Older adults are more approving of blunt honesty than younger adults: a cross-cultural study.

Research has explored age-related and cultural differences in moral evaluations of dishonesty; however, this has not yet been examined in an aging context. The present study provided a novel account of how younger and older adults (in Canada, Singapore, and China; N = 401) morally evaluate adults' truths and lies in antisocial, modesty, and politeness settings. Participants completed a questionnaire assessing how acceptable it is for adults to tell the truth or a lie in given social scenarios, and they reported on their levels of collectivism and individualism. In all countries, older adults provided more favorable evaluations to blunt and immodest truths than younger adults did. Compared with younger adults, older adults provided harsher evaluations to Polite Lies (in Canada and China) and Modesty Lies (in Canada and Singapore). Thus, there may be an age-related increase in the acceptability of direct honesty over good-intentioned lies, and this age effect is somewhat stable across cultures. Older adults were also more lenient in evaluations of an antisocial lie to conceal an affair compared to younger adults. Overall, adults in China tended to rate lies less negatively, and their greater levels of collectivism mediated their greater approval of polite lies. The present results demonstrate that evaluations of (dis)honesty differ as a function of age and culture and these results can assist in developing a more complete lifespan model of the morality of dishonesty. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-022-03785-6.

Can adults discriminate between fraudulent and legitimate e-mails? Examining the role of age and prior fraud experience.

The present study assessed how accurate adults are at detecting fraudulent e-mail activity. A total of 100 younger (18-26 years) and 96 older adults (60-90 years) categorized a series of e-mails as legitimate or fraudulent phishing schemes and self-reported their fraud experiences. Younger and older adults did not differ in accuracy rates when categorizing the e-mails (72%), but older adults used a "high-suspicion" strategy where they were more likely to mislabel a legitimate e-mail as fraudulent compared to younger adults. Younger adults were less likely to be targeted by fraud than older adults, but the groups were victimized at similar rates. Being a prior fraud victim negatively related to e-mail detection performance, but this differed across age groups and the extent of fraud experience. Together, these results provide insight into the relation between fraud experience and the ability to detect e-mail scams and can inform fraud prevention and education initiatives.

The role of theory of mind and social skills in predicting children's cheating.

The current study investigated the relation between children's (3- to 8-year-olds) cheating behaviors and their sociocognitive development, including theory-of-mind (ToM) understanding and social skills. A total of 295 children completed a temptation resistance paradigm where they were asked not to peek at a toy in the experimenter's absence (measure of cheating). Children completed first- and second-order ToM measures, and parents completed the Social Skills Improvement System (SSiS) Rating Scales questionnaire as an assessment of their children's social skills. Results indicated that ToM and total SSiS scores were unique predictors of children's cheating, such that with increased ToM and SSiS scores children were significantly less likely to cheat. In particular, children's responsibility scores (subscale of SSiS Rating Scales) emerged as a unique predictor of cheating. Children's performance on both scales were examined together and demonstrated that only children who had high levels of both ToM and responsibility were significantly less likely to cheat compared with children who were low on both measures. These findings demonstrate that children's sociocognitive development affects their cheating behaviors, likely through an understanding of the importance of maintaining positive social relationships.

Younger and Older Adults' Lie-Detection and Credibility Judgments of Children's Coached Reports.

Previous research has examined young and middle-aged adults' perceptions of child witnesses; however, no research to date has examined how potential older adult jurors may perceive a child witness. The present investigation examined younger (18-30 years, N = 100) and older adults' (66-89 years, N = 100) lie-detection and credibility judgments when viewing children's truthful and dishonest reports. Participants viewed eight child interview videos where children (9 to 11 years of age) either provided a truthful report or a coached fabricated report to conceal a transgression. Participants provided lie-detection judgments following all eight videos and credibility assessments following the first two videos. Participants completed a General Lifespan Credibility questionnaire to assess credibility evaluations across various witness ages. Lie-detection results indicated that older adults had significantly lower discrimination scores, a stronger truth bias, and greater confidence compared to younger adults. Older adults also rated children as more competent to testify in court, credible, honest, believable, and likeable than younger adults. Participants with greater differences in their credibility evaluations for truth and lie-tellers were significantly more accurate at detecting lies. Responses to the Lifespan Credibility questionnaire revealed significant differences in younger and older adults' credibility evaluations across the lifespan.

