Below is a descriptive list of current research centers and projects funded through CHW. The centers are listed first, and projects appear in alphabetical order by title.
More information about research conducted by CHW affiliates, including publications resulting from these projects, is available on their individual websites.
Center for Research on Experience and Wellbeing
The Center for Health and Wellbeing is home to a National Institute of Aging Roybal Center, called the Center for Research on Experience and Wellbeing (CREW). The overall objectives of CREW are to (1) develop new methods for the measurement of wellbeing and health and (2) use these measures to better understand and document the experience of aging. The measures developed will be used to analyze how different life circumstances and situations contribute to the overall quality of life across the life cycle. The combination of measurements of the affective experience of situations and activities with measurements of the time spent by the population in these activities, currently collected by the Department of Labor Statistics, will contribute to the development of an experimental system of National Wellbeing Accounts. CHW affiliates involved in the Center include Angus Deaton , Alan Krueger and Daniel Kahneman . External researchers include Arthur Stone (University of Southern California), former CHW visiting fellow David Schkade (University of California, San Diego) and Norbert Schwarz (University of Southern California).
The center has funded five pilot projects to date. The active pilot projects are:
- Survey Methods for Measuring Affect – Dylan Smith (Stony Brook University)
There is a growing emphasis on capturing subjective appraisals of emotional experiences, as a supplement to traditional “objective” economic performance measures such as income, or epidemiological measures of health such as longevity. This pilot study tests the validity of several recall-based methods for capturing affect in daily life. Specifically, it examines and compares assessments taken on the same day as the observation day (the “end of day” approach), versus assessments taken the next day. The next day assessment will be either with or without “instantiation” of the previous day, as operationalized in the Day Reconstruction Method (DRM). DRM is a structured diary methodology designed to enhance accurate recall via instantiation of the previous day, which is done by dividing the day into discrete “episodes.” These three approaches differ substantially in terms of the level of burden placed on respondents, and in terms of cost of implementation. The “next day” approach, which relies on memories of the previous day, is the least burdensome as it involves a (potentially) brief survey that can be administered by phone, in written form, or by web survey at any time of day, and at the respondent’s convenience. The “end of day” approach is also brief, but as its name suggests must be completed at the end of the day, which represents a significant constraint. Finally, a full version of the DRM requires around 45 minutes to complete, and thus is not amenable to a brief phone survey (although abbreviated versions have been successfully scaled up for national surveys). To explore the validity of these three approaches, this study will compare the different recall-based methods to real-time assessments taken during the observation day (ecological momentary assessments [EMA]). It will also employ a mood manipulation on the observation day, to examine how well it is captured by differing recall methods, and how it may affect recollection of other parts of the day.
- Expanding options for analyzing and summarizing hedonic wellbeing data from the Day Reconstruction Method – Stefan Schneider and Arthur Stone (University of Southern California)
Interest in the measurement of time-use and hedonic wellbeing (HWB) has risen substantially. One comprehensive method of evaluating time use and HWB is the Day Reconstruction Method (DRM) ( Kahneman et al., 2004 ) . It combines elements of experience sampling and time diaries, and is designed specifically to facilitate accurate recall of daily HWB. The DRM asks respondents to reconstruct all episodes of the previous day, and to indicate the activities, social contexts, and HWB experiences for each episode. This way, a wealth of information about activities, the duration of those activities, and associated HWB is available for each individual.
The DRM provides important and novel opportunities for characterizing and comparing daily HWB between individuals, demographic subgroups, and across cultures. The fact that respondents provide ratings of experiences for multiple daily episodes allows for a much more fine grained understanding of HWB that cannot be achieved by traditional "global" wellbeing survey methods. However, to date, strategies for analyzing DRM data have not exploited the full potential of the method.
The purpose of this application is to investigate several new approaches for analyzing and summarizing daily HWB based on multi-episode data from the DRM using state-of-the-art methods for the analysis of complex survey data. By applying these new approaches and examining their utility, our goal is to enrich the repertoire of available tools for understanding daily HWB from the DRM and similar data collection methods (for example, the Well Being Module of the American Time Use Survey). The application will take advantage of several existing datasets that have used the DRM; no new data will be collected. Drawing on several datasets will be important to determine whether results obtained for one study replicate across studies.
