changing environments for healthy habits: uncertainties

TheresaMarteauUniversityofCambridge

CatalinaAugust2017

ChangingEnvironmentsforHealthyHabits:UncertaintiesandChallenges

ChangingEnvironmentsforHealthyHabits

I. TheProblem

II. ChangingBehaviouri. changingminds(targetingconsciousprocesses)ii. changingenvironments(targetingnon-conscious

processes)

III. ChangingEnvironmentstoChangeBehaviouri. uncertaintiesii. challenges

TheProblem=OurUnhealthyBehaviour

Ø 63%prematuredeathsworldwideCancerCardiovasculardiseaseDiabetes

Ø Eliminatingthesewouldprevent:75%ofDiabetesandCardiovasculardisease40%ofCancersANDreducehealthinequalitiesbyabout50%

OurUnhealthyBehaviour intheUK – intheUSA

17% smoke15%

25% drinkatharmfullevels23%

65% overweightorobese74%

95% inactive 80%


I. TheProblem


processes)


RiskInformation:NotPersonalised

RiskInformation:Personalised

RiskInformation:Personalised

From18studies...Communicatinggenetic-baseddiseaserisksdoesnotchangebehaviour toreducetheserisks

Hollands,French,Griffin,Prevost,Sutton,King,MarteauBMJ 2016

Doesthisriskinformationchangeourbehaviour?

FourReviews…..I. Anydisease- Geneticbiomarkers

HollandsetalBMJ2016

II. Cardiovasculardisease- AnybiomarkerUsher-SmithetalBMJOpen2015

III. Cancer- AnybiomarkerUsher-Smithetalunderreview

IV. Anydisease- AnybiomarkerFrenchetalAnnBehav Med2017

LittleorNoBehaviour Change

TargetingConsciousProcessesPersonalised RiskInformation

Whydoesn’triskinformation(always)changeourbehaviour?

Lesseffective Information MoreeffectiveInformation

PerceptionofThreatNotbigenough

BehaviourEvenifmotivatedtochangeEnvironmentshaveastronginfluenceonmuchofourbehaviour

KeepinMind

Essentially,allmodelsarewrongbutsomeareuseful

GeorgeBox 1989

Non-consciousFastFeelingHabits

ConsciousSlowThinkingGoal-directed

behaviour

behaviour

DualProcessModelsofBehaviour

EnvironmentalCues

Strack &DeutschPers Soc PsychRev2004

Bari&RobbinsProg inNeurobiology2013

Changingbehaviour:Twobroadapproaches

ResistEnvironments ChangingEnvironments

TargetingConsciousProcessesto…. TargetingNon-ConsciousProcessesby…

Environmentalcuesshapingourbehaviour withoutawareness

Socialjudgements&warmthofdrink

Voting&ballotorder

Winebuying&music

Properties ofobjectsorstimuli

SIZE

PRESENTATION

FUNCTIONALITY

INFORMATION

Placement ofobjectsorstimuli

AVAILABILITY

POSITION

CuesinEnvironmentsShapingBehaviour

HollandsetalBMCPublicHealth2013HollandsetalNatureHumanBehaviour 2017

CuesinEnvironmentsShapingBehaviour

….toreduceconsumptionofFood,AlcoholandTobacco

Size1993 36g=85calories

2013 40g=95calories

Eatingasandwichforluncheverydayin2013is7,300caloriesmoreeachyearthanin1993

PlateSize

19608.5inch

199010inch

200011inch

201012inch

Size:SystematicReviewAimToestimatetheimpactofdifferentportion,packageortablewaresizesonselectionorconsumptionof:

food alcohol tobacco

72studies 69 0 3

Size:EffectonFoodConsumption

Thelargertheportion,packageortableware,themorepeopleeat….

..regardlessofbodyweightorgender…..

….whichmeans....

Hollands,Shemilt,Marteau,Jebb,Lewis,Wei,Higgins,Ogilvie 2015

Size:EffectonFoodConsumption

Makingsizessmallerforall foodsandtablewareonalloccasionscouldreduceenergyconsumedbyupto:

• 16%inUKadults=

• 29%inUSadults=

279 caloriesaday

527caloriesaday

Sizecueshowmuchwetakeo Packsize:larger=takemoreo Tableware:larger=servemore

Capacity

Perception

Sizecueshow weeatordrinko Smallportions&tableware=smallerbites&sips

HowdoesSizecueConsumption?

