Research

1. Firms and Worker Health
NBER Link: NBER Working Paper #32011

Joint with Alexander Ahammer and Jonathan Smith

Abstract: We estimate the role of firms in worker health care utilization. Using linked administrative data on Austrian workers from 1998-2018, we exploit mobility between firms to estimate how much a firm contributes to worker-level differences in utilization in a setting with non-employer provided universal health care. We find that firms are responsible for nearly 30 percent of the variation in across-worker health care expenditures. Effects are not driven by changes in geography or industry. We then estimate a measure of relative firm-specific utilization and explore existing correlates to help explain these effects.

2. Effects of Universal and Unconditional Cash Transfers on Child Maltreatment
NBER Link: NBER Working Paper #31733

Joint with Lindsey Rose Bullinger and Kerri Raissian

Abstract: We estimate the effects of cash transfers on a severe measure of child welfare: maltreatment. To do so, we leverage year-to-year household variation in cash transfers from a universal and unconditional cash transfer, the Alaska Permanent Fund Dividend (PFD). Using linked individual-level administrative data on PFD payments and child maltreatment referrals, we compare children in otherwise-similar families and find that an additional $1,000 to families in the first few months of a child's life reduces the likelihood that a child is referred to Children's Protective Services by age 3 by 2.0 percentage points, or 10 percent, on average. Effects are driven by declines in neglect and physical abuse. Additionally, we show that larger cash transfers reduce mortality by age 5. We present some evidence that the decline in maltreatment referrals is due to changes in family stability and reductions in risky caregiving.

3. _Accessing the Safety Net: How Medicaid Affects Health and Recidivism
NBER Link: NBER Working Paper #31971

Joint with David Slusky

Abstract: We estimate the causal impact of access to means-tested public health insurance coverage (Medicaid) on health outcomes and recidivism for those recently released from incarceration. To do so, we leverage a policy change in South Carolina that allowed simplified Medicaid re-enrollment for previously incarcerated individuals. Using linked administrative data on criminal convictions and health insurance claims, we find that reducing barriers in access to Medicaid for vulnerable populations increases enrollment and utilization of health care services. However, we do not find that this increased access to Medicaid reduces 1-year or 3-year recidivism, suggesting that effectiveness of such policies is context dependent.

4. Disability Insurance Screening and Worker Outcomes
IZA Link: Discussion Paper No. 16235

Joint with Alexander Ahammer

Abstract: We estimate the returns to more targeted disability insurance (DI) programs in terms of labor force participation, program spillovers, and worker health. To do so, we analyze workers after an acute workplace injury that experience differential levels of application screening. We find that when workers face stricter screening requirements, they are less likely to claim disability and are more likely to remain in the labor force. We observe no differences in any physical or mental health outcomes. Our findings imply that imposing stricter DI screening has large fiscal benefits but does not yield any detectable health costs, on the margin.

Media Coverage: AEI

5. Effects of Expanding Contraceptive Choice: New Evidence from Virginia's Contraceptive Access Initiative

Joint with Jessica Kiser
(awaiting approval)

Publications

1. Effects of Unemployment Insurance Duration on Mental and Physical Health
NBER Link: NBER Working Paper #27267

Journal of Public Economics, 226, 2023. Joint with Alexander Ahammer

Abstract: Using administrative data for Upper Austrian workers from 2003-2013, we show that a 9-week extension in unemployment insurance (UI) duration increases nonemployment length and impacts worker physical and mental health. These effects vary by gender. Specifically, we find that female workers eligible for an additional 9 weeks of UI benefits fill fewer opioid and antidepressant prescriptions and experience a lower likelihood of filing a disability claim. Moreover, we find some evidence of beneficial within-household spillovers for young children. For male workers, we find no health effects of extending UI benefit duration. We posit that these differential effects are driven by a combination of income and occupational changes that also vary by gender.

2. Syringe Exchange Programs and Harm Reduction: New Evidence in the Wake of the Opioid Epidemic
NBER Link: NBER Working Paper #26111
Journal of Public Economics, 215, 2022.

Frequently Asked Questions and explanation of methodology
Database of SEP clinic openings

Abstract: In light of the recent opioid crisis, many public health entities have called for an expansion in syringe exchange programs (SEPs), which provide access to sterile syringes and facilitate safe needle disposal for injection drug users. This paper uses a newly constructed administrative dataset to estimate the effects of recent SEP openings on HIV diagnoses and drug-related deaths. Estimates for HIV rates are relatively imprecise. However, I present new evidence that SEPs increase rates of opioid-related mortality, suggesting that needle exchanges alone may be less effective than other interventions at stimulating recovery, especially in areas with high barriers to substance abuse treatment.

