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Abstract

Objective: Does spending money on others (prosocial spending) improve the cardiovascular health of community-dwelling older adults diagnosed with high blood pressure? Methods: In Study 1, 186 older adults diagnosed with high blood pressure participating in the Midlife in the US Study (MIDUS) were examined. In Study 2, 73 older adults diagnosed with high blood pressure were assigned to spend money on others or to spend money on themselves. Results: In Study 1, the more money people spent on others, the lower their blood pressure was two years later. In Study 2, participants who were assigned to spend money on others for three consecutive weeks subsequently exhibited lower systolic and diastolic blood pressure compared to participants assigned to spend money on themselves. The magnitude of these effects was comparable to the effects of interventions such as antihypertensive medication or exercise. Conclusions: Together, these findings suggest that spending money on others shapes cardiovascular health, thereby providing one pathway by which prosocial behavior improves physical health among at-risk older adults.
Is spending money on others good for your heart?
Ashley V. Whillansa, Elizabeth W. Dunna,
Gillian M. Sandstroma Sally S. Dickersonb & Ken M. Maddenc
aDepartment of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC
Canada V6T 1Z4. Gillian M. Sandstrom is now at the University of Essex.
bDepartment of Psychology and Social Behavior, University of California, Irvine, 4201 Social &
Behavioral Sciences Gateway Irvine, CA 92697. Sally S. Dickerson is now at Pace University.
This work was completed while Sally Dickerson was serving at the National Science Foundation.
Any opinion, findings, and conclusions or recommendations expressed in this material are those
of the authors and do not necessarily reflect the views of the National Science Foundation.
cDepartment of Medicine, University of British Columbia, 2775 Laurel
Street, Vancouver, BC Canada V5Z 1M9.
Corresponding author:
Ashley Whillans, Department of Psychology,
The University of British Columbia
2136 West Mall, Vancouver, BC,
V6T 1Z4, 604-220-7975.
E-mail: ashleywhillans@psych.ubc.ca
Acknowledgements
The authors would like to thank Shirley Bi, Meghan Buckley, Sarah Cheung, Kyle Chou, Eva
Gifford, Chris Gorczynski, Kiran Kalkat, Jenny Lee, Leah Marks, Jacob Sussman, Carly
Thornton, and Brittany VanSchagen for their assistance with data collection as well as Haiyun
Liang for assistance with data management. This research was supported by Canadian Institute
for Health Research grant MOP-110968 awarded to E.D., a University of British Columbia
Graduate Research Award awarded to A.W., and a doctoral fellowship from the Social Sciences
and Humanities Research Council of Canada awarded to A.W.
RUNNING HEAD: Prosocial Spending & Health 2
Abstract
Objective: Does spending money on others (prosocial spending) improve the
cardiovascular health of community-dwelling older adults diagnosed with high blood pressure?
Methods: In Study 1, 186 older adults diagnosed with high blood pressure participating in the
Midlife in the US Study (MIDUS) were examined. In Study 2, 73 older adults diagnosed with
high blood pressure were assigned to spend money on others or to spend money on themselves.
Results: In Study 1, the more money people spent on others, the lower their blood pressure was
two years later. In Study 2, participants who were assigned to spend money on others for three
consecutive weeks subsequently exhibited lower systolic and diastolic blood pressure compared
to participants assigned to spend money on themselves. The magnitude of these effects was
comparable to the effects of interventions such as antihypertensive medication or exercise.
Conclusions: Together, these findings suggest that spending money on others shapes
cardiovascular health, thereby providing one pathway by which prosocial behavior improves
physical health among at-risk older adults.
Keywords: Health, Life Experiences, Social Behavior, Well Being, Prosocial Behavior
RUNNING HEAD: Prosocial Spending & Health 3
Can spending money on others improve physical health? Recent research suggests that
spending money on others improves emotional well-being (e.g., Dunn, Aknin & Norton, 2008;
see Dunn, Aknin & Norton, 2014 for a review). Indeed, the happiness benefits of spending on
others (“prosocial spending”) have been documented in rich and poor countries around the
world, from Canada and the United States to Uganda and India (Aknin et al., 2013). There has
been less research examining whether prosocial spending can affect physical health. There is
some evidence that generous or stingy economic decisions may have downstream consequences
for cortisol, a hormone that is implicated in the stress response (Dunn et al., 2010). However,
research in this area has not yet explored whether prosocial spending leads to clinically relevant
health benefits. Given that heart disease is the leading cause of death worldwide, and that high
blood pressure puts people at a higher risk of a heart attack, this article focused on examining
whether prosocial spending reduces blood pressure among at-risk older adults.
