Welcome from the Director
The Center for Health Economics & Policy Studies (CHEPS) is an interdisciplinary research center that supports impactful, policy relevant scholarship in the areas of health economics and social policy analysis. Housed in the College of Arts & Letters, CHEPS brings together faculty and graduate students engaged in complementary research in the areas of national defense policy, economic demography, the economics of crime and punishment, and the economics of risky health behaviors. Read more>>
Read the CHEPS Magazine 2023 and Mid-Year Report 2022-2023
CHEPS Pioneering Research
Racial Disparities, Policing, and Legalization of Recreational Marijuana
On October 6, 2022, President Biden requested that the Secretary of Health and Human Services and the Attorney General “initiate the administrative process to review expeditiously how marijuana is scheduled under federal law. Federal law currently classifies marijuana in Schedule I of the Controlled Substances Act, the classification for the most dangerous substances. This is the same schedule as for heroin and LSD, and even higher than the classification of fentanyl and methamphetamine – the drugs that are driving our overdose epidemic.” (The White House 2022).
One important impetus for this policy change was the disproportionately negative impact of marijuana prohibition on Black and Hispanic individuals. A new study by Zachary Fone (US Air Force Academy), Gokhan Kumpas (CSU-Los Angeles), and Joseph Sabia (CHEPS & SDSU) provides recent estimates of the effects of state-level recreational marijuana laws on racial disparities in arrests, psychiatric health, and mortality.
Their findings show that adopting an RML leads to a decline in marijuana-related arrests among both Black and White adults. In absolute terms, the decline was greater for Black adults, but this was entirely a reflection of pre-treatment differentials in arrest rates between Blacks and Whites. They find that (lagged) arrests for violent offenses involving Black adults rose following RML adoption, particularly when open recreational dispensaries are permitted. This could suggest a reallocation of policing resources to fight violent crime is undertaken in a racially disparate manner. They also show that RML adoption is associated with a reduction in opioid-involved mortality. The finding appears largest (in absolute and statistical significance terms) for non-Hispanic Whites relative to Blacks and Hispanics.
Together, their findings suggest that RMLs did little to reduce racial inequalities in arrests, psychological health, or mortality. However, the failure of RMLs to reduce racial disparities (from a relative perspective) does not imply that racial/ethnic minorities do not achieve important absolute gains from RML adoption.
Do Mandatory Seatbelt Laws Save Lives?
In 2020, traffic fatalities were the second leading cause of unintentional injury deaths among 1- through 44-year-olds in the United States. Over the past 40 years, mandatory seatbelt laws have become one of the most prominent demand-side policies to curb traffic fatalities. These laws, which impose civil fines on violators, take two forms: primary seatbelt laws (PSLs) and secondary seatbelt laws (SSLs).
PSLs allow law enforcement officials to stop and cite violators independently of other traffic behavior. SSLs permit citations for not wearing a seatbelt only if drivers have been stopped for a separate traffic offense. Recently, the National Governors Association listed the implementation of primary seatbelt laws as their top strategy to improve driver and passenger safety. As of January 2022, 34 states and the District of Columbia had a PSL, while 15 states had an SSL.
In this study, D. Mark Anderson (Montana State University), Yang Liang (San Diego State University & CHEPS), and Joseph Sabia (SDSU & CHEPS) examine the effect of mandatory seatbelt laws on occupant and non-occupant- related traffic fatalities. Their estimates suggest that PSLs are associated with a 5 to 9 percent reduction in fatalities among motor vehicle occupants. SSLs, on the other hand, are associated with markedly weaker effects. They conclude that strict seatbelt laws can potentially reduce vehicle occupant deaths without sizable “moral hazard” effects on non-occupants of vehicles.
Minimum Wages are a Poor Way to Help the Working Poor
For nearly a century, advocates of minimum wage increases have argued that raising the minimum wage will reduce poverty. A new study by Richard Burkhauser (Civitas Institute, UT-Austin, and Cornell), Drew McNichols (CHEPS), and Joseph Sabia (SDSU & CHEPS) uses data from the March Current Population Survey spanning four decades to study the effect of minimum wage increases on poverty. Their findings provide no evidence that minimum wage increases are an effective policy strategy to fight poverty.
