Prenatal Smoking Cessation and Infant Health: Evidence from Sibling Births

This article uses a large data set of sibling births to examine when mothers must quit smoking in pregnancy to deliver healthy babies. It applies sibling fixed effects models to provide robust evidence that smoking cessation in the first trimester has a negligible effect on infant health, but cessation as late as second trimester or smoking throughout pregnancy is associated with substantially lower birth weights and higher risks of delivering low birth weight babies. In particular, about two thirds of the total detrimental smoking impact on birth outcomes occurs in the second trimester. Therefore, reallocating resources on prenatal smoking cessation towards the first trimester can lead to a significant efficiency gain. This study also shows when the timing information of prenatal smoking cessation is improperly used, it will introduce a new nontrivial downward bias in estimating the causality between the conventionally used group measure “prenatal smoker” and infant health.     

User Fee Abolition and the Demand for Public Health Care

This research examines the effect of the abolition of user fees in South Africa, a policy implemented in 1994 for uninsured children under the age of six and the elderly uninsured, as well as pregnant and nursing mothers. The analysis focuses on the implementation of the policy and the use of curative public healthcare services by children following strict and fuzzy regression discontinuity designs. The estimates point to statistically insignificant average and local average policy effects, even though the policy appears to have been implemented reasonably effectively, albeit imperfectly. In other words, the policy did not, on average, affect the use of curative public healthcare, at least for those children who should have benefited from the policy.     

The Impact of Housing Prices on Health in the United States Before,During, and After the Great Recession

We estimate the effects of U.S. Metropolitan Statistical Area housing prices on a variety of health outcomes and health-related behaviors separately for homeowners and tenants. The constructed data set consists of information on individuals from the 2002–2012 Behavioral Risk Factor Surveillance System combined with homeownership data from the March Current Population Survey and housing prices from Freddie Mac. We estimate positive effects on homeowners' mental health when housing prices increase. We also find negative effects on tenants' health and health-related behaviors with increases in housing prices. These estimated contemporaneous effects are concentrated among low-income homeowners and tenants, and the effects for tenants are not persistent in the long run. However, the cumulative effects of an increase in housing prices on obesity become more pronounced for homeowners in the long run, resulting in worse self-reported health.     

Effect of Stress on Later-Life Health: Evidence from the Vietnam War Draft

This article contributes to the literature examining how stress during the early stages of life impacts later-life health using a novel proxy for stress: risk of military induction during the Vietnam War. The article estimates that an increase in induction risk in young adulthood is associated with higher rates of obesity, endocrine disease, and hypertension later in life. These findings do not appear to be cohort effects; these associations exist only for men who did not serve in the war, not for same-aged women. These results suggest stress experienced during early adulthood can have adverse health consequences later in life.     

Impact of Malaria Control on Late and Early Infant Mortality in Senegal

One of the greatest achievements of the twenty‐first century has been the dramatic decline in malaria prevalence notably in endemic developing countries. In this study, we estimate the impact of recent scale up in malaria control in Senegal on neonatal, postnatal and infant mortality. We exploit natural preintervention variation in malaria prevalence to estimate the impact of recent malaria control policy in Senegal. In a difference in differences design, we find a negative and significant effect on neonatal and infant mortality in malaria endemic regions while the impact on postnatal mortality is inconclusive. We rule out competing explanations such as contemporaneous health campaigns, general improvement in health care delivery and pre‐existing regional time trends. We identify a 26.9% and 16.3% reduction in neonatal and infant mortality, respectively, in malaria endemic regions during 2005–2014. We argue that increase in donor funding for malaria control as well as greater involvement of local communities and civil society organization has proven to be effective. However, the impact of malaria control on mortality may vary substantially depending on early or late infant mortality.     

The Affordable Care Act and Its Potential to Improve the Health of African-American Women

A complex set of historical and contemporary factors (such as racism, poverty and segregation) shape the life experiences, and health outcomes of African-American women. Their place in society and literally the places where they live both determine their health. This article considers whether the Patient Protection and Affordable Care Act (P.L. 111–148), as amended, signed into law by President Obama on March 30, 2010, can become a viable tool to help address the health needs of African-American women.     

