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Working Paper

The Effects of India’s COVID-19 Lockdown on Critical Non-COVID Health Care and Outcomes

Radhika Jain, Pascaline Dupas
Asia Health Policy Program working paper # 60 , 2020

India’s COVID-19 lockdown is widely believed to have disrupted critical health services, but its effect on non-COVID health outcomes is largely unknown. Comparing mortality trends among dialysis patients in the eight months around the lockdown with the previous year, we document a 64% increase in mortality between March and May 2020 and an estimated 22-25% total excess mortality through July 2020. The mortality increase is greater among females and disadvantaged groups.

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Journal Article

An Impact-Oriented Approach to Epidemiological Modeling

Nirav R. Shah, Debbie Lai, C. Jason Wang
Journal of General Internal Medicine , 2020

Epidemiological modeling has emerged as a crucial tool to help decision-makers combat COVID-19, with calls for non-pharmaceutical interventions such as stay-at-home orders and the wearing of masks. But those models have become ubiquitous and part of the public lexicon — so Nirav Shah and Jason Wang write that they should follow an impact-oriented approach.

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Journal Article

Association of Adverse Pregnancy Outcomes With Risk of Atherosclerotic Cardiovascular Disease in Postmenopausal Women

Mark A. Hlatky, Marcia Stefanick
JAMA Cardiology , 2020

Cardiovascular disease is the leading cause of death among women in the U.S. and identification of sex-specific risk factors could enhance cardiovascular risk assessment and prevention. Pregnancy is an exposure unique to women: 85% of women give birth at least once in their lives, and up to 30% may experience an adverse pregnancy outcome (APO).

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Journal Article

Rethinking Nuclear Arms Control

Rose Gottemoeller, Rose Gottemoeller
The Washington Quarterly , 2020

Where is nuclear arms control—negotiated restraints on the deadliest weapons of mass destruction—headed? This 50-year tool of US national security policy is currently under attack. The New Strategic Arms Reduction Treaty (New START), the last remaining nuclear arms agreement with the Russian Federation, will go out of force in February 2021 unless it is extended for an additional five years as the treaty permits. At this moment, nothing is on the horizon to replace it, though the Trump administration has promised a new and more extensive agreement that includes China as well as Russia.

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Journal Article

Political partisanship influences behavioral responses to governors’ recommendations for COVID-19 prevention in the United States

Soojong Kim
PNAS Journal , 2020

Voluntary physical distancing is essential for preventing the spread of COVID-19. We assessed the role of political partisanship in individuals’ compliance with physical distancing recommendations of political leaders using data on mobility from a sample of mobile phones in 3,100 counties in the United States during March 2020, county-level partisan preferences, information about the political affiliation of state governors, and the timing of their communications about COVID-19 prevention.

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Journal Article

Mapping Crop Types in Southeast India with Smartphone Crowdsourcing and Deep Learning

David Lobell, Sherrie Wang, Stefania Di Tomasso
Remote Sensing , 2020

High resolution satellite imagery and modern machine learning methods hold the potential to fill existing data gaps in where crops are grown around the world at a sub-field level. However, high resolution crop type maps have remained challenging to create in developing regions due to a lack of ground truth labels for model development. In this work, we explore the use of crowdsourced data, Sentinel-2 and DigitalGlobe imagery, and convolutional neural networks (CNNs) for crop type mapping in India.

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Journal Article

Fair Regression for Healthcare Spending

Anna Zink, Sherri Rose
Journal of the International Biometric Society , 2020
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Policy Brief

Exploring India's Strategic Futures

Arzan Tarapore
The National Bureau of Asian Research - Special Report no. 88 , 2020
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Journal Article

Al Qaeda’s Franchise Reboot

Asfandyar Mir, Asfandyar Mir, Colin P. Clarke
Foreign Affairs , 2020

Nineteen years after the terrorist attacks of September 11, 2001, does al Qaeda still pose a significant threat to U.S. national security? Among researchers, military and intelligence officials, and policymakers who study the group, there is little consensus. But very few experts on Salafi-jihadi movements would dismiss the group outright. So when U.S. Secretary of State Mike Pompeo confidently declared in a March interview on Fox & Friends that “al Qaeda is a shadow of its former self,” we were startled and concerned.

