Behavioral Economics and Health (2) PDF

Behavioral economics and health (2) UEC-12306 Health Economics Dr Jannette van Beek 04-11-2024 Previous lecture ▪ Health behavior: Different affective/visceral states Empathy gaps (classification, application to decision making) Trade-offs between short-term...

Behavioral economics and health (2) UEC-12306 Health Economics Dr Jannette van Beek 04-11-2024 Previous lecture ▪ Health behavior: Different affective/visceral states Empathy gaps (classification, application to decision making) Trade-offs between short-term and long-term outcomes Time preference (conceptualization & measurement, relation with empathy gaps) 2 Content of this lecture (1) ▪ Time preference Models of discounting Discounting and health behavior Domain differences in discounting 3 Content of this lecture (2) ▪ Time orientation Conceptualization & measurement Time orientation and (health) behavior Domain differences in time orientation Behavior-specific measurement Applications Recommendations for behavior change Real-life choices 4 The problem with the future... 5 Conceptualization of time preference ▪ Valuation of future outcomes relative to present outcomes Future outcomes are discounted (i.e., are worth less in the present) and immediate outcomes are given disproportionate weight ▪ Different terms: Temporal discounting Time discounting Delay discounting 6 Models of discounting ▪ Exponential discounting: Constant discount rate over time Example: Discount rate of 10% in every year ▪ Hyperbolic discounting: High discount rate in the near future, lower discount rate in the distant future Example: Discount rate of 10% in the first year, discount rate money > Money > health = < No difference ▪ Differences between some domains, but not between others Example: Health differs from money and the environment, whereas the latter two do not differ from each other 13 Domain (in)dependence ▪ Mixed results: Little or no correlation between money and health ▪ Dependency for some domains, independency for others Example: Health and vacation are dependent (i.e., correlated), whereas money is independent from the former two (i.e., uncorrelated) 14 Combination of methods ▪ Combination of domain effect and domain (in)dependence ▪ Monetary Choice Questionnaire vs. Weight-loss Choice Questionnaire ▪ Discount rates were Not significantly different Moderately correlated Lim & Bruce (2015) 15 Statements ▪ A. Discounting is a general phenomenon ▪ B. Discounting is a domain-specific phenomenon ▪ C. Discounting is both a general and a domain-specific phenomenon 16 Domain differences in discounting (1) ▪ Characteristics of a trait ▪ Variation according to context or domain ▪ Discount rate in one domain cannot predict behavior in another domain ▪ Discount rates in different domains do not represent one’s overall discount rate 17 Domain differences in discounting (2) ▪ Pre-defining a domain is difficult ▪ Domains have a common denominator, but exist of fairly different behaviors ▪ Differences within domains? HEALTH 18 Content of this lecture (1) ▪ Time preference Models of discounting Discounting and health behavior Domain differences in discounting 19 Content of this lecture (2) ▪ Time orientation Conceptualization & measurement Time orientation and (health) behavior Domain differences in time orientation Behavior-specific measurement Applications Recommendations for behavior change Real-life choices 20 Time orientation ▪ Time orientation: A general orientation towards either the present or the future van Beek et al. (2017b) ▪ In general: Future orientation → healthy behavior Present orientation → unhealthy behavior 21 Time perspective ▪ Time perspective: The extent to which individuals orient themselves towards the past, the present, and the future ▪ Zimbardo Time Perspective Inventory (ZTPI) – 56 items Past-Negative (PN) Past-Positive (PP) Present-Hedonistic (PH) Present-Fatalistic (PF) Future (F) Zimbardo & Boyd (1999) 22 Consideration of future consequences ▪ Consideration of future consequences: The extent to which individuals consider the potential future outcomes of their current behavior ▪ Consideration of Future Consequences scale – 14 items (CFC scale) CFC-future CFC-immediate Strathman et al. (1994) Joireman et al. (2008, 2012) 23 Predictive capacity different measures ▪ Discount