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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