(2020). Educative Interventions to Combat Misinformation: Evidence from A Field Experiment in India. Forthcoming.
Misinformation makes democratic governance harder, especially in developing countries. Despite its real-world import, little is known about how to combat fake news outside of the U.S., particularly in places with low education, accelerating Internet access, and encrypted information sharing.
This study uses a field experiment in India to test the efficacy of a pedagogical intervention on respondents’ ability to identify fake news during the 2019 elections (N=1224). Treated respondents received in-person media literacy training in which enumerators demonstrated two tools to identify fake news: reverse image searching and navigating a fact-checking website.
Receiving this hour-long media literacy intervention did not significantly increase respondents’ ability to identify fake news on average. However, treated respondents who support the ruling party became significantly less able to identify pro-attitudinal fake news. These findings point to the resilience of misinformation in India and the presence of motivated reasoning in a traditionally non-ideological party system.
(2020). Early-Stage Venture Incubation and Mentoring Promote Learning, Scaling, and Profitability among Disadvantaged Entrepreneurs. Organization Science, forthcoming.
Do founders learn during early-stage venture incubation? If so, what role does learning play in subsequent performance? To answer these questions, I use data from 2,153 applicants to an incubator in Johannesburg, South Africa, and study the relationship between changes in founders’ learning during incubation and their ventures’ post-incubation revenues and profits.
Further, I examine how founders’ random assignment to coaches in the incubator affected learning and compare changes in revenues, costs, employment, and rates of business registration within incubated and non-incubated ventures using a differences-in-differences design. I find that learning during incubation among founders was associated with profitability and revenue growth post-incubation. Every one standard-deviation increase in learning, as measured by changes in entrepreneurs’ mid-point and final exam scores, was associated with a 109% increase in monthly profits and a 136% increase in monthly revenues during the 11 months after venture incubation.
Further, coach centrality moderated the observed benefits of incubation, with a one unit increase in a coach’s centrality being associated with up to 25% increase in founders’ learning during incubation. These findings suggest that early-stage venture incubation promotes learning and that learning contributes to greater scaling and profitability among incubated ventures.
(2020). Institutional Change and Early-Stage Startup Selection: Evidence from Applicants to Venture Accelerators. Organization Science, forthcoming.
Existing research at the nexus of institutional theory and entrepreneurship suggests that lowering institutional barriers to forming, growing, and exiting new firms through legal and regulatory reforms can affect the types of startups that entrepreneurs found in a region. These institutional changes could affect entrepreneurs’ willingness to partner with organizational sponsors to develop high-growth startups and potentially enhance these sponsors’ ability to select high-growth startups to fund and develop.
This study evaluates these ideas by developing and testing three hypotheses, that institutional reforms (a) improve entrepreneurs’ perceived benefits of the resources that organizational sponsors provide, (b) increase the number, quality, and diversity of applicants for these resources within sponsors’ local ecosystems, and (c) enhance sponsors’ capacity to select high-growth startups into their cohorts.
To evaluate these hypotheses, I analyze data from 13,770 applicants to venture accelerators over multiple application cycles between 2016-2018 in 170 countries, using a difference-in-differences design that exploits institutional reforms that aimed to reduce the time and procedures to start new firms, obtain credit, and resolve bankruptcy for entrepreneurs.
The findings have important implications for how institutional reforms affect early-stage entrepreneurship and the capacity of organizational sponsors to select high-growth early-stage startups to fund and develop within their local ecosystems.
(September 2020). Unpolluted decisions: Air quality and judicial outcomes in China. Economics Letters, 194, 109369.
Judicial outcomes should not be influenced by factors that have no bearing on legal decisions, but studies have shown that judges can be affected by extraneous variables such as weather, sports events, and food consumption. Employing the universe of drug offense court decisions in five major Chinese cities between 2014 and 2015, we study whether air pollution and temperature affect sentencing outcomes in China, where air pollution is severe and judges have considerable discretion in sentencing drug cases.
We find that Chinese criminal judges are not at all affected by pollution or temperature changes. One standard deviation change in air pollutant PM2.5 level may change the sentence length by no more than 2% of its standard deviation with over 95% probability. Further analysis shows that our results are robust to a variety of specifications and a battery of robustness checks.
Our findings suggest that judicial rulings are not always swayed by extraneous factors, and we discuss conditions under which public officials are more likely to be shielded from these non-legal factors.
(July 2020). Anthropometric, Cognitive, and Schooling Benefits of Measles Vaccination: Longitudinal Cohort Analysis in Ethiopia, India, and Vietnam. Vaccine, 37(31), 4336-4343.
To estimate the associations between measles vaccination and child anthropometry, cognition, and schooling outcomes in Ethiopia, India, and Vietnam.
Longitudinal survey data from Young Lives were used to compare outcomes at ages 7–8 and 11–12 years between children who reported receipt or non-receipt of measles vaccine at 6–18 months-of-life (n = ∼2000/country). Z-scores of height-for-age (HAZ), BMI-for-age (BMIZ), weight-for-age (WAZ), Peabody Picture Vocabulary Test (PPVT), early grade reading assessment (EGRA), language and mathematics tests, and attained schooling grade were examined. Propensity score matching was used to control for systematic differences between measles-vaccinated and measles-unvaccinated children.
Using age- and country-matched measles-unvaccinated children as comparisons, measles-vaccinated children had better anthropometrics, cognition, and schooling. Measles-vaccinated children had 0.1 higher HAZ in India and 0.2 higher BMIZ and WAZ in Vietnam at age 7–8 years, and 0.2 higher BMIZ at age 11–12 years in Vietnam. At ages 7–8 years, they scored 4.5 and 2.9 percentage points (pp) more on PPVT and mathematics, and 2.3 points more on EGRA in Ethiopia, 2.5 points more on EGRA in India, and 2.6 pp, 4 pp, and 2.7 points more respectively on PPVT, mathematics, and EGRA in Vietnam. At ages 11–12 years, they scored 3 pp more on English and PPVT in India, and 1.7 pp more on PPVT in Vietnam. They also attained 0.2–0.3 additional schooling grades across all ages and countries.
