Health

Weight Lifting is for You

Joy Buchanan1 Comment

This is a guest post by Mary Buchanan, a Board Certified Behavior Analyst. Here she explores the intersection of behavioral economics with her own health and fitness behavior change.

My childhood dentist often said, “Take care of your teeth, or they’ll go away.” As I approach my 40th birthday, I’m learning the same is true of my muscle mass. I can use it or lose it. And I can lose it faster or slower based on my lifestyle choices. 

As a behavior analyst, I have spent many years practicing the science of behavior, specifically teaching others how to master new, meaningful skills. I see myself as my own client now as I work to replace my old aimless approach to fitness with evidence-based eating and exercise interventions. 

I wish I could say I embraced strength training as soon as I heard about its benefits. Instead, as I noticed more and more recommendations for women to “lift heavy”, I kept filing that information away for someday in the future. When I joined a gym last January, I returned to what I used to do in years past: Pilates classes or cardio machines. After 9 months of that approach with no benefits to show for my efforts, it was time to change my behavior.

Behavioral economics has a term for what causes people to resist changing their behaviors without a significant incentive for doing so: status quo bias. 

Another behavioral economics term, loss aversion, helps to explain what moved me into action. Loss aversion refers to how people are often more motivated not to lose something they have than they are motivated to gain something similar. All humans start to lose muscle mass around age 30, but that fact was not on my radar until recently. I wasn’t interested in building muscles when I thought mine were adequate to my daily tasks. Now that I realize my muscle loss has been underway for years and the liabilities of that loss are clear to me, I’m motivated to rebuild and mitigate future muscle loss. How? By doing heavy lifting 2-3x per week and eating enough protein for my body to keep the muscle it makes. 

There are many great resources that provide advice in this area, but I’ve decided to begin
with learning from Dr. Stacy Sims since she specializes in what works for women. Based on what I’ve learned, here are my target behaviors for increase:

  • Practice strength training for at least 30 minutes, 2x per week.
    Dr. Sims says 3x per week is better, but 2x is an acceptable minimum that I can commit to either through classes at a gym or YouTube videos. As a behavior analyst, I know that I’m more likely to maintain a new behavior pattern when it is easy to feel successful early and often.
  • Continue to challenge myself throughout strength training by adding weight as I get stronger.
    To stimulate muscle growth you must challenge your muscles so they break down and repair stronger. How heavy is enough? If you lift a weight 10x and it’s difficult to lift on the last two reps, but still possible for you to maintain good form, that is an appropriate weight for you to train with. When that weight gets easy to lift, it’s no longer heavy enough for your training purposes.
  • Increase my healthy protein intake.
    In Roar, Dr. Sims suggests that women aim for .75-0.8 grams of protein per lb. on a light or non-training day, and increase to 1-1.2 grams of protein per lb. on strength training days. 

Working on these goals together creates synergy. I am more motivated to make healthier eating choices because my eating is connected to my strength training goal. Strength training has also become more exciting for me the more I’ve learned about its benefits, including:

  • Increased metabolic rate
  • Improved posture and stability
  • Stronger bones
  • Better blood pressure control
  • Improved immunity
  • Maintenance of healthy body composition (lifting heavy helps maintain lean muscle and reduce fat gain)

As if that weren’t enough, I have another reason to keep going. As soon as I started resistance training, my sleep improved! I’ve had difficulty sleeping for many years already, both with falling asleep and staying asleep, and honestly, if sleeping through the night was the only benefit available to me from resistance-based workouts, I would still be all in.

While none of this constitutes professional medical advice, it is worth looking into, especially if you, like me, never saw role models strength training as a young person. Once you understand how it works in your favor now and as you age, the benefits are too good to pass up.

RESOURCES

Stacy Sims, MSC, PHD is an exercise physiologist and nutrition scientist. She specializes in teaching women what works for their bodies based on their body type, stage of life, and fitness goals. 

