6 + Fulvestrant compared to those treated with only Fulvestrant (44.72 vs 35.83 months; hazard ratio [HR], 0.70; 95% CI, 0.52–0.94; P < 0.0001). Conclusions: Consistent with what was reported in major clinical trials: PALOMA-2 and MONALEESA-3, receiving CDK4/6 inhibitor plus endocrine therapy (Letrozole or Fulvestrant) was associated with improved progression free survival compared with patients treated with ET alone in this “real-world” population of patients with HR+/HER2− MBC.
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