Top PDF Essays in Empirical Health Economics

Essays in Empirical Health Economics

Essays in Empirical Health Economics

for environmental risk factors that are hardly considered, at least in the economic literature. Although these factors might have a small impact on the individual level, the fact that a large share of the population is exposed to numerous risk factors may lead to substantial aggregate effects on HCE. The remainder of this thesis is structured as follows: in the next two subsections, I briefly discuss the data and methods used in the subsequent studies and provide a short summary of each of the following four chapters. Each of these chapters constitutes a self-containing empirical study in the field of health economics and addresses research questions related to either efficiency aspects in health insurance markets or the understanding of the prevalence of preventable risk factors. The former is addressed by chapters 2 and 3, which consider health insurance switching behavior between SHI and PHI and within the SHI respectively in the German context. The latter is covered by chapters 4 and 5, which investigate individual and environmental risk factors respectively. Concluding remarks are given in chapter 6.
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Wichert, Sebastian
  

(2018):


	Essays in empirical health economics.


Dissertation, LMU München: Volkswirtschaftliche Fakultät

Wichert, Sebastian (2018): Essays in empirical health economics. Dissertation, LMU München: Volkswirtschaftliche Fakultät

When it comes to the connection of health and wealth, there is a heated, often un- informed debate in the media, politics and the public in general. Ample research in various fields of science tries to inform this discussion and provide guidance. Economists and health economists in particular contribute their share in several ways. First, they have highlighted "the dual relation between health and economic status" (Smith 1999, p.145; Deaton 2013). More specifically, they have formalized this association by sepa- rating and analysing causes for and consequences of an individual’s health theoretically as well as empirically (Grossman 1972; Currie 2011). Second, economists are able to evaluate potential causal pathways empirically by using microeconometric methods based on quasi-experimental settings, even in absence of randomized controlled trials. For example, building on an earlier medical literature and several such settings, it has been documented that (shocks to) the prenatal environment in the womb and the peri- natal environment at birth can have short- and long-term consequences on various life domains for a newborn (see e.g. Barker 1990; Almond and Currie 2011; Almond et al. 2010). Chapter 2 and 3 of this dissertation add to this literature. Another ongoing public discussion is about the potential health effects of modern leisure technology. The international evidence so far is mixed and any well-identified studies on this topic for Germany are virtually non-existent. Chapter 1 tries to fill this gap.
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Geiger, Nadine
  

(2018):


	Essays in empirical health economics.


Dissertation, LMU München: Volkswirtschaftliche Fakultät

Geiger, Nadine (2018): Essays in empirical health economics. Dissertation, LMU München: Volkswirtschaftliche Fakultät

Class Scheme (HISCLASS) invented and explained by Van Leeuwen and Maas (2011) builds upon HISCO, assigns each occupational code one out of 12 social classes, and defines a social class as "a set of individuals with the same life chances" (Van Leeuwen and Maas 2011, p.18). These social classes are derived in the following step-wise pro- cedure: First Van Leeuwen and Maas (2011) identified (1)"type of work" (manual vs. non-manual), (2) "skill level" (4 levels), (3) "supervisory tasks" (yes vs. no) and (4) economic sector (primary vs. other sectors) as the four relevant dimensions of social class through an intensive literature review of existing historical class/status schemes. Second they used the American Dictionary of Occupational Titles (DOT) to grade the 1675 HISCO occupations along these dimensions. Third if there is additional informa- tion over and above the simple occupation name (e.g. baker) in the "Status" variable mentioned before (e.g. master, apprentice, helper, etc.) this is taken into account by promoting or demoting individuals into a higher/lower social class respectively. Since the DOT was constructed for modern-day occupations these grades were adjusted with help of expert historians which was only necessary in a few cases and finally led to 12 distinct social classes. In our empirical analysis we rely on the previous literature and use a compressed 7-class version of HISCLASS (see Abramitzky et al. (2011) and Schumacher and Lorenzetti (2005) and references therein). This simplifies the interpre- tation of regression coefficients, attenuates possible coding errors and increases sample size within classes. Table A.1 in the appendix shows the original and compressed HIS- CLASS versions along with the underlying dimensions of social class and the number of observations in each class.
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Essays on the economics of human capital and health

