Who is chronically obese in Indonesia? The role of individual preferences.

Numerous studies have confirmed the relationship between individual risk and time preference and obesity. Nevertheless, none has studied the effect of these attitudes on chronic (long-term) obesity. This study used Indonesia Family Life Survey (IFLS) data from 16,366 individuals. It tracked their obesity status in 2007 and 2014 by calculating body mass index, the ratio between body weight and square of height. Besides the conventional risk-averse and risk-tolerant behaviour, the IFLS sample includes people who fear uncertainty related to the status quo bias. The ordered logit regression results show that past impatience, risk tolerance, and status quo bias behaviour (in 2007) are associated with transient or chronic obesity, while only current behaviour of status quo bias (in 2014) is associated with obesity. Furthermore, our study confirms that chronic obesity in Indonesia is prevalent among highly educated, high-income, and urban-centric individuals, exacerbated by impatience, risk tolerance, and uncertainty aversion. Thus, providing information on the risk of obesity and food calories, giving the incentive to avoid obesity, and improving the quality of built environments such as public parks, public transportation, and footpath could help prevent the rising obesity prevalence.

Impact of Actor's Initial State of Engagement in a Course of Action on Judgements of Post-decisional Regret and Joy: Revisiting Kahneman and Tversky (1982).

According to the phenomenon commonly known as action effect and vastly replicated across the judgment and decision-making literature, more regret is associated with decisions resulting from action than inaction. Action vs. inaction, however, might either refer to change vs. no change or doing something vs. not doing something. The purpose of this study was to examine the effect of this variation in operationalization of action-inaction on the strength of action effect, for both positive and negative outcomes, across four different domains of employment, finance, education, and health. This was an experimental scenario-based study (N = 215) with four between-subjects conditions varying in outcome valence and the actor's initial state as either engaged or non-engaged in a particular course of action. Action effect was found to be stronger with respect to the initially engaged than the initially non-engaged decision-maker (ηp2 = .04), indicating that action as change results in a stronger action effect than action as doing something. The effect of the initial state was also moderated by domain. In addition, we both replicated and went beyond prior empirical literature regarding the effect of outcome valence and domain on action effect, with our findings being mostly consistent across joy and regret. Findings are discussed in light of the norm theory and its key concept of normality and contribute to the literature on moderators of action effect.

Impact of Actor’s Initial State of Engagement in a Course of Action on Judgements of Post-decisional Regret and Joy: Revisiting Kahneman and Tversky (1982)

According to the phenomenon commonly known as action effect and vastly replicated across the judgment and decision-making literature, more regret is associated with decisions resulting from action than inaction. Action vs. inaction, however, might either refer to change vs. no change or doing something vs. not doing something. The purpose of this study was to examine the effect of this variation in operationalization of action-inaction on the strength of action effect, for both positive and negative outcomes, across four different domains of employment, finance, education, and health. This was an experimental scenario-based study (N = 215) with four between-subjects conditions varying in outcome valence and the actor’s initial state as either engaged or non-engaged in a particular course of action. Action effect was found to be stronger with respect to the initially engaged than the initially non-engaged decision-maker (ηp2 = .04), indicating that action as change results in a stronger action effect than action as doing something. The effect of the initial state was also moderated by domain. In addition, we both replicated and went beyond prior empirical literature regarding the effect of outcome valence and domain on action effect, with our findings being mostly consistent across joy and regret. Findings are discussed in light of the norm theory and its key concept of normality and contribute to the literature on moderators of action effect. (AU)

An empirical investigation of household's waste separation intention: A dual-factor theory perspective.

Waste separation at a household level could facilitate sustainable waste management. However, despite several efforts by the government, the adoption of household waste separation practices is still at a nascent stage. Therefore, we aim to study the factors affecting household waste separation intention (WSI). Drawing on Dual Factor Theory (DFT), two distinct sets of factors (enablers and barriers) were used to explain the WSI at the household level. This study also extended the Self Determination Theory (SDT) and Status Quo Bias (SQB) theory to broadly identify the factors and develop a conceptual model. The main study analyzed data from 494 respondents using a structural equation modeling approach. The result reveals that environmental concern, anticipated guilt, awareness of consequences, and health consciousness have a significant positive effect on WSI. In contrast, perceived inconvenience, information, and infrastructure barriers significantly negatively affect WSI. Additionally, gender and income partially moderated the studied relationships. The results offer key insights and implications for marketers and public policymakers.

The role of attention in status quo bias.

