Smile Inequality: Oral Health and Labor Market Outcomes

Last registered on August 18, 2025

Pre-Trial

Trial Information

General Information

Title
Smile Inequality: Oral Health and Labor Market Outcomes
RCT ID
AEARCTR-0014977
Initial registration date
June 04, 2025

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
June 11, 2025, 6:49 AM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Last updated
August 18, 2025, 12:00 PM EDT

Last updated is the most recent time when changes to the trial's registration were published.

Locations

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Primary Investigator

Affiliation
University of Chicago

Other Primary Investigator(s)

Additional Trial Information

Status
On going
Start date
2024-06-01
End date
2026-06-30
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
This study investigates how visible oral health, a treatable but highly salient signal, interacts with entrenched caste and gender markers to shape entry-level hiring outcomes for low-income youth in urban India. Using three experiments (1) a perception survey, (2) a resume audit (correspondence study), and (3) an incentivized resume rating study with HR professionals, I explore how poor oral health influences perceived employability, actual employer callbacks, and hiring decisions. The study aims to isolate the effects of poor oral health on discrimination in employment and identify mechanisms driving such bias. Findings will inform practical interventions such as targeted dental health programs and awareness campaigns to reduce health-related stigma in hiring.
External Link(s)

Registration Citation

Citation
Hundal, Gursmeep (Rubina). 2025. "Smile Inequality: Oral Health and Labor Market Outcomes." AEA RCT Registry. August 18. https://doi.org/10.1257/rct.14977-2.1
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Experimental Details

Interventions

Intervention(s)
This study will implement three experiments: (i) a perception survey assessing public attitudes toward candidates with different visible traits, including oral health, (ii) a correspondence study analyzing callback rates based on oral health status in job applications, and (iii) an employer resume rating experiment where recruiters evaluate randomized candidate profiles and make hiring decisions.
Intervention Start Date
2024-10-10
Intervention End Date
2025-10-31

Primary Outcomes

Primary Outcomes (end points)
- Perceived employability and trait ratings in the perception survey
- Callback rate in the correspondence study
- Binary hiring decisions and Likert ratings in the employer experiment
Primary Outcomes (explanation)
- Perceived employability is the average of traits like confidence, trustworthiness, and competence ratings per headshot.
- Callback is a binary indicator: 1 if employer responds positively, 0 otherwise.
- HR ratings include binary and Likert scales on customer preference and team fit. Incentives reward accuracy compared to benchmark data from the other two studies.

Secondary Outcomes

Secondary Outcomes (end points)
- Trait-specific perception scores: attractiveness, wealth, etc.
- Heterogeneity by gender, caste, job type, marital status.
- HR justifications for hiring decisions (qualitatively coded)
Secondary Outcomes (explanation)
- Trait ratings averaged across raters; analyzed separately by condition
- Heterogeneity tested via interactions of visual traits with applicant background attributes
- HR justifications coded into themes like professionalism or oral stigma

Experimental Design

Experimental Design
Three randomized experiments examine oral health bias:
(i) Headshot features are randomized between respondents in a perception survey.
(ii) Job applications vary only by the headshot shown; callbacks are tracked.
(iii) Hiring managers are shown randomized resumes and incentivized to rate them.
Experimental Design Details
Not available
Randomization Method
Computer-generated randomization
Randomization Unit
- Perception survey: photo (individual headshot)
- Correspondence study: applicant (resume)
- Employer experiment: profile (resume)
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
na
Sample size: planned number of observations
- Perception: ~400-500 participants * 6 headshots = 2,400 to 3,000 ratings - Correspondence: ~5,000 applications - HR Resume Rating: ~300-400 HR professionals * 12 profiles = 3,600 to 4,800 evaluations
Sample size (or number of clusters) by treatment arms
- Perception: balanced across 6 visual features
- Correspondence: 2,500 control (good oral health), 2,500 treatment (poor oral health), cross-randomized with gender and caste
- HR Experiment: balanced combinations across oral health, qualifications, marital status, gender, caste
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Accounting for the study design (between-subject, no clustering), I calculate Minimum Detectable Effect Sizes (MDEs) at 80% power and a 5% significance level for each main outcome: - Perception Study (Likert outcomes, scale 1–10): Assuming a standard deviation of 2 points (based on pilot data) and a sample of 400–500 respondents rating six headshots each (totaling ~2,400–3,000 ratings), the study is powered at 80% with a 5% significance level to detect a minimum difference of 0.25–0.30 points on a 10-point scale. This would capture moderate shifts in perceived traits like trustworthiness or employability due to oral health appearance. - Correspondence Study (binary outcome – callback): Assuming a baseline callback rate of 10% and 5,000 applications equally split across control and treatment arms, the study is powered at 80% with a 5% significance level to detect a minimum decrease of 1.2 percentage points. This translates to detecting a reduction in callbacks from 10% to 8.8% or lower for resumes featuring poor oral health appearance. - Employer Resume Rating Experiment (binary outcome – hiring decision): Assuming a baseline “yes” rate of 50% per resume and 300 to 400 HR respondents, each rating about 12 resumes (totaling 3,600 to 4,800 observations), the study is powered at 80% with a 5% significance level to detect a minimum effect size of approximately 5.5 to 6 percentage points. This corresponds to detecting a drop in hiring likelihood from 50% to 44%–45% for resumes with visible oral health issues.
IRB

Institutional Review Boards (IRBs)

IRB Name
SBS-IRB University of Chicago
IRB Approval Date
2022-08-08
IRB Approval Number
IRB22-1081
Analysis Plan

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