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on Health Economics |
| By: | Conor Lennon; Johanna Catherine Maclean; Keith F. Teltser |
| Abstract: | We examine whether ridesharing provides a meaningful transportation alternative for those who require ongoing healthcare. Specifically, we combine variation in UberX entry across the U.S. with the Treatment Episode Data Set to estimate the effect of ridesharing on admissions to substance use disorder treatment. People needing such treatment report transportation as a barrier to receiving care. We find that UberX entry into a Core Based Statistical Area has no effect on the overall number of treatment admissions. However, we find a decline in non-intensive outpatient treatment which is fully offset by an increase in intensive outpatient treatment. Given the required relative frequency of non-intensive and intensive outpatient treatment in terms of visits per week, our findings indicate that UberX helps to reduce transportation barriers to accessing healthcare. Event-studies show parallel trends in outcomes before UberX entry and results are robust to numerous sensitivity checks. |
| JEL: | I12 L62 L92 R41 |
| Date: | 2024–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33077 |
| By: | Clarke, Damian; Rocha, Rudi; Szklo, Michel |
| Abstract: | There is surprisingly scarce evidence regarding the extent to which and how government health expenditure affects health outcomes. Exploiting variation generated by Brazil’s 29th Constitutional Amendment, which mandated minimum thresholds for municipal spending on health, we examine the chain connecting government health spending to health inputs, production and outcomes, with a focus on infant mortality. We find relatively low average elasticities, but relevant heterogeneity in spending returns. Reductions in infant mortality are greater where baseline spending was lower, pointing to concave returns; where investments in infrastructure and personnel were complementary; and particularly where strong institutional and public management capabilities exist. |
| Keywords: | Gobernabilidad, Salud, |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:dbl:dblwop:2300 |
| By: | Jeffrey Clemens; Pierre-Thomas Léger; Yashna Nandan; Robert Town |
| Abstract: | We examine the relationship between physician preferences and both the intensity and cost of care delivered to commercially insured heart attack patients. We match survey data on physician preferences, collected by Cutler, Skinner, Stern, and Wennberg (2019) (CSSW), to medical claims data from the Health Care Cost Institute, which spans over 50 million insurance beneficiaries. In contrast to CSSW, who find strong correlations between aggressive practice preferences and both expenditure and utilization for the Medicare population, we find relationships that are both economically and statistically smaller in magnitude within the commercially insured population. Variations in commercial insurers’ prices appear to play an important mediating role. |
| JEL: | I11 I13 |
| Date: | 2024–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33090 |
| By: | Foltyn, Richard (Dept. of Economics, Norwegian School of Economics and Business Administration); Olsson, Jonna (Dept. of Economics, Norwegian School of Economics and Business Administration) |
| Abstract: | Using biennial data from the Health and Retirement Study, we estimate agedependent health dynamics and survival probabilities at annual frequency conditional on race, sex, self-reported health and other covariates. The estimates can be used to calculate heterogeneous life expectancies in the population. We show that the racial life expectancy gap remains large, even conditional on health, socioeconomic and marital status. Due to racial differences in health dynamics and mortality, married black men on average can expect to receive $6, 400 (or 8%) less in Social Security benefits in present value terms. Using a rich life cycle model, we estimate that this corresponds to a welfare loss of about 4%, whereas black married women’s welfare loss is primarily driven not by their own shorter life expectancy but the shorter life expectancy of their husbands. |
| Keywords: | Life expectancy; health dynamics; racial life expectancy gap; Social Security wealth; life cycle model |
| JEL: | C23 E21 I14 J14 |
| Date: | 2024–10–28 |
| URL: | https://d.repec.org/n?u=RePEc:hhs:nhheco:2024_018 |
| By: | Xinming Du; Shan Zhang; Eric Zou |
| Abstract: | A century of plastic usage has led to an accumulation of plastic waste in waterways and oceans. Over time, these wastes break down into particles smaller than 5 microns – or “microplastics” – which can infiltrate human biological systems. Despite decades of research into this emerging source of pollution, there is a paucity of direct evidence on the health impacts of microplastics exposure at a population scale. This paper reports the first empirical link between in-utero microplastic exposure and adverse birth outcomes. Our analysis is based on a dataset of 3 million births that occurred in coastal areas of 15 countries spanning four continents, which we merge with novel remote-sensing measurements of marine microplastic concentrations. We show that in-utero exposure to microplastics, particularly during the second and third trimesters, leads to a significant increase in the likelihood of low birth weight. A doubling of exposure increases low birth weight hazard by 0.37 per 1, 000 births, which implies that over 205, 000 cases per year globally can be attributed to microplastic exposure. We further show that aerosolization – whereby microplastic particles become airborne and inhalable due to seawater evaporation – is an important pathway for health impact, a challenge likely to escalate as ocean temperatures rise. |