My first introduction to her work and recommendations was this 26-minute interview: https://www.youtube.com/watch?v=APwKKUtjINo

Her book, Roar, is helpful for those who want to learn about general women’s health, though it is especially geared towards female athletes. https://www.amazon.com/ROAR-Revised-Fitness-Physiology-Performance/dp/059358192X/

Next Level focuses on the physical changes women experience with the natural aging process. It clearly presents how we can use the latest research to work with what is happening in the body instead of against it. https://www.amazon.com/Next-Level-Kicking-Crushing-Menopause-ebook/dp/B091JVW6QR/

Pistol Squats Complete the Home Workout from James

National Survey of Drug Use and Health State-Level Data: Now Cleaned in Excel and Stata

James Bailey1 Comment

I offer a cleaned version of the state-level NSDUH in Stata .dta and Excel .xlsx formats here.

The NSDUH is mostly quite good as government datasets go- they share individual-level data in many formats and with the option to get most years together in a single file. But due to privacy concerns, the individual-level data doesn’t tell you what state people live in, which means it can’t be used to study things like state policy. SAMHSA does offer a state-level version of their data, but it is messy and only available in SAS format. So I offer the 1999-2019 state-level NSDUH Small Area Estimation Dataset in Stata .dta and Excel .xlsx formats here.

If you have Stata I recommend using that version, since the variables are labelled, making it much easier to understand what they represent.

This is the latest addition to my data page, where you can find cleaned/improved versions of other government datasets.

Protein, Protein Everywhere

Zachary Bartsch8 Comments

If you’ve ever been vegetarian or if you have ever spoken to a vegetarian about their diet, then you have probably heard or asked “How do you get enough protein?”.  While it’s important for health and economic achievement to get adequate protein, not too long after comes the questions about types and sources of protein. This question is relevant for vegetarians and vegans, but also people with meat allergies and people with religious dietary guidelines that prohibit meat always or seasonally. Let’s break it down.

Some omnivores are incredulous that vegetarianism can provide adequate protein or protein quality. But protein itself is relatively easy to get and any judgmental attitudes on both sides are mostly just vibes. Legumes and nuts tend to have a lot of protein. But relative to what?

The World Health Organization recommends that an 80-kilogram (176 lb) adult should get 66.4 grams of protein per day (0.83g per kg). That’s the protein content of about a 9oz of peanuts. Protein is super important and it’s luckily not that hard to get if you eat a variety of foods. Even if you’re trying to consume double the WHO recommended daily intake (RDI), it’s an easy feat.

Below is a table of some popular protein sources. The table includes the grams of protein per 100 grams of food, which makes the protein content a percent. The table also includes the number of grams needed in order to achieve the WHO protein RDI of 66.4 grams. The last column is for our American readers who need the serving to be in ounces.

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The Dietary Salt Wars

Scott BuchananLeave a comment

For many years, it has been stated as settled science that Americans need to cut back their sodium intake from the current averages of about 3400 mg/day to less than  2400 mg sodium (about 1 teaspoon of table salt). The 2400 mg figure is endorsed by the National Academies, as described in the 164-page (we’re from the government and we’re here to help) booklet Dietary Guidelines for Americans published by USDA and HHS. The reason given is that supposedly there is a roughly linear relationship between salt intake and blood pressure, with higher blood pressure correlating to heart disease. The World Health Organization (WHO) recommends less than 2000 mg.

The dietary salt boat has been rocked in the past several years by studies claiming that cutting sodium below about 3400 mg does not help with heart disease (except for patients who already incline toward hypertension), and that cutting it much below 2400 mg is actually harmful.

The medical establishment has come out swinging to attack these newer studies. A 2018 article (Salt and heart disease: a second round of “bad science”? ) in the premier British medical journal The Lancet acknowledged this controversy:

2 years ago, Andrew Mente and colleagues, after studying more than 130000 people from 49 different countries, concluded that salt restriction reduced the risk of heart disease, stroke, or death only in patients who had high blood pressure, and that salt restriction could be harmful if salt intake became too low. The reaction of the scientific community was swift. “Disbelief” was voiced that “such bad science” should be published by The Lancet.  The American Heart Association (AHA) refuted the findings of the study, stating that they were not valid, despite the AHA for many years endorsing products that contain markedly more salt than it recommends as being “heart healthy”.

