The Benefits of Knowledge: Mortality Risks, Mental health and Life-Cycle Behaviors

知识的好处：死亡风险、心理健康和生命周期行为

• 批准号: 9165415
• 负责人: ADELINE DELAVANDE
• 金额: $ 19.12万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9165415
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Adult; Affect; African; Age; Behavior; Collection; Data; Data Collection; Decision Making; Disease; Environment; Epidemic; Family health status; Fertility; Funding; HIV; Health; Health Expenditures; Health behavior; Incidence; Income; Individual; Intergenerational transfer; Intervention; Investments; Knowledge; Life Cycle Stages; Life Expectancy; Life Tables; Longevity; Longitudinal Studies; Low income; Malawi; Measures; Mental Health; Morbidity - disease rate; Occupational; Output; Pathway interactions; Perception; Personal Satisfaction; Policies; Population; Preparation; Prevalence; Probability; Psyche structure; Publications; Randomized; Randomized Controlled Trials; Reporting; Research; Research Support; Retirement; Risk; Role; Rural; Savings; Sex Behavior; Surveys; Testing; United States National Institutes of Health; Variant; aged; base; behavioral outcome; cognitive function; cost effective; design; economic outcome; effective intervention; evidence base; expectation; follow-up; health data; health economics; human capital; improved; low income country; member; mortality; population based; post intervention; programs; public health relevance; sexual risk taking; simulation; social; study population; transmission process; treatment group; trend

Project Summary: Recent improvements in adult life expectancies in high HIV-prevalence sub-Saharan African (SSA) low-income countries (LICs) have reversed previous adverse trends in adult survival during the 1990s and early 2000s when the HIV/AIDS epidemic considerably reduced life expectancies. Despite these improvements, there is widespread evidence that many individuals have distorted survival and disease perceptions (SDPs) and are overly pessimistic about their own survival and disease environment. For example, rural Malawians un- derestimate their chances to survive five years by 33–45%, which is consistent with considerable overestimation of local HIV prevalence and morbidity. These distorted SDPs are likely to affect mental health and influence a wide range of behaviors, including sexual behaviors, labor supply, human capital investments, and preparations for old-age. Despite the recent strong evidence about the benefits of more accurate SDPs, however, there are no population-based randomized controlled trials (RCTs) that have directly evaluated this hypothesis. The RCT pro- posed as part of this R21 project, which builds on separately-funded collection for mature adults in 2016 and 2018 in Malawi, is designed to (i) explore possibilities to improve the accuracy of SDPs by providing information about current health and mortality risks through a health-information intervention, and (ii) test whether more accurate SDPs improve mental health, life-course decision-making and a broad range of social/economic outcomes among mature adults (= individuals aged 45+). If our hypotheses are supported, this research will provide strong sup- port for cost-effective health-information programs that are highly pertinent in SSA LICs, where mortality levels and disease conditions/treatments have changed rapidly in recent years, and more generally, among older indi- viduals who are likely to underestimate their longevity given recent progress in reductions of old-age mortality. The Specific Aims of this project include: (1) Conduct exploratory research in 2016 on how to effectively convey evidence-based information about recent mortality levels and trends to mature adults to increase the accuracy of survival and disease perceptions (SDPs) in Malawi, and subsequent to the already-funded 2016 data collection for mature adults, conduct a health-information intervention that randomizes 50% of the study population (700+ individuals in 65+ villages) in a treatment group that will receive detailed information about recent mortality and health trends. (2) Collect new data in 2017 on (a) SDPs (including subjective expectations about survival, health, local HIV prevalence), (b) health (including mental health and cognitive function), (c) health behaviors and expenditures, (d) life-cycle behaviors and preparations for old age. (3) Using existing data, already-funded data collection and new data collection funded through this project on SDPs, health and life-cycle behaviors for the period 2006–18, (a) evaluate the causal impacts of health information on (i) SDPs, (ii) mental health and health be- haviors, and (iii) labor supply, savings, intergenerational transfers and other life-cycle behaviors, (b) investigate the pathways through which SDPs affect these behaviors and outcomes.

项目摘要：在艾滋病毒高发的撒哈拉以南非洲地区，成人预期寿命最近有所改善 (SSA)低收入国家(LIC)扭转了1990年代成年人存活率之前的不利趋势， 21世纪初，艾滋病毒/艾滋病的流行大大减少了预期寿命。尽管有这些改进， 有广泛的证据表明，许多人扭曲了生存和疾病认知(SDP)和 对自己的生存和疾病环境过于悲观。例如，马拉维农村人不-- 将他们存活fi五年的机会估计为33-45%，这与相当大的高估是一致的 关于当地艾滋病毒流行和发病率的信息。这些扭曲的SDP可能会影响精神健康，在fl情况下 广泛的行为，包括性行为、劳动力供应、人力资本投资和准备 为晚年准备的。尽管最近有强有力的证据表明更准确的sdp的好处fit，然而，没有 直接评估这一假设的基于人群的随机对照试验(RCT)。RCT PRO- 作为R21项目的一部分，该项目建立在2016和2018年为成年人单独提供资金的收集基础上 在马拉维，旨在：(I)通过提供关于以下方面的信息，探讨提高可持续发展计划准确性的可能性 通过健康信息干预当前的健康和死亡风险，以及(Ii)测试是否更准确 可持续发展方案可改善心理健康、终身决策和广泛的社会/经济成果 成年人(=45岁以上的人)如果我们的假设得到支持，这项研究将提供强有力的支持-- 支持与SSA LIC高度相关的具有成本效益的健康信息计划，在这些计划中，死亡率水平 近年来，疾病状况/治疗方法变化很快，更广泛地说，在老年患者中- 考虑到最近在降低老年死亡率方面取得的进展，可能会低估自己的寿命的人。 本项目的特殊fic目标包括：(1)在2016年进行探索性研究，研究如何有效地传达 向成年人提供关于最近死亡率水平和趋势的循证信息，以提高预测的准确性 马拉维的生存和疾病认知(SDP)，以及在已经获得资金的2016年数据收集之后 对于成年人，进行健康信息干预，随机选择50%的研究人群(700+ 65个以上村庄的个人)在治疗组中，将收到关于最近死亡的详细信息 和健康趋势。(2)收集2017年关于(A)SDP(包括对生存的主观期望， (B)健康(包括心理健康和认知功能)、(C)健康行为 (D)生命周期行为和老年准备。(3)利用现有数据，已有资金 数据收集和通过该项目资助的关于可持续发展方案、健康和生命周期行为的新数据收集 2006-18年期间，(A)评价健康信息对以下方面的因果影响：(1)SDP；(2)精神健康和健康-- 以及(三)劳动力供应、储蓄、代际转移和其他生命周期行为，(B)调查 SDP影响这些行为和结果的途径。