Can commitment contracts boost participation in public health programmes?

© 2019 The Author. Commitment devices aim to help people make better choices in the face of their inherent biases: they are voluntary strategies aimed at changing behaviours by introducing costs to your current self, to bring about gains for your future self. Adherence to a structured health intervention is an important part of achieving health goals, and may be improved by commitment devices designed to keep people on track with their health goals. A field experiment set in a public weight management programme tests whether a personal commitment device in the form of a contract with oneself, which relies solely on self-reputation costs, can raise weekly participation and completion of the programme. Results suggest the commitment contract can significantly improve attendance (p = 0.05) and completion rates (p = 0.032), with some suggestive evidence that the contract works especially well for people with more myopic health attitudes. Findings also suggest the commitment contract can substitute for, but does not necessarily add to, wider commitment features in the health programme; raising new questions around threshold effects and the theory underlying commitment devices

The Effects of a Commitment Device on Health Outcomes: Reputational Commitment and Weight Loss in an Online Experiment

This article tests the effectiveness of commitment devices on weight loss. It can be applied as a health ‘nudge' that locks in future behaviours to achieve a desired health outcome, by staking money or reputation on achieving that goal. A field experiment randomly assigned 364 clients of an online weight loss service to either a reputational commitment device or an upfront refund on the monthly fee. The reputational commitment intervention was expected to combat time inconsistency and promote greater weight loss. Weight outcomes were measured at 12 weeks. The results showed that all experimental groups lost weight on average, but the group experiencing the reputational commitment reported end weight outcomes 1.5 kg higher than the comparison group, indicating slower weight loss (± 0.05, effect size -0.32). One possible explanation for the findings is ‘commitment overload'. The study nuances the understanding of commitment devices and how best to deploy them in health programmes including e-heath platforms

The effectiveness of commitment devices: field experiments on health behaviour change

Behavioural public policy, as popularised by the “nudge” agenda, aims to help people make better choices in the face of their inherent biases (Thaler and Sunstein, 2008), including over diet and weight management (Liu et al, 2014). Present bias can lead to time inconsistency: individuals identify an optimal course of action but when the moment comes to take that action they delay or quit, prioritizing present gains at the expense of longer term benefits (O’ Donoghue and Rabin, 1999). Time inconsistency is explained in Thaler and Shefrin’s dual-self model (1981) as the result of an internal tussle between a myopic ‘doer’ and a far-sighted ‘planner’. Commitment devices – voluntary strategies to change future behaviours – can help people stay on track with their goals. Emerging empirical evidence from psychology, medicine, and behavioural economics bears out this prediction for health behaviours (Prestwich et al, 2012; Volpp et al, 2008; Giné et al, 2010), but commitment devices remain relatively under-researched (Perry et al, 2015). The dissertation sets out a fresh analytical framework applying, for the first time, planner-doer theory to health behaviours for weight loss. It also explores how commitment devices might work differently across sub-groups. The empirical strategy, combining quantitative and qualitative methods, centres on two field experiments testing for average and heterogeneous treatment effects of commitment devices on self-monitoring behaviour, participation in a weight loss programme, and weight loss outcomes. Results indicate commitment devices improve health behaviours, but have mixed effects on weight loss: highlighting the potential for commitment overload, and the importance of choosing the right dose of commitment. Qualitative evidence provides fresh insights for planner-doer theory. Differential impacts on sub-groups imply a need for careful targeting and design of commitment devices. The dissertation concludes there is scope for commitment devices to play an effective role in behaviour change programmes

Recent developments in Behavioural Public Policy: IBPPC 2022

Editorial

Human leukocyte antigen supertype matching after myeloablative hematopoietic cell transplantation with 7/8 matched unrelated donor allografts: a report from the Center for International Blood and Marrow Transplant Research

The diversity of the human leukocyte antigen (HLA) class I and II alleles can be simplified by consolidating them into fewer supertypes based on functional or predicted structural similarities in epitope-binding grooves of HLA molecules. We studied the impact of matched and mismatched HLA-A (265 versus 429), -B (230 versus 92), -C (365 versus 349), and -DRB1 (153 versus 51) supertypes on clinical outcomes of 1934 patients with acute leukemias or myelodysplasia/myeloproliferative disorders. All patients were reported to the Center for International Blood and Marrow Transplant Research following single-allele mismatched unrelated donor myeloablative conditioning hematopoietic cell transplantation. Single mismatched alleles were categorized into six HLA-A (A01, A01A03, A01A24, A02, A03, A24), six HLA-B (B07, B08, B27, B44, B58, B62), two HLA-C (C1, C2), and five HLA-DRB1 (DR1, DR3, DR4, DR5, DR9) supertypes. Supertype B mismatch was associated with increased risk of grade II-IV acute graft-versus-host disease (hazard ratio =1.78, P=0.0025) compared to supertype B match. Supertype B07-B44 mismatch was associated with a higher incidence of both grade II-IV (hazard ratio=3.11, P=0.002) and III-IV (hazard ratio=3.15, P=0.01) acute graft-versus-host disease. No significant associations were detected between supertype-matched versus -mismatched groups at other HLA loci. These data suggest that avoiding HLA-B supertype mismatches can mitigate the risk of grade II-IV acute graft-versus-host disease in 7/8-mismatched unrelated donor hematopoietic cell transplantation when multiple HLA-B supertype-matched donors are available. Future studies are needed to define the mechanisms by which supertype mismatching affects outcomes after alternative donor hematopoietic cell transplantation