| JEL: | I18 O13 Q25 Q53 |
| Date: | 2024–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33094 |
| By: | Kjell Arne Brekke; Snorre Kverndokk |
| Abstract: | We study how measures of socioeconomic health inequality inform about welfare inequality. We argue that transfers of either income or health from a better off to a worse off individual should reduce welfare inequality. Lacking an objective measure of individual welfare, we suggest that such a transfer should reduce at least one measure of inequality: inequality in income, health or socioeconomic health. This puts restrictions on measures of socioeconomic health inequality, where a correlation between income and health meets the requirement, while the concentration index only meets the requirement in a statistical sense. Finally, we show empirically that changes in the concentration index over time can be dominated by changes in income. Using data from HUNT, income changes account for 90% of the changes in the concentration index, while health and income are equally important with data from EU-SILC, with large variation across countries and years. |
| Keywords: | socioeconomic inequality, health inequality, health transfers, income transfers, concentration index |
| JEL: | D31 I12 |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_11318 |
| By: | Yunan Ji; Parker Rogers |
| Abstract: | We investigate the effects of substantial Medicare price reductions in the medical device industry, which amounted to a 61% decrease over 10 years for certain device types. Analyzing over 20 years of administrative and proprietary data, we find these price cuts led to a 25% decline in new product introductions and a 75% decrease in patent filings, indicating significant reductions in innovation activity. Manufacturers decreased market entry and increased outsourcing to foreign producers, associated with higher rates of product defects. Our calculations suggest the value of lost innovation may fully offset the direct cost savings from the price cuts. We propose that better-targeted pricing reforms could mitigate these negative effects. These findings underscore the need to balance cost containment with incentives for innovation and quality in policy design. |
| JEL: | H51 I18 O31 |
| Date: | 2024–10 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:33083 |
| By: | Jung, Dain (Liaoning University); Kim, Jun Hyung (Korea Advanced Institute of Science and Technology); Kwak, Do Won (Korea University) |
| Abstract: | Single-sex schooling is a controversial policy whose effects are inconsistent across different studies with its mechanisms poorly understood. Leveraging the random allocation of high school students in South Korea, we study the effect of single-sex schooling on mental health while considering its interactions with peer relationships and academic achievement. Our results closely align with gender-specific responses to competitive pressure in the literature. Female students with better academic achievement than their peers experience better mental health and peer relationships. However, relatively underperforming female students, subject to intense competitive pressure at school, do not benefit from being in the company of other female students in a single-sex environment. Impacts on male students do not significantly depend on the competitive pressures they face. Our study calls for caution in implementing educational policies that may affect competitive pressure or gender composition in schools. |
| Keywords: | single-sex schooling, gender and competition, mental health, peer relationship |
| JEL: | I21 I24 J16 |
| Date: | 2024–09 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17330 |
| By: | Shubhangi Agrawal (University of Edinburgh); Sambit Bhattacharyya (University of Sussex Business School); Chirantan Chatterjee (University of Sussex Business School); Somdeep Chatterjee (Indian Institute of Management Calcutta) |
| Abstract: | Conventional wisdom states that healthcare is a luxury good. Spending on healthcare is expected torise disproportionately with rising income. However, India appears to be a clear outlier with its aggregate national healthcare spending falling during rapid economic expansion. We explore this curious anomaly by estimating the causal effect of income on healthcare expenditure using large longitudinal household and patient level administrative datasets covering the period 2016-2020. An unanticipated shock in the form of a reduction in mandated employees’ provident fund contribution for women is used to identify the causal effect in female led households. We find that an unanticipated income shock is associated with a decrease in overall spending on healthcare in female led households even after controlling for improved health outcomes for women, health-status, healthcare uti-lization at the intensive margin (i.e., hospital visits to seek treatment). Our results suggest that healthcare spending by females in India and the global South is guided by dynamic preferences and social norms. |