Our findings suggest that measles vaccination may have benefits on cognitive gains and school-grade attainment that can have broad educational and economic consequences that extend beyond early childhood.
(May 2020). Time use and Sexual Maturity−related Indicators Differentially Predict Youth Body Mass Indices, Peruvian Girls Versus Boys. Annals of the New York Academy of Sciences, 1468(1), 55-73.
Rapid development in Latin America has been accompanied by lifestyle shifts, including changes in time use and social environments. Overweight/obesity has also emerged as a public health challenge. We examined whether lifestyle changes and sexual maturity−related indicators (early pubertal development and having a child) predict increases in adiposity among Peruvian youth.
Using longitudinal data from Young Lives, we examined changes in adiposity between ages 8 and 15 years old for the younger cohort and ages 15 and 22 years old for the older cohort. Boys and girls in both cohorts demonstrated substantial increases in age‐adjusted adiposity measures, but predictors were different for boys versus girls.
For boys, increases in time spent in work and domestic chores predicted increases in adiposity body mass index and BMI‐for‐age Z‐score, and increases in time spent sleeping were associated with decreases in adiposity (waist circumference and waist‐to‐height ratio). For girls, sexual maturity−related indicators (early menarche and childbearing) predicted increases in adiposity, regardless of time use.
Potential mechanisms for these results may include diet, physical activity, wealth, and urban−rural residence. Time use among youth was associated with diet quality and physical activity, but in different ways for boys versus girls. Strategies for dealing with rising overweight and obesity should incorporate sex‐based specificities.
(August 2020). The Logic of Violence in Drug War. The American Political Science Review, 114(3), 1-14.
Drug traffickers sometimes share profits peacefully. Other times they fight. We propose a model to investigate this variation, focusing on the role of the state. Seizing illegal goods can paradoxically increase traffickers’ profits, and higher profits fuel violence.
Killing kingpins makes crime bosses short-sighted, also fueling conflict. Only by targeting the most violent traffickers can the state reduce violence without increasing supply. These results help explain empirical patterns of violence in drug war, which is less studied than interstate or civil war but often as deadly.
(July 2020). Are Household Expenditures on Food Groups Associated with Children’s Future Heights in Ethiopia, India, Peru, and Vietnam? International Journal of Environmental Research and Public Health, 17(13), 4739.
Household expenditure surveys, routinely conducted in low—and middle-income countries (LMICs), usually include questions pertaining to recent household expenditures on key food groups. When child anthropometrics are also available, such expenditure data can provide insights into household food purchasing patterns that are associated with subsequent child growth measures.
We used data from 6993 children, born around 2001, from Ethiopia, India, Peru, and Vietnam, from the Young Lives younger cohort. We compared associations between two weeks of household food expenditures (in PPP—Purchasing Power Parity adjusted dollars) on food groups and child height-for-age-Z score (HAZ) at subsequent time points to assess longitudinal associations. Total food expenditures, rural/urban residence, maternal and paternal schooling, and child sex were included in our adjusted models because they may affect the relations between household food group expenditures and future child HAZ.
In Ethiopia, India, and Peru every extra PPP$ spent on fats was associated with 0.02–0.07 higher future HAZ. In Vietnam, every extra PPP$ spent on starches, was significantly associated with a 0.01 lower future HAZ. Across countries, different patterns of food expenditure and procurement may be differentially critical for predicting child HAZ. Our results demonstrate how expenditures on specific food groups can be associated with children’s linear growth. This study provides additional evidence of the utility of longitudinal household food expenditure data in understanding child nutritional status.
(June 2020). Cumulative Risk and Newly Qualified Teachers’ Professional Well-being: Evidence from Rural Ghana. SAGE Journals, 1745-4999.
The transition from student-teaching to full-time teaching is an understudied period in teachers’ careers. This paper uses a cumulative risk (CR) framework to assess personal and professional risks experienced by 135 student-teachers in rural Ghana during pre-service training and later as newly qualified teachers and examines how risks relate to their professional well-being and learning outcomes of children in their classrooms. Higher CR was associated with lower teacher motivation and personal accomplishment. Furthermore, higher CR predicted lower child numeracy skills and socioemotional development over the school year. Implications for teacher professional development and improving educational quality are discussed.
(July 2020). Assessment of an adolescent-girl-focused nutritional educational intervention within a girls’ empowerment programme: a cluster randomised evaluation in Zambia. Public Health Nutrition, 1-14.
Adolescent girls are at risk for both macro- and micronutrient deficiencies affecting growth, maternal and child health. This study assessed the impact of an adolescent-girl-tailored nutritional education curriculum on nutritional outcomes, including knowledge, dietary behaviour, anthropometry and anaemia.
A cluster-randomised evaluation was conducted with two study arms: girls in mentor-led weekly girls’ groups receiving sexual and reproductive health and life-skills training assigned to an age-appropriate nutritional curriculum and control girls in the weekly girls’ groups without the nutritional education. The primary analysis was intent-to-treat (ITT) generalised least squares regression. Secondary analysis using two-stage, instrumental-variables estimation was also conducted.
The intervention and evaluation were conducted in urban and rural areas across four of ten provinces in Zambia.
In total, 2660 girl adolescents aged 10–19 years were interviewed in 2013 (baseline) and annually through 2017.
