Smoking,drinking,anddrugusefortwo?

Infanthealthproductionandprenatalsubstanceabusepolicies

ChristineCoyerPAM4280/ECON3710

Fall2015

Outline

1. Infanthealthproduction2. Prenataldruguse3. Prenatalsubstanceabusepolicies

• Minnesotaexample

4. Discussion

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Review

• Theoryofhouseholdproduction(Becker,1965,1981)• Combinemarketgoodsandtimetoproducenon-marketgoods• Householdproductionfunction

• Modelofhumancapital(Becker,1964)• Optimalinvestmentsineducationovertime

• Modelofhealthcapitalandthedemandforhealth(Grossman,1972)• Healthisadurablestockthatvariesovertimeinresponsetodepreciationandinvestments

• Individual’sconstrainedoptimizationproblemistopurchasemarketgoodsandallocatetimetomaximizepresentdiscountedvalueoflifetimeutility

• MBofhealthstock=MCofhealthstock

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Demandforchildhealth

• ExtendtheGrossmanmodeltothefamily(Jacobson,2000;Bolinetal.,2001,2002)• Family’sconstrainedoptimizationproblemistopurchasemarketgoodsandallocatetimetomaximizepresentdiscountedvalueoflifetimefamilyutility

• RatioofMBandMCofhealthstockisequalacrossfamilymembers(lastdollarruleforinvestmentinchildren’shealth)

• Modelofparentalproductionofinfanthealth(RosenzweigandSchultz,1983,1991;CormanandGrossman,1985;Cormanetal.,1987;GrossmanandJoyce,1990)• Determinantsofthedemandforhealthproductioninputs(e.g.,parentalbehavior)

• Parametersofthehealthproductionfunction(e.g.,relationshipbetweenparentalbehaviorandhealthoutcomes)

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Modelofinfanthealthproduction

• Modelofinfanthealthproductionusedtostudybothpositivehealthinputs(e.g.,prenatalcare)andunhealthybehaviors(e.g.,smoking)

• Prenatalandearlychildhoodenvironmentscanhavelargeandpersistenteffectsonlaterlifeoutcomes(AlmondandCurrie,2011)• “Fetalorigins”and“earlyinfluences”literatures

• Policiesthatameliorateeffectsofnegativeshockstoprenatalandearlychildhoodenvironments• Education(e.g.,PerryPreschoolProgram,Abecedarian)• Income(e.g.,AFDC/TANF,EITC)• Nutrition(e.g.,SNAP,WIC)

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Cocaineepidemic

• In1985,approximately6.3percentofAmericansaged12andolderusedcocaineinpast12months(0.6percentin2013)(NSDUH)• Crackcocainewaspopularamongwomenandyouthduetoitslow

pricesandtheperceivedsafetyofsmokingcrackrelativetointravenousdruguse(Nadel,1991)

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Prenataldruguse

• Difficulttomeasuretheeffectofprenataldruguseonadverseoutcomes• Unobservedfactor(s)affectingbothdruguseandadverseoutcomes• Measurementerror(Kaestner etal.,1996;Corman etal.,2005)

• Prenataldruguseincreaseslowbirthweightby4-6ppandincreasesabnormalinfanthealthconditionsby7-12pp(Noonanetal.,2007)• Combinepostpartumsurveydatawithmedicalrecords

• Demandforillegaldrugsamongpregnantwomenisfairlyelastic(𝜖 =-0.77to-1.37)(Corman etal.,2005)• SimilartoChaloupka etal.(1999)(𝜖 =-1.0)

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Prenatalsubstanceabusepolicies

• Startinginmid-1980s,statesenactedtargetedpoliciestoreducesubstanceabuseduringpregnancy• Definedruguseduringpregnancyaschildabuse• Mandatoryreportingbydoctors,teachers,lawenforcement,priests,etc.

• Civilcommitment(i.e.,involuntarydetention)• Expandtreatmentservices• Education

• In2014,Tennesseebecamethefirststatetocriminalizedruguseduringpregnancy

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MinnesotaStatepoliciesonsubstanceabuseduringpregnancy

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1.Definitionofchildabuse

• Neglectisdefinedas,amongotherthings,“prenatalexposuretoacontrolledsubstance...usedbythemotherforanonmedicalpurpose,asevidencedbywithdrawalsymptomsinthechildatbirth,resultsofatoxicologytestperformedonthemotheratdeliveryorthechildatbirth,ormedicaleffectsordevelopmentaldelaysduringthechild'sfirstyearoflifethatmedicallyindicateprenatalexposuretoacontrolledsubstance.”MINN.STAT.ANN.§ 626.556(2)(c).

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2.Mandatoryreporting(drugs)

• Mandatedreportersofchildabuseandneglectmust“immediatelyreporttothelocalwelfareagencyifthepersonknowsorhasreasontobelieve thatawomanispregnantandhasusedacontrolledsubstanceforanonmedicalpurposeduringthepregnancy.”MINN.STAT.ANN.§ 626.5561.

• ProfessionalsrequiredtoreportMINN.STAT.ANN.§ 626.556,Subd.3.

