Background: Many health systems are exploring how to implement low-dose computed tomography (LDCT) screening programs that are effective and patient-centered. Objective: To examine factors that influence when LDCT screening is preference-sensitive. Design: State-transition microsimulation model. Data Sources: Two large randomized trials, published decision analyses, and the SEER (Surveillance, Epidemiology, and End Results) cancer registry. Target Population: U.S.-representative sample of simulated patients meeting current U.S. Preventive Services Task Force criteria for screening eligibility. Time Horizon: Lifetime. Perspective: Individual. Intervention: LDCT screening annually for 3 years. Outcome Measures: Lifetime quality-adjusted life-year gains and reduction in lung cancer mortality. To examine the effect of preferences on net benefit, disutilities (the “degree of dislike”) quantifying the burden of screening and follow-up were varied across a likely range. The effect of varying the rate of false-positive screening results and overdiagnosis associated with screening was also examined. Results of Base-Case Analysis: Moderate differences in preferences about the downsides of LDCT screening influenced whether screening was appropriate for eligible persons with annual lung cancer risk less than 0.3% or life expectancy less than 10.5 years. For higher-risk eligible persons with longer life expectancy (roughly 50% of the study population), the benefits of LDCT screening overcame even highly negative views about screening and its downsides. Results of Sensitivity Analysis: Rates of false-positive findings and overdiagnosed lung cancer were not highly influential. Limitation: The quantitative thresholds that were identified may vary depending on the structure of the microsimulation model. Conclusion: Identifying circumstances in which LDCT screening is more versus less preference-sensitive may help clinicians personalize their screening discussions, tailoring to both preferences and clinical benefit. Primary Funding Source: None.

Complementarity across occupations and industries implies that the relative size of those with high productivity growth shrinks, reducing their contributions toward aggregate productivity growth and thereby resulting in its slowdown. This force, especially the shrinkage of occupations with above-average productivity growth through "routinization," was present since the 1980s. Through the end of the 1990s, it was countervailed by the extraordinary productivity growth in the computer industry, of which output became an increasingly more important input in all industries ("com-puterization"). It was only when the computer industry's productivity growth slowed that the negative effect of routinization on aggregate productivity became apparent.

Background: Hydroxychloroquine (HCQ) is the standard of care medication for most SLE patients, however nonadherence is common. We investigated longitudinal patterns and predictors of nonadherence to HCQ in a U.S. SLE cohort of HCQ initiators. Methods: We used Medicaid data from 28 states to identify adults 18–65 years with prevalent SLE. We included HCQ initiators following ≥6 months without use, and required ≥1 year of follow-up after first dispensing (index date). We used the proportion of days covered (PDC) to describe overall HCQ adherence (<80% = nonadherent) and novel group-based trajectory models (GBTM) to examine monthly patterns (<80% of days/month covered = nonadherent), during the first year of use. Multivariable multinomial logistic regression models were used to examine predictors of nonadherence. Results: We identified 10,406 HCQ initiators with SLE. Mean age was 38 (±12) years, 94% were female, 42% black, 31% white; 85% had a mean PDC < 80%. In our 4-group GBTM, 17% were persistent adherers, 36% persistent nonadherers, and 47% formed two dynamic patterns of partial adherence. Adherence declined for most patients over the first year. Compared to persistent adherers, the odds of nonadherence were increased for blacks and Hispanics vs. whites and for younger ages vs. older; increased SLE-related comorbidities were associated with reduced odds of nonadherence for persistent nonadherers (0.95, 95% CI: 0.91–0.99). Conclusions: Among HCQ initiators with SLE, we observed poor adherence which declined for most over the first year of use. HCQ adherence is a dynamic behavior and further studies of associated predictors, outcomes, and interventions should reflect this.

This paper analyzes the intra-household distribution of wealth and welfare in the United States, within a theoretical framework based on a collective model of labor supply, where household decisions are Pareto efficient, and spouses negotiate a sharing rule for non-labor income. Using the American Time Use Survey for the years 2003 to 2015, estimates show a positive correlation between individual wages and labor supply, while cross-wages go in the opposite direction. Additionally, we find that wives tend to be more altruistic in comparison to their husbands regarding the intra-household allocation of income, which leads to wealth inequalities. However, the intra-household processes appear to be efficient in terms of welfare, as increases in any source of household income are associated with decreases in intra-household inequality, as measured by the spouses’ estimated indirect utility. Our results shed light on the spouses’ wealth shares and the sharing rule guiding the individual allocations, which may be important in the design of policies aimed at alleviating poverty.