Providing indirect support for this hypothesis, correlational and longitudinal research
suggests that individuals who provide help to others exhibit a reduced risk of mortality and better
overall health (e.g., Brown, Consedine & Magai, 2005; Brown et al., 2009; Piliavin & Siegl,
2007; Poulin, Brown, Dillard & Smith, 2013; see Konrath & Brown, 2013 for a recent review).
Helping others can take multiple forms, such as providing informal support to friends and family,
and participating in formal volunteer work (Tilly & Tilly, 1994; Wilson & Musick, 1997). In a
ground breaking longitudinal study, researchers found that providing social support was
associated with a decreased risk of mortality among older adults (Brown, Nesse, Vinokur &
Smith, 2003). Similarly, people who volunteered at least four hours per week were less likely to
develop high blood pressure four years later (Sneed & Cohen, 2013). Furthermore, research
suggests that volunteering leads to the greatest benefits for at-risk groups, including adults with
RUNNING HEAD: Prosocial Spending & Health 4
higher depressive symptomology (Wheeler et al., 1998), youth from lower SES backgrounds
(Schreier et al., 2013), and older adults (Van Willigen, 2000) in part by buffering against
declines in functional health (Fried et al., 2004). This research suggests that spending time
helping others may have potent effects on the health of at-risk older adults, yet no longitudinal or
experimental research has examined whether prosocial spending affects physical health.
Although time and money are typically identified as the primary resources that
individuals may use to benefit others (Liu & Aaker, 2008), past research has focused primarily
on the health benefits of giving time (i.e., volunteering). A growing body of research suggests
that people think about time and money in profoundly different ways (e.g., Mogilner 2010,
Whillans, Weidman & Dunn, 2015, Zauberman & Lynch, 2005). For example, whereas thinking
about time leads people to prioritize social connections (Mogilner, 2010), thinking about money
can lead people to distance themselves from others (Vohs, Mead & Goode, 2008). Thus, it is
unclear whether the observed health benefits of giving time would extend to giving money.
Two studies were conducted to assess whether spending money on others reduces high
blood pressure, a clinically relevant health outcome that is responsible for 7.5 million premature
deaths each year (World Health Organization [WHO], 2014). The decision to examine blood
pressure was driven by conceptual and pragmatic considerations. Conceptually, research
suggests that helping others can release restorative hormones that may have direct effects on
blood pressure (Petersson, 2002). Furthermore, research suggests that helping others may have
implications for blood pressure by decreasing activity in the hypothalamatic pituitary adrenal
(HPA) axis and by regulating the cortisol stress response (e.g., Brown et al., 2008). For example,
research suggests that engaging in prosocial behavior can activate areas of the brain associated
with the release of oxytocin and vasopressin—neurohormones that directly influence blood
RUNNING HEAD: Prosocial Spending & Health 5
pressure and that are implicated in HPA regulation, such as the release of cortisol, a hormone
involved in the stress response (e.g., Moll, 2006). Critically, dysregulation of the HPA axis has
been causally linked to hypertension (e.g., Kelly et al., 1998). It is also possible that prosocial
spending directly impacts the sympathetic nervous system (SNS), resulting in greater
parasympathetic activity (PNS) and/or reduced SNS activation. Indeed, recent research suggests
that higher levels of generosity are associated with greater PNS activity and lower SNS activity
(Miller, Kahle & Hastings, 2015). Consequently, to the extent that spending money on others
leads to the release of neurohormones that may directly affect blood pressure and/or directly
regulate the HPA axis, prosocial spending should have consequences for metabolic processes,
including cardiovascular functioning.
Practically, hypertension is an important, modifiable risk factor for cardiovascular disease
that can be measured precisely using non-invasive procedures. Hypertension also exhibits
reliable improvements due to lifestyle or psychosocial modifications within a short-time span
(e.g., James et al., 2014). Although prosocial spending might exert other effects related to the
HPA system, such as reduced inflammation and improved vasodilatation, blood pressure is a
theoretically and practically relevant outcome to provide the first empirical examination
regarding whether prosocial spending impacts cardiovascular health.
In Study 1, the association between financial generosity and lower blood pressure was
assessed among older adults diagnosed with high blood pressure who were participating in the
Midlife in the United States Study (MIDUS). It was predicted that respondents who spent more
money on others would exhibit lower systolic blood pressure (SBP) and diastolic blood pressure
(DBP). In Study 2, an experimental paradigm was employed to assess the causal benefits of
financial generosity among older adults diagnosed with high blood pressure. Across both studies,
RUNNING HEAD: Prosocial Spending & Health 6
we explored the effects of prosocial spending on cardiovascular health for older adults diagnosed
with high blood pressure. Analyses focused on individuals diagnosed by a physician with
hypertension based on recommendations from the Joint National Committee (JNC), which uses
scientific evidence to create guidelines for the management of hypertension (James et al., 2014).