Essays on the economics of human capital and health

add new dimensions to existing knowledge, but at the same time aim to explain results from previous literature, mostly concerned with educational and labour market outcomes. The chapter analyses school and work aspirations at the end of compulsory schooling age, which can work as channels for later educational achievement and earnings. It looks at earnings and employment, but also at non-monetary measures of adult well-being, such as adult life and job satisfac- tion, self-efficacy and crime participation. Finally, it evaluates long-term effects of school type on adult self-assessed health and biomarkers for risk of cardiovas- cular disease up to age 55, based on the idea that more and better schooling improves an individual’s health production function (Grossman, 1972). A move to a more selective system today is expected to increase average peer ability and school quality for the additional pupils admitted to grammar, while these would decrease for lower-ability pupils who do not pass selection. To account for this key difference, the second contribution of Chapter 2 is to estimate two separate average effects of selective schooling, splitting the sample of pupils along the cog- nitive ability dimension. Thus, grammar pupils are compared to comprehensive pupils who, given their ability scores, would have gone to grammar, had they experienced the selective system. Similarly, secondary modern pupils are com- pared to comprehensive pupils who are closest to them in terms of ability. In practice, similarity is achieved through entropy balancing (Hainmueller, 2012), matching individuals on their pre-treatment characteristics. The strategy relies on the validity of the conditional independence assumption, the implications of which are discussed, also in light of previous criticisms to the reference literature (Manning and Pischke, 2006). Results highlight that grammar schools positively affect academic aspirations and employment prospects for their pupils, but they also lower adult life satisfaction, compared to their mixed-ability counterparts. Secondary modern pupils, of lower cognitive ability, display higher average adult wages and, in some specifications, higher self-efficacy than their comprehensive counterparts. However, regardless of the cognitive ability level, attendance to se- lective schooling is not significantly linked to other measures of health and human capital later in life.
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Essays in Health Economics and Public Finance

Essays in Health Economics and Public Finance

The …rst speci…cation summarized in Panel A indicates that urban ‡oor counties have signi…cantly higher advertising for Medicare products. The estimate of $6.35 is sub- stantial, as it slightly exceeds the mean of our dependent variable, though its precision is limited with a standard error of $2.23. This is not surprising given that we have just 210 DMAs and the dependent variable is highly skewed. The corresponding estimate in Panel B, which uses the broader health insurance measure as the dependent variable, is also large in magnitude and statistically signi…cant. Both estimates are robust to the inclusion of ad prices (speci…cation 2) and per-capita FFS expenditures (speci…cation 3) in the DMA-year. One concern with this …rst set of estimates is that urban ‡oor counties may attract more advertising for reasons unrelated to MA reimbursement generosity. To address this concern, in the fourth speci…cation we add a control for per-capita credit card advertising in the DMA-year. This variable should not be a¤ected by the generosity of MA reimbursement though should control for unobserved factors that in‡uence the intensity of advertising in an area. While this variable is signi…cantly positively related with both of our dependent variables, it has little impact on our coe¢ cient estimates of interest.
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Essays in the Economics of Health, Risk, and Behavior

Essays in the Economics of Health, Risk, and Behavior

of the key variation in the data related to the HSA program. I restrict the sample to those who are (i) enrolled in one of the company’s health insurance plans, (ii) did not switch the number of covered dependents during the year on their insurance plan, (iii) had coverage the entire year when insured, (iv) participated in the HSA program after 2008 and did not have an HSA prior to 2008, (v) actively enrolled in the 401(k), and (vi) were younger than age 59. Restrictions (i) - (iii) are simply to isolate those whose insurance status is not fragmented (16,636 employees). I exclude employees who opened an HSA prior to 2008 because although the law tying the maximum contribution to the lesser of the deductible or the statutory limit was repealed in December 2006, some employees with an HSA may not have been aware of this rule change. The contribution decisions of employees who did not open an HSA prior to 2008 are less likely to be biased by the old rules governing plan contributions. I exclude the 20 percent of remaining employees who passively default into saving 4 percent in their 401(k) because my economic model of HSA saving views 401(k) saving as a reflection of inter-temporal preferences and retirement saving objectives. This approach requires employees make an active decision of how much to save in their 401(k), rather than be auto-enrolled in the 401(k). I finally exclude the small number of remaining employees aged 59 years and older because 401(k) assets can be withdrawn penalty free for any reason starting at age 59 1
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Essays on the economics of energy efficiency policies