This article went on to note that, “with an average lifespan of 87·3 years, women in Hong Kong top life expectancy worldwide despite consuming on average 8–9 g of salt per day, more than twice the amount recommended by the AHA recommendation. A cursory look at 24 h urinary sodium excretion in 2010 and the 2012 UN healthy life expectancy at birth in 182 countries, ignoring potential confounders, such as gross domestic product, does not seem to indicate that salt intake, except possibly when very high, curtails lifespan.”

A more recent (2020) article by salt libertarians, Salt and cardiovascular disease: insufficient evidence to recommend low sodium intake, stated in its introduction:

In 2013, an independent review of the evidence by the National Academy of Medicine (NAM) concluded there to be insufficient evidence to support a recommendation of low sodium intake for cardiovascular prevention. However, in 2019, a re-constituted panel provided a strong recommendation for low sodium intake, despite the absence of any new evidence to support low sodium intake for cardiovascular prevention, and substantially more data, e.g. on 100 000 people from Prospective Urban Rural Epidemiology (PURE) study and 300 000 people from the UK-Biobank study, suggesting that the range of sodium intake between 2.3 and 4.6 g/day is more likely to be optimal.

… In this review, we examine whether the recommendation for low sodium intake, reached by current guideline panels, is supported by robust evidence. Our review provides a counterpoint to the current recommendation for low sodium intake. We suggest that a specific low sodium intake target (e.g. <2.3 g/day) for individuals may be unfeasible, have uncertain consequences for other dietary factors, and have unproven effectiveness in reducing cardiovascular disease. We contend that current evidence, despite methodological limitations, suggests that most of the world’s population consume a moderate range of dietary sodium (1–2 teaspoons of salt) that is not associated with increased cardiovascular risk, and that the risk of cardiovascular disease increases when sodium intakes exceed 5 g/day.

The keepers of orthodoxy fired back the following year in an article with an ugly title Sodium and Health: Old Myths and a Controversy Based on Denial  and making ugly accusations:

Some researchers have propagated a myth that reducing sodium does not consistently reduce CVD but rather that lower sodium might increase the risk of CVD. These claims are not well-founded and support some food and beverage industry’s vested interests in the use of excessive amounts of salt to preserve food, enhance taste, and increase thirst. Nevertheless, some researchers, often with funding from the food industry, continue to publish such claims without addressing the numerous objections.

Ouch.

I don’t have the expertise to dig down and make a ruling on who is right here. But I do feel better about eating my tasty salty chips, knowing I have at least some scholarly support for my habit.

Herd Mentality Among Pediatricians Caused Current Peanut Allergy Epidemic

Scott Buchanan1 Comment

A headline, “How Pediatricians Caused the Peanut Allergy Epidemic” got me to click the other day. The article makes some important points, I think.

Having a peanut allergy is a serious health concern, both as an adult and for one’s child. For a sensitized person, exposure to peanut-containing products can be fatal if an Epi-pen or emergency room is not available for an epinephrin injection. Since this is an economics blog, I’ll note that a 2012 survey estimated the economic cost of any food allergy in US children at $24.8 billion annually, or $4184 per child. This includes direct medical costs, and the indirect costs, including opportunity costs, for children and their caregivers.

Out of an abundance of caution, pediatricians in the 1990s started recommending that parents keep peanuts from their infants and children. Instead of protecting children, however, this policy has done just the opposite. The incidence of peanut allergies has soared, with now some 2.5% of the pediatric population showing peanut allergies:

Around the year 2000 peanut allergies began to skyrocket. Sales of EpiPens, used in cases of peanut-induced anaphylactic shock, became a major expense for parents and a growing profit center for the manufacturer. … So, what changed? How did peanuts go from cheap, nutritious food source to become the little death pills that we think of them today? The answer is not what you would expect: pediatricians created the peanut allergy epidemic.