- Investigating the Relation between DRM and Experienced Yesterday Measures – Arie Kapetyn
The Day Reconstruction Method (DRM) elicits a full-day diary of episodes accompanied by an inventory of emotions/moods during each of the episodes. The DRM proves to be successful in reinstating feelings of the previous day (Kahneman et al., 2004) and has become a widely adopted method for eliciting experienced well-being. The DRM however takes considerable response time and hence is hard to incorporate in on-going major population surveys. Several simplifications have been proposed, where rather than asking about the whole previous day, one selects a small number of activities and asks for emotions during the performance of these activities.
A different approach to simplification is taken by the Hedonic Well-Being 12 measure (HWB12; Smith and Stone, 2011), which asks respondents for an overall day assessment on 12 dimensions (happy, enthusiastic, content, angry, frustrated, tired, sad, stressed, lonely, worried, bored, pain) on a 5-point scale. Similarly, the Gallup Experienced Well-Being Index includes 10 items (anger, depression, enjoyment, happiness, sadness, stress, worry, learning or doing something interesting, smiling or laughing a lot, being treated with respect) on a binary scale, in addition to whether the respondent would like to have more days like yesterday.
This project aims to investigate the relation between aggregate measures like the HWB12 and DRM-like approaches. To that end we will conduct a time diary study for one day (“yesterday”) among 2000 respondents in the Understanding America Study. We will moreover elicit emotions for a number of periods. By also asking the HWB12 for “yesterday” we can study the relation between the HWB12 and the DRM. Proper randomizations will take care of possible anchoring effects.
Demography of Aging Center
The Center for Health and Wellbeing is home to a Demography of Aging Center, funded by the National Institute of Aging. The Demography of Aging Center, started in 2004, fosters new research on the interrelationships between socioeconomic status and health as people age; examines the determinants of decision-making and wellbeing among the elderly; and explores the determinants and policy consequences of increased longevity and population aging across and within countries over time. An area of special emphasis is research on how HIV/AIDS is affecting the health and living conditions of the elderly. The key CHW faculty associates working on this project are Anne Case , Jonathan Cohen , Angus Deaton , Noreen Goldman , and Daniel Kahneman . The center is directed by Anne Case .
The center has funded 30 pilot projects to date. The active pilot projects are:
- Scarcity, Cognitive Function, and Stress – Eldar Shafir
This project investigates central aspects of the psychology of scarcity, a novel theoretical framework that looks at some of the psychological challenges faced by people living in poverty, and the behavioral patterns that ensue. Perhaps the defining property of being poor is that money is scarce; there is not enough of it to meet the demands imposed by daily life. One important corollary of monetary scarcity is the persistent need to think about tradeoffs: to compute the budgetary consequences of even small financial decisions (“If I purchase X, what will I not be able to purchase instead?”). This, we posit, yields a demanding and ever-present set of cognitive challenges that are encountered considerably less frequently in the lives of those who are financially more comfortable. The chronic challenges of tradeoff thinking, we suggest, may help explain the greater planning and decision difficulties, including health and financial troubles, so frequently exhibited by the poor, particularly as they age.
- An Exploratory Study of the Occurrence of Pharmaceutical-Induced Aging Symptoms in the United States and in Brazil – João Biehl
This study is a preliminary assessment of how medical professionals and patients identify and treat pharmaceutically-induced aging symptoms in Brazil. Brazil has one of the highest frequencies of drug-induced adverse symptoms in the world. This study is divided in two parts: 1) Identify and interview five to ten health professionals who are currently working in Gerontology and Neurology and/or medical scientists who are carrying out studies on the field of pharmaceutically-induced aging conditions in the city of Porto Alegre, the capital of the southern state of Rio Grande do Sul . The interviews will inquire about the prevalence and clinical forms of pharmaceutically-induced aging symptoms in their routine practices and what challenges these conditions pose for diagnosis and treatment. 2) With the assistance of the health professionals, identify and interview ten adult patients who would be willing to participate in the study. The interviews will inquire about their life history and medical trajectories, aiming to assess the impact that these conditions have on their functionality and quality of life.
- Assays of Immune and Inflammatory Markers in SEBAS – Noreen Goldman
This pilot project is an expansion of existing work being conducted by Dr. Goldman. For the past 15 years, Dr. Goldman and her colleague Dr. Maxine Weinstein (Georgetown University) have been directing a national survey operation in Taiwan under the auspices of the Bureau of Health Promotion in Taiwan, with funding from NIA. The objective of this survey, known as the Social Environment and Biomarkers of Aging Study (SEBAS), has been to explore linkages between the social environment and physical and mental health. SEBAS is based on a random subsample of the Taiwan Longitudinal Survey of Aging (TLSA), a national survey that includes adults approximately age 50 and older. Together with TLSA, the SEBAS data comprise extensive household interviews every three or four years (beginning in 1989 and going through 2011), two rounds of biomarker and genetic measures and information from clinical exams (2000 and 2006), and links with death certificates.
- Non-invasive reproductive steroid hormone indicators of male and female aging in a highly social wild primate model: estrogens in males and testosterone in females – Jeanne Altmann
Professor Altmann and colleagues seek to expand investigations of the physiology of aging to include novel studies of estrogens in males and testosterone in females. Estrogens and testosterone are present in both males and females but testosterone at higher levels in males than females and estrogens exhibit the opposite sex difference. Age changes in concentrations of the more common reproductive hormone found in each sex are well documented in humans. In contrast, the patterns in each sex for the less common reproductive hormones during aging are not well understood and the functional consequences of age changes are even less so. This project seeks to further validate noninvasive measurement of these hormones and exploration of their patterns during aging in a wild primate model using fecal samples.
Health Grand Challenge
The Health Grand Challenge, established in 2007 as part of the University’s Grand Challenges Program and administered by CHW, is an integrated research and teaching program that seeks solutions to the pressing problems of global health and infectious disease.
The Health Grand Challenge has funded 12 projects to date. The active projects are:
- Enhanced Production of Influenza Vaccine by Inhibition of Multiple Viral Restriction Factors - PI: Thomas Shenk
A set of human proteins have been identified that act to block the growth of viruses. They are termed viral restriction factors. We discovered several of the known viral restriction factors, including the family of sirtuin proteins. It is possible to delete or “knock down” expression of viral restriction factors to improve the growth of viruses. We plan to identify an optimal set of viral restriction factors that, when inactivated (deleted or knocked down), markedly improve the growth of influenza virus in cultured cells. Improved yields of the virus has the potential to revolutionize the influenza vaccine industry, markedly reducing the cost of goods and making the vaccine available to a much larger portion of the world’s population.
- Graphene Nanosensors for Ubiquitous Diagnostics - PI: Michael McAlpine
Direct interfacing of nanosensors onto biomaterials could revolutionize health quality monitoring and adaptive threat detection. Graphene is capable of highly sensitive analyte detection. Here we show that the nanoscale nature of graphene allows it to be printed onto water-soluble silk. This in turn permits intimate biotransfer of graphene nanosensors onto biomaterials, including teeth, skin and food. The result is a fully interfaced sensing platform which can be tuned to detect target analytes. For example, via self-assembly of peptides onto graphene, we show bioselective detection of bacteria at single cell levels. Incorporation of a resonant coil eliminates the need for onboard power and external connections. Combining these elements yields two-tiered interfacing of peptide-graphene nanosensors with biomaterials. In particular, we demonstrate integration onto a tooth for remote monitoring of respiration and bacteria detection in saliva. This hierarchical interfacing of biomolecules with nanosensors and biomaterials represents a versatile approach for detecting biochemical targets.
- Health as an Ecosystem Service Around Tanzanian Lakes and National Parks – PI: Andrew Dobson
Although sub-Saharan Africa’s national parks provide significant foreign currency to the government, the revenues they generate are rarely invested in the surrounding community health systems. Rural natives living in the parks’ vicinity have minimal access to basic health care, and many by default rely on traditional healers for treatment for zoonotic and vector-borne diseases.
This project investigates the dynamics and control of zoonotic and vector-borne disease in East Africa and the ‘ecosystem service’ that biodiversity plays in buffering and reducing disease outbreaks. How much do local people benefit from the presence of national parks? Specifically, do the parks serve as sources of ‘trickle down’ revenue from tourism to the local community, or as sources of ‘trickle down’ infections that impact their health and that of their livestock? Alternatively, does the park present a significant opportunity cost through loss of land for forage and crops? Or does it in turn protect local people and domestic livestock from disease outbreaks through the presence of host species that are preferred by vectors, or by other biological mechanisms that buffer disease outbreaks and improve water quality and volume? The research will address the health and economic costs and benefits of conserving biodiversity in the national parks and wildlife reserves.
- Informational Structure of Infectious Diseases – PIs: Ramanan Laxminarayan and Simon Levin
Infectious diseases are carried by individuals, but survive in populations. The transmission of infectious disease is influenced possibly as much by information and human behavior as by the biology of the infection and the ecological landscape. In some sense, information and human behavior are part of the larger ecological landscape in which diseases operate but are relatively less understood than other features such as the population age structure, spatial detail or vector ecology (in the case of vector-borne diseases).
Research in economics and epidemiology has demonstrated that individual behavior is not static and changes with the risk of infection and effectiveness and cost of prevention and treatment. For example, the availability of inexpensive, effective treatment for malaria could reduce bednet purchase and use if individuals perceive a lower cost to being infected. These individual perceptions of risk are formed using a number of factors, including public information (such as on disease risk and prevalence), private information (on one’s own circumstances and behavior) and actions undertaken by others. The effect of herd immunity has been incorporated into disease models; but herd behavior and information cascades, which form the basis for how individuals acquire information, are also important. Taken together, the structure of public (both government and rest of society) and private information plays a key role in disease ecology and the dynamics of transmission.
Informational structure, just like spatial structure, could fundamentally change our understanding of disease progression, predictions of disease models, and effectiveness of public health interventions. Information is among the most powerful tools available to government authorities in time of disease outbreaks, and it is unclear how this tool ought to be used either by itself or in conjunction with other policies such as quarantining or mass vaccination. Also information from public authorities may have to preempt rumors and other sources of information that could exacerbate a disease outbreak.
- Political Islam and the politics of health care in the Arab world - PIs: Amaney Jamal, Tarek Masoud and Elizabeth Nugent
This research grant will contribute to a large, multi-country study of political Islam and its impact on health outcomes in the Arab world. The project seeks to define and quantify the Islamic share of the market for medical services, to identify where and to what social groups such services are offered, to test systematically how the provision of Islamic medical services translates (or fails to translate) into political support for parties espousing identifiably Islamic agendas. This project will also trace the impact of Islamist governance on health outcomes—particularly for women. Do they for example, strive to make basic health services more accessible to women and children? Do they limit funding for family planning or for infectious diseases linked to sexual activity?
The project will involve multiple methodologies: GIS mapping of Islamic clinics; interviews with Islamic healthcare providers; statistical analyses of the correlations between Islamic vote shares and the “Islamic” share of the medical market; experimental and mass surveys of citizens’ political attitudes, voting behavior, and patterns of health care usage; and close analyses of health care legislation introduced by Islamist parliamentarians. The grant will be used to undertake a study in Tunisia in the summer of 2013, with a view toward making a larger proposal to a major research agency, such as the National Science Foundation and National Institutes of Health, to undertake further, cross-national research. The project promises not only to shed light on how Islamists view health care, but also the relationship between the provision of health care and winning elections, and how political Islam affects human development outcomes in the countries in which it has risen to power.
- Predictive Models of Meningitis Risk in the African Meningitis Belt – PIs: Nicole E. Basta, Paul Ginoux and Elena Shevliakova
The complex ecological factors driving the distinct seasonality of meningococcal disease epidemics in the African meningitis belt are poorly understood. Evidence suggests that dust, low absolute humidity, rainfall, wind direction and velocity, land cover, and surface temperature may contribute, and a plausible biological mechanism by which these factors could increase risk of meningococcal disease among asymptomatic carriers has been proposed. We aim to develop, test, and validate an epidemiologic meningococcal disease risk model for Mali and Niger using climatic factors drawn from several high-resolution climate models including a recently published model of global dust circulation.
Our goal is to develop tools to better understand the role of environmental factors in predicting meningitis outbreaks in Africa. Developing these tools will set the stage for more extensive research aimed at modeling epidemiologic risk across the entire meningitis belt and identifying high-priority areas that would most benefit from vaccination, thus addressing a significant public health challenge.
- The Role of Humoral Immunity in Human Health: How Does Infection Susceptibility Relate to Autoimmune Susceptibility? – PI: Andrea Graham
Antibodies are essential for resistance against infectious diseases such as malaria and influenza. Yet antibodies can also cause debilitating autoimmunity when they attack host tissue and/or accrue at such high densities that they damage organs. Despite the importance of these contrasting roles of antibody-mediated (humoral) immunity to human health, the overall relationship between risk of autoimmunity and resistance to infection remains unknown. Recent work on wild animals suggests that hosts actually experience a trade-off between autoimmune and infection susceptibilities. Might such a trade-off apply in people? The U.S. military has accrued a repository of serum samples that, combined with medical records of the serum donors, presents an opportunity to quantify the combined impacts of humoral immunity on human health. Using this resource will enable the pairing of an epidemiological analysis of infectious disease incidence in autoimmune individuals with a laboratory analysis of the strength of their antibody responses to infectious agents. In sum, the research project will use this longitudinal serum bank and database to test the idea that autoimmune susceptibility is associated with enhanced resistance to infectious disease.
- Towards eradication of human malaria: molecular characterization of plasmodial dormancy - PI: Alexander Ploss
Malaria is a life-threatening parasitic disease for which approximately half of the world's population is at risk. About 300-500 million cases of malaria are estimated to occur each year, causing nearly one million deaths. Although progress has been made in preventing and treating malaria, more effective, tolerable, and affordable therapies and vaccines are needed. The malaria parasites, which are transmitted through the bites of infected mosquitoes, causing the most harm to humans are Plasmodium falciparum (Pf) and Plasmodium vivax (Pv). They exhibit a unique and mechanistically undefined human tropism, and animal models that recapitulate these parasitic life cycles are scarce. Pv establishes frequently persistent forms in the liver called hypnozoites and in any attempt to eradicate malaria it will be necessary to know how, when and where to attack these forms. Due to the lack of experimental systems hypnozoites are almost completely undefined and mechanisms of their formation and/or reactivation are unknown. Here, we propose to utilize humanized mice, which harbor a human liver to analyze Pv infection in their native environment. We will transcriptionally profile Pv liver stages and their host cells using deep sequencing approaches. Molecular signatures of malarial dormancy will be critical for identifying putative therapeutic intervention points.
- Understanding the Impact of Meningococcal B Vaccination among Princeton University Students - PI: Nicole Basta
Outbreaks of bacterial meningitis are a significant public threat whenever they occur because of the severity of the disease and the high case fatality. Since the spring of 2013, an outbreak of bacterial meningitis caused by Neisseria meningitidis serogroup B has led to seven cases among Princeton University students, one case among a visitor, and the death of a Drexel University student. This prolonged outbreak has posed a significant public health threat and prompted the introduction of a recently developed, novel meningococcal B vaccine known as Bexsero, through the US Food and Drug Administration’s Investigational New Drug application process since the vaccine is not yet licensed in the US.
Plans to vaccinate incoming students in Fall 2014 presents a unique opportunity to assess the impact of the vaccine on immune response to the outbreak strain and to menB strains more broadly both before and after vaccination. Following our successful study of the impact of Bexsero among Princeton students after the 2013-2014 vaccination campaigns, we will investigate the immunogenicity of Bexsero by conducting an epidemiological study of immune markers of protection against invasive disease both before and after the Bexsero vaccination campaign in a cohort of incoming students. Our aim is to better understand the immune response to meningococcal B vaccination during an outbreak, to evaluate the immunogenicity of the vaccine among college students recently vaccinated with quadrivalent ACWY meningococcal vaccine, and to collect data that could provide evidence-based recommendations to guide future disease control and prevention policies.
- Wild baboons as a model to understand immune function and disease risk during pregnancy and lactation - PIs: Jeanne Altmann and Elizabeth Archie
Scientific understanding of women’s disease risk and immune function during pregnancy and lactation is surprisingly limited. This is partly because pregnant and lactating women are challenging study subjects; hence human studies are often constrained to small sample sizes, sub-optimal controls, and/or biased metadata. Our project will address these challenges by working in the well-studied Amboseli baboon population, which offers decades of dense, longitudinal sampling on behavior and physiology. We propose two aims to reveal how female reproductive status influences three major indices of immune function and disease risk: wound healing, the incidence of illness, and parasite burdens. Our preliminary results suggest that wound healing is delayed during lactation. The resulting data sets will be among the largest in the world on this topic, for either humans or animals, and the proposed project will place us in a competitive position to receive future funding on perinatal health.
Program on U.S. Health Policy
The Program on U.S. Health Policy , launched by CHW in early 2012, sponsors research and activities addressing aspects of domestic health care and health policy. The Program supports innovative faculty and student research, conferences, policy forums and special issues in health policy journals.
>> Call for faculty research proposals
The Program is currently supporting the following research projects:
- Epidemiology of Antibiotic Use in US Hospitals - PIs: Ramanan Laxminarayan and Simon Levin
Endemic antibiotic-resistant bacteria (ARB) in hospitals are a major challenge to in-patient health and significantly increase the costs of hospital stays. Antibiotic selection pressure is a significant determinant of prevalence of ARB, and previous studies have shown that antibiotics are prescribed heavily and often inappropriately in acute-care hospitals (Craig, Uman et al. 1978, Elhanan, Sarhat et al. 1997, Gorecki, Schein et al. 1999). Unnecessary use of antimicrobials contributes to the transmission of antimicrobial-resistant nosocomial pathogens in part by eliminating normal anaerobic bacterial flora that inhibit overgrowth of pathogenic microorganisms. The overuse and misuse of antimicrobials, combined with the growing challenges posed by antimicrobial-resistant organisms, have led to calls for better antimicrobial therapy in the in-patient setting.
Though various interventions to improve antimicrobial use have been developed, the implementation of these interventions has been hampered by a lack of data on the “epidemiology of antimicrobial use”—that is, how clinicians make decisions to start, stop, and change antimicrobial therapy for in-patients. A deeper understanding of what types of clinical syndromes tend to prompt antimicrobial therapy and what information then prompts changes in that therapy will be critical to ongoing efforts at the US Centers for Disease Control and Prevention (CDC) to improve in-patient antimicrobial use. For example, in the past 40 years no multicenter studies have examined the most common clinical syndromes for which antimicrobials are prescribed in the in-patient setting (Scheckler and Bennett 1970). Knowing which syndromes account for the most frequent use could inform the development of improved diagnostics and treatment algorithms to optimize antimicrobial therapy for these syndromes. Likewise, there is no information from multicenter studies on how frequently antibiotics are stopped when microbiologic studies show no sign of infection. Knowing how commonly this occurs and the factors that are associated with decisions to stop or continue antimicrobials in the setting of negative cultures could inform interventions to help improve these decisions in health care facilities.
In this study, we aim to characterize the general epidemiology of antibiotic use in the selected hospitals. The research will rely on an existing effort, funded by the CDC that uses full chart abstractions to capture detailed information on antimicrobial prescriptions, patient’s clinical information at the time of the prescription, subsequent changes to the antimicrobial therapy, and clinical information at the time antimicrobial prescription changes are made in hospitals. We have collected data from six acute-care facilities that vary with respect to location, size, type, and presence of antibiotic stewardship programs. We propose to use these existing chart-review data, and collect additional data on the performance of antibiotic stewardship programs from the six facilities to characterize the general epidemiology of antibiotic use in the selected hospitals.
- Exploring Small Area Variations in Children’s Health Care – PI: Janet Currie
One of the “stylized facts” about American medicine is that some areas spend much more on health care without achieving noticeably better results in terms of reductions in morbidity and mortality. Reining in such “excess” spending is an important goal of health care reform, yet we have little understanding of the reasons these variations exist. We do not even know how common they are in the non-elderly population, since virtually all of this research has been conducted using data on the elderly. It is possible that these patterns are quite different in the elderly and non-elderly since the elderly all have relatively generous health insurance coverage under the Medicare program. This research will first investigate small area variations in health care for children, and in subsequent health outcomes. The research will then investigate reasons that have been suggested for these variations including financial incentives facing providers; differences in patient populations; differences in legal regimes; spillovers from one provider to another in terms of practice style; and learning by individual practitioners.
- Impact of Meningcoccocal B Vaccination during the 2013 Princeton University Outbreak – PI: Nicole Basta
Meningococcal disease outbreaks caused by the bacterial pathogen Neisseria meningitides are a significant public health threat whenever they occur due to the severity of the disease and the high risk of mortality. Serogroup B outbreaks are on the rise, and how best to control these outbreaks is a key health policy question. We propose to investigate the impact of the introduction of the 4CMenB vaccine, not yet licensed in the US but imported, on the 2013 Princeton University outbreak. By assessing the level of immunity induced by the vaccine against the outbreak strain, we will be able to determine how well protected vaccinated students are compared to students who chose not to be vaccinated and to estimate the extent of protective immunity in the student population. The results of this investigation will provide insight into the impact of the vaccination campaign and provide evidence to inform future policy decisions.
- Improving maternity care in New Jersey: How do hospitals respond to policy mandates to reduce cesarean section rates and improve breastfeeding rates? – PI: Elizabeth Armstrong
This research proposes to investigate how the 50-some maternity hospitals in New Jersey are responding to maternity care policy mandates to reduce cesarean rates and increasing breastfeeding rates. Cesarean rates and breastfeeding rates are complex, multifactorial outcomes that reflect provider practices, institutional protocols, patient preferences, sociodemographic characteristics of the patient population, and cultural norms. The research project will analyze hospital-level and state-wide data, and conduct interviews with a range of actors from a sample of New Jersey hospitals, to investigate the following questions: How do providers and hospital administrators seek to achieve mandates to reduce cesareans and increase breastfeeding? What do they see as the most important determinants of these outcomes? How do they prioritize institutional responses? And what is the effect of these policy shifts on actual clinical practice as well as patient outcomes?
- Long-run effects of privatizing public health insurance - PI: Ilyana Kuziemko
Since the 1980s, health care costs and income inequality have risen more quickly in the US than in other developed countries. Past work suggests that one policy response to rising health-care costs--privatization of public insurance programs such as Medicaid and Medicare--may have exacerbated health inequality by rationing care to those in poor health. Another important strand of literature documents strong links between health and economic outcomes. This project asks whether more direct links can be drawn between privatization and later-life inequality. Specifically, I examine whether the privatization of Medicaid—which has been shown to exacerbated health inequalities among infants--affects later-life disparities in elementary- and secondary-school outcomes.
- mDiary Study of Adolescent Relationships - PIs: Marta Tienda and Rachel Goldberg
We will expand on a successful pilot by testing the scalability of a relationship diary study (mDiary) administered using smartphones. Specifically, we will administer bi-weekly mobile relationship diaries over a 12-month period to 250 youth in middle adolescence that have participated in the Fragile Families and Child Wellbeing Study (FFCWS) since birth. FFCWS is a unique panel study that represents births in large to medium cities, with oversamples of unmarried parents, and is especially useful for studying minority and disadvantaged populations. Pairing the FFCWS and mDiary data offers a unique opportunity to study the childhood and adolescent precursors to healthy and unhealthy partnering behaviors, and consequences for adolescent reproductive and emotional health. The scientific value of the proposed diary study transcends our specific focus on adolescent relationships because of the growing interest in using mobile technologies for health research and interventions across a range of outcomes.
- Making Health Insurance Work: Data-Driven Incentive Alignment – PIs: Mark Braverman and Sylvain Chassang
Capitation schemes, in which plans are paid expected health care costs for the people who join them, are a key component of health care insurance policies, but existing schemes are subject to gaming by health plans seeking to attract patients with lower than expected cost of care. In the past ill designed capitation schemes have contributed to the failure of health insurance exchanges in Texas (1999) and California (2006). This research program, at the intersection of Economics and Computer Science, studies the value of large exhaustive data sets of patient characteristics in resolving this issue. It proposes novel uses for such data that go beyond standard data mining applications, and instead focuses on correct incentive provision.
- Modeling the Impact of Pre-Exposure Prophylaxis and Targeted Hepatitis C Case-finding and Treatment on the HIV and HCV epidemics in Newark, NJ – PI: Bryan Grenfell
A key issue for US health policy is prioritizing the various approaches toward addressing the ongoing domestic HIV epidemic. While national prevalence is low on a global scale (<1%), prevalence in certain impoverished urban areas remains alarmingly high. Key at-risk populations in these high-prevalence hotspots may suffer additional morbidity from opportunistic infections such as Hepatitis C and tuberculosis. The research aim of this two-year proposal is to develop and deploy a novel mathematical model to assess the impact of a range of treatment and prevention interventions on the HIV and Hepatitis C (HCV) epidemics in Newark, NJ, one of these high-prevalence hotspots. This work will also be leveraged to provide significant undergraduate training opportunities in this important area of US health. The first stage of the project investigating interventions for HIV mono-infection along the Test-and-Treat pathway has already been piloted, and subsequent major refinements will form the main body of the grant. These extensions involve planning and implementing new models that take into account HCV transmission as well as a possible intervention in the form of pre-exposure prophylaxis (PrEP). Detailed research is necessary to carry out assessment of the impact of PrEP and Hepatitis C treatment. Results of this modeling work will be used to inform economic models to generate cost-effectiveness assessments and to help shape local and national control policy. We will collaborate with researchers at Princeton and the University of Medicine and Dentistry of New Jersey in Newark, NJ.
Dimensions of Subjective Well-Being: Aging, Religiosity, and Adaptation
Angus Deaton, PI
The project, funded in August 2011 by the National Institute on Aging, is directed by Angus Deaton , in collaboration with Arthur Stone, Distinguished Professor of Psychiatry and Psychology at Stony Brook University, and Nobel Laureate Daniel Kahneman , Professor Emeritus of Psychology and Public Policy at Princeton. The project will study the use of self-reports as measures of well-being, with a view to advancing the measurement of subjective well-being and to advancing the understanding of whether and how such measures can and should be used in policy. The analysis rests on the distinction between different concepts of “happiness.” One concept relates to hedonic well-being, the continuous flow of feelings that is experienced on a moment to moment basis. The other is an overall view of how life is going, which comes from a considered judgment. Accumulating evidence suggests that these two concepts capture different aspects of human well-being, and that they respond differently to different circumstances.
The project will explore this distinction using large new data sets for the United States and for more than 150 countries around the world. It will look at how the different measures of self-reported well-being are related to life circumstances, with a particular focus on age. There are several hypotheses in economics and psychology about how subjective well-being should change over the life-cycle, and these will organize the investigations.
Another major line of investigation is the role of religiosity in well-being; the research will seek to better understand both the determinants of religiosity—why people become more religious as they age, why women are more religious than men—as well as the benefits or costs of religion and whether they are or are not universal around the world. The final topic is the extent to which subjective well-being is relative: for example, whether well-being depends on a person’s own income, or instead on income relative to the income of others. One hypothesis is that the well-known phenomenon of adaptation can often be mistaken for relativity, and that this has important consequences for thinking about economic policy for the elderly, including such issues as the taxation of social security benefits or incentives for postponing retirement.
An overarching theme of the work is to understand whether self-reports of well-being can be defended as guides to policy, or whether the criticisms of them by some philosophers and economists are sufficient to rule them out. A better understanding of adaptation is also a key for this last endeavor.
Fragile Families and Child Wellbeing Study
Sara McLanahan, PI
The Fragile Families and Child Wellbeing Study is following a cohort of nearly 5,000 children born in large U.S. cities between 1998 and 2000 (roughly three-quarters of whom were born to unmarried parents). The Study consists of interviews with both mothers and fathers at birth and again when children are ages one, three, five, and nine, plus in-home assessments of children and their home environments at ages three, five, and nine. The Study provides new information on the capabilities and relationships of parents, particularly unwed parents, as well as the effects of parental resources and public policies on children's wellbeing. The Study is a joint effort of the Center for Research on Child Wellbeing, CHW, Columbia University's Columbia Population Research Center, and the National Center for Children and Families. The Principal Investigator is Sara McLanahan at Princeton University and Irwin Garfinkel and Jeanne Brooks-Gunn at Columbia University. It is funded through grants from the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), and a consortium of private foundations and other government agencies.
Future of Children
Sara McLanahan, Editor in Chief
The Future of Children is a journal that seeks to promote effective policies and programs for children by providing policymakers, service providers, and the media with timely, objective information based on the best available research. The journal is a collaborative effort between the Woodrow Wilson School and The Brookings Institution. The journal draws on the expertise of three Woodrow Wilson School research centers, including the Center for Health and Wellbeing. Sara McLanahan , director of the Bendheim-Thoman Center for Research on Child Wellbeing, is editor-in-chief; senior editors include Janet Currie , Director of the Center for Health and Wellbeing, and Cecilia Rouse, director of the Education Research Section (ERS). Isabel Sawhill, vice president and director of the Economic Studies Program at the Brookings Institution, and Brookings senior fellow Ron Haskins fill out the journal's permanent editorial staff. Kris McDonald, Program Manager of the Center for Research on Child Wellbeing (CRCW), is the associate editor of The Future of Children. The journal is published twice a year. Each issue serves as a basis for a graduate course offered at the Woodrow Wilson School. The Future of Children website is www.futureofchildren.org .