Robert Kaestner

The effect of pregnancy intention on child development

In this paper, we use data from the National Longitudinal Survey of Youth to investigate the empirical link between unintended pregnancy and child health and development. An important contribution of our study is the use of information on siblings to control for unmeasured factors that may confound estimates of the effect of pregnancy intentions on infant and child outcomes. Results from our study indicate that unwanted pregnancy is associated with prenatal and postpartum maternal behaviors that adversely affect infant and child health, but that unwanted pregnancy has little association with birth weight and child cognitive outcomes. Estimates of the association between unwanted pregnancy and maternal behaviors were greatly reduced after controls for unmeasured family background were included in the model. Our results also indicate that there are no significant differences in maternal behaviors or child outcomes between mistimed and wanted pregnancies.

Are Brothers Really Better? Sibling Sex Composition and Educational Achievement Revisited

In this paper, I examine the relationship between sibling sex composition and educational achievement. First, I replicate the study of Butcher and Case (1994) using data on a more recent birth cohort. Contrary to the findings of that study, I find basically no effect of sibling sex composition on the educational attainment of white males or females, although among black adults, those who grew up with a sister, or who had relatively more sisters, had greater levels of educational attainment than persons with no or fewer sisters. Second, I broaden the analysis by examining the educational outcomes of children and teenagers. This extension is important because it provides an additional opportunity to test for sibling sex composition effects, and it helps differentiate between potential causes of a sibling sex composition effect. The results obtained from the analysis of child and teen outcomes suggest that sibling sex composition had little effect on educational achievement. The only group to be affected was black teens between the ages of 15 and 18. Those who grew up with sisters had higher educational achievement levels than those who grew up with brothers.

On the Validity of Retrospective Assessments of Pregnancy Intention

Information on pregnancy intention is often gathered retrospectively (after the birth of a child). This article investigates whether the retrospective assessment of pregnancy intention leads to biased estimates of the extent or consequences of unintended fertility. Comparisons are made between pregnancy intentions ascertained during pregnancy and after birth using data from the National Longitudinal Survey of Youth. To address the bias caused by selective recognition or acknowledgment of pregnancy, we used the longitudinal feature of the data to determine actual pregnancy status at the time of interviews, which, in turn, was used as an instrumental variable for the retrospective (versus prospective) reporting of pregnancy intention. After correction for selective pregnancy recognition, we found no evidence that the retrospective assessment of pregnancy intention produces misleading estimates of either the number or the consequences of unintended births. This finding is supported by additional analyses of a small subsample of women for whom information on pregnancy intention was collected both during pregnancy and after birth.

The Effect of Illicit Drug Use on the Wages of Young Adults

This article examines the effects of cocaine and marijuana use on the wages of young adults. The endogeneity of drug use in a wage equation is considered, and a two-stage least squares procedure is implemented. The results suggest that increased use of marijuana or cocaine is associated with higher wages. The positive relationship between drug use and the wage does not diminish with age. I also investigate whether systematic differences in the return to measures of human capital investments can explain the positive relationship between drug use and wages.

An assessment of the validity of the ECERS-R with implications for measures of child care quality and relations to child development.

The Early Childhood Environment Rating Scale-Revised (ECERS-R) is widely used to associate child care quality with child development, but its validity for this purpose is not well established. We examined the validity of the ECERS-R using the multidimensional Rasch partial credit model (PCM), factor analyses, and regression analyses with data from the Early Childhood Longitudinal Study Birth Cohort. The PCM identified rating category disordering, indicating previously unrecognized problems with the scales response process validity. Factor analyses identified neither a single factor nor the ECERS-R six subscales, replicating prior research regarding the scales structural validity. Criterion validity results were mixed, with small effect sizes for regressions predicting child outcomes and moderate effect sizes for regressions predicting teacher-reported quality. Our results lend empirical support to recent critiques of the ECERS-R, and we discuss implications for its future use and for the development of future measures.

