The effect of parental involvement laws on teen birth control use

Neonatal mortality and contraceptive utilization following abortion restriction in the Dominican Republic: A difference-in-differences analysis

In 2009, the Dominican Republic's Constitutional Assembly banned abortion under all circumstances, including cases of rape and/or situations in which the mother's health is at risk. Abortion policies have the potential to influence access to reproductive and neonatal health services, health outcomes, and health equity. In this study, we utilized a difference-in-differences approach to evaluate the association between the 2009 abortion reform in the Dominican Republic and neonatal mortality and modern contraceptive utilization. We harmonized data from Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) between 1999 and 2019 to assemble a panel of 792,165 live births across 17 countries for analyses of neonatal mortality and 417,110 women ages 15-49 across 8 countries for analyses of modern contraceptive use. We compared outcome trajectories in the Dominican Republic to a group of control countries that did not change their abortion policies during the study period and are assumed to represent the counterfactual. Fixed effects for country and year were included to control for unobserved time-invariant confounders that varied across countries and temporal trends that were shared across countries, respectively. We also assessed for heterogeneity by household wealth, rural residency, and educational attainment through a stratified analysis. Over the study period, the rate of neonatal mortality was 27.0 per 1,000 live births and there were 39 per 100 women reporting use of modern contraceptives. Abortion restriction was associated with an additional 6.3 (95 % CI = 2.1, 10.5) neonatal deaths per 1,000 live births and a 9.6 (95 % CI = 4.2, 15.0) percentage-point decrease in modern contraceptive use. Estimates were robust to adjustment for individual, household, and country-level characteristics. However, there is possibility of residual confounding by unmeasured time-varying confounders, such as concomitant policy changes or interventions. Further research into how restrictive abortion policies compound racial, ethnic, and socioeconomic inequities is needed.

From Roe to Dobbs: 50 Years of Cause and Effect of US State Abortion Regulations

The Roe era was hardly a monolith. For more than 50 years-beginning with abortion reforms in the 1960s and continuing through the Dobbs decision in 2022-state regulations of abortion were neither uniform nor consistent. States reformed and repealed abortion bans leading up to the Roe decision in 1973. Following Roe, they enacted both demand-side regulations of people seeking abortions and supply-side regulations of people providing abortions. The resulting laboratory of state policies affords natural experiments that have yielded evidence on the effects of abortion regulations on demographic, health, economic, and other social outcomes. I present a brief history of state policy variation from 1967 through 2016 and review the empirical scholarship studying its effects. This literature demonstrates that the liberalization of abortion access in the 1960s and 1970s allowed women greater control over their fertility, resulting in increased educational attainment and earnings. Subsequent state restrictions in the 1980s through 2010s had the opposite effect, particularly when they increased the financial and logistical costs of obtaining an abortion. I conclude with a discussion of implications for the post-Dobbs era, considering to what extent evidence from the past foretells the future.

Intended and unintended effects of e-cigarette taxes on youth tobacco use

Over the past decade, rising youth use of e-cigarettes and other electronic nicotine delivery systems (ENDS) has contributed to aggressive regulation by state and local governments. Between 2010 and mid-2019, ten states and two large counties adopted ENDS taxes. We use two large national surveys (Monitoring the Future and the Youth Risk Behavior Surveillance System) to estimate the impact of ENDS taxes on youth tobacco use. We find that ENDS taxes reduce youth ENDS consumption, with estimated ENDS tax elasticities of -0.06 to -0.21. However, we estimate sizable positive cigarette cross-tax effects, suggesting economic substitution between cigarettes and ENDS for youth. These substitution effects are particularly large for frequent cigarette smoking. We conclude that the unintended effects of ENDS taxation may considerably undercut or even outweigh any public health gains.