According to the JNC, it is inappropriate to assess the effects of psychosocial variables or
interventions on blood pressure for individuals who do not suffer from hypertension. These
guidelines state that all patients that have systolic blood pressures less than 120 and diastolic
blood pressures less than 80 are classified as ‘normal’ and do not require lifestyle modifications
or pharmacological therapy since there is no evidence to support blood pressure lowering therapy
for individuals who do not suffer from hypertension. Thus, across Studies 1 and 2, our analyses
focused on individuals who were previously diagnosed with hypertension by a physician;
analyses for normotensives are presented in the Supplementary Online Material (SOM).1
These studies focus specifically on the impact of financial generosity among older adults.
Research suggests that older adults reap the greatest rewards from helping others (e.g., Van
Willigen, 2000). According to activity theory—a prominent theory in social gerontology—older
adults who remain productive and who keep or create new social networks maintain better health
than older adults who disengage from social involvements (e.g., Erikson, Erikson & Kivnick,
1986). Thus, prosocial spending may provide one way to help older adults maintain feelings of
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1 Participants who were included in Studies 1 and 2 had received a diagnosis of hypertension by
a physician prior to participation. Thus, the majority of participants were being treated for high
blood pressure at the time of data collection (see Tables 1 & 3), and participants’ blood pressure
at the time of measurement often fell within a “pre-hypertensive” range because their
hypertension was being managed through medication and/or diet and exercise. Consequently,
these two studies provide a conservative test of the impact of charitable spending on
cardiovascular health—the effects of charitable spending on blood pressure occurred in a sample
of individuals in which the vast majority were already being treated for hypertension.
RUNNING HEAD: Prosocial Spending & Health 7
productivity and to maintain social networks in older age (e.g., Van Willigen, 2000). Although
high blood pressure can affect people at any age, hypertension disproportionately afflicts older
adults (WHO, 2014), underscoring the importance of examining factors that improve
cardiovascular health among at-risk older adults.
Study 1
Method
Participants. Data from the MIDUS II biomarker project conducted in 2004-2006 was
examined. The MIDUS examines the relationship between psychosocial factors and health in a
nationally representative sample of non-institutionalized adults aged 25 to 74 living in the
contiguous United States (see Brim, Ryff & Kessler, 2004 for additional documentation).
Biological data were collected on a subset of MIDUS II participants who completed
telephone and mail surveys and who were willing and able to travel to one of three General
Clinical Research Centers (GCRC) for an overnight visit. At the GCRC, individuals provided a
complete medical history, underwent a physical exam with a physician, and completed health
measures including blood pressure measurements. Biomarker data collection took place approx.
two years after the initial phone and mail surveys (M = 27.70 months, SD = 14.74).
To include the largest number of older adult participants, while maintaining consistency
with other large-scale empirical investigations of the benefits of volunteering (e.g., Oman,
Thoresen & McMahon, 1999), the a priori decision was made to focus these analyses on
participants aged 55 years of age or older. Thus, the current analyses are based on MIDUS II
respondents aged 55 and older who provided charitable giving data, received a diagnosis of high
blood pressure by a physician prior to their participation in MIDUS, and provided blood pressure
data at a GCRC (N = 186; see Table 1 for demographic characteristics). It was predicted that
RUNNING HEAD: Prosocial Spending & Health 8
participants who reported greater financial generosity at the initial data collection would
demonstrate lower systolic and diastolic blood pressure at the follow-up visit two years later.
Measures
Financial Generosity. During the MIDUS II phone and interview data collection,
respondents reported how much money they contributed to each of the following people or
organizations each month: (1) religious groups, (2) political organizations or causes, (3) friends
and/or family, and (4) any other organization, cause, or charity (including donations made
through monthly payroll deductions)2. Participants’ responses were totaled to create an overall
index of the amount of money that participants reported contributing to others each month.
Consistent with published research, participants who reported donating more than $5,000 per
month were excluded because they were extreme outliers (N = 4; Choi & Chou, 2010; see SOM
for MIDUS survey items and variable names). The results are substantively unchanged upon
including these individuals in our analyses. Eighty-six percent of respondents reported that they
had contributed money to at least one person or organization in the last 12 months. Given the
high percentage of people who reported donating, our analyses focused on the amount that
participants donated. Due to the size of our sample, fine-grained analyses looking at the specific
spending targets were not conducted, because of the limited power to detect reliable effects. This
decision is consistent with a great deal of research that broadly defines prosocial spending as any
act of financial generosity—from making charitable donations to providing financial support to
family members (e.g., Dunn, Aknin & Norton, 2008; Dunn, Aknin & Norton, 2014).
