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Essays on Risky Health Behaviors and Policy Intervention
Date of Award
Doctor of Philosophy (PhD)
Chapter 1: “Protect Young Mothers from Cigarettes, Help Their Babies? A Regression Discontinuity Study on Minimum Cigarette Purchase Age” A key target of the U.S. health policies is to reduce costly adverse birth outcomes to which prenatal smoking is one of the most significant contributors. This paper is the first to address whether implementing minimum cigarette purchase age of 21 at Pennsylvania can improve infant health through curbing smoking among young mothers. My research question is crucial because young mothers are heavily engaged in smoking and have more low birth weight babies, and smoking prevalence among mothers in Pennsylvania also exceeds the national average. The potential scope of this regulation is therefore large. I use a unique large dataset to find there is a 16 percent decrease in the average cigarettes smoked per day and a 20 percent decrease in low birth weight for mothers subject to the regulation at the cutoff. The 2SLS regression discontinuity estimates indicate that smoking 1 more cigarette per day during pregnancy worsens a variety of birth outcomes among all the mothers. For the smokers, it reduces birth weight by 61.17 grams, increases the probability of low birth weight by 2.8 percentage points, and decreases the APGAR 1 minute score by 0.13 points. The large intergenerational benefits induced by the law shed new light on the current political debate in many other states on whether enforcing MCPA 21.
Chapter 2:“Early vs. Late Smoking Cessation in Pregnancy: When Should Mothers Quit Smoking?” This paper provides new evidence on when pregnant smokers should quit to nullify the adverse impact of smoking on infant health. I address this issue using a large panel dataset of about 80,000 mothers with multiple births between 2003 and 2006, which is much better than the small and selective cross sectional samples used in previous studies. I use a mother fixed effect model to find the adverse impact of smoking on birth outcomes is nullified for those who quit in the first trimester. Mothers who smoke up to the second trimester will have remarkably worse birth outcomes. In particular, two third of the overall fetal growth rate slowdown is due to smoking within the second trimester. These results suggest that pregnant smokers should be advised to quit as early as possible especially before the second trimester. Finally, the estimated effect of smoking on birth weight and low birth weight would be biased downward by a third and over a half respectively if a researcher codes late quitters as nonsmokers when applying a fixed effect model.
Chapter 3:“Youth Health Behaviors, Health Knowledge and Educational Attainments” Are young teenagers who are more aware of the risks in substance abuse less likely to later on become binge drinkers or smokers when they are high school seniors? What are the consequences of teen heavy drinking or smoking on their educational achievements? I address these questions using NLSY 97 which provides unique information on health knowledge of young teenagers and track them over high school education. I find young teenagers who had higher level of risk perception were less likely to be substance abusers by the time they were high school seniors. Heavy drinking and smoking were associated with a lower probability of college entrance by 13 and 18 percentage points, respectively. Twelfth grade smokers were 20 percent less likely to graduate in the next year. This study therefore indicates that middle childhood health education can be an effective policy to curb youthful substance abuse by modifying teen risk perception. Due to the key role of schooling in adulthood labor market outcomes and the adverse impact of teenage heavy drinking and smoking on their educational attainments, my paper highlights the importance of direct intervention on early age substance us
Chair and Committee
Lee Benham, Sebastian Galiani, Barton Hamilton, Karen Norberg, Ping Wang
Yan, Ji, "Essays on Risky Health Behaviors and Policy Intervention" (2010). Arts & Sciences Electronic Theses and Dissertations. 200.