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We quantified the impact of Vietnam-era G.I Bill eligibility, which subsidized college education for eligible Veterans, on the later-life blood pressure distribution by exploiting the Vietnam draft lottery natural experiment. We restricted Health and Retirement Study data (2006-2018) to men born between 1947-1953 (N=1,970). We estimated intention-to-treat effects at the mean and 1st-99th quantiles of blood pressure using linear and quantile regressions. Our outcomes were systolic blood pressure (SBP), diastolic blood pressure (DBP), hypertension, and self-reported stroke. We proxied G.I. Bill eligibility using lottery-defined draft eligibility. We also conducted analyses stratified by childhood socioeconomic status (cSES) defined based on a previously validated measure. Draft eligibility reduced mean blood pressure outcomes (e.g., effect on SBP: -1.33 [95% confidence interval (CI) -2.85, 0.19]). Draft eligibility also had larger protective effects at higher quantiles of the SBP and DBP distributions relative to lower quantiles (effects on SBP at the 10th and 90th quantiles: -0.33mmHg [95% CI -2.35,1.68]; -3.00mmHg [95% CI -5.68,-0.32]). Draft eligibility had protective effects on blood pressure among low and medium cSES men but opposite effects among high cSES men. G.I. Bill eligibility reshaped the blood pressure distribution to one of lower morbidity risk, particularly among low and medium cSES men.

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Background: Globally alcohol consumption is a leading risk factor for premature death and disability and is associated with crime, social and economic consequences. Local communities may be able to play a role in addressing alcohol-related issues in their area. Objectives: To evaluate the effectiveness and cost-benefit of an asset-based community development approach to reducing alcohol-related harm and understand the context and factors that enable or hinder its implementation. Design: A mixed-methods evaluation. Area-level quasi-experimental trial analysed using four different evaluation methods (a stepped-wedge design where each area was a control until it entered the intervention, comparison to matched local/national controls and comparison to synthetic controls), alongside process and economic evaluations. Setting: Ten local authorities in Greater Manchester, England. Participants: The outcomes evaluation was analysed at an area level. Ninety-three lay persons representing nineareas completed questionnaires, with 12 follow-up interviews in five areas; 20 stakeholders representing ten areas were interviewed at baseline, with 17 follow-up interviews in eight areas and 26 members of the public from two areas attended focus groups. Interventions: Professionals in a co-ordinator role recruited and supported lay volunteers who were trained to become alcohol health champions. The champion's role was to provide informal, brief alcohol advice to the local population and take action to strengthen restrictions on alcohol availability. Main outcome measures: Numbers of alcohol-related hospital admissions, accident and emergency attendances, ambulance call-outs, street-level crime and antisocial behaviour in the intervention areas (area size: 1600-5500 residents). Set-up and running costs were collected alongside process evaluation data exploring barriers and facilitators. Data sources: Routinely collected quantitative data on outcome measures aggregated at the intervention area and matched control and synthetic control areas. Data from policy documents, licensing registers, meeting notes, invoices, time/cost diaries, training registers, questionnaires, interviews, reflective diaries and focus groups. Results: The intervention rolled out in nine out of ten areas, seven of which ran for a full 12 months. Areas with better-established infrastructure at baseline were able to train more champions. In total, 123 alcohol health champions were trained (95 lay volunteers and 28 professionals): lay volunteers self-reported positive impact. Champions engaged in brief advice conversations more readily than taking action on alcohol availability. There were no consistent differences in the health and crime area-level indicators between intervention areas and controls, as confirmed by using three different analysis methods for evaluating natural experiments. The intervention was not found to be cost-beneficial. Limitations: Although the sequential roll-out order of the intervention was randomised, the selection of the intervention areas was not. Self-reported impact may have been subject to social desirability bias due to the project's high profile. Conclusions: There was no measurable impact on health and crime outcomes. Possible explanations include too few volunteers trained, volunteers being unwilling to get involved in licensing decisions, or that the intervention has no direct impact on the selected outcomes. Future work: Future similar interventions should use a coproduced community outcomes framework. Other natural experiment evaluations should use methodological triangulation to strengthen inferences about effectiveness. Trial registration: This trial is registered as ISRCTN81942890. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 15/129/03) and is published in full in Public Health Research; Vol. 12, No. 9. See the NIHR Funding and Awards website for further award information.

