Previous research documented that midwifery service quality improvements lead to improving maternal and infants’ health outcomes. However, little is known about its influence for later-life outcomes including disability. This paper explores the potential effects of early-life exposure to the establishment of midwifery laws across US states on later-life disability outcomes. Midwifery laws were enacted during the late 19th and early 20th century and required midwives to gain formal education and training to obtain a license in order to legally practice. We use decennial census data over the years 1970–2000 and implement a difference-in-difference method and show that being born in a reform state is associated with significant reductions in various measures of disability, including work disability, cognitive difficulty, ambulatory difficulty, self-care difficulty, and a proxy for severe mental health. We also find significant increases in education, socioeconomic scores, housing wealth, and income. We further discuss the policy implications of the results.
Prior research has found that
a high level of residential racial segregation, or the degree to which racial/ethnic groups are isolated from one another, is associated with worsened infant health outcomes, particularly among non-Hispanic (NH) Black infant populations. However, because exposure to segregation is non-random, it is unclear whether and to what extent segregation is causally linked to infant health. To overcome this empirical limitation, we leverage exogenous variation in the placement of railroad tracks in the 19th century to predict contemporary segregation, an approach first introduced by Ananat (2011). In alignment with prior literature, we find that residential segregation has statistically significant associations with negative birth outcomes among Black infant populations in the area. Using OLS methods underestimates the negative impacts of segregation on infant health. We fail to detect comparable effects on health outcomes among NH White infant populations. Further, we identify several key mechanisms by which residential segregation could influence health outcomes among Black infant populations, including lower access to prenatal care during the first trimester, higher levels of anti-Black prejudice, greater transportation barriers, and increased food insecurity. Given that poor birth outcomes have adverse effects on adults’ health and well-being, the findings suggest that in-utero exposure to residential segregation could have important implications for Black–White inequality over the life course.
This paper studies the effects of Secure Communities (SC), a wide-ranging immigration enforcement program, on infant health outcomes in the United States. Using administrative birth certificate data together with event study and triple-differences designs, I find that SC increases the incidence of very low birth weight by 21% for infants of foreign-born Hispanic mothers, who were most likely to be affected by immigration enforcement. There is suggestive evidence that the results are consistent with (i) changes in maternal stress induced by deportation fear and (ii) inadequate prenatal nutrition. A back-of-the-envelope calculation suggests that this unintended social cost of immigration enforcement ranges from $872 million to $1.59 billion annually.
Prior research provides evidence of implicit and explicit anti-Black prejudice among US physicians. However, we know little about racialized prejudice among physicians and non-physician healthcare workers. Using ordinary least squares models and data from Harvard’s Project Implicit (2007-2019), we assessed the associations between self-reported occupational status (physician, non-physician healthcare worker) and implicit and explicit prejudice toward Black, Arab-Muslim, Asian, and Native Americans, net of demographic characteristics. We found that physicians and non-physician healthcare workers exhibited more implicit and explicit anti-Black and anti-Arab-Muslim prejudice than the general population. After controlling for demographics, these differences became non-significant for physicians but remained for non-physician healthcare workers. Demographic controls largely explained anti-Asian prejudice among both groups and, physicians and non-physician healthcare workers exhibited comparatively lower and similar levels of anti-Native implicit prejudice, respectively. Finally, white non-physician healthcare workers exhibited the highest levels of anti-Black prejudice.
This study assessed a broad array of socioeconomic barriers in relation to preferred contraceptive use during a time of exacerbated personal and social financial strain (the COVID-19 pandemic). Using statewide data collected in early 2021 through the Survey of the Health of Wisconsin, we conducted bivariate analyses exploring the relationship between socioeconomic resources and preferred contraceptive use among Wisconsin women. Findings indicated that people lacking socioeconomic resources, including adequate food and housing, may be unable to access their preferred contraceptive method(s). Amidst competing demands on time and resources, the inability to obtain preferred contraceptive method(s) may represent system-wide barriers as well as people's lowered ability to prioritize and access care in light of socioeconomic struggles.
