Birth weight and vulnerability to a macroeconomic crisis.

This paper shows that early-life health is an important determinant of labor market vulnerability during macroeconomic downturns. Using data on twins during Sweden's crisis of the early 1990s, we show that individuals with higher birth weight are differentially less likely to receive unemployment insurance benefits after the crisis as compared to before it, and that this effect is concentrated among workers in the private sector. While differences in early-life health thus lead to increased inequality in employment outcomes, we also find that there is no differential effect of birth weight on total income after the crisis. This suggests that in the context of Sweden, the social safety net is able to mitigate the effects of early-life health on labor market outcomes during economic downturns.

Estimating returns to hospital volume: Evidence from advanced cancer surgery.

High-volume hospitals typically perform better than low-volume hospitals. In this paper, we study whether such patterns reflect a causal effect of case volume on patient outcomes. To this end, we exploit closures and openings of entire cancer clinics in Swedish hospitals which provides sharp and arguably exogenous variation in case volumes. Using detailed register data on more than 100,000 treatment episodes of advanced cancer surgery, our results suggest substantial positive effects of operation volume on survival. Complementary analyses point to learning-by-doing as an important explanation.

Intergenerational transmission of human capital: Is it a one-way street?

Studies on the intergenerational transmission of human capital usually assume a one-way spillover from parents to children. However, children may also affect their parents' human capital. Using exogenous variation in education, arising from a Swedish compulsory schooling reform in the 1950s and 1960s, we address this question by studying the causal effect of children's schooling on their parents' longevity. We first replicate previous findings of a positive and significant cross-sectional relationship between children's education and their parents' longevity. Our instrumental variables estimates are not statistically different from zero. However, they hide substantial heterogeneity by the gender of the child and the parent; female schooling is found to affect longevity of fathers and especially those from low socio-economic background. Taken together, our results point to the importance of daughters' schooling for parental health and to the importance of considering heterogeneous impacts.

Can Women Have Children and a Career? IV Evidence from IVF Treatments.

This paper introduces a new IV strategy based on IVF (in vitro fertilization) induced fertility variation among childless women to estimate the causal effect of having children on their career. For this purpose, we use administrative data on IVF treated women in Denmark. Because observed chances of IVF success do not depend on labor market histories, IVF treatment success provides a plausible instrument for childbearing. Our IV estimates indicate that fertility effects on earnings are: (i) negative, large, and long-lasting; (ii) driven by fertility effects on hourly earnings and not so much on labor supply; and (iii) much stronger at the extensive margin than at the intensive margin.

The Effect of Schooling on Mortality: New Evidence From 50,000 Swedish Twins.

By using historical data on about 50,000 twins born in Sweden during 1886-1958, we demonstrate a positive and statistically significant relationship between years of schooling and longevity. This relation remains almost unchanged when exploiting a twin fixed-effects design to control for the influence of genetics and shared family background. This result is robust to controlling for within-twin-pair differences in early-life health and cognitive ability, as proxied by birth weight and height, as well as to restricting the sample to MZ twins. The relationship is fairly constant over time but becomes weaker with age. Literally, our results suggest that compared with low levels of schooling (less than 10 years), high levels of schooling (at least 13 years of schooling) are associated with about three years longer life expectancy at age 60 for the considered birth cohorts. The real societal value of schooling may hence extend beyond pure labor market and economic growth returns. From a policy perspective, schooling may therefore be a vehicle for improving longevity and health, as well as equality along these dimensions.

Body size, skills, and income: evidence from 150,000 teenage siblings.

We provide new evidence on the long-run labor market penalty of teenage overweight and obesity using unique and large-scale data on 150,000 male siblings from the Swedish military enlistment. Our empirical analysis provides four important results. First, we provide the first evidence of a large adult male labor market penalty for being overweight or obese as a teenager. Second, we replicate this result using data from the United States and the United Kingdom. Third, we note a strikingly strong within-family relationship between body size and cognitive skills/noncognitive skills. Fourth, a large part of the estimated body-size penalty reflects lower skill acquisition among overweight and obese teenagers. Taken together, these results reinforce the importance of policy combating early-life obesity in order to reduce healthcare expenditures as well as poverty and inequalities later in life.