| Keywords: | Income, Health Spending |
| Date: | 2024–10 |
| URL: | https://d.repec.org/n?u=RePEc:sus:susewp:1324 |
| By: | Brassiolo, Pablo; Fagre, Eduardo; Harker Roa, Arturo; Peñaloza-Pacheco, Leonardo |
| Abstract: | This study evaluates the short-term impact of two school-based inter ventions designed to prevent alcohol use among children in high-risk schools in Bogotá, Colombia. The programs aimed at increasing the perception of risk and modifying normative values and beliefs related to alcohol consumption among students as a mechanism to delay first-time alcohol use and reduce consumption among those already consuming alcohol. The two interventions varied in terms of the core curriculum strategy and the organization that implemented them. A stratified random assignment procedure was used to allocate 100 schools, with approximately 13.000 sixth-grade students, across three study arms (i.e., two treatment groups and a control group). The stu dents who received treatment were given the first intervention in sixth grade, followed by a second wave in seventh grade. The study results show that both programs were effective in affecting the perception of the risk of alcohol consumption and normative attitudes toward alco hol use in the desired direction. One of the main factors that explain these results is the increase in students’ objective knowledge about the harmful effects of alcohol consumption. However, there were no systematic effects on actual consumption as reported by students. |
| Keywords: | Desarrollo, Desarrollo urbano, Educación, Jóvenes, Niñez, Salud, |
| Date: | 2023 |
| URL: | https://d.repec.org/n?u=RePEc:dbl:dblwop:2213 |
| By: | Tuba Tunçel (TSE-R - Toulouse School of Economics - UT Capitole - Université Toulouse Capitole - UT - Université de Toulouse - EHESS - École des hautes études en sciences sociales - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement) |
| Abstract: | After a drug obtains marketing authorization, the usage depends on the regulation of off-label prescriptions for unapproved indications. We investigate the impact of off-label prescription regulation on physicians' behavior, patients' health, treatment costs, and pharmaceutical firms' pricing with a structural demand and supply model. Exploiting rich panel data on physicians' activities and office visits in France over nine years, we use a model of prescription choice and health outcomes with unobserved patient-level heterogeneity. We identify the demand for on-label and off-label drugs and the effect of prescription choice on health outcomes. On the supply side, we use a Nash-in-Nash bargaining model between the government and the pharmaceutical companies that allows the partial identification of the marginal costs of drugs. Counterfactual simulations show that when we remove off-label drugs from the choice set of physicians, substitution to on-label drugs at constant prices would lead to an increase of 15% in the expenditure on prescription drugs. If we allow bargaining adjustment on drug prices under a ban on off-label prescriptions, the ban would further increase the treatment cost, by 26%, without improving health outcomes. |
| Keywords: | Physician Behavior, Prescription Drugs, Off-Label Drugs, Regulation, Bargaining |
| Date: | 2024–05–30 |
| URL: | https://d.repec.org/n?u=RePEc:hal:journl:hal-04758877 |
| By: | Cecilia Velázquez (CEDLAS-IIE-FCE-UNLP, CENEP & CINVE) |
| Abstract: | Following abortion legalization in Uruguay in late 2012, adolescent fertility rate fell by more than half. This paper aims at establishing a causality relationship. To estimate the impact of the abortion reform on adolescent fertility I use the Synthetic Control Method by comparing trends of Uruguay with Latin America and the Caribbean countries with restrictive abortion laws. Results suggest adolescent fertility rate was reduced in the postreform period by an average of 8.3 births per 1, 000 girls aged 15-19, a decline of almost 15% with respect to the synthetic control unit. In-space placebos indicate this effect is statistically significant at the 5% level. This conclusion holds after conducting an in-time placebo test and a leave-one-out test. To the present time, evidence on the impact of Uruguayan abortion legalization on adolescent fertility that has addressed endogeneity is mixed, and based entirely on identification strategies that exploit different sources of exogenous within-country variation that determines the exposure to the reform. My contribution here is to exploit between-country variation, bringing new evidence to the on-going debate. |
| JEL: | I18 J13 J18 |
| Date: | 2024–11 |
