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We study how individual political preferences changed in response to the influx of over 3.5 million Syrian refugees to Turkey during 2012–2016. Using a difference-in-differences research design, we compare the political outcomes in geographic areas with high versus low intensities of refugee presence before and after the beginning of the Syrian Civil War. To address the endogeneity of refugees’ location choices, we adopt an instrumental variables approach that relies on (1) historical dispersion of Arabic speakers in Turkish provinces and (2) driving distances between Turkish and Syrian residential areas to predict the flows of refugees across Turkish provinces during the study period. We find strong polarization in attitudes towards refugees between the supporters and opponents of the ruling Justice and Development Party (AKP). However, regression analyses of monthly survey data suggest that the massive inflow of refugees induced only a modest net drop in support for the AKP. Refugee inflows did not have a significant impact on election outcomes during the study period.

Using a strict, age-specific lockdown order for adults aged 65 and older in Turkey, we examine the mental health consequences of an extended period of tight mobility restrictions on senior adults. Adopting a regression discontinuity design, we find that the curfew-induced decline in mobility substantially worsened mental health outcomes, including somatic and nonsomatic symptoms of mental distress (approximately 0.2 standard deviation). Exploring potential channels, we document an increase in social and physical isolation, with no evidence of robust changes in labor market outcomes or intrahousehold conflict for this subpopulation.

Background: This paper investigates the long-term effects of the measles, mumps, and rubella (MMR) vaccine on healthcare, education, and economic outcomes using a novel dataset from the Copenhagen School Health Records Register. Methods: To address potential endogeneity, we use within-sibling variation in vaccination status induced by different periods of vaccine availability in Denmark. Results: Our findings reveal that, prior to the establishment of herd immunity, vaccinated cohorts experienced substantial protection against hospitalizations related to MMR. During the same period, we also observe modest improvements in educational outcomes and positive—though statistically insignificant—estimates for labor market outcomes among siblings with discordant vaccination status. We find no impact of vaccination on hospitalizations, education, or economic outcomes for cohorts born after herd immunity was established, a period when everyone benefited from herd protection regardless of individual vaccination status. Conclusions: MMR vaccination, before herd immunity, reduced hospitalization due to Measles, Mumps, and Rubella. The impact on later outcomes, such as education, income, and employment lacks statistical precision at conventional levels. Evidence suggest positive self-selection in vaccination among families with high socioeconomic status.

Couples in Turkey exhibit son preference through son-biased differential stopping behavior that does not cause a sex ratio imbalance in the population. Demand for sons leads to lower ratios of boys to girls in larger families but higher ratios in smaller families. Girls are born earlier than their male siblings, and son-biased fertility behavior is persistent in response to decline in fertility over time and across households with parents from different backgrounds. Parents use contraceptive methods to halt fertility following a male birth. The sibling sex composition is associated with gender disparities in health. Among third- or later-born children, female infant mortality is 1.5 percentage points lower if the previous sibling is male. The female survival advantage, however, disappears if the previous sibling is female. Having an older female sibling shifts the gender gap in infant mortality rate by 2 percentage points in favor of males. The improvement in infant mortality is strongest in favor of males who have no older male siblings.

Objectives. To describe demographic characteristics and abortion timing of minors in Arkansas who obtained an abortion through a judicial bypass, and to contrast the frequency of judicial bypass in other states in the United States. Methods. We used individual-level data on all abortions to minors (n = 2624) performed in Arkansas from 2005 to 2014 and aggregated data from 10 additional states on abortions obtained through a judicial bypass. We characterized correlates of the judicial bypass and its association with the timing of abortion. Results. Minors in Arkansas who used the courts were more likely to be 17 years of age, nonresidents of Arkansas, Hispanic, and with fewer previous pregnancies than their younger, resident, non-Hispanic White, and multigravida counterparts; 7.7% of abortions to minors were obtained via a bypass in 11 states, but only 2% if Texas and Arkansas are excluded. Conclusions. The demographics of minors who obtain an abortion through a judicial bypass differ significantly from those who have parental consent, and there is widespread variation in the proportion of bypass cases across states.

Objectives. To determine whether the 2014 Affordable Care Act Medicaid expansion affected well-being in the low-income and general adult US populations. Methods. We obtained data from adults aged 18 to 64 years in the nationally representative Gallup-Sharecare Well-Being Index from 2010 to 2016 (n = 1 674 953). We used a difference-in-differences analysis to compare access to and difficulty affording health care and subjective well-being outcomes (happiness, sadness, worry, stress, and life satisfaction) before and after Medicaid expansion in states that did and did not expand Medicaid. Results. Access to health care increased, and difficulty affording health care declined following the Medicaid expansion. Medicaid expansion was not associated with changes to emotional states or life satisfaction over the study period in either the low-income population who newly gained health insurance or in the general adult population as a spillover effect of the policy change. Conclusions. Although the public health benefits of the Medicaid expansion are increasingly apparent, improved population well-being does not appear to be among them. Public Health Implications. Subjective well-being indicators may not be informative enough to evaluate the public health impact of expanded health insurance.

