Working Papers

Minimum Wages and Racial Infant Health Inequality: Evidence from the Fair Labor Standards Act of 1966
Abstract: The Fair Labor Standards Act (FSLA) of 1966 increased the federal minimum wage to $1 in several previously excluded industries starting in 1967. These changes disproportionately affected Black workers, substantially narrowing the racial wage gap over the period of just a few years. In this paper, I use a triple differences approach to evaluate the effect of narrowing the racial wage gap on the infant mortality gap. I estimate the model at the county level, exploiting variation in industry employment shares measured in the early 1960s. Intuitively, counties that pre-reform had higher shares of employment in industries affected by the FLSA of 1966 were more treated by the reform and experienced greater narrowing of the racial wage gap. I find that an increase in covered employment by one percentage point reduced the infant mortality gap by about 0.16 deaths per 1,000 births (or 1.2% of the mean gap).

A Hard Pill to Swallow: Spillovers of the Opioid Epidemic on Educational Progress
Abstract: Despite a substantial increase in the number of children living in households and exposed to neighbors with opioid addiction in the past two decades, the impacts of this trend on children are poorly understood. This paper provides novel estimates of the causal effects of exposure to the opioid epidemic on educational progress for California students. I develop a new time-varying instrument for prescription opioids derived from Purdue Pharma's evolving marketing strategy, which targeted areas with high rates of different diseases over time. Moving from the 25th to the 75th percentile of instrumented per capita opioids, standardized test scores fall by 0.65--1.57% of the mean. High school exit exam pass rates fall by a greater magnitude. I find no evidence of overall changes in dropout rates, but ninth- and tenth-grade dropout rates increase. Estimates from IV regressions are much larger in magnitude than those using OLS. I find a significant adverse impact of community opioid use on the academic performance of the marginal affected child, highlighting previously overlooked intergenerational consequences of the opioid crisis.

Adding Salt to the Womb: The Benefits of Salt Iodization on Infant Health (with Donato Onorato)
Abstract: Iodine deficiency is a major public health issue across the world today affecting an estimated 241 million children. Iodine deficiency is particularly detrimental to fetal and infant health, increasing the risk of infant mortality and inhibiting cognitive development. This paper studies the effects of the nationwide introduction of iodized table salt to the United States in 1924. We exploit this natural experiment and pre-period geographic variation in iodine deficiency driven by differences in naturally occurring iodine using a difference-in-differences design. We find that the introduction of iodized table salt in the United States reduced infant mortality by 0.58–1.1 deaths per 1,000 births (0.8–1.6 percent) for counties at the 75th percentile of the goiter distribution relative to the 25th percentile. We also show that these reductions in infant mortality are concentrated among urban counties, where iodized salt was disproportionately available. Our estimates suggest that salt iodization can explain up to one third of the decline in the county-level urban-rural infant mortality gap between 1919 and 1929. Given the similarities in infant health outcomes between the United States during the 1920s and countries with high infant mortality today, our findings are relevant for contemporary policy targeting iodine deficient regions of the world.

First Do No Harm? Doctor Decision Making and Patient Outcomes (with Janet Currie and W. Bentley MacLeod)
Revise and Resubmit at the Journal of Economic Literature
Abstract: Doctors facing similar patients often make different treatment choices. These decisions can have important effects on patient health and health care spending. This paper seeks to organize the recent economics literature on physician decision making using a simple model that incorporates doctor diagnostic and procedural skills, differences in beliefs and patient populations, and incentives. Economic considerations that affect the quality of decision making include training, experience, peer effects, financial incentives and time constraints. We also consider interventions aimed at improving decision making including provision of informational, heuristics and guidelines, and the use of technologies including electronic medical records and algorithmic decision tools. Our review suggests that we have learned a great deal about specific factors that influence doctor decision making but that our knowledge of how to apply that knowledge to improve health care is still quite limited.

Work in Progress

Fostering a Gentler Flight from the Nest: Effects of Foster Care Reform on Labor Market Outcomes

Prior Authorization and Inappropriate Antipsychotic Prescribing to Children on Medicaid (with Janet Currie)