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This paper analyzes a randomized controlled trial of a personalized digital counseling intervention addressing informational constraints and choice architecture, cross-randomized with discounts for long-acting reversible contraceptives (LARCs), such as intrauterine devices (IUDs). The counseling intervention encourages shared decision-making (SDM) using a tablet-based app, which provides a tailored ranking of modern methods to each client according to their elicited needs and preferences. Take-up of LARCs in the status quo regime at full price was 11%, which increased to 28% with discounts. SDM roughly tripled the share of clients adopting a LARC at full price to 35%, and discounts had no incremental impact in this group. Neither intervention affected the take-up of short-acting methods, such as the pill. Consistent with theoretical models of consumer search, SDM clients discussed more methods in depth, which led to higher adoption rates for second- or lower-ranked LARCs. Our findings suggest that low-cost individualized recommendations can potentially be as effective in increasing unfamiliar technology adoption as providing large subsidies.

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In this Registered Report, we investigated the impact of a cash transfer based poverty alleviation program on cognitive performance. We analyzed data from a randomized controlled trial conducted on low-income, high-risk individuals in Liberia where a random half of the participants (n = 251) received a $200 lump-sum unconditional cash transfer - equivalent approximately to 300% of their monthly income - while the other half (n = 222) did not. We tested both the short-term (2-5 weeks) and the long-term (12-13 months) impact of the treatment via several executive function measures. The observed effect sizes of cash transfers on cognitive performance (b = .13 for the short- and b = .08 for the long-term) were roughly three and four times smaller than suggested by prior non-randomized research. Bayesian analyses revealed that the overall evidence supporting the existence of these effects is inconclusive. A multiverse analysis showed that neither alternative analytical specifications nor alternative processing of the dataset changed the results consistently. However cognitive performance varied between the executive function measures, suggesting that cash transfers may affect the subcomponents of executive function differently.

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This paper examines the links between adverse events, depression, and decision-making in Nigeria. It investigates how events such as conflicts, shocks, and deaths of family members can affect short-term mental health, as well as longer-term decisions on economic activities and human capital investments. First, the findings show that exposure to conflict has the largest and strongest relationship with depression, associated with a 21-26 percentage point increase in the probability of depressive symptomatology. Second, depression is associated with lower labour force participation, child educational investment, and annual per capita income, holding constant covariates such as exposure to adverse events. People with depressive symptoms are 8 percentage points less likely to work. In addition, parents exhibiting depressive symptoms spend 18% less on their children's education. These findings show the links between adverse events and important outcomes such as labour and education through mental health. As such, policymakers must consider both the direct and indirect effects that adverse events - particularly conflicts - and depression can have on welfare.

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Technological advances are enabling roles for machines that present novel ethical challenges. The study of 'AI ethics' has emerged to confront these challenges, and connects perspectives from philosophy, computer science, law, and economics. Less represented in these interdisciplinary efforts is the perspective of cognitive science. We propose a framework - computational ethics - that specifies how the ethical challenges of AI can be partially addressed by incorporating the study of human moral decision-making. The driver of this framework is a computational version of reflective equilibrium (RE), an approach that seeks coherence between considered judgments and governing principles. The framework has two goals: (i) to inform the engineering of ethical AI systems, and (ii) to characterize human moral judgment and decision-making in computational terms. Working jointly towards these two goals will create the opportunity to integrate diverse research questions, bring together multiple academic communities, uncover new interdisciplinary research topics, and shed light on centuries-old philosophical questions.

