Megastudy shows that reminders boost vaccination but adding free rides does not.

Encouraging routine COVID-19 vaccinations is likely to be a crucial policy challenge for decades to come. To avert hundreds of thousands of unnecessary hospitalizations and deaths, adoption will need to be higher than it was in the autumn of 2022 or 2023, when less than one-fifth of Americans received booster vaccines1,2. One approach to encouraging vaccination is to eliminate the friction of transportation hurdles. Previous research has shown that friction can hinder follow-through3 and that individuals who live farther from COVID-19 vaccination sites are less likely to get vaccinated4. However, the value of providing free round-trip transportation to vaccination sites is unknown. Here we show that offering people free round-trip Lyft rides to pharmacies has no benefit over and above sending them behaviourally informed text messages reminding them to get vaccinated. We determined this by running a megastudy with millions of CVS Pharmacy patients in the United States testing the effects of (1) free round-trip Lyft rides to CVS Pharmacies for vaccination appointments and (2) seven different sets of behaviourally informed vaccine reminder messages. Our results suggest that offering previously vaccinated individuals free rides to vaccination sites is not a good investment in the United States, contrary to the high expectations of both expert and lay forecasters. Instead, people in the United States should be sent behaviourally informed COVID-19 vaccination reminders, which increased the 30-day COVID-19 booster uptake by 21% (1.05 percentage points) and spilled over to increase 30-day influenza vaccinations by 8% (0.34 percentage points) in our megastudy. More rigorous testing of interventions to promote vaccination is needed to ensure that evidence-based solutions are deployed widely and that ineffective but intuitively appealing tools are discontinued.

Megastudies improve the impact of applied behavioural science.

Policy-makers are increasingly turning to behavioural science for insights about how to improve citizens' decisions and outcomes1. Typically, different scientists test different intervention ideas in different samples using different outcomes over different time intervals2. The lack of comparability of such individual investigations limits their potential to inform policy. Here, to address this limitation and accelerate the pace of discovery, we introduce the megastudy-a massive field experiment in which the effects of many different interventions are compared in the same population on the same objectively measured outcome for the same duration. In a megastudy targeting physical exercise among 61,293 members of an American fitness chain, 30 scientists from 15 different US universities worked in small independent teams to design a total of 54 different four-week digital programmes (or interventions) encouraging exercise. We show that 45% of these interventions significantly increased weekly gym visits by 9% to 27%; the top-performing intervention offered microrewards for returning to the gym after a missed workout. Only 8% of interventions induced behaviour change that was significant and measurable after the four-week intervention. Conditioning on the 45% of interventions that increased exercise during the intervention, we detected carry-over effects that were proportionally similar to those measured in previous research3-6. Forecasts by impartial judges failed to predict which interventions would be most effective, underscoring the value of testing many ideas at once and, therefore, the potential for megastudies to improve the evidentiary value of behavioural science.

A 680,000-person megastudy of nudges to encourage vaccination in pharmacies.

Encouraging vaccination is a pressing policy problem. To assess whether text-based reminders can encourage pharmacy vaccination and what kinds of messages work best, we conducted a megastudy. We randomly assigned 689,693 Walmart pharmacy patients to receive one of 22 different text reminders using a variety of different behavioral science principles to nudge flu vaccination or to a business-as-usual control condition that received no messages. We found that the reminder texts that we tested increased pharmacy vaccination rates by an average of 2.0 percentage points, or 6.8%, over a 3-mo follow-up period. The most-effective messages reminded patients that a flu shot was waiting for them and delivered reminders on multiple days. The top-performing intervention included two texts delivered 3 d apart and communicated to patients that a vaccine was "waiting for you." Neither experts nor lay people anticipated that this would be the best-performing treatment, underscoring the value of simultaneously testing many different nudges in a highly powered megastudy.

A megastudy of text-based nudges encouraging patients to get vaccinated at an upcoming doctor's appointment.

