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The demand for healthcare professionals is predicted to grow significantly over the next decade. Securing an adequate workforce is of primary importance to ensure the health and wellbeing of the population in an efficient manner. Occupational licensing laws and related restrictions on scope of practice (SOP) are features of the market for healthcare professionals and are also controversial. At issue is a balance between protecting the public health and removing anticompetitive barriers to entry and practice. In this paper, we examine the case of SOP restrictions for certified nurse midwives (CNMs) and evaluate the effects of changes in states' SOP laws on markets for CNMs and on maternal and infant outcomes. We find that SOP laws are neither helpful nor harmful in regards to health outcomes but states that have no SOP-based barriers have lower rates of induced labor and Cesarean section births. We discuss the implications for state policy., (Copyright © 2017 Elsevier B.V. All rights reserved.)

As of 2014, 37 states have passed mandates requiring many private health insurance policies to cover diagnostic and treatment services for autism spectrum disorders (ASDs). We explore whether ASD mandates are associated with out-of-pocket costs, financial burden, and cost or insurance-related problems with access to treatment among privately insured children with special health care needs (CSHCNs). We use difference-in-difference and difference-in-difference-in-difference approaches, comparing pre--post mandate changes in outcomes among CSHCN who have ASD versus CSHCN other than ASD. Data come from the 2005 to 2006 and the 2009 to 2010 waves of the National Survey of CSHCN. Based on the model used, our findings show no statistically significant association between state ASD mandates and caregivers' reports about financial burden, access to care, and unmet need for services. However, we do find some evidence that ASD mandates may have beneficial effects in states in which greater percentages of privately insured individuals are subject to the mandates. We caution that we do not study the characteristics of ASD mandates in detail, and most ASD mandates have gone into effect very recently during our study period.

Parental alcohol consumption is often associated with an increased likelihood of child abuse. As consumption is related to price, the purpose of this paper is to investigate the propensity for increases in the full price of alcohol to influence entry rates and the length of time spent in foster care. Using alcoholic beverage prices and a measure of availability in combination with data on foster care cases, we find that higher alcohol prices are not effective in reducing foster care entry rates; however, once in foster care, the duration of stay may be shortened by higher prices and reduced availability.

This study uses data from the National Institute of Child Health and Human Development Study on Early Child Care to examine the effects of maternal employment on maternal mental and overall health, self-reported parenting stress, and parenting quality. These outcomes are measured when children are 6 months old. Among mothers of 6-month-old infants, maternal work hours are positively associated with depressive symptoms and parenting stress and negatively associated with self-rated overall health. However, maternal employment is not associated with quality of parenting at 6 months, based on trained assessors' observations of maternal sensitivity.

Violence is one of the leading social problems in the United States. The development of appropriate public policies to curtail violence is confounded by the relationship between alcohol and violence. In this paper, we estimate the propensity of alcohol control policies to reduce the perpetration and victimization of criminal violence. We measure violence with data on individual level victimizations from the National Crime Victimization Survey. We examine the effects of a host of alcohol control policies in reducing violent crime. These policies include the retail price of beer, drunk driving laws and penalties, keg laws, and serving and selling laws. We find some evidence of a negative relationship between alcohol prices and the probability of alcohol or drug related assault victimizations, particularly for assaults against young adults ages 18-29. However, we find no strong evidence that other alcohol policies are effective in reducing violent crimes. These results provide policy makers with guidance on potential approaches for reducing violence through alcohol beverage control.