Alcohol consumption puts an individual's health and social relationships at risk of harm. The more a person drinks, the more harmful it is. The harmful effects can place a burden on emergency services and hospitals. We wanted to find out whether community members can make a difference by taking action to address alcohol harm in their local area. Local councils in Greater Manchester developed a project called Communities in Charge of Alcohol, where volunteers in targeted local areas were trained to become 'alcohol health champions'. Alcohol health champions gave alcohol-related brief advice to people to help them drink less. They had a say about when, where and how alcohol is sold by reporting issues to their local council. We compared numbers of alcohol-related hospital admissions, accident and emergency attendances, ambulance call-outs and reports of crime and antisocial behaviour between areas that had alcohol health champions with other similar areas in England that did not. We calculated how much it costs to run and whether Communities in Charge of Alcohol could save society money. Not as many volunteers came forward to become an alcohol health champion as hoped for. Those who did give alcohol-related brief advice to people. They preferred not to report issues about alcohol sales to their local council, either because it was too complicated or because they did not want to be called a 'grass'. We did not find levels of alcohol harm changed in the Communities in Charge of Alcohol areas. Because of this, we could not demonstrate that Communities in Charge of Alcohol could save society money. Getting involved in alcohol licensing decisions needs to be made easier for communities, with more anonymity, through the support of professionals. More work needs to be done to understand whether giving brief advice can reduce alcohol harm in whole communities.

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BACKGROUND: Potential differences in organ preservation between total neoadjuvant therapy (TNT) regimens integrating long-course chemoradiotherapy (LCCRT) and short-course radiotherapy (SCRT) in rectal cancer remain undefined. PATIENTS AND METHODS: This natural experiment arose from a policy change in response to the COVID-19 pandemic during which our institution switched from uniformly treating patients with LCCRT to mandating that all patients be treated with SCRT. Our study includes 323 locally advanced rectal adenocarcinoma patients treated with LCCRT-based or SCRT-based TNT from January 2018 to January 2021. Patients who achieved clinical complete response were offered organ preservation with watch-and-wait (WW) management. The primary outcome was 2-year organ preservation. Additional outcomes included local regrowth, distant recurrence, disease-free survival (DFS), and overall survival (OS). RESULTS: Patient and tumor characteristics were similar between LCCRT (n = 247) and SCRT (n = 76) cohorts. Median follow-up was 31 months. Similar clinical complete response rates were observed following LCCRT and SCRT (44.5% versus 43.4%). Two-year organ preservation was 40% [95% confidence interval (CI) 34% to 46%] and 31% (95% CI 22% to 44%) among all patients treated with LCCRT and SCRT, respectively. In patients managed with WW, LCCRT resulted in higher 2-year organ preservation (89% LCCRT, 95% CI 83% to 95% versus 70% SCRT, 95% CI 55% to 90%; P = 0.005) and lower 2-year local regrowth (19% LCCRT, 95% CI 11% to 26% versus 36% SCRT, 95% CI 16% to 52%; P = 0.072) compared with SCRT. The 2-year distant recurrence (10% versus 6%), DFS (90% versus 90%), and OS (99% versus 100%) were similar between WW patients treated with LCCRT and SCRT, respectively. CONCLUSIONS: While WW eligibility was similar between cohorts, WW patients treated with LCCRT had higher 2-year organ preservation and lower local regrowth than those treated with SCRT, yet similar DFS and OS. These data support induction LCCRT followed by consolidation chemotherapy as the preferred TNT regimen for patients with locally advanced rectal cancer pursuing organ preservation.

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Carbon emission reduction is crucial for mitigating global climate change, and green fiscal policies, through providing economic incentives and reallocating resources, are key means to achieve carbon reduction targets. This paper uses data covering 248 cities from 2003 to 2019 and applies a multi-period difference-in-differences model (DID) to thoroughly assess the impact of energy conservation and emission reduction (ECER) fiscal policies on enhancing carbon emission (CE1) reduction and carbon efficiency (CE2). It further analyzes the mediating role of Green Innovation (GI), exploring how it strengthens the impact of ECER policies. We find that: (1) ECER policies significantly promote the improvement of carbon reduction and CE2, a conclusion that remains robust after excluding the impacts of concurrent policy influences, sample selection biases, outliers, and other random factors. (2) ECER policies enhance CE1 reduction and CE2 in pilot cities by promoting green innovation, and this conclusion is confirmed by Sobel Z tests. (3) The effects of ECER policies on CE1 reduction and the improvement of CE2 are more pronounced in higher-level cities, the eastern regions and non-resource cities. This research provides policy makers with suggestions, highlighting that incentivizing green innovation through green fiscal policies is an effective path to achieving carbon reduction goals.