ITT results indicate that exposure to the nutritional educational programme did not meaningfully change outcomes for adolescents or their children. Intervention adolescents were no more likely to correctly identify healthy foods (P = 0·51) or proper infant-feeding practices (P = 0·92); were no less likely to be stunted (P = 0·30) or underweight (P = 0·87) and no less likely to be anaemic (P = 0·38). Outcomes for children of intervention participants were not improved, including being breastfed (P = 0·42), stunted (P = 0·21), wasted (P = 0·77) or anaemic (P = 0·51).
Even a high-quality nutritional educational intervention tailored to adolescents within an empowerment programme does not assure improved nutritional outcomes; adolescent preferences, resource control and household dynamics require consideration in the context of nutritional educational programmes.
(June 2020). Nutrition, Adult Cognitive Skills, and Productivity: Results and Influence of the INCAP Longitudinal Study. Food and Nutrition Bulletin, 41(1), S41-S49.
This article summarizes research based on the INCAP Longitudinal Study that demonstrates the positive effects of the atole intervention on prime-age adult cognitive skills and productivities.
The findings are interpreted in the context of a life-cycle stage model in which various factors and investments at each stage of life influence outcomes not only in that stage but in subsequent ones. The results point to the likely importance of improvements in adult cognitive skills due to better early-life nutrition on adult male labor market outcomes as well as on women’s “home productivity” in terms of anthropometrics for the next generation.
Possible mechanisms are also explored, including the impacts of early-life exposure to atole on children’s height when starting school, on grades of schooling attainment, and on the extent of experience with higher-skilled jobs, as well as the impacts of improved cognitive skills on wages. Not only are investments in early-life nutrition important for immediate welfare but also they have significant productivity payoffs in adulthood.
(June 2020). Anti-muslim bias in the Chinese labor market. Journal of Comparative Economics. 48(2), 235-250.
Is there a Muslim disadvantage in economic integration to the Chinese economy? Do political mandates from the government help reduce disparities? To answer these questions, we conducted a large-scale audit study and submitted over 4,000 fictitious resumes to job advertisements for accounting and administrative positions posted by private firms, state-owned firms, and foreign firms.
We randomized the ethnic identities of job applicants, their academic merits, and requested salaries. Our results show that a Muslim job seeker is at least 50 percent less likely to receive a callback than a Han job seeker, and higher academic merit does not compensate for this bias.
Importantly, we find that state-owned enterprises are equally likely to discriminate against Muslim job seekers, despite their political mandate to increase diversity. Interview evidence suggests that besides outright hostility towards outgroups, there exist operational costs to diversity-related to building infrastructure that accommodates religious and cultural needs.
(June 2020). Credit and attention in the adoption of profitable energy efficient technologies in Kenya, forthcoming.
What roles do credit constraints and inattention play in the under-adoption of high-return technologies? We study this question in the case of energy efficient cookstoves in Nairobi. Using a randomized field experiment with 1,000 households, we estimate a 300% average annual rate of return to investing in this technology, or $120 per year in fuel savings—around one month of income.
Despite this, adoption rates are low: eliciting preferences using an incentive-compatible Becker-DeGroot-Marschak mechanism, we find that average willingness-to-pay (WTP) is only $12. To investigate what drives this puzzling pattern, we cross-randomize access to credit with two interventions designed to increase attention to the costs and benefits of adoption.
Our first main finding is that credit doubles WTP and closes the energy efficiency gap over the period of the loan. Second, credit works in part through psychological mechanisms: around one-third of the total impact of credit is caused by inattention to loan payments. We find no evidence of inattention to energy savings. Private benefits and avoided environmental damages generate average benefits of $600 for each stove adopted and used for two years.
(May 2020). Predictors of anxiety and depressive symptoms among teachers in Ghana: Evidence from a randomized controlled trial. Social Science & Medicine, 253, 112957.
While teachers are heralded as key drivers of student learning outcomes, little attention has been paid to teachers’ mental health, especially in less-developed countries such as Ghana. Professional background, workplace environment, and personal life stressors may threaten teachers’ mental health and subsequent effectiveness in the classroom.
The objectives of this study were to investigate 1) whether and how professional background, workplace environment, and personal life stressors predicted teachers’ anxiety and depressive symptoms, and 2) whether participation in a professional development intervention predicted change in teachers’ symptoms over the course of one school year in Ghana.
We used multilevel models to examine predictors of depressive and anxiety symptoms among 444 kindergarten teachers (98% female; age range: 18-69) who participated in the Quality Preschool for Ghana (QP4G) Study. QP4G was a school-randomized control trial (n = 108 public schools; n = 132 private schools) evaluating a one-year teacher professional development intervention program implemented with and without parental-awareness meetings. Teacher depressive and anxiety symptoms were assessed at baseline before the intervention and at the end of the school year.
Poor workplace environment was associated with increased anxiety and depressive symptoms. Social support also predicted symptoms, with a lack of support from students’ parents and being new to the local community associated with more anxiety symptoms. Within teachers’ personal lives, household food insecurity predicted more depressive symptoms. Finally, anxiety and depressive symptoms increased for all teachers over the school year. However, randomization to either intervention was linked to a significantly smaller increase in symptoms over the school year.
Results suggest that teachers’ personal and professional lives are consequential for their mental health and that professional development interventions that provide training and in-class coaching and parent engagement may benefit teachers’ mental health.
(May 2020). Property Rights, Land Misallocation and Agricultural Efficiency in China. The Review of Economic Studies.
This paper examines the impact of a property rights reform in rural China that allowed farmers to lease out their land. We find the reform led to increases in land rental activity in rural households.
Consistent with a model of transaction costs in land markets, our results indicate that the formalization of leasing rights resulted in a redistribution of land toward more productive farmers. Consequently, the aggregate productivity of land increased significantly.
We also find that the reform increased the responsiveness of land allocation across crops to changes in crop prices.