Background: Maternal smoking causes adverse health outcomes for both mothers and infants and leads to excess healthcare costs at delivery and beyond. Even with substantial declines over the past decade, around 23% of women enter pregnancy as a smoker and though almost half quit during pregnancy, half or more quitters resume smoking soon after delivery., Purpose: To examine the independent effects of higher cigarette taxes and prices, smokefree policies, and tobacco control spending on maternal smoking prior to, during, and after a pregnancy during a period in which states have made changes in such policies., Methods: Data from pooled cross-sections of women with live births during 2000-2005 in 29 states plus New York City (n=225,445) were merged with cigarette price data inclusive of federal, state, and local excise taxes, full or partial bans on smoking in public places, and tobacco control spending. Probit regression models using a mixed panel, state fixed effects, and time indicators were used to assess effect of policies on smoking (during 3 months before pregnancy); quitting by last 3 months of pregnancy; and having sustained quitting at the time of completing the postpartum survey., Results: Multivariate analysis indicated that a $1.00 increase in taxes and prices increases third-trimester quits by between 4 and 5 percentage points after controlling for the other policies and covariates. Implementing a full private worksite smoking ban increases quits by the third trimester by an estimated 5 percentage points. Cumulative spending on tobacco control had no effect on pregnancy smoking rates overall. Association of tobacco control policies with maternal smoking varied by age., Conclusions: States can use multiple tobacco control policies to reduce maternal smoking. Combining higher taxes with smokefree policies particularly can be effective., (Copyright © 2012 American Journal of Preventive Medicine. All rights reserved.)

Background: Recent studies indicate that short maternity leave, and, more generally, full-time maternal employment during the first year of life, detract from children's health, cognitive development, and behavioral outcomes. Much less is known, however, about how early parental employment affects the mental and physical health of the mothers themselves., Aims of the Study: The purpose of this paper is to examine the association between short family leave length (less than 12 weeks of total leave after childbirth, less than 8 weeks of paid leave) and mental and physical health outcomes among new mothers., Methods: Data come from the Early Childhood Longitudinal Study--Birth Cohort (ECLS-B), a nationally representative sample of 14,000 children born in 2001 and followed until kindergarten entry. We focus on a sample of ECLS-B mothers from the first wave of the survey who had worked during pregnancy and who had returned to work by the time of the first follow-up interview, which was conducted about 9 months after childbirth. When examining the effects of paternal leave, we further restrict this sample to mothers who were married at the time of the first follow-up interview. The maternal health outcomes of interest are measures of depression and overall health status. We use standard OLS and ordered probit models, as well as two-stage least squares and two-stage residual inclusion methods which address the potential endogeneity of family leave with respect to maternal health., Results: Our findings from the OLS and ordered probit models indicate that, for mothers who worked prior to childbirth and who return to work in the first year, having less than 12 weeks of maternal leave and having less than 8 weeks of paid maternal leave are both associated with increases in depressive symptoms, and having less than 8 weeks of paid leave is associated with a reduction in overall health status. Findings from models that address the potential endogeneity of maternal leave generally support these results, and suggest that longer leave may improve the health of new mothers., Discussion: Our findings suggest that longer leave after childbirth may benefit families. However, one potential drawback of using cross-sectional variation in state policies and community characteristics for identification is that these measures may be correlated with other unmeasured factors that directly influence family leave and maternal health., Implications for Health Care Provision and Use: The mother's mental and physical health can be an important route through which infants are affected by parents' employment decisions. Our findings suggest that post-partum health services that target mothers' mental and physical health, and its effects on infants, may be useful., Implications for Health Policies: Our findings suggest that policies that support longer family leave may benefit maternal mental health., Implications for Further Research: Future research should examine how workplace and public policies related to maternal employment can be used to improve families' health outcomes.

In this paper we consider possible links between the diffusion of new pharmaceuticals used for treating mental illness and crime rates. We describe recent trends in crime and review the evidence showing that mental illness is a clear risk factor both for criminal behavior and victimization. We summarize the development of a number of new pharmaceutical therapies for the treatment of mental illness that came into wide use during the “great American crime decline.” We examine limited international data, as well as more detailed American data, to assess the relationship between rates of prescriptions of psychotropic drugs and crime rates, while controlling for other factors that may explain trends in crime rates. Using state-level variation in the rates that various drug therapies disperse within populations to identify impacts on crime rates, we find some evidence that the expansion of psychiatric drugs is associated with decreased violent crime rates, but not property crime rates. We find no robust impacts on homicide rates and no effects on arrest rates. Further, the magnitudes of the estimated effects of expanded drug treatment on violent crime are small. Our estimates imply that about 5 percent of the decline in crime during the period of our study was due to expanded mental health treatment.