Adults' Perceptions of Children's Referentially Ambiguous Responses.

The present study examined adults' (N = 295) interpretations of child witnesses' referentially ambiguous "yes" and "no" responses to "Do You Know/Remember (DYK/R) if/whether" questions (e.g., "Do you know if it was blue?"). Participants were presented with transcripts from child sexual abuse cases modified based on question format (DYK/R vs. Direct) and child response type (Yes, No, I don't know) in a between subjects design. We assessed whether adults recognized that children's ambiguous responses were unclear, and if not, how they were interpreting children's responses compared to the control (Direct) conditions. More specifically, we assessed whether adults interpreted children's responses as answering the explicit (e.g., "No, I don't remember") or implicit (e.g., "No, it wasn't blue") question. Participants virtually never recognized ambiguous responses as unclear, and their interpretations were influenced by the attorney's question and child's response type. In sum, these results suggest that DYK/R questions often lead to misinterpretation, resulting in miscommunication.

The relation between having siblings and children's cheating and lie-telling behaviors.

The current study investigated how having at least one child sibling influenced children's dishonest behaviors. Furthermore, for those children with a sibling, we examined whether having a younger or older sibling and the age difference between siblings influenced deceptive acts. Children between 3 and 8 years of age (N = 130) completed the temptation resistance paradigm, where they played a guessing game and were asked not to peek at a toy in the experimenter's absence. Children's peeking behavior was used as a measure of cheating, and children's responses when asked whether they had peeked were used as measures of lie-telling. Results demonstrate that siblings do indeed influence children's deceptive behaviors. First, children with a sibling were significantly more likely to cheat compared with children without any siblings. Next, for those with a sibling, children with a larger age difference with their younger sibling(s) were significantly more likely to lie compared with children closer in age, and children with a younger sibling were significantly more likely to maintain their lie during follow-up questioning compared with children with an older sibling.

Mirror, mirror on the wall: Increasing young children's honesty through inducing self-awareness.

Previous studies have shown that in older children, promising to tell the truth increases truth-telling rates; however, in preschool-aged children, this has not been found to be effective. The current study compared promising with a novel technique of increasing children's self-awareness (by asking children to look at themselves in a mirror). It was predicted that inducing self-awareness would encourage children's honesty given that self-awareness increases adherence to social and moral norms. Children aged 3 or 4 years (N = 135) completed a modified temptation resistance paradigm where they were asked to not peek at a toy in the absence of an experimenter. Next, children were randomly assigned to one of three conditions: Self-Awareness, Promise, or Control. When questioned about whether they peeked at the toy, children in the Self-Awareness condition were significantly more likely to tell the truth about peeking compared with those in the Promise condition. There was no significant difference between the Promise and Control conditions.

Community point distribution of insecticide-treated bed nets and community health worker hang-up visits in rural Zambia: a decision-focused evaluation.

BACKGROUND: In 2013, the Zambian Ministry of Health through its National Malaria Control Programme distributed over two million insecticide-treated bed nets (ITNs) in four provinces using a door-to-door distribution strategy, and more than 6 million ITNs were allocated to be distributed in 2014. This study was commissioned to measure attendance rates at a community point distribution and to examine the impact of follow-up community health worker (CHW) hang-up visits on short and medium-term ITN retention and usage with a view of informing optimal ITN distribution strategy in Zambia. METHODS: Households received ITNs at community point distributions conducted in three rural communities in Rufunsa District, Zambia. Households were then randomly allocated into five groups to receive CHW visits to hang any unhung ITNs at different intervals: 1-3, 5-7, 10-12, 15-17 days, and no hang-up visit. Follow-up surveys were conducted among all households at 7-11 weeks after distribution and at 5-6 months after distribution to measure short- and medium-term household retention and usage of ITNs. RESULTS: Of the 560 pre-registered households, 540 (96.4 %) attended the community point distribution. Self-installation of ITNs by households increased over the first 10 days after the community point distribution. Retention levels remained high over time with 90.2 % of distributed ITNs still in the household at 7-11 weeks and 85.7 % at 5-6 months. Retention did not differ between households that received a CHW visit and those that did not. At 7-11 weeks, households had an average of 73.8 % of sleeping spaces covered compared to 80.3 % at 5-6 months. On average, 65.6 % of distributed ITNs were hanging at 7-11 weeks compared to 63.1 % at 5-6 months. While a CHW hang-up visit was associated with increased usage at 7-11 weeks, this difference was no longer apparent at 5-6 months. CONCLUSIONS: This evaluation revealed that (1) the community point distributions achieved high attendance rates followed by acceptable rates of short-term and medium-term ITN retention and usage, as compared to reported rates achieved by door-to-door distributions in the recent past, (2) CHW hang-up visits had a modest short-term impact on ITN usage but no medium-term effect, and (3) community point distributions can yield sizeable time savings compared to door-to-door distributions.