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INTRODUCTION: Reduction of unmet need for contraception is associated with enhanced health outcomes. We conducted a randomised controlled trial in Mozambique analysing the effects of text messages encouraging use of family planning services. METHODS: This trial was conducted within a sample of women served by the Integrated Family Planning Program implemented by Population Services International, in which community health workers provide clinic referrals for family planning services. The evaluation enrolled 5370 women between 20 January and 18 December 2020 who received a referral, reported access to a mobile phone and provided consent. Women were randomly assigned to a treatment group that received a series of text message reminders encouraging them to visit a clinic or to a control arm. An intention-to-treat analysis was conducted to analyse the effect of reminders on the probability of a clinic visit and contraceptive uptake. The final analysis includes 3623 women; 1747 women were lost to follow-up. RESULTS: Women assigned to receive the text reminders are weakly more likely to visit a clinic (risk difference 2.3 percentage points, p=0.081) and to receive a contraceptive method at a clinic (2.2 percentage points, p=0.091), relative to a base rate of 48.0% and 46.9%, respectively. The effect on clinic visits is larger and statistically significant in the prespecified subsample of women enrolled prior to the COVID-19-related state of emergency (3.2 percentage points, p=0.042). CONCLUSION: Evidence from this trial suggests that text message reminders are a promising nudge that increases the probability that women receive contraception. TRIAL REGISTRATION NUMBER: AEARCTR-0005383.

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Introduction: Reduction of unmet need for contraception is associated with enhanced health outcomes. We conducted a randomised controlled trial in Mozambique analysing the effects of text messages encouraging use of family planning services. Methods: This trial was conducted within a sample of women served by the Integrated Family Planning Program implemented by Population Services International, in which community health workers provide clinic referrals for family planning services. The evaluation enrolled 5370 women between 20 January and 18 December 2020 who received a referral, reported access to a mobile phone and provided consent. Women were randomly assigned to a treatment group that received a series of text message reminders encouraging them to visit a clinic or to a control arm. An intention-to-treat analysis was conducted to analyse the effect of reminders on the probability of a clinic visit and contraceptive uptake. The final analysis includes 3623 women; 1747 women were lost to follow-up. Results: Women assigned to receive the text reminders are weakly more likely to visit a clinic (risk difference 2.3 percentage points, p=0.081) and to receive a contraceptive method at a clinic (2.2 percentage points, p=0.091), relative to a base rate of 48.0% and 46.9%, respectively. The effect on clinic visits is larger and statistically significant in the prespecified subsample of women enrolled prior to the COVID-19-related state of emergency (3.2 percentage points, p=0.042). Conclusion: Evidence from this trial suggests that text message reminders are a promising nudge that increases the probability that women receive contraception.

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OBJECTIVE: Countries have adopted different approaches, at different times, to reduce the transmission of coronavirus disease 2019 (COVID-19). Cross-country comparison could indicate the relative efficacy of these approaches. We assess various nonpharmaceutical interventions (NPIs), comparing the effects of voluntary behavior change and of changes enforced via official regulations, by examining their impacts on subsequent death rates. DATA SOURCES: Secondary data on COVID-19 deaths from 13 European countries, over March-May 2020. STUDY DESIGN: We examine two types of NPI: the introduction of government-enforced closure policies and self-imposed alteration of individual behaviors in the period prior to regulations. Our proxy for the latter is Google mobility data, which captures voluntary behavior change when disease salience is sufficiently high. The primary outcome variable is the rate of change in COVID-19 fatalities per day, 16-20 days after interventions take place. Linear multivariate regression analysis is used to evaluate impacts. DATA COLLECTION/EXTRACTION METHODS: publicly available. PRINCIPAL FINDINGS: Voluntarily reduced mobility, occurring prior to government policies, decreases the percent change in deaths per day by 9.2 percentage points (pp) (95% confidence interval [CI] 4.5-14.0 pp). Government closure policies decrease the percent change in deaths per day by 14.0 pp (95% CI 10.8-17.2 pp). Disaggregating government policies, the most beneficial for reducing fatality, are intercity travel restrictions, canceling public events, requiring face masks in some situations, and closing nonessential workplaces. Other sub-components, such as closing schools and imposing stay-at-home rules, show smaller and statistically insignificant impacts. CONCLUSIONS: NPIs have substantially reduced fatalities arising from COVID-19. Importantly, the effect of voluntary behavior change is of the same order of magnitude as government-mandated regulations. These findings, including the substantial variation across dimensions of closure, have implications for the optimal targeted mix of government policies as the pandemic waxes and wanes, especially given the economic and human welfare consequences of strict regulations.

