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.

Suicide in Foster Care: A High-Priority Safety Concern

Jan. 10, 2020

Lily A. Brown

Abstract [from journal]

Suicide rates among youths in foster care are among the highest in the United States. Despite this fact, many foster-care agencies do not perform universal suicide-risk assessments as part of routine care. This commentary includes an argument for the importance of implementing universal suicide-risk assessments for youths in foster care. Important contextual information that prevents behavioral-health clinicians from implementing universal suicide screenings of youths in foster care is discussed. Several possible strategies for implementing universal


Patient Phenotypes Help Explain Variation in Response to a Social Gamification Weight Loss Intervention

Dec. 26, 2019

Jeffrey Lienert, Mitesh Patel

Abstract [from journal]

Purpose: This study aims to determine latent classes of study participants using baseline characteristics, explore the patterns within the groups, and determine whether the intervention had differential effects on weight loss across the groups.

Design: Secondary analysis of a completed randomized clinical trial.

Setting: Participants in a gamification intervention with social incentives who were recruited as


Association of Cognitive Biases with Human Papillomavirus Vaccine Hesitancy: A Cross-Sectional Study

Dec. 20, 2019

Tiffany D. Poares, Alison M. Buttenheim, Avnika B. Amin, Caroline M. Joyce, Rachael M. Porter, Robert A. Bednarczyk, Saad B. Omer

Abstract [from journal]

Given the link between vaccine hesitancy and vaccine-preventable disease outbreaks, it is critical to examine the cognitive processes that contribute to the development of vaccine hesitancy, especially among parents of adolescents. We conducted a secondary analysis of baseline data from a two-phase randomized trial on human papillomavirus to investigate how vaccine hesitancy and intent to vaccinate are associated with six decision-making factors: base rate neglect, conjunction fallacy, sunk cost bias, present bias


A Randomized Trial to Encourage Healthy Eating Through Workplace Delivery of Fresh Food

Carolyn Cannuscio, ScD
Dec. 16, 2019

Rachel Feuerstein-Simon, Roxanne Dupuis, Ryan Schumacher, Carolyn C. Cannuscio

Abstract [from journal]

Purpose: This study aimed to increase the consumption of home-cooked meals among employees at a large urban worksite through a fully subsidized Community Supported Agriculture (CSA) program.

Design: Randomized trial.

Setting: Worksite in a large northeast city.

Participants: Employees were recruited through flyers, e-mail listservs, and outreach from departmental


Modification of Everyday Activities and its Association with Self-Awareness in Cognitively Diverse Older Adults

Jason Karlawish, MD of Penn Medicine
Nov. 7, 2019

Danielle Shaked, Preeti Sunderaraman, Jennifer Piscitello, Sarah Cines, Christiane Hale, Davangere Devanand, Jason Karlawish, Stephanie Cosentino

Abstract [from journal]

Cognitive impairment (CI) in older adults is frequently accompanied by difficulty performing complex everyday activities (e.g., managing finances). However, it is unclear if and how older adults with CI modify their activities (i.e., Do individuals continue, monitor, seek help with, change their approach to, or stop different activities?). In the current study, we examined if older adults with CI are concerned about their ability to carry out complex activities, if and how they modify activities based on their concern, and the factors associated with


Estimating the Effect of Calorie Menu Labeling on Calories Purchased in a Large Restaurant Franchise in the Southern United States: Quasi-Experimental Study

Oct. 30, 2019

Joshua Petimar, Fang Zhang, Lauren Cleveland, Denise Simon, Steven Gortmaker, Michele Polacsek, Sara Bleich, Eric Rimm, Christina Roberto, Jason Block

Abstract [from journal]

Objective: To evaluate whether calorie labeling of menus in large restaurant chains was associated with a change in mean calories purchased per transaction.

Design: Quasi-experimental longitudinal study.

Setting: Large franchise of a national fast food company with three different restaurant chains located in the southern United States (Louisiana, Texas, and Mississippi) from April 2015 until April 2018.

Participants: 104 restaurants with calorie information added


Diagnostic Testing During Pediatric Hospitalizations: The Role of Attending In-House Coverage and Daytime Exposure

Deepak Palakshappa, MD
Oct. 21, 2019

Kira L. Ryskina, Linda Dynan, Rebecca Stein, Evan Fieldston, Deepak Palakshappa

Abstract [from journal]

Objective: Overuse of diagnostic tests is of particular concern for pediatric academic medical centers. Our objective was to measure variation in testing based on proportion of hospitalization during the day versus night and the association between attending in-house coverage on the teaching service and test utilization for hospitalized pediatric patients.

Methods: Electronic health record data from 11,567 hospitalizations to a large, Northeastern, academic pediatric hospital were collected between January 2007


Wide Variation in the Percentage of Donation After Circulatory Death Donors Across Donor Service Areas - A Potential Target for Improvement

Oct. 21, 2019

Elizabeth Sonnenberg, Jesse Hsu, Peter Reese, David Goldberg, Peter Abt

Abstract [from journal]

Background: Substantial differences exist in the clinical characteristics of donors across the 58 donor services areas (DSAs). Organ procurement organization (OPO) performance metrics incorporate organs donated after circulatory determination of death (DCDD) donors, but do not measure potential DCDD donors.

Methods: Using 2011-2016 UNOS data, we examined the variability in DCDD donors/all deceased donors (%DCDD) across DSAs. We supplemented UNOS data with CDC death records and OPO statistics to characterize


8 Months to 5 Days: What Happened When Pennsylvania Changed the Vaccination Regulations for Provisional Enrollment?

Sep. 30, 2019

Salini Mohanty, Paul Delamater, Kristen Feemster, Alison M. Buttenheim

Abstract [from journal]

In March 2017, the Pennsylvania Department of Health reduced the time allowed to demonstrate compliance with school-entry vaccination requirements from eight months to five days. We describe changes in provisional enrollment, vaccine exemptions, and vaccine coverage rates before and after the new regulation. Across Pennsylvania, provisional enrollment decreased from 11.1 % in 2016/17 to 2.5% in 2017/18 (77% relative decrease). Personal belief exemptions continued a modest upward trend, similar to previous years, and medical exemptions remained steady


Effect of a Prize-Linked Savings Intervention on Savings and Healthy Behaviors Among Men in Kenya: A Randomized Clinical Trial

Sep. 13, 2019

Ellen Moscoe, Kawango Ago, Harsha Thirumurthy

Abstract [from journal]

Importance: Interventions to reduce men's alcohol use and risky sexual behaviors are essential for reducing new HIV infections in high-prevalence settings in sub-Saharan Africa. Prize-linked savings accounts can motivate savings and may decrease expenditures on risky behaviors, but few studies have examined the HIV prevention potential of such savings interventions among men.

Objective: To evaluate the effect of prize-linked savings accounts on savings behavior and expenditures on alcohol, gambling, and