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

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.