Article

Asymmetric Paternalism to Improve Health Behaviors

Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213-3890, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 12/2007; 298(20):2415-7. DOI: 10.1001/jama.298.20.2415
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    • "For example, making small sequential changes over time in formulations for improving nutritional profile has been applied to reducing the salt content of processed foods (Dotsch et al. 2009). Finally, in keeping with the concept of asymmetric paternalism (Thaler andSunstein 2003, 2008;Loewenstein et al. 2007), consumers were given the option to ask for the nondefault ( less healthy) side or beverage , which maintained freedom of choice. Based on the successful implementation of healthy defaults in the real-world context of a large theme park, it seems reasonable to investigate this same strategy in other, more prevalent contexts such as QSRs and TSRs in local communities around the United States as well as in other countries. "

    Full-text · Article · Jan 2016
    • "Two strategies that capitalize on eHealth technologies and leverage advances in decision science hold particular promise for encouraging walking among older adults: financial incentives and peer networks. First, financial incentives are behavioral economic interventions that capitalize on people's difficulty in trading off immediate gratification for delayed health benefits (Loewenstein, Brennan, & Volpp, 2007 ). These strategies have tripled long-term tobacco cessation rates, increased weight loss, and improved medication adherence (Kimmel et al., 2012; Kullgren et al., 2013; Volpp et al., 2009 ). "
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    ABSTRACT: Background: Financial incentives and peer networks could be delivered through eHealth technologies to encourage older adults to walk more. Methods: We conducted a 24-week randomized trial in which 92 older adults with a computer and Internet access received a pedometer, daily walking goals, and weekly feedback on goal achievement. Participants were randomized to weekly feedback only (Comparison), entry into a lottery with potential to earn up to $200 each week walking goals were met (Financial Incentive), linkage to four other participants through an online message board (Peer Network), or both interventions (Combined). Main outcomes were the proportion of days walking goals were met during the 16-week intervention and 8-week follow-up. We conducted a content analysis of messages posted by Peer Network and Combined arm participants. Results: During the 16-week intervention, there were no differences in the proportion of days walking goals were met in the Financial Incentive (39.7%; p = .78), Peer Network (24.9%; p = .08), and Combined (36.0%; p = .77) arms compared with the Comparison arm (36.0%). During 8 weeks of follow-up, the proportion of days walking goals were met was lower in the Peer Network arm (18.7%; p = .025) but not in the Financial Incentive (29.3%; p = .50) or Combined (24.8%; p = .37) arms, relative to the Comparison arm (34.5%). Messages posted by participants focused on barriers to walking and provision of social support. Conclusions: Financial incentives and peer networks delivered through eHealth technologies did not result in older adults walking more.
    No preview · Article · Oct 2014 · Health Education & Behavior
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    • "For example, nurture serves the need to rear altricial children, disgust helps keep parasites outside the body (Curtis 2013), affiliation promotes efforts to belong to social groups, and love drives behaviour that serves the need to pair-bond (Aunger & Curtis 2013). These habitual and motivated drivers of behaviour are often more fundamental and powerful than the intentional or willful control of behaviour (Baumeister & Tierney 2012; Bechara 2005; Loewenstein et al. 2007), which suggests they should be incorporated in any comprehensive approach to behaviour change. Our behaviour change model, which we call the Evo-Eco approach, uses evolutionary theory to identify the key psychological , environmental, and situational causes of any particular behaviour and then provides a process to help develop interventions for large-scale behaviour change promotions. "
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    ABSTRACT: Humans possess great capacity for behavioral and cultural change, but our ability to manage change is still limited. This article has two major objectives: first, to sketch a basic science of intentional change centered on evolution; second, to provide examples of intentional behavioral and cultural change from the applied behavioral sciences, which are largely unknown to the basic sciences community. All species have evolved mechanisms of phenotypic plasticity that enable them to respond adaptively to their environments. Some mechanisms of phenotypic plasticity count as evolutionary processes in their own right. The human capacity for symbolic thought provides an inheritance system having the same kind of combinatorial diversity as does genetic recombination and antibody formation. Taking these propositions seriously allows an integration of major traditions within the basic behavioral sciences, such as behaviorism, social constructivism, social psychology, cognitive psychology, and evolutionary psychology, which are often isolated and even conceptualized as opposed to one another. The applied behavioral sciences include well-validated examples of successfully managing behavioral and cultural change at scales ranging from individuals to small groups to large populations. However, these examples are largely unknown beyond their disciplinary boundaries, for lack of a unifying theoretical framework. Viewed from an evolutionary perspective, they are examples of managing evolved mechanisms of phenotypic plasticity, including open-ended processes of variation and selection. Once the many branches of the basic and applied behavioral sciences become conceptually unified, we are closer to a science of intentional change than one might think.
    Full-text · Article · Aug 2014 · Behavioral and Brain Sciences
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