Many Americans fail to get life-saving vaccines each year, and the availability of a vaccine for COVID-19 makes the challenge of encouraging vaccination more urgent than ever. We present a large field experiment (N = 47,306) testing 19 nudges delivered to patients via text message and designed to boost adoption of the influenza vaccine. Our findings suggest that text messages sent prior to a primary care visit can boost vaccination rates by an average of 5%. Overall, interventions performed better when they were 1) framed as reminders to get flu shots that were already reserved for the patient and 2) congruent with the sort of communications patients expected to receive from their healthcare provider (i.e., not surprising, casual, or interactive). The best-performing intervention in our study reminded patients twice to get their flu shot at their upcoming doctor's appointment and indicated it was reserved for them. This successful script could be used as a template for campaigns to encourage the adoption of life-saving vaccines, including against COVID-19.

A large-scale field experiment shows giving advice improves academic outcomes for the advisor.

Common sense suggests that people struggling to achieve their goals benefit from receiving motivational advice. What if the reverse is true? In a preregistered field experiment, we tested whether giving motivational advice raises academic achievement for the advisor. We randomly assigned n = 1,982 high school students to a treatment condition, in which they gave motivational advice (e.g., how to stop procrastinating) to younger students, or to a control condition. Advice givers earned higher report card grades in both math and a self-selected target class over an academic quarter. This psychologically wise advice-giving nudge, which has relevance for policy and practice, suggests a valuable approach to improving achievement: one that puts people in a position to give.

The mixed effects of online diversity training.

We present results from a large (n = 3,016) field experiment at a global organization testing whether a brief science-based online diversity training can change attitudes and behaviors toward women in the workplace. Our preregistered field experiment included an active placebo control and measured participants' attitudes and real workplace decisions up to 20 weeks postintervention. Among groups whose average untreated attitudes-whereas still supportive of women-were relatively less supportive of women than other groups, our diversity training successfully produced attitude change but not behavior change. On the other hand, our diversity training successfully generated some behavior change among groups whose average untreated attitudes were already strongly supportive of women before training. This paper extends our knowledge about the pathways to attitude and behavior change in the context of bias reduction. However, the results suggest that the one-off diversity trainings that are commonplace in organizations are unlikely to be stand-alone solutions for promoting equality in the workplace, particularly given their limited efficacy among those groups whose behaviors policymakers are most eager to influence.

Political ideology affects energy-efficiency attitudes and choices.

This research demonstrates how promoting the environment can negatively affect adoption of energy efficiency in the United States because of the political polarization surrounding environmental issues. Study 1 demonstrated that more politically conservative individuals were less in favor of investment in energy-efficient technology than were those who were more politically liberal. This finding was driven primarily by the lessened psychological value that more conservative individuals placed on reducing carbon emissions. Study 2 showed that this difference has consequences: In a real-choice context, more conservative individuals were less likely to purchase a more expensive energy-efficient light bulb when it was labeled with an environmental message than when it was unlabeled. These results highlight the importance of taking into account psychological value-based considerations in the individual adoption of energy-efficient technology in the United States and beyond.

A Randomized Trial of Behavioral Nudges Delivered Through Text Messages to Increase Influenza Vaccination Among Patients With an Upcoming Primary Care Visit.

PURPOSE: To evaluate if nudges delivered by text message prior to an upcoming primary care visit can increase influenza vaccination rates. DESIGN: Randomized, controlled trial. SETTING: Two health systems in the Northeastern US between September 2020 and March 2021. SUBJECTS: 74,811 adults. INTERVENTIONS: Patients in the 19 intervention arms received 1-2 text messages in the 3 days preceding their appointment that varied in their format, interactivity, and content. MEASURES: Influenza vaccination. ANALYSIS: Intention-to-treat. RESULTS: Participants had a mean (SD) age of 50.7 (16.2) years; 55.8% (41,771) were female, 70.6% (52,826) were White, and 19.0% (14,222) were Black. Among the interventions, 5 of 19 (26.3%) had a significantly greater vaccination rate than control. On average, the 19 interventions increased vaccination relative to control by 1.8 percentage points or 6.1% (P = .005). The top performing text message described the vaccine to the patient as "reserved for you" and led to a 3.1 percentage point increase (95% CI, 1.3 to 4.9; P < .001) in vaccination relative to control. Three of the top five performing messages described the vaccine as "reserved for you." None of the interventions performed worse than control. CONCLUSIONS: Text messages encouraging vaccination and delivered prior to an upcoming appointment significantly increased influenza vaccination rates and could be a scalable approach to increase vaccination more broadly.