(May 2020). Impact of the NREGS on Children’s Intellectual Human Capital. The Journal of Development Studies, 56(5), 929-945.
This paper uses panel data from the Young Lives Survey to examine the effect of the world’s largest public works program and India’s flagship social protection program, the National Rural Employment Guarantee Scheme (NREGS), on children’s learning outcomes such as grade progression, reading comprehension test scores, writing test scores, math test scores, and Peabody Picture Vocabulary Test (PPVT) scores.
We find that the program has strong positive effects on these outcomes in both the short-and-medium run. Finally, the impact estimates reported here are robust to a number of econometric concerns such as – program placement, selective attrition, and type I error.
(April 2020). Impact of the Juntos Conditional Cash Transfer Program on Nutritional and Cognitive Outcomes in Peru: Comparison between Younger and Older Initial Exposure. Economic Development and Cultural Change, 68(3), 865-897.
We evaluate whether the Juntos conditional cash transfer program in Peru has a larger effect on children who benefited initially from the program during the first 4 years of life compared with those children who benefited initially between ages 5 and 8. The former group was exposed during early-life sensitive periods, received the program for a longer period, and received more growth monitoring sessions and vaccinations.
We find that exposure to Juntos led to an improvement in nutritional status and in cognitive achievement, both of which were greater, but only the latter was significant for those initially exposed during the first 4 years of life.
(April 2020). Profits and Violence in Illegal Markets: Evidence from Venezuela. Journal of Conflict Resolution, 64(7-8), 1499-1523.
Some theories predict that profits facilitate peace in illegal markets, while others predict that profits fuel violence. I provide empirical evidence from drug trafficking in Venezuela. Using original data, I compare lethal violence trends in municipalities near a major trafficking route to trends elsewhere, both before and after counternarcotics policy in neighboring Colombia increased the use of Venezuelan transport routes.
For thirty years prior to this policy change, lethal violence trends were similar; afterward, outcomes diverged: violence increased more along the trafficking route than elsewhere. Together with qualitative accounts, these findings illuminate the conditions under which profits fuel violence in illegal markets.
(April 2020). Political Partisanship Influences Behavioral Responses to Governors’ Recommendations for COVID-19 Prevention in the United States. Social Science Research Network, 253, 112957.
Voluntary physical distancing is essential for preventing the spread of COVID-19. Political partisanship may influence individuals’ responsiveness to recommendations from political leaders.
Daily mobility during March 2020 was measured using location information from a sample of mobile phones in 3,100 US counties across 49 states. Governors’ Twitter communications were used to determine the timing of messaging about COVID-19 prevention.
Regression analyses examined how political preferences influenced the association between governors’ COVID-19 communications and residents’ mobility patterns. Governors’ recommendations for residents to stay at home preceded stay-at-home orders and led to a significant reduction in mobility that was comparable to the effect of the orders themselves.
Effects were larger in Democratic than Republican-leaning counties, a pattern more pronounced under Republican governors. Democratic-leaning counties also responded more to recommendations from Republican than Democratic governors.
Political partisanship influences citizens’ decisions to voluntarily engage in physical distancing in response to communications by their governor.
(April 2020). Household food insecurity and early childhood development: Longitudinal evidence from Ghana. Plos One, 15(4).
The burden of food insecurity is large in Sub-Saharan Africa, yet the evidence-base on the relation between household food insecurity and early child development is extremely limited. Furthermore, available research mostly relies on cross-sectional data, limiting the quality of existing evidence. We use longitudinal data on preschool-aged children and their households in Ghana to investigate how being in a food insecure household was associated with early child development outcomes across three years.
Household food insecurity was measured over three years using the Household Hunger Score. Households were first classified as “ever food insecure” if they were food insecure at any round. We also assessed the persistence of household food insecurity by classifying households into three categories: (i) never food insecure; (ii) transitory food insecurity, if the household was food insecure only in one wave; and (iii) persistent food insecurity, if the household was food insecure in two or all waves.
Child development was assessed across literacy, numeracy, social-emotional, short-term memory, and self-regulation domains. Controlling for baseline values of each respective outcome and child and household characteristics, children from ever food insecure households had lower literacy, numeracy, and short-term memory.
When we distinguished between transitory and persistent food insecurity, transitory spells of food insecurity predicted decreased numeracy (β = -0.176, 95% CI: -0.317; -0.035), short-term memory (β = -0.237, 95% CI: -0.382; -0.092), and self-regulation (β = -0.154, 95% CI: -0.326; 0.017) compared with children from never food insecure households. By contrast, children residing in persistently food insecure households had lower literacy scores (β = -0.243, 95% CI: -0.496; 0.009).
No gender differences were detected. Results were broadly robust to the inclusion of additional controls. This novel evidence from a Sub-Saharan African country highlights the need for multi-sectoral approaches including social protection and nutrition to support early child development.
(April 2020). Estimating the Effects of Educational System Contraction: The Case of China’s Rural School Closure Initiative. Economic Development and Cultural Change.
Global trends of fertility decline, population aging, and rural outmigration are creating pressures to consolidate school systems, with the rationale that economies of scale will enable higher quality education to be delivered in an efficient manner, despite longer travel distances for students. Yet, few studies have considered the implications of system consolidation for educational access and inequality, outside of the context of developed countries.
We estimate the impact of educational infrastructure consolidation on educational attainment using the case of China’s rural primary school closure policies in the early 2000s. We use data from a large household survey covering 728 villages in 7 provinces, and exploit variation in villages’ year of school closure and children’s ages at closure to identify the causal impact of school closure.
