Physical activity counseling in primary care: Insights from public health and behavioral economics.

Physical inactivity has reached epidemic proportions in modern society. Abundant evidence points to a causal link between physical inactivity and increased risk for numerous noncommunicable diseases, such as some types of cancer and heart disease, as well as premature mortality. Yet, despite this overwhelming evidence, many individuals do not meet the recommended amount of physical activity required to achieve maximum health benefits. Because primary care physicians' advice is highly regarded, clinicians have the unique opportunity to play an important role in enabling patients to modify their behavior at the point of care with the goal of guiding patients to adopt and maintain an active lifestyle. In the current study, the authors evaluate pertinent literature from the fields of medicine/public health and economics/psychology to suggest a comprehensive approach to physical activity counseling at the primary care level. They first examine the public health approach to physical activity counseling, and then proceed to offer insights from behavioral economics, an emerging field that combines principles from psychology and economics. The application of key behavioral economics tools (eg, precommitment contracts, framing) to physical activity counseling in primary care is elaborated. CA Cancer J Clin 2017;67:233-244. © 2017 American Cancer Society.

When Needs Don't Translate into Wants: Choosing the Right Tone to Communicate About Healthy Behaviors.

Although individuals should benefit from adhering to communication that promotes healthier behaviors, such communication often encounters mixed success. To understand this incongruity, we identify a misconception about the roles of two distinct drivers of health behavior: needs (which are more objective) and wants (which are more subjective). While needs generally translate into wants in ordinary consumption contexts, they sometimes clash with wants in the context of health behaviors. We propose that communicators' failure to anticipate this misalignment leads them to choose an inadequate communication tone (more or less assertive). Across three studies conducted in the field and online, adopting the perspectives of both communicators and receivers, we examine how the misalignment of needs and wants in health contexts affects the selection of communication tone and reactions to this communication. We find that communicators (and study participants taking the role of communicators) frequently select the tone (more or less assertive) of their communication based on the receivers' (objective) needs. Still, conversely, receivers' responses depend on how the tone of communication matches their (subjective) wants. This gap tends to disappear for more severe health issues, where wants align better with needs. The frequent misalignment of needs and wants in the health domain challenges health communication effectiveness. Communicators should seek ways to address this misalignment, for example, by increasing the perceived severity of the health issue or the perceived authority of the source.

Health & Wealth: is weight loss success related to monetary savings in U.S. adults of low-income? Findings from a National Study.

BACKGROUND: Many individuals aspire to attain various goals in life, such as committing to a healthful diet to slim down or saving for retirement to enhance future welfare. While these behaviors (weight loss and saving) share the common denominator of self-regulation, it is unclear whether success in one domain is related to the other. Therefore, we examined the relationship between long term weight loss (LTWL) success and monetary savings among U.S. adults who at one point in life diverged from normal weight status. METHODS: Data on 1994 adults with a maximum BMI ≥ 25 kg/m2 and with an annual household income equal or less than 200% poverty level. Data were derived from a U.S. population-based study (NHANES). The independent variable was LTWL success (loss maintained for at least 1 year), which was operationalized as < 10% (reference group), 10.00-19.99%, and ≥ 20.00%. The dependent variable was monetary savings (e.g., 401 K), defined as a 3-category ordinal variable. We employed ordered logistic regression to estimate the relationship between LTWL success and increased odds for higher overall savings. RESULTS: Multivariable analysis revealed that adjusting for income, education and other covariates, being in the highest LTWL category (≥20.00%) significantly reduced the likelihood of monetary savings in comparison to the reference group (OR = 0.55, 95%CI = 0.34-0.91). This relationship was not observed in the lower LTWL category (10.00-19.99%). CONCLUSIONS: Adults who in the past were overweight or obese and who presently exhibit high levels of LTWL, were markedly less successful when it came to their finances. This might stem from significant cognitive-affective resources exerted during the weight loss process coupled with a paucity of financial resources which impede financial decision making. This supposition, however, warrants future research.

Weighing heavy: Heavy serving dishes increase food serving.

The current work demonstrates that people serve themselves greater amounts of food when carrying heavier serving dishes. This effect occurs because increases in carried weight lower consumers' sensitivity to the weight of the food served. Decreased sensitivity to weight of food served in turn leads people to continue serving past the point where they would normally stop. The paper demonstrates this effect across two lab studies involving actual food serving (with a third lab study extending the outcomes to unhealthy food choices reported in the S1 Appendix). The studies also demonstrate liking for the food moderates the effect, such that carrying greater weight leads people to serve an increased amount of liked, but not of less well liked, foods. The findings extend prior research regarding the effects of dish weight on food judgment to provide a first demonstration of effects of weight not only on judgment but on behavior. In this, they help expand our understanding of the ways in which elements in the eating environment effects food consumption. In addition, the studies provide initial evidence for the mechanism behind the phenomenon: reduced sensitivity to weight. The research carries important implications for public well being, given that increases in serving sizes may contribute to obesity.