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BACKGROUND: The Ultra-Low Emission Zone (ULEZ), introduced in Central London in April 2019, aims to enhance air quality and improve public health. The Children's Health in London and Luton (CHILL) study evaluates the impact of the ULEZ on children's health. This analysis focuses on the one-year impacts on the shift towards active travel to school. METHODS: CHILL is a prospective parallel cohort study of ethnically diverse children, aged 6-9 years attending 84 primary schools within or with catchment areas encompassing London's ULEZ (intervention) and Luton (non-intervention area). Baseline (2018/19) and one-year follow-up (2019/20) data were collected at school visits from 1992 (58%) children who reported their mode of travel to school 'today' (day of assessment). Multilevel logistic regressions were performed to analyse associations between the introduction of the ULEZ and the likelihood of switching from inactive to active travel modes, and vice-versa. Interactions between intervention group status and pre-specified effect modifiers were also explored. RESULTS: Among children who took inactive modes at baseline, 42% of children in London and 20% of children in Luton switched to active modes. For children taking active modes at baseline, 5% of children in London and 21% of children in Luton switched to inactive modes. Relative to the children in Luton, children in London were more likely to have switched from inactive to active modes (OR 3.64, 95% CI 1.21-10.92). Children in the intervention group were also less likely to switch from active to inactive modes (OR 0.11, 0.05-0.24). Moderator analyses showed that children living further from school were more likely to switch from inactive to active modes (OR 6.06,1.87-19.68) compared to those living closer (OR 1.43, 0.27-7.54). CONCLUSIONS: Implementation of clean air zones can increase uptake of active travel to school and was particularly associated with more sustainable and active travel in children living further from school.

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As a strategic resource, big data has become a key force affecting carbon emission reduction in agriculture. However, its impacts remain controversial, and relevant empirical evidence remains to be explored. Based on quasi-natural experimental analysis, this study explored the impact and mechanism of the construction of the National Big Data Comprehensive Pilot Zone (NBDCPZ) on agricultural carbon emissions (ACE) in China and adopted a difference-in-difference (DID) model using China's provincial panel data from 2003 to 2020. The results showed that the ACE in the NBDCPZ establishment area was significantly reduced by 11.91%, a finding that remained robust following the parallel trend test and the placebo test, among others. Mechanism analysis showed that the ACE was reduced through industrial upgrading and technological innovation. Heterogeneity analysis showed that more pronounced policy gains were achieved in China's central-eastern regions as well as in non-major grain-producing areas compared to western and major grain-producing areas. This research provided supporting evidence for the prospect of big data application in ACE and provided useful guidance regarding the promotion of green and sustainable agricultural development.

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PURPOSE: Non-pharmaceutical interventions (NPIs) have been the cornerstone of COVID-19 pandemic control, but evidence on their effectiveness varies according to the methods and approaches taken to empirical analysis. We analysed the impact of NPIs on incident SARS-CoV-2 across 32 European countries (March-December 2020) using two NPI trackers: the Corona Virus Pandemic Policy Monitor - COV-PPM, and the Oxford Covid-19 Government Response Tracker - OxCGRT. METHODS: NPIs were summarized through principal component analysis into three sets, stratified by two waves (C1-C3, weeks 5-25, and C4-C6, weeks 35-52). Longitudinal, multi-level mixed-effects negative binomial regression models were fitted to estimate incidence rate ratios for cases and deaths considering different time-lags and reverse causation (i.e. changing incidence causing NPIs), stratified by waves and geographical regions (Western, Eastern, Northern, Southern, Others). RESULTS: During the first wave, restrictions on movement/mobility, public transport, public events, and public spaces (C1) and healthcare system improvements, border closures and restrictions to public institutions (C2) were associated with a reduction in SARS-CoV-2 incidence after 28 and 35-days. Mask policies (C3) were associated with a reduction in SARS-CoV-2 incidence (except after 35-days). During wave 1, C1 and C2 were associated with a decrease in deaths after 49-days and C3 after 21, 28 and 35-days. During wave 2, restrictions on movement/mobility, public transport and healthcare system improvements (C5) were also associated with a decrease in SARS-CoV-2 cases and deaths across all countries. CONCLUSION: In the absence of pre-existing immunity, vaccines or treatment options, our results suggest that the observed implementation of different categories of NPIs, showed varied associations with SARS-CoV-2 incidence and deaths across regions, and varied associations across waves. These relationships were consistent across components of NPIs derived from two policy trackers (CoV-PPM and OxCGRT).