Adolescent health and adult labor market outcomes.

Whereas a large literature has shown the importance of early life health for adult socioeconomic outcomes, there is little evidence on the importance of adolescent health. We contribute to the literature by studying the impact of adolescent health status on adult labor market outcomes using a unique and large-scale dataset covering almost the entire population of Swedish males. We show that most types of major conditions have long-run effects on future outcomes, and that the strongest effects result from mental conditions. Including sibling fixed effects or twin pair fixed effects reduces the magnitudes of the estimates, but they remain substantial.

Assessing the impact of obesity on labor market outcomes.

We study the effect of obesity on employment, using rich data from the British National Child Development Study (NCDS). The results show a significant negative association between obesity and employment even after controlling for a rich set of demographic, socioeconomic, environmental and behavioral variables. In order to account for the endogeneity of obesity, we use and assess instruments introduced by Cawley (2004); the obesity status of biological relatives. Using parental obesity as an instrument, we show that the association between obesity and employment is no longer significant. Similar results are obtained in a model of first differences. We provide a number of different checks on the instruments, by exploiting the richness of the NCDS data. The results show mixed evidence regarding the validity of the instruments.

Nature, nurture and socioeconomic policy-what can we learn from molecular genetics?

Many countries use public resources to compensate individuals with genetic disorders, identified by behaviors/symptoms such as chronic diseases and disabilities. This paper draws attention to molecular genetic research which may provide a new dimension to our understanding of how socioeconomic outcomes are generated. We provide an overview of the recently emerging evidence of gene-environment interaction effects. This literature points out specific areas where policies may compensate groups of individuals carrying genetic risks, without the need to identify anyone's genetic endowments. Moreover, epigenetics studies, which concern heritable changes in gene functions that occur independently of the DNA sequence, have shown that environments may affect heritable traits across generations. It means that policies which neutralize adverse environments may also increase intergenerational mobility, given that genetic and/or environmental risk factors are more common in socially disadvantaged groups.

Utilisation of physician services in the 50+ population: the relative importance of individual versus institutional factors in 10 European countries.

We analysed the relative importance of individual versus institutional factors in explaining variations in the utilisation of physician services among the 50+ in ten European countries. The importance of the latter was investigated, distinguishing between organisational (explicit) and cultural (implicit) institutional factors, by analysing the influence of supply side factors, such as physician density and physician reimbursement, and demand side factors, such as co-payment and gate-keeping, while controlling for a number of individual characteristics, using cross-national individual-level data from SHARE. Individual differences in health status accounted for about 50% of the between-country variation in physician visits, while the organisational and cultural factors considered each accounted for about 15% of the variation. The organisational variables showed the expected signs, with higher physician density being associated with more visits and higher co-payment, gate-keeping, and salary reimbursement being associated with less visits. When analysing specialist visits separately, however, organisational and cultural factors played a greater role, each accounting for about 30% of the between-country variation, whereas individual health differences only accounted for 11% of the variation.

Gender, risk perceptions, and smoking behavior.

The underlying reasons for gender differences in smoking behavior, and thus for the recent trends, are not well understood. Using a sample of 8592 Swedish adolescents aged 15-18, this paper contributes to the literature by exploring gender differences in smoking risk perceptions and in the responses to the latter. The results show significant gender differences in the perception of smoking mortality risk and in the perception of the addictiveness of smoking. Girls perceive the mortality risk of smoking as significantly greater than boys do, but they also perceive the addictiveness of cigarettes as less. These results persist after controlling for a wide range of background characteristics, including smoking risk information sources. Moreover, the findings suggest that while smoking information from sources such as teachers, pals, and own search, affect smoking mortality perceptions in a significant and positive manner among boys, no such effects are obtained among girls. Finally, our results show that both boys and girls take both the addictiveness and mortality risk of smoking into account when making their smoking decision. Moreover, the magnitude of the response is similar among boys and girls. This is in contrast to the general belief that females dislike risks to a greater extent than males.

Healthcare costs for people aged 65+ two years prior to their receiving long-term municipal care.

