HIV/AIDS has led to substantial declines in life expectancy in many parts of Africa. This may be causing people to alter their forward-looking behaviors in ways that are deleterious to future development prospects. At the same time, there is an increasing emphasis on the scale-up of HIV prevention interventions such as male circumcision. Understanding people's behavioral responses to declining life expectancy and their decisions to take-up prevention interventions requires data on their risk preferences, inter-temporal preferences, and subjective life expectancy - all of which play a central role in models of individual decision-making. However, these attitudes are rarely measured in population-based socio-economic surveys in developing countries. The career development activities in this application will allow me to combine insights from economics and psychology and apply them in ways that provide a better understanding of individuals'health behaviors as well as their behavioral responses to reduced life expectancy. I will measure and validate individuals'preferences and expectations using state-of-the-art techniques and I will examine how people form, and revise, these attitudes.
Specific aims i nclude: (1) empirical examination and evaluation of survey- and experiment-based approaches to the elicitation of risk preferences, inter-temporal preferences, and survival expectations;(2) development of direct measures of these preferences and expectations for socio-economic surveys in Kenya;(3) an examination of the predictive power of these measures when studying the take-up of beneficial health interventions such as male circumcision;and (4) implementation of studies that will use data on survival expectations and establish their causal effect on individuals'investment behavior. The training component will enable me to (a) review methods and tools used to understand and measure preferences and expectations in psychology, and (b) gain practical experience in using data from Mexico on risk and inter-temporal preferences. The training program will put me in a position to become an independent scientist who integrates ideas from economics and psychology in order to arrive at a richer understanding of decision-making.

Public Health Relevance

Properly measuring various aspects of individuals'attitudes - their risk preferences, inter-temporal preferences, and their survival expectations - is a necessary step toward empirically studying the many determinants of individuals'health behaviors. This in turn is critical for designing policies and interventions that can successfully promote healthy behavior. I will apply my training to the important public health challenge posed by HIV/AIDS in sub-Saharan Africa.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Scientist Development Award - Research & Training (K01)
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Study Section
Pediatrics Subcommittee (CHHD)
Program Officer
King, Rosalind B
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University of North Carolina Chapel Hill
Schools of Public Health
Chapel Hill
United States
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Evens, Emily; Lanham, Michele; Murray, Kate et al. (2016) Use of Economic Compensation to Increase Demand for Voluntary Medical Male Circumcision in Kenya: Qualitative Interviews With Male Participants in a Randomized Controlled Trial and Their Partners. J Acquir Immune Defic Syndr 72 Suppl 4:S306-10
Thirumurthy, Harsha; Masters, Samuel H; Rao, Samwel et al. (2016) The Effects of Providing Fixed Compensation and Lottery-Based Rewards on Uptake of Medical Male Circumcision in Kenya: A Randomized Trial. J Acquir Immune Defic Syndr 72 Suppl 4:S299-305
Thirumurthy, Harsha; Hayashi, Kami; Linnemayr, Sebastian et al. (2015) Time Preferences Predict Mortality among HIV-Infected Adults Receiving Antiretroviral Therapy in Kenya. PLoS One 10:e0145245
Damon, Maria; Zivin, Joshua Graff; Thirumurthy, Harsha (2015) Health Shocks and Natural Resource Management: Evidence from Western Kenya. J Environ Econ Manage 69:36-52
Thirumurthy, Harsha; Masters, Samuel H; Rao, Samwel et al. (2014) Effect of providing conditional economic compensation on uptake of voluntary medical male circumcision in Kenya: a randomized clinical trial. JAMA 312:703-11
Chi, Benjamin H; Thirumurthy, Harsha; Stringer, Jeffrey S A (2014) Maximizing benefits of new strategies to prevent mother-to-child HIV transmission without harming existing services. JAMA 312:341-2
Venkataramani, Atheendar S; Thirumurthy, Harsha; Haberer, Jessica E et al. (2014) CD4+ cell count at antiretroviral therapy initiation and economic restoration in rural Uganda. AIDS 28:1221-6
Goldstein, Markus; Zivin, Joshua Graff; Habyarimana, James et al. (2013) The Effect of Absenteeism and Clinic Protocol on Health Outcomes: The Case of Mother-to-Child Transmission of HIV in Kenya. Am Econ J Appl Econ 5:58-85
Thirumurthy, Harsha; Chamie, Gabriel; Jain, Vivek et al. (2013) Improved employment and education outcomes in households of HIV-infected adults with high CD4 cell counts: evidence from a community health campaign in Uganda. AIDS 27:627-34
Thirumurthy, Harsha; Galárraga, Omar; Larson, Bruce et al. (2012) HIV treatment produces economic returns through increased work and education, and warrants continued US support. Health Aff (Millwood) 31:1470-7

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