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Journal Article

Correlates of Participation in Community-Based Interventions: Evidence from a Parenting Program in Rural China

Yiwei Qian, Yi Ming Zheng, Sarah-Eve Dill, Scott Rozelle
PLOS One , 2020
A growing body of literature has documented that community-based early childhood development (ECD) interventions can improve child developmental outcomes in vulnerable communities. One critical element of effective community-based programs is consistent program participation. However, little is known about participation in community-based ECD interventions or factors that may affect participation. This paper examines factors linked to program participation within a community-based ECD program serving 819 infants and their caregivers in 50 rural villages in northwestern China. The results find that more than half of families did not regularly attend the ECD program. Both village-level social ties within the program and proximity to the program significantly predict program participation. Increased distance from the program site is linked with decreased individual program participation, while the number of social ties is positively correlated with participation. The average program participation rates among a family’s social ties is also positively correlated with individual participation, indicating strong peer effects. Taken together, our findings suggest that attention should be given to promoting social interactions and reducing geographic barriers among households in order to raise participation in community-based ECD programs.
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Journal Article

Safety of Eyeglasses Wear for Visual Acuity among Middle School Students in Northwestern Rural China: A Cluster-randomised Controlled Trial

Yue Ma, Xinwu Zhang, Haoyang Li, Xiaochen Ma, Dimitris Friesen, Scott Rozelle, Xiaopeng Pang, Ming Zhou, Nathan Congdon
BMJ Open Ophthalmology , 2020
Objective: To assess the effect of free eyeglasses provision on visual acuity among middle school students in northwestern rural China. Methods and analysis: Among 31 middle schools randomly selected from 47 middle schools in northwestern rural China, students were randomly allocated by school to one of two interventions: free eyeglasses (intervention group), and eyeglasses prescriptions given only to the parents (control group). The main outcome of this study is uncorrected visual acuity after 9 months, adjusted for baseline visual acuity. Results: Among 2095 students from 31 middle schools, 995 (47.5%) failed the visual acuity screening, 515 (51.8%, 15 schools) of which were randomly assigned to the intervention group, with the remaining 480 students (48.2%, 16 schools) assigned to the control group. Among these, a total of 910 students were followed up and analysed. Endline eyeglasses wear in the intervention group was 44%, and 36% in the control group. Endline visual acuity of students in the intervention group was significantly better than students in the control group, adjusting for other variables (0.045 LogMAR units, 95% CI 0.006 to 0.084, equivalent to 0.45 lines, p=0.027), and insignificantly better only for baseline visual acuity (difference of 0.008 LogMAR units, 95% CI −0.018 to 0.034, equivalent to 0.08 lines). Conclusion: We found no evidence that receiving free eyeglasses worsened visual acuity among middle school students in northwestern rural China.
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White Paper

Bolivarian Factions: Facebook takes down inauthentic assets

Elena Cryst, Esteban Ponce de León, Daniel Suárez Pérez, Shelby Perkins, David Thiel
2020
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White Paper

Reporting for Duty: How A Network of Pakistan-Based Accounts Leveraged Mass Reporting to Silence Critics

Shelby Grossman, Ross Ewald, Jennifer John, Asfandyar Mir, Kim Ngo, Natasha Patel, A. R.
2020
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Journal Article

Institutions, Implementation, and Program Effectiveness: Evidence from a Randomized Evaluation of Computer-Assisted Learning in Rural China

Di Mo, Yu Bai, Yaojiang Shi, Cody Abbey, LInxiu Zhang, Scott Rozelle, Prashant Loyalka
Journal of Development Economics , 2020
There is limited evidence on the degree to which differences in implementation among institutions matter for program effectiveness. To examine this question, we conducted an experiment in rural China in which public schools were randomly assigned to one of three treatments: a computer-assisted learning program (CAL) implemented by a government agency, the same program implemented by an NGO, and a pure control. Results show that compared to the pure control condition and unlike the NGO program, the government program did not improve student achievement. Analyzing impacts along the causal chain, we find that government officials were more likely to substitute CAL for regular instruction (contrary to protocol) and less likely to directly monitor program progress. Correlational analyses suggest that these differences in program implementation were responsible for the lack of impacts.
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White Paper