This study explores the long-term health effects of prenatal exposure to racialized violence by analyzing Social Security Administration death records linked with the 1940 census. We exploit variations in lynching incidences to understand their impact on old-age longevity. The results reveal a 3.7 month decrease in longevity for Black males who were exposed to a lynching of a Black victim during gestation. This exposure accounts for approximately 10% of the life expectancy gap between Black and White men in 1980, without negative effects observed among White individuals. Further analysis suggests reductions in socioeconomic measures are likely explanatory factors.
We examine the multigenerational impacts of legalized abortion in the United States by analyzing how early-life exposure to this policy shift affects birth outcomes in the next generation. Using event study and two-way fixed effects models, we link maternal early-life exposure to legal abortion with improved birth outcomes in the subsequent generation, including higher birth weights and reduced rates of low birth weight. Our analysis of the mechanisms shows that these improvements in birth outcomes are not driven by changes in maternal racial or age composition within the treated generation. Instead, enhanced educational attainment and increased prenatal care utilization among the treated generation appear to play a critical role. Our results highlight the far-reaching implications of reproductive health policies, especially relevant in the post-Dobbs era, where access may once again become constrained for many.
Non-Pharmaceutical Interventions (NPIs) remain a subject of intense debate during major pandemics and endemics, with studies highlighting varied benefits and costs. Yet, little is known about the long-term effects of NPIs, particularly among those exposed during early life and childhood. This study examines the long-term effects of early-life and childhood exposure to NPIs implemented during the 1918-1919 influenza pandemic on later-life longevity. Utilizing Social Security Administration death records linked to the 1940 census, we investigate the differences in longevity of cohorts exposed to the pandemic during early childhood compared to those born post-pandemic, in cities with stricter NPIs to those with less stringent measures. The findings suggest a reduction in longevity of approximately 2.8 months for those exposed at ages 7-10. We attribute these effects to school closures and disruptions in children’s socioemotional and cognitive development and provide empirical evidence that their later-life reductions in education and socioeconomic status as potential pathways.
During school segregations of the early decades of the 20th century, Black teachers faced lower salary compared to their similarly qualified white counterparts owing to de jure segregated pay schedules. The National Association for the Advancement of Colored People (NAACP) embarked on a mission to equalize teacher salaries through court rulings and litigations. In several southern states, such litigations resulted in state policy reforms that restructured the pay schedule in an attempt to increase Black teachers’ salary. Prior literature documented that the reforms were successful in increasing salary, students’ enrollment, and grade progression. In this paper, we contribute to this literature by investigating the long-term impacts of these policies on students’ longevity. We find that a full exposure to the reform during school ages is associated with 2.5 months increases in longevity among Black males. Through a battery of tests, we rule out the concern that the results are confounded by within-state cross-cohort changes in longevity, within-state race-specific overall improvement in longevity, or socioeconomic and sociodemographic compositional change in the treated cohorts versus control cohorts. We discuss the policy implications of these results in light of the literature on later-life impacts of schooling inputs, emphasizing the imperative to address racial disparities in educational access and quality, which play a crucial role in shaping health outcomes for Black males.
Inclusive by Design: Unveiling the Effectiveness of Accommodations and Universal Design Elements through Process Data with Burhan Ogut,
Michelle Yin,
Juanita Hicks, and
Ruhan Circi Under review
This study examines the correlation between testing accommodations and universal design (UD) elements and standardized test performance within a digital testing framework. Utilizing a novel dataset—the National Assessment of Educational Progress (NAEP) process data—and advanced statistical methodologies such as inverse propensity weighting and doubly robust models, we provide compelling evidence on the efficacy of specific accommodations and UD features. Extended time usage significantly improves test performance for students with disabilities, emphasizing the crucial role they play in fostering equitable testing conditions. While scratchwork is associated with improved test performance for students with disabilities, the association between text-to-speech and equation editors, and student performance is mixed, suggesting potential distractions rather than support for some students.
