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.

Using Behavioral Insights to Design Implementation Strategies in Public Mental Health Settings: A Qualitative Study of Clinical Decision-Making

Rinad Beidas head shot
Jan. 11, 2021

Briana S. Last, Simone H. Schriger, Carter E. Timon, Hannah E. Frank, Alison M. ButtenheimBrittany N. Rudd, Sara Fernandez-Marcote, Carrie Comeau, Sosunmolu Shoyinka, Rinad S. Beidas

Abstract [from journal]

Background: Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based intervention for youth with posttraumatic stress disorder. An important component of TF-CBT is the trauma narrative (TN), a phase in the intervention in which youth are guided to process the memories, thoughts, and feelings associated with their traumatic experience(s). Previous work has shown that TF-CBT clinicians complete TNs with only half of their clients, yet little is known about what determines TF-CBT clinicians' use of TNs


Validation of the Developmental Check-In Tool for Low-Literacy Autism Screening

Zuleyha Cidav, PhD, at the Leonard Davis Institute of Health Economics
Jan. 1, 2021

Jill F. Harris, Caroline N. Coffield, Yvette M. Janvier, David Mandell, Zuleyha Cidav

Abstract [from journal]

Background: Persistent disparities exist in early identification of autism spectrum disorder (ASD) among children from low-income families who are racial and/or ethnic minorities and where English is not the primary language. Parental literacy and level of maternal education may contribute to disparities. The Developmental Check-In (DCI) is a visually based ASD screening tool created to reduce literacy demands and to be easily administered and scored across settings. In a previous study, the DCI showed acceptable


The Healthy Food Marketing Strategies Study: Design, Baseline Characteristics, and Supermarket Compliance

Karen Glanz
Dec. 31, 2020

Karen Glanz, Annie Chung, Knashawn H. Morales, Pui L. Kwong, Douglas Wiebe, Donna Paulhamus Giordano, Colleen M. Brensinger, Allison Karpyn

Abstract [from journal]

Identifying effective strategies to promote healthy eating and reduce obesity is a priority in the USA, especially among low-income and minority groups, who often have less access to healthy food and higher rates of obesity. Efforts to improve food access have led to more supermarkets in low-income, ethnically diverse neighborhoods. However, this alone may not be enough to reduce food insecurity and improve residents' diet quality and health. This paper summarizes the design, methods, baseline findings, and supermarket in-store


Behavioral Insights Into Micronutrient Powder Use for Childhood Anemia in Arequipa, Peru

Dec. 23, 2020

Jessica D. Brewer, Julianna Shinnick, Karina Román, Maria P. Santos, Valerie A. Paz-Soldan, Alison M. Buttenheim

Abstract [from journal]

Childhood anemia remains a significant driver of morbidity in low- and middle-income countries, including Peru. To identify behavioral challenges to using micronutrient powder (MNP) that is given to supplement children's diets and prevent anemia, we applied a behavioral design approach to interviews and focus groups with 129 caregivers in Arequipa, Peru. We examined 3 key points in the decision-making process: accessing MNP through the health system; forming intentions to use MNP; and MNP use at the time of child feeding. Using the


No Evidence of Food or Alcohol Substitution in Response to a Sweetened Beverage Tax

Dec. 18, 2020

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

Abstract [from journal]

Introduction: Evidence suggests real-world beverage taxes reduce sweetened beverage purchases, but it is unknown if consumers consequently increase food or alcohol purchases. This study examines whether Philadelphia's 1.5 cents/ounce beverage tax was associated with substitution to 3 kinds of hypothesized substitutes: snacks, nontaxed beverage concentrates, and alcohol.

Methods: Using commercial retail sales data and a difference-in-differences approach, analyses compared logged volume and


Changes in Driving Behaviors After Concussion in Adolescents

Dec. 4, 2020

Catherine C. McDonald, Divya Jain, Eileen P. Storey, Madeline Gonzalez, Christina L. Master, Kristy B. Arbogast

Abstract [from journal]

Purpose: Although return to learn, exercise, and sports have evidence-based guidelines, there is limited research investigating return to driving after concussion. The purpose was to characterize and compare adolescent driving behaviors after concussion.

