Kandice A. Kapinos

Obesogenic environmental influences on young adults: Evidence from college dormitory assignments

This study utilizes a natural experiment-conditionally random dormitory assignments of first-year US college students-to investigate the influence of obesogenic environmental factors in explaining changes in weight and exercise behavior during the 2009-2010 academic year. The design addresses potential selection biases resulting from the likelihood that individuals sort into built environments that match their preferences for exercise and healthy eating. We find some evidence that the food environment, specifically access to campus dining, significantly affected the weight of female students in our study. Females assigned to dormitories where the nearest campus dining hall was closed on the weekends gained about 1lb less over the course of the year than females assigned to dormitories near dining halls that were open 7 days a week. We also find some evidence that female who lived in close proximity to a grocery store gained less weight over the course of the year. Finally, females who lived closer to campus gym reported more frequent exercise over the course of the year. We do not find significant effects of the built environment on weight changes of males in our sample, but we are cautious to draw strong conclusions from this because the male weight change in our sample was quite small.

Estimating Heterogeneous and Hierarchical Peer Effects on Body Weight Using Roommate Assignments as a Natural Experiment

We investigate peer effects in weight gain by exploiting a natural experiment, roommate assignments of 751 male and 845 female first-year college students. Results indicate that females are subject to peer influence in weight gain, with little evidence of peer effects for males. Peer influences appear to be heterogeneous as heavier and thinner females are affected by roommates more than average-weight females, and hierarchical with females influenced only by roommates who are thinner, of a higher socioeconomic status, and more sexually experienced relative to themselves. Similarity of academic performance, religiosity, and political views appears to facilitate transmission of peer influences.

Mandated Coverage of Preventive Care and Reduction in Disparities: Evidence From Colorectal Cancer Screening

OBJECTIVES We identified correlates of racial/ethnic disparities in colorectal cancer screening and changes in disparities under state-mandated insurance coverage. METHODS Using Behavioral Risk Factor Surveillance System data, we estimated a Fairlie decomposition in the insured population aged 50 to 64 years and a regression-adjusted difference-in-difference-in-difference model of changes in screening attributable to mandates. RESULTS Under mandated coverage, blood stool test (BST) rates increased among Black, Asian, and Native American men, but rates among Whites also increased, so disparities did not change. Endoscopic screening rates increased by 10 percentage points for Hispanic men and 3 percentage points for non-Hispanic men. BST rates fell among Hispanic relative to non-Hispanic men. We found no changes for women. However, endoscopic screening rates improved among lower income individuals across all races and ethnicities. CONCLUSIONS Mandates were associated with a reduction in endoscopic screening disparities only for Hispanic men but may indirectly reduce racial/ethnic disparities by increasing rates among lower income individuals. Findings imply that systematic differences in insurance coverage, or health plan fragmentation, likely existed without mandates. These findings underscore the need to research disparities within insured populations.

Colorectal Cancer Screening and State Health Insurance Mandates.

Colorectal cancer (CRC) is the third most deadly cancer in the USA. CRC screening is the most effective way to prevent CRC death, but compliance with recommended screenings is very low. In this study, we investigate whether CRC screening behavior changed under state mandated private insurance coverage of CRC screening in a sample of insured adults from the 1997 to 2008 Behavioral Risk Factor Surveillance Survey (BRFSS). We present difference-in-difference-in-differences (DDD) estimates that compare insured individuals age 51 to 64 to Medicare age-eligible individuals (ages 66 to 75) in mandate and non-mandate states over time. Our DDD estimates suggest endoscopic screening among men increased by 2 to 3 percentage points under mandated coverage among 51 to 64 year olds relative to their Medicare age-eligible counterparts. We find no clear evidence of changes in screening behavior among women. DD estimates suggest no evidence of a mandate effect on either type of CRC screening for men or women.

Lactation Support Services and Breastfeeding Initiation: Evidence from the Affordable Care Act

OBJECTIVE Despite substantial evidence of the benefits of breastfeeding for both mothers and children, rates of sustained breastfeeding in the United States are quite low. This study examined whether mandated coverage of lactation support services under the Affordable Care Act (ACA) affects breastfeeding behavior. DATA SOURCE We studied the census of U.S. births included in the National Vital Statistics System from 2009 to 2014. STUDY DESIGN We used regression-adjusted difference-in-differences (DD) to examine changes in breastfeeding rates for privately insured mothers relative to those covered by Medicaid. We adjusted for several health and sociodemographic measures. We also examined the extent to which the effect varied across vulnerable populations-by race/ethnicity, maternal education, WIC status, and mode of delivery. PRINCIPAL FINDINGS Results suggest that the ACA mandate increased the probability of breastfeeding initiation by 2.5 percentage points, which translates into about 47,000 more infants for whom breastfeeding was initiated in 2014. We find larger effects for black, less educated, and unmarried mothers. CONCLUSIONS The Affordable Care Act-mandated coverage of lactation services increased breastfeeding initiation among privately insured mothers relative to mothers covered by Medicaid. The magnitude of the effect size varied with some evidence of certain groups being more likely to increase breastfeeding rates.

