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Caso G, Vecchio R. Nudging low-medium income mothers towards healthy child options in an online restaurant scenario. Appetite 2023; 180:106360. [PMID: 36343869 DOI: 10.1016/j.appet.2022.106360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/18/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
Helping mothers make the healthiest choices for their children when eating out can contribute to preventing the prevalence of childhood overweight and obesity, particularly in economically disadvantaged classes. Herein, we tested whether two different nudges (a default option and a social norm prompt) could guide low- and middle-income mothers towards healthier children's menu choices in a fictive restaurant setting and investigated the drivers of healthy child menu selection. A cross-sectional online survey was performed among 809 Italian mothers with children aged between 3 and 12 years, and a between-subjects design (control, nudge 1, and nudge 2) was applied. The findings revealed that both nudges had no significant effect on the number of healthy menu selections compared with the healthy choices made in the control condition. Furthermore, considering the entire sample, the results show that certain characteristics of a mother (e.g., authoritative parenting style) and child (younger age) duo increase the likelihood of the former selecting a healthy children's menu. Similarly, a positive correlation between the likelihood of choosing a healthy children's menu and the mother's involvement in the child's nutrition (meal preparation and weekly diet) was observed.
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Affiliation(s)
- Gerarda Caso
- Department of Agricultural Sciences, University of Naples Federico II, Portici, Italy
| | - Riccardo Vecchio
- Department of Agricultural Sciences, University of Naples Federico II, Portici, Italy.
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Gynell I, Kemps E, Prichard I. The effectiveness of implicit interventions in food menus to promote healthier eating behaviours: A systematic review. Appetite 2022; 173:105997. [DOI: 10.1016/j.appet.2022.105997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 11/02/2022]
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Thompson HR, Martin A, Strochlic R, Singh S, Woodward-Lopez G. Limited implementation of California's Healthy Default Beverage law for children's meals sold online. Public Health Nutr 2022; 25:1-10. [PMID: 35000666 PMCID: PMC9991827 DOI: 10.1017/s1368980022000039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/20/2021] [Accepted: 01/05/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To reduce children's sugar-sweetened beverage intake, California's Healthy-By-Default Beverage law (SB1192) mandates only unflavoured dairy/non-dairy milk or water be the default drinks with restaurant children's meals. The objective of this study is to examine consistency with this law for meals sold through online platforms from restaurants in low-income California neighbourhoods. DESIGN This observational, cross-sectional study examines beverage availability, upcharges (additional cost) and presentation of beverage options consistent with SB1192 (using four increasingly restrictive criteria) within a random sample of quick-service restaurants (QSR) in Supplemental Nutrition Assistance Program Education eligible census tracts selling children's meals online from November 2020 to April 2021. SETTING Low-income California neighbourhoods (n 226 census tracts). PARTICIPANTS QSR that sold children's meals online via a restaurant-specific platform, DoorDash, GrubHub and/or UberEats (n 631 observations from 254 QSR). RESULTS Seventy percent of observations offered water; 63 % offered unflavoured milk. Among all beverages, water was most likely to have an upcharge; among observations offering water (n 445), 41 % had an upcharge (average $0·51). Among observations offering unflavoured milk (n 396), 11 % had an upcharge (average $0·38). No observations upcharged for soda (regular or diet). Implementation consistency with SB1192 ranged from 40·5 % (using the least restrictive criteria) to 5·6 % (most restrictive) of observations. CONCLUSIONS Based on observations from restaurant websites and three of the most popular online ordering platforms, most California QSR located in low-income neighbourhoods are not offering children's meal beverages consistent with the state's Healthy-By-Default Beverage law. As the popularity of online ordering increases, further work to ensure restaurants offering healthy default beverages with children's meals sold online is necessary.