In many decision-making contexts, people often persist with their previous selections. This predisposition to choose to maintain a current (or previous) choice is referred to as the status quo bias (SQB). In this work, we propose that increased attention towards the status quo option-enabled by its visual salience-is a previously underappreciated driver of SQB. We base this hypothesis on three propositions: (1) the status quo bias option is often more visually salient relative to the non-status quo options on offer, (2) greater visual salience of an option biases attention towards that option, and (3) increased attention towards an option leads to that option being selected at greater rates. We examined the attention hypothesis among 6,854 participants in four studies. Studies 1 and 2 showed that increasing the visual salience of a non-status quo option (i.e., the type of visual salience often garnered by the status quo option) increased the selection rate of that option. Study 3 directly tested the hypothesis by lessening the visual salience of the status quo option. Doing so eliminated SQB. Study 4 replicated and extended the findings of Study 3 in a real-world decision context. Collectively, these studies suggest that the selection of the status quo may often be related to its salience relative to other available options.

Parent's risk preference and childhood vaccination: evidence from Indonesia.

A vaccines advisory group to the World Health Organization (WHO) identified complacency, inconvenience in accessing vaccines, and lack of confidence as key reasons for hesitancy. In childhood vaccination, the decision to take a vaccine relies on parents' decisions. Our study explored the relationship between parents' risk aversion and complete childhood vaccination status to identify whether demand contributes to vaccine hesitancy in Indonesia. We examined risk aversion using data from the fifth-wave Indonesian Family Life Survey (IFLS), focusing on parents with extreme risk aversion or fear of uncertainty. The logistic regression shows a negligible relationship between parents' risk aversion and childhood vaccination; nevertheless, parents who fear uncertainty tend to avoid vaccination. The results of this study encourage public health professionals and policymakers to properly design vaccine campaigns with careful consideration of the risk preference dimension of the targeted beneficiaries.

Social position and economic system justification in Canada: Implications for advancing health equity and social justice from an exploratory study of factors shaping economic system justification.

Objective: Many socio-economic reforms that could reduce health disparities are not implemented because people justify existing systems and fear changes thereto. This study aimed to identify socio-demographic factors associated with system justifying beliefs to better understand how they are maintained in Canada. In doing so, we hypothesized that (1) systems justification is a default cognitive position, buttressed by the palliative benefits of system-justification, (2) lack of success in a given system generally motivates people to doubt the legitimacy of that system, and (3) system-justifying beliefs are rejected only when the costs of doing so are low enough and/or the benefits are high enough to outweigh the innate needs-fulfillment benefits of system-justification. Methods: Testing these hypotheses, we recruited participants living in Canada, aged 16+, to complete an online survey after being recruited via paid social media advertisements. Multivariable regression models identified factors associated with Economic System Justification Scale (ESJS) scores. Explanatory variables included demographic measures of social position, self-rated health, and patterns of social inclusion. Results: Among 2,619 participants, system-justifying beliefs were wide-spread, with the average level of support across ESJS scale items exceeding 50%. Lower ESJS scores were associated with worse health, more loneliness, and lower socioeconomic status. Despite the pattern that marginalization erodes system-justification, several historically marginalized characteristics (e.g., non-white ethnicity and non-binary gender) were associated with relatively high system-justification, compared to matching privileged characteristics (e.g., white ethnicity; masculine gender). Conclusion: Supporting our hypotheses, we identify a general trend that social marginalization is associated with less system-justification. Those benefitting from the status quo (e.g., healthier, wealthier, less lonely) were more likely to hold system-justifying beliefs. However, some groups who are disadvantaged within the existing system reported higher system-justification-suggesting that system oppression may be a key moderator of the effect of social position on system justification.

Delayed cognitive processing and treatment status quo bias in early-stage multiple sclerosis.