Effect of the Affordable Care Act on Breastfeeding Outcomes

Objectives To assess how the 2012 Affordable Care Act (ACA) policy change, which required most private health insurance plans to cover lactation-support services and breastfeeding equipment (without cost-sharing), affected breastfeeding outcomes. Methods We used a regression-adjusted difference-in-differences approach with cross-sectional observational data from the US National Immunization Survey from 2008 to 2014 to estimate the effect of the ACA policy change on breastfeeding outcomes, including initiation, duration, and age at first formula feeding. The sample included children aged 19 to 23 months covered by private health insurance or Medicaid. Results The ACA policy change was associated with an increase in breastfeeding duration by 10% (0.57 months; P = .007) and duration of exclusive breastfeeding by 21% (0.74 months; P = .001) among the eligible population. Results indicate no significant effects on breastfeeding initiation and age at first formula feeding. Conclusions Reducing barriers to receiving support services and breastfeeding equipment shows promise as part of a broader effort to encourage breastfeeding, particularly the duration of breastfeeding and the amount of time before formula supplementation.

Occupational Learning, Financial Knowledge, and the Accumulation of Retirement Wealth

This study explores the relationship between general human capital investment, financial knowledge, occupational spillovers, and the accumulation of wealth in a primarily descriptive manner. Drawing upon human capital theory and following previous related work by Delavande, Rohwedder and Willis (2008), we hypothesized that individuals with daily exposure to financial knowledge through their occupation would benefit by having greater financial knowledge that would translate into greater wealth accumulation than individuals who do not enjoy such spillovers from their occupation. Using data from the Cognitive Economics Study and the Health and Retirement Study, we find strong evidence that individuals in financial occupations tend to have greater financial knowledge and moderate evidence that they also have greater wealth accumulation.

Cesarean Deliveries and Maternal Weight Retention

BackgroundCesarean delivery accounts for nearly one-third of all births in the U.S. and contributes to an additional

Long-term Effect of Exposure to a Friend's Adolescent Childbirth on Fertility, Education, and Earnings

38 billion in healthcare costs each year. Although Cesarean delivery has a long record of improving maternal and neonatal mortality and morbidity, increased utilization over time has yielded public health concerns and calls for reductions. Observational evidence suggests Cesarean delivery is associated with increased maternal postpartum weight, which may have significant implications for the obesity epidemic. Previous literature, however, typically does not address selection biases stemming from correlations of pre-pregnancy weight and reproductive health with Cesarean delivery.MethodsWe used fetal malpresentation as a natural experiment as it predicts Cesarean delivery but is uncorrelated with pre-pregnancy weight or maternal health. We used hospital administrative data (including fields used in vital birth record) from the state of Wisconsin from 2006 to 2013 to create a sample of mothers with at least two births. Using propensity score methods, we compared maternal weight prior to the second pregnancy of mothers who delivered via Cesarean due to fetal malpresentation to mothers who deliver vaginally.ResultsWe found no evidence that Cesarean delivery in the first pregnancy causally leads to greater maternal weight, BMI, or movement to a higher BMI classification prior to the second pregnancy.ConclusionsAfter accounting for correlations between pre-pregnancy weight, gestational weight gain, and mode of delivery, there is no evidence of a causal link between Cesarean delivery and maternal weight retention.

Medical Costs for Osteoporosis-Related Fractures in High-Risk Medicare Beneficiaries: FRACTURE COSTS IN MEDICARE BENEFICIARIES

PURPOSE To examine the long-term effect of a female adolescents exposure to a peers childbirth on fertility, schooling, and earnings. METHODS Estimating causal peer effects in fertility is challenging because the exposure variable (peer pregnancy and childbirth) is nonrandomly assigned. Miscarriages in early pregnancy occur spontaneously in a significant proportion of pregnancies and, therefore, create a natural experiment within which the causal effect of childbirth can be examined. This exploratory study compared adjusted fertility, educational, and labor market outcomes of female adolescents whose adolescent pregnant friend gave birth to female adolescents whose pregnant friend miscarried. Longitudinal data from the National Longitudinal Study of Adolescent Health were analyzed using logistic, ordinal logistic, linear, and log-linear regressions. RESULTS Females whose adolescent pregnant friends gave birth (instead of miscarried) had decreased adolescent sexual activity, pregnancy, and teen childbearing and increased educational attainment, but there were no significant long-term effects on total fertility or differences in labor market outcomes, relative to females whose pregnant adolescent friend miscarried. CONCLUSIONS Adolescent females appear to learn vicariously from teen childbearing experiences of their friends, resulting in delayed childbearing and higher educational attainment. Interventions that expose adolescents to the reality of teen motherhood may be an effective way of reducing the rates of teen childbearing and improving schooling.