Delboeuf illusion

PortionSizeEffect:BottomlesssoupbowlexperimentsEvidence=largelyoutsideofawareness

RefilledvsNormalbowls• Ate73%moresoup

(14.7vs.8.4ozs)• Perceivedatesame

(5.4vs.5.4ozs)• Ratedfullnesssame

(5.1vs.5.7)

Wansink,Painter&NorthObesityResearch2005

SizeandAlcohol

SizeofwineglassesinEngland1700- 2017

2017

Zupan,Evans,Couturier,Marteauunderreview

WineGlassSize:ImpactonConsumption

Bar&RestaurantinCambridge“PintShop”CommonServingsizes

175ml750ml(bottle)

Seriesof2weekperiodsalternatingglasssizes

A StandardglassesB LargerglassesC Smallerglasses

Larger Standard Smaller

Pechey,Couturier,Hollands,Mantzari,Munafo,MarteauBMCPublicHealth2016

WineGlassSize:ImpactonConsumption

Bar&RestaurantinCambridge“PintShop”

Larger Standard Smaller

Pechey,Couturier,Hollands,Mantzari,Munafo,MarteauBMCPublicHealth2016

Winesales14%higherwhen175mlservedinLargerglasses

“Asyouwouldimagine,we’vestartedusingthelargerglasses,whichIknowwasn’tthereasonbehindthestudyfromCambridgeUniversity’spointofview.”

JamesHickey,PintShop

Non-consciousFastFeelingHabits

ConsciousSlowThinkingGoal-directed

behaviour

behaviour

InternalandExternalInfluencesonourBehaviour

EnvironmentalCues


I. TheProblem


processes


#1Uncertainty

CuestoTargetforGreatestEnduringBehaviour Change

CuestoTargetforGreatestEnduringBehaviourChangei.e.healthyhabits?

I. BuildingtheEvidenceBaseonPhysicalEnvironmentsi. Field&LabExperimentsii. Evidencesynthesis

II. IntegratingEvidenceusingaComplexSystemsPerspectivei. Cuesfromthemultipleenvironmentsweinhabit-

Ø physical,digital,economic,cultural,socialandmanymoreii. Actingsinglyandincombinationiii. Evaluatedwithoutassumptionsofsimplelinearcausalrelationships

ComplexSystems:e.g.ObesitySystemInfluenceDiagram

ObesityUKForesightReport2007


I. TheProblem


processes


#1Challenge

ChangingCuesinOurEnvironments

OurEnvironments

PublicSector PrivateSector

LevelsofInterventio

nEliminateChoice

RestrictChoice

Policyoptionsforchangingbehaviour

Taxation Effective

Acceptable

Diepeveen,Ling,Suhrcke,Roland,Marteau,BMCPublicHealth,2013

ChangeDefaults

ProvideServices

ProvideInformation

AcceptabilityofInterventionstoreduceconsumptionofsugarydrinks

0

10

20

30

40

50

60

70

80

90

100

Size Shape Location Taxation Education

Acceptab

le%

Petrescu,Hollands,Couturier,andMarteauPLoS One 2016

PredictorsofAcceptability

o PerceivedEffectiveness

o PerceivedFairness

o Environmentscauseobesity

IndustryResponsestoInterventionstoReduceConsumption

PredictorsofAcceptability

o PerceivedEffectiveness

o PerceivedFairness

o Environmentscauseobesity


I. TheProblemFoursetsofbehaviour,sociallypatterned=mostprematuredeathsII. ChangingBehaviour

i. changingminds(targetingconsciousprocesses)atbest=small,unscaleable effects

i. changingenvironments(targetingnon-consciousprocesses)promising

III. ChangingEnvironmentstoChangeBehaviouri. uncertaintiescuestotargetforgreatestenduringchangeii. challengeslegislatingforenvironmentsforhealthyhabits

TeamScience

[email protected]@MarteauTM @BHRUCambridge

changing environments for healthy habits: uncertainties

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