Research

Hidden in Plain Sight: Prevalence and Impact of Undiagnosed ADHD (Job Market Paper)

Partisan Mortality Cycles, with Daniel Millimet (Revise and Resubmit at Journal of Population Economics)

Flavored E-cigarette Sales Restrictions and Young Adult Tobacco Use in the United States, with Abigail Friedman and Michael Pesko, JAMA Health Forum, Forthcoming

Tobacco Product Flavor Policies in the United States, with Alyssa Crippen, Abigail Friedman, Alex Liber, Mayah Monthrope, and Tanisha Narine, Revise and Resubmit at Tobacco Control

The Labor Market Returns of Adolescent Mental Health Care, with Shuo Qi (Working Paper)

Constructing a Time Consistent Synthetic K6 for the National Health Interview Survey, with Abigail Friedman (Working Paper)

Trends in Young Adult Combustible Tobacco Usage, with Abigail Friedman and Michael Pesko (Work in Progress)

Assessing the Impact of Flavor Restrictions on Smoking and Vaping, with Abigail Friedman (Work in Progress)

Twin Epidemics: The Intersection of the Adolescent Mental Health Crisis and the Synthetic Opioid Crisis (Work in Progress)

Mental health is increasingly being recognized as a public health crisis. However, mental illness is more likely than other physical health issues to go untreated. This is particularly true in the case of adolescent mental health, where there has been growing concern about an epidemic of depression and anxiety among teenage students. My research primarily explores the intersections of adolescent mental health with education, labor market outcomes, public health policy, and health inequities.

In my job market paper, “Hidden in Plain Sight: The Prevalence and Impact of ADHD Underdiagnosis”, I assess the long-term education and labor market effects of missed ADHD diagnoses. Doing so is challenging for two reasons. First, a person’s true ADHD status is unobserved; only their diagnosed status is known. Second, even if diagnostic errors are observed, they are likely akin to non-classical misclassification errors and therefore endogenous. To overcome these empirical challenges, I use and extend on a partial observability model and estimate it with restricted data, including genetic information, from Add Health. I recover an estimate of individuals’ true ADHD status; and their probability of underdiagnosis. Then, I estimate their effect on educational attainment and adult financial outcomes.

The results are striking. First, ADHD is underdiagnosed and there are large diagnostic gaps along the lines of sex, race, ethnicity, and parental socioeconomic status. Second, both ADHD and its underdiagnosis are highly detrimental for human capital development outcomes, including employment and education. Large improvements can be made by correctly diagnosing a child who likely has ADHD, however little to no gains can be made by diagnosing a child who does not have ADHD. Due to the hereditary nature of ADHD, the paper discovers the existence of vicious intergenerational cycles in which inequity in mental health care drives and is driven by socioeconomic inequities. This is perhaps the most striking result of the paper, as it links access to mental health care as a driving determinant for persistent economic inequality. It implies that investment in early childhood human capital development not only improves a child’s adult financial outcomes but has positive downstream effects for future generations. I plan to further explore this result in future work where I test to what extent involuntary mental health capital bequests explain income gaps in a two-sector OLG model. Additional follow-up work includes examining the spillover effects of a student’s ADHD diagnosis on the likelihood that their peers are diagnosed. This paper is currently under review for publication. I have presented it at the American Society of Health Economics, Society for Economic Measurement, and Southern Economic Association conferences; and it won the best third year paper award at SMU.

In, “Partisan Mortality Cycles”, co-authored with Daniel Millimet, we assess partisan politics as a determinant for geographic inequity in mortality. Geographic inequities in mortality rates in the US are pronounced and growing. Yet, the causes of this inequality are not understood. Recently, the focus has turned to the role of place-specific factors. Here, we explore the importance of politics as a place-specific factor contributing to mortality inequality. Specifically, we test for the existence of partisan mortality cycles using panel data on US counties from 1968-2016. We confirm the existence of partisan mortality cycles, finding lower mortality in counties governed by more liberal political regimes. I plan to continue research on geographic determinants of mortality inequality by using the deinstitutionalization of public mental health hospitals to examine the role of mental healthcare access in public health inequities. We are in the process of revising and resubmitting this paper to Journal of Population Economics and it has been presented at the Canadian Economic Association and Southern Economic Association conferences.

I have multiple projects which utilize quasi-experimental methods to assess the impact of flavored tobacco and e-cigarette policies on the utilization of these projects, with a focus on youth and mental health disparities in policy coverage and impact. The overarching project funded through a grant from the National Institute of Health, “Assessing the Impact of Flavor Restrictions on Smoking and Vaping”, utilizes a constructed municipal policy dataset to assess how various tobacco policies change geographic youth and young adult smoking and vaping rates. For example, in, “Flavored E-cigarette Sales Restrictions and Young Adult Tobacco Use in the United States”, finds evidence of a substitution effect, in which e-cigarette flavor restrictions yielded a 2.4 percentage point reductions in daily vaping but 1.0 percentage point increases in daily smoking among 18-29 year olds. Additional works funded under this project include “Constructing a Time Consistent Synthetic K6 for the National Health Interview Survey”, “Tobacco Product Flavor Policies in the United States”, and “Trends in Young Adult Combustible Tobacco Usage”. Papers under this project are currently under review, and will be presented at conferences such as TCORS Grantee Meeting Planning Committee.

In, “The Labor Market Returns of Adolescent Mental Health Care”, co-authored with Shuo Qi, we explore the importance of counseling take-up in adolescence on adult labor market returns through a structural model of social stigma in peer networks. Using Add Health data, we assess the role of peer networks on the selection into mental health care and estimate the effect of counseling on future wages. We find large financial returns of counseling on future wages. However, these returns diminish as initial levels of a child’s social and cognitive capital rise, or mental health capital declines. We interpret these results as follows: Provided the child sees a counselor, the counselor must decide which capital input to invest time into, seeking to maximize investment into the child’s social and cognitive capital, subject to the constraint that mental health capital is sufficiently high. This creates an inequity where a child with lower initial mental health capital receives less investment into labor market inputs than a child with higher initial mental health capital. We plan to submit this paper for publication by the end of the academic year. It has been presented at the American Society of Health Economics and Southern Economic Association Conferences and has won best graduate economics presentation during SMU’s research and development week.

The second work in progress explores the intersection of the adolescent mental health crisis with the 3rd wave of the opioid epidemic. These two public health crises can be seen as ‘twin epidemics’, as the onset of both begins in 2012 and have seemingly moved in parallel. A common explanation for the mental health crisis has been the rise in social media usage, but the rise in adolescent suicide attempts over the past decade has been more pronounced in the U.S. than in other English-speaking countries which have similar access to social media platforms. One potential determinant is parental opioid usage. One study in JAMA Psychiatry finds 1/6th of the current adolescent suicide epidemic could potentially be attributed to parental opioid usage (Brent, 2019). I plan to first see if a similar measure could be replicated using CDC mortality and opioid dispensing data, and then explore potential mechanisms which connect the two epidemics.