“‘There She Is, Your Ideal’: Negative Social Comparisons and Health Behaviors” with Christopher S. Carpenter, Revisions Requested at Journal of Human Resources
We provide novel evidence on the role of negative social comparisons in population health behaviors by exploiting variation in Miss America and Miss USA beauty pageant winners. We show that there was more front-page newspaper coverage and more pageant-related internet search behavior following a home-state win. Teen girls and pageant-aged women with home-state winners were more likely to report that they were trying to lose weight, and pregnant women gained less gestational weight. We do not detect meaningful changes for teen boys, young adult men, or older women for whom social comparisons were plausibly less salient.
“Bad Lighting: Effects of Youth Indoor Tanning Prohibitions” with Christopher S. Carpenter and Michelle Marcus, NBER Working Paper No. 29443, Resubmitted to Journal of Health Economics
Indoor tanning beds (ITBs) emit UV light at high intensity and have been classified as carcinogenic to humans by the World Health Organization since 2009. We are the first to study the role of state laws prohibiting youths from indoor tanning using a difference-in-differences research design. We find that youth ITB prohibitions reduced population search intensity for tanning-related information. Among white teen girls, ITB prohibitions reduced self-reported indoor tanning and increased sun protective behaviors. We also find that youth ITB prohibitions significantly reduced the size of the indoor tanning market by increasing tanning salon closures and reducing tanning salon sales.
“Mandated School-Based BMI Assessments and Adolescent Health Behaviors” Revisions Requested at Journal of Policy Analysis and Management
I provide novel evidence on how youth-targeted anti-obesity policies affect health behaviors. From 2003 to 2017, 32 states passed laws requiring schools to perform annual Body Mass Index (BMI) assessments on students. Though intended to correct imperfect information by providing teens and their parents with a report stating whether the child is overweight or obese, there is concern that these assessments may induce body dysmorphia and increase the incidence of eating disorders. Using the 1991-2017 National and State Youth Risk Behavior Surveys, I show that mandated school-based BMI assessments increased the likelihood that teen girls described themselves as overweight and reported that they were trying to lose weight. These changes were driven by overweight and obese girls holding more accurate views of their body types, suggesting that the assessments were successful in improving awareness about BMI and overweight status. While I do not detect changes in exercise, I show that teen girls with a negative body image were more likely to report calorie-limiting behaviors, such as dieting, fasting, and using diet pills. I do not detect changes in BMI, indicating that combating childhood obesity will require more than correcting imperfect information about clinical weight thresholds.
“Market Responses to Vaccine Recommendations” with Laura E. Henkhaus and Emily C. Lawler
We provide novel evidence on how patients and firms respond to government-endorsed health recommendations. In 2014, the Advisory Committee on Immunization Practices recommended that elderly adults receive the pneumococcal vaccine Prevnar 13. Using a difference-in-differences strategy, we show that the recommendation increased pneumococcal vaccination among targeted adults and also had broader market impacts: the manufacturer (Pfizer) increased direct-to-consumer advertising, consumers increased Prevnar-related information search, and targeted adults were more connected to the health care system. Overall, the recommendation increased both Medicare Part B drug expenditures and Pfizer sales by approximately $1 billion annually, with little to no observable health benefits.
We provide novel evidence on how health care decision-making responds to changes in information by studying the effects of the United States Preventive Service Task Force’s 2009 decision to stop recommended mammogram screenings for women aged 40-49. Using a difference-in-differences identification strategy, we find that after the update women aged 40-49 were 1.4-4.9 percentage points less likely to report ever receiving a mammogram than their 50-59-year-old counterparts. We also identify large spillovers onto women aged 35-39: post-2009 they were significantly less likely to receive a mammogram recommendation or a mammogram. Additional analyses suggest the revision reduced overdiagnosis of early-stage tumors.
Work in Progress
“Public Funding and Disease Prevention: Evidence from Funding Awards to Promote HPV Vaccination” with Christopher S. Carpenter and Emily C. Lawler
“Pharmacists’ Scope-of-Practice and HPV Vaccine Take-Up”
“Sanctuary Cities and Infant Health” with Catalina Amuedo-Dorantes and Yang Song