Edward J. Timmons

Licensing One of the World’s Oldest Professions: Massage

In this paper, we analyze the development of occupational regulation of massage therapists in the United States as well as the effects of state licensing and certification on their earnings and numbers. Our results suggest that massage therapists working in states with licensing receive an earnings premium of as much as 16.2 percent. We also find some evidence that licensing seems to reduce the number of massage therapists. We find less convincing evidence that certification has had similar effects. We argue that, taken together, our results suggest that licensing restricts entry at the expense of consumers and that its effects are less likely to be explained by other competing factors.

Smoking, parent smoking, depressed mood, and suicidal ideation in teens

OBJECTIVES We address whether smoking is related to suicidal ideation in teens and whether there is evidence of a causal pathway. METHODS We use data from the 2002 National Annenberg Survey of Youth and employ multivariate logistic regression to model each teens risk of suicidal ideation as a function of self-report of depressive symptoms, own smoking, parent smoking, and demographic and household income variables. RESULTS Individuals reporting depressive symptoms have an increased risk of suicidal ideation (odds ratio [OR] = 13.13; 95% CI = 5.98-28.81). Relative to teens who do not smoke and whose parents do not smoke, teens who smoke and do not have a parent who smokes have increased risk of suicidal ideation (OR = 8.10; 95% CI = 2.88-22.80), whereas those with a parent who smokes do not have a statistically significant increased risk of suicidal ideation regardless of teen smoking behavior. CONCLUSION Relative to teens who do not smoke and do not have parents who smoke, suicidal ideation risk is increased in teens who smoke only if they do not have a parent who smokes. We find evidence that the smoking and suicidal ideation of the teens is likely due to common psychosocial causes rather than a causal pathway from smoking to suicidal ideation.

The effects of expanded nurse practitioner and physician assistant scope of practice on the cost of Medicaid patient care

The provision of health care to low-income Americans remains an ongoing policy challenge. In this paper, I examine how important changes to occupational licensing laws for nurse practitioners and physician assistants have affected cost and intensity of health care for Medicaid patients. The results suggest that allowing physician assistants to prescribe controlled substances is associated with a substantial (more than 11%) reduction in the dollar amount of outpatient claims per Medicaid recipient. I find little evidence that expanded scope of practice has affected proxies for care intensity such as total claims and total care days. Relaxing occupational licensing requirements by broadening the scope of practice for healthcare providers may represent a low-cost alternative to providing quality care to Americas poor.

Adolescent mental health as a risk factor for adolescent smoking onset.

Smoking continues to be a leading cause of preventable deaths and rates of trying cigarettes and progression to daily smoking among adolescents continues to remain high. A plethora of risk factors for smoking among adolescents has been addressed in the research literature. One that is gaining particular interest is the relationship between adolescent mental health and smoking (both initiation and progression). This paper reviews the evidence for adolescent mental health as a risk factor for cigarette smoking. We focus on the specific mental health conditions that have been more thoroughly addressed as possible risk factors in community-dwelling adolescents. We discuss the multiple hypotheses that have been posited as to the nature of the relationship between adolescent mental health and smoking, as well as detailing so called third factors that may account for the observed relationship. We highlight the contribution of the existing studies to the body of knowledge on this topic, as well as the limitations and open questions that remain as a result. We conclude with discussion of a broad research agenda going forward.

Bringing the Effects of Occupational Licensing into Focus: Optician Licensing in the United States

The labor market institution of occupational licensing continues to grow in scope in the United States and abroad. In this paper, we estimate the effects of occupational licensing on opticians using data from the US Census and American Community Survey. Our results suggest that optician licensing is associated with opticians receiving as much as 16.9 percent more in annual earnings. In an examination of malpractice insurance premiums in all states and participation rates in optician certification programs in Texas, we find little evidence that optician licensing has enhanced the quality of services delivered to consumers. By and large, optician licensing appears to be reducing consumer welfare by raising the earnings of opticians without enhancing the quality of services delivered to consumers.

Healthcare License Turf Wars: The Effects of Expanded Nurse Practitioner and Physician Assistant Scope of Practice on Medicaid Patient Access

The provision of health care to low-income Americans remains an ongoing policy challenge. In this paper, I examine how important changes to occupational licensing laws for nurse practitioners and physician assistants have affected cost and access to health care for Medicaid patients. The results suggest that allowing physician assistants to prescribe drugs (including controlled substances) is associated with a substantial (more than 11 percent) reduction in the dollar amount of outpatient claims per Medicaid recipient. I find little evidence that expanded scope of practice has affected proxies for access to care such as total claims and total care days. Relaxing occupational licensing requirements by broadening the scope of practice for healthcare providers may represent a low cost alternative to providing quality care to America’s poor.