Theodore J. Joyce

Trends in smoking before, during, and after pregnancy in ten states

BACKGROUND While trends in smoking prevalence during pregnancy are known, little is known about trends in quitting during pregnancy and resuming smoking after pregnancy. OBJECTIVES This study examined the trends in and correlates of quitting during pregnancy and resuming smoking after pregnancy. METHODS We used population-based random surveys of recent mothers in ten U.S. states (total of 115,000 women) conducted between 1993 and 1999. RESULTS Although the prevalence of smoking 3 months before pregnancy was stable at around 26%, quitting during pregnancy rose from 37% to 46% between 1993 and 1999. Adjusted for maternal and state characteristics, the odds of quitting during pregnancy increased 51% between 1993 and 1999 (odds ratio [OR]=1.51; 95% confidence interval [CI]=1.08-2.12). Approximately half of the women who quit smoking during pregnancy resumed smoking within 6 months postpartum. Primiparous, privately insured, college-educated women are more likely to quit and least likely to resume smoking after delivery, compared to multiparous, Medicaid-insured, and high school-educated women. Teenaged women are more likely to quit, but also more likely to resume smoking than older women. CONCLUSIONS The increase in quit rates during pregnancy is encouraging, but the lack of any change in smoking before pregnancy or in postpartum relapse rates suggests that permanent changes in maternal smoking will require additional focus.

Unobservables, Pregnancy Resolutions, and Birthweight Production Functions in New York City

This paper makes contributions to the estimation of health production functions and the economics of fertility control. We present the first infant health production functions that simultaneously control for self-selection in the resolution of pregnancies as live births or induced abortions and in the use of prenatal medical care services. We also incorporate the decision of a pregnant woman to give birth.

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.

Did Legalized Abortion Lower Crime

In this paper I compare changes in homicide and arrest rates among cohorts born before and after the legalization of abortion to changes in crime in the same years among similar cohorts who were unexposed to legalized abortion. I find little consistent evidence that the legalization of abortion in selected states around 1970, and then in the remaining states following Roe v. Wade, had an effect on recent crime rates. I conclude that the dramatic association as reported in a recent study is most likely the result of unmeasured period effects such as changes in crack cocaine use.

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.

Pregnancy wantedness and the early initiation of prenatal care

The study examines the impact of the wantedness of a pregnancy on the demand for early prenatal care. Using a cohort of pregnant women in New YorkCity, we estimate a prenatal care demand function in which we control for the probability of giving birth, given a woman is pregnant. We interpret this control as a measure of wantedness, The results indicate that if the black and Hispanic women who aborted had instead given birth, they would have delayed the initiation of prenatal care, on average, more than three-quarters of a month longer than the mean number of months of delay that were actually observed for the women who gave birth. Byallowing women to terminate an unwanted pregnancy, induced abortion increases the average use of prenatal care among black and Hispanic women relative to what would have been observed if the women who aborted had instead given birth.

Birth Outcome Production Function in the United States

This paper contains the first infant health production functions that simultaneously consider the effects of a variety of inputs on race-specific neonatal mortality rates. These inputs include the use of prenatal care, neonatal intensive care, abortion, federally subsidized organized family planning clinics, maternal and infant care projects, community health centers, and the WIC program. We place major emphasis on two-stage least squares estimation. Our results underscore the qualitative and quantitative importance of abortion, prenatal care, neonatal intensive care, and the WIC program in black and white birth outcomes.

State reproductive policies and adolescent pregnancy resolution: The case of parental involvement laws

State laws regulating abortion have increased markedly in the wake of recent Supreme Court decisions. We test whether laws that require minors to notify or obtain consent from a parent before receiving an abortion affect the likelihood that a pregnancy will be terminated. We use individual data on births and abortions from three southern states, South Carolina, Tennessee, and Virginia. We find that South Carolinas parent consent statute is associated with a decline of 10 percentage points in the probability of abortion among non-black minors of 16 years of age. We find no effect for any other age or racial group and conclude that the impact of parental involvement laws on the pregnancy resolution of minors is not large.

Self-Selection, Prenatal Care, and Birthweight Among Blacks, Whites and Hispanics in New York City

Most research on birth outcomes has found a direct relationship between appropriate prenatal care and increased birthweight. Researchers concede, however, that without a randomized design, which is clearly unethical, one cannot determine how much of the association is due to the medical intervention and how much is due to the characteristics of the women receiving the care. In short, the degree of selection bias is unknown and potentially substantial. In this paper we test for selection bias and estimate its direction and magnitude. We find that adjusted mean differences in birthweight between women who obtain intermediate as opposed to inadequate prenatal care substantially underestimate the effects of care that would be observed under random assignment. In particular, ordinary least squares estimates indicate that the gains to intermediate care are 113 grams for black infants, 76 grams for white infants and 92 grams for Hispanic infants. Under random assignment, black infants would experience gains of 130 grams, whites 234 grams, and Hispanics 183 grams. The gains for adequate as opposed to intermediate care are relatively minor. The results point to adverse selection in the demand for prenatal care.

Crime, Deterrence and the Business Cycle in New York City: A VAR Approach

A bstract-We apply a VAR (vector autoregressive) technique to estimate the interrelationships between unemployment, arrests, police, demographics, and property-related felony crimes in New York City from 1970 to 1984. Despite the limitations of using a VAR, the technique provides a useful alternative to more standard models in analyzing what causes crime. The study concludes that arrests provide a strong deterrent to crimes. But, the reverse effect of crime on arrests, is extremely small. We find a brief and relatively weak effect of changes in unemployment rates on crime. Changes in demographics are associated with relatively stronger changes in crime rates