Economic Impacts of Opioid Crisis and Mental Health

While deaths from opioid overdoses have dramatically declined in the past few years, the crisis remains, claiming the lives of thousands of teens and young adults each year. Mental health concerns among youth are an important contributor to opioid use, yet parents often struggle with their own mental health challenges as they raise middle schoolers.

In this episode, explore how two economics faculty members are tackling these important health-related issues, and what impact that research has within society. 

David Beheshti, assistant professor of economics, looks at the use and abuse of drugs, and the impact it has on labor markets. Qinyou Hu, assistant professor of economics, explores the interactions between health and education and the roles played by schools, families and the community.

Hear how their research insights explain the economic forces shaping health, education and policy — and how those insights can inform better solutions for society.

Stay connected with the UT San Antonio Carlos Alvarez College of Business to learn more about how we are empowering the next generation of business thinkers. Follow us on social media or visit us online at business.utsa.edu

Transcript

SPEAKER_03 0:01

While deaths from opioid overdoses have dramatically declined in the past few years, the crisis remains, claiming the lives of thousands of teens and young adults each year. Mental health concerns among youth are an important contributor to opioid use, yet parents often struggle with their own mental health challenges as they raise middle schoolers. Welcome to Inside Alvarez Business, a podcast dedicated to bringing you the stories behind the research. I'm your host, Jonathan Halbesleben, Dean of the Carlos Alvarez College of Business at the University of Texas at San Antonio. This season we're focusing on the business of healthcare, sharing the stories of our faculty, their research, and what led them into this area. This month's episode features the work of David Beheshti and Chin Yu Wu, both assistant professors of economics in the Carlos Alvarez College of Business. David's research looks at the use and abuse of drugs and the impact it has on labor markets. While Chin Yu explores the interactions between health and education and the roles played by schools, family, and the community. Listen to hear how their research insights help explain economic forces shaping health, education, and policy, and how those insights can inform better solutions for our society. Well, welcome back to another episode of Inside Alvarez Business, and delighted to have two guests with me for this particular episode. So our death, so David and Chenu, welcome to Inside Alvarez Business. I'm really looking forward to hearing the stories behind your research.

SPEAKER_04 1:29

Yeah, thanks for having us.

SPEAKER_03 1:30

All right. So I I'm always interested in how people kind of start in that like on the road of an academic career. I I don't know about you, but I've yet to meet somebody who, when they were a kid, said, I'm gonna be a professor when I grow up. You know, that's that's my my dream. You know, that that doesn't kind of rink up there with firefighter and some of the other occupations. So I'm curious what what was your path? And why don't we start with you, Jin Yu?

SPEAKER_00 1:54

For me, uh so my story is actually my father is um has been a middle school principal. Okay, and so he transitioned from a middle school teacher to a middle school principal for like three or four years. And then my mother is um, so he has been uh she has been a nurse for in the cardiology department for more than 20 years, and she just retired last year. And then so this like the first exposure coming from the family kind of motivates me all these interesting questions related to this education and health, these two aspects. Okay. And then to tell you the truth, when I went to college, I have never thought about becoming professor.

SPEAKER_02 2:37

Right.

SPEAKER_00 2:38

During the college, I tried like different types of internships. So I had this experience in like banking industry and uh some other like volunteer in like middle schools, something. But I feel like um this is not my passion. And I I I think like the the whole process, like everyday life is like so boring and tedious, and then it that doesn't make me feel like a life. And then I had a chance to like come to the United States for the my graduate study, and then then I remember it's um one of the math courses. So I still take the um the e-comm major, uh, e-comm master program at Duke, and then one of the real analysis courses. The teacher really inspired me and then encouraged me to kind of thinking about the potential of this academia like type of route. And then I also had a chance to get exposed to conducting research uh with professor, and then so then I tried to really like experience the whole trajectory, like the process of working with data, process of publishing, process of seeing the paper like out. And then so this whole process, I I feel like that's really the the one that I enjoy. And I all these ups and dumps make me feel alive. So that's that's kind of the then naturally I wind up and uh continue the PhD trajectory and then come to the UTSA.

SPEAKER_03 4:11

So very good. And that it sounds like a very familiar story in the sense that usually somebody has to encourage you to think about it, and then getting a little bit of experience with the research kind of helps get you a picture of what it's like gonna be like. So, David, how about you? What was your path?