Two important factors can explain the poor performance of past minimum wage increases in curbing poverty. First, most working-age individuals (ages 16-to-64) living in poor families are unemployed, and even fewer are steadily employed. Moreover, only 8 to 10 percent of working-age individuals living in poor or near-poor families earn minimum wages, so they are likely to be affected. Second, minimum wage increases may cause adverse employment effects among some low-skilled workers, generating income redistribution rather than net income gains for individuals in poor and near-poor families. In addition, the authors note that their measures of poverty may understate the adverse effects of the minimum wage on family well-being to the extent that minimum wage hikes reduce fringe benefits and workplace amenities not captured by our resource measures.
The authors further find that a $15 federal minimum wage would be a very target- inefficient means of delivering income to the working poor. Specifically, they find that just 5.9 percent of the benefits of a $15 minimum wage will accrue to workers in poor households. In comparison, 62.7 percent of those affected live in households with incomes twice or more than the federal poverty line. In contrast to the minimum wage, expansions in eligibility criteria for benefits from the Earned Income Tax Credit (EITC) may be more effective and more target-efficient policy strategies to deliver income to the families (households) of the working poor than the minimum wage.
E-Cigarette Taxes and Teenage Alcohol-Related Traffic Fatalities
A new National Bureau of Economic Research (NBER) study by Dhaval Dave (Bentley University), Yang Liang (SDSU & CHEPS), Matthew Braaksma (University of Minnesota), Catherine Maclean (George Mason University), and Joseph Sabia (SDSU & CHEPS) offers the first causal evidence on the impact of ENDS taxes on teen alcohol misuse and alcohol- related traffic fatalities. ENDS use rates are high, and ENDS taxes cause a sizable reduction in the number of ENDS users, thus providing us the ability to study the effect of ENDS taxes on an important secondary marketplace, alcohol, to provide a complete understanding of general equilibrium effects of public health policies targeting ENDS.
Teen alcohol misuse remains high and imposes substantial costs on society — with estimated annual social costs of $28 billion — and policy action by state and federal governments has largely stagnated.
This study combines a quasi-experimental difference-in-differences research design, applied to five survey and administrative databases, to bring much-needed evidence to bear on the relationship between ENDS taxes and teen alcohol misuse. The authors’ results show that ENDS taxation has little impact on the extensive margin of teen drinking (any alcohol consumption). Still, it curtails use on the intensive margin, particularly metrics of misuse that likely correlate with social costs. Specifically, the study shows that the probability of teen binge drinking declines by one to two percentage points following a one-dollar increase in the ENDS tax. The study also documents that alcohol-related traffic fatalities – a particularly costly externality associated with teen alcohol misuse – decline by 0.4 to 0.6 fatalities per 100,000 16-to-20-year-olds following a one-dollar hike in the ENDS tax.
Federal policymakers, public health researchers, and the National Academies of Sciences, Engineering, and Medicine have argued for a broad public health approach to reduce school bullying. This recommendation is owed, in part, to a comprehensive epidemiological literature that has concluded “probable evidence” of a causal relationship between bullying victimization and a wide set of risky health behaviors. However, the empirical methods used in these studies have made it difficult to disentangle the causal effect of bullying victimization from non-random targeting of victims based on difficult-to-measure traits associated with risky health behaviors.
This study, authored by Caterina Muratori (SDSU & CHEPS) and Joseph Sabia (SDSU & CHEPS), circumvents these empirical challenges by exploiting geographic and temporal variation in the adoption of state ABLs to identify their effect on risky health behaviors. They find that while ABLs — particularly more comprehensive statutes — are effective at reducing bullying victimization, they do little to facilitate a broad set of risky health behaviors for the average U.S. high school student.
When they turn to demographic subgroups, however, an intriguing result emerges. For LGBQ-identifying teenagers, they find that ABL adoption is associated with a significant (and large) reduction in binge drinking. These findings are consistent with prior evidence that LGBQ students experienced the largest psychological health gains from ABLs and appear to have reduced engagement in some risky health behaviors as a coping mechanism.
In the main, the results of this study suggest that the margin of bullying victimization reduced by ABLs likely generates, at most, only slight declines in youth risky behaviors for the average teenager. However, it is important to put our null findings on risky behaviors (for the average teen) in the context of the broader literature on the impacts of ABLs. Recent studies point to important psychological benefits that flow from ABL adoption, including a reduction in suicidal behaviors and depression.