A victim-centered approach to justice? Victim satisfaction effects on third-party punishments.

Three studies investigated whether victims' satisfaction with a restorative justice process influenced third-party assignments of punishment. Participants evaluated criminal offenses and victims' reactions to an initial restorative justice conference, and were later asked to indicate their support for additional punishment of the offender. Across the three studies, we found that victim satisfaction (relative to dissatisfaction) attenuates people's desire to seek offender punishment, regardless of offense severity (Study 2) or conflicting reports from a third-party observer (Study 3). This relationship was explained by the informational value of victim satisfaction: Participants inferred that victims felt closure and that offenders experienced value reform, both of which elevated participants' satisfaction with the restorative justice outcome. The informational value communicated by victim satisfaction, and its criminal justice implications, are discussed.

Effects of Ownership Text Message Wording and Reminders on Receipt of an Influenza Vaccination: A Randomized Clinical Trial.

Importance: Despite the availability of safe and effective vaccines, many people fail to get vaccinated. Messages using behavioral science principles may increase vaccination rates. Objective: To determine the effect on influenza vaccination rates of a text message telling patients that an influenza vaccine had been reserved for them. Design, Setting, and Participants: As part of a larger influenza vaccine messaging megastudy, in this randomized clinical trial, 11 188 patients in 2 large health systems were assigned to receive a text message that stated "a flu shot has been reserved for you," a text message that stated "flu shots will be available," or no text message. Both messages included the option to reply yes (Y) or no (N) to indicate that the patient wanted to get vaccinated. Patients 18 years or older were included if they had new or routine (nonsick) primary care appointments scheduled from September 20, 2020, through March 31, 2021. Interventions: The evening before the scheduled appointment, patients in the 2 message conditions were sent 3 back-to-back SMS messages containing the study wording. Patients in the usual care control group did not receive any study messages. Main Outcomes and Measures: Receipt of an influenza vaccine on the date of the patient's scheduled appointment. Results: A total of 11 188 patients were randomized to the reserved or the available message conditions or to usual care. The 10 158 patients analyzed in the study had a mean (SD) age of 50.61 (16.28) years; 5631 (55.43%) were women; and 7025 (69.16%) were White. According to health records, 4113 (40.49%) had been vaccinated in the previous influenza season, and 5420 (53.36%) were patients at Penn Medicine. In an intent-to-treat analysis, changes in vaccination rates in response to the reserved message did not reach statistical significance (increase of 1.4 percentage points, or 4% [P = .31]) compared with the message conveying that influenza vaccines were available. Relative to the usual care control, the reserved message increased vaccination rates by 3.3 percentage points, or 11% (P = .004). Patients in the reserved message condition were more likely to text back Y (1063 of 3375 [31.50%]) compared with those in the available message condition (887 of 3351 [26.47%]; χ2 = 20.64; P < .001), and those who replied Y were more likely to get vaccinated (1532 of 1950 [78.56%]) compared with those who did not (749 of 4776 [15.68%]; χ2 = 2400; P < .001). Conclusions and Relevance: This study found that patients who received text messages regarding flu vaccination had greater vaccine uptake than those who received no message. Messages that increase the likelihood that patients will indicate their intention to be vaccinated may also increase vaccination behavior. Clinical Trial Registration: ClincalTrials.gov Identifier: NCT04565353.

A citywide experiment testing the impact of geographically targeted, high-pay-off vaccine lotteries.

Lotteries have been shown to motivate behaviour change in many settings, but their value as a policy tool is relatively untested. We implemented a pre-registered, citywide experiment to test the effects of three high-pay-off, geographically targeted lotteries designed to motivate adult Philadelphians to get their COVID-19 vaccine. In each drawing, the residents of a randomly selected 'treatment' zip code received half the lottery prizes, boosting their chances of winning to 50×-100× those of other Philadelphians. The first treated zip code, which drew considerable media attention, may have experienced a small bump in vaccinations compared with the control zip codes: average weekly vaccinations rose by an estimated 61 per 100,000 people per week (+11%). After pooling the results from all three zip codes treated during our six-week experiment, however, we do not detect evidence of any overall benefits. Furthermore, our 95% confidence interval provides a 9% upper bound on the net benefits of treatment in our study.