Meanwhile, the more that health officials implored parents to follow the recommendation, the worse peanut allergies got. From 2005 to 2014, the number of children going to the emergency department because of peanut allergies tripled in the U.S. By 2019, a report estimated that 1 in every 18 American children had a peanut allergy. 

It did not have to go like this.  I poked about the web and found another article, titled The Medical Establishment Closes Ranks, and Patients Feel the Effects, which framed matters in terms of physician behaviors:

 Peanut allergies in American children more than tripled between 1997 and 2008, after doctors told pregnant and lactating women to avoid eating peanuts and parents to avoid feeding them to children under 3. This was based on guidance issued by the American Academy of Pediatrics in 2000.

You probably also know that this guidance, following similar guidance in Britain, turned out to be entirely wrong and, in fact, avoiding peanuts caused many of those allergies in the first place.

That should not have been surprising, because the advice violated a basic principle of immunology: Early exposure to foreign molecules builds resistance. In Israel, where babies are regularly fed peanuts, peanut allergies are rare. Moreover, at least one of the studies on which the British advice was based showed the opposite of what the guidance specified.

As early as 1998, Gideon Lack, a British pediatric allergist and immunologist, challenged the guidelines, saying they were “not evidence-based.” But for years, many doctors dismissed Dr. Lack’s findings, even calling his studies that introduced peanut butter early to babies unethical.

When I first reported on peanut allergies in 2006, doctors expressed a wide range of theories, at the same time that the “hygiene hypothesis,” which holds that overly sterile environments can trigger allergic responses, was gaining traction. Still, the guidance I got from my pediatrician when my second child was born that same year was firmly “no peanuts.”

It wasn’t until 2008, when Lack and his colleagues published a study showing that babies who ate peanuts were less likely to have allergies, that the A.A.P. issued a report, acknowledging there was a “lack of evidence” for its advice regarding pregnant women. But it stopped short of telling parents to feed babies peanuts as a means of prevention. Finally, in 2017, following yet another definitive study by Lack, the A.A.P. fully reversed its early position, now telling parents to feed their children peanuts early.

But by then, thousands of parents who conscientiously did what medical authorities told them to do had effectively given their children peanut allergies.

This avoidable tragedy is one of several episodes of medical authorities sticking to erroneous positions despite countervailing evidence that Marty Makary, a surgeon and professor at Johns Hopkins School of Medicine, examines in his new book, “Blind Spots: When Medicine Gets It Wrong, and What It Means for our Health.”

Rather than remaining open to dissent, Makary writes, the medical profession frequently closes ranks, leaning toward established practice, consensus and groupthink.

This article describes further instances of poorly-founded medical advice. Women were scared away from helpful estrogen hormone replacement therapy for many years because of unfounded fears of breast cancer. Blood donor institutions suppressed concerns about AIDS in donated blood, in order to not rock the boat:

In 1983, near the beginning of the AIDS crisis, the American Red Cross, the American Association of Blood Banks and the Council of Community Blood Centers rejected a recommendation by a high-ranking C.D.C. expert to restrict donations from people at high risk for AIDS. Instead, they issued a joint statement insisting that “there is no absolute evidence that AIDS is transmitted by blood or blood products.” The overriding concern was that Americans would not trust the blood supply, or donate blood, if people questioned its safety.

As with the advice on peanuts, a reversal came about far later than it should have. It took years for the blood banking industry to begin screening donors and it wasn’t until 1988 that the F.D.A. required all blood banks to test for H.I.V. antibodies. In the interim, half of American hemophiliacs, and many others, were infected with H.I.V. by blood transfusions, leading to more than 4,000 deaths.

That is poignant for me, since a good friend of mine died from AIDS that he contracted through a blood transfusion in that timeframe.

