Habit Formation and Rational Addiction: A Field Experiment in Handwashing (Job Market Paper) (with Atonu Rabbani, Giovanni Reggiani, and Natalia Rigol)
Abstract: Regular handwashing with soap is believed to have substantial impacts on child health in the developing world. Most handwashing campaigns have failed, however, to establish and maintain a regular practice of handwashing. Motivated by scholarship that suggests handwashing is habitual, we design, implement and analyze a randomized field experiment aimed to test the main predictions of the rational addiction model. To reliably measure handwashing, we develop and produce a novel soap dispenser, within which a time-stamped sensor is embedded. We randomize distribution of these soap dispensers as well as provision of monitoring (feedback reports) or monitoring and incentives for daily handwashing. Relative to a control arm in which households receive no dispenser, we find that all treatments generate substantial improvements in child health as measured by child weight and height. Our key test of rational addiction is implemented by informing a subset of households about a future boost in monitoring or incentives. We find that (1) both monitoring and incentives increase handwashing relative to receiving only a dispenser; (2) these effects persist after monitoring or incentives are removed; and (3) the anticipation of monitoring increases handwashing rates significantly, implying that individuals internalize the habitual nature of handwashing and accumulate habit stock accordingly. Our results are consistent with the key predictions of the rational addiction model, expanding its relevance to settings beyond what are usually considered `addictive' behaviors.
The Impact of Training Informal Healthcare Providers in India: A Randomized Controlled Trial (with Jishnu Das, Abhijit Chowdhury, and Abhijit Banerjee. Science, October 2016.)
Abstract: Healthcare providers without formal medical qualifications provide more than 70 percent of all primary care in rural India. Training these ‘informal providers’ may be one way to improve quality of care where few alternatives exist. We report on a randomized controlled trial assessing a program that provided 72 sessions of training over 9 months to 152 informal providers (out of 304). Using standardized patients (‘mystery clients’), we assessed clinical practice on three different conditions to which both providers and trainers were blinded during the intervention, representative of the range of conditions these providers normally diagnose and treat. Training increased correct case management by 7.9 percentage points (14.2%) but did not affect the use of unnecessary medicines and antibiotics. At a program cost of $175 per trainee, our results suggest that multi-topic medical training offers an effective short-run strategy to improve healthcare.
Abstract: Sex ratios at birth have risen steadily over the last three decades across much of the developing world. Many attribute this rise to improved access to sex selection technologies such as ultrasound since 1980. This study examines the effect of access to ultrasound technology, and the consequently skewed sex ratios, on the later life outcomes of females in India. Existing economic literature view male- skewed populations as a boon to the marital prospects of females. However, Edlund (1999) proposes a theory that, in environments where hypergamy is practiced and parents derive utility from married children, a male-skewed sex ratio can generate a permanent female underclass. I extend this theory to argue that if sex ratios are skewed disproportionately amongst the rich, then poorer matching in the marriage market can in turn lead to weaker bargaining positions for females. I first present evidence that sex ratios are disproportionately skewed in favor of males amongst the wealthy in high ultrasound regions. I then demonstrate that parents are indeed considering the sex ratio of their unborn child’s future marriage market when determining the sex composition of their family: ultrasound technology adoption varies not only by own wealth status but also by the state of the surrounding marriage market. I then utilize a difference-in-difference approach to identify the impact of ultrasound access on intrahousehold outcomes of affected women. I find evidence that greater parental access to sex selection technology at a son’s birth is related to lower education and health, greater marriage age and education gaps, and a smaller share of bargaining power as measured by autonomy and child production decision-making. As the first cohort of females affected by ultrasound at birth have entered the marriage market, this study provides timely empirical evidence of the consequences of wealth-dependent demographic shifts on the later life outcomes of females in India.
Throwing the Baby out with the Drinking Water: Unintended Consequences of Arsenic Mitigation Efforts in Bangladesh (with Erica Field and Rachel Glennerster)
Abstract: The 1994 discovery of arsenic in ground water in Bangladesh prompted a massive public health effort to test all tubewells in the country and convince nearly one-quarter of the population to switch to arsenic-free drinking water sources. According to numerous sources, the campaign was effective in leading the majority of households at risk of arsenic poisoning to abandon backyard wells in favor of more remote tubewells or surface water sources, a switch widely believed to have saved numerous lives. We investigate the possibility of unintended health consequences of the wide-scale abandonment of shallow tubewells due to higher expo- sure to fecal-oral pathogens in water from arsenic-free sources. Significant small-scale variability of arsenic concentrations in ground water allows us to compare trends in infant and child mortality between otherwise similar households in the same village who did and did not have an incentive to abandon shallow tubewells. While child mortality rates were similar among households with arsenic-contaminated and arsenic-free wells prior to public knowledge of the arsenic problem, post-2000 households living on arsenic-contaminated land have 27% higher rates of infant and child mortality than those not encouraged to switch sources, implying that the campaign doubled mortality from diarrheal disease. These findings provide novel evidence of a strong association between drinking water contamination and child mortality, a question of current scientific debate in settings with high levels of exposure to microbial pathogens through other channels.