Reporting for Duty: How A Network of Pakistan-Based Accounts Leveraged Mass Reporting to Silence Critics

Shelby Grossman, Ross Ewald, Jennifer John, Asfandyar Mir, Kim Ngo, Natasha Patel, A. R.
2020
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White Paper

Mapping U.S.–China Technology Decoupling

Graham Webster, Graham Webster, Yan Luo, Samm Sacks, Naomi Wilson, Abigail Coplin
2020

Over the past two decades, U.S. and Chinese technological trajectories have been closely linked. Internet protocols, hardware design and manufacturing, software development and deployment, and services and standards have to varying degrees been crossborder phenomena, with China and the United States two of the world’s most consequential and integrated countries. The last few years, however, have seen a rise in mutual suspicion and moves—both direct and indirect—to unwind this extraordinary level of technological interdependence.

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Journal Article

Modeling Contact Tracing Strategies for COVID-19 in the Context of Relaxed Physical Distancing Measures

Alyssa Bilinski , Farzad Mostashari, Joshua Salomon
JAMA Network Open , 2020

Stanford Health Policy’s Joshua Salomon, a professor of medicine and senior fellow at the Freeman Spogli Institute for International Studies, and colleagues developed a mathematical model to examine the potential for contact tracing to reduce the spread of the coronavirus.

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Journal Article

Spatial Models, Legislative Gridlock, and Resource Policy Reform

Nathan Chael, Christophe Crombez, Pieterjan Vangerven
Annual Review of Resource Economics , 2020

This review evaluates the use of spatial models for the analysis of policymaking. First, we examine spatial theory and its applications in a variety ofinstitutional settings.

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Working Paper

Leveraging the Power of Place: A Data-Driven Decision Helper to Improve the Location Decisions of Economic Immigrants

Jeremy Ferwerda, Nicholas Adams-Cohen, Jennifer Fei, Duncan Lawrence, Jeremy M. Weinstein, Jens Hainmueller
Immigration Policy Lab (IPL) Working Paper Series , 2020

A growing number of countries have established programs to attract immigrants who can contribute to their economy. Research suggests that an immigrant's initial arrival location plays a key role in shaping their economic success. Yet immigrants currently lack access to personalized information that would help them identify optimal destinations. Instead, they often rely on availability heuristics, which can lead to the selection of sub-optimal landing locations, lower earnings, elevated outmigration rates, and concentration in the most well-known locations.

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Journal Article

Conditional Cash Transfers, Uptake of Maternal and Child Health Services, and Health Outcomes in Western Rural China

Huan Zhou, Yuju Wu, Chengfang Liu, Chang Sun, Yaojiang Shi, Linxiu Zhang, Alexis Medina, Scott Rozelle
BMC Public Health , 2020
Background: Empirical evidence suggests that the uptake of maternal and child health (MCH) services is still low in poor rural areas of China. There is concern that this low uptake may detrimentally affect child health outcomes. Previous studies have not yet identified the exact nature of the impact that a conditional cash transfer (CCT) has on the uptake of MCH services and, ultimately, on child health outcomes. The objective of this study is to examine the relationship between CCT, uptake of MCH services, and health outcomes among children in poor rural areas of western China. Methods: We designated two different sets of villages and households that were used as comparisons against which outcomes of the treated households could be assessed. In 2014, we conducted a large-scale survey of 1522 households in 75 villages (including 25 treatment and 50 comparison) from nine nationally designated poverty counties in two provinces of China. In each village, 21 households were selected based on their eligibility status for the CCT program. Difference-in-difference analyses were used to assess the impact of CCT on outcomes in terms of both intention-to-treat (ITT) and average-treatment-effects-on-the-treated (ATT). Results: Overall, the uptake of MCH services in the sample households were low, especially in terms of postpartum care visits, early breastfeeding, exclusive breastfeeding, and physical examination of the baby. The uptake of the seven types of MCH services in the CCT treatment villages were significantly higher than that in the comparison villages. The results from both the ITT and ATT analyses showed that the CCT program had a positive, although small, impact on the uptake of MCH services and the knowledge of mothers of MCH health issues. Nonetheless, the CCT program had no noticeable effect on child health outcomes. Conclusions: The CCT program generated modest improvements in the uptake of MCH services and mothers’ knowledge of MCH services in poor rural areas of Western China. These improvements, however, did not translate into substantial improvements in child health outcomes for two potential reasons: poor CCT implementation and the low quality of rural health facilities.
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Journal Article

