No abstract

BackgroundWhile extensive evidence suggests that the economic recession has had far reaching effects on many economic sectors, little is known regarding its impact on prescription drug utilization. The purpose of this study is to describe the association between state-level unemployment rates and retail sales of seven therapeutic classes (statins, antidepressants, antipsychotics, angiotensin-converting enzyme [ACE] inhibitors, opiates, phosphodiesterase [PDE] inhibitors and oral contraceptives) in the United States.MethodsUsing a retrospective mixed ecological design, we examined retail prescription sales using IMS Health Xponent™ from September 2007 through July 2010, and we used the Bureau of Labor Statistics to derive population-based rates and mixed-effects modeling with state-level controls to examine the association between unemployment and utilization. Our main outcome measure was state-level utilization per 100,000 people for each class.ResultsMonthly unemployment levels and rates of use of each class varied substantially across the states. There were no statistically significant associations between use of ACE inhibitors or SSRIs/SNRIs and average unemployment in analyses across states, while for opioids and PDE inhibitors there were small statistically significant direct associations, and for the remaining classes inverse associations. Analyses using each state as its own control collectively exhibited statistically significant positive associations between increases in unemployment and prescription drug utilization for five of seven areas examined. This relationship was greatest for statins (on average, a 4% increase in utilization per 1% increased unemployment) and PDE inhibitors (3% increase in utilization per 1% increased unemployment), and lower for oral contraceptives and atypical antipsychotics.ConclusionWe found no evidence of an association between increasing unemployment and decreasing prescription utilization, suggesting that any effects of the recent economic recession have been mitigated by other market forces.

This article analyzes how a congregation's theology and denominational affiliation influence the racial ties of its white members. We posit two distinct pathways. In the first, theologically conservative congregations generate more embedded social ties (measured by number of friendships) than do non-conservative congregations, and more congregation friendships increase the likelihood of cross-racial ties. In the second pathway, congregations not affiliated with historically major denominational families report higher levels of racial diversity, and high levels of congregation racial diversity increase the likelihood of cross-racial ties. Our key methodological innovation is to divide Evangelical congregations into two categories: those affiliated with the historically major families (Baptist, Lutheran, Methodist, Presbyterian) and those not (e.g., Pentecostal, Seventh-Day Adventist). Christian groups that join theological conservatism and outsider (non-major) status generate high levels of friendships and racial diversity in their congregations, both of which contribute to cross-racial ties among white members. Analysis of survey data from a national probability sample of white Christians (2006 Faith Matters Survey) mostly supports our hypotheses.

Our findings suggest that drug prescription volume, rather than product age or therapeutic class age, should be scrutinized further to identify settings where the public health impact of unsupported off-label prescribing may be particularly important.

What are the social bases of neighborhood formation in urban areas, and at what spatial scale are they most distinct from other neighborhoods? We address these questions in the case of St. Louis, Missouri, in 1930, where we can take advantage of unique geocoded census microdata on the whole population of the city that identifies who, with what background characteristics, lived where. Our analyses show that homophily by race and ethnicity was by far the strongest factor linking characteristics of persons to the composition of their neighbors. Measures of social class also were quite important, while the person’s nativity and family status were statistically significant but minor predictors. Yet while this hierarchy of social factors held for the population as a whole, their relative importance varied greatly across racial/ethnic groups. Similarity in social class to neighbors was most important for native whites, nativity counted as much or more than class for recently arriving immigrant groups including Russians, Italians, and Poles, and race/ethnicity was by far the key predictor for these groups and blacks. We also found that these patterns of homophily were clearest at the scale of individual street segment and first-order combinations of segments. They were similar but less distinct at a larger spatial scale.