R01HD102382

Health Decision-Making in the Aftermath of Disaster - 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 a Comunidade e Crianças (FCC), which translates to "Strengthening Communities and Children." Out of 76 communities, half were assigned to the treatment group, receiving the FCC program, while the remainder served 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.

Regents Of The University Of Michigan

TO CONDUCT AND SUPPORT LABORATORY RESEARCH, CLINICAL TRIALS, AND STUDIES WITH PEOPLE THAT EXPLORE HEALTH PROCESSES. NICHD RESEARCHERS EXAMINE GROWTH AND DEVELOPMENT, BIOLOGIC AND REPRODUCTIVE FUNCTIONS, BEHAVIOR PATTERNS, AND POPULATION DYNAMICS TO PROTECT AND MAINTAIN THE HEALTH OF ALL PEOPLE. TO EXAMINE THE IMPACT OF DISABILITIES, DISEASES, AND DEFECTS ON THE LIVES OF INDIVIDUALS. WITH THIS INFORMATION, THE NICHD HOPES TO RESTORE, INCREASE, AND MAXIMIZE THE CAPABILITIES OF PEOPLE AFFECTED BY DISEASE AND INJURY. TO SPONSOR TRAINING PROGRAMS FOR SCIENTISTS, DOCTORS, AND RESEARCHERS TO ENSURE THAT NICHD RESEARCH CAN CONTINUE. BY TRAINING THESE PROFESSIONALS IN THE LATEST RESEARCH METHODS AND TECHNOLOGIES, THE NICHD WILL BE ABLE TO CONDUCT ITS RESEARCH AND MAKE HEALTH RESEARCH PROGRESS UNTIL ALL CHILDREN, ADULTS, FAMILIES, AND POPULATIONS ENJOY GOOD HEALTH. THE MISSION OF THE NICHD IS TO ENSURE THAT EVERY PERSON IS BORN HEALTHY AND WANTED, THAT WOMEN SUFFER NO HARMFUL EFFECTS FROM REPRODUCTIVE PROCESSES, AND THAT ALL CHILDREN HAVE THE CHANCE TO ACHIEVE THEIR FULL POTENTIAL FOR HEALTHY AND PRODUCTIVE LIVES, FREE FROM DISEASE OR DISABILITY, AND TO ENSURE THE HEALTH, PRODUCTIVITY, INDEPENDENCE, AND WELL-BEING OF ALL PEOPLE THROUGH OPTIMAL REHABILITATION.

93.865 - Child Health and Human Development Extramural Research

National Institute of Child Health and Human Development (NICHD) [HHS - NIH]

Ann Arbor, Michigan 481091276 United States

Single Zip Code

NIH Research Project Grant (Parent R01 Clinical Trial Not Allowed) (PA-20-185)

Amendment Since initial award the total obligations have increased 378% from $661,298 to $3,159,192.