rate, ZTPI, CFC & 2 other measures CFC was the best predictor of smoking, BMI, and physical activity Adams & Nettle (2009) ▪ Discount rate, ZTPI, CFC ZTPI Future was the best predictor Daugherty & Brase (2010) 24 Time orientation and behavior (1) ▪ Future-oriented people: engage more in environmentally-friendly behavior show better academic and job performance, are more effective leaders and procrastinate less engage less in impulsive buying, credit card use and gambling engage less in risky driving and are less aggressive show greater moral concern and ethical behavior 29 Time orientation and behavior (2) ▪ Future-oriented people: engage less in substance use, drink less alcohol and smoke less participate more in preventive health behavior (diabetes screening, vaccinations, sunscreen use) have better sleep habits have a lower body mass index and a better perceived health status eat healthier and exercise more 30 Domain differences in time orientation ▪ Focus on differences within domains instead of between domains ▪ Behavior-specific measurement instead of domain- specific measurement HEALTH 31 Behavior-specific measurement (1) ▪ Time Perspective Questionnaire Diet (TPQ-D) Exercise (TPQ-E) Alcohol consumption (TPQ-A) Smoking (TPQ-S) Hall & Epp (2013) Hall et al. (2012) 32 Behavior-specific measurement (2) ▪ Consideration of Future Consequences scale Consideration of Future Safety Consequences scale Probst et al. (2013) CFC-driving Murphy & Murphy (2018) CFC for health, work, college, environment, money Murphy et al. (2020) CFC-food & CFC-exercise van Beek et al. (2013, 2017a) 33 CFC-food and CFC-exercise ▪ Adaptation of the Consideration of Future Consequences Scale CFC-food: “Often I engage in a particular eating behavior in order to achieve outcomes that may not result for many years.” CFC-exercise: “Often I engage in a particular exercising behavior in order to achieve outcomes that may not result for many years.” ▪ Subscales CFC-future & CFC-immediate 34 Study overview ▪ Study 1 and 2: Do time orientation for food and time orientation for exercise predict eating and exercising behavior? Do CFC-future and CFC-immediate differentially predict eating and exercising behavior? ▪ Study 2: Structure of time orientation van Beek et al. (2013) 35 Your expectations? ▪ A. CFC-future will predict eating behavior, CFC- immediate will predict exercising behavior ▪ B. CFC-future will predict exercising behavior, CFC- immediate will predict eating behavior ▪ C. Both CFC-future and CFC-immediate will predict both eating and exercising behavior 36 Study 1: Method ▪ 55 students (21 male, 34 female), mean age of 21.29 (SD = 2.25) years ▪ CFC-food and CFC-exercise ▪ Self-reported behavior “In general, I eat healthy” “In general, my physical activity is sufficient” ▪ 7-point Likert scale 37 Study 1: Results Eating behavior Exercising behavior B t p B t p CFC-food/F 0.067 0.351.727 -0.250 -0.909.368 CFC-food/I -0.694 -3.315.002 0.031 0.107.915 CFC-exercise/F 0.061 0.355.724 1.125 4.656.000 CFC-exercise/I 0.168 0.920.362 -0.312 -1.226.226 Note. F = CFC-future; I = CFC-immediate. 38 Study 1: Conclusions ▪ CFC-food and CFC-exercise predict corresponding behavior, but do not predict non-corresponding behavior ▪ CFC-future and CFC-immediate differentially predict behavior Eating behavior: Immediate consequences Exercising behavior: Future consequences 39 Study 2: Method ▪ 165 train passengers (98 female, 67 male), mean age of 41.38 (SD = 18.71) years ▪ CFC-food and CFC-exercise ▪ Self-reported behavior 4 additional questions on eating fruits, eating vegetables, being physically active, and exercising 40 Study 2: Results ▪ One-factor model ▪ Two-factor model: CFC-food vs. CFC-exercise ▪ Two-factor model: CFC-future vs. CFC-immediate ▪ Four-factor model: CFC-food/future CFC-food/immediate Best fit with CFC-exercise/future the data CFC-exercise/immediate 41 Study 2: Results CFC-food/ future -0.84 -0.45 Eating -1.42 Four-factor model including eating and CFC-food/ immediate exercising behavior -0.08 1.36 CFC-exercise/ future 0.99 Exercising 1.06 -0.02 CFC-exercise/ immediate 42 Conclusions ▪ CFC-food and CFC-exercise predict corresponding behavior ▪ CFC-food and CFC-exercise are different constructs (even though both belong to the health domain) ▪ CFC-future and CFC-immediate differentially predict eating