A decade after the start of the Great Recession, economic recovery in the US has been uneven—not only across cities and regions, but also within them. In many cities that have witnessed significant economic growth, income inequalities are widening, housing costs are consuming an ever-larger share of family incomes, and homelessness is on the rise (Glyn and Fox 2017; Joint Center for Housing Studies of Harvard University 2017).1 In some of these cities, local leaders are prioritizing policies that harness growth for broadly shared benefit, including easing housing affordability pressures, preventing displacement and strengthening safety nets.2 In cities that have been left behind by the national recovery or continue to lose ground, local leaders are increasingly linking economic development to inclusion goals to ensure that all residents can contribute to turning around the local economy and share the benefits when economic fortunes shift (Funders Network for Smart Growth and Livable Communities et al. 2017; Mallach and Brachman 2013). Across all types of cities, local leaders are beginning to recognize that economic growth does not automatically lead to inclusion; rather intentional strategies are needed (Einstein at al. 2017; Pacetti 2014).

One in five new HIV diagnoses in the United States is among persons younger than 25 years old. Routine testing is a crucial prevention strategy. We assessed the relationships between sex, race, sexual orientation, and HIV testing among young adults. Odds of affirmative testing history were higher among women than men, and among Latino gay/bisexual men than their White counterparts. Among straight men, odds of having tested were greatest among Blacks. Mechanisms through which race/ ethnicity affect HIV vulnerability among young gay/bisexual men of color need to be explored, especially as these populations are more likely to have affirmative testing histories, yet are disproportionately impacted.

When do groups on the social periphery assimilate into the social core of a nation? Building on a diverse set of literatures, I argue that individual participation in military service creates a number of conditions that drive individuals to assimilate into a broader national culture. To test the theory, I focus on the case of World War I in the United States–a period that closely followed a massive wave of immigration into the United States. Using an instrumental variables strategy leveraging the exogenous timing of the war, I show that individuals of foreign, European nativity–especially, the Italians and Eastern Europeans–were more likely to assimilate into American society after serving in the U.S. military. The theory and results contribute to our understanding of the ways in which states make identity and the prospects for immigrant assimilation in an age without mass warfare.

Despite substantial public, political, and scholarly attention to the issue of immi-gration and crime, we know little about the criminological consequences of undocu-mented immigration. As a result, fundamental questions about whether undocumentedimmigration increases violent crime remain unanswered. In an attempt to addressthis gap, we combine newly developed estimates of the unauthorized populationwith multiple data sources to capture the criminal, socioeconomic, and demographiccontext of all 50 states and Washington, DC, from 1990 to 2014 to provide thefirst longitudinal analysis of the macro-level relationship between undocumentedimmigration and violence. The results from fixed-effects regression models reveal thatundocumented immigration does not increase violence. Rather, the relationship be-tween undocumented immigration and violent crime is generally negative, althoughnot significant in all specifications. Using supplemental models of victimization dataand instrumental variable methods, we find little evidence that these results are due todecreased reporting or selective migration to avoid crime. We consider the theoreticaland policy implications of these findings against the backdrop of the dramatic increasein immigration enforcement in recent decades.

Scholars theorize that messages advocating for small family size are promoted worldwide. This paper examines the influence of global messages advocating for small family size on the ideal family size preferences of people in Malawi. It is argued that Malawians are exposed to such messages through education curricula, media programs, urban environments, Christian religious associations, and foreign aid interventions. More specific education curricula and types of aid interventions in Malawi that depict small families as a sign of “development” are also examined. Combining survey, administrative, and archival data, I test the influence of these mechanism of global cultural dissemination in Malawi. Education is negatively related to family size preferences, especially exposure to Life Skills and Social Studies curricula, as are newspaper and television use, urban living, and Christian identity. Notably, aid interventions targeted at family planning are not associated with smaller family size preferences.