Well, what to do now about peanuts? It seems an obvious action is to expose infants to peanuts, at 4-6 months, along with other solid foods – – perhaps with the caveat to start with small doses and preferably stay within driving distance of an emergency room should that be needed. As for children who now manifest peanut allergies, there is some hope of desensitizing them if you start young enough, preferably no more than three years old.

What is vision insurance good for?

James Bailey5 Comments

The answer sure seems to be “nothing”. I just went for an eye exam for the first time since Covid and realized that I’ve been wasting my money by paying for vision insurance.

The problem isn’t the eye exam- that went fine, and was covered fine with a $35 copay. But it was covered by my health insurance, not my vision insurance. So what is the vision insurance good for, if it doesn’t cover eye exams?

The answer is supposed to be “glasses”. It is supposed to cover frames up to $150 with a $0 copay, and basic lenses with a $25 copay, from in-network providers. That sounds ok- but there are two problems.

One is that almost none of the in-network providers (like Glasses dot com or Target optical) appear to actually offer lenses where the $25 copay applies; instead the minimum lens price is at least $85.

The second problem is that the premiums are high enough that even if I use them to get $25 glasses (which I eventually found I could through LensCrafters), it wouldn’t be worth it. They don’t sound high at first, which is how I got suckered into signing up for this scam in the first place. It’s just $5/month for single coverage; that sounds like nothing, especially for an employer benefit. It is a rounding error compared to health insurance premiums, and it comes out of pre-tax money. A small waste, but still a waste. Why?

Glasses are just so cheap if you can avoid the monopoly retailers and get them somewhere like Zenni. Zenni will sell you perfectly functional (and IMHO good-looking) prescription eyeglasses for $16. Their frames start at $6.95, lenses at $3.95, and shipping at $4.95. Catch a sale, or order enough to get free shipping, and you could actually get glasses for well under $16.

Or you can do what I did- order glasses from Zenni with premium options that pushed them up to $50- and find it is still cheaper than using the insurance I already paid for to get the cheapest pair available at most of their in-network retailers. The cheapest possible deal with insurance would be to pay $60/year in premiums, get glasses as often as the insurance allows so as not to waste the benefit (every 12 months- much more often than I find necessary), find frames listed under $150 to get for $0 copay, and find an in-network provider that actually offers lenses for the $25 copay. In this best-case scenario you are still paying $85 per pair of glasses. Given that the $60 in premiums came from pre-tax money, perhaps you can argue that it was really more like $40 in real money; but you can also buy glasses from a competitive retailer like Zenni using pre-tax money from an HSA or FSA.

So as far as I can tell, vision insurance really is useless. I certainly decided not to use it for my latest pair of glasses even though I had already paid years of premiums; Zenni was still much cheaper for a comparable product. I’m dropping vision insurance now that open enrollment is here. My take-home pay will be going up, and EyeMed will stop getting my money for nothing.

Is there anyone vision insurance makes sense for? I think it could makes sense for someone who really wants brand name glasses, or for someone who really wants to get their glasses in-person at the optometrist, and wants new glasses every year. For everyone else, run the numbers for your own plan, but I suspect you would also be better off just buying glasses directly.

Disclaimer: This post is not sponsored & doesn’t use affiliate links; Zenni is the best option I currently know of, but I’d be happy to hear of other competitive retailers you think are better, or an argument for when vision insurance is actually useful.

You, Parent, Should have a Robot Vacuum

Zachary BartschLeave a comment

Do you have a robot vacuum? The first model was introduced in 2002 for $199. I don’t know how good that first model was, but I remember seeing plenty of ads for them by 2010 or so. My family was the cost-cutting kind of family that didn’t buy such things. I wondered how well they actually performed ‘in real life’. Given that they were on the shelves for $400-$1,200 dollars, I had the impression that there was a lot of quality difference among them. I didn’t need one, given that I rented or had a small floor area to clean, and I sure didn’t want to spend money on one that didn’t actually clean the floors. I lacked domain-specific knowledge. So I didn’t bother with them.

