Christopher J. Ruhm

The Economic Consequences of Parental Leave Mandates: Lessons from Europe

This study investigates the economic consequences of rights to paid parental leave in nine European countries over the 1969 through 1993 period. Since women use virtually all parental leave in most nations, men constitute a reasonable comparison group, and most of the analysis examines how changes in paid leave affect the gap between female and male labor market outcomes. The employment-to-populations ratios of women in their prime childbearing years are also compared with those of corresponding aged men and older females. Parental leave is associated with increases in womens employment, but with reductions in their relative wages at extended durations.

Inequality in Preschool Education and School Readiness

Attendance in U.S. preschools has risen substantially in recent decades, but gaps in enrollment between children from advantaged and disadvantaged families remain. Using data from the Early Childhood Longitudinal Study, Kindergarten Class of 1998–1999, we analyze the effect of participation in child care and early education on children’s school readiness as measured by early reading and math skills in kindergarten and first grade. We find that children who attended a center or school-based preschool program in the year before school entry perform better on assessments of reading and math skills upon beginning kindergarten, after controlling for a host of family background and other factors that might be associated with selection into early education programs and relatively high academic skills. This advantage persists when children’s skills are measured in the spring of kindergarten and first grade, and children who attended early education programs are also less likely to be retained in kindergarten. In most instances, the effects are largest for disadvantaged groups, raising the possibility that policies promoting preschool enrollment of children from disadvantaged families might help to narrow the school readiness gap.

Does prekindergarten improve school preparation and performance

Abstract Prekindergarten programs are expanding rapidly but evidence on their effects is limited. Using rich data from Early Childhood Longitudinal Study, we estimate the effects of prekindergarten on childrens school readiness. We find that prekindergarten is associated with higher reading and mathematics skills at school entry, but also higher levels of behavior problems. By the spring of first grade, estimated effects on academic skills have largely dissipated, but the behavioral effects persist. Larger and longer lasting associations with academic gains are found for disadvantaged children. Finally, we find some evidence that prekindergartens located in public schools do not have adverse effects on behavior problems.

Good times make you sick

This study uses microdata from the 1972-1981 National Health Interview Surveys (NHIS) to examine how health status and medical care utilization fluctuate with state macroeconomic conditions. Personal characteristics, location fixed-effects, general time effects and (usually) state-specific time trends are controlled for. The major finding is that there is a counter-cyclical variation in physical health that is especially pronounced for individuals of prime-working age, employed persons, and males. The negative health effects of economic expansions persist or accumulate over time, are larger for acute than chronic ailments, and occur despite a protective effect of income and a possible increase in the use of medical care. Finally, there is some suggestion that mental health may be procyclical, in sharp contrast to physical well-being.

Alcohol Policies and Highway Vehicle Fatalities

This study investigates the impact of beer taxes and a variety of alcohol-control policies on motor vehicle fatality rates. Special attention is paid to omitted variables biases resulting from failing to adequately control for grassroots efforts to reduce drunk driving, the enactment of other laws which simultaneously operate to reduce highway fatalities, and the economic conditions existing at the time the legislation is passed. In the preferred models, most of the regulations have little or no impact on traffic mortality. By contrast, higher beer taxes are associated with reductions in crash deaths and this result is relatively robust across specifications.

Is High School Employment Consumption or Investment

This study examines how high school employment affects future economic attainment. There is no indication that light to moderate job commitments ever have a detrimental effect; instead, hours worked during the senior grade are positively correlated with future earnings, fringe benefits, and occupational status. These gains occur even though employed seniors attain slightly less education than their counterparts. The results are robust across a variety of specifications and suggest that student employment increases net investments in human capital particularly toward the end of high school and for females.

Economic Conditions and Alcohol Problems

This study investigates the relationship between macroeconomic conditions and two alcohol-related outcomes--liquor consumption and highway vehicle fatalities. Fixed-effect models are estimated for the 48 contiguous states over the 1975-1988 time period. Alcohol consumption and traffic deaths vary procyclically, with a major portion of the effect of economic downturns attributed to reductions in incomes, rather than employment. The intake of hard liquor is the most sensitive to the state of the macroeconomy. There is no evidence, however, that fluctuations in economic conditions have a disproportionate impact on the drunk-driving of young adults.

A Healthy Economy Can Break Your Heart

Panel data methods are used to investigate how deaths from coronary heart disease (CHD) in the United States vary with macroeconomic conditions. A one-percentage-point reduction in unemployment is predicted to raise CHD mortality by 0.75%, corresponding to almost 3,900 additional fatalities. The increase in relative risk is similar across age groups, implying that senior citizens account for most of the extra deaths. Direct evidence is obtained of a role for decreases in medical interventions treating coronary problems. CHD mortality increases rapidly when the economy strengthens but returns to or near its baseline level within five years for most groups.

Recessions, healthy no more?

Over the 1976-2010 period, total mortality shifted from strongly procyclical to being weakly or unrelated to macroeconomic conditions. The association is likely to be poorly measured when using short (less than 15 year) analysis periods. Deaths from cardiovascular disease and transport accidents continue to be procyclical; however, countercyclical patterns have emerged for fatalities from cancer mortality and external causes. Among the latter, non-transport accidents, particularly accidental poisonings, play an important role.

Nurses’ Presenteeism and Its Effects on Self-Reported Quality of Care and Costs

ObjectiveAlthough research has been conducted on how nurse staffing levels affect outcomes, there has been little investigation into how the health-related productivity of nurses is related to quality of care. Two major causes of worker presenteeism (reduced on-the-job productivity as a result of health problems) are musculoskeletal pain and mental health issues, particularly depression. This study sought to investigate the extent to which musculoskeletal pain or depression (or both) in RNs affects their work productivity and self-reported quality of care and considered the associated costs. MethodsUsing a cross-sectional survey design, a random sample of 2,500 hospital-employed RNs licensed in North Carolina were surveyed using a survey instrument sent by postal mail. Specific measures included questions on individual and workplace characteristics, self-reported quality of care, and patient safety; a numeric pain rating scale, a depression tool (the Patient Health Questionnaire), and a presenteeism tool (the Work Productivity and Activity Impairment Questionnaire: General Health) were also incorporated. A total of 1,171 completed surveys were returned and used for analysis. ResultsAmong respondents, the prevalence of musculoskeletal pain was 71%; that of depression was 18%. The majority of respondents (62%) reported a presenteeism score of at least 1 on a 0-to-10 scale, indicating that health problems had affected work productivity at least “a little.” Pain and depression were significantly associated with presenteeism. Presenteeism was significantly associated with a higher number of patient falls, a higher number of medication errors, and lower quality-of-care scores. Baseline cost estimates indicate that the increased falls and medication errors caused by presenteeism are expected to cost