Health insurance is widely regarded as essential for financing the production of good health, but is insurance always beneficial for our health? Ex ante moral hazard may induce individuals with insurance to engage in behaviors that they otherwise would not undertake in the absence of insurance. Using data from the 1993-2002 Behavioral Risk Factor Surveillance System, we attempt to isolate the effects of ex ante moral hazard to determine the potential consequence of having health insurance on measures of body weight. In our analyses, we control for a variety of confounding factors that may influence body weight and address the endogenous nature of health insurance. Our results suggest that having insurance is associated with higher body mass but not the probability of being obese.

Sudden Infant Death Syndrome (SIDS) is a leading cause of mortality among infants and is responsible for thousands of infant deaths every year. Prenatal smoking and postnatal environmental smoke have been identified as strong risk factors for SIDS. Given the link between smoking and SIDS, this paper examines the direct effects of cigarette prices, taxes and clean indoor air laws in explaining changes in the incidence of SIDS over time in the United States. State-level counts of SIDS cases are generated from death certificates for 1973-2003. After controlling for some observed and unobserved confounding factors, the results show that higher cigarette prices and taxes are associated with reductions in SIDS cases. Stronger restrictions on smoking in workplaces, restaurants and child care centers are also effective in reducing SIDS deaths.

A series of drug innovations that began in 1987, including the introduction of several selective serotonin reuptake inhibitors (SSRIs), has led to a tremendous growth in the use of antidepressants in the United States. This growth, however, has been accompanied by a growing concern about the risks of prescribing antidepressants, particularly to children. Indeed, research linking the use of antidepressant drugs to an increased risk of suicidal behaviors in youth motivated the US Food and Drug Administration to direct antidepressant drug manufacturers to include warning labels about the potential dangers. This paper examines the relationship between antidepressants and suicide among youth in the USA. Using state-level data on youth suicides and age-specific prescriptions for antidepressants, we find no relationships between suicides for adolescents aged 15-19 and prescriptions for SSRIs/serotonin-norepinephrine reuptake inhibitors or tricyclic and tetracyclic antidepressants. In contrast, we find that newer generation antidepressants are associated with lower numbers of suicides for this age group. For younger children aged 10-14, we find no relationship with suicides for any type of antidepressant.

This chapter examines the impact of cigarette prices, taxes, and tobacco control policies on youth and young adult smoking propensity and intensity, in the U.S. during the years 1997-2001, a period characterized by significant changes in cigarette prices and tobacco control policies. Employing a fixed effects technique, we find a strong negative impact of cigarette prices and taxes on youth and young adult smoking prevalence and conditional demand. Moreover, we find purchase, use, and possession laws to be inversely related to youth and young adult smoking prevalence.

The purpose of this chapter is to examine the role of alcohol policies in reducing the incidence of sexually transmitted diseases (STDs) among youth. Previous research has shown that risky sexual practices (e.g., unprotected sex and multiple partners) that increase the risk of contracting an STD are highly correlated with alcohol use. If alcohol is a cause of risky sexual behaviour, then policies that reduce the consumption of alcohol may also reduce the incidence of STDs. In this chapter, we examine the relationship between alcohol policies (e.g., beer taxes and statutes pertaining to alcohol sales and drunk driving) and rates of gonorrhea and acquired immune deficiency syndrome (AIDS) among teenagers and young adults. Results indicate that higher beer taxes are associated with lower rates of gonorrhea for males and are suggestive of lower AIDS rates. Strict drunk driving policies in the form of zero tolerance laws may also lower the gonorrhea rate among males under the legal drinking age.

This study uses the Youth Risk Behavior Survey (YRBS) and the National Comorbidity Survey (NCS) to explore the causal relationship between alcohol abuse (binge drinking and clinically defined alcohol use disorders) and suicide attempts among youth. We use an empirical approach that allows one to assess the possible existence and strength of a causal relationship without relying on identifying assumptions. Our results suggest that a causal relationship between binge drinking and suicide attempts is very unlikely. The findings, however, support a causal relationship between clinically defined alcohol use disorders and suicide attempts among girls.

