Behavioral Economics / Behavior Change

The application of principles of economics and psychology to examine how individuals make choices in complex contexts--such as personal finances and health--and to improve these decisions and behaviors.

External Validation Of The Skilled Nursing Facility Prognosis Score For Predicting Mortality, Hospital Readmission, And Community Discharge In Veterans

Robert Burke, MD, University of Pennsylvania
Jul. 1, 2020

Robert E. Burke, Anne Canamucio, Elina Medvedeva, Kirstin A. Manges, Mary Ersek

Abstract [from journal]

Background/objectives: Prognostic tools are needed to identify patients at high risk for adverse outcomes receiving post-acute care in skilled nursing facilities (SNFs) and provide high-value care. The SNF Prognosis Score was developed in a Medicare sample to predict a composite of long-term SNF stay, hospital readmission, or death during the SNF stay. Our goal was to evaluate the score's performance in an external validation cohort.

Design: Retrospective observational analysis.


The Association Of A Sweetened Beverage Tax With Changes In Beverage Prices And Purchases At Independent Stores

Nandita Mitra, PhD
Jul. 1, 2020

Sara N. Bleich, Hannah G. Lawman, Michael T. LeVasseur, Jiali Yan, Nandita Mitra, Caitlin M. Lowery, Ana Peterhans, Sophia Hua, Laura A. Gibson, Christina A. Roberto

Abstract [from journal]

In January 2017 Philadelphia, Pennsylvania, implemented an excise tax of 1.5 cents per ounce on beverages sweetened with sugar or artificial sweeteners. Small independent stores are an important yet understudied setting. They are visited frequently in urban and low-income areas, and sugary beverages are among the most commonly purchased items in them. We compared changes in beverage prices and purchases before and twelve months after tax implementation at small independent stores in Philadelphia and an untaxed control city, Baltimore


What Do We Know About Health Insurance Choice?

Issue Brief
Jun. 30, 2020

From choosing a doctor to selecting an insurance plan, choices pervade nearly all aspects of our health care system. However, there is little agreement among policymakers and the public about what constitutes “choice,” which choices are important, and how and whether patients should be asked to make various health care choices. Although Americans claim to value having health insurance choices, research shows that when presented with options, people do not actually like to choose. Other studies suggest that people frequently make health insurance decisions that leave them worse off, or not much better than before. At Penn LDI’s Medicare for All and Beyond conference, a panel of researchers and policy experts discussed the current evidence around health insurance choice and implications for future health care reform efforts. This brief summarizes the panel’s key takeaways.

Determinants Of Stigma Among Patients With Hepatitis C Virus (HCV) Infection

Jun. 5, 2020

M. Elle Saine, Julia E. Szymczak, Tyler M. Moore, Laura P. Bamford, Frances K. Barg, Jason SchnittkerJohn H. HolmesNandita Mitra, Vincent Lo Re

Abstract [from journal]

Stigma around hepatitis C virus (HCV) infection is an important and understudied barrier to HCV treatment and elimination. The determinants of HCV-related stigma, including the impacts of stage of HCV treatment (i.e., spontaneously-cleared; diagnosed, untreated; previously treated, not cured; currently being treated; treated, cured) and coinfection with human immunodeficiency virus (HIV), remain unknown. To address these gaps, we conducted a cross-sectional study among patients with a history of HCV infection (n=270) at outpatient


Universal Background Checks For Handgun Purchases Can Reduce Homicide Rates Of African Americans

Elinore Kaufman, U of Penn
Jun. 1, 2020

Elinore J. Kaufman, Christopher N. Morrison, Erik J. Olson, David K. Humphreys, Douglas J. Wiebe, Niels D. Martin, Carrie A. Sims, Mark H. Hoofnagle, C. William Schwab, Patrick M. Reilly, Mark J. Seamon

Abstract [from journal]

Background: Federal law requires background checks for firearms purchased from licensed dealers, but states can extend requirements to private sales of handguns and purchases at gun shows (universal background checks for handguns [UBC-HG]). Although firearm homicide disproportionately affects African Americans, little is known about how UBG-HG impacts African Americans. We hypothesized that implementation of UBC-HG would reduce rates of firearm homicide of African Americans.

