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Direct and Spillover Effects of Middle School Vaccination Requirements

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  • Christopher S. Carpenter
  • Emily C. Lawler

Abstract

We study the direct and spillover effects of state requirements that middle school youths obtain a tetanus, diphtheria, and pertussis (Tdap) booster prior to middle school entry. These mandates significantly increased Tdap vaccine take-up and reduced pertussis (whooping cough) incidence by about 32 percent. We also document cross-vaccine spillovers: the mandates significantly increased adolescent vaccination rates for meningococcal disease and human papillomavirus (HPV)—which is responsible for 98 percent of cervical cancers—by 8–34 percent, with particularly large effects for children from low SES households. We find important roles for both parents and providers in generating these spillovers.

Suggested Citation

  • Christopher S. Carpenter & Emily C. Lawler, 2019. "Direct and Spillover Effects of Middle School Vaccination Requirements," American Economic Journal: Economic Policy, American Economic Association, vol. 11(1), pages 95-125, February.
    • Handle: RePEc:aea:aejpol:v:11:y:2019:i:1:p:95-125
    Note: DOI: 10.1257/pol.20170067
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    Citations

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    Cited by:

    1. Seth M. Freedman & Daniel W. Sacks & Kosali I. Simon & Coady Wing, 2022. "Direct and indirect effects of vaccines: Evidence from COVID-19," NBER Working Papers 30550, National Bureau of Economic Research, Inc.
    2. Alexander Karaivanov & Dongwoo Kim & Shih En Lu & Hitoshi Shigeoka, 2022. "COVID-19 vaccination mandates and vaccine uptake," Nature Human Behaviour, Nature, vol. 6(12), pages 1615-1624, December.
    3. Corey White, 2021. "Measuring Social and Externality Benefits of Influenza Vaccination," Journal of Human Resources, University of Wisconsin Press, vol. 56(3), pages 749-785.
    4. Hoffmann, Manuel & Mosquera, Roberto & Chadi, Adrian, 2019. "Vaccines at Work," VfS Annual Conference 2019 (Leipzig): 30 Years after the Fall of the Berlin Wall - Democracy and Market Economy 203661, Verein für Socialpolitik / German Economic Association.
    5. Fu, Minghui & Liu, Chuanjiang & Yang, Mian, 2020. "Effects of public health policies on the health status and medical service utilization of Chinese internal migrants," China Economic Review, Elsevier, vol. 62(C).
    6. Julie Metta, 2020. "Promoting discount schemes as a nudge strategy to enhance environmental behaviour," Working Papers 2020.11, FAERE - French Association of Environmental and Resource Economists.
    7. Matilde Giaccherini & Joanna Kopinska & Gabriele Rovigatti, 2022. "Vax Populi: The Social Costs of Online Vaccine Skepticism," CESifo Working Paper Series 10184, CESifo.
    8. John Brownstein & Jonathan H. Cantor & Benjamin Rader & Kosali I. Simon & Christopher M. Whaley, 2022. "If You Build it, Will They Vaccinate? The Impact of COVID-19 Vaccine Sites on Vaccination Rates and Outcomes," NBER Working Papers 30429, National Bureau of Economic Research, Inc.
    9. Sansone, Dario, 2019. "Pink work: Same-sex marriage, employment and discrimination," Journal of Public Economics, Elsevier, vol. 180(C).
    10. Shooshan Danagoulian & Daniel Grossman & David Slusky, 2022. "Health Care Following Environmental Disasters: Evidence from Flint," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 41(4), pages 1060-1089, September.
    11. Bouckaert, Nicolas & Gielen, Anne C. & Van Ourti, Tom, 2020. "It runs in the family – Influenza vaccination and spillover effects," Journal of Health Economics, Elsevier, vol. 74(C).
    12. Brilli, Ylenia & Lucifora, Claudio & Russo, Antonio & Tonello, Marco, 2020. "Vaccination take-up and health: Evidence from a flu vaccination program for the elderly," Journal of Economic Behavior & Organization, Elsevier, vol. 179(C), pages 323-341.
    13. Carpenter, Christopher S. & Churchill, Brandyn F. & Marcus, Michelle, 2023. "Bad lighting: Effects of youth indoor tanning prohibitions," Journal of Health Economics, Elsevier, vol. 88(C).
    14. Hair, Nicole L. & Gruber, Anja & Urban, Carly, 2020. "Personal Belief Exemptions for School-Entry Vaccinations, Vaccination Rates, and Academic Achievement," IZA Discussion Papers 12978, Institute of Labor Economics (IZA).
    15. Stefan Pichler & Katherine Wen & Nicolas R. Ziebarth, 2021. "Positive Health Externalities of Mandating Paid Sick Leave," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 40(3), pages 715-743, June.
    16. Riley K. Acton & Wenjia Cao & Emily E. Cook & Scott A. Imberman & Michael F. Lovenheim, 2022. "The Effect of Vaccine Mandates on Disease Spread: Evidence from College COVID-19 Mandates," NBER Working Papers 30303, National Bureau of Economic Research, Inc.
    17. Hair, Nicole L. & Gruber, Anja & Urban, Carly, 2021. "Personal belief exemptions for school-entry vaccinations, vaccination rates, and academic achievement," Journal of Health Economics, Elsevier, vol. 78(C).
    18. Schaller, Jessamyn & Schulkind, Lisa & Shapiro, Teny, 2019. "Disease outbreaks, healthcare utilization, and on-time immunization in the first year of life," Journal of Health Economics, Elsevier, vol. 67(C).
    19. Churchill, Brandyn F., 2021. "How important is the structure of school vaccine requirement opt-out provisions? Evidence from Washington, DC's HPV vaccine requirement," Journal of Health Economics, Elsevier, vol. 78(C).
    20. R. Aaron Hrozencik & Jordan F. Suter & Paul J. Ferraro & Nathan Hendricks, 2024. "Social comparisons and groundwater use: Evidence from Colorado and Kansas," American Journal of Agricultural Economics, John Wiley & Sons, vol. 106(2), pages 946-966, March.
    21. Humlum, Maria Knoth & Morthorst, Marius Opstrup & Thingholm, Peter Rønø, 2022. "Sibling Spillovers and the Choice to Get Vaccinated: Evidence from a Regression Discontinuity Design," IZA Discussion Papers 15109, Institute of Labor Economics (IZA).
    22. Hirani, Jonas Cuzulan & Wüst, Miriam, 2023. "Reminder Design and Childhood Vaccination Coverage," IZA Discussion Papers 15877, Institute of Labor Economics (IZA).

    More about this item

    JEL classification:

    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I21 - Health, Education, and Welfare - - Education - - - Analysis of Education
    • I28 - Health, Education, and Welfare - - Education - - - Government Policy
    • J13 - Labor and Demographic Economics - - Demographic Economics - - - Fertility; Family Planning; Child Care; Children; Youth

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