Younger and Older Adults' Health Lies to Close Others.

OBJECTIVES: Lying is a common social behavior; however, there is limited research on lying about health and if this differs into later life. This study sought to explore age differences in the frequency of and motivations behind telling health-related lies and if lying differs within romantic and parent/child relationships. METHODS: Younger (N = 158) and older adults (N = 149) reported how often they told general health-related lies, how often they lied about health to their romantic partner and parent or adult child, and why they told health lies. RESULTS: Compared with older adults, younger adults lied more frequently to conceal sickness and pain as well as to feign sickness. Younger adults also told more health lies to their parent than their romantic partner, but older adults lied to their adult child and partner at similar rates. Younger adults reported lying more about their health because they felt ashamed or embarrassed and they worried about what others would think of them compared with older adults. DISCUSSION: These results suggest that health-related honesty may increase in later life and that younger and older adults differ in why they tell health lies. Implications for psychological theory on lying about one's health and health interventions are discussed.

Mercury speciation and mobilization in a wastewater-contaminated groundwater plume.

We measured the concentration and speciation of mercury (Hg) in groundwater down-gradient from the site of wastewater infiltration beds operated by the Massachusetts Military Reservation, western Cape Cod, Massachusetts. Total mercury concentrations in oxic, mildly acidic, uncontaminated groundwater are 0.5-1 pM, and aquifer sediments have 0.5-1 ppb mercury. The plume of impacted groundwater created by the wastewater disposal is still evident, although inputs ceased in 1995, as indicated by anoxia extending at least 3 km down-gradient from the disposal site. Solutes indicative of a progression of anaerobic metabolisms are observed vertically and horizontally within the plume, with elevated nitrate concentrations and nitrate reduction surrounding a region with elevated iron concentrations indicating iron reduction. Mercury concentrations up to 800 pM were observed in shallow groundwater directly under the former infiltration beds, but concentrations decreased with depth and with distance down-gradient. Mercury speciation showed significant connections to the redox and metabolic state of the groundwater, with relatively little methylated Hg within the iron reducing sector of the plume, and dominance of this form within the higher nitrate/ammonium zone. Furthermore, substantial reduction of Hg(II) to Hg(0) within the core of the anoxic zone was observed when iron reduction was evident. These trends not only provide insight into the biogeochemical factors controlling the interplay of Hg species in natural waters, but also support hypotheses that anoxia and eutrophication in groundwater facilitate the mobilization of natural and anthropogenic Hg from watersheds/aquifers, which can be transported down-gradient to freshwaters and the coastal zone.

Rating the Honesty of White and Black Children via Implicit and Explicit Measures: Implications for Child Victims in the Criminal Justice System.

The present study explored implicit and explicit honesty perceptions of White and Black children and whether these perceptions predicted legal decisions in a child abuse case. Participants consisted of 186 younger and 189 older adults from the online Prolific participant pool. Implicit racial bias was measured via a modified Implicit Association Test and explicit perceptions through self-reports. Participants read a simulated legal case where either a Black or White child alleged physical abuse against their sports coach, and they rated the honesty of the child's testimony and rendered a verdict. Participants were implicitly biased to associate honesty with White children over Black children, and this bias was stronger among older adults. In the legal vignette, for participants who read about a Black child victim, greater implicit racial bias predicted less trust in the child's testimony and a lower likelihood of convicting the coach of abusing the child. In contrast to their implicit bias, participants self-reported Black children as being more honest than White children, suggesting a divergence in racial attitudes across implicit and explicit measures. Implications for child abuse victims are discussed.

Target Lipid Model and Empirical Organic Carbon Partition Coefficients Predict Sediment Toxicity of Polychlorinated Biphenyls to Benthic Invertebrates.

