Extreme air pollution events, like those from wildfires, negatively affect health through physiological responses but may also be salient enough to induce behavioral changes in individuals protecting their own health. The net impacts of these complex tradeoffs are poorly characterized. By joining the near-universe of emergency department visits in California from 2006 to 2017 with spatially and temporally resolved estimates of ambient wildfire smoke, we find total visits respond nonlinearly to increasing wildfire smoke concentrations, but that response differs by cause of visit. Total visits increase at lower concentrations but then decline at higher concentrations, suggesting that populations shift their behaviors following salient smoke periods. Whereas respiratory-related visits steadily increase, visits for accidental injuries and non-respiratory symptoms like stomach pains decline at high smoke concentrations.

Chapter in One Hundred Years of Turkish Foreign Policy (1923-2023), eds. Binnur Özkeçeci-Taner and Sinem Akgül Açıkmeşe. Part of the Global Foreign Policy Studies book series (GFPS).

Besides increasing knowledge, there is another potential mechanism at work when information is delivered to a treatment group: increasing the salience of existing knowledge. We use data from a randomized controlled trial of a health information campaign to explore the relative importance of this additional mechanism in a real-world environment. The health information campaign addressed the benefits of wearing eyeglasses and provided information meant to address the common misconceptions that contribute to low adoption rates of eyeglasses. In total, our study sample included 931 students with poor vision (mostly myopia), their parents, and their homeroom teachers in 84 primary schools in rural China. We find that the health information campaign was able to successfully increase student ownership and wearing of eyeglasses, relative to a control group. We demonstrate that the campaign had a larger impact when levels of preexisting information among certain subgroups of participants—namely, parents of students—were higher while we simultaneously provided new information to others. This suggests that the interaction between directed attention (i.e., salience) and baseline knowledge is important. We do not, however, find similar increases among teachers or the students themselves and additionally find no impacts on academic outcomes.

 Institutions, Information, and the Politics of Belief

Part of the symposium, "For a Better Democracy: Proportional Representation."

An essay in The Future of Intelligence: A Forum on the US Intelligence Community in Honor of Robert Jervis

Health, Economics and Social Choice

During the COVID-19 pandemic, courts have limited the federal government’s ability to impose vaccination mandates; some judges have also questioned whether states must grant religious exemptions to vaccination mandates. The Supreme Court’s June 2023 decision in Groff v DeJoy2 concerning Title VII of the Civil Rights Act of 1964 raises new questions about the ability of private employers—including health care organizations—to enforce vaccination requirements for employees who have religious objections.

Women and Foreign Policy Program

Spies have long been understood to not just obtain information but to interfere with or obstruct the operations to which they are privy

Objective
To test the feasibility and effectiveness of a mindfulness-based intervention in rural-to-urban migrant Chinese children using trained community volunteers.

Method
Migrant students ages 9 to 16 from 5 schools in Shanghai (N = 653) were randomly assigned to a mindfulness only group (n = 167), a mindfulness plus life skills group (n = 118), or a waitlist control group (n = 368). The first 2 groups received an 8-week mindfulness intervention delivered 1 hour weekly by trained community volunteers. The mindfulness plus life skills group received 8 additional hours of skills-based mentorship. Measurements on mindfulness, resilience, and anxiety and depression symptoms were collected before and after intervention. Multivariable regression analyses compared the intervention vs control groups.

Results
Before intervention, there were no significant demographic or outcome measure differences between groups except that students in the intervention groups were slightly older. Students had relatively low levels of mindfulness and prosociality difficulties and similar degrees of depression and anxiety symptoms compared with prior studies. After intervention, no statistically significant differences were found in mean scores for mindfulness, resilience, anxiety, or depression in the intervention vs control groups.

Conclusion
A volunteer-led mindfulness intervention did not significantly benefit migrant Chinese children after 8 weeks. More implementation research is needed for low-cost, scalable, and contextually effective mental health prevention programs.

