The Influence of Poverty and Culture on the Transmission of Parasitic Infections in Rural Nicaraguan Villages

Intestinal parasitic infections cause one of the largest global burdens of disease. To identify possible areas for interventions, a structured questionnaire addressing knowledge, attitude, and practice regarding parasitic infections as well as the less studied role of culture and resource availability was presented to mothers of school-age children in rural communities around San Juan del Sur, Nicaragua. We determined that access to resources influenced knowledge, attitude, and behaviors that may be relevant to transmission of parasitic infections. For example, having access to a clinic and prior knowledge about parasites was positively correlated with the practice of having fencing for animals, having fewer barefoot children, and treating children for parasites. We also found that cultural beliefs may contribute to parasitic transmission. Manifestations of machismo culture and faith in traditional medicines conflicted with healthy practices. We identified significant cultural myths that prevented healthy behaviors, including the beliefs that cutting a child’s nails can cause tetanus and that showering after a hot day caused sickness. The use of traditional medicine was positively correlated with the belief in these cultural myths. Our study demonstrates that the traditional knowledge, attitude, and practice model could benefit from including components that examine resource availability and culture

Savings, subgoals, and reference points

Decision makers often save money for a specific goal by forgoing discretionary consumption and instead putting the money toward the savings goal. We hypothesized that reference points can be exploited to enhance this type of saving. In two hypothetical scenario studies, subjects made judgments of their likelihood to forgo a small expenditure in order to put the money toward the savings goal. In Experiment 1, judgments were higher if the savings goal was presented as composed of weekly subgoals (e.g., save $60 per week to buy a$180 iPod). Experiment 2 replicated this finding and demonstrated that the subgoal manipulation increased judgments of likelihood to save money only when the money saved from the foregone consumption would allow the decision maker to meet the weekly subgoal exactly (not under or overshoot it). These results suggest a reference point mechanism and point to ways that behavioral decision research can be harnessed to improve economic behaviors

Goals and Social Comparisons Promote Walking Behavior

The effectiveness of a pedometer intervention was affected by manipulating the goals given to participants and by providing social comparison feedback about how participants’ performance compared with others. In study 1 (n = 148), university staff members received a low, medium, or high walking goal (10%, 50%, or 100% increase over baseline walking). Participants walked 1358 more steps per day (95% confidence interval [CI], 729, 1985), when receiving a high goal than when receiving a medium goal, but a medium goal did not increase walking relative to a low goal (554 more steps; 95% CI, –71,1179). In study 2 (n = 64), participants received individual feedback only or individual plus social comparison feedback. Participants walked 1120 more steps per day (95% CI, 538, 1703) when receiving social comparison feedback than when receiving only individual feedback. Goals and the performance of others act as reference points and influence the effect that pedometer feedback has on walking behavior, illustrating the applicability of the principles of behavioral economics and social psychology to the design of health behavior interventions

Grouping Promotes Equality: The Effect of Recipient Grouping on Allocation of Limited Medical Resources

Decisions about allocation of scarce resources, such as transplant organs, often entail a trade-off between efficiency (i.e., maximizing the total benefit) and fairness (i.e., dividing resources equally). In three studies, we used a hypothetical scenario for transplant-organ allocation to examine allocation to groups versus individuals. Study 1 demonstrated that allocation to individuals is more efficient than allocation to groups. Study 2 identified a factor that triggers the use of fairness over efficiency: presenting the beneficiaries as one arbitrary group rather than two. Specifically, when beneficiaries were presented as one group, policymakers tended to allocate resources efficiently, maximizing total benefit. However, when beneficiaries were divided into two arbitrary groups (by hospital name), policymakers divided resources more equally across the groups, sacrificing efficiency. Study 3 replicated this effect using a redundant attribute (prognosis) to create groups and found evidence for a mediator of the grouping effect—the use of individualizing information to rationalize a more equitable allocation decision

The format in which uncertainty information is presented affects decision biases

ABSTRACT-We examined how the format in which uncertainty information is presented affects two biases in humans' choice behavior. In a computer task, participants were given four common-ratio effect and four commonconsequence effect problems in each of four different formats. In these problems, uncertainty information was described, as percentages (e.g., 80%) or as frequencies (e.g., 16/20), or was experienced, either serially (20 outcomes shown one at a time) or simultaneously (20 outcomes all shown at once). Presenting information as percentages attenuated the common-ratio effect and augmented the common-consequence effect, which suggests that these biases have different underlying mechanisms. Participants' percentage estimates of outcome likelihoods did not differ according to the format in which the information was presented; however, participants' nonverbal estimates of outcome likelihoods differed across formats. The results suggest that uncertainty information presented as percentages is processed differently than the same uncertainty information presented in other formats. The world is predictable, but only probabilistically so. Choices rarely lead to certain outcomes, and an important part of an organism's life involves assessing an option when multiple outcomes are possible. Foraging animals must allocate time across locations, even though there is no guarantee that any one location will provide sustenance at any given time. People must choose which route is likely to be fastest, which course of action is most likely to provide relief from back pain, and which job will provide the best balance of money, security, and enjoyment. In all these choices, there is an element of uncertainty as to which particular outcome will occur, and how this uncertainty is represented and processed determines the choices organisms make. In studies of decision making under uncertainty in humans, people receive information about the value of an outcome and its likelihood of occurrence before being asked to make a decision based on that information. Typically, information is given in a summarized form that includes probabilities and payouts (e.g., ''Lottery A pays 5 with a probability of .75''), and less frequently information is presented as frequencies or in graphical form (E.U. Weber, Humans exhibit decision-making biases in which their choices are inconsistent with normative principles. One might wonder whether such decision biases reflect the functioning of core cognitive mechanisms that are likely present across species or rather result from the use of the more recently developed and uniquely human capacity to represent probabilistic information in symbolic form. This article focuses on how two decisionmaking biases, the common-ratio effect and the common-consequence effect, are influenced by the format in which uncertainty information is presented. Consider the following choice: Low-risk, high-probability option: 100% chance of 3,000 High-risk, high-probability option: 80% chance of $4,00

Social contacts, vaccination decisions and influenza in Japan.