SPEAKER_04 4:25

Yeah, so it sounds like Shin Yu had a lot of good reasons for going into academia, and I was the opposite. I just really liked school when I was an undergrad. Yeah, I had no idea what a PhD was, I had no idea what being a professor was. I thought professors were just teachers, but I liked school, thought, you know, PhD is just gonna be more school. Turns out that's wrong. I had no real sense of the whole research aspect of things, but I wanted to do more school, applied for some PhDs, and then you know, for the first year there was approximately right, just doing more classes at the same time. But then you make this transition into research, and that was just like totally out of left field for me. Fortunately, it all worked out and I ended up enjoying it. But I always tell my students who ask about, you know, potential PhDs, like, make sure you know why you're going. Um, it's not just more school, you know, you're really doing an apprenticeship in research. And, you know, worked out for me, but was probably not a wise decision, you know, ex ante.

SPEAKER_03 5:18

Okay. Very good. Very good. Kind of related to that, it's sort of related to the path part, but we're gonna talk a little bit more about some of your research here in a second. Before we do that, I'm curious. Both of you have studied elements of kind of health, or you know, you already kind of mentioned about the the family and you know, understand it like being kind of part of, of course, part of a family. You got interested in some of those topics. But could you all could you kind of we'll start with you, David, to talk about like what inspired you to study, like in your case, the some of the issues with drugs?

SPEAKER_04 5:50

Yeah, so a lot of the drug abuse stuff came from just kind of the environment that I was in in the time uh in graduate school. Okay. So this was, you know, I started graduate school in 2014. This was around the time when a lot of states were legalizing recreational or medical marijuana. Yeah. And so there was a lot of kind of policy interest in what are the effects of this? You know, what happens when you when you legalize this drug that's been federally illegal for, you know, a very long time. I was interested in that as well. I started becoming interested in how does one state legalizing marijuana affect neighboring states? The reason I had that thought was because there was some states suing other states for legalizing marijuana saying, hey, this is negatively affecting us, you can't do it. That those cases ended up going, I think, all the way up to the Supreme Court, although I don't think they ever actually made a decision on that. But as I was looking at this, there was a lot of interest at the time about, you know, does medical marijuana have a have a potential to reduce opioid dependence? Um, if you can get people on, you know, on something that is less dangerous, maybe that's a good thing. You know, that led me to start learning more about the opioid crisis and how big of a deal that was. And so I kind of naturally transitioned into that, into that direction just because it seemed, you know, the marijuana stuff was interesting, but the opioid crisis seemed just like much more important from a public policy perspective and from kind of a human cost perspective.

SPEAKER_03 7:11

Very good. Genie, do you want to kind of expand on maybe more specific a little bit like the things that inspired you to study the some of the topics that you're studying?

SPEAKER_00 7:18

Yeah, I think um the main reasons do go back to the my very beginning, like the first exposure coming from my family background. And then I think for me, I'm also naturally become interested in topics that way closer to my personal life or everything happening like a closer to me. So that's why I my uh research topics are more concentrated on the things happening to the kids, to the students, to the family and all the environments. And um yeah.

SPEAKER_03 7:49

Okay, um, very good. Let's continue. If you're it's okay, we're gonna stick with you and start talking a little bit more about your research. So I wanted to ask you in particular about some of your recent work on mental health. So, as a dad of a middle schooler, I took particular interest in your work on this this idea of the middle school blues. And David, you might want to listen up. I know uh we didn't mention it yet, but congratulations. David's it's a miracle he's here. He has a two-week-old newborn. So eventually middle school's coming for you too. So can you talk a little bit about what middle school blues is?

SPEAKER_00 8:19

Yeah, so that's actually one of my favorite papers. Okay. Um so the middle school blue is um a phenomenon that's already detected in the psychology field, but it's very weird that in economics we uh still pay very little attention to this phenomenon. And basically, that phenomenon, what it says is if you try to plot the relationship between like parents' adults' like mental health status and uh along with the the age. So what you can see is this V shape type of the figure, and then it's around the middle school when the when around the when their kids are during the middle school time, then you will see this adult they experience the lowest level of the mental health status. And this is the parents, yes, yes, and then yeah, so that's basically the idea of like the middle school blue, and then yeah, and then so I think the the psychology paper, they um what they find is coming from a set of like um population, and then then my paper tries to first replicate this phenomena using like a larger sample, and then still this phenomena holds in that like way larger sample compared to that. Yes.

SPEAKER_03 9:28

Okay, very good. So one of the kind of key things in your paper is you found an intervention that seems to help somewhat with this. Could you talk a little bit about what what's that like, maybe from like the the parents' perspective, what what they go through?

SPEAKER_00 9:41

Yeah, so the intervention is um it's a parental involvement program. So basically what the intervention did was we design a series of like parent-child activities. So things like you read books together with your kids or you watch movies together with your kids. And then uh we had this, so the intervention lasted for a semester, so basically like a four month. And then each month you were encouraged to engage with your kids like through this particular activity. And then the other feature of this activity is like it's not like with random topics, each activity, it's everything is about empathy. So we have this particular topic, particular thing, and then the the goal is kind of cultivating both the parents and also their kids' empathy skills. So empathy is more of um now you really start to understand from the other's perspective, and then so then that's how we think of like, because there's also another type of theory established in psychology that empathy can be learned, especially when you try to see, and then when you there's a like a simulation type of theory, and then so you can learn from observing like uh others' behavior, and then you can also try to through the conversation, you can understand what is in their mind. So then through this type of interactions between parents and the kids, so that's why we kind of in design all those all those activities into the intervention and then try to improve both the parents and uh the children's uh empathy level.

SPEAKER_03 11:13

So okay. So you try to improve the empathy level, and then how do you capture mental health?

SPEAKER_00 11:20

So the the mental health is we just follow like um usual type of method, and then the way that we try to measure a mental health level is through like um asking a series of questions in the survey questionnaire, okay, and then try to elicit their well-being level that they experienced. So that's kind of the way that we try mental health. And I think in addition to this just eliciting the measures using surveys, we also have some concrete like behaviors. So in the in the through this mice control trial experiment, we also collected data about the kids' actual test scores. So these are one of the education outcomes, and then uh we also have measures about like the interactions, like the real activities going on between the parents and the children. And then we also have records on the the bullying behavior. So that's more of a like real action type of measure.

SPEAKER_03 12:15

And those improved as well?

SPEAKER_00 12:17

Yes.

SPEAKER_03 12:17

Oh wow, okay. So if we kind of put this together, I what I'm hearing you say is spending time with your child helps increase your empathy. Which I guess makes sense, right? You're you get to kind of know who they are, what the way they're thinking, and then that improves some of the mental health outcomes like for the child and the parent.

SPEAKER_00 12:37

Yes. And then I think uh also the um interesting story is that I I think I'm through that paper, we can also see that there's this natural inter interaction between education and health. So it's like when we improve health outcomes, it can all we can also see this cross-productivity happening between health and education. And then there's also interesting spillover from the kids to the parents. Yeah. So the parents improve their mental health. One thing that so we also try to understand like why that's the case. So the first thing is because we teach the parents like these specific types of activities, they can work, they can engage with their kids. So, in the sense that they improve their printing skill. And then the second aspect is because the kids they also improve their mental health. So there's a this spillover coming from the kids' improved improvement of the mental health to the parents. So then, so these are the two things that I think it's like super interesting that we find.

SPEAKER_03 13:35

Okay, very good. So I guess tonight I need to go home and tell my kid to quit playing Minecraft. Make him talk to me instead, and uh then I'll feel better.

SPEAKER_00 13:46

So that's good. Okay. I I I can send you the scripts of the reading tasks and the movies.

SPEAKER_03 13:51

Perfect, perfect. Yeah, when move send me some ideas for movies, otherwise I know it's gonna be like Harry Potter again. So perfect. All right. Well, David, kind of turning things over to you for a little bit. You've been studying some interesting issues for a number of years related to drugs, drug use and abuse that you kind of talked about a little bit earlier. What would you say some of the kind of main takeaways are from your work? So I think there are a few.