BACKGROUND: The evolving therapeutic landscape requires more participation of patients with relapsing remitting multiple sclerosis (RRMS) in treatment decisions. The aim of this study was to assess the association between patient's self-perception, cognitive impairment and behavioral factors in treatment choices in a cohort of patients at an early stage of RRMS. METHODS: We conducted a multicenter, non-interventional study including adult patients with a diagnosis of RRMS, a disease duration ≤18 months and receiving care at one of the 21 participating MS centers from across Spain. We used patient-reported measures to gather information on fatigue, mood, quality of life, and perception of severity of their MS. Functional metrics (Expanded Disability Status Scale [EDSS], cognitive function by the Symbol Digit Modalities Test [SDMT], 25-foot walk test) and clinical and radiological data were provided by the treating neurologist. The primary outcome of the study was status quo (SQ) bias, defined as participant's tendency to continue taking a previously selected but inferior treatment when intensification was warranted. SQ bias was assessed based on participants treatment preference in six simulated RRMS case scenarios with evidence of clinical relapses and radiological disease progression. RESULTS: Of 189 participants who met the inclusion criteria, 188 (99.5%) fully completed the study. The mean age was 36.6 ± 9.5 years, 70.7% female, mean disease duration: 1.2 ± 0.8 years, median EDSS score: 1.0 [IQR=0.0-2.0]). Overall, 43.1% patients (n = 81/188) had an abnormal SDMT (≤49 correct answers). SQ bias was observed in at least one case scenario in 72.3% (137/188). Participant's perception of their MS severity was associated with higher SQ bias (ß coeff 0.042; 95% CI 0.0074-0.076) among those with delayed cognitive processing. Higher baseline EDSS and number of T2 lesions were predictors of delayed processing speed (OR EDSS=1.57, 95% CI: 1.11-2.21, p = 0.011; OR T2 lesions=1.50, 95% CI: 1.11-2.03, p<0.01). Bayesian multilevel model accounting for clustering showed that delayed cognitive processing (exp coeff 1.06; 95% CI 1.04-1.09) and MS symptoms severity (exp coeff 1.28; 95% CI 1.22-1.33) were associated with SQ bias. CONCLUSION: Over 40% of patients in earlier stages of RRMS experience delays in cognitive processing that might affect their decision-making ability. Our findings suggest that patients' self-perception of disease severity combined with a delay in cognitive processing would affect treatment choices leading to status quo bias early in the course of their disease.

Nudging COVID-19 Vaccine Uptake by Changing the Default: A Randomized Controlled Trial.

BACKGROUND: Although vaccination against SARS-CoV-2 is considered the central strategy against the pandemic, uptake lags behind target rates. METHOD: To explore whether this rate could be enhanced by a nudging strategy that exploits the status quo bias, we conducted a randomized controlled trial in northern Italy comparing vaccination acceptance among 2000 adults, ages 50 to 59 years, who were either invited to set an appointment (opt-in group) or assigned an individual appointment (opt-out group). RESULTS: Results indicate a difference of 3.2 percentage points, which represents a 32% relative increase in the vaccination rate for the opt-out group compared with the opt-in group. CONCLUSIONS: A significant portion of those who remain unvaccinated may not hold strong beliefs against vaccination but rather tend to inaction and may therefore be nudged toward vaccination with a reduction of action required. HIGHLIGHTS: Reluctant adults (50-59 years), who had not yet received vaccines against COVID-19, were sent letters announcing appointment availabilityIn an RCT, the status quo option in the notices influenced the rate of vaccine acceptanceNudging via pre-scheduled appointments encouraged vaccine uptake more than invitations to schedule didSwitching the default option yielded a 32% relative increase (13.1% vs. 9.9%) in vaccination.

Heritable genome editing and cognitive biases: why broad societal consensus is the wrong standard for moving forward.

Heritable genome editing (HGE) may one day safely correct mutations that cause serious monogenic diseases. Nevertheless, some scientists and bioethicists argue that HGE should be subject to a moratorium. In their view, no nation should proceed with clinical use absent broad societal consensus in favor of moving forward with HGE and a specific use. This article critiques this plan in light of two cognitive biases. First, human beings favor the status quo. We are primed to favor human reproduction and the human genome in their current forms and resist HGE. Second, human beings also dwell on negative information. Dr He Jiankui's unethical and premature experiment encourages us to judge HGE and its offspring harshly. By reinforcing these biases, the proposed moratorium would make it difficult to achieve broad societal consensus in support of using HGE even to correct dangerous mutations. As an alternative, this article recommends HGE be regulated for safety and efficacy. This approach will keep scientists from using HGE prematurely, while giving society time to discuss this new technology and enact further legislation if necessary.

Leveraging behavioral economics to promote treatment adherence: A primer for the practicing dermatologist.

The problem of suboptimal treatment adherence among patients with dermatologic or other diseases has not been adequately addressed in health care. Despite a wide range of efficacious therapies, nonadherence remains a primary driver of suboptimal clinical outcomes. Novel solutions to address this unmet need can be found in behavioral economics. By leveraging our understanding of human decision-making, we may better promote treatment adherence, thereby improving quality of life and decreasing economic burdens. Behavioral economics has been studied extensively in relation to topics such as health policy and health behaviors; however, there is a dearth of research applying this approach to chronic diseases and only a handful within dermatology. We conducted a scoping review in PubMed to identify articles that discuss behavioral economics and its application to treatment adherence in dermatologic patients, with a particular focus on psoriasis, followed by a summary of key ethical considerations. We found that such principles can be employed in cost-effective, scalable interventions that improve patient adherence to a range of medical therapies and lifestyle modifications.