Differences in sensitivity to deviance partly explain ideological divides in social policy support.

We propose that political differences in social policy support may be partly driven by the tendency for conservatives to show greater sensitivity to deviance than liberals, even among targets lacking social or functional relevance. In 3 studies, participants were shown geometric figures and were asked to identify the extent to which they were "triangles" (or circles, squares, etc.). More conservative participants reported greater differentiation between perfect and imperfect shapes than more liberal participants, indicating greater sensitivity to deviance. Moreover, shape differentiation partly accounted for the relationship between political ideology and social policy, partially mediating the link between conservatism and harsher punishment of wrongdoers (Studies 1 and 4), less support for public aid for disadvantaged groups (Study 2), and less financial backing for policies that benefit marginalized groups in society (Study 3). This effect was specific to policies that targeted deviant groups (Study 3) and who were not too highly deviant (Study 4). Results suggest that, in addition to commonly cited affective and motivational reactions to deviant actors, political differences in social policy may also be driven by conservatives' greater cognitive propensity to distinguish deviance. (PsycINFO Database Record

Pleasure From Another's Pain: The Influence of a Target's Hedonic States on Attributions of Immorality and Evil.

Can people's feelings about harm (i.e., their hedonic reactions) lead them to be morally condemned, even if they do not cause the harm themselves? We show that individuals who experience pleasure at serious harm that has befallen another person are judged both immoral and evil. This effect occurs for harm-causing actors, and for observers who play no role in causing the harm; actors can also be judged as immoral and evil when they experience mere indifference (Study 1). Observers are more likely to be similarly judged when they experience direct rather than indirect pleasure from harm caused to another (Study 2). The effects of pleasure are dissociable from those of malevolent desires (Study 3). Targets' experience of pleasure at the harm caused to another person leads to the social exclusion of observers (Studies 1-3) and the harsh punishment of actors, including the death penalty (Studies 1, 4a, and 4b).

Punishment.

UNLABELLED: Retributivism is a deontological theory of punishment that calls for the deserved punishment of a guilty offender in proportion with his moral blameworthiness for a past offense. It is often referred to as punishment based on 'just deserts', and it contrasts with consequentialist theories that ground punishment in its potentially beneficial future consequences. Rich philosophical debate surrounds the appropriateness of retributivism. From a psychological perspective, the key question concerns whether retributivism underlies ordinary individuals' desire for the legal punishment of wrongdoers. Past research in social psychology has answered this question in the affirmative. However, much of this existing evidence requires a new look, because it is premised on a fundamental ambiguity. We review alternative evidence for the existence of retributive motives from lesser-known correlational studies, and from studies of the punishment of companies and animals. We also explore the links between retributivism and restorative justice-an alternative justice approach that focuses on repairing the harms caused by an offense. Although often cast as diametrically opposed to one another, retributive and restorative justice in fact share more in common than is often supposed. Both are premised on notions of deservingness, and their goals can be achieved by the same action (i.e., retributive punishment can restore victims). In all areas of the research we review, more work is needed to better understand: retributivism directed at human offenders, the commonalities and discontinuities between retributive and restorative justice, and how the notion of desert structures moral life and thought more generally. WIREs Cogn Sci 2014, 5:561-572. doi: 10.1002/wcs.1301 For further resources related to this article, please visit the WIREs website. CONFLICT OF INTEREST: The authors have declared no conflicts of interest for this article.

How perceptions of mortality and HIV morbidity relate to substance abuse problems and risky sexual behaviors among former juvenile offenders.

This study investigates whether high-risk young adults' perceptions of their likelihood of living to age 35 and of acquiring HIV are related to their substance abuse problems and risky sexual behaviors. The sample consists of data from the 72- and 87-month follow-up assessments of 449 juvenile offenders referred to probation in 1999 and 2000. Results indicate that believing one is likely to get HIV is associated with having more concurrent substance use problems and engaging in more risky sexual behaviors. Longitudinal analyses indicate that youth who think they are likely to get HIV are at greater risk for later substance abuse problems and risky sexual behaviors, though these results are only marginally significant. The results demonstrate that respondents are aware of some of the risks associated with their recent substance using and sexual behaviors, but that holding these perceptions does not result in a reduction of these behaviors.