Hepatitis C Treatment in Prisons — Incarcerated People’s Uncertain Right to Direct-Acting Antiviral Therapy

Alexandra M. Daniels , David Studdert
New England Journal of Medicine , 2020

In a recent perspective published by the New England Journal of Medicine(NEJM), Stanford Law student Alexandra Daniels analyzed a growing body of federal litigation brought by prisoners with the hepatitis C virus (HCV) who are seeking access to treatment for their condition.

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Journal Article

Operational Considerations on the American Academy of Pediatrics Guidance for K-12 School Reentry

C. Jason Wang, Henry Bair
JAMA Pediatrics , 2020

There is general consensus among experts that K-12 schools should aim to reopen for in-person classes during the 2020-2021 school year. Globally, children constitute a low proportion of coronavirus disease 2019 (COVID-19) cases and are far less likely than adults to experience serious illness. Yet, prolonged school closure can exacerbate socioeconomic disparities, amplify existing educational inequalities, and aggravate food insecurity, domestic violence, and mental health disorders. The American Academy of Pediatrics (AAP) recently published its g

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Journal Article

Schooling and Covid-19: Lessons from Recent Research on EdTech

Robert Fairlie
Nature Partner Journal: Science of Learning , 2020
The wide-scale global movement of school education to remote instruction due to Covid-19 is unprecedented. The use of educational technology (EdTech) offers an alternative to in-person learning and reinforces social distancing, but there is limited evidence on whether and how EdTech affects academic outcomes. Recently, we conducted two large-scale randomized experiments, involving ~10,000 primary school students in China and Russia, to evaluate the effectiveness of EdTech as a substitute for traditional schooling. In China, we examined whether EdTech improves academic outcomes relative to paper-and-pencil workbook exercises of identical content. We found that EdTech was a perfect substitute for traditional learning. In Russia, we further explored how much EdTech can substitute for traditional learning. We found that EdTech substitutes only to a limited extent. The findings from these large-scale trials indicate that we need to be careful about using EdTech as a full-scale substitute for the traditional instruction received by schoolchildren. The wide-scale global movement of school education to remote instruction due to Covid-19 is unprecedented. The use of educational technology (EdTech) offers an alternative to in-person learning and reinforces social distancing, but there is limited evidence on whether and how EdTech affects academic outcomes, and that limited evidence is mixed.1,2 For example, previous studies examine performance of students in online courses and generally find that they do not perform as well as in traditional courses. On the other hand, recent large-scale evaluations of supplemental computer-assisted learning programs show large positive effects on test scores. One concern, however, is that EdTech is often evaluated as a supplemental after-school program instead of as a direct substitute for traditional learning. Supplemental programs inherently have an advantage in that provide more time learning material. Recently, we conducted two large-scale randomized experiments, involving ~10,000 primary school students in China and Russia, to evaluate the effectiveness of EdTech as a substitute for traditional schooling.3,4 In both, we focused on whether and how EdTech can substitute for in-person instruction (being careful to control for time on task). In China, we examined whether EdTech improves academic outcomes relative to paper-and-pencil workbook exercises of identical content. We followed students ages 9–13 for several months over the academic year. When we examined the impacts of each supplemental program we found that EdTech and workbook exercise sessions of equal time and content outside of school hours had the same effect on standardized math test scores and grades in math classes. As such, EdTech appeared to be a perfect substitute for traditional learning. In Russia, we built on these findings by further exploring how much EdTech can substitute for traditional learning. We examined whether providing students ages 9–11 with no EdTech, a base level of EdTech (~45 min per week), and a doubling of that level of EdTech can improve standardized test scores and grades. We found that EdTech can substitute for traditional learning only to a limited extent. There is a diminishing marginal rate of substitution for traditional learning from doubling the amount of EdTech use (that is, when we double the amount of EdTech used we do not find that test scores performance doubles). We find that additional time on EdTech even decreases schoolchildren’s motivation and engagement in subject material. The findings from the large-scale trials indicate that we need to be careful about using EdTech as a full-scale substitute for the traditional instruction received by schoolchildren. There are two general takeaways: First, to a certain extent, EdTech can successfully substitute for traditional learning. Second, there are limits on how much EdTech may be beneficial. Admittedly, we need to be careful about extrapolating from the smaller amount of technology substitution in our experiments to the full-scale substitution in the face of the coronavirus pandemic. However, these studies may offer important lessons. For example, a balanced approach to learning in which schoolchildren intermingle work on electronic devices and work with traditional materials might be optimal. Schools could mail workbooks to students or recommend that students print out exercises to break up the amount of continuous time schoolchildren spend on devices. This might keep students engaged throughout the day and avoid problems associated with removing the structure of classroom schedules. Schools and families can devise creative remote learning solutions that include a combination of EdTech and more traditional forms of learning. Activities such as reading books, running at-home experiments, and art projects can also be used to break up extensive use of technology in remote instruction.
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Working Paper