Approximately 30% of U.S. high school students who identify as lesbian, gay, or bisexual report having been bullied on school property, nearly twice the rate of bullying victimization reported by heterosexual youth. In an attempt to reduce bullying victimization, all 50 states (and D.C.) have enacted anti-bullying laws (ABLs). ABLs require school districts to train teachers to recognize bullying, impose graduated sanctions on perpetrators, and improve the recording and monitoring of bullying incidents.
This case-control study used updated state YRBS data from 2009-2019 and a difference- in-differences (DD) approach to explore the association between ABL adoption and changes in suicidal behaviors among gay, lesbian, bisexual, and questioning (LGBQ) teens.
A new study by Yang Liang (SDSU & CHEPS), Daniel Rees (Universidad Carlos III of Madrid), Joseph Sabia (SDSU & CHEPS), and Cooper Smiley (SDSU), published in JAMA: Pediatrics, finds that ABLs protect lesbian and gay students from suicidal ideation and making suicide plans. The authors also provide evidence that students who are not sure of their sexual identity gain protection against attempting suicide after ABL adoption.
Bisexual-identifying students appear to gain less protection from ABLs. These results underline policy-relevant differences in preventing suicide behaviors among sexual minorities through anti-bullying policies.
While public support for recreational marijuana has sharply risen in recent decades, public health experts have taken a more cautious approach, urging more research to assess the health benefits and costs of marijuana use and to understand potentially unintended consequences on other health behaviors. One important unintended consequence could be the renormalization of smoking, which could undermine the achievements of tobacco control policies over the last two decades.
This study, authored by Dhaval Dave (Bentley University), Yang Liang (SDSU & CHEPS), Serena
Phillips (Georgia State University), Michael Pesko (GSU), and Joseph Sabia (CHEPS & SDSU) is the first to comprehensively examine the impact of recreational marijuana legalization on tobacco use. In doing so, they introduce a novel nationally representative longitudinal dataset —the Population
Assessment of Tobacco and Health (PATH) — to the recreational marijuana legalization literature. This study finds little empirical support for the hypothesis that RMLs increase the net consumption of tobacco, as measured across a broad set of combustible tobacco products and e-cigarettes, either at the extensive or intensive margin. Instead, the preponderance of the evidence points to slight,occasionally significant longer-run declines in adult tobacco use. Reductions in e- cigarette use are primarily concentrated among men and for RMLs that open recreational dispensaries accompany. These findings are consistent with the hypothesis that recreational marijuana and tobacco may be substitutes for some adults.
The potential healthcare cost savings from substitution away from cigarette consumption could be substantial. Scaling these estimates to the national level, our estimates suggest a reduction in smoking prevalence by as many as 5.1 million, translating into tobacco- related healthcare cost savings of about $10.2 billion annually.
The COVID-19 pandemic took a toll on many children's lives in poor and rich countries. Children experienced intensified poverty, increased malnutrition and mortality, worse health outcomes, mounting risks of violence, exploitation and abuse, and learning loss.
To date, only a minimal number of empirical studies have focused on learning loss in late adolescence. The impact on young individuals in their final year of high school is of particular interest because these students are about to enter the labor market or embark on a university career without the opportunity to recover.
The authors explore the effect of a full year of the COVID-19 pandemic on students' school performance at the end of upper secondary school in Italy. The situation in Italy is particularly worrying because, even before the pandemic, adult literacy and numeracy levels were well below the average of OECD countries participating in the Survey of Adult Skills (PIAAC), the proportion of young individuals with tertiary education is among the lowest in Europe, and the ratio of NEETs (young adults not in Employment, Formal Education or Training) is among the highest. Moreover, compared to other countries, Italy lacked digital skills and proper infrastructures for remote learning to replace face-to-face teaching.
Their results reveal that students at the end of high school suffered huge learning losses during the pandemic, about 0.4 standard deviations in mathematics and reading. On average, each week of school closure results in a loss of -0.013 s.d. in mathematics and Italian. The analysis also shows that low-achieving students suffered the most. Boys lost ground to girls in Italian (where girls were already doing better, meaning the gap widened) and, to some extent, in mathematics (where girls typically do worse, narrowing the gap in favor of boys). When comparing students with similar performance at Grade 10, the disadvantage between migrant and native students and between southern and northern students decreased significantly. However, because of the pre-existing gap in favor of native and northern students and the fact that low-achieving students lost the most, overall inequalities between these groups increased.