SPEAKER_04 14:12

The main project, or I guess a couple of projects. The first thing that I started working on was looking at kind of the recent, I guess it's not recent anymore, but the transition between prescription drug use and abuse towards street drugs. So around 2010, that's where we really saw this transition from people misusing prescription painkillers to people misusing drugs like heroin, and then more recently fentanyl. One thing in that first paper that I that I looked at was, you know, there's a lot of reasons why you might think using heroin is worse than using prescription painkillers because, you know, you're not getting it from a pharmacy. Maybe it's stronger than the drugs that you were taking, you know, other things. One particular issue there, though, is that for the most part, people who are misusing prescription painkillers, they're they're taking the pills. Okay. They might, they might, they might snort them, but for the most part, they're just swallowing the pills, maybe chewing them up first if it's an extended release pill. But with heroin, people are much more likely to be injecting the drug. So one of the things that we looked at and saw there is that in this transition from prescription drugs to heroin, we start seeing more contagious bloodborne diseases spreading. So that was one kind of, you know, we think a lot of the transition from prescription drugs to heroin and fentanyl is in some sense policy driven, right? You reduce the accessibility of prescription painkillers. People are already addicted to them, so they go out and find the best substitute they can, and that's, you know, heroin or fentanyl. And that there are things to be worried about other than just, you know, the change in the substance itself. So we see, you know, yeah, changes in, yeah, and these contagious diseases like hepatitis C is the big one that we that we look at there. As far as other takeaways, another project that I have looking at this that I worked on a lot in grad school was looking at the relationship between prescription painkiller use and abuse and labor market conditions. So if you look at a map of the United States, the places that have lots of problems with drug abuse potentially not surprisingly tend to also be places that don't have particularly great labor markets. Um, so a lot of unemployment, low labor force participation, things like that. And you could imagine this being because drug abuse is causing bad labor market conditions. Okay. You could also imagine it being the case that the economy is bad, I don't have a job, I'm depressed, things are just bad. And so I turn to drugs as a kind of coping mechanism. And it's really hard to kind of disentangle that. So what we end up doing is trying to find, without getting too much into the weeds, trying to find variation in drug availability and see how that changes labor market outcomes. And we found something that was surprising. What I expected to find, we ended up finding a finding a situation where basically a certain type of opioid became much less accessible. In certain areas of the country, we're much more reliant on that particular type of opioid. What I expected to see was worse labor market conditions after this, after this policy change in those places. The reason I thought that is because there's some prior work looking at what happens when a particular type of NSAED was taken off the market for people with arthritis. So this was COX-2 inhibitors, VIOX was the drug. And what they found is when you took away this medicine that people were kind of relying on to get through the day, they were absent from work more often, they were more likely to quit their job. You know, they just weren't able to do what they what they needed to do because you know their pain wasn't treated. Yeah, it was helping to manage the pain. Exactly. I thought we were going to see a similar thing, but it turned out we found pretty much the exact opposite. We found that basically fewer people were getting hooked on this drug and preventing kind of these downward spirals that led to bad labor market outcomes. So we ended up actually seeing movement again in the opposite direction of what we expected, but reducing the amount of prescription painkillers out there ended up leading to positive labor market effects, which was surprising to me. I don't know if that was surprising to other people, but I thought we were going to see the opposite.

SPEAKER_03 18:00

Yeah. One of the things I as I was looking through those those two studies in particular, it kind of struck me is how often you kind of found what I think most people would think of as unintended consequences of the work, right? So, you know, for example, when in the first study you talked about when the opioids were reformulated to be less addictive, then people turn to heroin, and then then we start to see increases in hepatitis B and C. So it's like, you know, try to fix one thing and you you get something else. Yeah. Or even in the case, you know, I know you said the labor market changes were were not what you had had expected. But what's kind of interesting to me also is the the drug becomes less available, the labor market improves, but you also found that there were more drug-related deaths and what was it, higher arrests. Well, we saw higher arrests.

SPEAKER_04 18:49

That was the main thing. I mean, these were arrests that you would expect to be kind of related to drugs. And so, yeah, it seems like there's no real free lunch. You know, you take away these things that people have become dependent on. And there's kind of there's kind of a dynamic effect that I think is important in that if you take away these drugs that are really addicting, potentially you might have short run pain as a result of that. You know, you have these increases in arrests, you have people switching to more dangerous substances. I think the hope is that in the long run, if you can prevent people from just going down this path to begin with, then maybe, you know, it could be the case that in the short run, you know, these policies are causing a lot of negative effects, but in the long run, maybe things get better. I think there might be some evidence to suggest that that's true. But yeah, anytime you're changing, I mean, I think the, you know, what you brought up with Oxycotton. So Oxycottin was the most, the most popular prescription painkiller among people who were misusing prescription drugs. The reason for that was because it was an extended release pill. Um, it had up to 80 milligrams of oxycodone in it, which is the active ingredient, which is an insane amount, but it would release that that drug drug slowly over the course of you know 10, 12 hours.