Essays on the economics of energy efficiency policies

Chapter 3 provides an empirical analysis based on the empirical predictions of the model presented in Chapter 1. The objective of the analysis is to test for the presence of adverse selection in the adoption of energy efficiency improvements among households under government provided incentive schemes. Following the insights of the model in Chapter 1, when heterogeneity is driven by misperceptions selection into adoption is adverse. In particular, early adopters exhibit lower levels of pre-adoption energy consumption and experience lower consumption drops upon adoption. On the contrary, if heterogeneity is driven by preferences, the opposite correlations are expected. To test which of the two sources of heterogeneity dominates I perform the following empirical analysis. First, I look at the levels of energy consumption prior to adoption and compare them across technology adoption year cohorts. Second, I look at the energy consumption drop upon adoption over time to see if those who adopt earlier experience lower energy consumption drops upon adoption. In both tests, I find evidence supporting that heterogeneity in preferences (in true energy-efficiency) might be the force driving selection into adoption. However, this evidence does not rule out that misperceptions play a role in the technology diffusion mechanism. Furthermore, I use policy variation from the Boiler Scrappage Scheme to analyse the role of incentives in the selection into adoption mechanism. My findings are that households adopting the technology under the incentive scheme exhibit lower pre- adoption levels of energy consumption and experience higher energy consumption drops between two years before and the year after technology adoption.
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Essays in Health Care and Public Economics

Essays in Health Care and Public Economics

The literature on ED utilization patterns suggests that different groups of patients use emergency departments for different reasons, what would influence the way they value access to CHCs. The uninsured often lack a regular source of care, and are thus expected to take advantage of CHC services when these become more accessible. Medicaid patients are also often medically marginalized because physicians may be reluctant to accept them due to financial and administrative burdens of the Medicaid program (Cunningham and May, 2006). Nonetheless, this group tends to have better access to health care than people without insurance, and my estimates suggest that the impact of CHCs on this category of ED users is indeed less significant. This may be so because, first, the majority of Medicaid patients are women; 37 and women are more likely to visit family planning clinics such as Planned Parenthood affiliates, where they can get primary care services as part of reproductive health care (Frost et al., 2012). Second, Medicaid patients with medical homes have little incentive to switch providers because they can essentially obtain health care services for free irrespective of the source of care. Thus, it is likely that, on average, Medicaid patients value CHC access less than patients without insurance. I also find no impact of CHCs on patients with private insurance, who are more likely to use office- based physicians for primary care than patients without insurance.
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Three Essays on the Economics of Health Reform.

Three Essays on the Economics of Health Reform.

One major advantage of the PSID is that I can identify households that contain an individual with a pre-existing health condition that would result in denial of non-group health insurance in denial states. Because the definition of a pre-existing condition is insurer specific, several definitions have been offered in the literature and are outlined in a report by the Government Accountability Office Government Accountability Office (2012a). I construct two measures based on these definitions and work by Zellers, McLaughlin, and Frick (1992), who survey insurance companies to identify conditions that result in denial. The first is a narrow definition of pre-existing conditions set to one if the head answers yes to the question “Has a doctor ever told you that you/[your wife] have or had one of the following conditions,” which include heart disease, cancer, heart attack, or stroke. I also construct a broader measure of pre- existing conditions using the same question but expanding the conditions to include high blood pressure, diabetes, lung disease, emotional problems, memory loss, and obesity. By the narrow measure, 12 percent of households contain a person with a pre-existing condition and by the broad measure, 27 percent of households contain a person with pre-existing condition. For comparison, the Government Accountability Office estimates that the fraction of the adult population with a pre-existing condition is between 20 and 66 percent (Government Accountability Office 2012a).
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Essays on Industrial Organization and Health Care Economics