Background: Prenatal anaemia causes serious consequences for both mother and foetus, and dietary factors are suggested to be associated with anaemia. However, research in pregnant women living in rural areas is limited. We aim to assess the contribution of dietary diversity to the magnitude of prenatal anaemia in rural China and identify the interactions between dietary diversity and several sociodemographic and maternal characteristics in relation to anaemia. Methods: A multi-stage random cluster sampling method was used to select pregnant women in rural western China. The Woman’s Dietary Diversity Score was created to measure dietary diversity, which was recoded into terciles. Multinomial logistic regression models were used to assess the associations between dietary diversity score terciles and the magnitude of prenatal anaemia. Multiplicative interactions were tested by adding the product term of dietary diversity and several sociodemographic and maternal characteristics into the regression models. Results: Out of 969 participants, 54.3% were measured as anaemic, with 28.6% mildly anaemic and 25.7% moderately to severely anaemic. There was an absence of agreement between self-reported and measured anaemia status (κ = 0.28, 95% CI [0.22–0.34]). Participants in the highest dietary diversity score tercile had lower odds of being moderately to severely anaemic after adjusting for potential confounders (RRR = 0.65, 95% CI [0.44, 0.98]). In participants with moderate to severe anaemia, significant interactions were found between dietary diversity score terciles, age, and parity (p for interaction < 0.05). Conclusions: The prevalence of prenatal anaemia in rural China remains high, and pregnant women living in these areas are insufficiently aware of their anaemia status. Improving dietary diversity is needed to manage prenatal anaemia in rural areas.

Infants born small for gestational age (SGA) remains a significant global public health concern, with potential interconnections among maternal diet, pre-pregnancy BMI, gestational weight gain (GWG), and SGA. This prospective study investigated the association between dietary diversity (DD) during pregnancy and the risk of SGA, as well as the synergistic effect of DD with pre-pregnancy BMI and GWG on SGA. Maternal dietary intake during pregnancy was assessed using 24 h dietary recalls, and dietary diversity scores (DDS) were calculated based on the FAO’s Minimum Dietary Diversity for Women index. Infant information was followed up. The Poisson regression model was employed to determine the association between maternal DD and SGA. Interactions between DD and pre-pregnancy BMI or GWG were evaluated under additive and multiplicative models. Among the 560 singleton live births, 62 (11.07%) were classified as SGA. After adjusting for potential confounders, the DDS exhibited a protective effect against SGA (aRR: 0.76; 95% CI: 0.62–0.95). DD modified the association between being underweight prior to pregnancy and SGA on the additive scale (interaction contrast ratio = 7.39; 95% CI: 5.84, 8.94). These findings suggest that improving dietary diversity during pregnancy, particularly among women with a low pre-pregnancy BMI, may be a feasible strategy to reduce the risk of SGA newborns.

The Stanford Deliberative Democracy Lab, in collaboration with Helena and various partners, has conducted a national Deliberative Poll® to determine what Americans would really think about possible reforms to our democracy and our electoral processes if they had a chance to weigh the options under good conditions. This project received crucial support from Porticus, the Skoll Foundation, the Thiry-O’Leary Foundation, and other donors.

Low- to moderate-intensity statins were associated with a greater reduction in LDL-C levels in older persons than younger persons and may be more appealing as initial treatment in older adults who are at increased risk for adverse events.

The authority of states and localities to require vaccination is a bedrock principle of public health law. Since 1905, when the US Supreme Court upheld compulsory smallpox inoculations, there has been sustained judicial consensus that the Constitution “does not import an absolute right to be…wholly freed from restraint.” Otherwise, “organized society could not exist with safety to its members.” Until recently, objections to mandatory vaccinations were confined to a small minority of US residents. However, civic values eroded during the COVID-19 pandemic, creating a groundswell of resistance. With state legislatures now sharply limiting public health authority and a bevy of legal challenges mounted vaccination mandates—an old and highly effective public health tool—face legal uncertainty that only a few years ago seemed inconceivable.