This paper investigates the effect of the Affordable Care Act young adult provision on fertility and related outcomes. The expected effect of the provision on fertility is not clear ex ante. By expanding insurance coverage to young adults, the provision may affect fertility directly through expanded options for obtaining contraceptives as well as through expanded options for obtaining pregnancy-, birth-, and infant-related care, and these may lead to decreased or increased fertility, respectively. In addition, the provision may also affect fertility indirectly through marriage or labor markets, and the direction and magnitude of these effects is difficult to determine. This paper considers the effect of the provision on fertility as well as the contributing channels by applying difference-in-differences-type methods using the 2008-2010 and 2012-2013 American Community Survey, 2006-2009 and 2012-2013 Centers for Disease Control and Prevention abortion surveillance data, and 2006-2010 and 2011-2013 National Survey of Family Growth. Results suggest that the provision is associated with decreases in the likelihood of having given birth and abortion rates and an increase in the likelihood of using long-term hormonal contraceptives.
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Considering the Use of Stock and Flow Outcomes in Empirical Analyses: An Examination of Marriage Data
January 2017
Working Paper Number:
CES-17-64
This paper fills an important void assessing how the use of stock outcomes as compared to flow outcomes may yield disparate results in empirical analyses, despite often being used interchangeably. We compare analyses using a stock outcome, marital status, to those using a flow
outcome, entry into marriage, from the same dataset, the American Community Survey. This paper considers two different questions and econometric approaches using these alternative measures: the effect of the Affordable Care Act young adult provision on marriage using a difference-indifferences
approach and the relationship between aggregate unemployment rates and marriage rates using a simpler ordinary least squares regression approach. Results from both analyses show stock and flow data yield divergent results in terms of sign and significance. Additional analyses suggest prior-period temporary shocks and migration may contribute to this discrepancy. These results suggest using caution when conducting analyses using stock data as they may produce false negative results or spurious false positive results, which could in turn give rise to misleading policy implications.
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FIFTY YEARS OF FAMILY PLANNING:
NEW EVIDENCE ON THE LONG-RUN EFFECTS OF INCREASING ACCESS TO CONTRACEPTION
February 2014
Working Paper Number:
CES-14-15
This paper assembles new evidence on some of the longer-term consequences of U.S. family planning policies, defined in this paper as those increasing legal or financial access to modern contraceptives. The analysis leverages two large policy changes that occurred during the 1960s and 1970s: first, the interaction of the birth control pill's introduction with Comstock-era restrictions on the sale of contraceptives and the repeal of these laws after Griswold v. Connecticut in 1965; and second, the expansion of federal funding for local family planning programs from 1964 to 1973. Building on previous research that demonstrates both policies' effects on fertility rates, I find suggestive evidence that individuals' access to contraceptives increased their children's college completion, labor force participation, wages, and family incomes decades later.
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Health-Related Research Using Confidential U.S. Census Bureau Data
August 2008
Working Paper Number:
CES-08-21
Economic studies on health-related issues have the potential to benefit all Americans. The approaches for dealing with the growth of health care costs and health insurance coverage are ever changing and information is needed on their efficacy. Research on health-related topics has been conducted for about a decade at the Census Bureau\u2019s Center for Economic Studies and the Research Data Centers. This paper begins by describing the confidential business and demographic Census Bureau data products used in this research. The discussion continues with summaries of nearly 30 papers, including how this work has benefited the Census Bureau and its research findings. Some focus on data linkages and assessing data quality, while others address important questions in the employer, public, and individual insurance markets. This research could not have been accomplished with public-use data. The newly available data from the Agency for Healthcare Research and Quality and National Center for Health Statistics, as well as additional Census Bureau data now available in the Research Data Centers are also discussed.
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New Evidence on the Impacts of Early Exposure to the 1918 Influenza Pandemic on Old-Age Mortality
January 2018
Working Paper Number:
CES-18-06
This paper provides new evidence of the impacts of early life exposure to the 1918 pandemic with old-age mortality by analyzing data from the National Longitudinal Mortality Study (n ~ 220,000). The specifications used year and quarter of birth indicators to assess the effects of timing of pandemic exposure and used Cox proportional hazard models for all-cause mortality outcomes. The findings suggest evidence of excess all-cause mortality for cohorts born during 1918 and mixed evidence for cohorts born in 1917 and 1919. Therefore, contrary to some existing research, the results suggest no consistent evidence of the importance of specific windows of exposure by gestation period.
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EXAMINING THE LONG TERM MORTALITY EFFECTS OF EARLY HEALTH SHOCKS
March 2014
Working Paper Number:
CES-14-19
A growing literature in economics and other disciplines has tied exposure to early health shocks, particularly in utero influenza, to reductions in a variety of socioeconomic and health outcomes over the life course. However, no current evidence exists that examines this health shock on mortality because of lack of available data. This paper uses newly released files from the large, representative National Longitudinal Mortality Study to explore the mortality effects of the 1918 influenza pandemic for those in utero. While the results on socioeconomic outcomes mimic those in the literature, showing reductions in completed schooling and income fifty years following influenza exposure, the findings also suggest no effect on overall mortality or by categories of cause-of-death. These results are counter-intuitive in their contrast with the many reported effects on cardiovascular health as well as the literature linking education with later mortality
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Covering Undocumented Immigrants: The Effects of a Large-Scale Prenatal Care Intervention
August 2022
Working Paper Number:
CES-22-28
Undocumented immigrants are ineligible for public insurance coverage for prenatal care in most states, despite their children representing a large fraction of births and having U.S. citizenship. In this paper, we examine a policy that expanded Medicaid pregnancy coverage to undocumented immigrants. Using a novel dataset that links California birth records to Census surveys, we identify siblings born to immigrant mothers before and after the policy. Implementing a mothers' fixed effects design, we find that the policy increased coverage for and use of prenatal care among pregnant immigrant women, and increased average gestation length and birth weight among their children.
