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Theresa Marteau University of Cambridge Catalina August 2017 Changing Environments for Healthy Habits: Uncertainties and Challenges
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%
ChangingEnvironmentsforHealthyHabits
I. TheProblem
II. ChangingBehaviouri. changingminds(targetingconsciousprocesses)ii. changingenvironments(targetingnon-conscious
processes)
III. ChangingEnvironmentstoChangeBehaviouri. uncertaintiesii. challenges
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
Size
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
ChangingEnvironmentsforHealthyHabits
I. TheProblem
II. ChangingBehaviouri. changingminds(targetingconsciousprocesses)ii. changingenvironments(targetingnon-conscious
processes
III. ChangingEnvironmentstoChangeBehaviouri. uncertaintiesii. challenges
#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
ChangingEnvironmentsforHealthyHabits
I. TheProblem
II. ChangingBehaviouri. changingminds(targetingconsciousprocesses)ii. changingenvironments(targetingnon-conscious
processes
III. ChangingEnvironmentstoChangeBehaviouri. uncertaintiesii. challenges
#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
ChangingEnvironmentsforHealthyHabits
I. TheProblemFoursetsofbehaviour,sociallypatterned=mostprematuredeathsII. ChangingBehaviour
i. changingminds(targetingconsciousprocesses)atbest=small,unscaleable effects
i. changingenvironments(targetingnon-consciousprocesses)promising
III. ChangingEnvironmentstoChangeBehaviouri. uncertaintiescuestotargetforgreatestenduringchangeii. challengeslegislatingforenvironmentsforhealthyhabits