Essays on Industrial Organization and Health Care Economics

There are large number of people who contributed to this dissertation and I owe a huge debt of gratitude to all of them. First and foremost, I am very grateful to my ad- visor Kate Ho for motivating me to work on the industrial organization of healthcare, as well as providing invaluable guidance and advice. I benefited greatly from being her student, research assistant, teaching assistant, and advisee. I also benefited greatly from in depth discussions and feedback from Mike Riordan, Chris Conlon, Tobias Salz, Adam Kapor, Doug Almond, Bernard Salanié, Bentley Macleod, Fanyin Zheng, Matt Backus, and Tal Gross. I am positive that this dissertation would not exist without these indi- viduals. I also greatly benefited from the broader Columbia community. In particular, I relish my discussions with Ilton Sores, Paul Piveteau, Evan Riehl, Ildikó Magyari, Joe Hogan, Jessica Van Parys, and Nicolás de Roux, among others. I especially appreciate Chris Hansman being there when I wanted to bounce ideas around, and for shooting down bad ones. I also am thankful for the support of Shane Bordeau and Amy Devine. Outside of Columbia, I thank Mary Fields, Tyler Brannen, Maureen Mustard, and the New Hampshire Department of Health and Human Services for providing data and in- sight into the New Hampshire HealthCost website. I also benefited from over a decade of economics discussions with Melanie Wasserman. This dissertation was also supported by the National Science Foundation.
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Essays on microeconomics

Essays on microeconomics

If periods of unexpected power rationing entail baby booms, there may also be large hid- den social costs. Women may not continue their studies because of unexpected pregnan- cies. In turn, unexpected babies may experience worse health and educational outcomes than the expected ones. Fertility shocks have implications for investment in human cap- ital and asset accumulation in general, affecting the labor market outcomes and the life path of parents and their children. In short, extensive periods of power rationing may entail changes in fertility behavior and these changes may lead to large social costs. In order to test these hypotheses, we carry out three empirical exercises, all based on an episode of power rationing in Colombia that lasted from February 1992 to March 1993. In the first one, we provide evidence that there is a causal effect of power outages on short-run fertility. In order to identify this effect, we construct two novel datasets. First, we use the IPUMS micro-sample for the 2005 population census of Colombia to construct a retrospective mother-level birth history by linking mothers to children within the household. Next, we combine this dataset with municipality level variation in night lights as measured by satellite images for the period 1992/1993 and construct a variable of treatment intensity for the power crisis. By using the retrospective mother data and the intensity of the blackout on the municipalities where they live, we estimate that a full blackout leads to an increase of 0.005 percentage points in the probability of having a child the year after. When evaluated at the mean probability of having a child in any given year, this results in an increase in probability of having a birth by 5 percent. Using the mean intensity of the power outage across Colombia, we are able to calculate a back-of-the-envelope estimate of approximately 10,000 additional births in 1993 due to the blackout.
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Essays on empirical asset pricing

Essays on empirical asset pricing

Microsoft Word ThesisTotal20160728 docx 1 The London School of Economics and Political Science Essays on Empirical Asset Pricing Huaizhi Chen A thesis submitted to the Department of Finance of the Lon[.]