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Affiliation(s)
- Hannah R Thompson
- University of California Berkeley, School of Public Health, 2121 Berkeley Way, 6120, Berkeley, CA94720-7360, USA
- University of California Agriculture and Natural Resources, Nutrition Policy Institute, 1111 Franklin, Fifth Floor, Oakland, CA94607, USA
| | - Anna Martin
- University of California Agriculture and Natural Resources, Nutrition Policy Institute, 1111 Franklin, Fifth Floor, Oakland, CA94607, USA
| | - Ron Strochlic
- University of California Agriculture and Natural Resources, Nutrition Policy Institute, 1111 Franklin, Fifth Floor, Oakland, CA94607, USA
| | - Sonali Singh
- University of California Berkeley, School of Public Health, 2121 Berkeley Way, 6120, Berkeley, CA94720-7360, USA
- University of California Agriculture and Natural Resources, Nutrition Policy Institute, 1111 Franklin, Fifth Floor, Oakland, CA94607, USA
| | - Gail Woodward-Lopez
- University of California Agriculture and Natural Resources, Nutrition Policy Institute, 1111 Franklin, Fifth Floor, Oakland, CA94607, USA
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Application of Behavioral Economics Principles Improves Participation in Mailed Outreach for Colorectal Cancer Screening. Clin Transl Gastroenterol 2020; 11:e00115. [PMID: 31972609 PMCID: PMC7056051 DOI: 10.14309/ctg.0000000000000115] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION: Colorectal cancer (CRC) is a major cause of cancer-related morbidity and mortality in the United States. Although various interventions have improved screening rates, they often require abundant resources and can be difficult to implement. Social psychology and behavioral economics principles offer an opportunity for low-cost and easy-to-implement strategies but are less common in clinical settings. METHODS: We randomized 2,000 patients aged 50–75 years eligible for CRC screening to one of the 2 mailed interventions: a previously used text-based letter describing and offering fecal immunochemical testing (FIT) and colonoscopy (usual care arm); or a letter leveraging social psychology and behavioral economics principles (e.g., implied scarcity and choice architecture), minimal text, and multiple images to offer FIT and colonoscopy (intervention arm). We compared total screening uptake, FIT uptake, and colonoscopy uptake at 1-month intervals in each group. RESULTS: There were 1,882 patients included in the final analysis. The mean age was 69.3 years, and baseline characteristics in the 2 groups were similar. Screening completion at 26 weeks was 19.5% in the usual care arm (16.3% FIT vs 3.2% colonoscopy, P < 0.01) and 24.1% in the intervention arm (22.1% FIT vs 2.0% colonoscopy, P < 0.01) (P = 0.02). DISCUSSION: Among primary care patients aged 50–75 years in an academic setting, mailed CRC outreach employing social psychology and behavioral economics principles led to a higher participation in CRC screening than usual care mailed outreach. TRANSLATIONAL IMPACT: Mailed interventions to increase CRC screening should incorporate social psychology and behavioral economics principles to improve participation.
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Dalrymple JC, Radnitz C, Loeb KL, Keller KL. Optimal defaults as a strategy to improve selections from children's menus in full-service theme park dining. Appetite 2020; 152:104697. [PMID: 32277951 DOI: 10.1016/j.appet.2020.104697] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 11/27/2022]
Abstract
An "optimal default" refers to a pre-selected default option that promotes an outcome intended to be favorable to the individual and/or society at large. Optimal defaults preserve the decision-maker's ability to opt-out of the default and choose an alternative option. This behavioral economics strategy has been shown to nudge both child and adult consumers toward healthier food selections. Full-service restaurants with children's menus are key settings for implementing this approach. The current field study manipulated children's menus at two theme park restaurants, testing the effects of three different item presentations (i.e., lower-energy-dense default, standard fare default, and free array menus). Each menu was presented to consumers for 1 week at a time, in random order. Full choice was preserved with all menu options appearing across conditions, with non-default items listed as available upon request. The restaurants tracked food orders during each of the three weeks. Results showed that positioning lower-energy-dense foods as default menu choices increased the likelihood of lower-energy-dense menu selections and decreased the likelihood that customers would "opt-out" for standard fare. There were also significant differences in total caloric value of food ordered across conditions, with the optimal default menu condition promoting the lowest potential energy intake. This study further supports the effectiveness of optimal defaults to increase healthy food choices for children.