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2 Because the MIDUS uses relatively broad spending categories, it is debatable whether all of
these categories (e.g., donations to political organizations or causes) should be classified as
prosocial spending. In the context of the MIDUS survey, however, all of these categories were
presented as forms of giving financial support. Thus, consistent with past research (e.g., Choi &
Chou, 2010), we include all categories to form a broad index of prosocial spending.
RUNNING HEAD: Prosocial Spending & Health 9
Blood Pressure. During the MIDUS II biomarker data collection, participants completed
several health measures, including blood pressure. To measure resting systolic and diastolic
blood pressure, participants were seated in a chair, and a trained nurse placed a blood pressure
cuff on the participant’s non-dominant arm. Following a five-minute rest period, three blood
pressure readings were collected using an automatic BP monitor (BPM, VSM MedTech; Ryff,
Seeman & Weinstein, 2010). Following standard protocol, the first reading was excluded to
allow for participants to adjust to the procedure. Thus, SBP and DBP were calculated as the
average of the second and third readings.
Covariates. The identical set of covariates were examined as in previously published
research assessing the effects of social support on well-being with the MIDUS dataset (level of
education, household income, self-rated health, physical activity and exercise, religious
identification, work status, number of hours spent working, age, gender, race/ethnicity and
marital status; Choi & Chou, 2010; Choi & Kim, 2011). Additionally, income and net-worth as
well as several consumption-based measures of socioeconomic status (SES) were examined—
given that these measures often serve as a better proxy for SES than household income (Headey,
Muffels & Wooden, 2004). The length of time between the initial survey and the biomarker data
collection, and variables known to influence cardiovascular health including body mass index
(BMI), waist-to-hip ratio (WHR), smoking status (yes/no), heart condition (yes/no), number of
chronic conditions, blood pressure medication (yes/no), and number of blood pressure
medications were also examined. Further, psychological variables such as conscientiousness and
emotional well-being were examined. Finally, whether participants volunteered (yes/no), how
many hours they reported volunteering, how many community organizations they participated in,
and the amount of financial support that participants reported receiving were examined. These
RUNNING HEAD: Prosocial Spending & Health 10
covariates allowed for the examination of the impact of financial generosity on blood pressure
independent of other forms of social support received or provided (see SOM for names of the
MIDUS variables assessed in these covariate analyses).
Each potential control variable was first included individually in the model to explore
whether it was associated with the blood pressure measures assessed in this study (SBP and
DBP); covariates that were not significantly associated with the key blood pressure measures
either initially or upon entering other significant covariates into our analyses were not retained in
the final model to preserve degrees of freedom (Adam, 2006). Because the associations between
these covariates and each of our key blood pressure measures differed, the final regression
models vary. To ensure that this covariate selection technique did not lead to spurious
associations (Babyak, 2004), these analyses were also conducted controlling for an alternative set
of covariates. These covariates were selected by the physician member of the author team who
was not in charge of analyzing the data, and who identified covariates that are considered critical
for assessing the impact of psychosocial factors on cardiovascular health: age, gender, smoking,
alcohol intake, BMI, WHR, ethnicity, physical activity levels, BP medications, and whether
participants had a heart condition (yes/no). The results across both BP outcome measures are
substantially unchanged upon controlling for this alternative set of covariates (see SOM).
Results and Discussion
Blood Pressure Measures. As predicted, respondents who reported spending more
money on others during the initial data collection had lower systolic blood pressure at the health
visit approximately two years later, β = -.15, p = .04, and this relationship remained significant
after controlling for our set of covariates, β = -.21, p < .01 (Tables 2 & 3). People who spent
more money on others also had lower diastolic blood pressure, β = -.16, p = .03, and these results
RUNNING HEAD: Prosocial Spending & Health 11
held controlling for our set of covariates, β = -.23, p < .01. Although the goal of this research
project was to examine factors that predict healthy aging among older adults, the salutary effects
of prosocial spending held upon examining adults of any age in this sample diagnosed with
hypertension (SOM). Additional analyses revealed that the benefits of prosocial spending were
not moderated by age, but were moderated by hypertension status (see SOM), further suggesting
that the benefits of prosocial spending were strongest for individuals with high blood pressure.