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Essays on the economics of migration and labour: Empirical evidence from the UK

Essays on the economics of migration and labour: Empirical evidence from the UK

Using data from the rst wave of the Understanding Society Survey (2009-2010), this paper provides rst empirical evidence on the life satisfaction assimilation of immigrants in the UK. The life satisfaction of immigrants across dierent generations is compared against that of their native peers. First results conrm that life satisfaction appears U-shaped in the immigrant generation. A number of socio-demographic individual and neighbourhood-level characteristics help explain the life satisfaction gaps. When ethnic characteristics are taken into account, the association between rst and second immigrant generations and life satisfaction halves. Conditioning on home-ownership, rst generation immigrants with less than 10 years since migration seem not to dier with respect to natives. When conditioning on neighbourhood deprivation, on the one hand, being a second generation immigrant does not aect the probability of being at least somewhat satised or higher. On the other hand, it signicantly aects the probability for second generation immigrants of being mostly satised or higher, but not so for those living outside the London area. The life satisfaction gap suered by generation 2.5 remains an unsolved puzzle 1 .
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Empirical essays on the interaction between housing and labour markets

Empirical essays on the interaction between housing and labour markets

This chapter explores whether the length of commuting time can affect a worker’s effort in the workplace. For most workers, commuting is an unavoidable daily activity to connect housing and labour markets and accounts for a relatively large proportion of working hours. The RAC foundation (2007) reports that the average commuting time per day is 54 minutes in the UK which would be equivalent to one-eighth of the working hours of full-time workers. It is much higher in large cities such as London where workers spend 84 minutes every working day. Unfortunately, workers’ feelings about this important daily activity are generally negative. Rouwendal and Meijer (2001) argue that workers dislike commuting as the value they put on commuting time is even higher than their wage rates. Transportation studies as well as psychological literature also demonstrate the negative effect of commuting on both the physical and mental health of commuters (Koslowskyet et al., 1995; Evans and Wener, 2006; Hoehner et al., 2012). Considering the negative effects of commuting on workers, it is natural to link commuting time with worker effort. Commuting may not only cause commuters to feel exhausted but also impose mental stress from aggravating events such as traffic jams, road accidents, etc. Indeed, it has been reported that the degree of commuting stress negatively impacts on the level of job strain (Wener et al., 2006).
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Essays on health economics and risk preferences

Essays on health economics and risk preferences

I find that hospital size and total inpatient days decreased by almost a 20 percent, hospitals substitute towards more Medicare patients, and many converting hospitals clos[r]

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Essays in labor and public economics

Essays in labor and public economics

approaches use consumption responses to unemployment or job loss (combined with measures of the coefficient of relative risk aversion) to infer the value of unemployment insurance (Baily, 1978; Gruber, 1997; Chetty, 2006a). The main limitation of consumption- implementation approaches is their reliance on consumption data, for which availability is limited and often partial, and where there are issues of mis-measurement and difficul- ties with assignment to individuals within a household. From a theoretical standpoint, the approach also relies on the potentially strong assumptions of state-independent pref- erences and no anticipation effects. Partly in response to these limitations, recent work has developed revealed-preference, optimization-based approaches that exploit behav- ioral responses to estimate the welfare gains from social insurance. While most work has been done in the context of unemployment insurance (Shimer and Werning, 2008; Chetty, 2008; Landais, 2015; Hendren, 2017), similar approaches have been developed for social insurance against fatal and non-fatal health shocks (Fadlon and Nielsen, 2018; Dobkin et al., 2018). 11 I contribute to this literature by providing a simple revealed-preference method based on within-state participation responses to benefit losses that allows for state dependence and is applicable to a broad class of public policies involving income transfers. Moreover, because it requires labor supply rather than consumption data, the revealed-preference approach that I propose has the advantage of being widely applica- ble given the increasingly large availability of detailed data on individual labor supply from administrative and other sources.
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Essays in health economics

Essays in health economics

Two recent studies have explored the pharmaceutical utilization implications of the ACA Medicaid expansions in particular. Mulcahy et al. (2016) used prescription transaction data to longitudinally follow a sample of non-elderly adults who reported any prescription drug use during January 2012. They find that adults who gained Medicaid in 2014 increased their prescription drug use by 79 percent. However, their sample was limited to those already using medications, nearly two-thirds of whom reported chronic health conditions such as diabetes, asthma and breast cancer. Thus, their study population had a much higher prevalence of chronic disease than the overall population, such as adults newly eligible for coverage through the ACA Medicaid expansions (Decker et al., 2014). More importantly, their sampling design did not allow them to consider the effects on those who did not use prescription medications prior to the expansions. The second study, by Wen and colleagues (2016), examines aggregate Medicaid medication use as reported in the CMS State Drug Utilization Database (SDUD) through 2014. They find a significant increase in the number of prescriptions per enrollee following expansion, but no significant change in total spending. Notably, none of these aforementioned studies examine heterogeneity in effects by therapeutic class, state cost-sharing requirements, across payer types other than Medicaid or by sub-state geography.
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Essays In Health Economics