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Out-of-home eating (takeaway, take-out and fast-foods) is associated with intakes of higher energy and fat, and lower intakes of micronutrients, and is associated with excess weight gain. In 2017, a unique opportunity arose to measure the association between the opening of a new multi-national fast-food restaurant (McDonald's) and consumption of fast-food on young people aged 11-16. This study uses a repeated cross-sectional design to explore group level change over time with respect to out-of-home eating behaviours of young people. Two secondary schools in Redcar and Cleveland agreed to participate and facilitated the completion of a questionnaire on their pupils eating behaviours at three timepoints a) prior to the new restaurant opening, b) three months post-opening and c) nine months post opening. Reported frequency of visits to McDonald's showed a statistically significant increase in visits between 3 and 9 months of the restaurant opening. This research asks and explores the question of whether the introduction of a new multi-national fast-food restaurant influences eating habits of young people attending schools near the new outlet.

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A growing number of birth interventions had led to a concern for potential health consequences. This study investigates the consequences of earlier routine labor induction. It exploits a natural experiment caused by the introduction of new Danish obstetric guidelines in 2011. Consequently, routine labor induction was moved forward from 14 to 10-13 days past the expected due date (EDD) and extended antenatal surveillance was introduced from 7 days past the EDD. Using administrative data, I find that affected mothers on average had a 9-11 percentage points (32%-38%) higher risk of being induced the following years. Yet, mother and child short- and medium-term morbidity were largely unaffected.

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OBJECTIVES: The COVID-19 pandemic and associated lockdowns disrupted health care worldwide. High-income countries observed a decrease in preterm births during lockdowns, but maternal pregnancy-related outcomes were also likely affected. This study investigates the effect of the first COVID-19 lockdown (March-June 2020) on provision of maternity care and maternal pregnancy-related outcomes in the Netherlands. STUDY DESIGN: National quasi-experimental study. METHODS: Multiple linked national registries were used, and all births from a gestational age of 24+0 weeks in 2010-2020 were included. In births starting in midwife-led primary care, we assessed the effect of lockdown on provision of care. In the general pregnant population, the impact on characteristics of labour and maternal morbidity was assessed. A difference-in-regression-discontinuity design was used to derive causal estimates for the year 2020. RESULTS: A total of 1,039,728 births were included. During the lockdown, births to women who started labour in midwife-led primary care (49%) more often ended at home (27% pre-lockdown, +10% [95% confidence interval: +7%, +13%]). A small decrease was seen in referrals towards obstetrician-led care during labour (46%, -3% [-5%,-0%]). In the overall group, no significant change was seen in induction of labour (27%, +1% [-1%, +3%]). We found no significant changes in the incidence of emergency caesarean section (9%, -1% [-2%, +0%]), obstetric anal sphincter injury (2%, +0% [-0%, +1%]), episiotomy (21%, -0% [-2%, +1%]), or post-partum haemorrhage: >1000 ml (6%, -0% [-1%, +1%]). CONCLUSIONS: During the first COVID-19 lockdown in the Netherlands, a substantial increase in homebirths was seen. There was no evidence for changed available maternal outcomes, suggesting that a maternity care system with a strong midwife-led primary care system may flexibly and safely adapt to external disruptions.

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Introduction: Recent years have witnessed an increase in highly publicized attacks targeting members of ethnoracial and religious minority groups. To date, existing research has primarily focused on the tendency for such "trigger events" to generate violent aftershocks. We argue that beyond such ripple effects, highly salient trigger events significantly increase hate-crime related stress among racial and ethnic minorities. Additionally, we explore whether these effects are limited to the group most clearly targeted, or if they "spill over" to other minoritized communities. Methods: To study reactions to hate crimes, we draw upon national survey data (N = 1,122) in combination with a natural experiment involving the Unite the Right rally and vehicle attack in Charlottesville, Virginia in August 2017. We employ an "unexpected event during survey" design to estimate the causal effect of the Charlottesville rally on stress about hate crimes. Results: We first show that there was an increase in anti-Black hate crimes in the 2 weeks following the Charlottesville incident. We also find a corresponding increase in stress due to the perception of personal vulnerability to hate crimes among African-Americans. However, we do not observe a significant increase in levels of stress following the trigger event among Hispanics and Asian Americans. Discussion: Our results suggest that highly publicized instances of intergroup violence can have significant impacts on stress about hate crime victimization within the target group. However, we find that this effect is short-lived, and that both violent aftershocks and the general climate of fear spurred by hate crimes may be racially bounded.