This dissertation comprises two papers that examine the effect of urban transportation systems on employment outcomes and traffic congestion. The first paper evaluates the labor market effects of subway systems on low-skilled workers. A model of labor supply predicts that this should improve search and employment outcomes. The empirical findings confirm that improved subway access increases low-skilled labor force participation. Related effects for light rail and bus service are much smaller. For low-skilled men without a car, a 10 percent expansion in subway, rail, and bus service increases labor force participation by 3.0, 0.3, and 0.3 percentage points, respectively. Improved subway service increases hourly wage, but has no significant effect on work hours and commuting time. These findings confirm that subway access increases travel speed and has potential to expand the geographic scope of workers’ labor market. The second paper investigates the effects of subway expansions on passenger miles traveled (PMT) in subways and vehicle miles traveled (VMT) on roads in the US. Drawing on a panel dataset that tracks city-level expansions of subway and road systems, estimates indicate that the fundamental law of subway congestion holds as the PMT increases one for one with the length of the subway systems. Subway systems have substitution and growth effects on road traffic. A 10 percent expansion of a subway system reduces contemporaneous traffic on ring interstate highways and non-highway arterial roads by 0.7 percent and 1.4 percent, respectively. With a three-year lag, a 10 percent increase in subway capacity increases VMT on ring highways by 0.4 percent and increase VMT on radial highways by 1.7 percent. Together, these estimates suggest that subway expansions do not reduce congestion on radial highways but do relieve congestion on roads that are close substitutes to subways (ring highways and non-highway arterial roads).

Each year, the Nobel Prize is awarded to outstanding individuals in the fields of Economics, Physics, Medicine or Physiology, Chemistry, Literature, and Peace. Unlike in prior years, in 2018, none of the American winners were foreign-born individuals who immigrated to the United States or who were working at a U.S. institution at the time they won. But the United States did play an important role in their formation; nine of the twelve 2018 Nobel Laureates were either students, teachers, or research fellows at U.S. institutions of higher education at some point in their lives, even if they were not born in the United States. Three of the 2018 Nobel Laureates were foreign-born academics who spent considerable time at U.S. institutions. Originally from Canada, Dr. Donna Strickland was on staff at Princeton University and at the Lawrence Livermore National Laboratory after earning her doctoral degree at the University of Rochester. Her fellow 2018 Laureate in Physics, French-born Dr. Gerard Mourou, was also at the University of Rochester. Finally, Japanese-born immunologist Dr. Tasuku Honjo was a visiting fellow at the Carnegie Institution of Washington and then the U.S. National Institutes of Health for seven years, and was later elected to the U.S. National Academy of Sciences as a foreign associate. Their stories are the stories of dozens of foreign-born Nobel Prize Laureates and other gifted scientists who came to the United States to follow their dreams of knowledge and of genuine contribution to the wellbeing of humankind.

This article examines the relationship between collective action and the size of worker and employer groups in the United States. It proposes and tests a theory of union formation and strikes. Using a new county-by-industry level dataset containing the location of unions, the location of strikes, average establishment size, and the number of establishments around the turn of the twentieth century, I find that unions were more likely to form and strikes were more likely to occur in counties with intermediate-sized worker groups and large employer groups.

Recent decades have seen a surge in local interior immigration enforcement. In this paper we examine a little discussed, but potentially important, spillover effect of enforcement policies: changes in high-skilled citizen women’s labor supply due to changes in the cost of outsourcing household production. Undocumented immigrants disproportionately supply household services - e.g. as maids, cooks, child care workers, and gardeners - so the price of outsourcing these services is expected to rise in response to enforcement. Combining data on the timing and location of these enforcement policies, with data on labor supply from the American Community Survey over 2005-2012, we implement a difference-indifference approach with location and year fixed effects to take advantage of the staggered implementation of these policies. We find that an increase in intensity of immigration enforcement in a local area reduced the labor supply of citizen college- educated women with children. Several results suggest that changes in the price of outsourcing are driving these results: 1) we see an increase in time spent on household production tasks among mothers in the American Time Use Survey, 2) we confirm that there is an increase in the wages of household workers, and 3) we see no similar effects for high-skilled men or women without children. This indicates there are important unintended consequences of enforcement policies on high-skilled citizen mothers’ ability to work.

What are the effects of universal and permanent cash transfers on the labor market? Since 1982, all Alaskan residents have been entitled to a yearly cash dividend from the Alaska Permanent Fund. Using data from the Current Population Survey and a synthetic control method, we show that the dividend had no effect on employment, and increased part-time work by 1.8 percentage points (17 percent). Although theory and prior empirical research suggests that individual cash transfers decrease household labor supply, we interpret our results as evidence that general equilibrium effects of widespread and permanent transfers tend to offset this effect, at least on the extensive margin. Consistent with this story, we show suggestive evidence that tradable sectors experience employment reductions, while non-tradable sectors do not. Overall, our results suggest that a universal and permanent cash transfer does not significantly decrease aggregate employment.