Quantifying causal exposure-response relationships for polychlorinated biphenyl (PCB) toxicity to benthic invertebrates can be an important component of contaminated sediment assessments, informing cleanup decisions and natural resource injury determinations. Building on prior analyses, we demonstrate that the target lipid model accurately predicts aquatic toxicity of PCBs to invertebrates, providing a means to account for effects of PCB mixture composition on the toxicity of bioavailable PCBs. We also incorporate updated data on PCB partitioning between particles and interstitial water in field-collected sediments, to better account for effects of PCB mixture composition on PCB bioavailability. To validate the resulting model, we compare its predictions with sediment toxicity data from spiked sediment toxicity tests and a variety of recent case studies from sites where PCBs are the primary sediment contaminant. The updated model should provide a useful tool for both screening-level and in-depth risk analyses for PCBs in sediment, and it should aid in diagnosing potential contributing factors at sites where sediment toxicity and benthic community impairment are observed. Environ Toxicol Chem 2023;42:1134-1151. © 2023 SETAC.

Dishonesty during a pandemic: The concealment of COVID-19 information.

Honest disclosures of COVID-19 behaviors and symptoms is critical. A sample of adults on MTurk (N = 451, 20-82 years of age) were asked if they have concealed social distancing practices, COVID-19 symptoms, and quarantine instructions, as well as how they evaluated others' COVID-19 concealment. Those who believed they had contracted COVID-19 engaged in greater rates of concealment and evaluated concealment more positively compared to those without the virus. As age and communal orientation increased, COVID-19 concealment behaviors decreased, and evaluations of this concealment were rated more negatively. Implications for public health initiatives and psychological theory on concealing health information is discussed.

Ecological Risk Analysis for Benzalkonium Chloride, Benzethonium Chloride, and Chloroxylenol in US Disinfecting and Sanitizing Products.

Use of three topical antiseptic compounds-benzalkonium chloride (BAC), benzethonium chloride (BZT), and chloroxylenol (PCMX)-has recently increased because of the phaseout of other antimicrobial ingredients (such as triclosan) in soaps and other disinfecting and sanitizing products. Further, use of sanitizing products in general increased during the coronavirus (COVID-19) pandemic. We assessed the environmental safety of BAC, BZT, and PCMX based on best available environmental fate and effects data from the scientific literature and privately held sources. The ecological exposure assessment focused on aquatic systems receiving effluent from wastewater-treatment plants (WWTPs) and terrestrial systems receiving land-applied WWTP biosolids. Recent exposure levels were characterized based on environmental monitoring data supplemented by modeling, while future exposures were modeled based on a hypothetical triclosan replacement scenario. Hazard profiles were developed based on acute and chronic studies examining toxicity to aquatic life (fish, invertebrates, algae, vascular plants) and terrestrial endpoints (plants, soil invertebrates, and microbial functions related to soil fertility). Risks to higher trophic levels were not assessed because these compounds are not appreciably bioaccumulative. The risk analysis indicated that neither BZT nor PCMX in any exposure media is likely to cause adverse ecological effects under the exposure scenarios assessed in the present study. Under these scenarios, total BAC exposures are at least three times less than estimated effect thresholds, while margins of safety for freely dissolved BAC are estimated to be greater than an order of magnitude. Because the modeling did not specifically account for COVID-19 pandemic-related usage, further environmental monitoring is anticipated to understand potential changes in environmental exposures as a result of increased antiseptic use. The analysis presented provides a framework to interpret future antiseptic monitoring results, including monitoring parameters and modeling approaches to address bioavailability of the chemicals of interest. Environ Toxicol Chem 2022;41:3095-3115. © 2022 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

Formation and stability of atmospherically relevant isoprene-derived organosulfates and organonitrates.

Isoprene is the precursor for number of alcohol, organosulfate, and organonitrate species observed in ambient secondary organic aerosol (SOA). Recent laboratory and field work has suggested that isoprene-derived epoxides may be crucial intermediates that can explain the existence of these compounds in SOA. To confirm this hypothesis, the specific hydroxy epoxides observed in gas phase isoprene photooxidation experiments (as well as several other related species) were synthesized and the bulk phase aqueous reactions of these species in the presence of sulfate and nitrate were studied via nuclear magnetic resonance (NMR) techniques. The results indicate that both primary and tertiary organosulfates and organonitrates are efficiently formed from the potential SOA reactions of isoprene-derived epoxides. However, the tertiary organonitrates are shown to undergo rapid nucleophilic substitution reactions (in which nitrate is substituted for by water or sulfate) over the whole range of SOA pH, while the tertiary organosulfates are found to undergo a much slower acid-dependent hydrolysis reaction. The primary organonitrates and organosulfates under study were found to be stable against nucleophilic substitution reactions, even at low pH. This finding provides a potential explanation for the fact that organosulfates are more commonly detected in ambient SOA than are organonitrates.

