Works in Progress:
"Indiscriminate Social Learning among Physicians Providing HIV Treatment"
Social learning has been identified as an important mechanism for information transfer in the workplace; however, extant research on social learning has focused primarily on the beneficial effects of such "knowledge spillovers"' on workers' performance. The current paper contributes to this growing literature on social learning by identifying the detrimental as well as beneficial effects of social learning on performance in a high-stakes medical context: physicians' HIV treatment practices. The findings reveal that inexperienced physicians indiscriminately learn proper and improper HIV treatment practices from their more-experienced peers, resulting in differential patient health outcomes depending on experienced peers' task performance. The paper then uses network-structure analysis to identify organizational policies that leverage beneficial social learning effects to help reduce the transmission of improper treatment practices, thereby improving overall treatment performance and subsequent medical outcomes for HIV-infected patients.
"Can Behavioral Economic Incentives Promoting Medication Adherence Improve Other Intertemporal Choices?"
(with Sebastian Linnemayr)
This paper evaluates the impact of behavioral economic incentives that target antiretroviral medication adherence on patients' intertemporal decision-making in other settings. A variable-rewards incentive mechanism was implemented among a sample of HIV-infected adults through a randomized controlled trial in Kampala, Uganda between 2012 and 2015. As behavioral economic theory would suggest, larger intervention effects are observed among participants who display behavioral biases identified in the baseline survey. Survey measurements additionally quantify intervention effects on other behaviors, where preliminary results find that participants in the intervention group have increased savings and lower rates of drinking and smoking. These findings suggest that behavioral economic interventions can induce positive spillover effects on intertemporal decision-making in other contexts.
"The Impact of Recession on Health Behavior"
This project describes how changes in market work hours affect the time allocated towards health maintenance behaviors over the business cycle. Utilizing daily time-use journals compiled by the American Time Use Survey (ATUS) between 2003 and 2014, the analysis focuses on the reallocation of time towards health promoting behaviors resulting from lost formal work hours during the great recession. Comparisons of time use before and after the recession, as well as between states that experienced different recession severities, find that roughly 10% of lost work hours are allocated to physical activities, increasing the probability of meeting the CDCs daily recommendation of 30 minutes of physical exercise by 12%. This shift towards healthier behavior corroborates the previously observed cyclicality of personal health in the United States.
"Behavioral Economic Incentives to Improve Adherence to Antiretroviral (ARV) Medication: Early Evidence from a Randomized Controlled Trial in Uganda" (with Sebastian Linnemayr) AIDS, 35; 5 (2017): pp. 716 - 26.
Innovative approaches are needed to improve adherence to antiretroviral (ARV) medication in sub-Saharan Africa to maintain HIV patients' health and avoid drug resistance in a region where second-line regimens are often unavailable or prohibitively expensive. This study evaluates whether small prizes allocated by drawings conditional on timely clinic visits and appropriate pill-taking can increase ARV adherence in this setting. 155 HIV-positive men and women in Kampala, Uganda aged 19-78 were randomized to 1 of 2 intervention groups or a control group receiving the usual standard of care. Participants in the first intervention group were eligible for prize drawings conditional on attending scheduled clinic appointments; eligibility in the second group was based on ARV adherence measured by medical event monitoring system (MEMS) caps. Results from the first nine months of this intervention show statistically signicant improvements in the percent of participants who maintain mean adherence rates of 90% or higher in both intervention groups relative to the control. Such lotteries may represent a highly cost-effective and scalable mechanism for improving adherence in this region.
"Behavioral Economics Matters for HIV Research: The Impact of Behavioral Biases on Adherence to Antiretrovirals (ARVs)" (with Sebastian Linnemayr) AIDS and Behavior, 19 (2015): pp. 2069 - 75.
Behavioral economics (BE) has been used to study a number of health behaviors such as smoking and drug use, but there is little knowledge of how these insights relate to HIV prevention and care. We present novel evidence on the prevalence of the common behavioral decision-making errors of present-bias, overoptimism, and information salience among 155 Ugandan HIV patients, and analyze their association with subsequent medication adherence. 36% of study participants are classified as present-biased, 21% as overoptimistic, and 34% as having salient HIV information. Patients displaying present-bias were 13% points (p = 0.006) less likely to have adherence rates above 90%, overoptimistic clients were 9% points (p = 0.04) less likely, and those not having salient HIV information were 17% points (p < 0.001) less likely. These findings indicate that BE may be used to screen for future adherence problems and to better design and target interventions addressing these behavioral biases and the associated suboptimal adherence.
"The Impact of Natural Disasters on Child Health and Investments in Rural India"
(with Ashlesha Datar, Jenny Liu, and Sebastian Linnemayr) Social Science and Medicine, 76 (2013): pp. 83 - 91.
There is growing concern that climate change will lead to more frequent natural disasters that may adversely affect short- and long-term health outcomes in developing countries. Prior research has primarily focused on the impact of single, large disaster events but very little is known about how small and moderate disasters, which are more typical, affect population health. In this paper, we present one of the first investigations of the impact of small and moderate disasters on childhood morbidity, physical growth, and immunizations by combining household data on over 80,000 children from three waves of the Indian National Family and Health Survey with an international database of natural disasters (EM-DAT). We find that exposure to a natural disaster in the past month increases the likelihood of acute illnesses such as diarrhea, fever, and acute respiratory illness in children under 5 by 9 - 18%. Exposure to a disaster in the past year reduces height-for-age and weight-for-age z-scores by 0.12 - 0.15 units, increases the likelihood of stunting and underweight by 7%, and reduces the likelihood of having full age-appropriate immunization coverage by nearly 18%. We also find that disasters' effects vary signicantly by gender, age, and socioeconomic characteristics. Most notably, the adverse effects on growth outcomes are much smaller among boys, infants, and families with more socioeconomic resources.