SPEAKER_01 19:59

Okay.

SPEAKER_04 20:00

But if you just chewed it up, that broke down the extended release. So you get the whole dose at once. And this was very well known. But then the, you know, the manufacturers, I think to their credit, recognized this was a problem. They did what you said, they reformulated it to where chewing the drug didn't release or didn't break down the extended release anymore. And so, you know, you can find you can find threads on the internet of like drug user forums where people are saying, Hey, where can I get the old oxycotin? You know, people are looking for it. And then you see these conversations of people saying, you know, we're just switching to heroin, and you see it in the data too. You see heroin's death spiking right at that time. Fortunately, those have come down, but unfortunately, we've just seen skyrocketing fentanyl deaths. Um, so yeah, I think what the future looks like is I think uncertain. I think the hope is that a lot of the a lot of the work that's been done to prevent people from getting addicted to prescriptions in the first place will pay off in the long run.

SPEAKER_01 20:53

Yeah.

SPEAKER_04 20:53

But I think something that's alarming is more and more you're seeing people uh skip the prescription stage altogether. So it used to be the case that almost everyone who was addicted to heroin started by using prescriptions. That's no longer the case. People are taking fentanyl without ever having used a prescription opioid. And so I think, you know, the in a in a way that's kind of depressing, the ability of policy on the medical side to do anything about where the opioid crisis is now, I'm a bit pessimistic about, honestly, because you know, it's not the prescriptions that are getting people hooked now, they're going right to right to the hard stuff.

SPEAKER_03 21:29

Yeah, yeah. Well, and it it really does feel like it's really all about trade-offs with any of these types of things. So, I mean, one of your other papers, for example, had found that because of the increase in opioid availability for prescriptions, like people are actually able to get the surgeries that they otherwise wouldn't have really been able to do because they couldn't manage the pain post surgery. And so, I mean, obviously it helps those people to be able to get the surgeries.

SPEAKER_01 21:54

Yeah.

SPEAKER_03 21:55

But then, of course, there's the potential issues of abuse, or in this case, now the prescription drugs maybe. Aren't as much of the problem. So it becomes even harder to figure out what it's like sort of like that whack-a-mole game. You know, if you go to an old arcade, I guess if those still exist, but you know, you you kind of hit one mole and another one pops up. And so I think it's tricky.

SPEAKER_04 22:12

Yeah, yeah. Really hard to figure figure out what the best kind of policy policies are surrounding opioid availability. Because you know, these drugs exist for a reason. You know, if you're in a lot of pain, they're gonna do better than pretty much anything else, especially for you know acute pain, post-surgical pain, but they come with all these, you know, potential negatives. And I think figuring out kind of where to strike the right balance is is definitely tricky.

SPEAKER_03 22:33

Yeah. So I'm curious with with both of you, because a lot of economics research, you know, that there's the potential to potentially lead to policy of some sort, right? Not not everything everything, but in many cases. If you could, based on the work that you've done, whether it's the studies we've talked about or if it could be something completely different, that's okay too. If you could kind of wave a wand and a a law gets passed or a policy gets put in place that you think would really make a difference, what would that look like?

SPEAKER_04 23:00

Yeah, I think it's honestly really hard to say, especially with the opioid stuff, because you know, if you look at the history, at least the relatively recent history in the US, in the 80s, late 70s, early 90s, you know, you go to the hospital, you're in severe pain, they're so afraid of opioid addiction at that time that they're not prescribing anything.

SPEAKER_01 23:20

Yeah.

SPEAKER_04 23:20

And so you can read all these accounts and you can read medical literature from the time with doctors saying, hey, this is probably not the best way to practice medicine. We're letting people suffer, you know, potentially needlessly. We should be more aggressive in in treating their pain. Then we went the complete opposite direction to where now, not now, but in you know, maybe 2002, you go to the doctor, you say, Hey, my lower back hurts, and they're here's a lifetime supply of oxycontin, which you know comes with its own problem. And then over the last 10 years, we've gone back towards where we kind of where we started. But I think there's, you know, real issues with that in that if you're in a lot of pain, these drugs do help. And so trying to figure out, you know, again, as you said, it's all about trade-offs, and it's hard to figure out where exactly the right, the right, the right kind of the sweet spot is. Yeah. I think some potentially low-hanging fruit, and this is already something that a lot of states have done, is to try to make prescriptions for you know high potency opioids just shorter at the beginning. So, you know, for example, I had my wisdom teeth out when I was, I think, a senior in high school, and I got a 30-day supply of chemical. I'm glad that I had it. You're wrong. But I didn't need 30 days.