On June 24, 2022, the U.S. Supreme Court issued a decision in Dobbs v. Jackson Women’s Health Organization case, overruling Roe v. Wade (1973) and Planned Parenthood v. Casey (1992). The court decision ends the legalization of abortion nationwide and gives individual states the full power to regulate abortion. At the same time, in many other regions of the world, the debate on abortion has reignited, and restrictions on abortion access are now at the center of political agendas.
The right to abortion allows women to decide whether and when to have children. A possible consequence of the lack of choice in this domain may be a decrease in women’s bargaining power in the private and public spheres, particularly among low-income individuals. The arrival of a child lowers women’s socio-economic status, making them more vulnerable and raising their probability of suffering abuse. An unintended pregnancy may especially increase women’s likelihood to suffer from intimate partner violence, as it also directly affects a woman's ability to leave a relationship.
Starting from studies that estimate a sharp reduction in the abortion rate and an increase in the fertility rate after the implementation of many state laws regulating abortion in the U.S., the author addresses the question of
whether part of the aftermath of lower access to abortion services, with a consequent decrease in bargaining power, is an increase in the likelihood of women to be victims of violence. The focus of the study is on Texas since it experienced a dramatic cut in abortion facilities as a consequence of House Bill 2, a state policy targeting abortion providers implemented in July 2013.
Results show that, depending on the initial distance, a 25-mile increase to the nearest abortion clinic is estimated to increase the number of reported cases of gender violence per municipality by up to 1.9 percent. This impact persisted after one year. The relationship is non-linear, in the sense that the effect of distance on violence is lower for municipalities already far from their nearest abortion clinic, while it is more significant for women living relatively close to a clinic before the closure. The impact of an increase in distance is more significant among Hispanic and Black women, with the latter group experiencing an increase in violence against them by up to 4.8 percent.
Local labor market conditions — especially low-skilled workers’ expected wages and employment opportunities — have been shown to play an important role in criminal behavior. This study, authored by Zach Fone (US Air Force Academy), Resul Cesur (University of Connecticut), and Joseph Sabia (CHEPS & SDSU), examines the impacts of U.S. minimum wage laws, which are designed to impact low- skilled labor markets, on crime- related outcomes.
First, using data from the 1998-2016 Uniform Crime Reports, the authors find that a 10 percent increase in the minimum wage led to increases in property crime arrests for those between the ages of 16-to-24 of approximately 2 to 3 percent. Supplemental analyses from the National Longitudinal Survey of Youth 1997 show that self-reported property crime rises for workers who earn wages such that minimum wage increases directly bite (i.e., those earning between the old minimum and new minimum wage.
Estimates obtained using Current Population Survey data suggest that the labor market effects of minimum wage increases — increased wages but reduced employment and hours — play an essential role in its net crime effects for young adults.
Together, the study’s findings are consistent with (1) minimum wage increase-induced employment declines, which reduce both the opportunity costs of crime as well as the incapacitation effects of employment, (2) minimum wage-induced increases in wages, which may increase durable goods purchases that increase the rewards to larceny by some teenagers and young adults, and (3) possible changes in policing practices in response to minimum wage hikes, that disproportionately affect the most vulnerable teenagers and young adults.
A new study by Benjamin Hansen (University of Oregon), Jessamyn Schaller (Claremont McKenna College), and Joseph Sabia (SDSU & CHEPS) studies how in-person schooling affects teenage suicide. The findings of this study suggest that youth suicides decline when school does not meet in- person. The authors find evidence of this link based historic cross-sectional differences in school calendars and recent school closures and reopenings that occurred during the COVID-19 pandemic. Among the mechanisms the authors test include: (1) the interrupted cycle of bullying and other stresses related to in-person schooling, and (2) protective effects from more frequent interactions with family members.
However, this interruption in the rise of youth suicides was short lived, as suicide levels have increased as schools have reopened. Moreover, this comes at a time when there has also been a consistent upward trend in youth suicide since 2006, which raises many concerns. Despite the promise that anti-bullying laws may have in reducing marginal bullying victimization, the seasonal pattern in youth suicide and bullying related queries existed prior the pandemic and have reemerged as schools have reopened.
The authors caution that their results should not be interpreted as supporting a policy of school closures to reduce youth suicide risks. There are substantial long-term benefits to education, including, but not limited to, higher earnings, improved health, and reduced criminality. A growing body of research shows school shutdowns had many other adverse spillover effects including decreases in human capital acquisition for children. This research shines a light on the continued need for more research on youth mental health and a deeper investigation into why it declines for some students when school is in session.