Media Coverage: Brookings Institute, Wall Street Journal, Probable Causation, Vice, The Economist

3. Hungry for Success? SNAP Timing, High-Stakes Exam Performance, and College Attendance
NBER Link: NBER Working Paper #28386
American Economic Journal: Economic Policy, 14(4), 2022. Joint with Timothy Bond, Jillian B. Carr, and Jonathan Smith

Abstract: Monthly government transfer programs produce cycles of consumption that track benefit receipt, creating periods in which many households experience food insecurity. In this paper, we exploit state-level variation in the staggered timing of nutritional assistance benefit issuance across households to analyze how this monthly cyclicality in food availability affects academic achievement. Using individual-level score data from a large national college entrance exam in the United States linked to national college enrollment data, we find that taking this high-stakes exam in the last two weeks of the SNAP benefit cycle reduces test scores and lowers the probability of attending a 4-year college for low-income high school students.

Media Coverage: NYTimes

4. COVID-19 and Crime: Effects of Stay-at-Home Orders on Domestic Violence
NBER Link: NBER Working Paper #27667
American Journal of Health Economics, 7(3), 2021. Joint with Lindsey Rose Bullinger and Jillian B. Carr

Abstract: COVID-19 has led to an abrupt change in time spent at home, with many cities and states implementing official stay-at-home (SAH), or ``lockdown" policies. Using cell phone block-level activity data and administrative 911 and crime data from the city of Chicago, we estimate the effects of the Illinois governor's SAH order on calls for police service, crimes recorded by police, and arrests made relating to domestic violence. We find that the SAH order announcement increased time spent at home, leading to a decrease in total calls for police service, but a subsequent increase in domestic violence-related calls for police service. Effects are larger in areas with a high proportion of renters and married households with children, for whom staying at home may be particularly challenging. These effects for domestic violence calls, however, are at odds with reported domestic-related crimes and arrests by police officers; we find that official reports and arrests for domestic violence crimes fell by 8.7 percent and 26.3 percent, respectively. Trends in reported domestic violence crimes mirror drops in total reported crimes; however, declines for domestic violence crimes are an order of magnitude smaller than the decline in other non-violent crime rates. Overall, we estimate that nearly 1,000 cases of domestic violence crimes went underreported between March and April.

Media Coverage: The Conversation

5. SNAP Schedules and Domestic Violence
Journal of Policy Analysis and Management, 40(2), 2021. Joint with Jillian B. Carr

Abstract: This paper exploits a policy change in Illinois that altered monthly nutritional assistance benefits dates to estimate the impact of in-kind benefit receipt on domestic violence. We find that issuing SNAP benefits on days other than the first of the month increases domestic crimes. On average, we find the shifting benefit dates increases domestic abuse by 6.9% and child maltreatment by 30.0%. We posit that these effects are driven by increases in opportunities for conflict or changes in drug use.

Media Coverage: Closer Look Podcast, Chicago Policy Review, Economics Observatory

6. The Power of the IUD: Effects of Expanding Access to Contraception Through Title X Clinics
NBER Link: NBER Working Paper #25656
Journal of Public Economics, 192, 2020. Joint with Jason M. Lindo and Andrea Kelly

Abstract: We estimate the effect of Colorado's Family Planning Initiative, the largest program to have focused on long-acting-reversible contraceptives in the United States, which provided funds to Title X clinics so that they could make these contraceptives available to low-income women. We find substantial effects on birth rates, concentrated among women in zip codes within 7 miles of clinics: the initiative reduced births by approximately 20 percent for 15-17 year olds and 18-19 year olds living in such zip codes. We also examine how extensive media coverage of the initiative in 2014 and 2015 altered its reach. After information spread about the availability and benefits of LARCs, we find a substantial increase in LARC insertions, extended effects on births among 15-17 year olds living greater than 7 miles from clinics, and significant reductions in births among 20–24 and 25–29 year olds.