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Schools in the United States are increasingly offering ethnic studies classes, which focus on exploring students' ethnic-racial identities (ERI) and critical analysis of systemic racism, to their diverse student bodies, yet scant research exists on their effectiveness for students of different ethnic-racial backgrounds in multiracial classrooms. A policy change to require all high school students in one school district to take an ethnic studies class facilitated a natural experiment for comparing the effects of quasi-random assignment to an ethnic studies class (treatment) relative to a traditional social studies class (control; e.g., U.S. Government, Human Geography). Student surveys and school administrative data were used to compare students' ERI development, well-being, and academic outcomes across ethnic studies and control classes. Participants (N = 535 9th graders; 66.1% ethnic studies) had diverse ethnic-racial (33.5% non-Latine White, 29.5% Black, 21.1% Latine, 10.7% biracial, 2.8% Asian, 2.2% Native American) and gender identities (44.7% female, 7.1% non-binary). Ethnic studies students reported marginally higher ERI exploration and resolution than controls, and sensitivity analyses showed a statistically significant effect on ERI among participants with complete midpoint surveys. Higher resolution was associated with better psychological well-being for all students and higher attendance for White students. Students with low middle school grades (GPA < 2.0) had better high school grades in core subjects when enrolled in ethnic studies than the control class. Overall, the results of this natural experiment provide preliminary support for ethnic studies classes as a method for promoting ERI development, well-being, attendance, and academic achievement for students from diverse ethnic-racial backgrounds.

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Housing is a pressing problem worldwide and a key determinant of health and wellbeing. The right to adequate housing, as a pillar of the right to an adequate standard of living, means more than a roof to live under. Adequate means the dwelling must fulfill material functions and psychosocial functions, thus contributing to dwellers health and wellbeing. Social housing policies aim to fulfill the right to housing, but frequently fail in fulfilling the right to it being adequate. This study capitalizes on the implementation of a national urban regeneration program in two social housing villas in central Chile (one in Santiago, in the central valley, the other in Viña del Mar, a coastal city) to run a natural experiment assessing the impact of dwelling renovation on several dimensions of perceived habitability and housing satisfaction among the -mostly female-household homemakers. We use 5 waves of survey data collected with a step-wedge design to estimate the association between a time-varying exposure status (the intervention) and 7 binary outcomes for habitability and 5 for housing dissatisfaction, including overall housing satisfaction. We use Poisson regression models with robust variance and a random intercept at the respondent level. At baseline, reports of poor habitability and dissatisfaction across all features were markedly high, the highest levels of dissatisfaction being with acoustic insulation and dwelling size in both villas, and with indoor temperature in Santiago. The intervention resulted in statistically significant and markedly large improvements in reported habitability and dissatisfaction relative to those housing components targeted by the intervention, as well as with overall dwelling satisfaction in both study cases. Implications are, first, that the policy response to quantitative housing deficits must not overlook housing quality; second, that housing renovation appears as a promising intervention for qualitative housing crises; third, that while improvements in habitability and satisfaction are specific to the interventions in place, overall housing satisfaction can improve in more limited, tailored, dwelling renovation interventions. Social housing renovation in Latin America appears as a promising intervention to improve quality of life among the urban poor dwellers and reduce inequalities in health related to housing conditions.

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As a global public health problem, sedentary behavior has attracted more and more attention. Although numerous studies have demonstrated many benefits of green spaces to health, causal evidence on how green spaces affect people's sedentary behavior is scarce. This study used a natural experiment to evaluate the impact of greenway intervention on sedentary behavior. Two waves of data were collected in 2016 and 2019 (before and after the intervention) at East Lake Greenway (102-km-long) in Wuhan, China, with 1020 participants in 52 neighborhoods. We adopted three major methods to evaluate the impact of greenway intervention on sedentary behavior, including Propensity Score Matching and difference-in-difference (PSM-DID) method (with both individual and neighborhood variables to match samples), continuous treatment DID method (with distance to the greenway as the continuous treatment), and mediation analysis (with moderate to vigorous physical activity or MVPA, and walking time as the mediator). The results revealed that the greenway intervention significantly reduced participants' sedentary time and the intervention has a distance decay effect. The closer to the greenway, the greater decrease in sedentary time after the greenway opening. Furthermore, we found that MVPA and walking time mediate the impact of the greenway intervention on the change in sedentary behavior. The effect of greenway intervention was more beneficial for those under the age of 60, those who were employed, or those who were married. Our findings provided robust evidence that exposure to urban greenways affects sedentary behavior and such green infrastructures help protect public health in high-density urban areas.

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Research has documented that neighborhood disadvantage is associated with increased cardiovascular disease risk, but it is unclear which mechanistic pathways mediate this association across the life course. Leveraging a natural experiment in which refugees to Denmark were quasi-randomly assigned to neighborhoods across the country during 1986-1998 and using 30 years of follow-up data from population and health registers, we assessed whether and how individual-level poverty, unstable employment, and poor mental health mediate the relation between neighborhood disadvantage and the risk of hypertension, hyperlipidemia, and type 2 diabetes among Danish refugees (N= 40,811). Linear probability models using the discrete time-survival framework showed that neighborhood disadvantage was associated with increased risk of hypertension (0.05 percentage points [pp] per year [95%CI -0.00, 0.10]); hyperlipidemia (0.03 pp per year [95%CI -0.01, 0.07]), and diabetes (0.01 pp per year (95%CI -0.02, 0.03)). The Baron-Kenny product-of-coefficients method for counterfactual mediation analysis indicated that cumulative income mediated 6%-28% of the disadvantage effect on these outcomes. We find limited evidence of mediation by unstable employment and poor mental health. This study informs our theoretical understanding of the pathways linking neighborhood disadvantage with cardiovascular disease risk and identifies income security as a promising point of intervention in future research.

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To test the hypothesis that early-life adversity accelerates the pace of biological aging, we analyzed data from the Dutch Hunger Winter Families Study (DHWFS, N = 951). DHWFS is a natural-experiment birth-cohort study of survivors of in-utero exposure to famine conditions caused by the German occupation of the Western Netherlands in Winter 1944 to 1945, matched controls, and their siblings. We conducted DNA methylation analysis of blood samples collected when the survivors were aged 58 to quantify biological aging using the DunedinPACE, GrimAge, and PhenoAge epigenetic clocks. Famine survivors had faster DunedinPACE, as compared with controls. This effect was strongest among women. Results were similar for GrimAge, although effect-sizes were smaller. We observed no differences in PhenoAge between survivors and controls. Famine effects were not accounted for by blood-cell composition and were similar for individuals exposed early and later in gestation. Findings suggest in-utero undernutrition may accelerate biological aging in later life.

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As disasters increase due to climate change, population density, epidemics, and technology, information is needed about postdisaster consequences for people's mental health and how stress-related mental disorders affect multiple spheres of life, including labor-market attachment. We tested the causal hypothesis that individuals who developed stress-related mental disorders as a consequence of their disaster exposure experienced subsequent weak labor-market attachment and poor work-related outcomes. We leveraged a natural experiment in an instrumental variables model, studying a 2004 fireworks factory explosion disaster that precipitated the onset of stress-related disorders (posttraumatic stress disorder, anxiety, and depression) among individuals in the local community (N = 86,726). We measured labor-market outcomes using longitudinal population-level administrative data: sick leave, unemployment benefits, early retirement pension, and income from wages from 2007 to 2010. We found that individuals who developed a stress-related disorder after the disaster were likely to go on sickness benefit, both in the short- and long-term, were likely to use unemployment benefits and to lose wage income in the long term. Stress-related disorders did not increase the likelihood of early retirement. The natural experiment design minimized the possibility that omitted confounders biased these effects of mental health on work outcomes. Addressing the mental health and employment needs of survivors after a traumatic experience may improve their labor-market outcomes and their nations' economic outputs.

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Natural experiments provide remarkable opportunities to test the large-scale effects of human activities. Widespread energy blackouts offer such an 'experiment' to test the impacts of artificial light at night (ALAN) on wildlife. We use the situation in South Africa, where regular scheduled blackouts are being implemented, to highlight this opportunity.

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