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Covid-19 and the measures taken to contain it have led to unprecedented constraints on work and leisure activities, across the world. This paper uses nationally representative surveys to document how people of different ages and incomes have been affected in the early phase of the pandemic. The data was collected in six countries (China, South Korea, Japan, Italy, UK, and US) in the third week of April 2020. First, we document changes in job circumstances and social activities. Second, we document self-reported negative and positive consequences of the crisis on well-being. We find that young people have experienced more drastic changes to their life and have been most affected economically and psychologically. There is less of a systematic pattern across income groups. While lower income groups have been more affected economically, higher income groups have experienced more changes in their social life and spending. A large fraction of people of low and high income groups report negative effects on well-being.

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Given the role of human behavior in the spread of disease, it is vital to understand what drives people to engage in or refrain from health-related behaviors during a pandemic. This paper examines factors associated with the adoption of self-protective health behaviors, such as social distancing and mask wearing, at the start of the Covid-19 pandemic in the USA. These behaviors not only reduce an individual's own risk of infection but also limit the spread of disease to others. Despite these dual benefits, universal adoption of these behaviors is not assured. We focus on the role of socioeconomic differences in explaining behavior, relying on data collected in April 2020 during the early stages of the Covid-19 pandemic. The data include information on income, gender and race along with unique variables relevant to the current pandemic, such as work arrangements and housing quality. We find that higher income is associated with larger changes in self-protective behaviors. These gradients are partially explained by the fact that people with less income are more likely to report circumstances that make adopting self-protective behaviors more difficult, such as an inability to tele-work. Both in the USA and elsewhere, policies that assume universal compliance with self-protective measures-or that otherwise do not account for socioeconomic differences in the costs of doing so-are unlikely to be effective or sustainable.

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The primary focus of this paper is to offer guidance on the analysis of time streams of effects that a project may have so that they can be discounted appropriately. This requires a framework that identifies the common parameters that need to be assessed, whether conducting cost-effectiveness or benefit-cost analysis. The quantification and conversion of the time streams of different effects into their equivalent health, health care cost or consumption effects avoids embedding multiple arguments in discounting policies. This helps to identify where parameters are likely to differ in particular contexts, what type of evidence would be relevant, what is currently known and how this evidence might be strengthened. The current evidence available to support the assessment of the key parameters is discussed and possible estimates and default assumptions are suggested. Reporting the results in an extensive way is recommended. This makes the assessments required explicit so the impact of alternative assumptions can be explored and analysis updated as better estimates evolve. Some projects will have effects across different countries where some or all of these parameters will differ. Therefore, the net present value of a project will be the sum of the country specific net present values rather than the sum of effects across countries discounted at some common rate.

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We show that a number of noncognitive skills and preferences, including patience and identity, are malleable in adults, and that investments in them reduce crime and violence. We recruited criminally engaged men and randomized one-half to eight weeks of cognitive behavioral therapy designed to foster self-regulation, patience, and a noncriminal identity and lifestyle. We also randomized $200 grants. Cash alone and therapy alone initially reduced crime and violence, but effects dissipated over time. When cash followed therapy, crime and violence decreased dramatically for at least a year. We hypothesize that cash reinforced therapy's impacts by prolonging learning-by-doing, lifestyle changes, and self-investment.

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Intimate partner violence is widespread and represents an obstacle to human freedom and a significant public health concern. Poverty alleviation programs and efforts to economically "empower" women have become popular policy options, but theory and empirical evidence are mixed on the relationship between women's empowerment and the experience of violence. We study the effects of a successful poverty alleviation program on women's empowerment and intimate partner relations and violence from 2009 to 2011. In the first experiment, a cluster-randomized superiority trial, 15 marginalized people (86% women) were identified in each of 120 villages (n = 1800) in Gulu and Kitgum districts in Uganda. Half of villages were randomly assigned via public lottery to immediate treatment: five days of business training, $150, and supervision and advising. We examine intent-to-treat estimates of program impact and heterogeneity in treatment effects by initial quality of partner relations. 16 months after the initial grants, the program doubled business ownership and incomes (p < 0.01); we show that the effect on monthly income, however, is moderated by initial quality of intimate partner relations. We also find small increases in marital control (p < 0.05), self-reported autonomy (p < 0.10), and quality of partner relations (p < 0.01), but essentially no change in intimate partner violence. In a second experiment, we study the impact of a low-cost attempt to include household partners (often husbands) in the process. Participants from the 60 waitlist villages (n = 904) were randomly assigned to participate in the program as individuals or with a household partner. We observe small, non-significant decreases in abuse and marital control and large increases in the quality of relationships (p < 0.05), but no effects on women's attitudes toward gender norms and a non-significant reduction in autonomy. Involving men and changing framing to promote more inclusive programming can improve relationships, but may not change gender attitudes or increase business success. Increasing women's earnings has no effect on intimate partner violence.

