To Vaccinate or to Procrastinate? That is the Prevention Question

Effects of organized screening programs on breast cancer screening, incidence, and mortality in Europe

We link data on regional Organized Screening Programs (OSPs) throughout Europe with survey data and population-based cancer registries to estimate effects of OSPs on breast cancer screening (mammography), incidence, and mortality. Identification is from regional variation in the existence and timing of OSPs, and in their age-eligibility criteria. We estimate that OSPs, on average, increase mammography by 25 percentage points, increase breast cancer incidence by 16% five years after the OSPs implementation, and reduce breast cancer mortality by about 10% ten years after.

Factors associated with COVID-19 vaccination intentions and attitudes in France

Objectives

The objective of the study is to investigate the factors associated with COVID-19 vaccination intentions and attitudes in France.

Study design

An online cross-sectional study was conducted among a representative sample of the French population between November 20th and 23rd 2020 (N = 1146).

Methods

Factors associated with the intention to get vaccinated and with COVID-19 vaccine attitudes were estimated using ordered logistic and multinomial logistic regressions, respectively. Independent variables of interest include COVID-19 and vaccine perceptions, trust, endorsement of COVID-19 conspiracy theories and time/risk preferences.

Results

Only 30.5% of our respondents would agree to get vaccinated against COVID-19 during the first semester of 2021 while 31.1% declare being unsure of their vaccination intentions. COVID-19 risk perceptions are associated with vaccination intentions and attitudes. Individual and collective benefits of the vaccine and the concerns over its safety are strongly associated with COVID-19 vaccination intentions and attitudes. Vaccine acceptors are more willing to take risks in the health domain compared with vaccine hesitant respondents which indicates that the COVID-19 vaccine is perceived as a greater health risk than the COVID-19 itself by some respondents. We also find a positive association between future preference and the willingness to get vaccinated.

Conclusion

Awareness campaigns should be conducted to enhance vaccination uptake among vaccine hesitant individuals. These campaigns could highlight the positive benefit-risk balance of the COVID-19 vaccines or the short-term benefits of vaccination and should reinsure the public on the safety of the COVID-19 vaccines.

A fresh look at primary prevention for health risks

The author analyzes how risk preferences affect primary prevention for health risks using Kihlstrom and Mirman (1974) transformation function approach. This ensures consistency of ordinal preferences. Higher risk aversion may increase or decrease optimal prevention depending on a probability threshold. Higher downside risk aversion always has a negative effect on optimal prevention. Our findings corroborate the role of downside risk aversion as an important determinant of optimal prevention for health risks but renders fear of sickness irrelevant. We also point out several unique properties of prevention for health risks compared to financial risks.

It runs in the family - Influenza vaccination and spillover effects

We study a population-based influenza vaccination program in the Netherlands, and the spillovers it has within families. Individuals aged 65 years and over qualify for the program and receive a personal invitation for a free flu shot, while ineligible individuals have to pay out-of-pocket and face additional barriers to getting vaccinated. The quasi-random variation at age 65 is exploited to analyse program impact on vaccination behavior of cohabiting partners and adult children. We find that the program induced a 10 percentage points increase in vaccination coverage among individuals at age 65. The program further led to a similar effect on vaccination take-up by cohabiting younger partners, but spillovers on children were negative. These asymmetric patterns of vaccination uptake are consistent with partners and children learning about influenza mortality risk, target group membership, and cost and benefits of vaccination, as well as salience. We conclude that public health campaigns should pay attention to the effects on voluntary preventive care participation as within-family spillovers impact the program's overall public health impact.

Risk-taking in vaccination, surgery, and gambling environments: Evidence from a framed laboratory experiment

Vaccination involves a tradeoff between two risky alternatives, namely, susceptibility and immunization. By designing a controlled laboratory experiment, we investigate the association between risk preferences and immunization decisions. To contrast the role of risk preferences in vaccination decisions with other domains, we implemented four frames: vaccination, surgery, complex neutral, and simple neutral. We found direct framing effects for females but not for males. For the former, the demand for the safer alternative is significantly larger in the surgery frame than in all other frames. For male subjects, we found a significant association between stated risk preferences and choice behavior in the simple neutral frame but not in the other three frames. For female subjects, we observed the exact opposite. Although the complexity of the decision problem matters, there is no indication of differential roles of risk preferences for a given complexity. We found that the share of consistent choices is significantly larger in the surgery frame as compared to the two neutral frames, that is, context improves decision making. This does not apply to the vaccination frame, so there is something about vaccinations that prevents individuals from better understanding the decision problem at hand.

Economic preferences and fast food consumption in US adults: Insights from behavioral economics

OBJECTIVE

To examine the relationship between economic time preferences and frequency of fast food and full-service restaurant consumption among U.S. adults.

METHODS

Participants included 5871U.S. adults who responded to a survey conducted in 2011 pertaining to the lifestyle behaviors of families and the social context of these behaviors. The primary independent variable was a measure of time preferences, an intertemporal choice assessing delay discounting. This was elicited via responses to preferences for an immediate dollar amount or a larger sum in 30 (30-day time horizon) or 60days (60-day time horizon). Outcomes were the frequency of fast food and full-service restaurant consumption. Ordered logistic regression was performed to examine the relationship between time preferences and food consumption while adjusting for covariates (e.g. socio-demographics).

RESULTS

Multivariable analysis revealed that higher future time preferences were significantly related to less frequent fast food intake for both the 30- and 60-day time horizon variables (P for linear trend <0.05; both). Notably, participants with the highest future time preference were significantly less likely to consume fast food than those with very low future time preferences (30-day: OR=0.74, 95%CI: 0.62-0.89; and 60-day: OR=0.86, 95%CI: 0.74-1.00). In comparison, higher future time preferences were not significantly associated with full-service restaurant intake (30-day: p for linear trend=0.73; 60-day: p for linear trend=0.83).

CONCLUSIONS

Higher future time preferences were related to a lower frequency of fast food consumption. Utilizing concepts from behavioral economics (e.g. pre-commitment contracts) to facilitate more healthful eating is warranted using experimental studies.