SPEAKER_01 24:35

Yeah.

SPEAKER_04 24:35

I think a two-day supply would have been much, much more appropriate to, you know, managing the pain while I was while I was in it, but not, you know, running the risk of having these pills around where I could get addicted, someone could steal them, I could sell them, you know, all these potential negative things. But, you know, the opposite is sometimes true now. So I had this, I think this is an interesting kind of just anecdote about how prescribing patterns have changed over time. I broke my hand when I was in high school playing football, similar to when I got my wisdom teeth out. I got a 30-day supply of opioids for a broken hand. I broke my hand about three years ago, and I'm sitting there in urgent care, my hand's the size of a softball, and they ask if it hurts. And I'm like, yes, of course it hurts. Okay, we'll we'll give you something for that. And they come in with two ibuprofen. Oh, good. And so, and so that's what I get. And I say, Hey, can I get something a little bit stronger? And they're like, Oh no, sorry, we can't do that. And you know, this is, I don't know, eight years apart, just how much things have how much things have changed. And I think it, you know, would have been appropriate for a for a small, you know, short opioid script for, you know, something like a like a you know, broken bone. And I think it's just yeah, really a struggle to find out, you know, what's the what's the right pain management versus risk of addiction and negative consequences.

SPEAKER_03 25:53

Yeah. Yeah. Very good. Junyu, how about you? Is there a a policy you can think of that you would you'd put in place based on the work that you've done?

SPEAKER_00 26:00

Yeah. So my take is because a lot of my papers are around this topic of trying to improve the adolescent's health well-being. So I think one takeaway is that we should really also involve the parents' side and we should also consider this additional factor. And a lot of the health inequality or health disparities, they actually started beyond just we thought like medical type of industry or healthcare industry. It's also about this social environment, like families, schools, and uh communities. So I think trying to improve the one of the factors that's like through the family perspective can be a potential cue. And I think the other thing that I'm also find through one of my papers is that usually when we consider about someone making decisions, we attempt to consider like this is like individual decision. But usually it's not a case. It's usually because they are affected by a lot of social factors because, for example, there are like uh PA effects, very, very common among adolescents. Like maybe they get addicted addicted to something is because they feel it's so cool, like they try to follow what other kids are doing. Yeah. So then I think the other thing is we can also look into the the school side and then try to see, try to capture this type of friendship network and then try to target potential like um head of the social network among the kids and then starting from that individual, and then yeah, that would be also another way to think of potential like effective policy and then can be cost effective because we don't need to like uh incorp include like everyone, but we can just target a particular like head of the.

SPEAKER_03 27:42

You know, I I was just thinking about as you were describing that too, you know, those little nuances and complications, even in that. I mean, so you've got an intervention, for example, that you showed really works well. But if you've got a parent that, you know, as has to because of the economy, for example, it's not that great and they have to work two jobs, you know, inflation stuff, they have to work two jobs and they so they don't have as much time to spend with the child. You know, you've got all these other kind of factors that that kind of creep in there that make it make it all the more difficult, and potentially for the folks that need it most, need that intervention the most. So would would you say the intervention is simple enough that you can get around some of that, or or or would that really be a challenge?

SPEAKER_00 28:25

Yeah, I think uh definitely for this type of situation, if we um so I think how I think of this problem is that ultimately the students or the children's well-being can be a product of a lot of factors. So the factors include schools, communities, and the families. So and one when when one of the factors is not that it's hard to work for some of the population, then we can consider increasing the input of the other factors. So say like uh the school side or the community side. But and then the other thing is also these factors can be like affecting each other. So say like um if the the family part is really like difficult to deal with for some particular population, then we can try to see what is going on in the classroom side and then what is going on in this inside the school, and then so that's another thing that I find uh in another one of my another paper that the friendship also matters, and then we can see this interactions going on between like what happened in the within the family and what happens in the classroom. So that's also I think the way that I try to understand why we see this intersection.

SPEAKER_03 29:39

Okay, very good. So, what's up next for for both of you? What what you know, David, what's the the next project that you've been thinking about or maybe even gotten started with?