COVID-19 Vaccine Passport and International Traveling: The Combined Effect of Two Nudges on Americans' Support for the Pass.

Immunity passports have the potential to allow large-scale international traveling to resume. However, they can only become an effective tool if they are widely supported by the general public. We carry out a double blind randomized online experiment with a sample of N=4000 Americans to study (i) whether two nudges can increase the level of support for a COVID pass for international traveling, (ii) the relationship between the effects of the nudges, and (iii) if these nudges have a negative spillover on the intention to get vaccinated. We find that both nudges increase the support for the COVID pass and that their impact is stronger when they are used together. Moreover, we find that the two nudges do not negatively affect intentions to get vaccinated. Our findings have important implications for policymakers and for the nascent literature on the interaction between multiple nudges.

Therapeutic status quo in patients with relapsing-remitting multiple sclerosis: A sign of poor self-perception of their clinical status?

BACKGROUND: Status quo (SQ) bias is defined as patient´s tendency to continue taking a previously selected but inferior therapeutic option. OBJECTIVE: To assess the presence of SQ bias and its associated factors in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS: A multicenter, non-interventional study involving 211 patients with RRMS was conducted. Participants answered questions regarding risk preferences and management of simulated MS case-scenarios. The SymptoMScreen (SMSS) questionnaire was used to assess the perception of severity from the patients´ perspective. SQ bias was defined as patients' preference to maintain the current treatment despite evidence of disease activity. Mixed linear models adjusting for clustering assessed the association of candidate predictors with the outcome of interest. RESULTS: The mean age (SD) was 39.1 (9.5) years and 70.6% were women. SQ bias was observed in 74.4% (n=161) participants. Univariate analysis showed that SMSS score was associated with SQ bias (OR 1.04; 95% CI 1.01-1.07). Mixed linear regression models suggest that for every point increase in SMSS, there was a 4% increase in the likelihood of SQ bias (ß 0.04; 95%CI 0.015-0.06; p<0.002). Among the different symptomatic dimensions included in the SMSS, only vision impairment (ß 0.32; 95%CI 0.05-0.50) and depression (ß 0.29; 95%CI 0.006-0.58) remained associated with SQ bias in the multivariate analysis. There was no association between participants' risk preferences and SQ bias. CONCLUSIONS: Unwillingness to pursue treatments that are more effective is a common phenomenon affecting over 7 out of 10 patients with RRMS. This phenomenon appears to be driven by patients' negative self-perception of their clinical status.

The inhibiting effects of resistance to change of disability determination system: a status quo bias perspective.

BACKGROUND: Information systems implementation projects have been historically plagued by failures for which user resistance has consistently been identified as a salient reason. Most prior studies investigated either the causes or the consequences of Resistance to Change (RTC) of medical related Information Systems. In this study, we simultaneously explore the causes and impacts of RTC of Disability Determination System (DDS). METHODS: This study adopts the Status Quo Bias perspective and combines the information systems usage model and Technology Acceptance Model (TAM) as theoretical foundation to investigates the causes and impacts of users' RTC on their intention to use the DDS. Data were obtained through internet questionnaire survey. Totally, 326 respondents from 22 local governments and 142 hospitals were collected, of which 252 were valid samples and were analyzed using structure model analysis. RESULTS: The research model is proved with eight out of 11 hypotheses being supported. The antecedents of RTC can explain 21.4% of the RTC variation, and the RTC impacts can explain 57.5% of the variation of intention to use DDS. CONCLUSIONS: Combining the Status Quo Bias perspective and key component of TAM provides an adequate explanation of adopting intention of changing systems and extend the existing knowledge of information systems adoption. The results provide as a reference for managing users' RTC and enhance the effects and efficiency of new systems adoption.

Progress bias versus status quo bias in the ethics of emerging science and technology.

How should we handle ethical issues related to emerging science and technology in a rational way? This is a crucial issue in our time. On the one hand, there is great optimism with respect to technology. On the other, there is pessimism. As both perspectives are based on scarce evidence, they may appear speculative and irrational. Against the pessimistic perspective to emerging technology, it has been forcefully argued that there is a status quo bias (SQB) fuelling irrational attitudes to emergent science and technology and greatly hampering useful development and implementation. Therefore, this article starts by analysing the SQB using human enhancement as a case study. It reveals that SQB may not be as prominent in restricting the implementation of emergent technologies as claimed in the ethics literature, because SQB (a) is fuelled by other and weaker drivers than those addressed in the literature, (b) is at best one amongst many drivers of attitudes towards emergent science and technology, and (c) may not be a particularly prominent driver of irrational decision-making. While recognizing that SQB can be one driver behind pessimism, this article investigates other and counteracting forces that may be as strong as SQB. Progress bias is suggested as a generic term for the various drivers of unwarranted science and technology optimism. Based on this analysis, a test for avoiding or reducing this progress bias is proposed. Accordingly, we should recognize and avoid a broad range of biases in the assessment of emerging and existing science and technology in order to promote an open and transparent deliberation.