These findings provide initial support for the hypothesis that financial generosity is
associated with lower blood pressure among older adults who were previously diagnosed with
high blood pressure. However, given the non-experimental nature of these data, causality cannot
be inferred. Although a wide range of potential confounds were controlled for (e.g., age, gender,
physical activity, and multiple indicators of SES), it is always possible that some unmeasured
variable might explain the observed relationship between prosocial spending and blood pressure.
Consequently, in Study 2, an experimental study was conducted to investigate whether prosocial
spending has a causal effect on blood pressure among at-risk older adults.
Study 2
Participants, who were diagnosed with high blood pressure by a physician prior to
participation, were given three payments of $40 to spend for three consecutive weeks during a
six-week study period. Participants were randomly assigned to spend the payments on other
people (prosocial spending condition) or themselves (personal spending condition). Each week,
participants received a phone call, which allowed us to collect information related to spending
and health. Participants also completed three lab visits, during which we assessed blood pressure,
body-mass index, and waist-to-hip ratio.
Method
RUNNING HEAD: Prosocial Spending & Health 12
Inclusion Criteria. Community-dwelling adults aged 65 and older responded to
advertisements in community centers, newspapers, and shopping malls in the greater Vancouver
area. Eligibility was determined based on responses to questionnaires administered over the
phone and in the lab. A priori exclusion criteria was established to ensure that participants were
able to complete the complex procedures required throughout the study and did not have health
issues that would make their health unstable (e.g., new medications) or that would affect the key
dependent measures (e.g., depression or recent surgeries; see Table S8 for the full list of
eligibility criteria). Only non-institutionalized individuals and individuals who did not report
knowing anyone else completing the study were eligible to participate. The majority of
participants identified as White and female, and had completed some post-secondary education.
The research team was interested in detecting effects of at least a medium size (d = .40;
Cohen, 1999). Assuming an effect size of .40, and using a 2-sided test at a 0.05% significance
level, it was determined that we needed 72 participants to attain 95% power to detect condition
differences on our blood pressure measures (GPower, 2013; approx. 36 participants per
condition). The research team slightly over-recruited to account for exclusions on a priori
criteria, resulting in a final sample of N = 73 individuals who met the eligibility requirements.
Because the aim of the current manuscript was to provide the first empirical evidence that
spending money on others improves cardiovascular health, and given the significant time and
monetary costs associated with conducting the study, only enough participants were recruited to
detect a main effect of prosocial spending on blood pressure. This study is therefore
underpowered to detect interactions between condition, other psychological variables, and/or
spending targets. To encourage future research, the results of exploratory analyses examining
when and how prosocial spending leads to cardiovascular benefits are reported in the SOM.
RUNNING HEAD: Prosocial Spending & Health 13
Years 1 and 2. Data collection occurred over two years. In Year 1, data was collected as
part of a larger exploratory study on the emotional and physical consequences of prosocial
spending. This sample (N = 96) included 36 people diagnosed with high blood pressure.
Exploratory analyses suggested that prosocial spending was linked to lower blood pressure
within this sub-sample of adults previously diagnosed with hypertension. Because this initial
study was exploratory, data was collected for an additional 37 participants in Year 2 to confirm
the hypothesis; therefore, in Year 2 (unlike in Year 1), only participants who were diagnosed
with high blood pressure prior to participation were recruited. Not surprisingly, given that
individuals with poorer cardiovascular health were purposefully recruited, individuals recruited
in Year 2 of the study had significantly higher BMI, WHR and were significantly more likely to
be taking blood pressure medication (Table S9). There were no other differences on demographic
or psychosocial characteristics between participants recruited in Year 1 vs. 2 of the study.
The data was analyzed after Year 1, potentially increasing the risk of Type 1 error
(Simmons, Nelson & Simonsohn, 2011). Thus, current best practices were used to quantify this
risk (Sagarin, Ambler & Lee, 2014). In the SOM, the Paugmented statistic for each dependent
variable is reported. These results suggest that Type 1 error was not substantially inflated.
General Procedure.
Individuals who expressed interest in participating in our study completed a brief phone
screening. During this phone screening, individuals provided health, demographic, and
availability information. Following this initial phone call, individuals who still wished to
participate and who met basic health criteria were invited to the laboratory to complete final
eligibility measures and to receive more information about the study. During this initial lab visit,
participants reviewed the study procedures and had the opportunity to ask questions before
RUNNING HEAD: Prosocial Spending & Health 14
providing written consent. Participants also provided demographic information and completed
blood pressure, weight, height, hip, and waist measures. Of the 85 individuals who participated
in this initial lab visit, 92% (N = 73) completed the study in its entirety. Nine people were
excluded during the initial lab visit for failing to meet the study’s cognitive requirements, and
three people chose not to participate in the study due to the time commitment involved.