SPEAKER_04 29:47

Yeah, so I've got a couple things that I'm excited about that are in like really early stages. One of which is me and another guy that I was friends with in grad school. We put together a data set, basically the history of physicians training.

SPEAKER_01 30:00

Okay.

SPEAKER_04 30:01

Um, so it's been publicly available for a long time where physicians went to medical school. But if you talk to a lot of doctors about kind of where they learned actually how to practice medicine, more commonly you'll hear that it's during their residency or during their fellowship. And that hasn't really been studied to my knowledge in economics, looking at the effect of you know residency training on behavior. So we've put together that data. So now for every physician in the United States, we know where they did their medical school, where they did their residency, if they did a fellowship, where they did it. And then we can look at kind of their their practice styles now. What has been, I think, most interesting so far, again, we're in the early stages of figuring out what to do with what to do with this data, is we thought we were going to see just crazy strong effects everywhere based on the conversations that we had had with physicians. What's been, I think, much more or much more interesting is so far, we have yet to find strong impacts of where you did your residency on anything. You know, one of the first ideas that we had was looking at if you did your residency in a location where there was, you know, lots of where opioid prescribing was more common. Are you more likely to prescribe opioids later on in your career? The answer to that is basically no. Oh, okay. We we've looked at just general spending. So if you go, so you know, something about the US, if you look at a map again, we spend wildly different amounts of money per patient in different areas of the country. Okay. We were curious if that had to do with you know your residency. So if you do your residency in a place where you're spending loss per patient, do you then spend lots per patient later in your career? All of these I should caveat with where you do your residency impacts where you go. Oh, you're not to, you know, you're disproportionately likely to practice medicine in the location where you did your residency later in your career. And so if you do your residency in a location, that's high spending, you're in a high spending region. But if we look at people who move away from that region, they pretty much look like the people where they moved to. So they don't seem to be carrying a lot of their residency behaviors with them.

SPEAKER_01 32:02

Okay.

SPEAKER_04 32:02

And so we're still trying to figure out, you know, what's the right setting to look at this, or is the story just residency matters a whole lot less than we thought it did?

SPEAKER_03 32:10

Yeah. Okay. Very good. That sounds like some interesting stuff then. Junyu, how about you? What are you working on?

SPEAKER_00 32:16

So I think um I have like two big directions. The first direction is still like uh expanding around my this intervention. And it's so interesting because this directly goes back to the point that you raised about some cases, the the family side may not work for the particular population, right? So then we are so lucky that there are like some people reaching out to us and then trying to invite us to collaborate and then conduct a similar type of intervention, but in the context and also some Latin American countries, uh, including like Colombia and Ecuador, something. So these are so I'm I'm super excited because these are completely like different contexts compared to the one that I implemented, the uh the ex uh the experiment.

SPEAKER_01 33:01

Yeah.

SPEAKER_00 33:01

And um I also they also told me that because the intervention that we did rely uh some sort of like um high-tech type of thing, because what we did is we designed a mobile app.

SPEAKER_02 33:12

Okay.

SPEAKER_00 33:12

Um, but then there's some digital literacy happening uh in the GDM and uh Columbia and uh these contexts that they invited us to implement the intervention. So I'm very excited about this, and I now we are at the stage of trying to incorporate and adapt some of the elements and to better suit uh these types of contexts. And then the other thing is I also very curious about whether this type of intervention can have external validity. So we show that works in the context that I implemented, but who knows about whether it can also apply to these like completely different types of contexts. So that's one direction. And the other direction is because I feel like the my research is everything about the intersect among like education, health, and the family. So the next this direction is more about. So now I try also to investigate the into this healthcare industry, and um, what I'm trying to ask the answer the question is whether this type of family signals can also affect some of the physician behavior. So we studied this in the context of ADHD diagnosis and the prescription. And then the question is so we um so it's in the uh the in the context of Taiwan, and then so the they have this admin, like the very large-scale type of data. And then basically we can track all the households, all the physicians, all the histories and all the prescription records, diagnosis records. And then so we really want to see like when there's a new drug coming out, and then, for example, if the physician already had experience of treating some of the siblings of the new patient, whether that will affect like how they prescribe the the how they prescribe the specific drug, whether they will still follow this old drug prescription uh style where they will try to prescribe, like try to experiment what will happen using this new drug. So this is kind of um another direction that I'm curious about, like whether this family signal can also affect this healthcare industry and then particular physician decision.

