The release of Enovid in 1960, the first birth control pill, afforded U. S. women unprecedented freedom to plan childbearing and their careers. This paper uses plausibly exogenous variation in state consent laws to evaluate the causal impact of the pill on the timing of first births and extent and intensity of women's labor-force participation. The results suggest that legal access to the pill before age 21 significantly reduced the likelihood of a first birth before age 22, increased the number of women in the paid labor force, and raised the number of annual hours worked.

BACKGROUND Late afternoon hospital discharges are thought to contribute to admission bottlenecks, overcrowding, and increased length of stay (LOS). In January 2012, the discharge before noon (DBN) percentage on 2 medical units was 7%, below the organizational goal of 30%. OBJECTIVE To sustainably achieve a DBN rate of 30% and to evaluate the effect of this intervention on observed‐to‐expected (O/E) LOS and 30‐day readmission rate. DESIGN Pre‐/post‐intervention retrospective analysis. SETTING Two acute care inpatient medical units in an urban, academic medical center. PATIENTS All inpatients discharged from the units. INTERVENTION All staff helped create a checklist of daily responsibilities at a DBN kickoff event. We initiated afternoon interdisciplinary rounds to identify next‐day DBNs and created a website for enhanced communication. We provided daily feedback on the DBN percentage, rewards for success, and real‐time opportunities for case review. MEASUREMENTS Calendar month DBN percentage, O/E LOS, and 30‐day readmission rate. RESULTS The DBN percentage increased from 11% in the 8‐month baseline period to an average of 38% over the 13‐month intervention (P = 0.0002). The average discharge time moved 1 hour and 31 minutes earlier in the day. The O/E LOS declined from 1.06 to 0.96 (P = 0.0001), and the 30‐day readmission rate declined from 14.3% to 13.1% (P = 0.1902). CONCLUSIONS Our study demonstrates that increased DBN is an achievable and sustainable goal for hospitals. Future work will allow for better understanding of the full effects of such an intervention on patient outcomes and hospital metrics. Journal of Hospital Medicine 2014;9:210–214. © 2014 Society of Hospital Medicine

This paper uses the rollout of the first Community Health Centers (CHCs) to estimate the longterm health effects of increasing access to primary care. The results show that CHCs reduced age-adjusted mortality rates among those 50 and older by almost 2 percent within 10 years. The implied 6-to 8-percent decrease in one-year mortality risk among the treated amounts to 18 to 24 percent of the 1966 poor-nonpoor mortality gap for this age group. Large effects for those 65 and older suggest that increased access to primary care has long-term benefits, even for populations with near universal health insurance.

Increasing the DBN rate correlates with admissions arriving earlier in the day and reductions in high-frequency peaks of ED admissions. Statistically significant improvements in DBN rates are sustainable.

This paper assembles new evidence on some of the longer-term consequences of U.S. family planning policies, defined in this paper as those increasing legal or financial access to modern contraceptives. The analysis leverages two large policy changes that occurred during the 1960s and 1970s: first, the interaction of the birth control pill's introduction with Comstock-era restrictions on the sale of contraceptives and the repeal of these laws after Griswold v. Connecticut in 1965; and second, the expansion of federal funding for local family planning programs from 1964 to 1973. Building on previous research that demonstrates both policies' effects on fertility rates, I find suggestive evidence that individuals' access to contraceptives increased their children's college completion, labor force participation, wages, and family incomes decades later.Family planning policies, defined in this paper as those increasing legal or financial access to modern contraceptives and related education and medical services, have grown increasingly controversial over the last decade. 1 In 2010 and 2011, congressional Republicans supported proposals to cut family planning funding through Title X of the Public Health Service Act, which funds U.S. family planning clinics serving over 4 million women (Cohen 2011). This represents a significant departure from the bipartisan support enjoyed by these programs over the last 40 years. The first legislation authorizing a national family planning program passed in 1970 with the strong support of Republican President Richard Nixon. In fact, public opinion surveys indicate that support for family planning programs was stronger at that time among Republicans than among Democrats. 2 Much of the current debate surrounding family planning focuses on women's reproductive rights and health. In the 1960s, however, proponents of these programs often emphasized their links to the economy. Both President Lyndon Johnson and President Nixon stressed how family planning programs would promote the opportunities of children and families and thus drive economic growth. This reasoning is consistent with a long theoretical tradition in economics, including standard formulations of the quantity-quality models of investments in children (Becker and Lewis 1973, Willis 1973, Hotz, Klerman, and Willis 1997 Contact Information: Department of Economics, University of Michigan, 611 Tappan Street, Ann Arbor, Michigan 48109; baileymj@umich.edu. 1 In this paper I do not consider the effects of policies regarding abortion. I refer the interested reader to the large literature in economics on this topic. See, for instance, Levine and others (1999), Gruber, Levine, and Staiger (1999), Donahue and Levitt (2001), Charles and Stephens (2006), Foote and Goetz (2008), and Ananat and others (2009). 2 Today the situation is reversed, with Democrats slightly more favorable. NIH Public Access Author ManuscriptBrookings Pap Econ Act. Author manuscript; available in PMC 2014 October 20. Published in final edited form as:Bro...

