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Parental behavior has potentially large implications for child health and child economic outcomes. In three essays, I explore two topics: how the health behavior of parents impacts their children's health and wellbeing, and the degree to which policy can alter parental behavior such that child health improves. The first essay examines how cash transfers to pregnant single mothers via the Earned Income Tax Credit (EITC) improve child birth weight. The second essay shows that cigarette taxes reduce maternal smoking and improve childhood health outcomes. The final essay documents the correlation between parental and teen smoking using the Current Population Survey Tobacco Use Supplement. As a whole, this dissertation contributes to our understanding of how health transmits from parent to child, an important mechanism in the intergenerational transmission of inequality.
This dissertation is comprised of three papers on health and household behavior. Two of the papers focus on the influence of family on health outcomes. The third paper examines household member preferences and their association with outcomes for other individuals within the family unit. The first paper tests the relationship of adult-child and elderly-parent contact frequency on elderly cognitive functioning (dementia) using the Health and Retirement Study (HRS). The paper examines various mechanisms through which the intensity of contact with adult, nonresident children impacts elderly cognitive functioning. An instrumental variables model is used to account for the endogeneity in the level of parent-child contact. Results indicate a positive association between intensity of contact from nonresident adult children and mothers' cognitive functioning; however, no causal relationship is found suggesting that higher levels of contact are due to selection. The second paper examines the prediction of stated, altruistic, preferences on an individual's revealed preferences, observed intergenerational family transfers. Measures of altruism toward children and parents are constructed, using hypothetical questions in the 1996 wave of the HRS that assess individuals' willingness to transfer income to others, and evaluated for their additional explanatory power, within traditional models of intergenerational transfers, on observable transfer behavior. Results indicate that higher levels of altruistic preferences are associated with higher probabilities of transfers and larger transfer amounts from respondents to children; however, transfers to parents do not appear to be related to the altruism measure. The final paper investigates the link between relationship status and body mass index. There are four hypotheses (selection, protection, social obligation and marriage market) that might explain the relationship between marital status transitions and changes in Body Mass Index (BMI). Using the National Longitudinal Survey of Youth 1979, individual fixed effects models are estimated to examine associations between the change in log BMI, and the incidence of overweight and obesity, and changes in relationship status. There is no support for the marriage protection hypothesis. Rather evidence supports the social obligation and marriage market hypotheses-BMI increases for both men and women during marriage and in the course of a cohabiting relationship.
In the first chapter of this dissertation, I study the effect of child support health insurance mandates on children's health insurance coverage. Children are more likely to lose health insurance when their parents divorce or separate, which is problematic because lack of health insurance is associated with reduced preventive care, diagnosis of diseases at later stages, and higher mortality. In order to increase coverage for children and reduce costs associated with public health insurance, many states have passed child support laws which mandate that a parent provide health insurance for the children if it is available at a reasonable cost. This paper is the first to evaluate the impact of these statutes on the number of children who lose health insurance due to parental divorce or separation. I codify the relevant laws by state and year from 1990 through 2007 in terms of the presence of mandates and the number and type of enforcement mechanisms. These variables are then linked to panels of the Survey of Income and Program Participation (SIPP), which provide the remainder of the necessary variables. Three main regressions are estimated. The first measures the overall effect of child support health insurance mandates on children's insurance coverage. The second equation measures the first intermediate step, whether child support health insurance mandates result in an order in the child support agreement to provide health insurance. The third equation measures the second intermediate step, whether an order for the parents to provide health insurance results in insurance coverage for children. I find that child support laws requiring parents to provide health insurance do not significantly impact the presence or type of health insurance coverage for children of divorced or separated parents. Additionally, these laws do not increase the probability that the child support agreement contains an order to provide health insurance, and an order to provide health insurance does not increase the probability of either any coverage or private coverage. In the second paper, we study the relationship between divorce and health insurance. Changing marital status is an important source of health insurance change. However, neither the health nor family economics literatures have examined this phenomenon. Using the SIPP, we document how health insurance status changes over time for men, women, and children as divorce and separation occur, as well as the likely causes of these changes. We find modest changes in overall coverage, but these changes mask large changes in type of coverage as people divorce or separate. In the third paper, we look at the effects of government aid expansions on labor market outcomes. While many studies investigate the magnitude by which public insurance expansions 'crowdout' private coverage, we ask a question new question: are such families able to recoup the benefits of no longer relying on employer provided coverage for children when they move to public coverage? Our findings from the SIPP do not show noticeable improvements, though our findings from the Current Population Survey (CPS) show a positive and significant effect on income and hourly wages.
This dissertation is comprised of three independent research papers, which broadly focuses on the introduction and outcomes of policies concerning children's health and education. Although the chapters are related in theme, the objective, scope and empirical strategy of each paper differs. The first chapter, "How Did SCHIP Affect the Insurance Coverage of Immigrants Children?" (with Thomas Buchmueller and Anthony Lo Sasso), focuses on the passage of the State Children's Health Insurance Program in the late 1990s, which expanded public insurance eligibility and coverage for children in "working poor families". Despite this success, over 6 million children are eligible for public insurance, but remain uninsured. The study focuses on children born to immigrant parents because of their low rates of insurance coverage and unique enrollment barriers. The results indicate SCHIP was successful in increasing overall insurance take-up and in reducing disparities in access to health insurance coverage. The second chapter, "Looking Beyond Test Score Gains" determines whether the introduction of school accountability programs (prior to the No Child Left Behind Act in 2001) affected individuals' educational attainment and labor market outcomes. The effects are evaluated along two dimensions: differences in the length of program exposure and variation in program quality. The results indicate school accountability had mixed success in increasing outcomes across gender and racial/ethnic groups. They also suggest the heterogeneous treatment effects are consistent with some of the unintended consequences documented in the school accountability literature. The third chapter, "The Role of Education on Health Behaviors, Investments and Outcomes", uses a new combination of instrumental variables to predict individuals' schooling and determine whether there is a causal effect of education on young adults' health behaviors. The instruments rely on changes to state policies, dating back to the 1970s, that dictate when children are permitted to start and stop attending school. The results indicate education not only decreases the likelihood of smoking, heavy drinking and obesity, but affects the frequency of these behaviors and degree of obesity. Education also promotes behaviors that are akin to health investments, such as increasing sunscreen use and the receipt of preventive services.