Thar’ She Blows: Can Bubbles be Rekindled with Experienced Subjects? (with David Porter and Vernon Smith. American Economic Review, June 2008.)
Abstract: We report 28 new experiment sessions consisting of up to three experience levels to examine the robustness of learning and "error" elimination among participants in a laboratory asset market and its effect on price bubbles. Our answer to the title question is: "yes." We impose a large increase in liquidity and dividend uncertainty to shock the environment of experienced subjects who have converged to equilibrium, and this treatment rekindles a bubble. However, in replications of that same challenging environment across three experience levels, we discover that the environment yields a rare residual tendency to bubble even in the third experience session. Therefore, a caveat must be placed on the effect of twice-experienced subjects in asset markets: in order for price bubbles to be extinguished, the environment in which the participants engage in exchange must be stationary and bounded by a range of parameters. Experience, including possible "error" elimination, is not robust to major new environment changes in determining the characteristics of a price bubble.
Research in Progress
The Cream of the Crop: Targeting High Ability Entrepreneurs Using Microcredit Group Information (with Natalia Rigol and Benjamin Roth)
This experiment assesses (1) whether community members have information about one another that can be used to identify high-ability microentrepreneurs, (2) whether they have incentives to misreport this information, and (3) whether simple techniques from mechanism design can realign incentives for truthful reporting. We ask 1380 respondents in rural Maharashtra, India to rank their entrepreneur peers on various metrics of business profitability and growth, borrower reliability, and household financial activity. We then distribute grants to a randomly selected set of respondents and track investment and business growth over one year. We find that the information provided by community members is predictive of key business and household characteristics at baseline. We also find a considerable degree of misreporting in favor of respondents' family members and close friends, substantially diminishing the value of reports. We then test the effectiveness of various mechanisms to encourage truthfulness: paying respondents for the accuracy of reports, collecting reports in public rather than in private, and using cross-reporting techniques motivated by implementation theory. All methods significantly improve the accuracy of reports. Finally, preliminary evidence suggests that community members are able to correctly predict the real business profits of their peers over several months, and importantly, also predict the marginal returns of their peers from the randomized grants, or business growth.
Spillovers from the Nursery: Transferring Hygiene Practices from School to Home (with David Levine and Sami Safiullah)
Programs in early education are often intended to teach basic skills that should be adopted not only within schools but more broadly in daily life. The process of information transfer from the institution to the home, however, is both poorly understood and often unsuccessful. This study examines (1) the impact of introducing a handwashing campaign and handsoap dispenser into nursery schools in West Bengal, India, on hygiene practice and child health; and (2) the precise process of information transfer of such practices from the school to the home. Using time-stamped sensor technology in handsoap dispensers distributed both at the school level and at the household level to a random subset of nursery attendees, paired with a hygiene curriculum randomized at the school level, we can track the process of spillovers along two key dimensions: (1) home-to-school and peer-to-peer spillovers, as some schools will have a higher concentration of treated children than others; and (2) school-to-home spillovers, as some children will come from treated schools while others will not.
Hygiene Media and Targeting: Examining Agency in the Household (with Abu Shonchoy and Chikako Yamauchi)
Whether behavioral change campaigns regarding basic public health should be delivered to parents, who have greater decision-making power, or to children, whose behaviors may be more malleable, remains an open question. We explore a unique method of targeting public health information to households in an impoverished region of Bangladesh: mobile-phone based media. This technology generates a captive audience for whom a public health message inserted within a piece of entertainment cannot be skipped. We randomize whether the hygiene campaign messages and entertainment are directed to children or adults and use sensor-laden handsoap dispensers to track the effectiveness of each form of targeting. We pair the time-stamped sensors with time-stamped data on media exposure from the mobile phones to examine and model the role of limited attention in the takeup of hygiene practices.