During this initial lab visit, after eligibility was confirmed, participants were assigned to
spend money on themselves or to spend money on others for the duration of the study. Each
participant received two payments of $40. These payments were placed in a small bottle with a
cap that recorded the date and time that the bottle was opened (Aardex, 2010). Each bottle was
clearly labeled with the date that participants were supposed to spend their payments and a
reminder of their spending condition. Participants returned to the lab three weeks and five weeks
after the initial lab visit (Week 4 and 6 of the study). Research assistants were blind to the
hypothesis of the study and to condition assignment at the time of the health measures. During
the Week 4 lab visit, health measures were assessed and participants received their final study
payment of $40. During the Week 6 lab visit, health measures were assessed. Upon completion
of each lab visit, participants received $10 for travel. At the end of the study, participants were
debriefed and received a health report that included information about their blood pressure.
Spending Intervention. Participants who met the inclusion criteria were randomly
assigned to spend money on others or to spend money on themselves. Participants assigned to the
personal spending condition were provided with written instructions to “Spend the study
payment on yourself. It does not matter how you spend the $40, as long as you spend it on
yourself.” Participants assigned to the prosocial spending condition were provided with written
instructions to “Spend the study payment on someone else. It does not matter how you spend the
RUNNING HEAD: Prosocial Spending & Health 15
$40, as long as you spend it on someone else.” Participants were asked to spend the study
payment by 4:30pm on a day of their choosing during weeks 3, 4, and 5 of the study. At 4:30pm
on the spending day, participants received a phone call from a research assistant. To ensure that
participants had spent their payment as instructed, participants completed a brief spending survey
during this phone call. Participants were asked, “How did you spend your study payment today,
and what did you spend it on? Please answer with as much detail as possible, in at least 2-3
sentences.” Research assistants recorded participants’ exact responses and completed a
compliance report. To increase compliance, participants were asked to keep receipts of the
purchases they made, and to provide these receipts at each lab visit throughout the study. Only
one participant failed to comply with the spending instructions during the majority of spending
weeks, and the results are robust when this participant is excluded from the critical analyses.
Blood Pressure. To measure resting systolic and diastolic blood pressure, participants
were seated in a chair, and a research assistant placed a blood pressure cuff on the participant’s
non-dominant arm. Appropriately sized cuffs were selected according to the diameter of each
participant’s arm. Following a twenty-minute rest period, six blood pressure readings, spaced
two minutes apart, were collected using an automatic BP monitor (BPM-100, VSM MedTech).
Following standard protocol, the first reading was excluded to allow participants to adjust to the
procedure. SBP and DBP were calculated by averaging the last five measures taken. This device
and protocol have been validated in adult populations and yield readings that meet the standards
of the U.S. Association for the Advancement of Medical Instrumentation (Zorn et al., 1997).
Other Health Measures. WHR was calculated as the ratio of the waist (measured at the
narrowest point between the ribs and the iliac crest) to hip circumference (measured at the
maximum diameter of the buttocks). Height and weight were measured by our research assistants
RUNNING HEAD: Prosocial Spending & Health 16
at each lab visit (Weeks 1, 4, and 6 of the study) and BMI was calculated as weight in pounds
divided by height in inches squared and multiplied by a factor of 703.
Data Availability. Because the data presented here were part of a larger study,
participants also completed other measures. Complete data are available by request from the first
author; these data are not posted online due to the sensitive nature of some measures.
Results.
Critically, there were no significant differences in age, blood pressure, BMI or WHR
between conditions at baseline (Table 4), suggesting that random assignment was successful at
equating groups on potential confounding variables. To assess condition effects on the study’s
cardiovascular measures (SBP and DBP), analyses of covariance were conducted assessing
group differences in blood pressure collapsing across the two post-spending measurements and
adjusting for baseline. Consistent with reporting standards to maximize transparency (Simmons,
Nelson & Simonsohn, 2011), the results of condition assignment on the blood pressure measures
at each occasion are also reported separately (see Table S10 and Figure S1).
Blood Pressure Measures. After spending money on others, participants had lower
systolic blood pressure (M = 113.85, SD = 9.87) as compared to participants assigned to spend
money on themselves (M = 120.71 SD = 15.04), F(1, 73) = 6.72, p = .012, η2 = .09, CI95[-11.19, -
1.46]. Likewise, participants assigned to spend money on others had significantly lower diastolic
blood pressure (M = 67.03, SD = 7.80) compared to participants assigned to spend money on
themselves (M = 72.97, SD = 8.59), F(1, 73) = 10.45, p = .002, η2 = .13, CI95[-7.43, - 1.76].