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Affiliation(s)
- Jessica C Dalrymple
- School of Psychology, Fairleigh Dickinson University, 1000 River Road, T-WH1-01, Teaneck, NJ, 07666, USA.
| | - Cynthia Radnitz
- School of Psychology, Fairleigh Dickinson University, 1000 River Road, T-WH1-01, Teaneck, NJ, 07666, USA
| | - Katharine L Loeb
- School of Psychology, Fairleigh Dickinson University, 1000 River Road, T-WH1-01, Teaneck, NJ, 07666, USA
| | - Kathleen L Keller
- Department of Nutritional Sciences/Department of Food Science, The Pennsylvania State University, 321 Chandlee Laboratory, University Park, PA, 16802, USA
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Guglielmo D, Chantaprasopsuk S, Kay CM, Hyde ET, Stewart C, Gazmararian JA. Nutrition Policies, Practices, and Environments in Low-Income Georgia Elementary Schools, United States, 2015-2017. THE JOURNAL OF SCHOOL HEALTH 2020; 90:278-285. [PMID: 31997370 DOI: 10.1111/josh.12874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND A nutritious diet can prevent obesity and chronic disease and improve academic performance, yet many children have energy-dense, nutrient-poor diets. The objective of this study was to assess nutrition policies, practices, and environments in Georgia Supplemental Nutrition Assistance Program Education (SNAP-Ed) elementary schools and compare them across school-level demographic characteristics. METHODS We distributed a cross-sectional online survey to administrators, grade level chairs, and nutrition managers from 113 Georgia SNAP-Ed elementary schools during 2015-2017. Logistic regression, one-way ANOVA, and Tukey's tests were performed to assess differences by free and reduced-price lunch eligibility and percentage black. Fisher's exact and Rao-Scott chi-square tests were performed to assess differences by school size and geography. RESULTS The majority of schools established wellness policies and committees, provided nutrition education, and offered fresh fruits and/or vegetables daily. Fewer schools had policies limiting sugar-sweetened foods within classrooms or had established a school garden. There were minimal significant differences in survey responses across school-level demographics. CONCLUSIONS Georgia SNAP-Ed elementary schools are providing healthy nutrition settings for their students in a number of areas, and can further improve by establishing more comprehensive wellness policies, a committee to enforce them, and engaging children in hands-on nutrition education activities.
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Affiliation(s)
- Dana Guglielmo
- Emory University, Rollins School of Public Health, Department of Behavioral Sciences and Health Education, 1518 Clifton Road NE, Atlanta, GA, 30322
| | - Sicha Chantaprasopsuk
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, GA, 30322
| | | | - Eric T Hyde
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, GA, 30322
| | | | - Julie A Gazmararian
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, GA, 30322
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Loch MR, Dias DF, Castro ASR, Guerra PH. [Remote control or unlikely control? Behavioral economics and the promotion of healthy behaviors¿Control remoto o remota probabilidad de control? La economía comportamental y la promoción de determinados patrones de comportamiento]. Rev Panam Salud Publica 2019; 43:e18. [PMID: 31093242 PMCID: PMC6393740 DOI: 10.26633/rpsp.2019.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 09/05/2018] [Indexed: 12/11/2022] Open
Abstract
Behavioral economics is a field of knowledge and practices that studies the effect of psychological, cognitive, emotional, and social factors relating to decision-making by individuals and institutions. It assumes that human choices are not the result of careful consideration of costs and benefits, and that some aspects (e.g., defaults, framings, and anchoring effects) may influence an individual's decision-making. Thus, the aim of this essay is to present some general aspects of behavioral economics and discuss its possible application in the promotion of healthy behaviors. One of the roles of health care professionals is to facilitate the adoption of healthy behaviors by the population. There is evidence of a positive influence of some behavioral economics concepts regarding the adoption of various health behaviors, such as food choices, physical activity, adherence to vaccination campaigns, and organ donation. Thus, it is believed that the appropriation of some of these concepts and insights may both promote healthier behaviors and support more effective actions to encourage these healthy behaviors.
