Healthier by precommitment.

We tested a voluntary self-control commitment device to help grocery shoppers make healthier food purchases. Participants, who were already enrolled in a large-scale incentive program that discounts the price of eligible groceries by 25%, were offered the chance to put their discount on the line. Agreeing households pledged that they would increase their purchases of healthy food by 5 percentage points above their household baseline for each of 6 months. If they reached that goal, their discount was awarded as usual; otherwise, their discount was forfeited for that month. Thirty-six percent of households that were offered the binding commitment agreed; they subsequently showed an average 3.5-percentage-point increase in healthy grocery items purchased in each of the 6 months; households that declined the commitment and control-group households that were given a hypothetical option to precommit did not show such an increase. These results suggest that self-aware consumers will seize opportunities to create restrictive choice environments for themselves, even at some risk of financial loss.

The influence of irrelevant anchors on the judgments and choices of doctors and patients.

BACKGROUND: Little research has examined how anchor numbers affect choice, despite several decades of research showing that judgments typically and robustly assimilate toward irrelevant anchors. METHODS: In one experiment, HIV-positive patients (N = 99) judged the chances that sexual partners would become infected with HIV after sex using a defective condom and then indicated their choices of remedial action. In a second experiment, Iowa physicians (N =191) rated the chances that hypothetical patients had a pulmonary embolism and then formulated a treatment plan. RESULTS: Irrelevant anchor numbers dramatically affected judgments by HIV-infected patients of the chances of HIV infection after a condom broke during sex (43% v. 64% in the low- and high-anchor conditions, respectively) and judgments by doctors of the chances of pulmonary embolism (23% v. 53%, respectively). Despite large anchoring effects in judgement, treatment choices did not differ between low-and high-anchor conditions. Accountability did not reduce the anchoring bias in the doctors' judgments. DISCUSSION: The practical implications of anchoring for risk judgments are potentially large, but the bias may be less relevant to treatment choices. The findings suggest that the theoretical underpinnings of the anchoring bias may be more complex than previously thought.

Targeted Calorie Message Promotes Healthy Beverage Consumption Better than Charity Incentive.

OBJECTIVE: Sugar-sweetened beverage (SSB) consumption is cited as a major contributor to the U.S. obesity epidemic. The objective of this paper was to leverage insights from behavioral economics to examine whether nudges would entice college students to save meal calories by choosing water over SSBs. METHODS: Three message-based nudge interventions, with washout periods between, were used during the 7-week study. Calorie savings (self-interest), charity (prosocial), or charity-plus-calorie message posters were displayed in a college-based food franchise. Multilevel logistic regressions compared the proportions of students choosing water during three experimental conditions. This study assessed whether the frequency of dining establishment visits over the study period moderated effects of the experimental conditions on beverage choices. Multiple data points from the same customer were treated as repeated measures. RESULTS: A total of 2,393 unique students purchased 6,730 meals. Posters displaying calorie information increased water choice relative to washout periods, while the poster without calorie information (charity only) had no effect. Controlling for fixed effects produced the same results. The calorie message poster influenced less frequent diners more than frequent diners. CONCLUSIONS: Food-service operations can nudge college students to substitute water for SSBs with a simple calorie-based message to save hundreds of calories per meal.

The effects of accountability on bias in physician decision making: going from bad to worse.

Members of the Iowa Academy of Family Physicians participated in a survey study in which they were asked to make hypothetical decisions in either high- or low-conflict treatment conditions. In the low-conflict treatment condition the options were a common medication with a referral or a referral only. In the high-conflict treatment condition the same two options were given plus another attractive medication. In addition, we manipulated accountability by asking half of the participants to provide a written defense of their treatment options, which they would then agree to discuss at a later time. The results showed that physicians in the high-conflict condition chose the referral-only option significantly more than the physicians in the low-conflict condition, thus violating the normative rule of regularity. Moreover, that pattern was significantly amplified for physicians who were held accountable for their treatment decisions. These findings replicate and extend previous research and are discussed within the framework of reason-based choice.

Better medicine by default.

BACKGROUND: American health care is transitioning to electronic physician ordering. These computerized systems are unique because they allow custom order interfaces. Although these systems provide great benefits, there are also potential pitfalls, as the behavioral sciences have shown that the very format of electronic interfaces can influence decision making. The current research specifically examines how defaults in electronic order templates affect physicians' treatment decisions and medical errors. METHODS: Forty-five medical residents completed order sets for 3 medical case studies. Participants were randomly assigned to receive order sets with either "opt-in" defaults (options visible but unselected) or "opt-out" defaults (options visible and preselected). RESULTS: compare error rates between conditions and examine the type and severity of errors most often made with opt-in versus opt-out defaults. Results. Opt-out defaults resulted in a greater number of items ordered and specifically increased commission errors (overordering) compared with opt-in defaults. However, while opt-in defaults resulted in fewer orders, they also increased omission errors. When the severity of the errors is taken into account, the default effects seem limited to less severe errors. CONCLUSION: The defaults used in electronic order sets influence medical treatment decisions when the consequences to a patient's health are low. This pattern suggests that physicians cognitively override incorrect default choices but only to a point, and it implies tradeoffs that maximize accuracy and minimize cognitive effort. Results indicate that defaults for low-impact items on electronic templates warrant careful attention because physicians are unlikely to override them.

Choosing among employer-sponsored health plans: what drives employee choices?

OBJECTIVE: To probe employee basis for choosing health plans. METHODS: In a Web study, 337 employees from large private and public employers were asked to choose among health plans varying on several common dimensions. RESULTS: On per-dollar basis, respondents were more willing to spend $3 to $4 on out-of-pocket copayments than $1 on premiums. Nevertheless, sensitivity to monthly premium is greatest among those who are younger and cover only themselves, whereas sensitivity to the annual deductible is greatest among nonwhite families. CONCLUSION: Employees are facing a complicated choice and might be well-served by more information about the value of options under different likelihood scenarios.

Inviting consumers to downsize fast-food portions significantly reduces calorie consumption.

Policies that mandate calorie labeling in fast-food and chain restaurants have had little or no observable impact on calorie consumption to date. In three field experiments, we tested an alternative approach: activating consumers' self-control by having servers ask customers if they wanted to downsize portions of three starchy side dishes at a Chinese fast-food restaurant. We consistently found that 14-33 percent of customers accepted the downsizing offer, and they did so whether or not they were given a nominal twenty-five-cent discount. Overall, those who accepted smaller portions did not compensate by ordering more calories in their entrées, and the total calories served to them were, on average, reduced by more than 200. We also found that accepting the downsizing offer did not change the amount of uneaten food left at the end of the meal, so the calorie savings during purchasing translated into calorie savings during consumption. Labeling the calorie content of food during one of the experiments had no measurable impact on ordering behavior. If anything, the downsizing offer was less effective in changing customers' ordering patterns with the calorie labeling present. These findings highlight the potential importance of portion-control interventions that specifically activate consumers' self-control.