| URL: | https://d.repec.org/n?u=RePEc:dls:wpaper:0339 |
| By: | Laura Breitkopf; Shyamal Chowdhury; Shambhavi Priyam; Hannah Schildberg-Hörisch; Matthias Sutter |
| Abstract: | We study the relationship between parenting style and a broad range of children’s skills and outcomes. Based on survey and experimental data from 5, 580 children and their parents, we find that children exposed to positive parenting have higher IQs, are more altruistic, open to new experiences, conscientious, and agreeable, have a higher locus of control, self-control, and self-esteem, perform better in scholarly achievement tests, behave more prosocially in everyday life, and are more satisfied with their life. Positive parenting is negatively associated with children’s neuroticism, patience, engagement in risky behaviors, and their emotional and behavioral problems. |
| Keywords: | parenting style, child outcomes, economic preferences, personality traits, IQ |
| JEL: | C91 D01 D10 |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_11391 |
| By: | Fan, Simon (Lingnan University); Pang, Yu (Macau University of Science and Technology); Pestieau, Pierre (Université catholique de Louvain, LIDAM/CORE, Belgium) |
| Abstract: | This paper develops an overlapping generations model analyzing parenting choices from a life cycle perspective. Young parents educate their children to foster their human capital development. Strict discipline requires minimal time from parents yet but can strain intergenerational relations. Pedagogical practice preserves familial bonds but demands significant time and effort, adversely affecting parental income. As parents age, they desire caregiving support from their adult children, who may bring earlier conflicts with their parents into the care environment. We suggest that the prevalence of strict discipline declines when the probability of living into old adulthood increases. We then incorporate health investments into the model to endogenize longevity and investigate the transitional dynamics of life expectancy, parenting styles, and human capital stock. Moreover, we examine how the interaction between parenting styles and monetary transfers induces children’s provision of eldercare in a bargaining framework. We characterize multiple stationary Markov perfect equilibria, shedding light on the observed diversity in parenting across different cultures. |
| Keywords: | Parenting ; longevity ; old-age support ; human capital ; health investment |
| JEL: | I19 I21 J14 |
| Date: | 2024–06–22 |
| URL: | https://d.repec.org/n?u=RePEc:cor:louvco:2024018 |
| By: | Mustafa Özer; Jan Fidrmuc |
| Abstract: | Large-scale immigration waves can have adverse effects on physical and mental health of the natives. We investigate the impact of the unprecedented influx of Syrian refugees after 2011 on the mental health of native Turks. Our results suggest that immigration may adversely affects the mental health of natives. The adverse effects, however, are conditioned by the underlying political environment: they are strong in opposition-controlled provinces but limited in areas controlled by the Justice and Development Party (AKP) of president Erdoğan. At the individual level, we observe adverse effects of immigration among married, older, less-educated, and employed women, for women with unemployed husbands, and for children with young or less-educated mothers or unemployed fathers. We believe these individual-level patterns reflect the combined effect of increased demand for health-care services and increased competition at the labor and marriage markets. |
| Keywords: | health, mental health, immigration, instrumental variable, natural experiment |
| JEL: | F22 I12 J15 |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_11399 |
| By: | Gräser, Melanie; Grimm, Christine; Hoffmann, Roman |
| Abstract: | Medical treatments in hospitals can be highly stressful for children, potentially affecting their well-being and recovery. Clown interventions have been proposed as an effective non-medical approach to alleviate this stress and improve health outcomes. Here, we employ a randomized controlled trial (RCT) to evaluate the effects of hospital clown visits on pediatric patients in Palestine, an environment characterized by challenges in healthcare access, sociopolitical tensions and conflicts, and limited resources. As outcomes, we consider the children’s well-being during the hospital stay, the recovery process, and the caregiver’s perception of the quality of the hospitals. The results show that clown visits have a significant, positive effect on the well-being of children during their hospital stay: The children’s well-being in the treatment group was by 0.25 standard deviations higher compared to children who did not see a clown during their hospital stay. The positive well-being impacts are particularly strong among children with a higher socio- economic status and those with a positive attitude towards clowns. No effects of clown visits are found on the subjective recovery of patients as measured by caregivers and on the caregiver’s perception of the hospitals. The findings underscore the potential of non-medical interventions like clown visits to alleviate the psychological burden of hospitalization for children and to increase their well-being, particularly in vulnerable settings like Palestine. |