Antioxidant Protects against Increases in Low Molecular Weight Hyaluronan and Inflammation in Asphyxiated Newborn Pigs Resuscitated with 100% Oxygen

BACKGROUND: Newborn resuscitation with 100% oxygen is associated with oxidative-nitrative stresses and inflammation. The mechanisms are unclear. Hyaluronan (HA) is fragmented to low molecular weight (LMW) by oxidative-nitrative stresses and can promote inflammation. We examined the effects of 100% oxygen resuscitation and treatment with the antioxidant, N-acetylcysteine (NAC), on lung 3-nitrotyrosine (3-NT), LMW HA, inflammation, TNFα and IL1ß in a newborn pig model of resuscitation. METHODS & PRINCIPAL FINDINGS: Newborn pigs (n = 40) were subjected to severe asphyxia, followed by 30 min ventilation with either 21% or 100% oxygen, and were observed for the subsequent 150 minutes in 21% oxygen. One 100% oxygen group was treated with NAC. Serum, bronchoalveolar lavage (BAL), lung sections, and lung tissue were obtained. Asphyxia resulted in profound hypoxia, hypercarbia and metabolic acidosis. In controls, HA staining was in airway subepithelial matrix and no 3-NT staining was seen. At the end of asphyxia, lavage HA decreased, whereas serum HA increased. At 150 minutes after resuscitation, exposure to 100% oxygen was associated with significantly higher BAL HA, increased 3NT staining, and increased fragmentation of lung HA. Lung neutrophil and macrophage contents, and serum TNFα and IL1ß were higher in animals with LMW than those with HMW HA in the lung. Treatment of 100% oxygen animals with NAC blocked nitrative stress, preserved HMW HA, and decreased inflammation. In vitro, peroxynitrite was able to fragment HA, and macrophages stimulated with LMW HA increased TNFα and IL1ß expression. CONCLUSIONS & SIGNIFICANCE: Compared to 21%, resuscitation with 100% oxygen resulted in increased peroxynitrite, fragmentation of HA, inflammation, as well as TNFα and IL1ß expression. Antioxidant treatment prevented the expression of peroxynitrite, the degradation of HA, and also blocked increases in inflammation and inflammatory cytokines. These findings provide insight into potential mechanisms by which exposure to hyperoxia results in systemic inflammation

LeishVet update and recommendations on feline leishmaniosis

Limited data is available on feline leishmaniosis (FeL) caused by Leishmania infantum worldwide. The LeishVet group presents in this report a review of the current knowledge on FeL, the epidemiological role of the cat in L. infantum infection, clinical manifestations, and recommendations on diagnosis, treatment and monitoring, prognosis and prevention of infection, in order to standardize the management of this disease in cats. The consensus of opinions and recommendations was formulated by combining a comprehensive review of evidence-based studies and case reports, clinical experience and critical consensus discussions. While subclinical feline infections are common in areas endemic for canine leishmaniosis, clinical illness due to L. infantum in cats is rare. The prevalence rates of feline infection with L. infantum in serological or molecular-based surveys range from 0 % to more than 60 %. Cats are able to infect sand flies and, therefore, they may act as a secondary reservoir, with dogs being the primary natural reservoir. The most common clinical signs and clinicopathological abnormalities compatible with FeL include lymph node enlargement and skin lesions such as ulcerative, exfoliative, crusting or nodular dermatitis (mainly on the head or distal limbs), ocular lesions (mainly uveitis), feline chronic gingivostomatitis syndrome, mucocutaneous ulcerative or nodular lesions, hypergammaglobulinaemia and mild normocytic normochromic anaemia. Clinical illness is frequently associated with impaired immunocompetence, as in case of retroviral coinfections or immunosuppressive therapy. Diagnosis is based on serology, polymerase chain reaction (PCR), cytology, histology, immunohistochemistry (IHC) or culture. If serological testing is negative or low positive in a cat with clinical signs compatible with FeL, the diagnosis of leishmaniosis should not be excluded and additional diagnostic methods (cytology, histology with IHC, PCR, culture) should be employed. The most common treatment used is allopurinol. Meglumine antimoniate has been administered in very few reported cases. Both drugs are administered alone and most cats recover clinically after therapy. Follow-up of treated cats with routine laboratory tests, serology and PCR is essential for prevention of clinical relapses. Specific preventative measures for this infection in cats are currently not available