and exercising behavior 43 Other types of health behavior ▪ Timing of costs and benefits Eating and exercising can also provide current benefits Detective (e.g., diabetes screening) and preventive (e.g., sunscreen use) behavior are accompanied with current costs ▪ Necessity and addictiveness Food vs. alcohol, cigarettes and drugs 44 Predictive capacity ▪ Correlation between CFC-food and healthy eating behavior (no correlation for the original CFC scale) ▪ CFC-food has a larger predictive capacity for healthy eating behavior than the original CFC scale Dassen et al. (2015) ▪ TPQ-Diet and TPQ-Exercise have a larger predictive capacity than the original TPQ Hall & Epp (2013) Hall et al. (2012) 45 CFC-future & CFC-immediate ▪ CFC-future and CFC-immediate both predict eating behavior, but CFC-immediate is the strongest predictor Dassen et al. (2015) van Beek et al. (2016, 2017a) ▪ CFC-future and CFC-immediate both predict exercising behavior, but CFC-future is the strongest predictor van Beek et al. (2017a) 46 Applications ▪ Recommendations for behavior change Ads, health campaigns ▪ Real-life choices/behavior 47 Recommendations for behavior change (1) ▪ Future-oriented individuals were more inclined to engage in cancer screening when this was communicated as having short-term negative, but long-term positive consequences ▪ Present-oriented individuals were more inclined to engage in cancer screening when this was communicated as having long-term negative, but short-term positive consequences Orbell et al. (2004) 48 Recommendations for behavior change (2) ▪ When recommendations for behavior change highlighted proximal (instead of distal) consequences of unhealthy food consumption, present-oriented individuals perceived these messages as more persuasive reported stronger intentions to eat healthy ▪ No differences for future-oriented individuals Kees et al. (2011) 49 Recommendations for behavior change (3) ▪ Lower snack consumption when immediate (instead of future) health consequences were highlighted Pavey & Churchill (2017) 50 “I’ll have the ice cream soon and the vegetables later” (1) ▪ Data of an online supermarket ▪ Delay between completion and delivery of an order 75% of orders are made 1 day in advance 25% of orders are made 2 to 5 days in advance ▪ Relation between delay and the content of an order (e.g., percentage of healthy and unhealthy products) Milkman et al. (2010) 51 “I’ll have the ice cream soon and the vegetables later” (2) ▪ As the delay increases, consumers: spend less -2% ($2.70) for each day of delay order more ‘should’ items (e.g., vegetables) order less ‘want’ items (e.g., ice cream) 52 Advance ordering for healthier eating ▪ Advance lunch orders vs. immediate lunch orders ▪ Study 1: decrease of 38 calories for every hour of delay ▪ Study 2: 5% reduction in calories (marginally significant) ▪ Study 3: 10% reduction in calories VanEpps et al. (2016) 53 Conclusions ▪ Discounting/time orientation are domain-specific/ behavior-specific (instead of general) phenomena ▪ Time orientation is differentially related to health behavior Importance of future and immediate consequences ▪ Applications to recommendations for behavior change and real-life choices 54 Begeleiding BSc scripties ▪ Psychologische en gedragseconomische benadering van gezondheidsgedrag ▪ Tijdsoriëntatie en intertemporele keuzes (heden vs. toekomst) op het gebied van eetgedrag, beweging, of ander gezondheidsgedrag ▪ Toepassen van Construal Level Theory (abstract vs. concreet) of Regulatory Focus Theory (preventie vs. promotie) op gezondheidsgedrag ▪ Gezondheidseffecten (fysiek, mentaal en sociaal) van muziek 55 References (1) Adams, J., & Nettle, D. (2009). Time perspective, personality and smoking, body mass, and physical activity: An empirical study. British Journal of Health Psychology, 14, 83–105. doi:10.1348/135910708X299664 Dassen, F. C., Houben, K., & Jansen, A. (2015). Time orientation and eating behavior: Unhealthy eaters consider immediate consequences, while healthy eaters focus on future health. Appetite, 91, 13–19. doi:10.1016/j.appet.2015.03.020 Daugherty, J. R., & Brase, G. L. (2010). Taking time to be healthy: Predicting health behaviors with delay discounting and time perspective. Personality and Individual Differences, 48, 202–207. doi:10.1016/j.paid.2009.10.007 Hall, P. A., & Epp, L. (2013). Does