| Keywords: | Healthcare; clown visits; pediatrics; well-being; randomized controlled trial; Palestine |
| Date: | 2024–10 |
| URL: | https://d.repec.org/n?u=RePEc:wiw:wus005:68240480 |
| By: | Jan Fidrmuc; Maksym Obrizan; Piotr Stanek |
| Abstract: | We analyze the wellbeing socio-economic characteristics of Ukrainian refugees in Poland and compare them with their co-nationals who remained in Ukraine. Specifically, we identify the determinants of happiness, trust and self-declared health, and the patterns of self-selection into becoming a refugee in Poland. We focus on how having experienced violence in the course of the current conflict affects socio-economic outcomes of refugees and stayers. We find that the refugees are less well-off both economically and in terms of their general wellbeing (happiness). Having experienced violence does not seem to compel Ukrainians to become refugees, suggesting that they move preemptively, due to the threat of violence, and not after having experienced it. Having suffered violence, however, has a lasting adverse impact on the happiness, trust and health of Ukrainians in Poland and Ukraine alike. |
| Keywords: | refugees, violence, happiness, trust, health, Ukraine |
| JEL: | F22 F51 I10 I30 |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_11393 |
| By: | Lefebvre, Mathieu (University of Strasbourg); Pestieau, Pierre (Université catholique de Louvain, LIDAM/CORE, Belgium); Schoenmaeckers, Jérôme (Université de Liège) |
| Abstract: | The phenomenon of grandparents assuming the role of caretakers for their grandchildren is both substantial and on the rise, a trend partially attributed to mothers’ increasing participation in the workforce. While altruism is commonly believed to be the primary driver behind such caregiving, we propose to examine an additional motivation: the expectation among grandparents that they will receive care from their offspring in the event of their own incapacity. This paper aims to investigate this hypothesis from both theoretical and empirical perspectives. Initially, we construct a theoretical framework, delineating a Subgame Perfect Nash Equilibrium, wherein the grandparent first commits to caring for the grandchild, followed by the anticipation of receiving care from their adult child in scenarios of disability. Subsequently, we empirically test the feasibility of this model by analyzing data sourced from the Survey of Health, Ageing and Retirement in Europe (SHARE). Our results confirm that elderly who took care of their grandchildren receive more support from their children in the case of a loss of autonomy. |
| Keywords: | Long-term care ; Intergenerational transfers ; Informal care |
| JEL: | D13 J14 D64 |
| Date: | 2024–05–30 |
| URL: | https://d.repec.org/n?u=RePEc:cor:louvco:2024014 |
| By: | Mukesh Khanal; Jack Mintz; Janice MacKinnon |
| Abstract: | The World Health Organization has advocated the earmarking of health-related taxes to mobilize revenues to be spent on public health spending. While there are certain advantages and disadvantages in the use of earmarked taxes to fund healthcare, its ability to mobilize revenues will depend on whether earmarked taxes are acceptable to voters or not. Earmarking might generate more funding for health care if voters know their tax payments are to be spent on program important to them. However, earmarking might discourage funding if voters are not willing to pay more taxes for health care. Regardless, earmarking will not succeed if government simply replace earmarked taxes for general revenues, leaving public health expenditure untouched. We find that earmarked taxes do not lead to more per capita public health spending in the OECD. If a country has earmarked taxes to support public healthcare, per capita public health spending may decline by over $800, compared to a country with no earmarked taxes supporting public healthcare. The case for earmarking has to be based on other arguments instead. |
| Keywords: | taxation, earmarking, health financing |
| JEL: | H20 I18 |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_11306 |
| By: | Magalhães, Júlia; Ziebold, Carolina; Evans-Lacko, Sara; Matijasevich, Alicia; Paula, Cristiane Silvestre |
| Abstract: | Background The Bolsa Família cash transfer Program (BFP) aims to break the poverty cycle by providing a minimum income to poor families conditioned on their investment in human capital (such as, education and health) and currently is the largest Program in the world in terms of the number of beneficiaries. Because there is a scarcity of reviews grouping studies on the impacts of the BFP, the objective of this scoping review was to identify and describe studies which evaluate the impact of the BFP on poverty, health, education, and other related outcomes. Methods We searched for quantitative, qualitative, and mixed-method articles that assessed the impact of the BFP on any aspect of the beneficiaries' lives between 2003 and March 2021. We included quantitative articles