Education and EdTech during COVID-19: Evidence from a Large-Scale Survey during School Closures in China

Guirong Li, Xinwu Zhang, Delei Liu, Hao Xue, Derek Hu, Oliver Lee, Chris Rilling, Yue Ma, Cody Abbey, Robert Fairlie, Scott Rozelle
2020
In response to the COVID-19 epidemic, many education systems have relied on distance learning and educational technologies to an unprecedented degree. However, rigorous empirical research on the impacts on learning under these conditions is still scarce. We present the first large-scale, quantitative evidence detailing how school closures affected education in China. The data set includes households and teachers of 4,360 rural and urban primary school students. We find that although the majority of students engaged in distance education, many households encountered difficulties including barriers to learning (such as access to appropriate digital devices and study spaces), curricular delays, and costs to parents equivalent to about two months of income. We also find significant disparities across rural and urban households.
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Working Paper

The Impact of Computer Assisted Learning on Rural Taiwanese Children: Evidence from a Randomized Experiment

Yue Ma, Cody Abbey, Derek Hu, Oliver Lee, Weiting Hung, Xinwu Zhang, Chiayuan Chang, Chyi-In Wu, Scott Rozelle
2020
The effectiveness of educational technology (EdTech) in improving the outcomes of poor, marginalized students has primarily been documented by studies conducted in developing countries; however, relevant research involving randomized studies in developed country contexts is relatively scarce. The objective of the current study is to examine whether an in-school computer assisted learning (CAL) intervention can improve the math performance (the primary outcome) and academic attitudes (secondary outcomes) of rural students in Taiwan, including a marginalized subgroup of rural students called Xinzhumin. We also seek to identify which factors are associated with the effectiveness of the intervention. In order to achieve this, we conducted a randomized control trial involving 1,840 sixth-grade students at 95 schools in four relatively poor counties and municipalities of Taiwan during the spring semester of 2019. According to the ITT analysis, the O-CAL intervention had no significant ITT impacts on the primary outcome of student math performance as well as on most secondary outcomes of the overall treatment group (who on average used the software for only about one quarter of the protocol’s minimum required time of 30 minutes per week, indicating that compliance was low). However, the LATE analysis revealed significant improvements in the math performance of the 30% most active students in the treatment group (who used the software for about two thirds of the minimum required time). Effect sizes of active users overall (0.16 SD-0.22 SD) increased in accordance with increases in usage and were larger for active Xinzhumin users specifically (0.21 SD-0.35 SD). A wide range of student-level and (in particular) teacher-level characteristics were associated with the low compliance to the intervention, which are findings that may help inform educational policymakers and administrators of the potential challenges of introducing school-based interventions that depend heavily on teacher adoption and integration.  
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