Younger and older adults' prospective memory: the role of delay task difficulty.

There is mixed evidence on the impact of delay task difficulty on prospective memory (PM) performance and little research has examined this among older adults. The present study examined younger (N = 60) and older (N = 57) adults' prospective memory (PM) performance after completing an easy or difficult Raven's matrices task. To assess whether delay difficulty impacted how often participants thought about their PM intention, participants were asked to report on what they thought about during the delay task itself and retrospectively after all tasks were completed. Younger adults outperformed older adults on the PM task; however, delay task difficulty had no impact PM for either age group. Reports of thinking about the intention during the delay task differed by age group depending whether they were online or retrospective, however, overall greater reports of thinking about the intention was positively associated with PM performance.

Correct diagnosis of childhood pneumonia in public facilities in Tanzania: a randomised comparison of diagnostic methods.

OBJECTIVE: This study compares two methods for clinical diagnosis of childhood pneumonia that aim to estimate rates of underdiagnosis and overdiagnosis of childhood pneumonia by examining the sensitivity of Integrated Management of Childhood Diseases implementation in routine care against lung ultrasound (LUS) diagnosis. SETTING: We conducted observations in 83 public health facilities (dispensaries, health centres and district hospitals) in Pwani, Dodoma and Tabora, Tanzania between October and December 2017. METHODS: We used a novel method to estimate rates of underdiagnosis and overdiagnosis of childhood pneumonia by comparing directly observed public provider diagnoses to the results of diagnoses made by trained clinicians using Mindray DP-10 ultrasound machines. We perform multivariate analysis to identify confounding effects and robustness checks to bound the result. We also explore a number of observable characteristics correlated with higher rates of agreement between provider diagnoses and ultrasound diagnoses. RESULTS: We observed 93 providers conducting exams on patients aged 2 months-5 years who presented respiratory symptoms or were given a respiratory diagnosis by the provider. Of these 957 patients, 110 were excluded from analysis resulting in a final sample of 847.17.6% of cases identified as pneumonia via LUS examinations in our sample were diagnosed as pneumonia by providers, suggesting that a significant number of pneumonia cases for which care is sought in the public sector go undiagnosed. Provider knowledge of breath counting and years of experience are positively correlated with higher agreement. While clinical examination rates are not statistically correlated with agreement, it is notable that providers conducted a clinical examination on only about one-third of patients in the sample. CONCLUSION: Our results suggest that provider training and knowledge of clinical examination protocols for pneumonia diagnosis are predictive of correct diagnosis of pneumonia and should be further explored in future research as a tool for improving quality of care.

Interleukin-7 enhances memory CD8(+) T-cell recall responses in health but its activity is impaired in human immunodeficiency virus infection.

Memory CD8(+) T cells regain function during a recall response, but the requirement of signals in addition to antigen during a secondary immune response is unknown. In this study, the ability of interleukin-7 (IL-7) to enhance memory CD8(+ ) CD45RA(- ) CD127(+) T-cell responses in health and in human immunodeficiency virus (HIV) infection was investigated. CD8(+) T-cell-depleted peripheral blood mononuclear cells (PBMCs) from HIV(-) and untreated HIV(+) donors were pulsed with a cytomegalovirus/Epstein-Barr virus/influenza (CEF) peptide pool, and co-cultured with autologous memory CD8(+) T cells in the presence of IL-7. Cell survival and the function of memory CD8(+) T-cell subsets were then evaluated. Memory CD8(+) T-cell proliferation and interferon-γ (IFN-γ) production was enhanced by the presence of antigen, and the addition of IL-7 further enhanced antigen-induced proliferation. In HIV(+) individuals, the presence of antigen enhanced IFN-γ production to a small degree but did not enhance proliferation. Lastly, IL-7 did not enhance antigen-mediated proliferation of memory CD8(+) T cells from HIV(+) individuals. IL-7 therefore appears to have a role in secondary immune responses and its activity is impaired in memory CD8(+) T cells from HIV(+) individuals. These results further our understanding of the signals involved in secondary immune responses, and provide new insight into the loss of CD8(+) T-cell function in HIV infection.

