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. Two-way fixed-effects (TWFE) estimates show that greater dollar store density is associated with higher average birth weight and an increased probability of high birth weight, suggesting a rightward shift in the birth-weight distribution rather than reductions in low birth weight. However, dollar store placement may be endogenous to local economic and demographic trends. To address this concern, we implement an instrumental variables (IV) strategy based on a shift–share design using dollar store expansion in neighboring counties. The IV estimates differ markedly from fixed-effects results and indicate that marginal dollar store expansion may reduce birth weight and worsen other infant health outcomes, particularly in economically disadvantaged, rural, and low food access counties. We find consistent evidence linking dollar store exposure to increased maternal gestational diabetes, supporting a nutritional mechanism. Additional analyses show that dollar store expansion reshapes local food markets in ways that reduce access to healthy food options. Together, the results highlight substantial heterogeneity in the health effects of retail expansion and suggest that policies emphasizing physical food access alone may overlook important dimensions of dietary quality and maternal 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]
Abstract: Information-based nutrition interventions are widely used to promote healthier diets, yet limited evidence exists on how such interventions affect household food demand behavior beyond observed changes in consumption. This study evaluates the impact of a video-based behavioral change communication (BCC) intervention on household food demand in urban Ethiopia. Using three rounds of household survey data collected between 2019 and 2021 and exploiting randomized assignment to two BCC treatment arms, the analysis combines reduced-form expenditure-share models with a structural Quadratic Almost Ideal Demand System (QUAIDS) estimated via seemingly unrelated regressions. The results indicate that the BCC intervention induces a modest but meaningful reallocation of food expenditures toward fruits and vegetables, with expenditure shares increasing by approximately 1–1.3 percentage points in the post-intervention period. These changes persist at follow-up and are accompanied by distributional shifts in fruit and vegetable budget shares among treated households. However, once prices and total expenditure are accounted for, the intervention does not generate large or persistent shifts in baseline demand parameters. Income and prices remain the dominant determinants of dietary choice, with fruits and vegetables exhibiting strong income and price responsiveness, particularly among poorer households. Allowing the intervention to affect price responsiveness reveals statistically significant differences in elasticities between treated and control households, reflecting changes in behavioral responses to price variation rather than fundamental changes in preferences. Poor households remain highly price sensitive, underscoring the importance of affordability constraints. Overall, the findings suggest that behavioral change communication can influence dietary allocation within existing budgets but is unlikely to generate sustained improvements in diet quality in the absence of complementary policies that address food affordability and access.
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)