The drug crisis and the living arrangements of children.

We examine the impact of the US drug crisis on children's living arrangements. Because factors that lead to drug use could also alter family structure, we instrument for the intensity of the drug crisis with cross-state exposure to marketing of the prescription opioid at the epicenter of the crisis. We find that the crisis increased the likelihood that a child lives away from a parent or in a household headed by a grandparent. Our results suggest that if drug use had remained at 1996 levels, 1.5 million fewer children aged 0-16 would have lived away from a parent in 2015.

Worth the Wait? The Effect of Early Term Birth on Maternal and Infant Health.

Early term birth is defined as birth at 37 or 38 weeks gestation. While infants born early term are not considered premature, the medical literature suggests that they have an increased risk of serious adverse health outcomes compared to infants born at term (39 or 40 weeks). Despite these known harms, we document a rise in early term births in the United States from 1989 to the mid-2000s, followed by a decline in recent years. We posit that the recent decline in early term births has been driven by changes in medical practice advocated by the American College of Obstetricians and Gynecologists, programs such as the March of Dimes' "Worth the Wait" campaign, and by Medicaid policy. We first show that this pattern cannot be attributed to changes in the demographic composition of mothers, and provide some evidence that efforts to reduce early term elective deliveries (EEDs) through Medicaid policy were effective. We next exploit county-level variation in the timing of these changes in medical practice to examine the effect of early term inductions (our proxy for EEDs) on infant and maternal health. We find that early term inductions lower birth weights and increase the risks of precipitous labor, birth injury, and required ventilation. Our results suggest that reductions in early term inductions can explain about one-third of the overall increase in birth weights between 2010 and 2013 for births at 37 weeks gestation and above.

The effect of college education on mortality.

We exploit exogenous variation in years of completed college induced by draft-avoidance behavior during the Vietnam War to examine the impact of college on adult mortality. Our estimates imply that increasing college attainment from the level of the state at the 25th percentile of the education distribution to that of the state at the 75th percentile would decrease cumulative mortality for cohorts in our sample by 8 to 10 percent relative to the mean. Most of the reduction in mortality is from deaths due to cancer and heart disease. We also explore potential mechanisms, including differential earnings and health insurance.

Prenatal investments, breastfeeding, and birth order.

Mothers have many opportunities to invest in their own or their child's health and well-being during pregnancy and immediately after birth. These investments include seeking prenatal care, taking prenatal vitamins, and breastfeeding. In this paper, we investigate a potential determinant of mothers' investments that has been largely overlooked by previous research-birth order. Data are from the National Longitudinal Study of Youth 1979 (NLSY79) Child and Young Adult Survey, which provides detailed information on pre- and post-natal behaviors of women from the NLSY79. These women were between the ages of 14 and 22 in 1979, and form a nationally representative sample of youth in the United States. Our sample includes births to these women between 1973 and 2010 (10,328 births to 3755 mothers). We use fixed effects regression models to estimate within-mother differences in pre- and post-natal behaviors across births. We find that mothers are 6.6 percent less likely to take prenatal vitamins in a fourth or higher-order birth than in a first and are 10.6 percent less likely to receive early prenatal care. Remarkably, mothers are 15.4 percent less likely to breastfeed a second-born child than a first, and are 20.9 percent less likely to breastfeed a fourth or higher-order child. These results are not explained by changing attitudes toward investments over time. These findings suggest that providers may want to increase efforts to encourage these behaviors at women with higher parity. The results also identify a potential mechanism for the emergence of differences in health and other outcomes across birth orders.

Season of Birth and Later Outcomes: Old Questions, New Answers.

Season of birth is associated with later outcomes; what drives this association remains unclear. We consider a new explanation: variation in maternal characteristics. We document large changes in maternal characteristics for births throughout the year; winter births are disproportionally realized by teenagers and the unmarried. Family background controls explain nearly half of season-of-birth's relation to adult outcomes. Seasonality in maternal characteristics is driven by women trying to conceive; we find no seasonality among unwanted births. Prior seasonality-in-fertility research focuses on conditions at conception; here expected conditions at birth drive variation in maternal characteristics while conditions at conception are unimportant.

Selection and the marriage premium for infant health.

Previous research has found a positive relationship between marriage and infant health, but it is unclear whether this relationship is causal or a reflection of positive selection into marriage. We use multiple empirical approaches to address this issue. First, using a technique developed by Gelbach (2009) to determine the relative importance of observable characteristics, we show how selection into marriage has changed over time. Second, we construct a matched sample of children born to the same mother and apply panel data techniques to account for time-invariant unobserved characteristics. We find evidence of a sizable marriage premium. However, this premium fell by more than 40 % between 1989 and 2004, largely as a result of declining selection into marriage by race. Accounting for selection reduces ordinary least squares estimates of the marriage premiums for birth weight, prematurity, and infant mortality by at least one-half.

Infertility insurance mandates and multiple births.

In 2002, 15.4% of women of childbearing age in the USA reported struggles with infertility. Over the past 3 decades, drugs and assisted reproductive technologies have been developed to treat infertility, but treatment is costly. Since 1985, several states have adopted insurance mandates that require providers to cover or offer infertility treatments. In this paper, I examine the impact of strong mandate-to-cover laws on multiple births, which are associated with infertility treatment use. I also investigate whether the laws had heterogeneous treatment effects. Using birth certificate data from 1980-2002, I show that the laws had a small and statistically insignificant impact on multiple birth rates. However, I find that there were over 5300 mandate-induced triplet and higher-order births over the period, for which the delivery costs alone are estimated to be over $900 million. Increases in multiple birth rates are only observed for women over 30 and are greater for women who are married, white, or have a college degree. This is consistent with previous work, which finds that the mandates did not reduce disparities in treatment use.

Geographic variation in the appropriate use of cesarean delivery.

There is enormous geographic variation in the use of cesarean delivery: For births over 2,500 grams, adjusted cesarean rates vary fourfold between low- and high-use areas. Even for births under 2,500 grams, high-use counties have rates that are double those of low-use ones. Higher cesarean rates are only partially explained by patient characteristics but are greatly influenced by nonmedical factors such as provider density, the capacity of the local health care system, and malpractice pressure. Areas with higher usage rates perform the intervention in medically less appropriate populations-that is, relatively healthier births-and do not see improvements in maternal or neonatal mortality.