Essays In Health Economics

Recent studies that examine the effect of wealth on healthcare spending include Okunade, Suraratdecha, and Benson (2010), Kim and Ruhm (2012), and Lusardi, Schnei- der, and Tufano (2015). Okunade, Suraratdecha, and Benson (2010), using the Thailand Socio-Economic Surveys, measure wealth as household ownership of durable goods (e.g., air conditioner, motorbike, car, television etc) and find that there is a significant positive relationship between wealth and out-of-pocket (OOP) spending. Kim and Ruhm (2012) use an elderly sample from Health and Retirement Survey and document that wealth shocks associated with inheritances of greater than or equal to $10,000 have positive and significant impact on expected OOP spending, conditional on positive OOP spending. Using data on individuals between ages of 18 and 65 from the TNS Global Economic Crisis Survey (2009), Lusardi, Schneider, and Tufano (2015) find that economic shocks generated by the economic crisis resulted in relatively large reduction in the use of rou- tine non-emergency medical care for United States households than those for Canadian, French, German, and British households. These studies, however, do not differentiate between the effects of housing and financial wealth on healthcare spending, though the literature in macroeconomics and finance suggests that they may exist.
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Empirical essays in the economics of neighbourhoods and education

Empirical essays in the economics of neighbourhoods and education

Economics is a social science, and all of the processes we study are the product of social interactions at various levels of abstraction (Manski (2000)). Markets work by social interaction, whether this is at the level of the street market trader, or the brokers of financial derivatives. But the kind o f social interactions we should have in mind here are the interactions that generate spillovers, or externalities in the economic sense. These interactions between individuals crystallise as intangible commodities that are not bought and sold explicitly in conventional markets. These commodities are not readily visible and are hard to quantity. But a defining characteristic is that they are, to some extent, geographically localised. This is corollary of their basis in social interactions, which are fundamentally spatial in character. For sure, in this age o f high speed telecommunications, the net o f social interactions is spread wider. Any yet there are deep issues around the codifiability o f knowledge and experience that mean that much o f what we share with others is shared within geographically localised spaces (see Leamer and Storper (2001) for discussion in relation to production technologies). It is on this basis that we look for evidence of social interactions and their value to individuals and society through neighbourhood effects.
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Empirical essays on the economics of education and pay

Empirical essays on the economics of education and pay

Not all health habits can be used as an instrument for two reasons. Firstly, some health habits have consumption as well as investment value. Going to the gym or playing squash for example, have consumption value and are likely to be correlated with family income/background and possibly correlated with the unobserved component of earnings. Secondly, some health habits such as heavy drinking or drug abuse would be unsuitable as they are likely to have an effect on current wage through their effect on productivity. I follow Evans and Montgomery in arguing that smoking as a teenager is a health habit that can be used as a valid instrument for education. The decision that an individual makes at age 16 as to whether to continue in education or not is likely to be significantly affected by his/her discount rate – whether that is because of access to financial resources or because of the individual’s rate of time preference. In the UK this is the first point at which individuals can choose to leave education, moreover it remains the case that staying in school post-16 and taking A-levels is still the major route into university, therefore the decision to remain at school at 16 is likely to be affected by the individual’s discount rate. Moreover, whether an individual chooses to smoke at 16 is also likely to be determined in large part by their rate of time preference. Whether I look at the largest sample of working age men available in the BHPS or my estimation sample it is the case that of the individuals who have ever smoked, approximately 61% were smoking when age 16, and approximately 80% were smoking when age 18 6 . Therefore it is clear that the majority of individuals who ever
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