Working papers

Declining economic opportunity is often portrayed as one of the drivers of the opioid epidemic. Better employment conditions can, however, affect opioid use through two channels: increasing physical pain from working or reducing mental distress that can contribute to substance abuse. I use a large dataset of opioid and over-the-counter (OTC) painkiller sales to measure the effect of employment shocks on demand for pain medication. To separate the channels, I contrast the effect of labor demand shocks on the use of opioids with the effect on the use of OTC painkillers---which address pain but not mental health---allowing for the effects to depend on the injury rate of local industries. I find that a 1 percent increase in the employment-to-population ratio decreases the per-capita demand for opioids by 0.20 percent, while it increases the per-capita demand for OTC painkillers by 0.14 percent. To decompose the effect of employment on opioid use in the two channels, I calculate the substitution between these pain medications, exploring the introduction of a policy that increased requirements to prescribe opioids. My findings show that during local economic expansions, the decline in opioid abuse is 40 percent larger than the total effect on use while, at the same time, the demand for pain relief medication increases and is related to jobs in high injury industries.

The earlier a woman learns about her pregnancy status, the sooner she can make decisions about her own and her infant’s health. This paper examines how women learn about their pregnancy status and measures how access to pregnancy tests affects pregnancy knowledge. Using ten-years of individual-level monthly panel data in Nepal, we find that, on average, women learn they are pregnant in their 5.4th month of pregnancy. Living approximately a mile farther from a clinic offering pregnancy tests increases the time they know they are pregnant by one week (a 4.5 percent increase), and decreases the likelihood of knowing in the first trimester by 3.8 percentage points (a 13.5 percent decrease). Women with prior pregnancies experience the most substantial effects of distance within the first two trimesters, while, for women experiencing their first pregnancy, distance does not affect knowledge in the first trimesters. This difference suggests that access to pregnancy tests is a binding constraint only after women’s beliefs, or symptoms, about being pregnant are strong enough.

Work in progress

The Mechanisms Underlying the Decline in Fertility during the Zika Epidemic in Brazil

Brazil was hit by the Zika epidemic for the first time in 2015. The epidemic affected the population in several ways and is correlated with a decline in fertility observed in 2016. This paper replicates this drop in fertility and examines the mechanisms that caused the decision to not have children. Specifically, this study proposes to disentangle three mechanisms that are related to the Zika epidemic and may have affected the decision not to have children: the prevalence of Zika, the prevalence of microcephaly in newborns, and the media coverage of the epidemic. As the epidemic occurred for the first time in Brazil in the period of this study, the results tell about how people learn and respond to information during epidemics.

The Effect of Presidential Election Outcomes on Alcohol Drinking (with Rodrigo Schneider)

The growing political polarization in the media and social media has been linked to straining social ties worldwide. The 2016 presidential elections in the United States reflected this trend, with reports of anger and mistrust among voters. We examine how the 2016 election results can be linked to episodes of anxiety and self-medication. We analyze purchases of alcohol after the elections, comparing counties by the share of votes to the losing party. We show that counties with a larger percentage of losing votes increase the consumption of alcohol in the weeks right after the election results. The effect is driven by counties with more immigrants, higher income, and higher education levels. Preliminary results also show that the number of fatal car crashes increased in counties with a higher share of losers. This result is unique to the 2016 elections and absent in previous years.

Early Resolution of Pregnancy Uncertainty: a Research Agenda on Pregnancy Tests and Reproductive Health (with Akito Kamei, Ryoko Sato and Rebecca Thornton)

Women in developing countries, especially in African countries, bear high reproductive health burdens, which can be reduced through the access to continuum of care, a continuity of essential care throughout the reproduction cycle starting from pre-pregnancy through post-delivery. Earlier resolution of pregnancy status lead to earlier initiation of the causal chain of continuum reproductive care. However, little attention has been given to the potential effect of early resolution of pregnancy uncertainty. Access to pregnancy tests can resolve the uncertainty of pregnancy status earlier, which can then lead to adequate and sufficient health behaviors. This paper presents the high prevalence of pregnancy uncertainty faced by women in developing countries, and discusses the potential benefits of early pregnancy detection, through the utilization of pregnancy tests, as well as potential barriers to the use of pregnancy tests.

Published work

The Impacts of Business Support Services for Small and Medium Enterprises on Firm Performance in Low-and Middle-Income Countries: A Systematic Review. Campbell Systematic Reviews 12, no. 1, 2016 (with Piza, C, T. Cravo, L. Taylor, L. Gonzalez, I. Furtado, A. Sierra, and S. Abdelnour)

This Campbell systematic review assesses the effects of business support services in low- and middle-income countries on firm performance and economic development. The review summarizes findings from 40 studies. Support to small and medium enterprises (SMEs) can improve their revenue and profits, their ability to create jobs, labour productivity and their ability to invest. But these effects are not large, and the cost effectiveness of the interventions not known. The effects on innovation are unclear.

The Profile of Individuals with a Professional Degree in Brazil. (Perfil dos indivíduos que cursam educação profissional no Brasil). Economia e Sociedade (UNICAMP), v. 22, p. 237-262, 2013 (with Ana Flavia Machado)

An increasing number of public and private institutions provide professional qualification in Brazil, which qualifies individuals for the labor market. However, we do not know who the individuals who join this training are, or if there is a wage gap which favors those who receive the qualification. Using the 2007 National Household Survey (PNAD), we show that this type of qualification is mostly sought after by unemployed individuals. Among those employed, the professional qualification leads to an increase in labor-market income.

Determinants of Access to Credit for Low-Income Population in Brazil from 2002 to 2008. Cambridge Conference on Business Economics Program, Proceedings, 2011 (with Claudia Yoshinaga and William Eid Junior)

This study evaluates the supply of credit for the low-income population in Brazil in two periods – 2002 and 2008. During this period, the poorest share of the population achieved higher real purchasing power due to the good economic period in Brazil and to the public policies such as income transfer and real raise of minimum wage (from BRL200.00 or USD56.61 in 2002 to BRL415.00 or USD117.58 in 2008). This paper contributes to the literature because it shows that, besides becoming more accessible, credit has become more democratic; attributes such as years of formal education are now more important to determine access to credit than previously used characteristics, such as race or gender. Moreover, its access has become more geographically distributed within the national territory, reducing regional difference traits in Brazil. At last, it is important to highlight the chance to companies and also to the government to act, since access to credit for the low-income population, although being in expansion, is still restrict. Therefore, considering the size and representativeness of this population in the Brazilian economy, there is still a long way to go, which may bring opportunities to companies and individuals.