We evaluate the impact of a nationwide public health intervention on deaths from sudden infant death syndrome (SIDS), using population data from Denmark in a regression discontinuity research design. The information campaign–implemented primarily through a universal nurse home visiting program–reduced infant mortality by 17.2 percent and saved between 11.6-13.5 lives over 10,000 births. The estimated effect sizes are 11-14 times larger among low birthweight and preterm infants relative to the overall population. Improvement in infant mortality is concentrated among those with low socio-economic status and with limited access to health information, thereby reducing health inequities at birth.

Randomized experiments provide unbiased estimates of treatment effects, but are costly and time consuming. We demonstrate how a randomized experiment can be leveraged to measure selection bias by conducting a subsequent observational study that is identical in every way except that subjects choose their treatment—a quasi-doubly randomized preference trial (quasi-DRPT). Researchers first strive to think of and measure all possible confounders and then determine how well these confounders as controls can reduce or eliminate selection bias. We use a quasi-DRPT to study the effect of class time on student performance in an undergraduate introductory microeconomics course at a large public university, illustrating its required design elements: experimental and choice arms conducted in the same setting with identical interventions and measurements, and all confounders measured prospectively to treatment assignment or choice. Quasi-DRPTs augment randomized experiments in real-world settings where participants choose their treatments.

This dissertation consists of three chapters. Chapter 1. Couples in Turkey exhibit son preference through son-biased differential stopping behavior that does not cause a sex ratio imbalance in the population. Demand for sons leads to lower ratios of boys to girls in larger families but higher ratios in smaller families. Girls are born earlier than their male siblings, and son-biased fertility behavior is persistent in response to decline in fertility over time and across households with parents from different backgrounds. Parents use contraceptive methods to halt fertility following a male birth. The sibling sex composition is associated with gender disparities in health. Among third- or later-born children, female infant mortality is 1.5 percentage points lower if the previous sibling is male. The female survival advantage, however, disappears if the previous sibling is female. Having an older female sibling shifts the gender gap in infant mortality rate by 2 percentage points in favor of males. The improvement in infant mortality is strongest in favor of males who do not have an older male sibling. Chapter 2. This chapter is co-authored with Alper Dinçer and David Jaeger. My co-authors and I examine the causal of impact of increased fertility on labor market outcomes in Turkey. Because Turkish parents exhibit a strong preference for sons and there is no evidence of selective abortion in Turkey, we use female births in the first two parities as instruments for family size. Using the 2000 Census, we find that although OLS estimates indicate a negative effect of fertility on labor supply for women, there is no evidence that this effect is causal. For men we find a small positive increase in labor force participation when the first child born is female. Analyzing the characteristics of compliers (i.e. those parents whose fertility is influenced by having a preference for sons), we find little difference with the overall population, suggesting that the finding of no effect of fertility is likely to be generalizable to the overall population. Results from the 2004-2012 Household and Labor Force Survey confirm our results from the Census and also indicate that there is little impact of fertility on the intensive margin of labor supply (i.e. hours or wages). Chapter 3. This chapter is co-authored with Theodore Joyce and Julie Reeder. A long-standing tension within the Special Supplemental Nutrition Program for Women, Infants and Children or WIC is promotion of breastfeeding while making available free infant formula. The WIC program purchases over half of all infant formula sold in the US and unsurprisingly, breastfeeding initiation and duration is substantially lower among WIC participants than their eligible non-participants. In an effort to improve breastfeeding, the Oregon WIC Program tested whether a relatively low-cost telephone peer counseling initiative to support breastfeeding could increase the initiation and duration of exclusive breastfeeding among its participants. They conducted a large randomized field experiment (RFE) with over 1900 women from four WIC agencies in the state. They found significant increases in exclusive breastfeeding among Spanish- but not English-speaking clients. In this study, my co-authors and I use data from the RFE along with administrative data from the rest of the state to assess whether the results from the RFE can be extended to other agencies in the state. We use randomization as an instrument to estimate the effect of treatment on the treated and we compare these to non-experimental estimates of the effect of peer counseling from the same or similar WIC agencies as the RFE. We find small or non-existent effects of peer counseling in the non-experimental settings, which suggest that the experimental estimates may reflect Hawthorne effects. We present evidence of selection into RFE in that exclusive breastfeeding among the controls is significantly greater than among women who were offered but declined to participate in the RFE as well as from women in the rest of the state who had no access to peer counseling. We conclude that despite the strong internal validity of the RFE, extending the program to other agencies in the state would have a limited impact at best on exclusive breastfeeding. (Abstract shortened by ProQuest.)

Working Paper No. 21013 In an effort to improve breastfeeding, the Oregon WIC Program tested whether a relatively low-cost telephone peer counseling initiative to support breastfeeding could increase the initiation and duration of exclusive breastfeeding among its participants. They conducted a large randomized field experiment (RFE) with over 1900 women from four WIC agencies in the state. In this study we use data from the RFE along with administrative data from the rest of the state to assess whether the results from the RFE can be extended to other agencies in the state. We find small or non-existent effects of peer counseling in the non-experimental settings, which suggest that the experimental estimates may reflect Hawthorne effects. We present evidence of selection into RFE in that exclusive breastfeeding among the controls is significantly greater than among women who were offered but declined to participate in the RFE as well as from women in the rest of the state who had no access to peer counseling. We conclude that despite the strong internal validity of the RFE, extending the program to other agencies in the state would have a limited impact at best on exclusive breastfeeding.