that used experimental, quasi-experimental or pre and post comparison designs. We excluded articles that analyzed impacts on political outcomes. There was no age restriction for the participants. The search was done in seven electronic databases. Results One thousand five hundred forty-six papers were identified and 94 fulfilled the inclusion criteria. Poverty and health outcomes were the most common outcomes studied. We found consistent evidence of the positive impact of the BFP on poverty reduction, as well as employment outcomes. We also found positive impacts in relation to mortality rates for children and adults, school dropout and school attendance among children and adolescents, and violence related outcomes such as homicide, suicide, crime, and hospitalization. However, we also found some evidence that BFP increased intimate partner violence and gender stereotypes among women and no evidence of impact on teenage pregnancy. Conclusions Overall, the studies included found that BFP showed positive impacts on most poverty, health and education outcomes. More studies are needed to confirm some results, especially about violence and stereotype against women as there were few evaluations on these outcomes. |
| Keywords: | Bolsa família; employability; food insecurity; gender roles; mortality; poverty; social inclusion; social protection; UKRI fund |
| JEL: | J1 |
| Date: | 2024–10–14 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:125534 |
| By: | Somers, Melline (RS: GSBE other - not theme-related research, ROA / Health, skills and inequality); Stolp, Tom (RS: GSBE other - not theme-related research, ROA / Education and transition to work); Burato, Francesca; van Merode, Frits (Faculteit FHML Centraal, RS: CAPHRI - R2 - Creating Value-Based Health Care); Vooren, Melvin |
| Abstract: | The healthcare and education sectors suffer from shortages of nurses and teachers. Extending their working hours has often been proposed as a solution to this. In this study, we conduct a discrete choice experiment (DCE) in the Netherlands to elicit nurses’ and teachers’ preferences for different jobs and working conditions. We present both nurses and teachers with nine hypothetical choice sets, each consisting of two jobs that differ in seven observable job attributes. From the DCE, we infer workers’ willingness to pay for these different job characteristics. Moreover, we calculate how many additional hours workers would be willing to work if a specific workplace condition were met. We find that both nurses and teachers most negatively value high work pressure. Spending a lot of time on patient-related tasks is highly valued by nurses, followed by having more control over working hours. Next to work pressure, teachers place significant importance on receiving social support from both colleagues and managers. Nurses and teachers who work part-time require higher incentives to work additional hours compared to full-time workers. |
| JEL: | J45 J81 |
| Date: | 2024–10–30 |
| URL: | https://d.repec.org/n?u=RePEc:unm:umaror:2024005e |
| By: | Feldman, Emily; Slavish, Danica Christine (University of North Texas) |
| Abstract: | Objective: To explore the impact of risk and protective factors on insufficient sleep among adolescents, and to investigate whether these associations vary by race/ethnicity. Methods: This study utilized data from the 2021 Youth Risk Behavior Surveillance System (YRBSS), a nationally representative sample of high school students (N = 8, 289). Race/ethnicity and a sum of 6 community risk factors and 4 interpersonal protective factors were used to predict odds of insufficient sleep (< 7 hours/night). Results: Black and multiracial non-Hispanic adolescents had a 32-45% increase in odds of reporting insufficient sleep compared to White adolescents. Endorsing fewer interpersonal protective factors and more community risk factors were independently associated with higher odds of insufficient sleep. Only one significant interaction with protective factors and race/ethnicity emerged for multiracial non-Hispanic (vs. White) adolescents. Conclusions: Risk and protective factors each play a unique role in predicting sleep duration among racially/ethnically diverse adolescents. Policy Implications: To improve sleep health outcomes among adolescent populations, it is crucial to address structural barriers, improve community safety, and strengthen protective factors like parental involvement and a sense of belonging. |
| Date: | 2024–10–24 |
| URL: | https://d.repec.org/n?u=RePEc:osf:osfxxx:u4wpx |
| By: | Loup Beduchaud; Enoa Celingant; Clara Faure; Mathilda Meunier; Iñaki Blanco-Cazeaux (BPH - Bordeaux population health - UB - Université de Bordeaux - Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED) - INSERM - Institut National de la Santé et de la Recherche Médicale) |