For girls exposed to closure during their primary school ages, we find an average decrease of 0.60 years of schooling by 2011, when children were, on average, 17 years old. Negative effects strengthen with time since closure. For boys, there is no corresponding significant effect. Different effects by gender may be related to the greater sensitivity of girls’ enrollment to distance and greater responsiveness of boys’ enrollment to quality
(February 2020). Are Private Kindergartens really Better? Examining Preschool Choices, Parental Resources, and Children’s School Readiness in Ghana. Comparative Education Review, 64(1), 107-136.
Low-cost private schools are expanding across sub-Saharan Africa and are often perceived by parents to be of better quality than public schools. This article assesses the interplay between kindergarten (or preschool) choice, household resources, and children’s school readiness in Ghana. We examine how child, household, and school characteristics predict private versus public kindergarten attendance and whether household characteristics are associated with school readiness beyond preschool selection.
Using a geospatial-identification strategy to account for observed and unobserved determinants of preschool choice, we find that parental investments—including the number of books at home and caregiver help with homework—predict both private-preschool selection and start-of-year child outcomes beyond their influence on preschool choice. We take this evidence as suggesting that investments in children support learning beyond simply selecting the presumed best preschool type.
We also find independent associations between attending private preschool and one-year changes in early literacy scores. The findings contribute knowledge to the literature on the recent expansion of preschool education in sub-Saharan Africa and globally and shed new light on the role of private-preschool attendance in early academic skill development.
(December 2019). Bridging the Efficacy–Effectiveness Gap in HIV Programs: Lessons from Economics. Journal of Acquired Immune Deficiency Syndromes. 82, S183-S191.
Background: Bridging the efficacy-effectiveness gap in HIV prevention and treatment requires policies that account for human behavior.
Methods: We conducted a narrative review of the literature on HIV in the field of economics, identified common themes within the literature, and identified lessons for implementation science.
Results: The reviewed studies illustrate how behaviors are shaped by perceived costs and benefits across a wide range of health and non-health domains, how structural constraints shape decision-making, how information interventions can still be effective in the epidemic’s fourth decade, and how lessons from behavioral economics can be used to improve intervention effectiveness.
Conclusion: Economics provides theoretical insights and empirical methods that can guide HIV implementation science.
(December 2019). Shedding light on quality of care: A study protocol for a randomized trial evaluating the impact of the Solar Suitcase in rural health facilities on maternal and newborn care quality in Uganda. BMC Pregnancy and Childbirth, 19(1).
Background: Continued progress in reducing maternal and newborn morbidity and mortality in low-income countries requires a renewed focus on the quality of delivery care. Reliable electricity and lighting are a cornerstone of a well-equipped health system, but most primary maternity care facilities in sub-Saharan Africa are either not connected to the electrical grid or suffer frequent blackouts.
Lack of reliable electricity and light in maternity facilities may contribute to poor quality of both routine and emergency obstetric and newborn care, by hindering infection control, increasing delays in providing care, and reducing health worker morale. The “Solar Suitcase” is a solar electric system designed specifically for maternity care facilities in low-resource environments. The purpose of this trial is to evaluate the impact of the Solar Suitcase on the reliability of light, quality of obstetric and newborn care, and health worker satisfaction.
Methods: We are conducting a study with 30 maternity care facilities in rural Uganda that lack access to a reliable, bright light source. The study is a stepped wedge cluster randomized controlled trial. Study facilities are identified according to predefined eligibility criteria and randomized by blocking on baseline covariates. The intervention is a “Solar Suitcase”, a complete solar electric system that provides essential lighting and power for charging phones and small medical devices.
The primary outcomes are the reliability and quality of light during intrapartum care, the process quality of obstetric and newborn care, and health worker satisfaction. Outcomes will be assessed via direct clinical observation by trained enumerators (estimated n = 1980 birth observations), as well as interviews with health workers and facility managers. Lighting and blackouts will be captured through direct observation and via light sensors installed in facilities.
Discussion: A key feature of a high-quality health system is an appropriate infrastructure, including reliable, bright lighting, and electricity. Rigorous evidence on the role of a reliable light source in maternal and newborn care is needed to accelerate the “electrification” of maternity facilities across sub-Saharan Africa. This study will be the first to rigorously assess the extent to which reliable light is an important driver of the quality of care experienced by women and newborns.
(October 2019). Nutritional Status from 1 to 15 Years and Adolescent Learning for Boys and Girls in Ethiopia, India, Peru, and Vietnam. Population Research and Policy Review, 38(6), 899-931.
There has been little examination of (1) associations of early-life nutrition and adolescent cognitive skills, (2) if they vary by gender, (3) if they differ by diverse contexts, and (4) contributions of post-infancy growth to adolescent cognitive attainment. We use Young Lives data on 7687 children from Ethiopia, India, Peru, and Vietnam to undertake ordinary least squares estimates of associations between age-1 height-for-age z-score (HAZ) and age-15 cognitive outcomes (math, reading, vocabulary), controlling for child and household factors. Age-1 HAZ is positively associated with cognitive scores in all countries.
Child gender-specific estimates for these coefficients either do not differ (math, reading) or favor girls (vocabulary). Augmenting models to include growth in HAZ between ages 1 and 15 years that was not predicted by HAZ at age 1 reveals that such improvements are associated with higher cognitive scores, but that sex-specific coefficients for this predictor favor boys in India and Peru.
The results suggest that nutritional indicators at age 1 have gender-neutral associations with math and reading and favor girls for vocabulary achievement at age 15, but unpredicted improvements in HAZ by adolescence are associated with higher cognitive scores for boys than for girls. This evidence enriches our understanding of relationships between children’s nutritional trajectories during childhood and adolescent cognitive development, and how these associations vary by gender in some contexts to the possible disadvantage of girls.
(October 2019). It Takes a Village: Peer Effects and Externalities in Technology Adoption. American Journal of Political Science, 64(3), 536-553.
