Essays in Labor Economics: Alcohol Consumption and Socioeconomic Outcomes

Recent studies indicate that alcohol consumption may affect economic outcomes through its effects on health capital and social capital. If, in fact, differences in economic outcomes are causally linked to differences in alcohol consumption, then lack of adequate insight into such connectivity may adversely affect the labor market and retirement outcomes of some groups of individuals in society. In two essays, this dissertation examines the impact of alcohol consumption on wealth at retirement using data from the RAND Health and Retirement Study (HRS) from 1992 through 2002; and the effects of alcohol consumption on employment duration and earnings using the Geocode version of the National Longitudinal Survey of Youth (NLSY1979) micro dataset from 1984 through 1996. This dissertation relies on Grossman\u27s 1972 health capital model. Empirically, the research relies on panel data methods and duration analysis to determine whether differences in economic outcomes can be explained by differences in alcohol consumption. The results indicate that drinking is positively related to improved socioeconomic outcomes as compared to total abstention, when endogeneity has not been taken into account under both duration analysis and panel data methods. When endogeneity is taken into account, alcohol consumption tends to shorten the duration of employment via survival analysis. Also, estimation via instrumental variables approach indicates that the relationship between alcohol consumption and socioeconomic outcomes (retirement wealth and earnings) is rather an inverted U-shaped for some panel data specifications. Moreover, the effects of alcohol consumption on retirement wealth and earnings tend to diminish with instrumental variables approach. These findings did not change even with abstainers partitioned into lifetime abstainers and infrequent or light drinkers (less than one drinking day per week)

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways