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In an era of fluctuating energy costs where we observe increasing concerns for environmental protection, energy sources and energy efficiency, it is of great importance to understand the mechanisms underlying consumer vehicle choices. This dissertation develops a theoretical model of vehicle choice by embedding the disaggregate indirect utility function model of household choice in the aggregate framework of the threshold model of adoption/diffusion. This approach incorporates multiple sources of heterogeneity including household income levels, household structure, comfort/quality levels and attitudes towards environmental awareness. Then, we examine the diffusion of vehicle adoption through dynamic processes such as learning-by-doing (Arrow 1962). In addition, the simulation model based on this theoretical model enables forecasts particularly suited for examining both household level adoption as well as overall diffusion of different vehicle technologies with relatively few calibrated parameters, especially in dynamic economies such as China or India.First, this dissertation starts out with the threshold model of diffusion introduced by David (1969) and Sunding and Zilberman (2001), applying the theoretical foundation commonly used in analyzing modern irrigation technology adoption to household vehicle adoption. Households are assumed to be heterogeneous and utility-maximizing through a discrete vehicle choice and a continuous choices of miles traveled, and they adopt the technology that provides the highest utility given the optimal number of miles chosen for that particular technology. Then, the theoretical model is extended to include both parameters of vehicle comfort/quality and environmental awareness in the choice process. Another extension of the theoretical model includes household heterogeneity through the inclusion of household structures where each household structure may have their own preference set for vehicle comfort/quality. On the aggregate level, the aggregate flow demand of vehicles at time t is derived and determined to be a combination of these effects: the population growth rate (Population Effect), the shift of income distribution within the population (Income Distribution Effect) and the movement of the critical income levels for each type of vehicle (affected by characteristics of each vehicle technology as well as preferences of households including the Variable Cost Effect and Fixed Cost Effect).Next, we develop a computer simulation model with the theoretical household vehicle choice threshold model as foundation. Utilizing a CES utility functional form as the starting point, we calibrate the simulation model using data from various sources, including data of income distribution, vehicle attributes and pricing, vehicle sales data in the U.S. and environmental awareness factors. The final calibrated specification yields an R^2 equal to 0.9595, indicating the simulated results explains approximately 95.95% of the variance in historical vehicle sales data. Using this simulation model, we forecast the influence of various factors on vehicle adoption patterns and optimal miles traveled by households. We find that changes in the fixed cost of vehicles (influenced through government policies regarding rebates or through learning-by-doing) and shifts in income distribution (including both income distribution shifts and shape changes) present particularly dominant effects on vehicle adoption compared to changes in energy price, environmental awareness or vehicle comfort/quality. The main conclusion here is that as parameters are changing, households are not only changing what type of vehicle they prefer to purchase, they also adjust how much they would like to travel.The theoretical model and the simulation model culminate in Chapter 5 where three very different case studies illustrating potential scenarios in emerging markets, ageing economies and public transportation are presented. Case Study I presents the scenarios of rapidly growing economies with rapidly changing population dynamics such as China or India. The results from this case study illustrate the potential trend towards the adoption of bigger, better (more comfortable) and newer vehicles which are less fuel-efficient and more polluting as the economy experiences high income growth and increases in inequality. The extended scenarios presented in Case Study I incorporates the increasing trend of transportation infrastructure construction. Two effects are hypothesized in this extension: increasing comfort levels due to better roadways and networks of roadways, and decreasing comfort levels due to increasing congestion or pollution caused by the increasing stock of vehicles and miles traveled. The other extension in this portion proposes increasing environmental awareness in a developing economy as it is growing, possibly due to the Environmental Kuznets Curve. Both increasing overall comfort levels and increasing environmental awareness lead to the high rates of adoption of energy-efficient vehicles such as the new hybrid vehicle or the new compact vehicle.Case Study II of Chapter 5 examines the ageing economies of Japan and Europe. The population dynamics are also shifting in these regions, although at a slower rate, towards a larger percentage of childless households and senior households. The substitution towards energy-efficient vehicles is driven by a combination of increased environmental concern, increasing energy prices, decreasing cost of new hybrid vehicle technology as well as increasing income levels. The effects caused by the larger percentage of childless households and senior households depend on the magnitude of each as well as on the income distribution shape within each household structure.Case Study III takes the simulation model one step further by introducing public transportation as an alternative travel mode. Public transportation is unique because it entails zero private fixed cost but with the tradeoff of higher variable cost per mile traveled compared to driving a private vehicle. In addition, public transportation provides lower levels of comfort/quality/convenience as well as higher utility from environmental awareness. Unsurprisingly, we find that public transportation ridership benefits from high energy price increases and low public transit fares. We also observe that increasing public transit fares not only decreases the overall number of households who ride public transit, but also induces them to ride less. This case study is extended to incorporate the income distribution shifts in economies such as China. We find that public transportation usage declines and new SUV adoption rapidly increases as the population experiences income increases, demonstrating the dominant effect of the income distribution shift on the adoption of vehicle technologies.

In Nigeria, access to malaria diagnostics may be expanded if drug retailers were allowed to administer malaria rapid diagnostic tests (RDTs). A 2012 pilot intervention showed that short message service (SMS) reminder messages could boost treatment adherence to RDT results by 10-14% points. This study aimed to replicate the SMS intervention in a different population, and additionally test the effect of an expanded message about anticipated RDT access policy change on customers' acceptability for drug retailers' administration of RDTs. One day after being tested with an RDT, participants who purchased malaria treatment from drug shops were randomized to receive (1) a basic SMS reminder repeating the RDT result and appropriate treatment actions, (2) an expanded SMS reminder additionally saying that the 'government might allow pharmacists/chemists to do RDTs' or (3) no SMS reminders (i.e. control). Using regression analysis, we estimate intent-to-treat (ITT) and treatment effects on the treated for 686 study participants. Results corroborate previous findings that a basic SMS reminder increased treatment adherence [odds ratio (OR) = 1.53, 95% CI 0.96-2.44] and decreased use of unnecessary anti-malarials for RDT-negative adults [OR = 0.63, 95% CI 0.39-1.00]. The expanded SMS also increased adherence for adults [OR = 1.42, 95% CI 0.97-2.07], but the effects for sick children differed-the basic SMS did not have any measurable impact on treatment adherence [OR = 0.87, 95% CI 0.24-3.09] or use of unnecessary anti-malarials [OR = 1.27, 95% CI 0.32-1.93], and the expanded SMS actually led to poorer treatment adherence [OR = 0.26, 95% CI 0.10-0.66] and increased use of unnecessary anti-malarials [OR = 4.67, 95% CI 1.76-12.43]. Further, the targeted but neutral message in the expanded SMS lowered acceptance for drug retailers' administration of RDTs [OR = 0.55, 95% CI 0.10-2.93], counter to what we hypothesized. Future SMS interventions should show consistent positive results across populations and be attuned to message ...

In Nigeria, access to malaria diagnostics may be expanded if drug retailers were allowed to administer malaria rapid diagnostic tests (RDTs). A 2012 pilot intervention showed that short message service (SMS) reminder messages could boost treatment adherence to RDT results by 10–14% points. This study aimed to replicate the SMS intervention in a different population, and additionally test the effect of an expanded message about anticipated RDT access policy change on customers' acceptability for drug retailers' administration of RDTs. One day after being tested with an RDT, participants who purchased malaria treatment from drug shops were randomized to receive (1) a basic SMS reminder repeating the RDT result and appropriate treatment actions, (2) an expanded SMS reminder additionally saying that the 'government might allow pharmacists/chemists to do RDTs' or (3) no SMS reminders (i.e. control). Using regression analysis, we estimate intent-to-treat (ITT) and treatment effects on the treated for 686 study participants. Results corroborate previous findings that a basic SMS reminder increased treatment adherence [odds ratio (OR) = 1.53, 95% CI 0.96–2.44] and decreased use of unnecessary anti-malarials for RDT-negative adults [OR = 0.63, 95% CI 0.39–1.00]. The expanded SMS also increased adherence for adults [OR = 1.42, 95% CI 0.97–2.07], but the effects for sick children differed—the basic SMS did not have any measurable impact on treatment adherence [OR = 0.87, 95% CI 0.24–3.09] or use of unnecessary anti-malarials [OR = 1.27, 95% CI 0.32–1.93], and the expanded SMS actually led to poorer treatment adherence [OR = 0.26, 95% CI 0.10–0.66] and increased use of unnecessary anti-malarials [OR = 4.67, 95% CI 1.76–12.43]. Further, the targeted but neutral message in the expanded SMS lowered acceptance for drug retailers' administration of RDTs [OR = 0.55, 95% CI 0.10–2.93], counter to what we hypothesized. Future SMS interventions should show consistent positive results across populations and be attuned to message ...