How Data Security Concerns Can Hinder Natural Experiment Research: Background and Potential Solutions

Health economists conducting cancer-related research often use geocoded data to analyze natural experiments generated by policy changes. These natural experiments can provide causal interpretation under certain conditions. Despite public health benefit of this rigorous natural experiment methodology, data providers are often reluctant to provide geocoded data because of confidentiality concerns. This paper provides an example of the value of natural experiments from e-cigarette research and shows how this research was hindered by security concerns. Although the tension between data access and security will not be resolved overnight, this paper offers 3 recommendations: 1) provide public access to aggregated data at area levels (eg, state) where possible; 2) approve projects with enough time to allow for publication in journals with lengthy peer-review times; and 3) improve communication and transparency between data providers and the research community. The Foundations for Evidence Based Policymaking Act of 2018 also presents a unique opportunity for improving the ability of researchers to use geocoded data for natural experiment research without compromising data security.

Did parental involvement laws grow teeth? The effects of state restrictions on minors' access to abortion

We compile data on the locations of abortion providers and enforcement of parental involvement laws to document dramatic increases in the distances minors must travel if they wish to obtain an abortion without involving a parent or judge: from 58 miles in 1992 to 454 in 2016. Using both double and triple-difference estimation strategies, we estimate the effects of parental involvement laws, allowing them to vary with the distances minors might travel to avoid them. Our results confirm previous findings that parental involvement laws did not increase teen births in the 1980s, and provide new evidence that in more recent decades they have increased teen birth by an average of 3 percent. The estimated effects are increasing in avoidance distance to the point that a confidential abortion is more than a day's drive away, and also are substantially larger in the poorest quartile of counties.

Graduated driver licensing and teen fertility

This paper evaluates the effect of implementing nighttime driving curfews and passenger restrictions mandated by graduated driver licensing (GDL) on teen fertility. Both components of GDL potentially restrict the freedom and mobility of minor drivers by requiring adult supervision, and therefore reduces opportunities to become pregnant. Using birth data from the National Vital Statistics (NVSS) and a triple differences approach, I find that the implementation of "tough" GDL decreased fertility by 3-4% among mothers between the ages of 16 and 18. This effect is driven by the states that require driving curfews for at least a year before teenagers can obtain their unrestricted drivers license.

Confidentiality in the Doctor-Patient Relationship: Perspectives of Youth Ages 14-24 Years

OBJECTIVE

To describe the experiences of youth regarding confidentiality with their healthcare provider and how confidentiality affects their interactions with the healthcare system.

STUDY DESIGN

Using MyVoice, a national mixed methods text message poll, 4 qualitative probes were asked to 1268 youth age 14-24 years from July 2017 through December 2017. Respondents were asked about their opinions and experiences with confidentiality in their healthcare. Data were analyzed using a modified grounded theory approach.

RESULTS

The overall response rate was 75% (n = 948) with a mean age of 18.6 years (SD = 3.2). Respondents were mostly female (56%) and white (70%) with 44% reporting some college education or greater. Qualitative analysis revealed that the majority of youth have not had a conversation with their provider about confidentiality; many youth think all care should be confidential; youth worry about privacy and future discrimination; and youth may lie about their risk behaviors or not seek healthcare when concerned about confidentiality.

CONCLUSIONS

Confidentiality in healthcare is concerning to many youth and affects how they interact with the healthcare system. It is imperative for healthcare providers to discuss confidentiality while building trusting relationships with each youth to provide the highest level of care for this vulnerable population.

Predicted changes in abortion access and incidence in a post-Roe world

OBJECTIVE

To examine changes in travel distance and abortion incidence if Roe v. Wade were reversed or if abortion were further restricted.

STUDY DESIGN

We used a national database of abortion facilities to calculate travel distances from the population centroids of United States counties to the nearest publicly-identifiable abortion facility. We then estimated these travel distances under two hypothetical post-Roe scenarios. In the first, abortion becomes illegal in eight states with preemptive "trigger bans." In the second, abortion becomes illegal in an additional 13 states classified as at high risk of outlawing abortions under most circumstances. Using previously-published estimates of the short-run causal effects of increases in travel distances on abortion rates in Texas, we estimate changes in abortion incidence under each scenario.