Physician health and wellness is a critical issue gaining national attention because of the high prevalence of physician burnout. Pediatricians and pediatric trainees experience burnout at levels equivalent to other medical specialties, highlighting a need for more effective efforts to promote health and well-being in the pediatric community. This report will provide an overview of physician burnout, an update on work in the field of preventive physician health and wellness, and a discussion of emerging initiatives that have potential to promote health at all levels of pediatric training.Pediatricians are uniquely positioned to lead this movement nationally, in part because of the emphasis placed on wellness in the Pediatric Milestone Project, a joint collaboration between the Accreditation Council for Graduate Medical Education and the American Board of Pediatrics. Updated core competencies calling for a balanced approach to health, including focus on nutrition, exercise, mindfulness, and effective stress management, signal a paradigm shift and send the message that it is time for pediatricians to cultivate a culture of wellness better aligned with their responsibilities as role models and congruent with advances in pediatric training.Rather than reviewing programs in place to address substance abuse and other serious conditions in distressed physicians, this article focuses on forward progress in the field, with an emphasis on the need for prevention and anticipation of predictable stressors related to burnout in medical training and practice. Examples of positive progress and several programs designed to promote physician health and wellness are reviewed. Areas where more research is needed are highlighted. Pediatrics 2014;134:830-835 INTRODUCTIONPhysician health and wellness is an issue garnering national interest because of the high prevalence of burnout in medical practitioners and trainees. Burnout takes a steep toll on physicians and has negative effects on patients and health care systems. 1 Research advances detailing the detrimental effects of chronic stress, including impaired immune function, inflammation, elevation of cardiovascular risk factors, and depression, 2-9 are directly relevant to pediatric practitioners and create a need for organized efforts to address physician health and well-being in the pediatric community. The purpose of this report is to provide an update on the issue of physician health and wellness with regard to how they relate to pediatricians. Rather than reviewing programs already in place to address substance abuse and other serious conditions in distressed physicians, this report focuses on forward progress in the field, with an emphasis on the need for prevention and anticipation of predictable stressors related to burnout in medical training and practice. Although specific recommendations are beyond the parameters of this report, examples of positive progress and national programs to promote physician health and wellness will be reviewed. BURNOUT: THE ANTITHESIS ...

The 1960s ushered in a new era in U.S. demographic history characterized by significantly lower fertility rates and smaller family sizes. What catalyzed these changes remains a matter of considerable debate. This paper exploits idiosyncratic variation in the language of "Comstock" statutes, enacted in the late 1800s, to quantify the role of the birth control pill in this transition. Almost fifty years after the contraceptive pill appeared on the U.S. market, this analysis provides new evidence that it accelerated the post-1960 decline in marital fertility.

for their many contributions to the LIFE-M project. NBER working papers are circulated for discussion and comment purposes. They have not been peer-reviewed or been subject to the review by the NBER Board of Directors that accompanies official NBER publications.