Fast forward to 2024: I’ve got four kids, a larger floor area, and less time. My wife and I agreed early in our marriage that we would be a ‘no shoes in the house’ kind of family.  That said, we have different views when it comes to floor cleanliness. Mine is: if the floors are dirty, then let’s wait until the source of crumbs is gone, and then clean them when they will remain clean. In practice, this means sweeping or vacuuming after the kids go to bed, and then steam mopping (we have tile) after parties (not before). My wife, in contrast, feels the crumbs on her feet now and wants it to stop ASAP. Not to mention that it makes her stressed about non-floor clutter or chaos too.

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When Beer is Safer than Water

James BaileyLeave a comment

I’ve often heard that before modern water treatment, it was safer to drink beer; but I’ve also heard people call this a historical myth. A new paper in the Journal of Development Economics by Francisca Antman and James Flynn comes down strongly on the side of “beer really was safer”:

This paper provides the first quantitative estimates into another well-known water alternative during the Industrial Revolution in England.

Although beer in the present day is regarded as being worse for health than water, several features of both beer and water available during this historical period suggest the opposite was likely to be true. First, brewing beer requires boiling the water, which kills many dangerous pathogens often found in drinking water. As Bamforth (2004) puts it, “the boiling and the hopping were inadvertently water purification techniques”. Second, alcohol itself has antiseptic qualities. Homan (2004) notes that “because the alcohol killed many detrimental microorganisms, it was safer to drink than water” in the ancient near-east.

They use several identification strategies to establish this, for instance when a tax on malt was increased and mortality went up:

But did this mean people were drunk all the time? Probably not:

beer in this period was generally much weaker than it is today, and thus would have been closer to purified water. Accum (1820) found that common beers in late 18th and early 19th century England averaged just 0.75% alcohol by volume, a fraction of the content of the beers of today. Beer in this period was therefore far less harmful to the liver. Taken together, these facts suggest that beer had many of the benefits of purified water with fewer of the health risks associated with beer consumption today.

In fact, people at the time didn’t necessarily know that beer was healthier:

Thus, even though people did not recognize beer as a safer choice, drinking beer would have been an unintentional improvement over water, and thus may have contributed to improvements in human health and economic development over the period we investigate

Though as usual, Adam Smith was ahead of his time. Here’s what he had to say in his 1776 Wealth of Nations, in a chapter on malt taxes:

Spirituous liquors might remain as dear as ever, while at the same time the wholesome and invigorating liquors of beer and ale might be considerably reduced in their price.

Was 2022 The “Deadliest Year on Record” For Children in Arkansas?

Jeremy HorpedahlLeave a comment

In my Inbox I read the following sentence, summarizing an article on child health in Arkansas: “The latest Annie E. Casey Foundation KIDS COUNT Data Book shows 2022 was the deadliest year on record for child deaths in Arkansas.”

Deadliest on record! That certainly grabbed my attention. I clicked the link and read the article. Indeed, they emphasize three times that 2022 was the “deadliest year” for kids in Arkansas, including with a chart! And the chart does seem to support the claim: in 2022 there were 44 child and teen deaths per 100,000 in Arkansas, higher than any year on the chart.

But wait a minute, this chart only goes back to 2010. Surely the record goes back further than that? Indeed it does. It took me three minutes (yes, I timed myself, and you have to use 4 different databases) to complete the necessary queries from CDC WONDER to extract the data to replicate their 2010-2022 chart, and to extend the data back a lot further: all the way to 1968 (though in 30 seconds I could have extended it back to 1999).

And what do we find in 1968? The death rate for children and teens in Arkansas was twice as high as it was in 2022. Not just a little higher, but double. With some more digging, I might be able to go back further than 1968, but from the easily accessible CDC data, that’s as far back as “the record” goes. Of course, I knew where to look, but I would hope that a group producing a data book on child health also knows where to look. And you don’t need to extend this very far past the arbitrary 2010 cutoff in the article quoted: 2008 and every year before it was more deadly than 2022 for children in Arkansas. Here’s a chart showing the good long-run trend:

Now there is a notable flattening of the long-run trend in the past 15 years or so, and a big reversal since 2019. What could be causing this? The article I read doesn’t get specific, but here’s what they say: “The state data isn’t broken out into cause of death, but firearm-related deaths have become the leading cause of death among U.S. teens in recent years. Deaths from accidents such as car crashes account for most child deaths.”