Do social networks matter for the adoption of new forms of political participation? We develop a formal model showing that the quality of communication that takes place in social networks is central to understanding whether a community will adopt forms of political participation where benefits are uncertain and where there are positive externalities associated with participation. Early adopters may exaggerate benefits, leading others to discount information about the technology’s value.
Thus, peer effects are likely to emerge only when informal institutions support truthful communication. We collect social network data for 16 Ugandan villages where an innovative mobile‐based reporting platform was introduced. Consistent with our model, we find variation across villages in the extent of peer effects on technology adoption, as well as evidence supporting additional observable implications. Impediments to social diffusion may help explain the varied uptake of new and increasingly common political communication technologies around the world.
(September 2019). A behavioral design approach to improving a Chagas disease vector control campaign in Peru. BMC Public Health. 19(1272).
Individual behavior change is a critical ingredient in efforts to improve global health. Central to the focus on behavior has been a growing understanding of how the human brain makes decisions, from motivations and mindsets to unconscious biases and cognitive shortcuts. Recent work in the field of behavioral economics and related fields has contributed to a rich menu of insights and principles that can be engineered into global health programs to increase impact and reach. However, there is little research on the process of designing and testing interventions informed by behavioral insights.
In a study focused on increasing household participation in a Chagas disease vector control campaign in Arequipa, Peru, we applied Datta and Mullainathan’s “behavioral design” approach to formulate and test specific interventions. In this Technical Advance article we describe the behavioral design approach in detail, including the Define, Diagnosis, Design, and Test phases. We also show how the interventions designed through the behavioral design process were adapted for a pragmatic randomized controlled field trial.
The behavioral design framework provided a systematic methodology for defining the behavior of interest, diagnosing reasons for household reluctance or refusal to participate, designing interventions to address actionable bottlenecks, and then testing those interventions in a rigorous counterfactual context. The behavioral design offered us a broader range of strategies and approaches that are typically used in vector control campaigns.
Careful attention to how behavioral design may affect the internal and external validity of evaluations and the scalability of interventions is needed going forward. We recommend behavioral design as a useful complement to other intervention design and evaluation approaches in global health programs.
(September 2019). Effect of a Prize-Linked Savings Intervention on Savings and Healthy Behaviors among Men in Kenya: A Randomized Clinical Trial. JAMA Network Open, 2(9), e1911162.
Importance Interventions to reduce men’s alcohol use and risky sexual behaviors are essential for reducing new HIV infections in high-prevalence settings in sub-Saharan Africa. Prize-linked savings accounts can motivate savings and may decrease expenditures on risky behaviors, but few studies have examined the HIV prevention potential of such savings interventions among men.
Objective To evaluate the effect of prize-linked savings accounts on savings behavior and expenditures on alcohol, gambling, and transactional sex among men in Kenya.
Design, Setting, and Participants Randomized clinical trial among communities in Siaya County, Kenya. Participants were men 21 years or older who owned a mobile phone were engaged in fishing or transportation sector work, and were willing to open an account with a local bank; they were screened for eligibility between September 3 and October 5, 2018.
Interventions Eligible participants were offered savings accounts endowed with 1000 Kenya shillings (US $10) and randomized (1:1) to receive weekly lottery-based rewards contingent on growth in savings balance or to a control group that received standard interest.
Main Outcomes and Measures The primary outcome was an indicator of whether a participant saved any money in the bank account (intent-to-treat analysis) during the study period. Secondary outcomes included the total amount saved in the bank account, the total amount saved in all sources, and expenditures on alcohol, gambling, and transactional sex.
Results A total of 425 men were screened, 329 (77.4%) met eligibility criteria, 300 (70.6%) were enrolled (with 152 randomized to the intervention group and 148 to the control group), and 270 of 300 (90.0%) opened bank accounts. Participants’ mean age was 33.7 years (interquartile range, 13.5 years), 84.3% (253 of 300) were married, and the mean weekly earnings were US $30 (interquartile range, US $23). During a mean (SD) follow-up of 9 (2) weeks, 37.3% (50 of 134) in the intervention group saved money in a bank account vs 27.2% (37 of 136) in the control group, although the difference was not statistically significant (odds ratio, 1.62; 95% CI, 0.96-2.74). The intervention group had higher growth in bank savings balances (US $10.26; 95% CI, US $5.00-US $58.20 vs US $4.87; 95% CI, US $0.67-US $9.00) and higher total savings from all sources (US $201; 95% CI, US $133-US $269 vs US $145; 95% CI, US $88-US $202), but neither difference was statistically significant. The intervention did not have a significant effect on alcohol, gambling, and transactional sex expenditures.
Conclusions and Relevance Prize-linked savings accounts modestly increased savings among high-risk men in Kenya over a 9-week period, but the difference compared with standard-interest savings accounts was not significant. Testing of more powerful savings products is needed to assess whether such savings-led interventions can reduce men’s expenditures on alcohol, gambling, and transactional sex.
(September 2019). Differences at the Extremes? Gender, National Contexts, and Math Performance in Latin America. American Educational Research Journal, 57(3), 1290-1322.
Studies of gender disparities in STEM (science, technology, engineering, and mathematics) performance have generally focused on average differences. However, the extremes could also be important because disparities at the top may shape stratification in access to STEM careers, while disparities at the bottom can shape stratification in dropout.
This article investigates determinants of gender disparities in math across the performance distribution in Latin American countries, where there is a persistent boys’ advantage in STEM performance. Findings reveal disparate national patterns in gender gaps across the performance distribution. Furthermore, while certain national characteristics are linked to gender gaps at the low- and middle-ranges of the performance distribution, female representation in education is the only characteristic associated with a reduced gender gap at the top level.
