Essays on the Link Between Alcohol Consumption and Youth Fertility

In the first chapter, I use exogenous variation in state minimum legal drinking ages to examine the relationship between restrictions on teen alcohol consumption and youth fertility. Using individual level data, I find that a decrease in the minimum drinking age during the late 1970s and 1980s leads, surprisingly, to a decrease in pregnancy rate among 15-17 year-old white women. The pregnancy rate among 15-17 year-old black women, on the other hand, significantly increases with the decrease in the drinking age. I find similar racial variations for unwanted pregnancies among 15-17 years old. The differentiated response to changes in eligibility requirements persist for 18-20 year-old women. I find evidence of a compositional change toward wanted pregnancies associated with the decrease in drinking age for 18-20 year-old white women; the eligibility restrictions have only a statistically weak effect on fertility of 18-20 year-old blacks and Hispanics. These effects can only be found in individual level data. Analysis of state-level aggregate fertility rates fails to reveal these important racial differences. In the second chapter, I study the effect of alcohol consumption on youth fertility. Alcohol consumption is often believed to be a cause of risk-taking behaviors. Despite a well-established correlation between alcohol intake and various risk-taking sexual behaviors, the causality remains unknown. I attempt to establish a causal effect of alcohol use on the likelihood of pregnancy among youth using a variety of models ranging from a fully parametric to a semi-parametric discrete factor approximation method. Using data on 17-28 year-old women from the National Longitudinal Survey of Youth, I find that even after controlling for unobserved heterogeneity alcohol consumption increases the likelihood of pregnancy by 4.7 percentage points. This positive effect was observed in the semi-parametric model where the cumulative distribution of heterogeneity was approximated by a 4-point discrete distribution. Quantitatively similar but statistically weaker estimates were obtained from the two-stage least squares model and the bivariate probit model. Finally, models that ignore the effect of unobserved heterogeneity failed to establish this relationship

Current and projected future economic burden of Parkinson's disease in the U.S.

Parkinson's disease (PD) is one of the world's fastest growing neurological disorders. Much is unknown about PD-associated economic burdens in the United States (U.S.) and other high-income nations. This study provides a comprehensive analysis of the economic burdens of PD in the U.S. (2017) and projections for the next two decades. Multiple data sources were used to estimate the costs of PD, including public and private administrative claims data, Medicare Current Beneficiary Survey, Medical Expenditure Panel Survey, and a primary survey (n = 4,548) designed for this study. We estimated a U.S. prevalence of approximately one million individuals with diagnosed Parkinson's disease in 2017 and a total economic burden of $51.9 billion. The total burden of PD includes direct medical costs of$25.4 billion and $26.5 billion in indirect and non-medical costs, including an indirect cost of$14.2 billion (PWP and caregiver burden combined), non-medical costs of $7.5 billion, and$4.8 billion due to disability income received by PWPs. The Medicare program bears the largest share of excess medical costs, as most PD patients are over age 65. Projected PD prevalence will be more than 1.6 million with projected total economic burden surpassing $79 billion by 2037. The economic burden of PD was previously underestimated. Our findings underscore the substantial burden of PD to society, payers, patients, and caregivers. Interventions to reduce PD incidence, delay disease progression, and alleviate symptom burden may reduce the future economic burden of PD

Current and projected future economic burden of Parkinson's disease in the U.S.

Parkinson's disease (PD) is one of the world's fastest growing neurological disorders. Much is unknown about PD-associated economic burdens in the United States (U.S.) and other high-income nations. This study provides a comprehensive analysis of the economic burdens of PD in the U.S. (2017) and projections for the next two decades. Multiple data sources were used to estimate the costs of PD, including public and private administrative claims data, Medicare Current Beneficiary Survey, Medical Expenditure Panel Survey, and a primary survey (n = 4,548) designed for this study. We estimated a U.S. prevalence of approximately one million individuals with diagnosed Parkinson's disease in 2017 and a total economic burden of $51.9 billion. The total burden of PD includes direct medical costs of$25.4 billion and $26.5 billion in indirect and non-medical costs, including an indirect cost of$14.2 billion (PWP and caregiver burden combined), non-medical costs of $7.5 billion, and$4.8 billion due to disability income received by PWPs. The Medicare program bears the largest share of excess medical costs, as most PD patients are over age 65. Projected PD prevalence will be more than 1.6 million with projected total economic burden surpassing $79 billion by 2037. The economic burden of PD was previously underestimated. Our findings underscore the substantial burden of PD to society, payers, patients, and caregivers. Interventions to reduce PD incidence, delay disease progression, and alleviate symptom burden may reduce the future economic burden of PD