Protests are one of the most common expressions of modern political conflict, and the wave of demonstrations that marked the onset of the Arab Spring contributed to a global increase in protest activity. Yet few studies have examined the effects of exposure to protests on population well-being even though such exposure may have profound and lasting effects, especially if experienced at critical stages of development over the life course. The aim of our study is to estimate the effects of exposure to political protests on the human capital accumulation and well-being of youth during the tumultuous political transition experienced in Egypt from 2011 - 2014. For a nationally representative panel of youth captured in the 2009 and 2013/2014 waves of the Survey of Young People in Egypt (SYPE), we exploit exogenous geospatial variation in the occurrence of political protests from the Armed Conflict Location & Event Data (ACLED) Project, to estimate individual-level changes in social trust, uncertainty, education, and health outcomes for youth exposed to protests. In our panel, 31.1% of the sample lived in districts where riots or protests occurred. Exposure to protests increased overall perceptions of uncertainty about the future. Young men ever exposed to protests were slightly more likely to report good overall health, but experienced sizable worsening in mental health compared to young women ever exposed. Differences by own and family participation in protest events were found for perceptions of uncertainty and mental health. In the aftermath of the Arab Spring and other mass protest movements around the globe, these findings highlight the importance of examining the population-level impacts of different forms of political conflict, particularly as substantial numbers of youth in Middle East and North Africa and elsewhere progress to adulthood under conditions of political instability.

A panel survey of decision-making by Ohio voters (N=605 from 1,966 R's) found differences between the 1972 & 1974 general election campaigns in terms of attributes the voters used to choose candidates, when they chose, & how difficult their choices were to make. Relations between those differences were explored & variations were found between the campaigns in voters' attention to & discussion of the campaigns, & in their uses of mass media. Difficulty of decision-making in particular, was highly associated with certain campaign information-seeking behaviors, suggesting that mass media & other political information sources may be used in specific ways by voters experiencing difficulty. 3 Tables. AA.

LAY SUMMARY Moral injury (MI) can be defined as a diverse set of outcomes associated with actions that transgress one's moral beliefs or values. MI can be distressing for an individual at the interpersonal level (e.g., shifting relationships, feelings of betrayal) and the intrapersonal level (e.g., internalized guilt and shame). Indeed, these transgressions of moral beliefs and values have been associated with a high prevalence of mental illnesses, such as posttraumatic stress disorder (PTSD) and depression. Although various forms of assessment exist to identify MI in the individual, treatments for MI are often interlinked or embedded in evidence-based treatments for PTSD and depression. As such, unique contributions of MI as a target of treatment remain largely unclear. In this article, the authors explore existing treatments that may be used to treat MI as a distinct mental health construct and examine their utility in reducing symptoms of MI in military and Veteran populations.

AbstractEquating contraceptive use with programmatic success is fundamentally flawed in failing to account for whether individuals desire contraceptive use; this is problematic because nonuse can reflect empowered decision‐making and use may reflect an individual's inability to refuse or discontinue a method. A rights‐based approach demands respect for individuals' freedom to weigh options and choose how their desire for pregnancy prevention can be accommodated by available methods and within the context of their own personal, social, and material constraints. We offer an alternative construct, preference‐aligned fertility management (PFM), that provides a more holistic indicator of whether one's contraceptive needs are met. PFM is more person‐centered and informative for programming than status quo measures of unmet need, demand satisfied, and contraceptive use which define a positive outcome in relation to pregnancy risk rather than one's stated preferences. The PFM approach goes beyond other recent proposals for modifying the concept of unmet need by refraining from judgment of legitimate reasons for nonuse of contraception and offers a straightforward way to capture whether people act in line with their preferences. We conclude with discussion of how we plan to measure PFM in the Innovations for Choice and Autonomy (ICAN) study in Nigeria and Uganda.

