“Market Responses to Vaccine Recommendations” with Laura E. Henkhaus and Emily C. Lawler
We provide novel evidence on how pharmaceutical companies and consumers 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 identification strategy, we first show that the manufacturer (Pfizer) responded by increasing direct-to-consumer advertising. We then show that the recommendation increased Prevnar 13-related information-seeking behavior and pneumococcal vaccination. Overall, our analyses suggest that the recommendation directly increased Medicare Part B drug expenditures by over $14 per beneficiary and Pfizer product sales by approximately $1 billion annually, with little to no observable health benefits.
Vaccination has been called one of the greatest public health success stories, and policymakers have adopted a variety of strategies to increase and keep coverage rates at socially optimal levels. While researchers have documented successful strategies for increasing coverage rates in children and adolescents, little is known about how to successfully increase adult vaccination rates – a fact that has been highlighted by the COVID-19 pandemic. Using data from the 2008-2019 National Health Interview Survey, we show that 60-year-olds – who were recommended by the Advisory Committee on Immunization Practices to receive the shingles vaccine – were no more likely to be vaccinated than their 59-year-old counterparts prior to the Affordable Care Act. After the ACA’s preventive services provision required insurance plans to cover recommended vaccines without patient cost-sharing, adults 60 or older were more likely to receive the vaccine, and we document a similar increase for 50-59-year-olds after the recommendation age was lowered to 50. Using both difference-in-differences and regression discontinuity identification strategies, we estimate that the ACA increased vaccine take-up of the shingles vaccine by 3.0-5.2 percentage points.
“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.
“Bad Lighting: Effects of Youth Indoor Tanning Prohibitions” with Christopher S. Carpenter and Michelle Marcus
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.
“‘There She Is, Your Ideal’: Negative Social Comparisons and Health Behaviors” with Christopher S. Carpenter
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.
Work in Progress
“Pharmacists’ Scope-of-Practice and HPV Vaccine Take-Up”
“Recommendations and Health Behaviors: Evidence from Routine Breast Cancer Screenings” with Emily C. Lawler
“Sanctuary Cities and Infant Health” with Catalina Amuedo-Dorantes and Yang Song