Doctoral Dissertation Research In Economics: Misinformed or In Denial? Explaining the Low Take-Up of Tuberculosis Preventative Therapy

世界各地对免疫等预防性卫生技术的采用率很低，这是一个重大的公共卫生问题，但人们普遍不理解为什么家庭在预防性卫生方面投资不足。该项目使用现场实验，以结核病预防疗法(TPT)--一种防止潜在结核病(TB)感染进展为疾病的药物疗程-作为案例研究，寻求这种投资不足的行为解释。尽管向接受者免费提供TPT，但成人接触者的TPT接受率很低。该项目调查这是由于对低感染风险的错误信念(错误信息)，还是接触者因为害怕被污名化或害怕药物不良反应而不接受治疗(动机信念)。虽然错误信息可以通过有针对性的信息运动来解决，但动机信念可能并不容易解决，因此，重要的是要理清这些在制定有效的公共卫生政策方面投资不足的行为来源。这项研究的结果将为制定政策，增加对预防性卫生的投入，从而全面提高卫生水平和人力资本水平提供重要指导。健康状况和总体人力资本的改善也将带来更快的经济增长，进一步提高美国人的生活水平。关于低感染风险的错误信念有两种行为解释-缺乏对感染风险的认识(错误信念)和故意低估感染风险以应对对污名化的恐惧(动机信念关于低易感性)。为了验证这些假设，与最近确诊的肺结核患者有接触的成年家庭将接受调查，以得出有关结核病感染风险的信念。被引出的信念将被用来经验性地检验关于动机信念形成的理论预测(针对错误信息)。为了解释高非货币成本激励的另一种可能性，该项目还通过使用假设的TPT接受情景的离散选择实验，得出了联系人如何权衡TPT的非货币成本与预期收益。由此得出的信念和偏好将被用来估计联系人的TPT摄取决定的模型；估计将被用来模拟在各种反事实的政策情景下联系人的反应。这项研究的结果将为制定政策以增加对预防性健康的投资，从而全面提高健康水平和人力资本提供重要指导。这一奖项反映了NSF的法定使命，并通过使用基金会的智力优势和更广泛的影响审查标准进行评估，被认为值得支持。

Low adoption rates of preventative health technologies, such as immunization, around the world is a major public health problem, yet it is generally not understood why households underinvest in preventative health. This project uses field experiments to seek behavioral explanations for such under-investment using the Tuberculosis Preventative Therapy (TPT)—a course of medication that prevents the progression of latent Tuberculosis (TB) infection into disease---as a case study. TPT uptake among adult contacts is low, despite being offered at no cost to the recipient. This project investigates whether this is due to incorrect beliefs of low infection risk (misinformation), or if contacts do not take the therapy for fear of being stigmatized or fear of adverse drug reactions (motivated beliefs). While misinformation can be solved with targeted information campaigns, motivated beliefs may not be easily solved, hence it is important to disentangle these behavioral sources of under-investment in formulated effective public health policies. The results of this research will provide major guide to developing polices to increase investment in preventative health, thus improving the level of health and human capital generally. Improved health and general human capital would also lead to faster economic growth, further increasing the living standards of Americans. Two behavioral explanations for incorrect beliefs about low infection risk are hypothesized---lack of awareness about the risk of contracting the infection (misinformed beliefs) and deliberate underestimation of infection risk to cope with fears of stigmatization (motivated beliefs about low susceptibility). To test these hypotheses, adult household who have contacts with a recently diagnosed pulmonary TB patients will be surveyed to elicit beliefs about TB infection risk. The elicited beliefs will be used to empirically test theoretical predictions for motivated belief formation (against misinformation). To account for an alternate possibility of motivation by high non-monetary costs, the project also elicits how contacts trade off the non-monetary costs of TPT against the expected benefits, using discrete choice experiments with hypothetical TPT-taking scenarios. The beliefs and preferences thus elicited will then be used to estimate a model of contacts’ TPT uptake decisions; the estimates will be used to simulate contacts’ responses under various counterfactual policy scenarios. The results of this research will provide major guide to developing polices to increase investment in preventative health, thus improving the level of health and human capital generally.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.