Grantee Research Project Results
2002 Progress Report: Valuing Reduced Asthma Morbidity in Children
EPA Grant Number: R829665Title: Valuing Reduced Asthma Morbidity in Children
Investigators: Hanemann, Michael , Brandt, Sylvia
Institution: University of California - Berkeley , University of Massachusetts - Amherst
EPA Project Officer: Hahn, Intaek
Project Period: May 14, 2002 through December 31, 2006
Project Period Covered by this Report: May 14, 2002 through December 31, 2003
Project Amount: $328,205
RFA: Valuation of Environmental Impacts on Children's Health (2001) RFA Text | Recipients Lists
Research Category: Human Health , Children's Health , Environmental Justice
Objective:
The objective of this research project is to model households’ willingness-to-pay to minimize a specific health endpoint: morbidity effects of pollution on children with asthma (defined as asthma symptoms, including coughing, wheezing, and/or shortness of breath). The project addresses three main questions:
(1) What determines households’ perceptions of risks to an asthmatic child?
(2) What averting and/or mitigating actions do households take?
(3) What are households’ stated willingness-to-pay for a reduction in their children’s asthma morbidity?
Progress Summary:
We have conducted five focus groups in Fresno, CA, and nine personal interviews in Springfield, MA. The focus groups and interviews were conducted over an 11-month period, from July 2002 to May 2003. In the summer of 2003, the survey instrument was reviewed by asthma specialists, including Dr. Kathleen Mortimer, University of California-Berkeley School of Public Health, and Dr. Matthew Sadof, Associate Director of Ambulatory Pediatrics at Baystate Children’s Hospital. During the fall of 2003, the team wrote the protocol for contacting families and tracking all surveys and correspondence. By early October 2003, the survey will be mailed to all households participating in the Fresno Asthmatic Children’s Environment Study (FACES) and households with an asthmatic child who was either ineligible or declined to participate in a longitudinal environment study. We extended the sample group to include families outside of FACES because recruitment for the epidemiological study was lower than predicted.
Through these focus groups and interviews, we identified issues central to the survey. In common to all respondents was the increase in the monitoring of the child’s health. In some cases, caregivers changed or terminated careers to increase supervision. The goal of the monitoring was to “catch the asthma before it was too late”, that is, to employ rescue medication while it was still effective in increasing lung function. The need for constant monitoring entails both reduced earnings and psychosocial costs because of the strain on family and social relationships.
There was a wide range in responses to questions on risk reducing behavior employed by households. A surprising result of the focus groups and interviews was that when initially asked if the household had changed anything because of the asthmatic child’s health, respondents tended to significantly underestimate their change in behavior. Then, when directed through a series of specific changes or activities pertaining to reducing triggers, households revealed a range of changes from small to extensive. Our conclusion is that it often is very difficult for households to identify “what they do for asthma” because either the child had been experiencing respiratory distress for such a long time that there is no basis for comparison, or the changes have become such a routine that it is difficult to compare their behavior over time.
A critical component of risk reducing behavior is compliance with prescribed asthma medication and monitoring of respiratory function using a peak flow meter. Although respondents were able to list most of the medications their child took for asthma, it was apparent that there were wide discrepancies in understanding of the role of each medication. There was significant concern over the side effects of inhaled steroids despite the clinical evidence that their benefits greatly outweigh their risks. In addition, personal disposition was evident in both the manner in which the child’s guardian interacted with the healthcare provider and with compliance.
Several respondents voiced concern over balancing all the actions that could reduce asthma morbidity versus instilling a sense of confidence or creating a sense of being “normal” for the child. This points out that the clinical guidelines for optimal household behavior may deviate from household behavior when the psychosocial costs of the risk reducing behavior are incorporated.
Past experience with healthcare providers was correlated with a sense of self-efficacy in controlling asthma symptoms. Those households that experienced a long delay between symptoms and diagnosis were less likely to feel that they were able to control asthma symptoms. In contrast, households provided with asthma management plans had a sense of improved self-efficacy. Self-efficacy has been shown in previous studies to be positively correlated with risk reducing behavior. Thus, in modeling compliance with medication and mitigating and averting behavior, the length of time between symptoms and diagnosis may be an important factor.
Future Activities:
The second component of the economic valuation of reduced morbidity is a contingent valuation question. Critical to this instrument is that the scenario be relevant and realistic. As a result of discussions in the focus groups, we developed two types of contingent valuation questions. In the first scenario, we asked parents to trade work-hours for reduced number of bad asthma days. In the second scenario, we proposed a hypothetical insurance program that would provide additional services that were predicted to reduce asthma symptoms. We will conduct additional focus groups and interviews to refine these questions.
Journal Articles:
No journal articles submitted with this report: View all 5 publications for this projectSupplemental Keywords:
ambient air, ozone, particulate matter, sulfur dioxide, nitrogen oxides, asthma, child health, exposure, risk assessment, nonmarket valuation, survey, willingness-to-pay, preferences, socioeconomic, contingent valuation, asthmatic child, asthma morbidity, respiratory function, asthma symptoms,, RFA, Economic, Social, & Behavioral Science Research Program, Health, Scientific Discipline, Geographic Area, Health Risk Assessment, State, Susceptibility/Sensitive Population/Genetic Susceptibility, Allergens/Asthma, Environmental Monitoring, Children's Health, decision-making, genetic susceptability, Ecological Risk Assessment, Social Science, Economics & Decision Making, social psychology, surveys, behavioral effects, asthma, contingent valuation, sensitive populations, social impact analysis, valuation, morbidity, random utility model, air toxics, economic valuation, decision analysis, incentives, ozone, behavioral assessment, airway disease, risk perception, children's health values, preference formation, air pollution, environmental values, survey, airway inflammation, children, willingness to pay (WTP), adult valuation of children's health, asthmatic children, psychological attitudes, environmental health hazard, children's environmental health, environmentally caused disease, stated preference, willingness to pay, California (CA), economic objectives, behavior reactions, asthma morbidityProgress and Final Reports:
Original AbstractThe perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Conclusions drawn by the principal investigators have not been reviewed by the Agency.