And what about the kids? Divorce, child support, and childhood health investment
Abstract: Children of divorce are known to achieve worse health outcomes in childhood and through adulthood. However, a dearth of detailed longitudinal data in the US has thus far prevented an investigation of the short-run effects of parental divorce on investment in children's health, which might provide insight into the long-term adverse health outcomes in affected children. In this paper, I use a unique set of linked administrative records to estimate the effect of parental divorce on investment in children's preventive health care. I find that children of divorce fall behind on preventive care in the pre-divorce period. However, preventive care increases markedly after divorce; there is a 6.5% increase in the likelihood of having a well-visit after divorce and a 10% increase in vaccination receipt. Extensive mechanism analyses suggest that this compensatory response to divorce is underpinned by child support establishment, the low levels of pre-divorce investment, and a probable shift in post-divorce parental preferences. The results suggest that the parental response to divorce works in an attempt to counteract the adverse health effects of divorce on children, which has important implications for our understanding of these children's long-term health outcomes.
The Muslim Ban and Preventive Care for Children of Middle Eastern Ancestry (with Shooshan Danagoulian, Daniel Grossman, and David Slusky), Accepted, Forum for Health Economics & Policy, 2025
Quality of Childhood Preventive Care Delivered by Non-Physicians: Evidence from Medicaid Claims
Abstract: The share of patients receiving primary care from non-physician practitioners (NPP) has experienced sizable growth in recent years. As these providers have different training and licensing requirements than physicians, the growth of the NPP workforce stands to affect quality of care. In this paper, I study these quality implications as it pertains to childhood preventive care by estimating the effect of using nurse practitioners (NP) and physician associates (PA) for early childhood primary care on preventive care outcomes. Using an instrumental variables strategy that exploits quasi-random variation in provider type assignment at a child’s first well-visit, I find that Medicaid-insured children seeing more NPs in early childhood achieve the same preventive care outcomes as children seeing physicians. However, I find that receiving more early childhood care from PAs decreases the likelihood of complying with well-visit and vaccination periodicity guidelines, which results in subsequently worse health outcomes for children seeing PAs. These findings suggest that while NPs are equivalent substitutes for physicians in terms of the quality of pediatric preventive care, PAs are not.
The Effect of Federally Qualified Health Centers on Childhood Utilization of Preventive Care
Abstract: The health center program aims to address barriers to health care access through the grant funding of Federally Qualified Health Centers (FQHCs). However, recent FQHC openings have been shown to be less likely to target areas with greater need, potentially undermining the public health benefits of program expansion. This paper studies whether the establishment of an FQHC influences childhood receipt of preventive care among Medicaid beneficiaries in Michigan. I estimate the effect of FQHC establishment on childhood preventive care utilization using an event study framework with a stacked difference-in-differences design that exploits plausibly exogenous variation in the timings of FQHC openings across primary care service areas in Michigan. Results indicate that the opening of an FQHC increases utilization of preventive care at FQHCs but displaces care from non-FQHCs, resulting in no effect of FQHC establishment on overall preventive care use. Subgroup analyses show that the substitution of FQHC for non-FQHC care is most prominent in rural areas, wherein FQHC opening has the greatest reduction in distance to care. The results suggest that recent expansions of the health center program may have yielded little public health benefits.
The Spillover Effects of Nurse Practitioner Scope of Practice Expansions on Safety Net Program Participation: Evidence from WIC (with Lilly Springer)
Abstract: Nurse practitioner (NP) scope of practice (SOP) reform has been shown to improve access to healthcare, leading to direct health benefits. However, given that NPs are likely to practice in underserved areas, liberalizing SOP may also have spillover benefits on safety net program participation, which would amplify the benefits of SOP expansion for underrepresented populations. In this paper, we study these potential spillovers by examining the effect of NP SOP expansions on enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Leveraging the staggered rollout of NP SOP expansions across states, we find that starting 4-5 years after SOP expansion, total WIC participation increases by 4% in treated states, which rises to 6.8% one decade after SOP expansion. This increase in total WIC enrollment is driven by increases in the enrollment of women and children. Mechanism analyses suggest that while access to healthcare is an important channel, the effect may also be driven by the fact that NPs are trained to deliver holistic, patient-centered care. Our results suggest that spillovers on safety net program participation are another pathway by which NP SOP expansions can improve the health and well-being of underserved populations.
Abstract: Suicide rates increased 37% in the US from 2000 to 2018; while structural factors are extensively studied, short-term triggers remain less understood. We examine the impact of small exogenous shocks – allergies triggered by seasonal pollen – on suicides. Pollen allergies diminish cognitive function and disrupt sleep—predictors of suicidality. Combining data on pollen and mortality across 34 localities in the United States from 2006 to 2017, we use a specification with granular fixed effects to identify the effect of pollen on suicides from daily variation in each. We find that as pollen levels rise, the count of suicides in a county increases – with up to 6.8% more suicides occurring when pollen reaches its highest levels. Among individuals with a known mental health condition or treatment, we find an 11.8% higher incidence of suicides on days with the highest pollen levels. We also show that this effect is not spurious – Google searches for allergy and depression symptoms increase substantively as pollen levels rise. These estimates are robust to multiple specifications. As climate change extends and intensifies the pollen season, we expect the number of deaths by suicide attributable to pollen to more than double by the end of the century. These results point toward the importance of relatively small exogenous shocks on suicidality and the potential for relatively inexpensive and routine health care measures such as allergy testing and treatment to improve mental health.
The Effect of Online Sports Gambling Laws on Time Use (with Olanrewaju Yusuff and Tejendra Singh)
Pollen Emissions and Seasonal Allergies: Evidence from Grocery Purchases (with Shooshan Danagoulian)