There were no interactions between condition and cohort to predict blood pressure, and results
held controlling for variables that differed across cohort, including BMI, WHR, and whether
RUNNING HEAD: Prosocial Spending & Health 17
participants were taking BP medication (SOM).3 Follow-up analyses revealed that these results
were driven by decreased blood pressure among individuals who spent money on others, and not
by increased blood pressure among individuals who spent money on themselves (see SOM).
Other Health Measures. Research suggests that prosocial behaviour is associated with
greater physical activity (Fried et al., 2004, Tan et al., 2009, Tan, Xue, Li, Carlson, & Fried,
2006). Thus, it is possible that these effects stemmed from participants in the prosocial spending
condition increasing physical activity and/or medical compliance throughout the study. Although
the measures were limited, this study provides suggestive evidence that improved physical
activity and/or medical compliance might not explain the reductions in blood pressure among
individuals who were randomly assigned to spend money on others (see SOM).
General Discussion
Two studies provide the first empirical evidence that prosocial spending may lead to
lower blood pressure among older adults diagnosed with high blood pressure. In Study 1,
participants who spent more money on others exhibited lower systolic and diastolic blood
pressure two years later. In Study 2, participants assigned to spend money on others showed
significant improvements in systolic and diastolic blood pressure compared to participants
assigned to spend money on themselves. Thus, prosocial spending was linked to lower blood
pressure both when people used their own money to provide financial support to others in daily
life (Study 1), and when they were instructed to spend a windfall of money on others (Study 2).
Furthermore, the effects of prosocial spending on systolic and diastolic blood pressure, ranging
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3 The impact of prosocial spending among normotensives recruited during Year 1 of data
collection was also examined (SOM). As expected, these additional analyses revealed that the
benefits of prosocial spending were moderated by hypertension status. Along with Study 1, these
results suggest that prosocial spending had the greatest benefits for hypertensive individuals.
!
RUNNING HEAD: Prosocial Spending & Health 18
from 5-7 mm of Hg in Study 2, were similar to the changes documented in response to starting
new hypertension medication, high frequency exercise or diet modifications (Chobanian et al.,
2003). The current studies point to the idea that financial generosity can lead to improvements in
the cardiovascular health of at-risk adults.
This was the first research to examine the implications of prosocial spending for the
cardiovascular health of at-risk older adults. Thus, the goal of this research was to document the
existence of a relationship between financial generosity and cardiovascular health, rather than to
illuminate the complex pathways that might underlie these effects. Nonetheless, to facilitate
future research, exploratory analyses were conducted to assess three potential mechanisms that
could shed light on how spending money on others improves cardiovascular health: improving
emotional well-being, bolstering social connection, and buffering against stress.
First, it is possible that prosocial spending might reduce blood pressure by enhancing
positive emotions or reducing negative emotions (Dunn, Aknin & Norton, 2008). However, there
was no support for this pathway in the present research (see SOM for additional analyses).
Beyond self-reported affect, prosocial spending might confer other psychological benefits with
downstream consequences for physical health, such as increasing social connection (Holt-
Lundstad, Smith & Layton, 2010). There was also no support for this pathway (SOM).
Furthermore, spending money on others might improve cardiovascular health by protecting
individuals from the deleterious effects of stress on cardiovascular health (e.g., Chida & Steptoe,
2010). Consistent with research documenting the stress buffering effects of helping others
(Poulin et al., 2013), there was some evidence that prosocial spending protected participants
from the negative impact of stress: For participants who were assigned to spend money on
RUNNING HEAD: Prosocial Spending & Health 19
themselves, there was a positive association between stress and blood pressure; this relationship
disappeared for participants assigned to spend money on others (SOM).
It is also possible that spending money on others is linked to improved cardiovascular
health through mechanisms that are not measured here. Spending money on others may boost
feelings of self-worth, which could protect older adults from social isolation and/or stressful life
experiences (Seeman et al., 1987; Seeman et al., 2001). Engaging in prosocial spending may give
individuals perspective on their own life struggles, promoting more positive coping strategies in
the face of stressful situations. For example, in a recent correlational study, people who provided
more social support to others reported higher levels of self-efficacy, which predicted lower
systolic and diastolic blood pressure (Piferi & Lawler, 2006). Spending money on others might
also protect individuals from social isolation, as providing instrumental financial support to
others might replenish social ties that can often be lost in older age due to social changes such as
retirement and bereavement (see: Sneed & Cohen, 2013 for a similar discussion). Because
participants were not explicitly asked to report how much self-worth or efficacy they felt after
spending money on others, more research is needed to replicate and extend this research, such as
by examining the specific pathways by which generous spending affects cardiovascular health.