| Abstract: | This review investigates the effectiveness of utilizing foreign physicians or International Medical Graduates to alleviate medical shortages in rural and underserved areas of developed countries. Conducted in February 2024, this systematic review follows PRISMA 2020 guidelines, analysing 15 English-language studies from the United States, Canada, Australia, and New Zealand. The focus is on comparing physicians with international graduation to national graduates in rural and underserved contexts. Results reveal diverse trends across countries: in the United States, national graduates are generally more represented in rural areas, while foreign physicians are more prevalent in Health Professional Shortage Areas. In Canada, foreign graduates are more common in rural areas, varying by province. Australia and New Zealand show foreign physicians practicing more in rural areas than national counterparts. This study underscores significant reliance on foreign physicians to mitigate rural healthcare disparities. While this strategy partially addresses immediate shortages, long-term effectiveness is uncertain due to retention and integration challenges. Future policies should focus on sustainable solutions for equitable healthcare access and physicians' retention in underserved areas. This review emphasizes also the need for Europe-specific studies and further evaluation of policy effectiveness. |
| Keywords: | Systematic review, Medical shortage area, International medical graduate, Health policy, Healthcare access inequalities |
| Date: | 2024–10–28 |
| URL: | https://d.repec.org/n?u=RePEc:hal:journl:hal-04756497 |
| By: | Bertocchi, Graziella (University of Modena and Reggio Emilia); Dimico, Arcangelo (Queen's University Belfast); Falco, Chiara (University of Milan Bicocca) |
| Abstract: | Family planning is a critical issue in countries, particularly those in sub-Saharan Africa, where high fertility rates coexist with low contraceptive use alongside adverse perinatal outcomes. Using a combination of ethnographic, ecological, and folklore data, we investigate the role played in this context by postpartum sexual abstinence, an extensively documented practice that, in preindustrial societies, nds its biological justication as a means to safeguard child survival. First, we show that the duration of contemporary postpartum abstinence increases with the duration of ancestral postpartum sex taboos within a woman's ethnic group. Second, postpartum abstinence is de facto pronatalist, as it increases the number of children ever born to a woman. At the same time, it increases the number of children of a woman who have died; lengthens birth intervals though not suciently to meet recommended guidelines; and increases neonatal death and child stunting. Exploring the underlying mechanisms reveals that postpartum abstinence is associated with patriarchal cultural norms and that the motivation for its adoption is that it serves as a purication ritual. Overall, our ndings question the biological rationale for postpartum abstinence as a means to protect child health, while aligning with anthropological evidence documenting its adoption as a ritual. |
| Keywords: | family planning, postpartum abstinence, postpartum sex taboos, contraception, fertility, birth spacing, child health, tuber suitability, folklore, female empowerment, rituals, sub-Saharan Africa |
| JEL: | J13 I18 N37 O11 D15 |
| Date: | 2024–10 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp17391 |
| By: | Breen, Casey; Rahman, Saeed; Kay, Christina; Smits, Joeri; Azar, Abraham; Ahuka-Mundeke, Steve; Feehan, Dennis |
| Abstract: | Reliable estimates of death rates in complex humanitarian emergencies are critical for assessing the severity of a crisis and for effectively allocating resources. However, in many humanitarian settings, logistical and security concerns make conventional methods for estimating death rates infeasible. We develop and test a new method for estimating death rates in humanitarian emergencies using reports of deaths in survey respondents’ social networks. To test our method, we collected original data in Tanganyika Province of the Democratic Republic of the Congo, a setting where reliable estimates of death rates are in high demand. Qualitative fieldwork suggested testing two different types of personal networks as the basis for death rate estimates: deaths among immediate neighbors and deaths among kin. We benchmarked our network estimates against a standard retrospective household mortality survey, which estimated a crude death rate nearly twice as high as our network-based methods. Given both methods are equally plausible, our findings underscore the need for further validation and development of both methods. |
| Date: | 2024–10–24 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:4efdt |
| By: | Aurélia Lépine (UCL - University College of London [London]); Fanny Procureur (UCL - University College of London [London]); Sandie Szawlowski (UCL - University College of London [London]); Carole Treibich (GAEL - Laboratoire d'Economie Appliquée de Grenoble - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement - UGA - Université Grenoble Alpes - Grenoble INP - Institut polytechnique de Grenoble - Grenoble Institute of Technology - UGA - Université Grenoble Alpes); El Hadj Mbaye (Ministry of Health and Social Action, Dakar); Khady Gueye (Ministry of Health and Social Action, Dakar); Cheikh Tidiane Ndour (Ministry of Health and Social Action, Dakar) |
