Dollar Stores, Food Environments, and Birth Outcomes in the United States (JMP) with Pinka Chatterji and Chun-Yu Ho [Paper]
Abstract: Prior research shows that neighborhood food environments influence infant birth outcomes (Lhila, 2011; Powell & Bao, 2009; Kinsey et al., 2023), but existing studies largely focus on supermarkets and grocery stores or on small geographic areas, overlooking the role of fast-growing discount retailers such as dollar stores. We study whether the expansion of dollar stores affects infant birth outcomes in the United States. Combining 2003–2021 birth certificate data from the National Vital Statistics System with county-level dollar store counts from the National Neighborhood Data Archive, we examine birth outcomes among singleton births to unmarried mothers with a high school degree or less. Fixed-effects estimates indicate that greater dollar store exposure is associated with higher average birth weight and increased prevalence of high-birth-weight and large-for-gestational-age births, suggesting a shift toward the upper tail of the birth-weight distribution rather than a broad improvement in infant health. To address the endogenous location of dollar stores, we implement a spatial instrumental-variables strategy that exploits expansion in geographically distant markets. The IV estimates reinforce the broad fixed-effects pattern but imply substantially larger effects, highlighting the importance of endogenous store placement and the source of identifying variation. The effects are heterogeneous across maternal and community characteristics, including race, age, income, rural status, and local food access, but are not uniformly concentrated among the most disadvantaged populations. Mechanism analyses suggest that dollar store expansion reshapes local retail environments rather than simply displacing existing retailers and may increase some dimensions of food availability while reducing access to healthier food options. Pregnancy-related outcomes provide additional evidence of changes in maternal health and delivery timing. Overall, the findings highlight an important distinction between physical food access and nutritional quality and suggest that increased retail availability does not necessarily translate into improved early-life health.
State EITC Expansions, Children’s health care Utilization, and the role of Social Protection Programs [Paper]
Abstract: The Earned Income Tax Credit (EITC) is one of the largest anti-poverty policies in the United States, designed to reduce financial constraints faced by low-income working families. While prior research has documented positive effects of the EITC on children’s health outcomes, relatively little is known about its impact on healthcare utilization or the mechanisms through which these effects occur. This paper examines the effect of state-level EITC expansions on children’s healthcare access and utilization using data from the 2016–2023 National Survey of Children’s Health (NSCH). Employing a TWFE difference-in-differences framework with continuous treatment intensity, I focus on families where the highest parental education is a high school degree. I find that a $1,000 increase in state EITC benefits raises the probability of a doctor visit by 1.4 percentage points and increases preventive medical and ER visits by 0.7 and 1.7percentage points, respectively, with significant effects being observed for older Hispanic children. Further analysis identifies ease of access and usual source of care as mechanisms. EITC expansions improve ease of access and increase the likelihood that children have a usual source of care when sick. Importantly, the effects are stronger when accounting for participation in other social protection programs such as SNAP, WIC, school lunch programs, and Medicaid/CHIP. These results provide new evidence that state EITC expansions improve children’s healthcare utilization and suggest that complementarities with other safety-net programs amplify these effects, with implications for ongoing state-level policy debates.
Behavioral Information and Household Food Demand: Evidence from Nutrition Video Experiment in Urban Ethiopia [Paper] Under Review
Abstract: Behavioral change communication (BCC) interventions are widely used to promote healthier diets, yet limited evidence exists on how such interventions affect underlying demand behavior and price responsiveness. This paper evaluates the impact of a video-based BCC intervention on household food demand in urban Ethiopia using three rounds of panel data from a randomized controlled trial conducted between 2019 and 2021. The analysis combines reduced-form expenditure share models with a structural Quadratic Almost Ideal Demand System (QUAIDS) to examine both expenditure allocation and demand responsiveness. The results show that the BCC intervention leads to a modest but persistent increase in the expenditure share allocated to fruits and vegetables, reflecting a reallocation of spending within constrained food budgets. However, once prices and total expenditure are accounted for, there is limited evidence of systematic shifts in baseline demand parameters. Instead, the intervention primarily affects how households respond to price variation, with statistically significant differences in price elasticities across treatment groups. These findings indicate that behavioral change communication operates through changes in allocation and price responsiveness rather than through fundamental shifts in preferences. Despite increased awareness, households remain highly sensitive to food prices, particularly among poorer households, highlighting the continued importance of affordability constraints. Overall, the results provide causal evidence that information-based interventions alone are unlikely to generate sustained improvements in diet quality without complementary policies that address food prices and household purchasing power.