Kinetics of the hydrolysis of atmospherically relevant isoprene-derived hydroxy epoxides.

Isoprene (the most abundant nonmethane hydrocarbon emitted into the atmosphere) is known to undergo oxidation to 2-methyl-1,2,3,4-butanetetraol, a hydrophilic compound present in secondary organic aerosol (SOA) in the atmosphere. Recent laboratory work has shown that gas phase hydroxy epoxides are produced in the low NOx photooxidation of isoprene and that these epoxides are likely to undergo efficient acid-catalyzed hydrolysis on SOA to 2-methyl-1,2,3,4-butanetetraol at typical SOA acidities. In order to confirm this hypothesis, the specific hydroxy epoxides observed in the isoprene photooxidation experiment (as well as several other related species) were synthesized, and the hydrolysis kinetics of all species were studied via nuclear magnetic resonance (NMR) techniques. It was determined that the isoprene-derived hydroxy epoxides should undergo efficient hydrolysis under atmospheric conditions, particular on lower pH SOA. An empirical structure-reactivity model was constructed that parametrized the hydrolysis rate constants according to the carbon substitution pattern on the epoxide ring and number of neighboring hydroxy functional groups. Compared to the previously studied similar nonfunctionalized epoxides, the presence of a hydroxy group at the alpha position to the epoxy group was found to reduce the hydrolysis rate constant by a factor of 20, and the presence of a hydroxy group at the beta position to the epoxy group was found to reduce the hydrolysis rate constant by a factor of 6.

Improving measles vaccine uptake rates in Nigeria: An RCT evaluating the impact of incentive sizes and reminder calls on vaccine uptake.

OBJECTIVE: To assess the impact of increasing incentive size and reminder calls on the measles vaccine uptake rate. DESIGN: Randomized controlled trial, randomized at individual level, stratified by clinic. SETTING: Nigeria. PARTICIPANTS: 1088 caregivers with children aged nine months or older; had received at least one previous conditional cash transfer (CCT) at a program clinic, had received their Penta-3 immunization but had not yet received their measles immunization, and the caregiver had provided a phone number. INTERVENTION: Nine clinics were randomized to two models; caregivers in Model 1 received a default of 2000 Nigerian Naira (NGN) for completing the measles vaccine, and those in Model 2 received by 3000 NGN. Caregivers from the respective clinics were then randomized to one of the four arms: 1) control (baseline amount of 2000 NGN or 3000 NGN), 2) baseline amount plus a reminder call, 3) baseline amount plus 1000 NGN and a reminder call, and 4) baseline amount plus 3000 NGN and a reminder call. MAIN OUTCOME MEASURE: Receipt of measles vaccine as reported on a child health card. RESULTS: Overall, there was no clear trend that increasing the incentive amount resulted in an increase in vaccine uptake rates. In Model 1 households, an additional 1000 NGN and 3000 NGN resulted in a 6.4 percentage point (95% CI: -2.3-15, p-value = 0.15) and 11.8 percentage point (95% CI: 3.9-19.6, p-value = 0.003) increase in the probability of completing the measles vaccines, respectively. This increase, however, was only significant for the 3000 NGN increase. On the other hand, in Model 2 households, increasing the incentive by 1000 NGN and 3000 NGN increased the probability by 3.3 (95% CI: -3.8-10.4, p-value = 0.36) and 3.3 (95% CI: -3.7-10.4, p-value = 0.35) percentage points. These increases were not statistically significant. Adding reminder calls to CCTs increased the probability of completing the measles vaccine; caregivers who received reminder calls plus CCTs were 5.1 percentage points more likely to get their children vaccinated (95% CI: 0.50-9.8, p-value = 0.03) compared to those who received CCTs and did not receive a reminder call. These results were largely driven by caregivers who went to clinics in Model 1. CONCLUSION: A combination of increasing incentive amounts and reminder calls modestly improves measles immunization rates. However, this program also shows that there is substantial regional heterogeneity in response to both incentives and calls. While one possible conclusion is that a larger incentive and phone reminders are more likely to work in higher income and higher baseline coverage settings, the study is not designed to evaluate this claim. Rather, policymakers could consider experimenting with a similar low-cost calling study as part of the design of other cash transfer programs to identify whether adding reminder phone calls could increase the impact of the program.