(August 2019). Effect of Prices, Distribution Strategies, and Marketing on Demand for HIV Self-Testing in Zimbabwe: A Randomized Clinical Trial. JAMA Network Open, 2(8), e199818.
Greater awareness of HIV status and more frequent testing in high-risk populations are essential for realizing the promise of treatment as prevention and achieving the 90-90-90 targets of the Joint United Nations Programme on HIV/AIDS (that by 2020, 90% of people living with HIV will know their HIV status, 90% of people with diagnosed HIV will be on antiretroviral therapy [ART], and 90% of people receiving ART will be virally suppressed).1 Yet in sub-Saharan Africa, nearly 20% of people living with HIV were unaware of their status in 2017.2 Despite the scale-up of a clinic- and community-based models for providing HIV testing services, testing coverage remains suboptimal, particularly among men and other key populations.3 To close the testing gap and advance HIV prevention objectives, innovative approaches are needed to increase the uptake of HIV testing in sub-Saharan Africa.
A self-administered test for HIV allows individuals to collect their own sample and to perform a simple, rapid HIV antibody test in the absence of a health care practitioner.4 Several oral fluid-based or blood-based HIV tests have received prequalification from the World Health Organization and showed high sensitivity and specificity among lay users.4 Existing research shows high interest in and acceptability of HIV self-testing across a wide range of populations.5–12 After the 2016 World Health Organization guidelines that recommended large-scale implementation of HIV self-testing, self-tests are becoming more widely available in governmental health facilities and retail outlets in several countries in sub-Saharan Africa with high HIV prevalence.4
Donor agencies and governments have heavily subsidized HIV self-tests for distribution in some countries, and private sector availability is emerging in parallel.13 However, the cost of self-tests and the price for consumers represent important obstacles to large-scale implementation of HIV self-testing. As countries seek to scale up HIV self-testing for priority populations, little evidence exists on the effect of alternative pricing and marketing strategies on self-testing demand. A growing body of evidence from low-income countries shows that demand for prevention technologies, such as antimalarial bed nets and water filtration solutions, is highly price sensitive.14–19 Knowing the self-testing demand at various prices in the general population and key subgroups is important for setting appropriate subsidy levels for these self-tests and for understanding the demand for HIV prevention technologies in general. Moreover, with HIV self-testing, information is limited about the optimal distribution approaches for reaching untested individuals and messaging strategies for promoting the adoption of such new technologies. Estimating how demand is affected not only by prices but also by various distribution approaches and types of information provided to consumers can further inform HIV self-testing scale-up efforts.
We conducted a large community-based randomized clinical trial to examine the optimal pricing policies and distribution strategies for HIV self-testing in Zimbabwe.
(July 2019). Viral Voting: Social Networks and Political Participation. Quarterly Journal of Political Science.
Social context theory suggests that an important driver of political participation is the behavior of family, friends, co-workers, and neighbors. How do social ties between individuals shape equilibrium behavior in larger populations? Despite theoretical inroads into this question, direct empirical tests remain scarce due to data limitations.
We fill this gap using full social network data from 15 villages in rural Uganda, where village-level turnout is the outcome of interest. We find that levels of participation predicted by structural features of village networks are strongly associated with actual village-level turnout in low-salience local elections, and weakly associated in high-salience presidential elections. We also find these features predict other forms of political participation, including attending village meetings and contributing to village projects.
In addition to demonstrating that networks help explain political participation, we provide evidence that the mechanism of influence is that proposed by social context theory rather than alternative mechanisms like the presence of central brokers or the ability of networks to diffuse information.
(March 2019). The Uncertain Effect of Financial Incentives to Improve Health Behaviors. JAMA: The Journal of the American Medical Association, 321(15), 1451-1452.
If intrinsic motivations alone were enough to influence health behaviors, individuals would not smoke, all drivers would wear seat belts, and patients with chronic conditions would take their medications. Yet approximately half of patients prescribed single-drug therapy for hypertension discontinue their medications within a year,¹ even though presumably they want to avoid strokes and hopefully know that taking their medication is one way to reduce health risks.
To supplement the intrinsic motivations apparently insufficient to the task, economists and others have long proposed extrinsic motivations in the form of financial rewards. These rewards offer the added benefit of being immediate rather than the typically delayed intrinsic rewards of better health sometime in the future. Studies in varied health domains have revealed that financial incentives work well.
For example, a 2015 systematic review determined that to reduce smoking during pregnancy, financial or material incentives were more effective than other medical or behavioral strategies.² The use of incentives is also widespread. In 2018, 86% of US employers offered some financial incentives for healthy behavior,³ and in lower-income countries, conditional cash transfer programs rewarded utilization of preventive services.
(February 2019). Electric Heating and the Effects of Temperature on Household Electricity Consumption in South Africa. The Energy Journal, 41(4).
How does temperature affect household energy demand in low-income countries? I use 132,375,282 hourly electricity consumption observations from 5,975 households in South Africa to estimate the causal effects of short-term temperature changes on household electricity consumption. The estimates flexibly identify a constant log-linear temperature response – for every 1°C increase in temperature, electricity consumption decreases by 4.1% among temperatures below the heating threshold but increases by 8.1% among temperatures above the cooling threshold.
This relationship is driven more strongly by seasonal than hourly temperature changes. Holding all else constant, a 3.25°C increase in temperatures would reduce electricity consumption by 1,093.4 kWh (6.2%) per year per household. Widespread use of electric heating due to limited residential gas heating infrastructure likely drives this. These results point to important regional heterogeneity in how temperature increases may affect household energy demand in the coming decades.
(July 2018). Comparative Effectiveness of Novel Nonmonetary Incentives to Promote HIV Testing. AIDs, 32(11).
To assess the comparative effectiveness of alternative incentive-based interventions to promote HIV testing among men.