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Affiliation(s)
- Mathias Roberto Loch
- Universidade Estadual de Londrina, Programa de Pós-Graduação em Saúde Coletiva, Londrina (PR), Brasil
| | - Douglas Fernando Dias
- Universidade Estadual de Londrina, Programa de Pós-Graduação em Saúde Coletiva, Londrina (PR), Brasil
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Jenssen BP, Buttenheim AM, Fiks AG. Using Behavioral Economics to Encourage Parent Behavior Change: Opportunities to Improve Clinical Effectiveness. Acad Pediatr 2019; 19:4-10. [PMID: 30172918 PMCID: PMC6644058 DOI: 10.1016/j.acap.2018.08.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 08/13/2018] [Accepted: 08/25/2018] [Indexed: 01/22/2023]
Abstract
Pediatric clinical practice often involves improving child health by changing parents' behavior. Strategies from behavioral economics-a field that leverages predictable patterns in human decision making to overcome barriers to behavior change-can improve health outcomes in adults. Although more research is needed, the application of these approaches to parent behavior change in pediatric settings has the potential to improve the clinical effectiveness of child health care. We review the foundational concepts of behavioral economics and identify the unique role of pediatricians in motivating parent behavior change. We then discuss how to apply 4 key strategies in practice-message framing, use of defaults, enhanced active choice, and harnessing social forces-to support parent decision making to improve child health. Leveraging behavioral economic principles around parental decision making has the potential to supercharge program effectiveness and improve patient and family health.
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Affiliation(s)
- Brian P Jenssen
- Department of Pediatrics, University of Pennsylvania School of Medicine, and PolicyLab and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia (BP Jenssen and AG Fiks), Philadelphia, Pa.
| | - Alison M Buttenheim
- Department of Family and Community Health, University of Pennsylvania School of Nursing, and Center for Health Incentives and Behavioral Economics (AM Buttenheim), University of Pennsylvania, Philadelphia, Pa
| | - Alexander G Fiks
- Department of Pediatrics, University of Pennsylvania School of Medicine, and PolicyLab and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia (BP Jenssen and AG Fiks), Philadelphia, Pa
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Effect of default menus on food selection and consumption in a college dining hall simulation study. Public Health Nutr 2018; 21:1359-1369. [PMID: 29409556 DOI: 10.1017/s1368980017004220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To test an obesity prevention strategy derived from behavioural economics (optimal defaults plus delay), focused on changing the college dining hall service method. DESIGN After a uniform pre-load, participants attended an experimental lunch in groups randomized to one of three conditions: a nutrient-dense, lower-fat/energy lunch as an optimal default (OD); a less-nutrient-dense, higher-fat/energy lunch as a suboptimal default (SD); or a free array (FA) lunch. In the OD condition, students were presented a menu depicting healthier vegetarian and omnivore foods as default, with opt-out alternatives (SD menu) available on request with a 15 min wait. In the SD condition, the same menu format was used with the positioning of food items switched. In the FA condition, all choices were presented in uniform fonts and were available immediately. SETTING Private rooms designed to provide a small version of a college dining hall, on two campuses of a Northeastern US university. SUBJECTS First-year college students (n 129). RESULTS There was a significant main effect for condition on percentage of optimal choices selected, with 94 % of food choices in the OD condition optimal, 47 % in the FA condition optimal and none in the SD condition optimal. Similarly, energy intake for those in the SD condition significantly exceeded that in the FA condition, which exceeded that in the OD condition. CONCLUSIONS Presenting menu items as optimal defaults with a delay had a significant impact on choice and consumption, suggesting that further research into its long-term applicability is warranted.
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