Duke 2008 | ASHE | Equity and Efficiency in Health and Healthcare

Rationale and Objective: Adverse health events in childhood are associated with a number of long-term impacts. For example, previous research has shown that maltreatment by a caregiver as a child increases the likelihood that a person will be a perpetrator of violence (Fang and Corso (2007)). In this session, we focus on both the causes and effects of adverse health events in childhood, and the impact of such events on both short and long-term economic outcomes. The objective of this session is to show that adverse health events in childhood have long-term effects that should be considered when estimating the cost and benefits of interventions to reduce such events.

Studies presented: Three different studies will be presented in this session. The first "Attention-Deficit/Hyperactivity Disorder Symptoms and Child Maltreatment: A Population Based Study" examines whether attention-deficit/hyperactivity disorder (ADHD) symptoms are associated with increased child maltreatment. The authors examine a nationally representative sample of adolescents from the National Longitudinal Survey of Adolescent Health (Add Health) that contains information on ADHD symptoms and self-reported information on child maltreatment (supervision neglect, physical neglect, physical abuse, and sexual abuse). The results show that children who exhibit six or more ADHD symptoms are more likely to suffer maltreatment across all of these dimensions.

The second study in this session "Family Background, Child Maltreatment and High School Dropout" shows that child maltreatment impacts individuals long after the early childhood years. The authors also use data from the Add Health survey, which follows participants from early childhood into the young adult years. This study uses data from Wave III, which contains information on high school completion. The authors use a multivariate probit model to control for the potential endogeneity of child maltreatment on high school completion. They find that child maltreatment significantly increases the likelihood of dropping out of high school. Maltreatment also mediates the influence of other factors typically associated with drop out, such as family poverty.

The final study, "The Association between Cigarette Smoke Exposure and Children's School Attendance and Behavior" examines a well known risk factor for adverse health outcomes, but considers outcomes that are not typically included in determining the impact of second-hand smoke. This study uses nationally representative data from the Medical Expenditure Panel Survey (MEPS) to estimate the impact of smoke exposure on school days missed due to illness and injury, and on school related behavioral problems. The results show that smoke exposure is significantly associated with more missed school days, and increased risks of school behavior problems and problems with school work.

Conclusions: Adverse health events in childhood can contribute to a wide range of other health problems, and have substantial economic consequences. Child behavior problems such as ADHD are associated with higher rates of child maltreatment, and higher rates of maltreatment are related to higher rates of high school dropout in subsequent years. Childhood smoke exposure also has a negative impact on education. This reduction in human capital may lead to reduced productivity over the lifecycle.