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Preschoolers Enrolled and Mothers at Work? The Effects of Universal Pre-Kindergarten
March 2008
Working Paper Number:
CES-08-04
Three states (Georgia, Oklahoma and Florida) recently introduced Universal Pre- Kindergarten (Universal Pre-K) programs offering free preschool to all age-eligible children, and policy makers in many other states are promoting similar policies. How do such policies affect the participation of children in preschool programs (or do they merely substitute for preschool offered by the market)? Does the implicit child care subsidy afforded by Universal Pre-K change maternal labor supply? I present a model that includes preferences for child quality and shows the directions of change in preschool enrollment and maternal labor supply in response to Universal Pre-K programs are theoretically ambiguous. Using restricted-access data from the Census, together with year and birthday based eligibility cutoffs, I employ a regression discontinuity framework to estimate the effects of Universal Pre-K availability. Universal Pre-K availability increases preschool enrollment by 12 to 15 percent, with the largest effect on children of women with less than a Bachelor's Degree. Universal Pre-K availability has little effect on the labor supply of most women. However, women residing in rural areas in Georgia increase their children's preschool enrollment and their own employment by 22 and 20 percent, respectively, when Universal Pre-K is available.
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Geographic Disparities in Alzheimer's Disease and Related Dementia Mortality in the US: Comparing Impacts of Place of Birth and Place of Residence
January 2025
Working Paper Number:
CES-25-11
Objective: Building on the hypothesis that early-life exposures might influence the onset of Alzheimer's Disease and Related Dementia (ADRD), this study delves into geographic variations in ADRD mortality in the US. By considering both state of residence and state of birth, we aim to discern the comparative significance of these geospatial factors.
Methods: We conducted a secondary data analysis of the National Longitudinal Mortality Study (NLMS), that has 3.5 million records from 1973-2011 and over 0.5 million deaths. We focused on individuals born in or before 1930, tracked in NLMS cohorts from 1979-2000. Employing multi-level logistic regression, with individuals nested within states of residence and/or states of birth, we assessed the role of geographical factors in ADRD mortality variation.
Results: We found that both state of birth and state of residence account for a modest portion of ADRD mortality variation. Specifically, state of residence explains 1.19% of the total variation in ADRD mortality, whereas state of birth explains only 0.6%. When combined, both state of residence and state of birth account for only 1.05% of the variation, suggesting state of residence could matter more in ADRD mortality outcomes.
Conclusion: Findings of this study suggest that state of residence explains more variation in ADRD mortality than state of birth. These results indicate that factors in later life may present more impactful intervention points for curbing ADRD mortality. While early-life environmental exposures remain relevant, their role as primary determinants of ADRD in later life appears to be less pronounced in this study.
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A Dynamic Structural Model of Contraceptive Use and Employment Sector Choice for Women in Indonesia
September 2010
Working Paper Number:
CES-10-28
This research investigates the impact of the Indonesian family planning program on the labor force participation decisions and contraceptive choices of women. I develop a discrete choice dynamic structural model, where each married woman in every period makes joint choices regarding the method of contraceptive used and the sector of employment in which to work in order to maximize her expected discounted lifetime utility function. Each woman obtains utility from pecuniary sources, nonpecuniary sources, and choice-specific time shocks. In addition to the random shocks, there is uncertainty in the model as a woman can only imperfectly control her fertility. Dynamics in the model are captured by several forms of state and duration dependence. Women in this model make different choices due to different preferences, differences in observable characteristics, and realization of uncertainty. The choices made by a woman depend on the compatibility between raising children and the sector of employment (including wages). While making decisions regarding contraceptive use, a woman considers the trade-off between costs (monetary and nonmonetary) of having a child and the benefits from having one. The primary source of data for this study is the first wave of the Indonesia Family Life Survey (IFLS 1), a retrospective panel. In my research, I use the geographic expansion and the changing nature of the Indonesian family planning program as sources of exogenous variation to identify the parameters of the structural model. I estimate the model using maximum likelihood techniques with data from IFLS 1 for the periods 1979-1993. Structural model estimates indicate that informal sector jobs offer greater compatibility between work and childcare. Parameter estimates indicate that choices of contraception method and employment sector vary by exogenous characteristics.
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Transitions in Welfare Participation and Female Headship
February 2004
Working Paper Number:
CES-04-01
This study uses data from the 1990, 1992, 1993, and 1996 panels of the Survey of Income and Program Participation to examine how welfare policies and local economic conditions contribute to women's transitions into and out of female headship and into and out of welfare participation. It also examines whether welfare participation is directly associated with longer spells of headship. The study employs a simultaneous hazards approach that accounts for unobserved heterogeneity in all of its transition models and for the endogeneity of welfare participation in its headship model. The estimation results indicate that welfare participation significantly reduces the chances of leaving female headship. The estimates also reveal that more generous welfare benefits contribute indirectly to headship by increasing the chances that mothers will enter welfare. More generous Earned Income Tax Credit benefits are associated with longer spells of headship, nonheadship, and welfare participation and nonparticipation. Other measures of welfare policies, including indicators for the adoption of welfare waivers and the implementation of Temporary Assistance for Needy Families programs, are generally not significantly associated with headship or welfare receipt. Better economic opportunities are estimated to increase headship but reduce welfare participation among unmarried mothers.
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