Health insurance generosity and conditional coverage: Evidence from medicaid managed care in Kentucky

This article estimates the impact of the introduction of Medicaid managed care (MMC) on the formal Medicaid participation of children. We employ a quasi‐experimental approach exploiting the location‐specific timing of MMC implementation in Kentucky. Using data from the March Current Population Survey from 1995 to 2003, our findings suggest that the introduction of MMC increases the likelihood of being uninsured and decreases formal Medicaid participation. This finding is consistent with an increase in “conditional coverage,” waiting until medical care is needed to sign up or re‐enroll in Medicaid. These effects are concentrated among low‐income children and absent for high‐income children. We find no evidence of “crowd‐in,” substituting private coverage for Medicaid. These results are robust to multiple placebo tests and imply the potential for less formal participation (i.e., more conditional coverage) among the Affordable Care Act‐Medicaid expansion population (which is likely to be primarily covered under MMC) than is typically predicted.     

Unemployment and Health Behaviors over the Business Cycle: A Longitudinal View

We examine the first-order internal effects of unemployment and nonemployment on a range of health behaviors during the most recent recession using longitudinal data from the Panel Study of Income Dynamics and the National Longitudinal Survey of Youth-1979. Ours is the first study to analyze the effect of own-unemployment on energy intake, energy expenditure, and the net effect (body mass index) using longitudinal records. Exploiting information enveloping the recent steep recession and prolonged recovery is valuable since recent job losers will modify their behavior little if they expect soon to be re-employed, whereas if they expect joblessness to last, they will adjust to a possibly prolonged decline in income and increase in nonwork time. We find that becoming unemployed is associated with a small increase in leisure-time exercise, a moderate decrease in smoking, and a substantial decline in total physical activity. We also find that unemployment and nonemployment are associated with a decline in purchases of fast food. Together, these results imply that both energy consumption and expenditure may decline in the United States during recessions, the net result being essentially no change in body weight. There is considerable heterogeneity in these effects across specific health behaviors, across the intensive and extensive margins, across the outcome distribution, and across gender.     

An Assessment of the Forward-Looking Hypothesis of the Demand for Cigarettes

In this article, we develop a model of the demand for cigarettes that incorporates forward-looking behavior related to the adverse health consequences of smoking and the addictive nature of cigarettes. The model results in several testable hypotheses that we use to examine the extent to which smokers exhibit forward-looking behavior. Results of our study are generally supportive of the notion that smokers behave in a forward-looking manner.     

Identifying the causal effect of alcohol abuse on the perpetration of intimate partner violence by men using a natural experiment

Intimate partner violence (IPV) is widespread and has substantial negative consequences. Researchers have documented a strong positive correlation between alcohol abuse and IPV. However, alcohol abuse is potentially endogenous to IPV. We deal with this problem by exploring a unique instrumental variable—the September 11 terrorist attack—in Wave III of the National Longitudinal Study of Adolescent Health. Ordinary least squares results confirm a strong positive correlation between alcohol abuse and IPV. However, our two‐stage least squares results are statistically insignificant. These results indicate that alcohol abuse might not have a causal effect on IPV and, therefore, have important policy implications.     

Estimating the Associations between SNAP and Food Insecurity,Obesity, and Food Purchases with Imperfect Administrative Measures of Participation

Administrative data are considered the “gold standard” when measuring program participation, but little evidence exists on their potential problems or implications for econometric estimates. We explore these issues using the FoodAPS, a unique data set containing two different administrative measures of Supplemental Nutrition Assistance Program (SNAP) participation and a survey‐based measure. We document substantial ambiguity in the two administrative measures and show that they disagree with each other almost as often as they disagree with self‐reported participation. Estimated participation and misreporting rates can be meaningfully sensitive to choices made to resolve this ambiguity and disagreement. We explore sensitivity in regression estimates of the associations between SNAP and food insecurity, obesity, and the healthy eating index. The signs are unchanged across the three measures, and the estimates are mostly not statistically different from each other. However, there are some meaningful differences in the magnitudes and levels of statistical significance of the estimates.     

The impact of diabetes insurance mandates on infant health

Among the factors thought to contribute to lagging improvements in infant health in recent years are increasing obesity and diabetes prevalence among women of childbearing age. This article uses a difference‐in‐difference‐in‐difference empirical strategy to investigate the impact of mandated insurance coverage for diabetes on adverse pregnancy outcomes. Among educated women, who have high rates of coverage through private insurance that is subject to insurance mandates, diabetes mandates are associated with a reduction in low birth weight and premature birth prevalence. These gains are concentrated among older women and are larger for African‐Americans. There is a weaker effect on the prevalence of high birth weight, potentially because of the deleterious effects of an increased probability of pregnancy weight gain in excess of 35 pounds among diabetic women in states with mandates.     

