title: Care-giver advice as a preventive measure for drinking during pregnancy: zeros, categorical outcome responses, and endogeneity.
abstract: We conduct an empirical investigation of the impact of prenatal care-giver advice on alcohol consumption by pregnant women. In the design of the model and estimator, we pay particular attention to three aspects of the data. First, a large proportion of pregnant women do not drink at all. To accommodate this aspect of the sample we base the essential formulation of the model on the modified version of the two-part approach of Duan et al. (Journal of Business and Economic Statistics 1983; 1: 115-126.) suggested by Mullahy (Journal of Health Economics 1998; 17: 247-281.). Second, in the survey that we analyze (the 1988 National Maternal and Infant Health Survey - NMIHS), respondents were only required to report their consumption up to a specified range of values (e.g. 1-2 drinks per week, 2-5 drinks per week, and so on). For this reason, the model is cast in the grouped regression framework of Stewart (Review of Economic Studies 1983; 50: 141-149.). Third, the binary physician advice variable is likely to be endogenous and the econometric specification explicitly accounts for this possibility. To summarize the results, we find that failing to account for endogeneity leads to the counterintuitive conclusion that advice has a positive and statistically significant influence on drinking during pregnancy. When the model is extended to allow for potential endogeneity, we find that advice has a negative and statistically significant impact.
authors.affiliation: Department of Epidemiology and Health Policy Research, University of Florida, Gainesville, FL 32610-0147, USA. jvt@ichp.ufl.edu
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Terza
authors.forename: Donald S
authors.initials: DS
authors.lastname: Kenkel
authors.forename: Tsui-Fang
authors.initials: TF
authors.lastname: Lin
authors.forename: Shinichi
authors.initials: S
authors.lastname: Sakata
mesh_terms: D000428:Alcohol Drinking / Q000523:psychology*; D017028:Caregivers; D005260:Female; D006801:Humans; D015233:Models, Statistical; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011247:Pregnancy; D037841:Pregnant People; D012959:Socioeconomic Factors