Randomized clinical trial.
We enumerated four Ugandan parishes and enrolled men at least 18 years. Participants were randomized to six groups that received incentives of varying types and amount for HIV testing at a 13-day community health campaign. Incentive types were: gain-framed (control): participants were told they would receive a prize for testing; loss-framed: participants were told they had won a prize, shown several prizes, asked to select one, then told they would lose the prize if they did not test; lotteries: those who tested had a chance to win larger prizes. Each incentive type had a low and high amount (∼US$1 and US$5/participant). The primary outcome was HIV-testing uptake at the community health campaign.
Of 2532 participants, 1924 (76%) tested for HIV; 7.6% of those tested were HIV-positive. There was no significant difference in testing uptake in the two lottery groups (78%; P = 0.076) or two loss-framed groups (77%; P = 0.235) vs. two gain-framed groups (74%). Across incentive types, testing did not differ significantly in high-cost (76%) vs. low-cost (75%; P = 0.416) groups. Within low-cost groups, testing uptake was significantly higher in the lottery (80%) vs. gain-framed (72%; P = 0.009) group.
Overall, neither offering incentives via lotteries nor framing incentives as losses resulted in significant increases in HIV testing compared with standard gain-framed incentives. However, when offering low-cost incentives to promote HIV testing, providing lottery-based rewards may be a better strategy than gain-framed incentive
(2016). Education in Emergencies and Protracted Crises: Developing Inclusive, Responsive, and Resilient Education Services for All. Education2030 Brief, 2. UNESCO.
UNESCO Dakar has launched the Education 2030 Brief series that aims to inform education policy makers and practitioners, including Ministers of Education and senior sector managers, of significant and important policy-related issues on education and learning in sub-Saharan Africa, especially West and Central Africa.
Published on a regular basis, each four-page brief note draws on the past and current research and experience to present concise analyses of policy gaps, challenges, options, and recommendations surrounding a specific education-related theme. The Education 2030 Brief series is intended to provide policy makers with relevant background information that helps them further explore relevant policy options in related thematic areas.
The second of this series, entitled “Education in Emergencies and Protracted Crises in sub-Saharan Africa. Developing Inclusive, Responsive, Resilient Education Services for All”, discusses the issue of education, out-of-school children and adolescents in conflict-affected areas and post-disaster situations due to insecurity within and across borders, severe vulnerability resulting from climate change, chronic poverty, and underinvestment in social services. The brief calls upon policy makers in sub-Saharan Africa to address education data and planning in emergency situations, respond to the needs of marginalized groups and ensure timely coordination between humanitarian and development aid for education in order to develop more inclusive, responsive, and resilient education systems.
(2016). Strengthening Education in West and Central Africa by Improving Learners Sexual and Reproductive Health. Education2030 Brief, 3. UNESCO Dakar
West and Central Africa (WCA) is the region of the world with the largest percentage of young people (32%, UNFPA, 2016) and the highest gender disparity in education. Upper secondary school completion rates are 35% for boys and 25% for girls (UNICEF, 2016). A number of factors are responsible for the persistent gender disparities in education. Among them, early and unintended pregnancy, which is often linked to child marriage, poor sexual and reproductive health (SRH) including HIV infection, and school-related gender-based violence (GBV) have a marked impact on the education and future prospects of young people (UNESCO, 2016).
Few young people in the region receive adequate preparation for their sexual lives. Fortunately, education itself can be harnessed to give young people the knowledge and skills to make informed decisions about their SRH and to develop attitudes and values which support human rights and gender equality. Tea growing population of young people in the region requires that ministries of education and local education authorities in WCA countries improve and scale up comprehensive sexuality education (CSE), which is defined as an age-appropriate and culturally relevant approach to teaching about sex and relationships by providing scientifically accurate, realistic, non-judgemental information (UNESCO, 2009).
To be effective, CSE needs to fully integrate gender and human rights (UNFPA, 2014) and to be paired with adolescent-friendly SRH services. CSE is best delivered in safe and healthy learning environments, where school-related GBV is also addressed at the level of rules and regulations, links with communities, and reporting and referral mechanisms. Addressing issues surrounding both health and gender equality, as recommended in global commitments (Box 1), will contribute to achieving SDG4 – to “Ensure inclusively and quality education for all and promote lifelong learning ”- as well as to realizing the demographic dividend.
(2009). Globalization and human cooperation, Proceedings of the National Academy of Sciences, 106(11), 4138-4142.
Globalization magnifies the problems that affect all people and that require large-scale human cooperation, for example, the overharvesting of natural resources and human-induced global warming. However, what does globalization imply for the cooperation needed to address such global social dilemmas? Two competing hypotheses are offered.
One hypothesis is that globalization prompts reactionary movements that reinforce parochial distinctions among people. Large-scale cooperation then focuses on favoring one’s own ethnic, racial, or language group. The alternative hypothesis suggests that globalization strengthens cosmopolitan attitudes by weakening the relevance of ethnicity, locality, or nationhood as sources of identification. In essence, globalization, the increasing interconnectedness of people worldwide, broadens the group boundaries within which individuals perceive they belong. We test these hypotheses by measuring globalization at both the country and individual levels and analyzing the relationship between globalization and individual cooperation with distal others in multilevel sequential cooperation experiments in which players can contribute to individual, local, and/or global accounts.
Our samples were drawn from the general populations of the United States, Italy, Russia, Argentina, South Africa, and Iran. We find that as a country and individual levels of globalization increase, so too does individual cooperation at the global level vis-à-vis the local level. In essence, “globalized” individuals draw broader group boundaries than others, eschewing parochial motivations in favor of cosmopolitan ones. Globalization may thus be fundamental in shaping contemporary large-scale cooperation and maybe a positive force toward the provision of global public goods.