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.

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


Effectiveness of Behaviorally Designed Gamification Interventions With Social Incentives for Increasing Physical Activity Among Overweight and Obese Adults Across the United States: The STEP UP Randomized Clinical Trial

Sep. 9, 2019

Mitesh S. Patel, Dylan S. Small, Joseph D. Harrison, Michael P. Fortunato, Ai Leen Oon, Charles A. L. Rareshide, Gregory Re, Gregory Szwartz, James Guszcza, David Steier, Pameljit Kalra, Victoria Hilbert

Abstract [from journal]

Importance: Gamification, the use of game design elements in nongame contexts, is increasingly being used in workplace wellness programs and digital health applications. However, the best way to design social incentives in gamification interventions has not been well examined.

Objective: To assess the effectiveness of support, collaboration, and competition within a behaviorally designed gamification intervention to increase physical activity among overweight and obese adults.



Disparities in Acceptance of Deceased Donor Kidneys Between the United States and France and Estimated Effects of Increased US Acceptance

Peter P. Reese, MD, MSCE
Aug. 26, 2019

Olivier Aubert, Peter P. Reese, Benoit Audry, Yassine Bouatou, Marc Raynaud, Denis Viglietti, Christophe Legendre, Denis Glotz, Jean-Phillipe Empana, Xavier Jouven, Carmen Lefaucheur, Christian Jacquelinet, Alexandre Loupy

Abstract [from journal]

Importance: Approximately 3500 donated kidneys are discarded in the United States each year, drawing concern from Medicare and advocacy groups.

Objective: To estimate the effects of more aggressive allograft acceptance practices on the donor pool and allograft survival for the population of US wait-listed kidney transplant candidates.

Design, Settings, and Participants: A nationwide study using validated registries from the United States and France comprising comprehensive cohorts of


Difference Between Users and Nonusers of a Patient Portal in Health Behaviors and Outcomes: Retrospective Cohort Study

Jul. 10, 2019

Jing Huang, Yong Chen, J. Richard Landis, Kevin B. Mahoney

Abstract [from journal]

Background: Patient portals are frequently used in modern health care systems as an engagement and communication tool. An increased focus on the potential value of these communication channels to improve health outcomes is warranted.

Objective: This paper aimed to quantify the impact of portal use on patients’ preventive health behavior and chronic health outcomes.

Methods: We conducted a retrospective, observational cohort study of 10,000 patients aged 50 years...