Research

Publications

"Policy-Making, Trust and the Demand for Public Services: Evidence from a Mass Sterilizations Campaign" Forthcoming at the American Economic Journal: Economic Policy. (with Gianmarco Leon and Fernando Fernandez)

Media Coverage: VOXDev, VOXEu CEPR, Nada es Gratis

Abstract: We study a large-scale family planning intervention in which more than 260,000 Peruvian women were sterilized. Many of these medical procedures are alleged to have been performed without patient consent. The subsequent disclosure of alleged illegal sterilizations caused reductions in the usage of contraceptive methods, prenatal and birth delivery services, and—more generally—the demand for medical services in affected areas. As a result, child health worsened. The results persist for at least 17 years after the information disclosure and are driven by disappointed supporters of the implementing government. Learning about the government’s malpractices undermined trust in institutions.

"Does political participation recover after a civil war? Evidence from Bosnia and Herzegovina"  Journal of Comparative Economics, December 2020, Volume 48, Issue 4, Pages 841-865. (with Caterina Alacevich)

Abstract: We investigate the effect of violence against civilians on voting. Using data from elections in Bosnia and Herzegovina between 1990 and 2014 and exploiting variation in war intensity across municipalities, we estimate a negative impact on voter turnout. The effect is stable and persistent over twenty years after the war resolution. Our results are robust to the inclusion of pre- and post-war socioeconomic and political characteristics, to instrumental variable estimations based on terrain ruggedness, and to restricting the sample to voters who were too young to be selectively targeted. Distinguishing between civilian and military victims, we show that violence against civilians drives the negative effect. Next, we examine different mediating mechanisms including forced migration and demographic selection, ethnic composition, physical capital damage, post-conflict reconstruction, and economic conditions. Our results support the hypothesis that violence affects voting through a "moral" disutility from showing allegiance to politics and the society by casting a vote. Using survey data, we show that respondents in more affected municipalities report lower generalized trust, trust in institutions, and voting.

Working Papers

"Lost in the Net? Broadband Internet and Youth Mental Health" (with Dante Donati, Ruben Durante, and Francesco Sobbrio)

Media Coverage: CEPR Video Vox

Abstract: How does the internet affect young people’s mental health? We study this question in the context of Italy using administrative data on the universe of cases of mental disorders diagnosed in Italian hospitals between 2001 and 2013, which we combine with information on the availability of high-speed internet at the municipal level. Our identification strategy exploits differences in the proximity of municipalities to the pre-existing voice telecommunication infrastructure, which was previously irrelevant but became salient after the advent of the internet. We find that access to high-speed internet has a significant positive effect on the incidence of mental disorders for young cohorts but not for older ones. In particular, internet access leads to an increase in diagnoses of depression, anxiety, drug abuse, and personality disorders - for both males and females - and of eating and sleep disorders - for females only. We find similar results for urgent and compulsory hospitalizations and self-harm episodes. These results suggest that the effect of broadband is driven by a rise in the underlying prevalence of mental disorders and not merely by increased awareness about these pathologies.

"The Role of Pharmaceutical Promotion to Physicians in the Opioid Epidemic" (with Fernando Fernandez)

Abstract:  This paper studies the effects of pharmaceutical promotion of opioid drugs on opioid-related overdose deaths in the US. Using novel data on links between sales representatives of opioid drugs and physicians, we show that counties with higher opioid promotion targeted to doctors also have higher opioid overdose mortality rates. We identify these effects using the presence of state-level bans on pharmaceutical promotion to physicians and the distance between counties and pharmaceutical companies' headquarters to instrument opioid promotion. Moreover, we present evidence from Medicare Part D prescription data showing that doctors receiving promotion of opioid drugs prescribe more opioid painkillers.

Handbook Chapters

"Economics of Suicide". Zimmermann K. (eds) Handbook of Labor, Human Resources and Population Economics. Springer, Cham.  (with Dave Marcotte)

Resting working papers

"Opioid Promotions and Suicide"  (with Mark Borgschulte)

Abstract: We study the relationship between opioid painkiller availability and non-poisoning suicide rates in the US. We show that suicide rates are higher in counties where doctors are more likely to receive pharmaceutical promotion for opioid drugs, which leads to higher opioid prescription rates. The positive relationship is mitigated in states with mandatory access prescription drug monitoring programs, which track patients’ and physicians’ opioid prescription history. Doctors in these states prescribe fewer opioids in response to promotion. Our estimates imply that the increase in opioid prescriptions can explain an important share of the rise in suicide over the last 25 years.