Structural Inequality in Bankruptcy and Black-White Infant Health Disparities: A Research Note with Emma Romell,
Tiffany Green, and
Laura Swan Under review
Studies have documented Black-White disparities in bankruptcy filings and outcomes, as well as links between bankruptcy and filers’ health. However, little research examines how bankruptcy patterns at the area level may be associated with racial disparities in health outcomes, particularly during early life. Spatial measures of bankruptcy may better capture how structural forces influence bankruptcy patterns and health across groups. In this research note, we use a ProPublica dataset of all consumer bankruptcy cases from 2008-2015, as well as data from the National Vital Statistics System and the American Community Survey, to develop and test a novel measure of racialized spatial inequality in bankruptcy and its relationship with infant health disparities. Specifically, we measure the odds ratio of case dismissal in predominately Black versus White zip codes in the same county. We show that inequality in bankruptcy between Black and White zip codes is associated with Black (but not White) infant health. Our findings persist after controlling for poverty and unemployment, and parental education does not have a protective effect. We also find no evidence to suggest that segregation is the driving factor. This study contributes to literature on race and bankruptcy, as well as structural racism and population health.
Not Feeling Welcome: The Impact of 2016 Presidential Election on International Student Enrollments with William Duncan Under review
This paper examines the effects of the 2016 election on international student enrollments in the United States. Using variation in international student enrollments across U.S. higher education institutions, we find that the Trump election has a negative and significant impact on international enrollments. We provide suggestive evidence that Trump's 2016 win increases the weight on political factors when international students decide where to study. This is evidenced by the decline in international enrollments in Trump counties relative to Clinton counties. Some students, who would have chosen to study at a university in a Trump county may now no longer do so, favoring a university in a Clinton county. Other students who might once have chosen the U.S. for higher education now seem to be reconsidering and looking at other English speaking countries as alternatives.
The Spillover Effects of E-Verify on High-Skilled Citizen Women
Verify Employment Eligibility (E-Verify) is designed to curb the hiring of unauthorized immigrants. This paper examines the spillover impact of E-Verify on highly-educated citizen women's labor supply (particularly those with young children). Using variation in the implementation of E-Verify across states, I find that E-Verify reduces the labor supply of high-skilled citizen women by 0.3 to 1 percentage point. These estimates are larger for women with children. Supplemental analyses suggest that lower inflows of undocumented migrants is an important channel. A back-of-the-envelope calculation suggests that E-Verify generated $6.1 billion in annual social costs of lower labor supply of high-skilled citizen women.
The Healthy Undocumented Immigrant Effect: Evidence from the US
This paper uses the residual approach to identify undocumented populations hidden in micro survey data. I then document what I term the "Healthy Undocumented Immigrant Effect": undocumented immigrants are healthier than legal immigrants. I show evidence that the paradox of the undocumented immigrants’ health advantage can be attributed to the return-migrant effect.
We extend Feng and Sabarwal (2018)’s results on two stage 2×2 games with strategic complements to games with strategic substitutes and games with strategic heterogeneity. We characterize strategic substitutes and strategic heterogeneity in such games, and show that the set of such games has infinite measure. Our conditions are easy to apply and yield uncountably many examples of such games. Moreover, in contrast to the case for strategic complements, we show that generically, the set of SPNE in these games is totally unordered (no two equilibria are comparable).
Effects of Medicaid Birth Cost Recovery Policy Changes on Child Support Outcomes with Tiffany Green and Steve Cook
Evaluating the Impacts of Wisconsin’s Birth Cost Recovery Policy on the Health and Wellbeing of Low-Income Black Birthing Parents: A Community-Centered Approach with Tiffany Green, Laura Swan, Gina Green-Harris, and David Pate