The role of new media on teen sexual behaviors and fertility outcomes—the case of 16 and Pregnant

This article investigates the 2009 premiere of 16 and Pregnant as a shock to teen information sets and potential influence on sexual activity and fertility. The program, chronicling teen pregnancy and providing educational links on sex/contraception, began a continuing stream of teen pregnancy reality shows. My conceptual framework considers how such programs alter the expected (dis)utility or perceived risk of becoming pregnant. I test for differential effects across ages, state‐sex education requirements, and viewership levels in a quasi‐difference‐in‐difference framework that controls for confounding effects of coincident contraception policy changes, the economy, and downward trends in teen fertility. The results indicate that while fertility declined across all adolescents in the postperiod, there are stronger effects among young teens in states without sex education mandates and higher viewership. Supporting evidence from the National Survey of Family Growth shows increased hormonal contraception use in the postperiod for young relative to older teens.     

Food Access,Program Participation,and Health: Research Using FoodAPS

This piece is an introduction to the symposium on Food Access, Program Participation, and Health: Research using FoodAPS. The symposium includes articles presented at the National Bureau of Economic Research Conference on Food Security on December 7 and 8, 2017. The research herein was supported by the Economic Research Service of the U.S. Department of Agriculture, grant number 59‐5000‐5‐0115. The grant included funding to study the effects of various food assistance programs on outcomes, using data from the National Household Food Acquisition and Purchase Survey (FoodAPS). We describe the programs and the FoodAPS data, and point out highlights from the articles.     

Effects of Family,Friends, and Relative Prices on Fruit and Vegetable Consumption by African Americans

We investigate the effects of parents, best friends, and relative prices on fruit and vegetable consumption by African American youths using behavioral data from the Family and Community Health Study and area‐specific food prices from the Quarterly Food‐at‐Home Price Database. We construct a simultaneous equation ordered probit model that accounts for social interactions in fruit and vegetable consumption and specific aspects of the available food intake data. We estimate statistically significant endogenous consumption effects between a youth and a parent. Lower relative prices tend to increase intakes, particularly in the case of vegetables; however, the statistical significance of these effects is marginal. The results indicate the existence of social multipliers in fruit and vegetable consumption in African American families. The presence of these multipliers supports the design of youth‐parent–based interventions to increase fruit and vegetable intake by African Americans. Additionally, intake also may be increased through relative price reductions.     

The Role of Economic Shocks on Health: Evidence from German Reunification

Sudden economic shocks impact the everyday lives of people from one day to the next. A number of studies have examined the association between economic fluctuations and health; however, no consensus on the nature of this relationship has been established. By exploiting the dramatic economic fluctuations following the German Reunification of 1990, which included a sudden change from a socialist to a capitalist system in East Germany, this study examines the association between broad negative economic shocks and health. The article finds that increases in state unemployment rates are associated with large and statistically significant declines in health outcomes. Estimates are stronger for people who became unemployed shortly after reunification, for low‐income individuals, and for East Germans, a group confronted with larger economic fluctuations. When examining potential mechanisms that could explain the observed health deteriorations, the study finds significant reductions in exercise frequency and increases in economic uncertainty and overall stress.     

Identifying the Effects of WIC on Food Insecurity Among Infants and Children

The Women, Infants, and Children (WIC) Program is considered a crucial component of the social safety net in the United States, yet there is limited supporting evidence on the effects of WIC on the nutritional well‐being and food security of infants and young children. Using data from the National Health and Nutrition Examination Survey, we apply recently developed partial identification methods to jointly account for unobserved counterfactual outcomes and systematic underreporting of WIC participation. Under nonparametric assumptions, we find that WIC reduces the prevalence of child food insecurity by at least 3.6 percentage points (20%).     

Food, nutrition, and substitution in the late nineteenth century

Economic historians hypothesize that households in the nineteenth century substituted away from carbohydrates and fiber and towards protein and fat as their incomes rose. Anthropometric historians assert that there was increased nutrient intake without any nutritional substitution. I test these hypotheses using the 1888 Cost of Living Survey. I fail to reject the hypothesis that the income elasticity of fiber is greater than or equal to the income elasticities of protein, fat, or sugar—contrary to the nutritional substitution posited by economic historians. A food modified Engel curve reveals that the shares of carbohydrates, fat, and sugar in the diet vary with household income, but the shares of protein and fiber do not. I do find, however, that the share of protein from animal sources increases with household income. I also find that the diets of late nineteenth century industrial workers were surprisingly balanced by modern standards.