domain-specific time perspective predict accelerometer assessed physical activity? An examination of ecological moderators. Psychology of Sport and Exercise, 14, 50– 56. doi:10.1016/j.psychsport.2012.07.003 Hall, P. A., Fong, G. T., & Cheng, A. Y. (2012). Time perspective and weight management behaviors in newly diagnosed Type 2 diabetes: A mediational analysis. Journal of Behavioral Medicine, 35, 569–580. doi:10.1007/s10865-011-9389-6 Joireman, J., Balliet, D., Sprott, D., Spangenberg, E., & Schultz, J. (2008). Consideration of future consequences, ego-depletion, and self-control: Support for distinguishing between CFC-Immediate and CFC-Future sub-scales. Personality and Individual Differences, 45, 15–21. doi:10.1016/j.paid.2008.02.011 56 References (2) Joireman, J., Shaffer, M. J., Balliet, D., & Strathman, A. (2012). Promotion orientation explains why future-oriented people exercise and eat healthy: Evidence from the two-factor Consideration of Future Consequences-14 scale. Personality and Social Psychology Bulletin, 38, 1272–1287. doi:10.1177/0146167212449362 Kees, J. (2011). Advertising framing effects and consideration of future consequences. Journal of Consumer Affairs, 45, 7–32. doi:10.1111/j.1745-6606.2010.01190.x Lim, S.-L., & Bruce, A. S. (2015). Can’t wait to lose weight? Characterizing temporal discounting parameters for weight-loss. Appetite, 85, 8–13. doi:10.1016/j.appet.2014.11.001 Milkman, K. L., Rogers, T., & Bazerman, M. H. (2010). I’ll have the ice cream soon and the vegetables later: A study of online grocery purchases and order lead time. Marketing Letters, 21, 17–35. doi:10.1007/s11002-009-9087-0 Murphy, L., & Murphy, G. (2018). Time to drive: Present vs. future orientation and self-reported driving behaviour. Transportation Research Part F: Traffic Psychology and Behaviour, 56, 1–13. Murphy, L., Cadogan, E., & Dockray, S. (2020). The consideration of future consequences: Evidence for domain specificity across five life domains. Personality and Social Psychology Bulletin, 46, 663–678. Orbell, S., Perugini, M., & Rakow, T. (2004). Individual differences in sensitivity to health communications: Consideration of future consequences. Health Psychology, 23, 388–396. doi:10.1037/0278-6133.23.4.388 Pavey, L., & Churchill, S. (2017). Impulsivity and temporal frame: Reducing frequency of snacking by highlighting immediate health benefits. Eating Behaviors, 26, 1–5. doi:10.1016/j.eatbeh.2017.01.004 57 References (3) Strathman, A., Gleicher, F., Boninger, D. S., & Edwards, C. S. (1994). The consideration of future consequences: Weighing immediate and distant outcomes of behavior. Journal of Personality and Social Psychology, 66, 742–752. doi:10.1037/0022-3514.66.4.742 van Beek, J., Antonides, G., & Handgraaf, M. J. J. (2013). Eat now, exercise later: The relation between consideration of immediate and future consequences and healthy behavior. Personality and Individual Differences, 54, 785–791. doi:10.1016/j.paid.2012.12.015 van Beek, J., Handgraaf, M. J. J., & Antonides, G. (2016). Choosing consistently: Intertemporal food choice and construal level. Manuscript in preparation. van Beek, J., Handgraaf, M. J. J., & Antonides, G. (2017a). Time orientation and construal level: Effects on eating and exercising behaviour and preferences. International Journal of Consumer Studies, 41, 54– 60. doi:10.1111/ijcs.12313 van Beek, J., Handgraaf, M. J. J., & Antonides, G. (2017b). Time orientation effects on health behavior. In M. Altman (Ed.), Handbook of behavioural economics and smart decision-making: Rational decision- making within the bounds of reason (pp. 413–428). Cheltenham: Edward Elgar Publishing. VanEpps, E. M., Downs, J. S., & Loewenstein, G. (2016). Advance ordering for healthier eating? Field experiments on the relationship between the meal order–consumption time delay and meal content. Journal of Marketing Research, 53, 369–380. doi:10.1509/jmr.14.0234 Zimbardo, P. G., & Boyd, J. N. (1999). Putting time in perspective: A valid, reliable, individual- differences metric. Journal of Personality and Social Psychology, 77, 1271–1288. doi:10.1037/0022- 3514.77.6.1271 58 Thank you! Tomorrow lecture by Johan van Ophem on patient (consumer) choice in health Thursday lecture by Franziska Klein on healthy cities Friday deadline for registration pair essay 59