Essays on outcomes from federal and state health policies
Creators: name: Behrmann, Rachel
Publisher: name: The University of Texas at Austin
Year: 2023
Subjects: Benzodiazepines
Opioids
Mental health

description: This dissertation consists of three chapters analyzing health consequences of federal and state drug policies. In the first chapter, I analyze the effects of the 2016 benzodiazepine and opioid black box warning on prescribing behavior of both these and non-targeted drugs. In August of 2016, the United States Food and Drug Administration released a black box warning for the concurrent use of benzodiazepines and opioids, reflecting concerns about the combined sedating effects of these drugs including an increased risk of death. To investigate the effects of this warning on US prescribing behavior, I utilize claims data from the Medicare Part D Prescribers by Provider and Drug dataset from 2013-2019. I implement an event-study framework that leverages pre-treatment prescribing intensity of benzodiazepines to determine the effect of this policy on county-level prescribing behavior. I find that counties that had higher claims of benzodiazepines before the black box warning experienced a larger and sustained decline in both benzodiazepines and opioid claims for at least three years following the warning. I also find that the black box warning affected prescribing behavior for drugs not targeted by this warning. Specifically, this warning also resulted in a decrease in county-level claims for the class of selective serotonin reuptake inhibitors, which may be concurrently used with benzodiazepines in treating anxiety. Prescribing of serotonin-norepinephrine reuptake inhibitors also decreased. While prescribing of non-benzodiazepine sedatives increased, this does not completely compensate in magnitude for the observed decrease in benzodiazepine claims per beneficiary. In the second chapter, I investigate the long-term effects of cigarette taxation on children’s mental health. Cigarette taxation has been shown to reduce maternal smoking during pregnancy, leading to an increase in infant birth weights. This paper evaluates the long-term effects of cigarette taxes during the prenatal period on the proportion of children with mental health conditions, focusing on attention-deficit/hyperactivity disorder (ADHD), behavioral problems or conduct disorders, and learning disabilities. I leverage geographic variation across time in United States state cigarette taxes from 1986-2018. Using data from the National Survey of Children’s Health, I find that cigarette taxes lower the incidence of learning disabilities. In the third chapter, I evaluate the effect of state medical marijuana legalization on asthma in the United States. While medical marijuana legalization is becoming increasingly prevalent across the United States, the effects of this increased availability on both health and non-health outcomes is still being determined. In this study, I use a difference-in-differences strategy to analyze the effect of states adopting a medical marijuana law on asthma prevalence. I use individual-level microdata from the Behavioral Risk Factor Surveillance System from 1999-2018 to determine how this policy change affects the likelihood of an individual reporting having asthma. I find evidence that enacting a medical marijuana law increases the prevalence of asthma, although the effects attenuate in magnitude and significance when including later state policy adopters.