| Abstract: | Context: There is compelling evidence that eliminating sexually transmitted infections (STIs) among female sex workers (FSWs) is a cost-effective approach to reducing the spread of HIV/ AIDS. Although many countries recognise sex work as a public health issue, few have implemented public health policies specifically aimed at controlling the transmission of HIV/ AIDS among FSWs. In particular, Senegal stands out as the only African country to regulate sex work through a specific public health policy that requires FSWs to register with a health centre. Despite the potential health and legal benefits associated with registration, a staggering 80% of FSWs in Senegal remain unregistered. This low registration rate hinders the realisation of the policy's full potential for public health benefits. The reluctance of FSWs to register is due to inherent flaws in the policy design, where the disadvantages of registration outweigh the benefits for FSWs. Objective: To identify which modifications to the current registration policy have the potential to increase uptake of registration by FSWs and to assess their feasibility in the context of Senegal. Method: We conducted a qualitative policy research study using semi-structured in-depth interviews with 22 national stakeholders in this policy, including representatives from the police, government and non-governmental organisations (NGOs) in Dakar, Senegal, as well as FSWs' leaders. The interview data were thematically coded using the interview topic guide and other recurring themes and analysed using thematic analysis on Nvivo 12. Results: A total of 20 relevant themes were selected, focusing primarily on assessing the feasibility of potential interventions and identifying potential barriers and associated risks. We found that, without changing current legislation, improving relationships between FSWs and police officers, providing accurate and accessible information about the rules and benefits of the policy, and offering psychosocial support have the potential to improve both the registration rate of FSWs and their wellbeing. Policy features designed to increase registration by improving FSWs' confidentiality, and thus their confidence in the services offered, were also discussed. Conclusions: The study highlighted that several national public health policies could be changed to increase the registration rate of FSWs and improve their wellbeing without overturning constitutional law. |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:hal:journl:hal-04750353 |
| By: | Brotherhood, Luiz; Kircher, Philipp (Université catholique de Louvain, LIDAM/CORE, Belgium); Santos, Cezar; Tertilt, Michele |
| Abstract: | This paper investigates the importance of the age composition for pandemic policy design. To do so, it introduces an economic framework with age heterogeneity, individual choice, and incomplete information, emphasizing the value of testing. Calibrating the model to the US Covid-19 pandemic reveals an 80% reduction in death toll due to voluntary actions and the lockdown implemented in the US. The optimal lockdown, however, is more stringent than what was implemented in the US. Moreover, the social planner follows an asymmetric approach by locking down the young relatively more than the old. We underscore the importance of testing, showing its impact on reduced deaths, lower economic costs and laxer lockdown. We use the framework to provide systematic insights into pandemics caused by different viruses (among others the Spanish flu), and underline the influence of economic conditions on optimal policies. |
| Keywords: | Covid-19 ; testing ; social distancing ; age ; age-specific policies |
| JEL: | E17 C63 D62 I10 I18 |
| Date: | 2024–06–05 |
| URL: | https://d.repec.org/n?u=RePEc:cor:louvco:2024012 |
| By: | Christina A. Martini; Björn Bos; Moritz A. Drupp; Jasper N. Meya; Martin F. Quaas |
| Abstract: | This paper investigates the link between dishonesty and the spread of COVID- 19 infections. In an online experiment and panel survey, 2, 723 Germans completed an incentivized coin-tossing task in March 2020 and reported their infection status in four subsequent survey waves up until December 2021. We find that individuals who are most likely dishonest in the coin-tossing task at the onset of the pandemic, as they report the highest number of winning coin tosses, are more than twice as likely to get a future COVID-19 infection than the sample mean. Respondents who are most likely to have reported dishonestly also engage more in behaviors that increase the risk of becoming infected and of transmitting the infection relative to likely honest respondents. Hence, we postulate that differences in preferences and norm compliance are underlying determinants that affect behavior in the experiment and in the field. We observe a similar relationship at the country level between an incentivized measure of civic honesty and excess deaths due to COVID-19 in 22 OECD countries. |
| Keywords: | dishonesty, Covid-19 infections, excess deaths, online experiment |
| JEL: | C90 I12 |
| Date: | 2024 |
| URL: | https://d.repec.org/n?u=RePEc:ces:ceswps:_11381 |