Methods: We


Providing Incentive for Emergency Physician X-Waiver Training: An Evaluation of Program Success and Postintervention Buprenorphine Prescribing

May. 25, 2020

Sean D. Foster, Kathleen Lee, Christopher Edwards, Arthur P. Pelullo, Utsha G. Khatri, Margaret Lowenstein, Jeanmarie Perrone

Abstract [from Journal]

Study objective: Emergency department (ED) initiation of buprenorphine for patients with opioid use disorder increases treatment engagement but remains an uncommon practice. One important barrier to ED-initiated buprenorphine is the additional training requirement (X waiver). Our objective is to evaluate the influence of a financial incentive program on emergency physician completion of X-waiver training. Secondary


Early Childhood Sleep Intervention In Urban Primary Care: Clinician And Caregiver Perspectives

Alexander G. Fiks, MD, MSCE
May. 20, 2020

Ariel A Williamson, Izabela Milaniak, Bethany Watson, Olivia Cicalese, Alexander G Fiks, Thomas J Power, Frances K Barg, Rinad S Beidas, Jodi A Mindell, Katharine A Rendle

Abstract [from journal]

Background: Despite significant income-related disparities in pediatric sleep, few early childhood sleep interventions have been tailored for or tested with families of lower socio-economic status (SES). This qualitative study assessed caregiver and clinician perspectives to inform adaptation and implementation of evidence-based behavioral sleep interventions in urban primary care with families who are predominantly of lower SES.

Methods: Semi-structured interviews were


Does Implementing A New Intervention Disrupt Use Of Existing Evidence-Based Autism Interventions?

Rinad Beidas, PhD, U of Penn
May. 20, 2020

Melanie Pellecchia, Rinad S Beidas, Gwendolyn Lawson, Nathaniel J Williams, Max Seidman, John R Kimberly, Carolyn C Cannuscio, David S Mandell

Abstract [from journal]

Interventions for children with autism spectrum disorder are complex and often are not implemented successfully within schools. When new practices are introduced in schools, they often are layered on top of existing practices, with little attention paid to how introducing new practices affects the use of existing practices. This study evaluated how introducing a computer-assisted intervention, called TeachTown:Basics, affected the use of other evidence-based practices in autism support classrooms. We compared how


COVID-19 Pandemic: Every Day Feels Like A Weekday To Most

Konrad Kording, University of Pennsylvania professor
May. 18, 2020

Tony Liu, Jonah Meyerhoff, David C Mohr, Lyle H Ungar, Konrad P Kording

Abstract [from journal]

The COVID-19 outbreak has clear clinical and economic impacts, but also affects behaviors e.g. through social distancing, and may increase stress and anxiety. However, while case numbers are tracked daily, we know little about the psychological effects of the outbreak on individuals in the moment. Here we examine the psychological and behavioral shifts over the initial stages of the outbreak in the United States in an observational longitudinal study. Through GPS phone data we find that homestay is increasing, while being at work


Annual Prevalence Of Use Of Potentially Inappropriate Medications For Treatment Of Affective Disorders In Parkinson's Disease

May. 18, 2020

Danielle S. Abraham, Thanh Phuong Pham Nguyen, Sean Hennessy, Shelly L. Gray, Dawei Xie, Daniel Weintraub, Allison W. Willis

Abstract [from journal]

Objective: To examine the national prevalence of pharmacological treatment of affective disorders in older adults with Parkinson's disease (PD), and determine the prevalence and risk factors for receipt of an American Geriatrics Society Beers Criteria® defined potentially inappropriate medication (PIM) for affective disorder treatment.

Design: Cross-sectional analysis of 2014 Medicare data.

Setting: Research Identifiable File data from the Centers for Medicare and


Are Sexual Minority Stressors Associated With Young Men Who Have Sex With Men's (YMSM) Level Of Engagement In PrEP?

José Bauermeister
May. 13, 2020

Steven Meanley, Cristian Chandler, Jessica Jaiswal, Dalmacio D. Flores, Robin Stevens, Daniel Connochie, José A Bauermeister

Abstract [from journal]

Sexual minority stressors (community homophobia, sexuality-related discrimination, and internalized homonegativity) are negatively associated with accessing HIV prevention services among men who have sex with men (MSM). Few studies have tested minority stressors' associations with PrEP engagement among high-HIV risk young MSM (YMSM). Therefore, we assessed the associations between PrEP-indicated YMSM's progression along the PrEP continuum and their experiences of minority stress. N = 229 YMSM completed a web-survey on PrEP-related behaviors and minority...

Framing Social Comparison Feedback With Financial Incentives For Physical Activity Promotion: A Randomized Trial

May. 11, 2020

Mitesh S Patel, David A Asch, Roy Rosin, Dylan S Small, Scarlett L Bellamy, Karen Hoffer, David Shuttleworth, Victoria Hilbert, Jingsan Zhu, Lin Yang, Xingmei Wang, Kevin G Volpp

Abstract [from journal]

Background: Social comparison feedback is often used in physical activity interventions but the optimal design of feedback is unknown.

Methods: This 4-arm, randomized trial consisted of a 13-week intervention period and 13-week follow-up period. During the intervention, 4-person teams were entered into a weekly lottery valued at about $1.40/day and contingent on the team averaging ≥7000 steps per day. Social comparison feedback on performance was delivered weekly for 26 weeks, and varied by reference point (50th vs...