RESULTS

If Roe were reversed and all high-risk states banned abortion, 39% of the national population of women aged 15-44 would experience increases in travel distances ranging from less than 1 mile to 791 miles. If these women respond similarly to travel distances as Texas women, county-level abortion rates would fall by amounts ranging from less than 1% to more than 40%. Aggregating across all affected regions, the average resident is expected to experience a 249 mile increase in travel distance, and the abortion rate is predicted to fall by 32.8% (95% confidence interval 25.9-39.6%) in the year following a Roe reversal.

CONCLUSION

In the year following a reversal, increases in travel distances are predicted to prevent 93,546-143,561 women from accessing abortion care.

IMPLICATIONS

A reversal or weakening of Roe is likely to increase spatial disparities in abortion access. This could translate to a reduction in abortion rates and an increase in unwanted births and self-managed abortions.

Incentive design to boost health for juveniles with Medicaid coverage: Evidence from a field experiment

Augmenting incentives for juveniles with separate incentives for parents could boost juvenile efforts to reduce BMI. However, financing a parent incentive by reducing the incentives offered to adolescents could attenuate the juvenile response. In a field experiment, Medicaid-covered juveniles enrolled in a cardiac wellness program were randomly assigned to two groups: juveniles in the focused-incentive group received all earned points; juveniles in the split-incentive group split earned points with a parent. The focused-incentive group was 12.8 percentage points more likely to achieve their stipulated goals compared to the split-incentive group at the end of the 3-month active phase of the program. In contrast, members of the split-incentive group outperformed their peers in the focused-incentive group during the second quarter, and the two incentives structures were equally effective at the year-end session. Additional quasi-experimental data indicates that members of both incentivized groups significantly outperformed (focused-incentive group by 8.48 percentage points and split-incentive group by 11.0 percentage points) a pre-experiment (non-incentivized) set of juveniles enrolled in the same program at year-end.

The effects of e-cigarette minimum legal sale age laws on youth substance use

We use difference-in-differences models and individual-level data from the national and state Youth Risk Behavior Surveillance System from 2005 to 2015 to examine the effects of e-cigarette minimum legal sale age (MLSA) laws on youth cigarette smoking, alcohol consumption, and marijuana use. Our results suggest that these laws increased youth smoking participation by about one percentage point and approximately half of the increased smoking participation could be attributed to smoking initiation. We find little evidence of higher cigarette smoking persisting beyond the point at which youth age out of the laws. Our results also show little effect of the laws on youth drinking, binge drinking, and marijuana use. Taking these together, our findings suggest a possible unintended effect of e-cigarette MLSA laws-rising cigarette use in the short term while youth are restricted from purchasing e-cigarettes.

High School Physical Education Requirements and Youth Body Weight: New Evidence from the YRBS

Previous research has found that high school physical education (PE) requirements are largely ineffective at reducing youth body weight. However, these studies were forced to rely on cross-state variation in PE requirements to identify their impacts, raising concerns that estimated policy effects may be confounded by state-level unobservables. Using data from the State and National Youth Risk Behavior Surveys and exploiting recent changes in state high school PE laws, we re-examine the effect of PE requirements on body weight. Our estimates show that a one-semester increase in PE requirements is associated with a 10 to 13% increase in minutes per week spent physically active in PE classes, but with no change in net vigorous exercise and little change in youth body weight. We conclude that substitution of in-school for outside-of-school physical activity and small resultant net energy expenditures can explain the absence of body weight effects. Copyright © 2016 John Wiley & Sons, Ltd.

Do Restrictions Beget Responsibility? The Case of U.S. Abortion Legislation

Over the past decade, more than 25 U.S. states enacted legislation surrounding abortions. By analyzing state abortion legislation and proxying how the cost of obtaining an abortion varies across states, this study assesses the implications of legislative changes on women’s contraceptive choices. Examining women by race/ethnicity, income, age, and religious affiliation, the results show that women respond to increased restrictions on abortion availability and cost but that the effects are very small. This study demonstrates that legislation restricting women’s access to abortions fails to promote greater use of more effective contraceptive methods, increasing the likelihood of unwanted births and illegal abortion procedures.

JEL Classifications: D1, D81, I18, J13