Abstract

Nursing has historically been one of the few professional opportunities available to women.  Until the 1960s, most nurses were trained in private apprentice-like programs in hospitals.  A deliberate change in nurse training policy combined with increased federal support for through the 1965 Nurse Training Act resulted in a shift in nurse training out of hospitals and into community colleges and universities.  With new data on the growth in nurse training programs across the US 1960-1980, we find that the shift from private to public training of nurses led to a significant increase in the number of nurses, particularly among those living in previously underserved communities.  Using this growth and variation in nurse training opportunities, we instrument for the local supply of nurses to estimate the impact of nurses on an important marker of community health: mortality.  The increase in nurses brought about by the shift to public support of nurse training led to a significant decline in local rates of mortality (including infant and elderly), suggesting important spillovers associated with public investments in women’s human capital.

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Abstract

The 1940s witnessed substantial reductions in the Black-white earnings gap. We study the role that domestic WWII defense production played in reducing this gap. Exploiting variation across labor markets in the allocation of war contracts to private firms, we find that war production contracts resulted in significant increases in the earnings of Black workers and declines in the racial wage gap, with no effect on white workers. This was achieved via occupational upgrading among Black men to skilled occupations. The gains largely persisted through at least 1970. Using a structural model, we show that declines in discrimination (and not migration or changes in productivity) account for all of the occupational upgrading and half of the estimated wage gains associated with the war production effort. Additionally, the war production effort explains one quarter (one seventh) of the overall improvements in racial gaps in occupation allocations (wages) witnessed over this decade. Finally, war spending led to an increase in the high school graduation rate of Black children, suggesting important intergenerational spillovers associated with declines in labor market discrimination.

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Abstract

We study the lifetime effects of the first and largest American youth employment and training program in the U.S. – the Civilian Conservation Corps (CCC), 1933-1942. We match newly digitized enrollee records to census, WWII enlistment, Social Security, and death records. We find that longer service in the CCC led to improvements in height, health status, longevity, geographic mobility, and lifetime earnings but did not improve short-term labor market outcomes including employment and wages. We address potential selection into CCC duration using an IV strategy as well as two newly developed control function approaches that leverage unbiased estimates of the short-term effects of a randomized control trial of Job Corps (the modern version of the CCC). Our findings suggest that short- and medium-term evaluations of employment programs underestimate impacts because they do not estimate lifetime effects and often ignore or underestimate health and longevity benefits which increase in magnitude at later ages. While the benefits of the program were substantial, they only partly offset losses in income and longevity associated with the Great Depression. JEL Codes: I28, I38, H53, J26

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Abstract

Child poverty fell to historic lows in 2021, in large part due to the temporary expansion of the Child Tax Credit (CTC). We consider the possible implications of this expansion on children’s short- and long-term development. To do so, we review the available short-run evidence from the 2021 expansion and the existing research evidence on the longer-run effects of similar income transfers in childhood on child health and human capital. We conclude that the CTC likely improved child health and well-being in the short and long run, with greater impacts for poor children and modest or nonexistent effects for nonpoor children. Moreover, the effects might be more substantial for younger children and for those in places with weaker safety nets. 

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Abstract

Using a unique dataset linking preschool blood lead levels, birth, school, and detention records for 125,000 children born 1990-2004 in Rhode Island, we estimate the impact of lead on school suspension and juvenile detention. Sibling fixed effect models suggest that omitted variables related to family disadvantage do not bias OLS estimates. However, measurement error does. We use IV methods that exploit local, within neighborhood, variation in lead exposure deriving from road proximity and the de-leading of gasoline. For boys, a one-unit increase in lead increased the probability of suspension from school by 6 percent and detention by 57 percent.

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Abstract

Violence within families and child neglect are strikingly common: 700,000 children are found to be victims of abuse or neglect in the United States each year; over the course of childhood, 6% of children are placed in foster care, and 18% witness intimate partner violence. These children are at much higher risks of homelessness, criminal justice involvement, unemployment, and chronic health conditions compared to their neighbors. This article reviews the state of the economics literature on the causes and consequences of child maltreatment and intimate partner violence and calls for greater research into interventions aimed at improving child well-being.

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We estimate the long-run impact of cash transfers to poor families on children's longevity, educational attainment, nutritional status, and income in adulthood. To do so, we collected individual-level administrative records of applicants to the Mothers' Pension program--the first government-sponsored welfare program in the US (1911-1935) --and matched them to census, WWII and death records. Male children of accepted applicants lived one year longer than those of rejected mothers. Male children of accepted mothers received one-third more years of schooling, were less likely to be underweight, and had higher income in adulthood than children of rejected mothers.