What types of financial generosity might lead to the greatest benefits for cardiovascular
health? Research on hedonic adaptation has shown that people adapt quickly to positive and
negative lifestyle changes (Kahneman, 1999), and the effect of new circumstances can diminish
quickly or disappear completely once people have habituated to their new circumstances
(Brickman, Coates & Janoff-Bulman, 1978). To sustain the health benefits of prosocial spending,
it may be necessary to engage in novel acts of financial generosity (Sheldon, Boehm &
Lyubomirsky, 2012). In addition, research on prosocial spending and well-being suggests that
RUNNING HEAD: Prosocial Spending & Health 20
individuals reap greater benefits from spending money on people they consider close social ties
than from spending money on acquaintances or other weak ties (Aknin et al., 2013; Aknin,
Sandstrom, Dunn & Norton, 2011). In Study 2, there was initial evidence that participants
exhibited larger improvements in blood pressure if they spent money on close (vs. less close)
others (SOM). Thus, this research tentatively suggests that individuals might benefit most from
engaging in a variety of types of prosocial spending, while prioritizing people closest to them.
It is worth noting that financial generosity might not always benefit health. Studies of
caregivers show that support provision can burden caregivers and negatively impact
cardiovascular health (Capistrant, Moon, Berkman, & Glymour, 2011; Haley, Roth, Howard &
Safford, 2010). Even reflecting on support provision can have negative consequences; in a recent
experimental study, participants who were asked to write about providing support had higher
systolic and diastolic blood pressure upon completing a stressful task compared to participants
assigned to write about receiving support (and as compared to a control condition; Creavan &
Hughes, 2012). Of course, providing ongoing social support may be more physically taxing than
providing financial support. Yet, this work points to the hypothesis that financial generosity
might provide health benefits only when it does not incur overwhelming personal costs.
High blood pressure currently affects 67 million people in the U.S. (CDC, 2012) and 1
billion people worldwide (WHO, 2014). This work provides the first longitudinal and
experimental evidence that financial generosity can improve cardiovascular health. The impacts
were clinically relevant—the effects of prosocial spending on systolic and diastolic blood
pressure were similar in magnitude to the changes documented in response to well documented
interventions such as high frequency exercise or diet modification (Chobanian et al., 2003).
Given that most research on prosociality and health has relied on correlational or longitudinal
RUNNING HEAD: Prosocial Spending & Health 21
designs, the use of experimental methodology in the present research provides some of the
strongest evidence to date that prosocial behaviour exerts a causal effect on physical health.
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RUNNING HEAD: Prosocial Spending & Health 28
Table 1. Characteristics of participants in MIDUS sample (N = 186)
Mean (SD)
Female (%)
50.5%
Caucasian (%)
94.6%
Age
65.74 (7.38)
Annual Household Income
$64,217.07 ($53,942.77)
Highest Level of Educationa
7.64 (2.63)
Married (%)
69.6%
Hours of Paid Work per Week
31.93 (17.04)
Hours of Volunteer Work per Week
3.86 (11.28)
Ever smoked cigarettes? (%)
47.8%
Cognitive Functioning Scaleb
5.33 (.72)
Depression Scorec
2.48 (1.56)
Take Hypertension Medication at T1 (%)
82.3%
SBP
138.72 (18.64)
DBP
74.93 (9.32)
Waist to Hip Ratio
0.93 (.09)
BMI
30.76 (5.61)
a The mean score of education represents the category “Graduated from 2-year college,
vocational school, or with an associate degree”
b Cognitive control, 1 = Lowest Cognitive Functioning to 7 = Highest Cognitive Functioning
c This scale ranges from 1 = Lowest Depressed Affect to 7 = Highest Depressed Affect

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... Prosocial actions take on many familiar forms, like charitable giving, volunteering, donating blood, or the everyday kinds of helping that we focus on in the current research, such as sharing food or offering advice to others (Aknin & Whillans, 2021). Prosociality is a hallmark of a well-functioning society (Bowles & Gintis, 2003;Rand & Nowak, 2013), and performing prosocial acts can provide personal benefits to the helper, including positive reputational rewards (Willer, 2009;Willer et al., 2010), better physical health (Brown et al., 2009;Kushlev et al., 2020;Lyubomirsky et al., 2005;Whillans et al., 2016), and increased emotional well-being and meaning in life (Aknin et al., 2013(Aknin et al., , 2015Van Tongeren et al., 2016). Despite the benefits of prosociality, people sometimes choose not to help others, and research has examined factors that restrict helping behaviors (Latané & Darley, 1970;Piliavin et al., 1981), including gender roles. ...
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