Hirvonen, K., Wolle, A., Laillou, A., Vinci, V., Chitekwe, S., & Baye, K. (2024). Child growth faltering dynamics in food insecure districts in rural Ethiopia. Maternal & Child Nutrition, 20, e13262. https://doi.org/10.1111/mcn.13262
Hirvonen, K., Wolle, A., Laillou, A., Vinci, V., Chitekwe, S., & Baye, K. (2024). Understanding delays in the introduction of complementary foods in rural Ethiopia. Maternal & child nutrition, 20, e13247. https://doi.org/10.1111/mcn.13247
Abate, Gashaw T., Kaleab Baye, Alan de Brauw, Kalle Hirvonen, and Wolle A. (2023). Video‐based behavioral change communication to change consumption patterns: Experimental evidence from urban Ethiopia. Journal of the Agricultural and Applied Economics Association2: 164–180. https://doi.org/10.1002/jaa2.51
Abate, G. T., De Brauw, A., Hirvonen, K., & Wolle, A. (2023). Measuring consumption over the phone: Evidence from a survey experiment in urban Ethiopia.* Journal of Development Economics, 161, 103026. https://doi.org/10.1016/j.jdeveco.2022.103026
*AAEA Africa Section's best publication for 2023
Abate, G. T., De Brauw, A., Gibson, J., Hirvonen, K., & Wolle, A. (2022). Telescoping Error in Recalled Food Consumption: Evidence from a Survey Experiment in Ethiopia, The World Bank Economic Review, Volume 36, Issue 4, Pages 889 - 908. https://doi.org/10.1093/wber/lhac015
Birhane, Guush; Abate, Gashaw Taddese; and Wolle, Abdulazize, (2022). Agricultural Intensification in Ethiopia: Patters, Trends, and Welfare Impacts. IFPRI Discussion Paper #02150. Washington, DC: International Food Policy Research Institute (IFPRI).
Birhane, Guush et al. (2020) Evaluation of the nutrition-sensitive features of the fourth phase of Ethiopia's Productive Safety Net Programme. ESSP Working Paper 140. Washington, DC: International Food Policy Research Institute (IFPRI)
Wolle, A., Hirvonen, K., de Brauw, A., Baye, K. & Abate, G. T. (2020). Household food consumption patterns in Addis Ababa, Ethiopia. Working Paper #139. Ethiopia Strategy Support Program, International Food Policy Research Institute.
Hirvonen K, and Wolle A. Consumption, production, market access and affordability of nutritious foods in the Afar Region of Ethiopia. Addis Ababa, Ethiopia: Alive & Thrive and International Food Policy Research Institute, 2019. https://www.aliveandthrive.org/wp-content/uploads/2019/10/Afar-Nutrition-Sensitive-Agriculture-full-report.pdf
Hirvonen K, and Wolle A. Consumption, production, market access and affordability of nutritious foods in the Amhara Region of Ethiopia. Addis Ababa, Ethiopia: Alive & Thrive and International Food Policy Research Institute, 2019. https://www.aliveandthrive.org/wp-content/uploads/2019/10/Amhara-Nutrition-Sensitive-Agriculture-full-report.pdf
Hirvonen, K., Wolle, A., & Minten, B. (2018). Affordability of fruits and vegetables in Ethiopia. Research Note #70. Ethiopia Strategy Support Program, International Food Policy Research Institute.
Smoke-Free Laws, E-Cigarettes, and Health at Birth
Agricultural intensification, Productivity, and Household Welfare: Evidence from panel data in Ethiopia (with Gashaw T. Abate, Guush Birhane)
Parental Locus of Control and the Effect of Nutrition Sensitive Interventions in Rural Ethiopia