BACKGROUND: Military-related posttraumatic stress disorder (PTSD) is a complex diagnosis with non-linear trajectories of coping and recovery. Current approaches to the evaluation of PTSD and treatment discontinuation often rely on biomedical models that dichotomize recovery based on symptom thresholds. This approach may not sufficiently capture the complex lived experiences of Veterans and their families. To explore conceptualizations of recovery, we sought perspectives from Veterans and their partners in a pilot study to understand: 1) how Veterans nearing completion of treatment for military-related PTSD and their partners view recovery; and 2) the experience of progressing through treatment towards recovery. METHODS: We employed a concurrent mixed methods design. Nine Veterans nearing the end of their treatment at a specialized outpatient mental health clinic completed quantitative self-report tools assessing PTSD and depressive symptom severity, and an individual, semi-structured interview assessing views on their treatment and recovery processes. Veterans' partners participated in a separate interview to capture views of their partners' treatment and recovery processes. Descriptive analyses of self-report symptom severity data were interpreted alongside emergent themes arising from inductive content analysis of qualitative interviews. RESULTS: While over half of Veterans were considered "recovered" based on quantitative assessments of symptoms, individual reflections of "recovery" were not always aligned with these quantitative assessments. A persistent narrative highlighted by participants was that recovery from military-related PTSD was not viewed as a binary outcome (i.e., recovered vs. not recovered); rather, recovery was seen as a dynamic, non-linear process. Key components of the recovery process identified by participants included a positive therapeutic relationship, social support networks, and a toolkit of adaptive strategies to address PTSD symptoms. CONCLUSIONS: For participants in our study, ...

Even though eliminating malaria from the endemic margins is a part of the Global Malaria Action Plan, little guidance exists on what resources are needed to transition from controlling malaria to eliminating it. Using Philippines as an example, this study aimed to (1) estimate the financial resources used by sub-national malaria programs in different phases during elimination and (2) understand how different environmental and organizational factors may influence expenditure levels and spending proportions. The Philippines provides an opportunity to study variations in sub-national programs because its epidemiological and ecological diversity, devolved health system, and progressive elimination strategy all allow greater flexibility for lower-level governments to direct activities, but also create challenges for coordination and resource mobilization. Through key informant interviews and archival record retrieval in four selected provinces chosen based on eco-epidemiological variation, expenditures associated with provincial malaria programs were collected for selected years (mid-1990s to 2010). Results show that expenditures per person at risk per year decrease as programs progress from a state of controlled low-endemic malaria to elimination to prevention of reintroduction regardless of whether elimination was deliberately planned. However, wide variation across provinces were found: expenditures were generally higher if mainly financed with donor grants, but were moderated by the level of economic development, the level of malaria transmission and receptivity, and the capacity of program staff. Across all provinces, strong leadership appears to be a necessary condition for maintaining progress and is vital in controlling outbreaks. While sampled provinces and years may not be representative of other sub-national malaria programs, these findings suggest that the marginal yearly cost declines with each phase during elimination.

BACKGROUND: Health workforce planning is critical for health systems to safeguard the ability to afford, train, recruit, and retain the appropriate number and mix of health workers. This balance is especially important when macroeconomic structures are also reforming. The Kingdom of Saudi Arabia is moving toward greater diversification, privatization, and resiliency; health sectorreform is a key pillar of this transition. METHODS: We used the Ministry of Health Yearbook data on the number of workers and health expenditures from 2007 to 2018 and projected health labor market supply and demand of workers through 2030, evaluated the potential shortages and surpluses, and simulated different policy scenarios to identify relevant interventions. We further focused on projections for health workers who are Saudi nationals and health worker demand within the public sector (versus the private sector) to inform national objectives of reducing dependency on foreign workers and better deploying public sector resources. RESULTS: We projected the overall health labor market to demand 9.07 physicians and nurses per 1,000 population (356,514) in 2030; the public sector will account for approximately 67% of this overall demand. Compared to a projected supply of 10.16 physicians and nurses per 1,000 population (399,354), we estimated an overall modest surplus of about 42,840 physicians and nurses in 2030. However, only about 17% of these workers are estimated to be Saudi nationals, for whom there will be a demand shortage of 287,895 workers. Among policy scenarios considered, increasing work hours had the largest effect on reducing shortages of Saudi workers, followed by bridge programs for training more nurses. Government resources can also be redirected to supporting more Saudi nurses while still ensuring adequate numbers of physicians to meet service delivery goals in 2030. CONCLUSION: Despite projected overall balance in the labor market for health workers in 2030, without policy interventions, severe gaps in the Saudi ...