Methods: Using the Minds Matter Concussion Registry, we queried data of adolescents, aged 16-19 years, diagnosed with a concussion ≤28 days of injury and seen between January 31, 2017 and August 31, 2018 at the specialty care concussion


Health Equity, Social Policy, and Promoting Recovery From COVID-19

Julia Lynch
Dec. 1, 2020

Julia Lynch

Abstract [from journal]

The COVID-19 pandemic has revealed starkly and publicly the close interconnections between social and economic equality, health equity, and population health. To better understand what social policies would best promote population health, economic recovery, and preparedness for future pandemics, one must look both upstream and abroad for inspiration. In this article, the author argues for a suite of near-term and longer-term interventions, including universal health insurance and paid...

Greater Self-Reported Preference for Fat Taste and Lower Fat Restraint Are Associated With More Frequent Intake of High-Fat Food

Douglas Wiebe, PhD, University of Pennsylvania
Nov. 25, 2020

Agata Chmurzynska, Monika A. Mlodzik-Czyzewska, Anna M. Malinowska, Anna Radziejewska, Joanna Mikołajczyk-Stecyna, Ewa Bulczak, Douglas J. Wiebe

Abstract [from journal]

The determinants of the intake of high-fat products are not well recognized, but fat preference may be one of them. The aim of this study was thus to determine whether intake of different types of high-fat food is associated with fat preference in people with normal and increased body weight. Participants aged 20-40 years [n = 421] were enrolled in Poznań, Poland in 2016-2018. Fat preference was measured using the Fat Preference Questionnaire. Self-reported preference for fat taste (TASTE) and fat restraint (DIFF) scores were


Association of COVID-19 Misinformation With Face Mask Wearing and Social Distancing in a Nationally Representative U.S. Sample

Robert C. Hornik, PhD
Nov. 22, 2020

Robert Hornik, Ava Kikut, Emma Jesch, Chioma Woko, Leeann Siegel, Kwanho Kim

Abstract [from journal]

Wide-spread misinformation about the COVID-19 pandemic has presented challenges for communicating public health recommendations. Should campaigns to promote protective behaviors focus on debunking misinformation or targeting behavior-specific beliefs? To address this question, we examine whether belief in COVID-19 misinformation is directly associated with two behaviors (face mask wearing and social distancing), and whether behavior-specific beliefs can account for this association and better predict behavior, consistent with


A Multidisciplinary Approach to Improving Process and Outcomes in Unscheduled Cesarean Deliveries

Nov. 16, 2020

Hayley S. Quant, Rebecca F. Hamm, Nadav Schwartz, Sindhu K. Srinivas

Abstract [from journal]

Background: Effective communication between providers of various disciplines is crucial to the quality of care provided on labor and delivery. The lack of standardized language for communicating the clinical urgency of cesarean delivery and the lack of standardized processes for responding were identified as targets for improvement by the Obstetric Patient Safety Committee at the Hospital of the University of Pennsylvania. The committee developed and implemented a protocol aimed at improving the performance of our


The Impact of Change in Neighborhood Poverty on BMI Trajectory of 37,544 New York City Youth: A Longitudinal Study

Nov. 10, 2020

Krista Schroeder, Sophia Day, Kevin Konty, Levent Dumenci, Terri Lipman

Abstract [from journal]

Background: Neighborhood poverty may increase childhood obesity risk. However, evidence for the neighborhood poverty-obesity relationship is limited. The purpose of this study was to examine how moving to a higher or lower poverty neighborhood impacts body mass index (BMI) z-score trajectories among youth, with the goal of informing policy change, interventions, and clinical practices to reduce childhood obesity.

Methods: Methods entailed secondary analysis of existing longitudinal data. The


Analysis Of Multicenter Clinical Trials With Very Low Event Rates

Nov. 9, 2020

Jiyu Kim, Andrea B. TroxelScott D. HalpernKevin G. Volpp, Brennan C. Kahan, Tim P. Morris, Michael O. Harhay

Abstract [from journal]

Introduction: In a five-arm randomized clinical trial (RCT) with stratified randomization across 54 sites, we encountered low primary outcome event proportions, resulting in multiple sites with zero events either overall or in one or more study arms. In this paper, we systematically evaluated different statistical methods of accounting for center in settings with low outcome event proportions.

Methods: We conducted a simulation study and a reanalysis of a completed RCT to compare five popular