BACKGROUND AND AIMS: More knowledge is needed about patterns of healthcare consumption at different times during old age, particularly with regard to the relationship between various agents in the healthcare and social services system. One aim was to investigate healthcare costs in the public medical healthcare system in men and women (65+) and, with regard to age, in the two years prior to the start of long-term municipal care and services. Another aim was to investigate patterns and determinants of costs. METHODS: The study comprised 362 people who received decisions about municipal care and/or services during 2002-2003, and data were derived from the Swedish National Study of Aging and Care (SNAC) and county councils registers about healthcare consumption. SNAC provided data concerning demographics, functional dependency and informal care at the time of the decision, which were merged with data from the Skåne County Council patient administrative system regarding costs in the two years prior to decision. RESULTS: Cluster analysis revealed 13% overall higher healthcare costs. Those involved were more often younger, men, married, and diagnosed with circulatory diseases, cancer, or injuries. Most (58% for women, 54% for men) of the costs for acute inpatient care occurred within five months prior to municipal care. Men had significantly higher costs compared with women for visits to outpatient physicians (EUR 700 vs 400) and inpatient care (EUR 4700 vs 700) 12-0 months prior to municipal care. CONCLUSIONS: A share of 13% had higher healthcare costs throughout the two years. Those involved were more often younger, men, married, and diagnosed with circulatory diseases, cancer, or injuries. Those older people at risk of high healthcare costs should benefit from systematic clinical assessments and more proactive and integrated care, to prevent escalating costs in the period preceding long-term municipal care and services.

Does smoking increase sick leave? Evidence using register data on Swedish workers.

OBJECTIVE: To examine the effect of smoking on sick leave. METHODS: Nationally representative data on 14,272 workers aged 16-65 years from the 1988-91 waves of the Swedish Survey of Living Conditions were used for the analyses. The data are linked to register-based data, on the annual number of absences due to sickness, from the National Board of Social Insurance. As outcome variable, the annual number of days of sick leave was used. This outcome was analysed as a function of smoking status and an extensive number of control variables, including occupational risk factors, work characteristics and health status. RESULTS: Smoking was found to increase the annual number of days of absence by 10.7 compared with never smoking. Controlling for risk factors at work, and thereby accounting for some of the selection of smokers into riskier jobs, reduced the effect to 9.7 days, corresponding to 38% of all annual absences due to sickness. Moreover, controlling for health status further reduced the effect of smoking to 7.7 days. The effect of smoking on sick leave was similar for men and women. CONCLUSIONS: Smoking showed a large positive effect on the annual number of sick leaves. Hence, the results suggest that the gains to preventing and/or reducing smoking, in terms of reduced production losses, may be large. However, since the large effect of smoking persists when controlling for a range of health factors and occupational factors, the results also suggest that much of the higher number of absences among smokers may be explained by factors other than reduced health. The estimates should be viewed as upper bounds of the effect of smoking on sick leave, since smoking is potentially an endogenous variable.

Obesity and occupational attainment among the 50+ of Europe.

This paper brings a European perspective to the mainly U.S.-based literature on the relationship between obesity and labour-market outcomes. Using micro-data on workers aged 50 and over from the newly developed SHARE database, the effects of obesity on employment, hours worked, and wages across 10 European countries were analysed. Pooling all countries, the results showed that being obese was associated with a significantly lower probability of being employed for both women and men. Moreover, the results showed that obese European women earned 10% less than their non-obese counterparts. For men, however, the effect was smaller in size and insignificant. Taking health status into account, obese women still earned 9% less. No significant effect of obesity on hours worked was obtained, however. Regressions by country-group revealed that the effects of obesity differed across Europe. For instance, the effect of obesity on employment was greatest for men in southern and central Europe, while women in central Europe faced the greatest wage penalty. The results in this study suggest that the ongoing rise in the prevalence of obesity in Europe may have a non-negligible effect on the European labour market.

Getting ready for the marriage market? The association between divorce risks and investments in attractive body mass among married Europeans.