BACKGROUND: Contact patterns and vaccination decisions are fundamental to transmission dynamics of infectious diseases. We report on age-specific contact patterns in Japan and their effect on influenza vaccination behaviour. METHODS: Japanese adults (N=3146) were surveyed in Spring 2011 to assess the number of their social contacts within a 24 h period, defined as face-to-face conversations within 2 m, and gain insight into their influenza-related behaviour. We analysed the duration and location of contacts according to age. Additionally, we analysed the probability of vaccination and influenza infection in relation to the number of contacts controlling for individual's characteristics. RESULTS: The mean and median reported numbers of daily contacts were 15.3 and 12.0, respectively. School-aged children and young adults reported the greatest number of daily contacts, and individuals had the most contacts with those in the same age group. The age-specific contact patterns were different between men and women, and differed between weekdays and weekends. Children had fewer contacts between the same age groups during weekends than during weekdays, due to reduced contacts at school. The probability of vaccination increased with the number of contacts, controlling for age and household size. Influenza infection among unvaccinated individuals was higher than for those vaccinated, and increased with the number of contacts. CONCLUSIONS: Contact patterns in Japan are age and gender specific. These contact patterns, as well as their interplay with vaccination decisions and infection risks, can help inform the parameterisation of mathematical models of disease transmission and the design of public health policies, to control disease transmission

Smoking, Cardiac Symptoms, and an Emergency Care Visit: A Mixed Methods Exploration of Cognitive and Emotional Reactions

Emergency departments and hospitals are being urged to implement onsite interventions to promote smoking cessation, yet little is known about the theoretical underpinnings of behavior change after a healthcare visit. This observational pilot study evaluated three factors that may predict smoking cessation after an acute health emergency: perceived illness severity, event-related emotions, and causal attribution. Fifty smokers who presented to a hospital because of suspected cardiac symptoms were interviewed, either in the emergency department (ED) or, for those who were admitted, on the cardiac inpatient units. Their data were analyzed using both qualitative and quantitative methodologies to capture the individual, first-hand experience and to evaluate trends over the illness chronology. Reported perceptions of the event during semistructured interview varied widely and related to the individual's intentions regarding smoking cessation. No significant differences were found between those interviewed in the ED versus the inpatient unit. Although the typical profile was characterized by a peak in perceived illness severity and negative emotions at the time the patient presented in the ED, considerable pattern variation occurred. Our results suggest that future studies of eventrelated perceptions and emotional reactions should consider using multi-item and multidimensional assessment methods rated serially over the event chronology

A 680,000-person megastudy of nudges to encourage vaccination in pharmacies

Encouraging vaccination is a pressing policy problem. To assess whether text-based reminders can encourage pharmacy vaccination and what kinds of messages work best, we conducted a megastudy. We randomly assigned 689,693 Walmart pharmacy patients to receive one of 22 different text reminders using a variety of different behavioral science principles to nudge flu vaccination or to a business-as-usual control condition that received no messages. We found that the reminder texts that we tested increased pharmacy vaccination rates by an average of 2.0 percentage points, or 6.8%, over a 3-mo follow-up period. The most-effective messages reminded patients that a flu shot was waiting for them and delivered reminders on multiple days. The top-performing intervention included two texts delivered 3 d apart and communicated to patients that a vaccine was “waiting for you.” Neither experts nor lay people anticipated that this would be the best-performing treatment, underscoring the value of simultaneously testing many different nudges in a highly powered megastudy

The dynamics of risk perceptions and precautionary behavior in response to 2009 (H1N1) pandemic influenza

<p>Abstract</p> <p>Background</p> <p>The trajectory of an infectious disease outbreak is affected by the behavior of individuals, and the behavior is often related to individuals' risk perception. We assessed temporal changes and geographical differences in risk perceptions and precautionary behaviors in response to H1N1 influenza.</p> <p>Methods</p> <p>1,290 US adults completed an online survey on risk perceptions, interests in pharmaceutical interventions (preventive intervention and curative intervention), and engagement in precautionary activities (information seeking activities and taking quarantine measures) in response to H1N1 influenza between April 28 and May 27 2009. Associations of risk perceptions and precautionary behaviors with respondents' sex, age, and household size were analyzed. Linear and quadratic time trends were assessed by regression analyses. Geographic differences in risk perception and precautionary behaviors were evaluated. Predictors of willingness to take pharmaceutical intervention were analyzed.</p> <p>Results</p> <p>Respondents from larger households reported stronger interest in taking medications and engaged in more precautionary activities, as would be normatively predicted. Perceived risk increased over time, whereas interest in pharmaceutical preventive interventions and the engagement in some precautionary activities decreased over time. Respondents who live in states with higher H1N1 incidence per population perceived a higher likelihood of influenza infection, but did not express greater interests in pharmaceutical interventions, nor did they engage in a higher degree of precautionary activities. Perceived likelihood of influenza infection, willingness to take medications and engagement in information seeking activities were higher for women than men.</p> <p>Conclusions</p> <p>Perceived risk of infection and precautionary behavior can be dynamic in time, and differ by demographic characteristics and geographical locations. These patterns will likely influence the effectiveness of disease control measures.</p