Working Papers
“Government Recommendations and Health Behaviors: Evidence from Breast Cancer Screening Guidelines” with Emily C. Lawler, Conditionally Accepted at Economic Journal (pending replication package review), previously released as NBER Working Paper No. 34368
We provide novel evidence on how healthcare decision-making responds to changes in government recommendations by studying the United States Preventive Services Task Force’s 2009 decision to stop recommending mammogram screenings for women aged 40-49. Using a difference-in-differences identification strategy, we find that the guideline revision reduced mammography among 40-49-year-old women by 6-10 percent relative to their older counterparts. We also identify large spillovers onto women aged 30-39 who were subsequently less likely to receive a mammogram recommendation or a mammogram. Additional analyses suggest the revision reduced overdiagnosis of early-stage tumors. Finally, we find that the 2009 update increased confusion about recommendations for preventing cancer.
“Health Care Reform and Firm Dynamics: Evidence from Medicare Part D and the Retail Pharmacy Industry” with Georgina Cisneros and Kelli Marquardt
Retail pharmacies fill over 4 billion prescriptions each year and are the most frequent healthcare touchpoint in the U.S. Yet relatively little is known about the economic factors driving pharmacy access. We provide new evidence on how Medicare Part D shaped the retail pharmacy industry using 2000-2009 National Establishment Time-Series data and a difference-in-differences strategy leveraging pre-period variation in the share of the customers likely enrolled in Medicare. The two-year period between Part D’s passage and implementation was marked by substantial uncertainty about its financial implications for pharmacies. Though Part D ultimately increased prescription utilization, it also reduced drug prices and raised administrative costs. We find that Part D was associated with a 5-percent reduction in the number of pharmacies, driven entirely by a reduction in the number of openings rather than an increase in closures. Finally, we find suggestive evidence that the mortality reduction attributable to Part D was smaller in counties that experienced a reduction in pharmacy access.
I use two online experiments to test whether physical characteristics affect how people evaluate non-physical traits. I find that participants scored dating profiles displaying overweight/obese photos 19% lower than profiles displaying healthy-weight photos. This penalty was driven by a reduction in the scores assigned to both the photos and the same profile text; participants who viewed heavier photos perceived the text as less indicative of work ethic and intelligence. There is no evidence that participants imposed smaller penalties on profiles reporting higher-earning occupations, suggesting that individuals are limited in their ability to compensate for excess bodyweight with higher socioeconomic status.
“Broadband Internet Access and Adolescent Mental Health in the U.S.” with Kathryn R. Johnson
Broadband internet has become a critical component of U.S. infrastructure, but policymakers are increasingly concerned that the widespread adoption of this technology has adversely affected adolescent mental health. To test this hypothesis, we use 2009–2019 National and State Youth Risk Behavior Survey data and leverage the nationwide rollout of broadband internet. First, we show that adolescents in states with greater broadband internet access reported spending more time online. Next, we find that a one-standard-deviation increase in broadband internet access was associated with a 9.3–16.5-percent increase in adolescent suicide ideation. While we document increases in suicide ideation for both girls and boys, the results are most pronounced for adolescent girls. Exploring potential mechanisms, we show that greater broadband internet access was associated with increases in cyberbullying and body dissatisfaction among adolescent girls and a reduction in the likelihood that adolescent boys reported getting an adequate amount of sleep.
Work in Progress
“The Vaccines for Children Program and the Health of Low-Income Children” with Emily C. Lawler and Samuel J. Mann