Think positive! Emotional response to assertiveness in positive and negative language promoting preventive health behaviors.

OBJECTIVE: There is insufficient evidence for the effectiveness of various tones of communication in modifying health behaviours. We examine the moderating role of assertiveness in the effect of positive/negative language on emotional responses (optimism, self-efficacy, and guilt), and resulting preventive health behaviours. DESIGN: Three experiments were employed. An online experiment tests the relationship between positive/negative language and assertiveness when people communicate about healthful eating. Next, a field study examines the moderating effect of assertiveness in positive and negative language encouraging using sunscreen among street passers-by. Third, an online study explores whether the effect of assertiveness in positive and negative messages on hand-washing intentions is mediated by increased optimism and self-efficacy, and decreased guilt, respectively. RESULTS: Positive language increases compliance when expressed assertively because the assertive tone emphasises optimism and self-efficacy. Conversely, negative communication is more effective when expressed non-assertively, because of the replenishing effect of the gentler tone on the guilt evoked by the negative communication. CONCLUSION: Assertiveness serves as an intensifier of what is being communicated. When considering whether to employ positive or negative language in health messaging, assertiveness should be considered as part of the design of effective health communication strategies leading to health promoting behaviour change.

Consistency in identity-related sequential decisions.

Consumers often make decisions that reflect either personal or social identities. In many cases, such decisions are made along a sequence. Our research introduces a central factor that influences consumers' likelihood of expressing a consistent identity type along a sequence of decisions: the extent to which their usage of the product involved in the first decision is expected to be observable by others (the product's expected visibility). A field experiment, and four lab studies, coupled with an internal meta-analysis, show that when the product involved in the first decision has high (as opposed to low) expected visibility, consumers are more likely to make a subsequent decision that is consistent with the first. Results show that self-presentation mediates this effect, and suggest that low integration between the identities involved in the decisions might attenuate it. Our findings offer implications for identity research and practical implications for marketers seeking to develop products and design communications that encourage consistent (or inconsistent) behavior.

Carbon innumeracy.

Individuals must have a quantitative understanding of the carbon footprint tied to their everyday decisions to make efficient sustainable decisions. We report research of the innumeracy of individuals as it relates to their carbon footprint. In three studies that varied in terms of scale and sample, respondents estimate the quantity of CO2 released when combusting a gallon of gasoline in comparison to several well-known metrics including food calories and travel distance. Consistently, respondents estimated the quantity of CO2 from gasoline compared to other metrics with significantly less accuracy while exhibiting a tendency to underestimate CO2. Such relative absence of carbon numeracy of even a basic consumption habit may limit the effectiveness of environmental policies and campaigns aimed at changing individual behavior. We discuss several caveats as well as opportunities for policy design that could aid the improvement of people's quantitative understanding of their carbon footprint.

The unhappy postdoc: a survey based study.

Background: The emerging public discourse about the "broken" postdoc system is mostly conceptual (with several recent exceptions). The current work offers an attempt to quantify postdocs' perceptions, goals, and well-being. Methods: A survey of 190 postdocs in North America. Results: This article first reveals a surprisingly unhappy postdoc community with low life satisfaction. Second, it demonstrates how over the course of the fellowship many postdocs lose interest in the goal of pursuing a tenure track academic position (~20%) or in recommending the postdoc track to others (~30%). Finally, we find that among a large number of factors that can enhance life satisfaction for postdocs (e.g., publication productivity, resources available to them) only one factor stood out as significant: the degree to which atmosphere in the lab is pleasant and collegial. Conclusions: Our findings can stimulate policy, managerial, and career development improvements in the context of the postdoc system.

From Research to Practice: Which Research Strategy Contributes More to Clinical Excellence? Comparing High-Volume versus High-Quality Biomedical Research.

The question when and to what extent academic research can benefit society is of great interest to policy-makers and the academic community. Physicians in university hospitals represent a highly relevant test-group for studying the link between research and practice because they engage in biomedical academic research while also providing medical care of measurable quality. Physicians' research contribution to medical practice can be driven by either high-volume or high-quality research productivity, as often pursuing one productivity strategy excludes the other. To empirically examine the differential contribution to medical practice of the two strategies, we collected secondary data on departments across three specializations (Cardiology, Oncology and Orthopedics) in 50 U.S.-based university hospitals served by 4,330 physicians. Data on volume and quality of biomedical research at each department was correlated with publicly available ratings of departments' quality of care, demonstrating that high-quality research has significantly greater contribution to quality of care than high-volume research.