Media Coverage: The Daily Mail, The Denver Post, The Weeds (Vox), PBS, NYTimes, Brookings

7. The Effects of Physical Education on Student Fitness, Achievement, and Behavior
Economics of Education Review, 72, 2019. Joint with Brittany Street

Abstract: Despite the mounting evidence that physical education (PE) has health and education benefits for elementary-aged children, much less is known on the effectiveness of such programs for older children. To study the effects of PE on adolescents, we analyze the impact of Texas Fitness Now (TFN), a four-year $37 million grant program that mandated daily PE for middle-school students in low-income schools. Using a regression discontinuity approach to exploit the cutoff in school eligibility, we find that daily PE mandates do not lead to overall improvements in student fitness, including cardiovascular endurance, strength, and flexibility. Although we show that program was ineffective at changing average student body composition, estimates indicate that TFN reduced the proportion of obese students, suggesting that PE may be beneficial for the most at-risk students. Using individual-level school records data, we find that PE does not lead to positive spillover effects in the classroom, including improvements in standardized test scores, or increases in attendance for 6th, 7th and 8th graders. Instead, we provide some evidence to suggest that PE reduces attendance rates and increases disciplinary incidents for middle-school students.

Media Coverage: The Atlantic, WDEL

8. SNAP Benefits and Crime: Evidence from Changing Disbursement Schedules
Review of Economics and Statistics, 101(2), 2019. Joint with Jillian B. Carr

Abstract: In this paper, we study the effects of the timing of nutritional aid disbursement on crime, using two main sources of variation: (i) a policy change in Illinois that substantially increased the number of SNAP distribution days, and (ii) an existing Indiana policy that issues SNAP benefits by last name. We find that staggering SNAP benefits leads to large reductions in crime and theft at grocery stores by 17.5 percent and 20.9 percent, respectively. Findings also show that theft decreases in the second and third weeks following receipt, but increases in the last week of the benefit cycle due to resource constraints.

Media Coverage: Washington Post, Chicago Tribune, Berkshire Eagle, Boston Globe, Oklahoma Policy Institute, Illinois Public Media, Business Insider, Vox, Marginal Revolution, Brookings Institute

9. Family Planning Funding Cuts and Teen Childbearing
Journal of Health Economics, 55(1), 2017.

Abstract: Publicly funded family planning clinics provide low-cost and free contraception to nearly 1.5 million teens each year. In recent years, several states have considered legislation to defund family planning services, although little is known about how these cuts affect teen pregnancy. This paper fills this knowledge gap by exploiting a policy change in Texas that reduced funding for family planning services by 67 percent and resulted in over 80 clinic closures. I estimate the effects of the funding cuts on teen health outcomes using a difference-in-differences approach that compares the changes in teen birth rates in Texas counties that lost family planning funding to changes in counties outside of Texas with publicly funded clinics. Results indicate that reducing funding for family planning services in Texas increased teen birth rates by approximately 3.4 percent over four years with effects concentrated 2-3 years after the initial cuts.

Media Coverage: Dallas Morning News, Politico, Huffington Post, Daily Kos, Vice, The Austin Chronicle, The Daily Dot, Romper, Refinery29, Houston Chronicle, America Now, Teen Vogue, Washington Monthly, Patheos, Common Dreams, Self, The Mary Sue, Bustle (1), The Young Turks, The Pump Handle, Dead State, Think Progress, Cleveland.com, Red State Disaster, Rare Houston, National Review, The Nation, Tulsa World, Salon, Metro, RedOrbit, Real Clear Life, Longview News-Journal, Sheila Kennedy, IFLScience, Bustle (2), Houston Public Media, The Battalion, Las Vegas Sun

10. How Much Can Expanding Access to Long-Acting Reversible Contraceptives Reduce Teen Birth Rates?
American Economic Journal: Economic Policy, 9(3), 2017. Joint with Jason M. Lindo

Abstract: We estimate the degree to which expanding access to long-acting reversible contraceptives (LARCs) can reduce teen birth rates by analyzing Colorado's Family Planning Initiative, the first large-scale policy intervention to expand access to LARCs in the United States. Using a difference-in-differences approach, we find that the $23M program reduced the teen birth rate in counties with clinics receiving funding by 6.4 percent over five years. These effects were concentrated in the second through fifth years of the program and in counties with relatively high poverty rates. State-level synthetic control estimates offer supporting evidence but suffer from a lack of power.

Media Coverage: NYTimes, Denver Post, Vox, publichealtheconomics.org

11. The Effects of State-Level Abstinence-Based Sex Education Mandates on Teen Health Outcomes
Health Economics, 26(4), 2017. Joint with Jillian B. Carr

Abstract: In 2011 the United States had the second highest teen birth rate of any developed nation, according to the World Bank. In an effort to lower teen pregnancy rates, several states have enacted policies requiring abstinence-based sex education. In this study, we utilize a difference-in-differences research design to analyze the causal effects of state-level sex education policies from 2000-2011 on various teen sexual health outcomes. We find that state-level abstinence education mandates have no effect on teen birth rates or abortion rates, although we find that state-level policies may affect teen sexually transmitted disease rates in some states.