SPEAKER_03 35:22

Very good. Well, some good good uh work coming out from from both of you here in the future. So one I do have one last question for you. You know, uh I I understand you must do some other things besides your research. I hope you do some other things besides your research. So I'm curious, outside your work for the Carlos Salvaras College of Business, what are some of the things that that interest you? I want to start with you, Ginia.

SPEAKER_00 35:44

So I actually am a big fan of high intensity interval training.

SPEAKER_03 35:49

Oh, okay.

SPEAKER_00 35:50

Uh so I um I I basically uh usually in my weekends I would just immerse myself in the gym. Um and I'm also planning to uh register this HIROX competition.

SPEAKER_01 36:02

Oh, okay, yeah.

SPEAKER_00 36:03

But so that's why this lunch uh this breakfast I had getting shake. Uh-huh. And I I just adapt to that. And then I also uh when I try to like calm myself down, I will just play in with Lego. So I'm a big fan of the collection of Lego. Okay um so that's how I spend my time outside of the very good, very good.

SPEAKER_03 36:22

We have we have something of a connection, not on the the training part, obviously. Um but uh if I were to spend more time with that middle schooler, it probably would be building Legos.

SPEAKER_00 36:34

So the other thing is I also like hiking. So that's why I was like so excited about San Antonio because Houston, I moved from Houston, and Houston is so flat.

SPEAKER_03 36:43

Yeah, yeah. So yeah, not not exactly known for its hiking. Yeah, okay. Very good. David, how about you?

SPEAKER_04 36:52

Yeah, so I've got a couple of things. Starting about five years ago, I started training Brazilian jujitsu. Oh, okay. So I train, you know, five, six days a week. Uh-huh. I compete several times a year. Wow, okay. Yeah, so been doing that. Just got my purple belt, if anybody out there knows what that means. But yeah, so spent a lot of time doing that. And then I've also been learning some music. So I started playing piano about a year and a half ago. Oh, wow. Recently picked up lessons and then really enjoyed that. So I got a guitar too and doing guitar lessons as well. So goodness lots of lots of music stuff, and then, you know, yeah, fighting with other people.

SPEAKER_03 37:24

Yeah. Sorry, I know this is supposed to be a podcast about research, but I'm curious because there's actually a Brazilian jiu-jitsu place right by my house. And I've always kind of wondered, I mean, I know what how a Brazilian steakhouse is different from a steakhouse. Well, how is Brazilian jiu-jitsu different from other forms of martial arts?

SPEAKER_04 37:40

Yeah, so I mean, so jujitsu is primarily grappling based. Okay. Um, so if you think of something like, you know, karate or taekwondo or something, or you know, boxing, you're you're hitting each other, yeah. Which in fighting is great. One of the downsides of that though is you can't train full intensity all the time. Uh so if we hit each other in the face over and over again, we're gonna have problems.

SPEAKER_03 37:59

Um you're gonna need some of those opioids.

SPEAKER_04 38:01

Exactly. Exactly. One of the advantages to grappling is you can train full intensity every day. Uh you're not hitting each other, you know, you're trying to take take each other down, you're putting each other in submissions. And, you know, I think if you look at kind of modern mixed martial arts, if that if you if you watch that, grappling is a huge component of that. And a lot of the most dominant fighters have a grappling background, either in wrestling or in jujitsu.

SPEAKER_03 38:27

Yeah.

SPEAKER_04 38:27

And yeah, a lot of fun.

SPEAKER_03 38:29

Very cool. Well, you two do really have a lot going on. I'm I'm just happy if I can make it through the day most of the time. So this is terrific. So, well, Chiny and David, it has been such a joy talking with you. I'm so glad to know that we have amazing researchers like you here in the Carlos Alvarez College of Business tackling these particularly important health-related issues that impact our society so broadly. So, thank you for being here today, and more importantly, thank you for the great work that you're doing to improve the health of everyone. Thank you. Thank you. Thank you for listening to the Inside Alvarez Business Podcast. Special thanks to our producer, Brittany Johnson, and for the support of Wendy Frost and Melissa Lackey to help make this podcast possible. Stay connected with the Carlos Alvarez College of Business at the University of Texas in San Antonio to learn more about how we are empowering the next generation of business thinkers and conducting groundbreaking research to ensure their success. Follow us on social media or visit us online at business.utsa.edu. Until next time, I'm Jonathan Halbesleiden. Thank you for listening.