This article explores to what extent married middle-aged individuals in Europe are governed by the risk of experiencing divorce, when shaping their physical appearance. The main result is that divorce risks, proxied by national divorce rates, are negatively connected to body mass index (BMI) among married individuals but unrelated to BMI among singles. Hence, it seems that married people in societies where divorce risks are high are more inclined to invest in their outer appearance. One interpretation is that high divorce rates make married people prepare for a potential divorce and future return to the marriage market.

A community action programme for reducing harmful drinking behaviour among adolescents: the Trelleborg Project.

AIMS: To evaluate a 3-year community intervention programme by measuring changes in drinking patterns in a 15-16-year-old population. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: The action programme included five demand-reducing and one supply-reducing interventions. Cross-sectional, non-repeated data were collected from a questionnaire distributed in classrooms from 1999 to 2001 and 2003 (n = 1376, 724 boys and 652 girls; response rate = 92.3%). Stepwise logistic regression analyses were used to determine the relationship between different risk factors and excessive drinking, heavy episodic drinking, purchaser of alcohol and alcohol provided by parents. The results from the intervention community were also compared with similar Swedish cross-sectional data sets. FINDINGS: The results of our analyses indicated a decrease in harmful drinking behaviour in Trelleborg when comparing baseline with postintervention measurements. The comparison with other studies showed that the changes in these indicators were more rapid and consistent in Trelleborg. Finally, the multivariable logistic regression analyses showed that the outcomes were not likely to be attributed to changes in environmental factors. CONCLUSIONS: We concluded that a community action programme based on the systems approach reduced hazardous alcohol consumption effectively among adolescents in Trelleborg.

Having the wrong friends? Peer effects in adolescent substance use.

Swedish cross-sectional survey data on young individuals aged 12-18-year-old was used to analyse school-class based peer effects in binge drinking, smoking and illicit-drug use. Significant and positive peer effects were found for all three activities. By introducing school/grade fixed effects, the estimated peer effects were identified by variation in peer behaviour across school-classes within schools and grades, implying that estimates were not biased due to endogenous sorting of students across schools. Further, endogeneity bias due to bi-directionality of peer effects was found for binge drinking and smoking. Controlling for this source of endogeneity resulted in even stronger peer effects.

Social capital and substance use among Swedish adolescents--an explorative study.

Cross-sectional survey data on Swedish adolescents aged 12-18 was used to estimate the link between individual social capital and smoking, illicit drug use and binge drinking. Major conclusions drawn were (1) that social capital, indicated by measures of social participation and trust, was negatively correlated with the probability of smoking and illicit drug use, but (2) that social capital showed no statistically significant correlation with the probability of binge drinking.

Young people and alcohol: an econometric analysis.

AIMS: To analyse the determinants of youth drinking behaviour within an economic -theoretical framework. The paper focuses especially on the effects of (a) having parents willing to supply alcohol, (b) living in a single-parent household, (c) having parents who are currently unemployed and (d) having received education about alcohol, narcotics and tobacco. DESIGN, SETTING AND PARTICIPANTS: A Swedish cross-sectional survey data on 833 individuals aged 12-18 years was used to analyse the effects of the above variables on participation in drinking, frequency of drinking, intensity of drinking and binge drinking. Separate analyses were conducted for beer, wine and spirits. Care was taken in using appropriate econometric methods for the questions posed (negative binomial regression, censored regression and probit regression). FINDINGS: Having parents willing to supply alcohol increased frequency (P < 0.05) of beer, wine and spirits consumption, intensity (P < 0.05) of wine, spirits and illicit alcohol consumption, and increased probabilities (P < 0.10) of binge drinking and participation in drinking (P < 0.05). No effects were seen from living in a single-parent household. Having received education about alcohol, narcotics and tobacco had a negative association only with intensity (P < 0.10) of beer consumption. Having a father who was currently unemployed was associated with an increased (P < 0.05) probability of binge drinking but a reduced (P < 0.05) frequency of wine consumption. CONCLUSIONS: The positive effect of having parents willing to supply alcohol could reflect that these individuals face lower acquisition costs or lower psychological costs in consumption. It could also reflect a price effect, if the individual receives the alcohol free from his or her parents.