Health Decision-Making in the Aftermath of Disaster

灾后的健康决策

• 批准号: 10407021
• 负责人: Dean Yang
• 金额: $ 64.15万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-20 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10407021
• 关键词: Affect; Africa; Area; Baseline Surveys; Behavior; Belief; COVID-19; Child; Clinic; Communicable Diseases; Communities; Control Groups; Crime; Data; Decision Making; Deterioration; Developed Countries; Developing Countries; Devices; Disasters; Disease; Economics; Evaluation; Exposure to; Funding; Future; Health; Health Services; Heterogeneity; Household; Human; Hurricane; Incidence; Income; Individual; Infection; Interruption; Intervention; Lead; Light; Measurement; Measures; Mediating; Mediator of activation protein; Mozambique; Natural Disasters; Outcome; Persons; Pharmaceutical Preparations; Play; Policies; Population; Post-Traumatic Stress Disorders; Poverty; Prevalence; Province; Psychological Factors; Psychology; Public Health; Randomized; Recovery; Regimen; Resistance development; Risk; Role; Running; Sampling; Selection Bias; Sex Behavior; Sexual Transmission; Sexually Transmitted Diseases; Shock; Stress; Surveys; Testing; Time; Unsafe Sex; Violence; Visit; Weather; base; behavior test; behavioral economics; design; follow-up; food security; frontier; high risk sexual behavior; improved; insight; interest; novel; optimism; preference; programs; protective effect; public health intervention; response; secondary outcome; sex; study population; support network; tool; transmission process; treatment effect; treatment group

Abstract How do disasters affect health decision-making? Do disaster impacts operate, at least in part, through changes in economic preferences and psychological factors? Can public health programs help shield communities from the impacts of disasters? We pursue these questions by studying a major disaster that struck in the midst of a randomized evaluation we are conducting of a community-level public health program in Mozambique. Prior to the disaster, in 2017-2018, this study team had administered a baseline survey of approximately 4,500 households, and had facilitated random assignment of the program, Força à Comunidade e Crianças (FCC, “Strengthening Communities and Children”). Out of 76 communities, half were assigned to the treatment group, receiving the FCC program; the remainder serve as the control group. In March 2019, Cyclone Idai, the most destructive cyclone ever recorded in Africa, struck our study areas. The FCC program implements an interrelated set of health, educational, and economic interventions. Households are connected to community support networks, encouraged to visit and use local public health clinics, provided with information to improve health decision-making, and participate in microfinance programs. We first estimate human and economic losses, as well as impacts on risky sexual behaviors (including transactional sex), sexually transmitted infection (STI) testing, STI incidence, and COVID-19-related outcomes. We estimate impacts in a survey sample determined prior to the disaster, and are thus able to deal with selection biases (e.g., differential sample inclusion based on disaster exposure) that otherwise compromise treatment effect estimates. Impact estimates will exploit heterogeneity in hurricane exposure across study communities. Then, we will study impacts on individual preferences and psychological factors that may mediate the effects of disasters on health decision- making. Examining motivated belief biases (in this context, over-optimism maintained by health risk denial) is particularly novel; it is a new behavioral economics frontier but has not been empirically evaluated in health- related contexts. Our measurement tools are piloted, refined, and ready for large-scale implementation. Finally, we will assess whether the FCC program helps shield communities from the negative impacts of disaster exposure on risky sexual behaviors; STI testing, prevalence, and treatment; and on COVID-19-related outcomes. Causal inference will rely on the pre-disaster random assignment of the FCC program. We will also examine mechanisms through which the program achieves its protective effects. This project's findings can help guide the design of public health programs in the future. Insights into the economics and psychology of post-disaster decision-making can suggest novel interventions to mitigate disaster-induced deterioration of health decisions. Evidence on whether and how public health programs shield people from disasters can provide guidance on their optimal design.

抽象的 灾难如何影响健康决策？灾难的影响至少部分通过更改作用 在经济偏好和心理因素中？公共卫生计划可以帮助社区免受 灾难的影响？我们通过研究一场重大灾难来追求这些问题 随机评估我们正在莫桑比克进行社区级公共卫生计划。之前 这场灾难是在2017-2018，该研究团队管理了大约4,500的基线调查 家庭，并准备了该计划的随机分配，涉足Ecrianças（FCC， “加强社区和儿童”）。在76个社区中，一半被分配给治疗 小组，接收FCC计划；其余作为对照组。 2019年3月，Cyclone Idai， 有史以来在非洲记录的大多数破坏性旋风袭击了我们的研究区域。 FCC程序实施 相互关联的健康，教育和经济干预措施。家庭与社区有联系 支持网络，鼓励访问和使用当地公共卫生诊所，并提供了信息以改进 健康决策，并参加小额信贷计划。我们首先估计人类和经济 损失以及对风险的性行为（包括交易性行为）的影响，性传播感染 （STI）测试，STI事件和COVID-19与19的结果。我们估计调查样本中的影响 在发生灾难之前确定，因此能够处理选择偏见（例如，差异样本 基于灾难暴露的包含），否则会损害治疗效果估计。影响估计 将探索研究社区飓风暴露的异质性。然后，我们将研究对 个人偏好和心理因素可能介导灾难对健康决策的影响 - 制作。检查动机信念偏见（在这种情况下，否认健康风险维持的过度优势）是 特别是新颖的；这是一种新的行为经济学领域，但尚未在健康中进行经验评估 - 相关上下文。我们的测量工具已进行了试验，精制和准备大规模实施。最后， 我们将评估FCC计划是否有助于保护社区免受灾难的负面影响 风险的性行为暴露； STI测试，患病率和治疗；并在19号相关 结果。因果推理将依靠FCC程序的污点前随机分配。我们也会 检查该程序实现其受保护作用的机制。这个项目的发现可以 帮助指导未来的公共卫生计划的设计。对经济学和心理学的见解 灾后决策可以提出新的干预措施，以减轻灾难引起的延迟 健康决定。关于公共卫生计划是否以及如何使人们免于灾难的证据 提供有关其最佳设计的指导。