The business cycle and health behaviors

While it is well documented that economic expansions provide widespread and immediate financial benefits, the evidence on how an economic downturn affects individuals health behaviors is surprisingly mixed. In this paper, we take a structural approach to investigate the effects of wages and working hours on health behaviors of low-educated persons using variations in wages and hours caused by changes in local economic activity. In the empirical analysis, we adopt a two-sample instrumental variables approach to combine the data on individual health behaviors from the Behavioral Risk Factor Surveillance System (BRFSS) and the National Health Interview Survey (NHIS) with the data on individual employment from the Current Population Survey (CPS). The total sample size of the combined CPS-BRFSS data for the time period of 1984-2005 is 967,594, while that of the combined CPS-NHIS data for the time period of 1976-2001 is 364,078. We find that increases in wages caused by economic expansions are associated with greater consumption of cigarettes in the United States. We also find that increases in hours of work caused by economic expansions are associated with more cigarette consumption, but less physical activity and physician visits. More importantly, the evidence suggests that most of such effects associated with changes in hours of work can be attributed to the changes at the extensive margin of employment, meaning the changes in employment status, rather than the changes at the intensive margin, meaning changes in hours of work conditional on being employed. These findings imply that changes in employment may have heterogeneous impacts on time-intensive and less time-intensive health behaviors and also provide additional evidence on the importance of time in health production, particularly for time-intensive activities.

New estimates of the effect of marijuana and cocaine use on wages

Using the 1984 and 1988 waves of the National Longitudinal Survey of Youth, this study provides an update of several previous cross-sectional estimates of the effect of illicit drug use on wages, as well as the first longitudinal estimates of that effect. The cross-sectional results, which are generally consistent with the surprising findings of previous research, suggest that illicit drug use has a large, positive effect on wages. The longitudinal estimates, which control for unobserved heterogeneity in the sample, are mixed: among men, the estimated wage effects of both marijuana and cocaine use are negative, but among women, the effect of cocaine use remains positive and large. Because the longitudinal model is imprecisely estimated, however, those results are inconclusive.

Labor Market Effects of September 11th on Arab and Muslim Residents of the United States

We investigated whether the September 11, 2001 terrorists’ attacks had any effect on employment, earnings, and residential mobility of first- and second-generation Arab and Muslim men in the United States. We find that September 11th did not significantly affect employment and hours of work of Arab and Muslim men, but was associated with a 9-11 percent decline in their real wage and weekly earnings, with some evidence that this decline was temporary. The adverse earnings effects were strongly linked to hate crime incidence. Estimates also suggest that the terrorists’ attacks reduced intrastate migration of Arab and Muslim men.

Aggressive Treatment Style and Surgical Outcomes

OBJECTIVE Aggressive treatment style, as defined by the Dartmouth Atlas of Health Care, has been implicated as an important factor contributing to excessively high medical expenditures. We aimed to determine the association between aggressive treatment style and surgical outcomes. DATA SOURCES/STUDY SETTING Medicare admissions to 3,065 hospitals for general, orthopedic, and vascular surgery between 2000 and 2005 (N = 4,558,215 unique patients). STUDY DESIGN A retrospective cohort analysis. RESULTS For elderly surgical patients, aggressive treatment style was not associated with significantly increased complications, but it was associated with significantly reduced odds of mortality and failure-to-rescue. The odds ratio for complications in hospitals at the 75th percentile of aggressive treatment style compared with those at the 25th percentile (a U.S.

Medical malpractice liability and its effect on prenatal care utilization and infant health.

10,000 difference) was 1.01 (1.00-1.02), p<.066; whereas the odds of mortality was 0.94 (0.93-0.95), p<.0001; and for failure-to-rescue it was 0.93 (0.92-0.94), p<.0001. Analyses that used alternative measures of aggressiveness--hospital days and ICU days--yielded similar results, as did analyses using only low-variation procedures. CONCLUSIONS Attempting to reduce aggressive care that is not cost effective is a laudable goal, but policy makers should be aware that there may be improved outcomes associated with patients undergoing surgery in hospitals with a more aggressive treatment style.