And what about the kids? Divorce, child support, and childhood health investment [Link]
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 U.S. 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 these children's long-term health outcomes. 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 and a 10% increase in vaccination receipt. 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 parents respond to divorce by increasing investment in their children's health, which has important implications for understanding these children's long-term adverse health outcomes.
Nurse Practitioner Scope of Practice Law and Safety Net Participation: Evidence From WIC
(with Lilly Springer)
Contemporary Economic Policy - [Link]
Seasonal Allergies and Mental Health: Do Small Health Shocks Affect Suicidality?
(with Shooshan Danagoulian and Joelle Abramowitz)
Journal of Health Economics - [Link]
The Muslim Ban and Preventive Care for Children of Middle Eastern Ancestry
(with Shooshan Danagoulian, Daniel Grossman, and David Slusky)
Forum for Health Economics & Policy, 2025 - [Link]
Association of Licensure and Relationship Requirement Waivers with Out-of-State Tele-Mental Healthcare, 2019-2021
(with Antonios Koumpias and Lewei Alison Lin)
Health Affairs Scholar, 2023 - [Link]
Long-haul COVID: Healthcare Utilization and Medical Expenditures 6 Months Post-diagnosis
(with Antonios Koumpias and David Schwartzman)
BMC Health Services Research, 2022 - [Link]
The Effect of Federally Qualified Health Centers on Childhood Utilization of Preventive Care
Revise & Resubmit, Journal of Policy Analysis and Management - [Link]
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.
Stronger through Strain? The effect of childhood health on parental divorce
(With Huong Nguyen and Shooshan Danagoulian)
Working Paper - [Available Upon Request]
Adverse childhood health conditions impose substantial burdens on families and may generate spillover effects on parental relationships. Existing evidence on their impact on divorce is limited, largely due to the lack of linked longitudinal administrative data. Prior studies typically rely on small survey samples, focus on specific conditions, and yield mixed findings. Using unique linked administrative data from Michigan including birth records, Medicaid claims, and divorce and child support filings, we follow children from birth and identify the timing of first diagnoses across a wide range of conditions. We examine how childhood health shocks affect parental divorce following the onset of a major condition within the first eight years of life. Employing a Cox proportional hazards model combined with an event study framework, we find that such shocks increase the hazard of divorce by approximately 5.8%. The effect emerges gradually and accumulates over time rather than occurring immediately. The magnitude of the impact varies by condition type, age at diagnosis, and socio-demographic characteristics. This study highlights childhood health shocks as an important source of family strain and suggests a critical window for policy interventions aimed at supporting families and mitigating marital dissolution.
Are Behavioral Effects of Pollen Exposure Due to Symptoms or Avoidance? Evidence from Consumer Data
(with Shooshan Danagoulian)
Working Paper - [Link]
Pollen emissions-the primary trigger of seasonal allergies-have been linked to adverse behavioral outcomes, including traffic accidents, violent crime, and suicide. However, it remains unclear whether these effects are driven by physiological allergies symptoms or by behavioral responses such as avoidance of outdoor activity. In this paper, we disentangle these mechanisms by evaluating the effect of pollen exposure on consumer purchasing behavior. Linking daily pollen observations from 41 U.S. measurement stations to household level spending data from NielsenIQ, we find that a 100% increase in pollen exposure -- a common occurrence during the pollen season -- increases purchases of allergy-related products by 1.3%, but has negligible effects on total spending behavior, suggesting that the behavioral effects of pollen are explained by physiological impairment rather than by changes in activity patterns. As climate change intensifies and lengthens the pollen season, these results underscore the value of investments in allergy diagnosis, treatment, and mitigation.
Quality of Childhood Preventive Care Delivered by Non-Physicians: Evidence from Medicaid Claims
Working paper - [Link]
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.
Signals not Substitutes: What Counties' Adoption of Baby Boxes Reveal about Abortion Preferences
(with Balikis Kabir and Lilly Springer)
Effects of Air Pollution on Children's Health: Case Study of the Detroit Incinerator'
(with Sara Syeda, Phillip Levy, and Shooshan Danagoulian)
Environmental Impact on Suicide: Heat and Seasonal Pollen
(with Shooshan Danagoulian and Joelle Abramowitz)
The Effect of Online Sports Gambling Laws on Time Use
(with Olanrewaju Yusuff and Tejendra Singh)