But using CDC WONDER, we can easily check on what is causing the increase since 2019. “Firearm-related deaths” is an interesting phrase, since it lumps together three very different kinds of deaths: homicides, suicides, and accidents. And while it is true that “deaths from accidents” are the leading category of deaths for children, this also lumps together many different kinds of deaths: not only car crashes, but also poisonings, drownings, or accidental firearm deaths.

For Arkansas in 2022, here are the leading categories of deaths for children and teens (ages 1-19) if we break down the categories a bit:

  • Homicides: 66
  • Non-transport accidents: 58 (largest subcategories: poisonings/ODs and drowning)
  • Transport accidents: 52 (almost all car crashes)
  • Suicides: 24
  • Birth defects: 16
  • Cancers: 14
  • Cardiovascular diseases: 13

And no other categories are reported, because CDC WONDER won’t show you anything smaller than 10 deaths.

We might also ask what caused the increase since 2019, especially since this a report on child health and possible solutions. The death rate increased by 9 deaths per 100,000, and over 80% of the increase is accounted for by just two categories: homicides and non-transport accidents. Car crashes actually fell slightly (though the rate increased a bit, since the denominator was also smaller). Deaths from suicides, cancer, and heart diseases also declined from 2019 to 2022 among children in Arkansas, and these are the three on the list above that we would probably consider the “health” categories. Things actually got better!

But the really big increase, and very bad social trend, is the category of homicides. Among children and teens in Arkansas, it rose from 35 deaths in 2019 to 66 deaths in 2022. It almost doubled. That’s bad! But homicides are not mentioned anywhere in the article on this topic that I read (“firearm-related deaths” is the closest they get). And while car accidents are definitely a major problem, they didn’t really increase from 2019 to 2022 (among kids in Arkansas).

One more thing we can do with CDC WONDER is break down the homicides by age. The numbers so far are looking at a very broad range of children and teens, from ages 1-19. As I’ve written about before, the is a huge difference between homicide rates for older teens versus all of the kids. Indeed for Arkansas we see the same pattern, such as when I run a CDC WONDER query for single-years of age: only the ages 17, 18, and 19 show up (remember, anything less than 10 deaths won’t register in the query).

Breaking it down by five-year age groups, we see that 53 of the 66 homicides (in Arkansas among kids and teens) were for ages 15-19, that is 80% of the total. And further if we run the query by race, we see that 40 of the 66 homicides were for African Americans age 15-19. This is clearly a social problem, but it’s an extremely concentrated social problem. And the increase for older teen Blacks has been large too: it was just 17 deaths in 2019, more than doubling to 40 homicides in 2022.

Now, small numbers can jump around a bit, so just looking at 2019 and 2022 might be deceptive. What if we had a longer annual series to look at? Again, CDC WONDER allows us to do this. Here is the chart for homicides among older Black teens in Arkansas:

This is a dramatic chart. The steady rise in homicides among this demographic since 2019 is staggering. Not only the dramatic increase, but notice that 2021 and 2022 are much worse than the crime wave of the early 1990s, which also jump out in this chart. The homicide rate for older Black teens in 2022 was almost 50 percent higher than 1995, the prior worst year on record.

So is there a problem with child and teen deaths in Arkansas? Yes! But with just a few minutes of searching on CDC WONDER, I think we can get a much better picture of what is causing it than the article I read summarizing the report. Indeed, if we read the full national report, the word “homicide” is only mentioned once in a laundry list of many causes of death.

The most important part of addressing a social problem, such as “deadliest year on record for child deaths in Arkansas” is to know some basic details about what is causing a bad social indicator to worsen. Hopefully after reading this blog post you know a little bit more. If you want to read my summary of the research on how to reduce deaths from firearms, see this June 2022 post.