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Over 130,000 juveniles are detained in the US each year with 70,000 in detention on any given day, yet little is known whether such a penalty deters future crime or interrupts social and human capital formation in a way that increases the likelihood of later criminal behavior. This paper uses the incarceration tendency of randomly-assigned judges as an instrumental variable to estimate causal effects of juvenile incarceration on high school completion and adult recidivism. Estimates based on over 35,000 juvenile offenders over a ten-year period from a large urban county in the US suggest that juvenile incarceration results in large decreases in the likelihood of high school completion and large increases in the likelihood of adult incarceration. These results are in stark contrast to the small effects typically found for adult incarceration, but consistent with larger impacts of policies aimed at adolescents.

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We study how endowments, investments and fertility interact to produce human capital in childhood. First we explore the human capital production function. Exploiting an exogenous source of investment, the launch of Head Start in 1966, to identify the impact of investments (preschool) on child human capital (IQ), we find strong evidence of complementarity between investments and early human capital as evidenced by greater gains from preschool on the IQ of those with the highest initial human capital. Second, because this complementarity generates incentives for parents to invest in children with higher initial levels of human capital, we explore how investments respond to child endowments and find that they are reinforcing. Third, the degree of reinforcement increases with family size. Thus, in addition to the tradeoff in quantity and average quality, an increase in quantity also leads to greater variation in quality, due to both greater variation in endowments (from higher fertility) and greater reinforcing investments. Finally, we show that our findings are replicated by a quantity-quality tradeoff model in which children are heterogeneous with respect to their endowment and parental preferences feature weak complementarity between quality and quantity as well as moderate aversion to inequality in the human capital of children.

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Two percent of women in the US suffer from intimate partner violence annually, with poor and minority women disproportionately affected. I provide evidence of an important negative externality associated with domestic violence by estimating a negative and causal relationship between violence during pregnancy and newborn health, exploiting variation in the enforcement of laws against domestic violence for identification. I find that hospitalization for an assault while pregnant reduces birth weight by 163 grams. This sheds new light on the infant health production process as well as observed income gradients in health given that poor mothers are disproportionately affected by violence.

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Many violent relationships are characterized by a high degree of cyclicality: women who are the victims of domestic violence often leave and return multiple times. To explain this we develop a model of time inconsistent preferences in the context of domestic violence. This time inconsistency generates a demand for commitment. We present supporting evidence that women in violent relationships display time inconsistent preferences by examining their demand for commitment devices. We find that no-drop policies – which compel the prosecutor to continue with prosecution even if the victim expresses a desire to drop the charges – result in an increase in reporting. No-drop policies also result in a decrease in the number of men murdered by intimates suggesting that some women in violent relationships move away from an extreme type of commitment device when a less costly one is offered.

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Abstract

Most Americans are now in some form of managed care plan that restricts access to services in order to reduce costs. It is difficult to determine whether these restrictions affect health because individuals and firms self-select into managed care. We investigate the effect of managed care using a California law that required some pregnant women on Medicaid to enter managed care.We use a unique longitudinal database of California births in which we observe changes in the regime faced by individual mothers between births. We find that Medicaid managed care reduced the quality of prenatal care and increased low birth weight, prematurity, and neonatal death.

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This paper explores whether choice of provider explains any of the observed infant health gradients, and if so, why poor women choose different providers than their richer neighbors. We exploit an exogenous change in policy that occurred in California in the early 1990s that suddenly increased Medicaid payments to hospitals and which lead to a sharp change in where women with Medicaid delivered. To characterize the extent to which poor women responded to the increase in provider access, we calculate hospital segregation indices (which measure the extent to which Medicaid mothers delivered in separate hospitals than privately insured mothers residing in the same geographic area) both before and after the policy change for each market in California and show that it fell sharply after the policy change. Even though black mothers responded least to the increase in provider choice afforded by the policy change, they benefited the most from hospital desegregation in terms of reduced neonatal mortality and decreased incidence of very low birth weight. In contrast, other groups with lower initial neonatal mortality moved more and gained less in terms of improvements in birth outcomes.