The American Time Use Survey 2003-15, the French Enquête Emploi du Temps, 2009-10, and the German Zeitverwendungserhebung, 2012-13, have sufficient observations to allow examining the theory of household production in much more detail than ever before. We identify income effects on time use by nonworkers, showing that relatively time-intensive commodities—sleep and TV-watching—are inferior. For workers we identify income and substitution effects separately, with both in the same direction on these commodities as the income effects among non-workers. We rationalize the results within a generalization of the theory, allowing both substitution between time and goods in household production and substitution among commodities in utility functions. We then use the substantial evidence of price discrimination in product markets against minorities in the U.S. and immigrants in France to motivate estimating how household production differs between members of these groups and the majority. We find the predicted results that they engage in more time-intensive activities, sleep and TV-watching, than otherwise identical majority-group members.

This dissertation explores the role of family and gender in understanding the disparities in human capital accumulation and corresponding disparities in labor market outcomes. The first chapter explores the relationship between workers’ wages and the gender of their supervisor, conditioning on the occupational gender composition. It develops a theoretical model suggesting that supervisors’ task assignment accuracy is affected disparately in occupations of different gender types, leading to varying degrees of skill mismatch among workers. This leads to average wage differences between workers with female supervisors and those with male supervisors in occupations of different gender types. Consistent with the theoretical predictions, the empirical evidence suggests that workers have better occupation-skill matches and higher average wages if they work with female supervisors in predominantly female occupations, compared to those with male supervisors; the opposite is true for workers in predominantly male occupations. Although not significant at the early career stage, supervisor wage effects emerge as a worker’s career develops. These findings emphasize the importance of supervisors’ task assignment accuracy in workplace gender wage disparity, and underscore the necessity of integrating minority managers to the “gendered” organizational contexts. The second chapter examines the extent to which children enter occupations that are different from their father’s occupation, but require similar skills, which we call task following. We distinguish between task followers and occupational followers, considering the possibility that fathers can transfer task specific human capital either through investments or genetic endowments to their children. We show that there is indeed substantial task following, beyond occupational following and that task following is associated with a wage premium of around 5% over otherwise identical workers employed in a job with the same primary task. The wage premium is robust to controls for industry, occupation categories and occupation characteristics. The premium is largest for followers in non-routine cognitive jobs and college graduates.

Location and sectoral moving costs can generate similar average patters, disguising different sources and effects on subpopulations. Appendix Figure E.1 shows the effects of a shock in Location 1 and Sector A when location 2 only has jobs in Sector B. As a result, to change locations, individuals also have to change sectors. Panel A shows the effects of increasing location moving costs on wages and migration decisions of workers originally in location 1 (when sectoral moving costs are 0), while Panel B shows the effects of increasing sectoral moving costs (when location moving costs are 0). Increasing either cost reduces out-migration and increases the magnitude of the impact on average wages. However, turning to Panels C and D, we see that these similar average effects hide heterogenous effects. These panels, which show how the effects of raising each type of moving costs affects workers originally in location A broken down by their original sector, shows that raising location moving costs hurts both workers originally in Sector A and Sector B. Conversely, increasing sectoral moving costs hurts workers in Sector A, while actually helping those originally in Sector B. Furthermore, costs of changing locations versus sectors or occupations are likely driven by different factors and may have different policy solutions. Consequently, exploiting data that allows me to distinguish these two types of costs is essential. . .

We exploit the discontinuous jump in criminal sanctions at the age of majority in conjunction with administrative data from California to generate regression discontinuity estimates of the deterrent effect. Estimates show that the greater severity imposed upon adolescents at age 18 deters violent crime by 10-12%. Results are robust to multiple techniques and specifications. Using these results, we estimate an elasticity of crime with respect to sanction intensity that ranges from -0.145 to -0.174. We extend our results to demographic sub-populations and find female offenders, as well as white and Asian offenders, are relatively more responsive to sanctions.

In this study we utilize data from over a million ownership spells between 1990 and 2013 in 9 metropolitan areas - Boston, Chicago, Detroit, Los Angeles, Miami, New York, Pittsburgh, San Diego, and San Francisco - to provide what we believe to be the most extensive analysis of the variation in the financial returns to homeownership along racial and socioeconomic dimensions. Holding constant a buyer's purchase price, property type, neighborhood, and purchase and sale timing, we find that capital gains have been systematically lower for low-income and minority home buyers in every market in our sample. In some cases, the unconditional returns realized by these buyers were higher, a phenomenon driven by their higher propensity to purchase lower-priced homes that experienced high levels of appreciation. Taken as whole, our findings call into question the widespread claim that encouraging homeownership for low-income and minority households is a panacea for addressing wealth inequality.