(iPoster) Crack, Media Exposure, and Long-Term Impacts on Trust and Health

• In Event: Poster Session: Public Opinion 2

Abstract

The crack cocaine crisis and the punitive political environment that accompanied the war on drugs continue to shape health, economic, and civic outcomes in the United States. These legacies are especially salient for Black Americans, who bore the brunt of racially targeted enforcement, concentrated economic disinvestment, and the policy architecture that expanded mass incarceration in the 1980s and 1990s. Crack—a cheaper, faster-acting form of powder cocaine—emerged in urban centers during a period marked by retrenchment of the social safety net, recession, and double-digit unemployment. The crisis intensified structural inequalities and helped institutionalize a political narrative that framed urban crime, illicit drug markets, and racialized deviance as central threats to public order. By the mid-1990s, media coverage cemented these frames and contributed to broader debates about state legitimacy, accountability, and institutional responsiveness.

In 1996, a major investigative news series alleged that U.S. foreign policy operations in Latin America facilitated the entry of cocaine into the United States, indirectly fueling the crack epidemic and its disproportionate harms in Black communities (Webb 1996). These claims echoed earlier findings in the 1989 Kerry Committee Report, which identified connections between U.S.-backed Contra networks and drug trafficking. Although these allegations sparked widespread controversy and public debate, the political science literature has not examined whether they produced measurable shifts in public opinion—particularly trust in government and medical institutions among Black Americans, who have historically been subject to discriminatory state interventions. Prior scholarship documents the long-term effects of crack on education, crime, and social outcomes (Evans et al. 2018), and work on the Tuskegee Study disclosure shows how historical episodes of government misconduct can undermine trust in medical institutions and depress health-seeking behaviors for decades (Alsan 2018). Yet no research has assessed whether media coverage implicating the U.S. government in the origins of the crack epidemic generated similar trust shocks, nor how such changes in trust may have shaped subsequent disparities in health care utilization and mortality.

This study integrates media analysis, public opinion data, and administrative health records to evaluate the political and behavioral consequences of the 1996 disclosure. Leveraging geographic and temporal variation in the intensity of media coverage from full-text archives in ProQuest U.S. Newsstream and Access World News, I measure institutional trust using restricted-access General Social Survey items capturing confidence in government, medicine, and related institutions. These measures are linked to Medicare enrollment, inpatient, outpatient, and hospice claims from 1985–2022, enabling an assessment of whether shifts in trust translated into changes in preventive care, utilization, and mortality among older Black Medicare beneficiaries.

Preliminary evidence suggests sizeable post-1996 divergences in chronic-disease mortality among older Black men in media-exposed jurisdictions. In Los Angeles—one of the cities with the most extensive reporting—mortality rates for Black men over 65 rose by up to 2.7% relative to White men, with gaps widening to 7.5% among men over 85. These patterns are consistent with a trust-mediated mechanism in which exposure to allegations of government complicity reduced willingness to engage with medical institutions, particularly among cohorts already shaped by earlier state-perpetrated harms such as the Tuskegee Study revelation.

To isolate causal effects, I employ a triple-differences (DDD) design combined with a staggered-exposure framework that compares cohorts in heavily exposed media markets to those in demographically similar but minimally exposed markets. This strategy exploits plausibly exogenous local variation in the timing and volume of newspaper reporting on alleged CIA involvement. By examining downstream behavioral and health outcomes, the study connects media-induced trust shocks to concrete expressions of political and institutional opinion and disengagement.

This project provides the first causal evidence on whether media coverage alleging U.S. government involvement in the crack epidemic eroded institutional trust among Black Americans and whether such declines in trust had measurable consequences for health-seeking behavior and mortality. More broadly, it advances the political science literature on the determinants of institutional legitimacy, the role of scandal and state misconduct in shaping public opinion, and the long-run political consequences of racialized policy failures.

Author

• Simone Nicole Matecna, Harvard University