Essays on the economics of children's health and wellbeing: Foster care, physical education, and leadership training
- Perales, Nicole
- Advisor(s): Gertler, Paul
Abstract
In this dissertation, I evaluate the effectiveness of policies designed to interrupt cycles of child abuse and neglect, prevent childhood obesity, and empower adolescents with leadership skills.
In the first chapter, I study the effectiveness of higher payments to foster care providers as a quality improvement tool in the United States. Experience in foster care is common among youth in the United States and high quality foster care is critical to ensure their safety and long-term wellbeing. I leverage a federal court case that induced a 21-37\% increase in monthly payments to foster families and relatives recruited and managed by California counties but did not extend to those recruited and managed by private agencies. Additionally, some relatives who established guardianship over a child in California were retroactively eligible for the pay raise based on the date their guardianship was established. I use a regression discontinuity designs and two decades of administrative data to identify the short term effects of the court case on the safety of children in foster care, as well as its long term effects on the safety of children in a related guardian's care. I find that higher monthly payments did not immediately affect the safety of children in the care of foster families or relatives recruited by the county, but the long-term receipt of higher payments by related guardians reduced the likelihood that a child was maltreated within five years of their guardianship start by 68\%. Further, despite no change in pay, the announcement of the raise for county-recruited homes immediately decreased the monthly likelihood of maltreatment while placed in private agency homes by 34\%. These findings are consistent with changes in provider effort and investments on the intensive margin and contrast with the scarce evidence to-date that suggests wages are an ineffective quality improvement tool for foster care.
In the second chapter, I study the effectiveness of a state-level policy that sought to increase the intensity of physical education (PE) by requiring at least 50\% of high school PE time to be moderate-to-vigorous physical activity in the United States. PE is used to promote physical activity among youth but has demonstrated limited success in affecting health behaviors and health outcomes. Using a synthetic difference-in-differences design and nine waves of Youth Risk Behavior Surveillance System, we find this policy had no overall effect on students' physical activity levels or obesity, and reduced PE participation. The selection out of PE is larger among older students and in settings where PE is not required. Among older students in voluntary enrollment settings, non-White students were most likely to reduce their participation in PE despite being more likely to benefit. We conclude that school-based PE policies targeting the intensive margin risk unintended consequences on the extensive margin when enrollment is voluntary.
In the third chapter, I study the long-term impact of a school-based program for leadership and social entrepreneurship skill development in Uganda. Recent evidence suggests that traditional education alone is inadequate to close gender gaps in human capital, economic productivity, and intra-household bargaining, when women remain at a low-empowerment equilibrium and face internal constraints related to aspirations, confidence, and other socio-emotional (soft) skills. The Educate! Experience supplemented the typical secondary school curriculum and was implemented as a cluster randomized controlled trial (RCT) in 48 schools. Four years after the program concluded, we document lasting impacts on a wide array of soft skills with larger effects for females. The acquired skills are consistent with female Educate! graduates who feel more in control of their lives (self-efficacy and stress regulation) and empowered to pursue goals (plasticity and grit). Graduates translated these skills into changes in human capital and fertility that differ by gender. For female graduates, the program increased the likelihood of completing secondary education, delaying family formation, enrolling in tertiary education, and pursuing STEM and Business majors. For male graduates, the program led to fewer sexual partners. The program also yielded positive social spillovers that were common to male and female graduates alike. Graduates reported more egalitarian views of gender roles and better quality partners in terms of communication, social standing, and wealth. Further, female graduates perceived less social acceptability of intimate partner violence (IPV) and were less likely to report experiencing it. These findings demonstrate that a gender-blind intervention can influence gender-relevant outcomes, like norms and IPV, and help to close the gender gap in outcomes of interest.