Background and Study Aims: There is a large body of literature examining the determinants of juvenile crime, which highlights economic, family, peer, and educational factors associated with delinquency and recidivism, and the important roles of social service and educational systems. Two factors, substance abuse and mental illness are also potentially important. The observed high correlations between crime, substance abuse and poor mental health suggests that factors which reduce substance abuse and improve mental health may also be effective in reducing criminal activities. The purpose of this paper is to examine the effectiveness of mental health and substance abuse treatment in reducing crimes committed by juveniles., Methods: This paper uses detention data in conjunction with substance abuse and mental health treatment data for youth enrolled in the Colorado state foster care program over a three year period. Duration models are used to examine the structural determinants of detention. We analyze the impact of treatment in delaying or preventing this group of at-risk youth from engaging in criminal behavior. Violent crimes are analyzed separately. We also include the price of beer in all models to gauge the effectiveness of higher beer prices in reducing crime, holding treatment constant., Results: The analysis finds that individuals who receive treatment have lower probabilities of being detained for any offence. Accounting for the unobserved heterogeneity makes the magnitude of these effects larger. Also consistent with our theory, higher beer prices lower the detention hazard., Conclusion: Results of this study suggest that expansion of health services targeted at these youth may be effective at reducing crime. For violent crime, where the literature shows that substance abuse plays a significant role, stricter alcohol-regulatory policies may also be highly effective.

This paper analyzes the effects of daylight and daylight saving time (DST) on pedestrian and motor vehicle occupant fatalities in the United States. Multivariate analyses of county level data from the Fatality Analysis Reporting System for 2-week periods in 1998 and 1999 are used. Results show that full year daylight saving time would reduce pedestrian fatalities by 171 per year, or by 13% of all pedestrian fatalities in the 5:00-10.00 a.m. and in the 4:00-9:00 p.m. time periods. Motor vehicle occupant fatalities would be reduced by 195 per year, or 3%, during the same time periods.

This paper examines the influence of body weight, body image, and cigarette prices in determining adolescent smoking initiation. Adolescents who desire to lose weight may initiate smoking as a method of appetite control. Such behavior may undermine the goals of tobacco control policies that seek to prevent smoking initiation. Using a nationally representative panel of adolescents, we show that smoking initiation is more likely among females who are overweight, who report trying to lose weight, or who describe themselves as overweight. In contrast, neither objective nor subjective measures of weight predict smoking initiation by males. Higher cigarette prices decrease the probability of smoking initiation among males but have no impact on female smoking initiation. These gender-specific differences may help explain the mixed and inconclusive evidence of the impact of price on smoking initiation found in previous literature.

Background: Alcohol consumption has been identified as one of the most important risk factors for youth suicide. Previous research has shown a strong, empirical link between alcohol use and suicide. If alcohol use is a contributing factor in determining suicidal behaviors, then policies designed to reduce the alcohol consumption may succeed in reducing youth suicides as well., Aims of the Study: This paper looks at the role of alcohol-related policies in reducing completed suicides by American youths and young adults. This hypothesis comes from two well established relationships: i) the observed correlation between alcohol consumption and incidents of suicide, and ii) the negative relationship between the full price of alcohol and consumption. The alcohol policies examined are excise taxes on beer, measures of alcohol availability, and drunk driving laws., Methods: Data on completed suicides for each state in the United States are analyzed for the period 1976-1999. Negative binomial regressions are used to estimate a reduced form model of youth suicide. Suicides are analyzed by gender and age groups (ages 10-14, 15-19 and 20-24)., Results: The results indicate that increases in the excise tax on beer are associated with a reduced number of male suicides. This tax, however, has no impact on female suicides. Suicides by males ages 20-24 are positively related to the availability of alcohol, and negatively related to the presence of a 0.08 BAC (blood alcohol concentration) law and a zero tolerance law for drunk driving. Female suicides are not impacted by the availability of alcohol, although the drunk driving laws may impact suicides by teenage females., Implications for Health Policies: Policies designed to reduce alcohol consumption may have the unintended benefit of reducing suicides, particularly among young males., Implications for Further Research: While this research shows that alcohol policies may be successful in reducing male suicides, such policies have little impact on female suicides. Future research should explore other potential types of policies and programs to reduce female suicides. Also, illegal drug use has been linked to suicides in a similar manner as alcohol consumption. Future research should consider the role of illegal drug consumption and related policies in determining youth suicides.