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Abstract

This study focuses on ‘‘network effects’’ in the utilization of publicly-funded prenatal care using Vital Statistics data from California for 1989–2000. Networks are defined using 5-digit zip codes and a woman’s racial or ethnic group. Like others, we find evidence that the use of public programs is highly correlated within groups defined using race/ethnicity and neighborhoods. These correlations persist even when we control for many unobserved characteristics by including zip code-year fixed effects, and when we focus on the interaction between own group behavior and measures of the potential for contacts with other members of the group (‘‘contact availability’’). However, the richness of our data allows us to go further and to conduct several tests of one important hypothesis about networks: that the estimated effects represent information sharing within groups. The results cast doubt on the idea that the observed correlations can be interpreted as evidence of information sharing. In particular, we find estimated effects to be as large or larger among women who have previously used the program as among first-time users

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Abstract

Sawhill and Steinberg approach risky behavior among youth from two different angles: Steinberg argues for intervention during the adolescent years to alter behavior in ways that prioritize patience and self-regulation, while Sawhill advocates interventions that mitigate the negative effects of risky behavior. Both argue that disadvantaged youth suffer worse consequences as a result of risky behavior and therefore stand to gain the most from interventions. While the authors develop strong arguments for adolescent interventions, the existing evidence on their effectiveness is less compelling. To reconcile the promise with the reality, I argue that growing up in environments of significant uncertainty reduces the returns to forward-thinking behavior in the daily lives of disadvantaged youths. Interventions to develop adolescent decision-making skills so as to reduce risky behavior will not be effective if they are inconsistent with the incentives generated by a local environment that is often characterized by uncertainty.

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In 1994 Tennessee moved virtually its entire Medicaid population and new eligibles into fully capitated managed care (TennCare). We analyze Tennessee’s strategy, given limited existing managed care; and health plans’ development of managed care infrastructure. We find signs of progress and developing infrastructure, but these are threatened by concerns over TennCare’s financial viability and the state’s commitment to TennCare’s objectives. State policymakers seeking systems change need to recognize the substantial challenges and be committed to long-term investment.

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We study how advances in scientific knowledge affect the evolution of disparities in health. Our focus is the 1964 Surgeon General Report on Smoking and Health – the first widely publicized report of the negative effects of smoking on health.  Using an historical dataset that includes the smoking habits of pregnant women 1959-1966, we find that immediately after the 1964 Report, more educated mothers immediately reduced their smoking as measured by both self-reports and serum cotinine levels, while the less educated did not, and that the relative health of their newborns likewise increased.  We also find strong peer effects in the response to information: after the 1964 report, educated women surrounded by other educated women were more likely to reduce smoking relative to those surrounded by less educated women.  Over time, the education gradient in both smoking and newborn health continued to increase, peaking in the 1980s and then shrinking, eventually returning to initial levels.  These results can explain why in an era of great advancements in medical knowledge, health disparities may actually increase, at least initially.

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Abstract

During the 1990s many states extended Medicaid eligibility to low-income parents who were not receiving welfare. We evaluate the effects of those expansions on health insurance coverage. To account for unobservable differences between expansion states and non-expansion states that may be correlated with both policy decisions and insurance coverage, we employ a within-state difference-in-difference technique that makes use of data only from expansion states. We find that the parental eligibility expansions increased Medicaid coverage of mothers with only small effects on private coverage. The expansions also increased the coverage of children, presumably by raising the benefit to the family of applying for coverage. We find substantial racial and ethnic differences in the effects of the expansions. As a result, the expansions help reduce racial and ethnic gaps in insurance coverage, particularly for adults.

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Abstract

Three quarters of American children have been exposed to neighborhood violence in their lifetimes. Most of the existing research has concluded that exposure to violence leads to restricted emotional development, aggressive behavior and poor school outcomes. However, this literature fails to account for the fact that children exposed to neighborhood violence are highly disadvantaged in other ways: they are more likely to be black, poor and have poorly educated parents. As such, it is not clear whether exposure to violence or the underlying measures of disadvantage are responsible for the poor child outcomes observed. Using individual survey data on urban youth and their families from Los Angeles, we find that the most violent neighborhoods are also characterized by the highest degree of disadvantage: greatest poverty, highest unemployment, least education. And while living in a violent neighborhood increases the probability of exposure to violence, within violent neighborhoods those personally exposed to street violence are significantly more disadvantaged and are more likely to associate with violent peers than their unexposed neighbors. Once we control for observed and unobserved family disadvantage, the impact of violence declines for some child outcomes, suggesting that underlying disadvantage explains some of the negative outcomes observed, but not all - it is still the case that associating with violent peers is negatively correlated with cognitive test scores. In addition, when we control for underlying differences across families, the relationship between violence and internalizing behavioral problems appears stronger.

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