• Aprofessionalorprofessional’sdelegatewhoisengagedinthepracticeofthehealingarts,hospitaladministration,psychologicalorpsychiatrictreatment,childcare,education,socialservices,correctionalsupervision,probationorcorrectionalservices,orlawenforcement

• Amemberoftheclergywhoreceivedtheinformationwhileengagedinministerialduties

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3.Mandatoryreporting(alcohol)

• Bystatute,“abuseofalcohol”includesthefollowing:ifawomanrequiredalcoholdetoxificationduringthepregnancyorifthereisapositiveresultfromanalcoholscreeningtest.Apersonrequiredtoreportunderthestate’schildabusereportinglawsmayeitherarrangefordrugscreeningforawomanthereportersuspectsispregnantandabusingalcohol,ormakeareporttothelocalwelfareagencyormaternalsubstanceabuseproject.Ifthewomanisreferredforscreeningandfailstoeithercompletescreeningorcomplywiththeresultingrecommendations,areportisrequired.Adulthouseholdmembersmayalsomakeavoluntaryreport.Localwelfareagenciesarerequiredtoreacttosuchreportswithinfiveworkingdaysbyconductinganassessmentandofferingservices.Thestatewillcollectdataonthenumberofreportsandreferralsandthenumberofwomenwhoreceiveorrefuseservices.MINN.STAT.ANN.§ 626.5563.

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4.Mandatorytesting

• Aphysicianwhosuspectsthatobstetricalcomplicationsmaybeduetoapregnantwoman’suseofdrugsisrequiredtoadministertoxicologyteststoboththepregnantwomanandtheinfantwithineighthoursafterdelivery.Thephysicianisrequiredtoreportpositiveresultsasperthestate’schildabusereportingstatutes.“Anegativetestresultdoesnoteliminatetheobligationtoreport undersection626.5561,ifotherevidencegivesthephysicianreasontobelievethepatienthasusedacontrolledsubstanceforanonmedicalpurpose.”Confirmatorytestsarerequiredunderthisstatute.MINN.STAT.ANN.§ 626.5562.

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5.Civilcommitment

• Uponreceivingareportthatapregnantwomanhasusedacontrolledsubstanceduringherpregnancy,alocalwelfareagency“shallimmediatelyconductanappropriateassessmentandofferservicesindicatedunderthecircumstances[and]mayalso[seek]anemergencyadmission”ofthepregnantwomanunderMinnesota’sCivilCommitmentAct (MINN.STAT.ANN.§ 253B.05).MINN.STAT.ANN.§ 626.5561(1)&(2).

• One1992Minnesotanewsstoryreportedthat“intheTwinCities,atleast30womenhavebeenconfinedinalockedpsychiatricwardattheUniversityofMinnesotaHospitalsincethe[civilcommitment] lawwaspassed”(Cook,1992).

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6.Treatmentservices

• Thestateistodevelopcomprehensivematernalandchildhealthandsocialserviceprogramstoaddresstheneedsofchildrenexposedtocontrolledsubstancesandalcoholatbirth.Theprogramsaretoservechildrenthroughpreschoolyears.Treatmentprogramsaretobedevelopedforchildrenbetweentheagesof6and12whoareinneedofchemicaldependencytreatment.Fundingshallbemadeavailabletoprogramsprovidingcomprehensivedrugtreatmentforpregnantwomenandwomenwithchildren. Earlyinterventionprogramsaretobedevelopedtoidentifyandprovideservicestochildrenandfamiliesatriskduetosubstanceabuse.MINN.STAT.ANN.§ 254A.17.

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7.Education

• Anyplacelicensedfortheretailsaleofalcoholicbeveragesmustpostasignthatincludes,amongotherthings,"awarningstatementregardingdrinkingalcoholwhilepregnant." MINN.STAT.ANN.§ 340A.410.

• Statestatuterequiresthatthe"boardofmedicalpracticeandboardofnursingshallrequirebyrulethatfamilypractitioners,pediatricians,obstetriciansandgynecologists,andotherlicenseeswhohaveprimaryresponsibilityfordiagnosingandtreatingfetalalcoholsyndromeinpregnantwomenorchildrenreceiveeducationonthesubjectoffetalalcoholsyndromeandfetalalcoholeffects,includinghowto:(1)screenpregnantwomenforalcoholabuse;(2)identifyaffectedchildren;and(3)providereferralinformationonneededservices."MINN.STAT.ANN.§214.12.

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Policysummary

1. Definitionofchildabuse2. Mandatoryreporting(drugs)3. Mandatoryreporting(alcohol)4. Mandatorytesting5. Civilcommitment6. Treatmentservices7. Education

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Discussion

1. Isthereaneconomicrationaleformandatoryreportingandcivilcommitment ofpregnantwomenwhousedrugs?Ifso,describethemarketfailure(s).Howwelldothepoliciesaddressthemarketfailure(s)?• Externalities• Imperfectinformation• Irrationalbehavior• Principal-agentproblem

2. Doyouthinkthesepoliciesmayhaveunintendedeffectsorspillovereffects?Ifso,whatarethey?Howwouldyoumodifythesepoliciestoincreasesocialwelfare?

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