Research
Working Papers
Get Fit with MA? Estimating the Impact of Medicare Advantage on Physical Activity Paper
(with Li J.)
Medicare Advantage plans increasingly offer fitness benefits, yet the evidence on their behavioral effects remains limited. This paper studies whether Medicare Advantage enrollment increases physical activity among older adults using a regression discontinuity in difference-in-difference design centered on the age-65 Medicare eligibility threshold. Using nationally representative survey data on workout behavior with insurance coverage information, we find that the discontinuity in the probability of daily exercise at age 65 is significantly larger for MA enrollees than for non-MA beneficiaries. Estimates for ages below 65 show no evidence of differential pre-trends, while the post-65 pattern indicates that the effect is concentrated in the short run. The response is larger among women, non-White, and individuals without a college degree. Robustness checks, including placebo tests and a donut-hole analysis yield consistent results. These findings suggest that insurance design can affect preventive behaviors and highlight supplemental benefits as a potentially important policy margin for promoting healthy aging.
Move to Move? Neighborhood Fitness Culture and Exercise Among Older Adults
Regular physical activity is an important determinant of healthy aging, yet exercise participation varies substantially across neighborhoods in the United States. A central challenge in interpreting these differences is separating true neighborhood effects from residential sorting. This paper examines whether neighborhood fitness culture shapes exercise behavior among older adults using nationally representative longitudinal data from the Health and Retirement Study from 2004 to 2022. The analysis focuses on residential movers and uses variation in neighborhood exercise culture across origin and destination ZIP codes to identify place-based influences on physical activity. I measure neighborhood fitness culture using local exercise prevalence and construct a place-based treatment that captures how much more or less active the destination neighborhood is relative to the origin.
The empirical strategy uses movers only and decomposes origin and destination locations into separate place components, allowing me to estimate whether moves to systematically more active places are associated with higher post-move exercise participation. I find that older adults who relocate to neighborhoods with stronger fitness culture become more likely to exercise after the move. The estimated place shock is positive and statistically significant, indicating that differences across destination and origin neighborhoods meaningfully predict changes in exercise behavior. Additional analyses suggest that these patterns are especially pronounced among individuals who were previously inactive and among older adults in later life stages, consistent with the idea that neighborhood environments can play an important role in shaping preventive health behavior even at older ages. Overall, the findings suggest that local fitness culture is an important determinant of exercise behavior among older adults. More broadly, the results highlight the role of residential environments in generating spatial disparities in healthy aging and suggest that policies that strengthen neighborhood-level opportunities and norms for physical activity may increase exercise participation and reduce inequalities in healthy aging. </small>
Where Seniors Sweat: Geographic Variation in SilverSneakers Uptake
(with Rovniak L.)
Abstract forthcoming.
Cross-national Analysis of the Determinants of Dementia Prevalence: Evidence from the United States and Caribbean Countries
(with Li J. & Dow W.)
Abstract forthcoming.
Predictors of Discontinued Participation in a Fruit and Vegetable Voucher Program: The Role of Community Organizations in Engaging Non-English Speakers
(with Chaparro, P., Wallace, J., Baquero, B., Jones-Smith, J., & Knox, M.)
Healthy food voucher programs (HFVPs) are an important fiscal tool for addressing inequities in healthy food consumption. Fresh Bucks, a HFVP in Seattle, Washington, USA, provides US$40/month for fruit and vegetable (FV) purchases to low-income households, encouraging long-term participation and utilizing a community-supported enrollment model to engage non-English speaking households. Previous research demonstrated that Fresh Bucks participation reduced food insecurity and increased FV consumption; yet 46% of participating households chose to discontinue participation when requested to re-apply ~2 years post initial enrollment. We sought to identify factors that predict discontinuation of Fresh Bucks participation, particularly among non-English speakers
Do Unionized Firms Have Better Management Practice? Paper
(with Basu A)
Using restricted data from the World Management Survey (WMS), we examine the relationship between labor unions and management practices across private manufacturing firms in Latin America, North America, and Europe. While prior research shows that management quality is strongly correlated with firm performance, the role of unions in shaping managerial practices remains unclear. We find that unionized firms are significantly better managed overall. However, this aggregate relationship masks substantial heterogeneity across different management domains. Firms with higher union rate score lower on People Management practices, reflecting constraints on hiring, promotion, and dismissal, but score markedly higher on Operations, Monitoring, and Target-setting practices. These patterns suggest that unions are associated with the adoption of more structured performance systems while limiting managerial discretion in personnel management