I Have, Therefore I Love: Status Quo Preference in Mate Choice.

Decades of research indicate that individuals adhere to existing states ("status quo bias") and value them more ("endowment effect"). The present work is the first to investigate status quo preference within the context of trade-offs in mate choice. Across seven studies (total N = 1,567), participants indicated whether they would prefer remaining with a current partner possessing a particular set of traits (e.g., high trustworthiness, low attractiveness) or switching to an alternative partner possessing opposite traits. Preference for a given trait was highest when the individual representing the status quo (one's romantic partner or an interaction partner) possessed that trait. Concerns about hurting the partner, ambiguity avoidance, and biased construal of the partner and the alternative predicted status quo preference and disapproval of the current partner by network members eliminated this effect. These findings indicate that when it comes to matters of the heart, we tend to love what we currently have.

Dominated choices and Medicare Advantage enrollment.

Research in behavioral economics suggests that certain circumstances, such as large numbers of complex options or revisiting prior choices, can lead to decision errors. This paper explores the enrollment decisions of Medicare beneficiaries in the Medicare Advantage (MA) program. During the time period we study (2007-2010), private fee-for-service (PFFS) plans offered enhanced benefits beyond those of traditional Medicare (TM) without any restrictions on physician networks, making TM a dominated choice relative to PFFS. Yet more than three quarters of Medicare beneficiaries remained in TM during our study period. We analyze the role of status quo bias in explaining this pattern of enrollment. Our results suggest that status quo bias plays an important role; the rate of MA enrollment was significantly higher among new Medicare beneficiaries than among incumbents. These results illustrate the importance of the choice environment that is in place when enrollees first enter the Medicare program.

Healthcare professionals' use of health clouds: Integrating technology acceptance and status quo bias perspectives.

PURPOSE: Cloud computing technology has recently been seen as an important milestone in medical informatics development. Despite its great potential, there are gaps in our understanding of how users evaluate change in relation to the health cloud and how they decide to resist it. Integrating technology acceptance and status quo bias perspectives, this study develops an integrated model to explain healthcare professionals' intention to use the health cloud service and their intention to resist it. METHODS: A field survey was conducted in Taiwan to collect data from healthcare professionals; a structural equation model was used to examine the data. A valid sample of 209 healthcare professionals was collected for data analysis. RESULTS: The results show that healthcare professionals' resistance to the use of the health cloud is the result of regret avoidance, inertia, perceived value, switching costs, and perceived threat. Attitude, subjective norm, and perceived behavior control are shown to have positive and direct effects on healthcare professionals' intention to use the health cloud. The results also indicate a significant negative effect in the relationship between healthcare professionals' intention and resistance to using the health cloud. CONCLUSION: Our study illustrates the importance of incorporating user resistance in technology acceptance studies in general and in health technology usage studies in particular. This study also identifies key factors for practitioners and hospitals to make adoption decisions in relation to the health cloud. Further, the study provides a useful reference for future studies in this subject field.

Subjective numeracy and preference to stay with the status quo.

BACKGROUND: Preference for the status quo, or clinical inertia, is a barrier to implementing treat-to-target protocols in patients with chronic diseases such as rheumatoid arthritis (RA). The objectives of this study were to examine the influence of subjective numeracy on RA-patient preference for the status quo and to determine whether age modifies this relationship. METHODS: RA patients participated in a single face-to-face interview. Numeracy was measured using the Subjective Numeracy Scale. Treatment preference was measured using Adaptive Conjoint Analysis. RESULTS: Of 205 eligible subjects, 156 agreed to participate. Higher subjective numeracy was associated with lower preference for the status quo in a regression model including race, employment, and use of biologics (adjusted odds ratio [95% confidence interval] = 0.71 [0.52-0.95], P = 0.02). Higher subjective numeracy was protective against status quo preferences among subjects younger than 65 years (adjusted odds ratio [95% confidence interval] = 0.64 (0.43-0.94), P = 0.02) but not among older subjects. CONCLUSIONS: Subjective numeracy is independently associated with younger, but not older, RA patients' preferences for the status quo. Our results add to the literature demonstrating age and numeracy differences in treatment preferences and medical decision-making processes.