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OBJECTIVE: The authors evaluated the use of conditional cash transfers as an HIV and sexually transmitted infection prevention strategy to incentivise safe sex. DESIGN: An unblinded, individually randomised and controlled trial. SETTING: 10 villages within the Kilombero/Ulanga districts of the Ifakara Health and Demographic Surveillance System in rural south-west Tanzania. PARTICIPANTS: The authors enrolled 2399 participants, aged 18-30 years, including adult spouses. INTERVENTIONS: Participants were randomly assigned to either a control arm (n=1124) or one of two intervention arms: low-value conditional cash transfer (eligible for $10 per testing round, n=660) and high-value conditional cash transfer (eligible for $20 per testing round, n=615). The authors tested participants every 4 months over a 12-month period for the presence of common sexually transmitted infections. In the intervention arms, conditional cash transfer payments were tied to negative sexually transmitted infection test results. Anyone testing positive for a sexually transmitted infection was offered free treatment, and all received counselling. MAIN OUTCOME MEASURES: The primary study end point was combined prevalence of the four sexually transmitted infections, which were tested and reported to subjects every 4 months: Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Mycoplasma genitalium. The authors also tested for HIV, herpes simplex virus 2 and syphilis at baseline and month 12. RESULTS: At the end of the 12-month period, for the combined prevalence of any of the four sexually transmitted infections, which were tested and reported every 4 months (C trachomatis, N gonorrhoeae, T vaginalis and M genitalium), unadjusted RR for the high-value conditional cash transfer arm compared to controls was 0.80 (95% CI 0.54 to 1.06) and the adjusted RR was 0.73 (95% CI 0.47 to 0.99). Unadjusted RR for the high-value conditional cash transfer arm compared to the low-value conditional cash transfer arm was 0.76 (95% CI 0.49 to 1.03) and the adjusted RR was 0.69 (95% CI 0.45 to 0.92). No harm was reported. CONCLUSIONS: Conditional cash transfers used to incentivise safer sexual practices are a potentially promising new tool in HIV and sexually transmitted infections prevention. Additional larger study would be useful to clarify the effect size, to calibrate the size of the incentive and to determine whether the intervention can be delivered cost effectively. TRIAL REGISTRATION NUMBER: NCT00922038 ClinicalTrials.gov.

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Reflecting an increasing awareness of the importance of treatment adherence on outcomes in psychiatric populations, the National Institute of Mental Health (NIMH) convened a panel of treatment adherence researchers on September 27-28, 2007 to discuss and articulate potential solutions for dealing with methodological adherence research challenges. Panel discussions and presentations were augmented with targeted review of the literature on specific topics, with a focus on adherence to medication treatments in adults with serious mental illness. The group discussed three primary methodological areas: participants, measures, and interventions. When selecting patients for adherence-enhancing interventions (AEIs), a three-tier model was proposed that draws from the universal (targeting all patients receiving medication treatment for a specific condition, regardless of current adherence), selective (targeting patients at risk for nonadherence), and indicated (targeting patients who are currently nonadherent) prevention model and emphasizes careful patient characterization in relevant domains and appropriate matching of interventions to the selected population. Proposals were also made to reduce problematic selection biases in patient recruitment and retention. The panel addressed the pros and cons of various methods that can be used to measure adherence, and concluded that it is appropriate to use multiple measures whenever possible. Finally, the panel identified a broad range of intervention approaches, and conditions under which these interventions are likely to be most effective at reducing barriers to adherence and reinforcing adherence behavior.

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