What’s Killing Girls Ages 10-14?

Jeremy HorpedahlLeave a comment

I’m in the process of writing a review of Jon Haidt’s book The Anxious Generation. I wrote some preliminary thoughts a few weeks ago, but I’m diving a lot deeper now, so watch for that review soon. But one of the main startling pieces of data in the book is the dramatic rise in suicides among young girls. Haidt isn’t the first to point this out, but in large part his book is an attempt to explain this rise (as well as the rise among boys and slightly older girls).

This got me thinking a bit more broadly about not just suicides, but all causes of mortality among young Americans. So in the style of my 2022 post about the leading causes of death among men ages 18-39, let’s look at the historical trends for deaths among girls 10-14 in the US.

Data comes from CDC WONDER. The top dark line shows total deaths, and the scale for total deaths is the right-axis. Notice that for total deaths, there is a U-shaped pattern. From 1999 to about 2012, deaths for girls aged 10-14 are falling. Then, the bottom out and start to rise again. While the end point in 2022 is lower than 1999 (by about 9 percent), there is a 22 percent increase from 2010 to 2022.

What’s driving those trends? A fall in motor vehicle accidents (blue line, the leading cause of death in both 1999 and 2022) is driving the decline. This category fell 41 percent over the entire time period: a big drop for the leading cause of death!

But the rise in suicides (thick red line) starting in 2013 is the clear driver of the reversal of the overall trend. Suicides for this demographic in 2022 were 268 percent higher than 1999, and 116 percent higher than 2010. Haidt and others are right to investigate the causes of this trend (I’m not convinced they have the complete answer, but more on that in my forthcoming book review).

There has been no clear trend in cancer deaths over this time period, and the combination of all the three of these trends means that roughly equal number of girls ages 10-14 die from car accidents, suicide, and cancer.

What can we learn from this data? First, we should acknowledge just how rare death is for girls ages 10-14. At 14.8 deaths per 100,000 population, it is the lowest 5-year age-gender cohort, other than the ages just below it (ages 5-9, for both boys and girls). But just because it is small doesn’t mean we should ignore it. The big increase, especially in suicides, in the past decade is worrying and could be indicative of broader worrying social trends (and suicides have risen for almost every age group too, see my linked post above).

If a concern, though, is that we are over-protecting our kids and this is leading them to retreat into a world of social media, we might want to see if there are any benefits of this overprotection in addition to the costs. The decline in motor vehicle accidents is one candidate. Is this decline just a result of the overall increase in car safety? Or is there something specific going on that is leading to fewer deaths among young teens and pre-teens?

As we know from other data, a lot fewer young people are getting driver’s licenses these days, especially compared to 1999 (and engaging in fewer risky behaviors across the board). Of course, 10-14 year-olds themselves usually weren’t the ones getting licenses — they are too young in most states — but their 15 and 16 year-old siblings might be the ones driving them around. Is fewer teens driving around their pre-teen siblings a cause of the decline in motor vehicle deaths? We can’t tell from this data, but it is worth investigating further (note: best I can tell, only about 23 percent of the decline is from fewer pedestrian deaths, though in the long-run this is a bigger factor).

Social tradeoffs are hard. If there really is a tradeoff between fewer car accident deaths and more suicides, how should we think about that tradeoff? Or is the tradeoff illusory, and we could actually have fewer deaths of both kinds? I don’t think I know the answer, but I do think that many others are being way too confident that they have the answer based on what data we have so far.

One final note on suicides. For all suicides in the US, the most common method is suicide by firearm: about 55% of suicides in the US were committed with guns in 2022, with suffocations a distant second at about 25%. For girls ages 10-14, this is not the case, with suffocation being by far the leading method: 62% versus just 17% with firearms. I only mention this because some might think the increasing availability of firearms is the reason for the rise in suicides. It could be true overall, but it’s not the case for young girls.