544 Matching Annotations
  1. Jul 2025
    1. tastes and preferences formed at this early age are likely to have repercussions throughout life.

      This is why tests on children are so interesting to me, as they provide raw insights to how people are or how they will be with much lower risk of worrying about inaccurate self reports

    2. Children who had received tangible rewards consumed more of the vegetable than all other groups; they liked the vegetable equally well as other exposure groups, and more than the control group.

      Similar effect as the gym goers

    3. incentivized college students for gym attendance and found students who had received contingent incentives attended the gym more frequently than the control group after incentives were removed.

      I feel like the trend will be contingent and continued activities such as going to the gym will yield higher results of the opposite effect because people will notice they feel better and want to continue doing it rather than one time behaviors that people could just see as "getting it over with"

    4. Few studies have examined the impact of rewarding health behavior change with a specific focus on their potential to undermine intrinsic motivation.

      Some of the studies we have looked at already have inadvertently done this and could be used as an example in this article if they needed more evidence

    5. “crowd in,” or increase, intrinsic motivation

      Not wanting to let others down and potentially increasing performance, a great example of social facilitation

    6. In a within-subject design, Frey and Oberholzer-Ghee (1997) found acceptance of the siting of a nuclear waste repository close by dropped from about 50% to about 25% when financial compensation was offered.

      Similar to vaccination rates dropping in some cases when compensation was offered

    7. Laboratory studies often use economic games that require some cooperation between parties

      More evidence that humans are often motivated by not wanting to let down others or be ostracized and have an internal need to feel accepted by their peers

    8. Cognitive evaluation theory (CET; Deci & Ryan, 1985) predicts that rewards only reduce intrinsic motivation when they are perceived as controlling the behavior, and might actually enhance intrinsic motivation if they engender feelings of competence.

      Humans like to feel as though they are in control of themselves and do things on their own accord, a big reason to why many people in the other studies rejected the incentives from my point of view

    9. Of particular relevance to the question of crowding out in health contexts is that the rewards have no undermining or even a positive effect on “dull,” “boring,” “uninteresting” tasks, that is, tasks for which initial intrinsic motivation is low, operationalized by low initial task activity.

      Interesting result that shows rewards arent everything to most level headed people, and many people do what they want because they truly enjoy it

    10. These meta-analyses come to different conclusions, either that the undermining effect of tangible external rewards on intrinsic motivation is pervasive

      I dont know that testing children at such a young age would actually yield very good results since their intrinsic motivation levels seem like they would be much lower than that of an older child

    11. 50% of nursery schoolchildren who showed the highest initial spontaneous interest in a new drawing opportunity

      Testing nursery age children is an interesting way to conduct this since they act more on instincts and dont usually have a good sense of patience yet

    12. Both studies found that behavior levels were lower in the group that had previously been rewarded.

      Instant gratification is a dangerous thing built into all humans and is what can cause addictions such as drug use and screen usage

    13. Policymakers are increasingly interested in the potential of financial incentives to change individual behavior to achieve health-related outcomes, including smoking cessation, weight loss, attendance for disease screening, undergoing vaccination,

      The article that covered policymakers in England stated that they werent very interested in incentives because of the worry it would undermine intrinsic motivation and cause gaming of the system, the very thing this article covers

    14. When Do Financial Incentives Reduce Intrinsic Motivation? Comparing Behaviors Studied in Psychological and Economic Literatures

      As I have done with the other articles, since there is a lot of repetitive information from similar pieces, I will highlight any information that has been similarly referenced in other literatures in other articles I have already annotated

    15. who benefits from the behavior (the individual or others)

      This is interesting phrasing since I dont think there is an example of the only beneficiary being other people in any of these behaviors

    16. These include smoking cessation, weight loss, physical activity, medication adherence, vaccination, screening

      These are almost the exact same behaviors studied in other articles we have read so it will be interesting to see how similar the results are to the other articles

    17. undermining intrinsic motivation and the economic literature around motivation crowding out.

      I would think that the incentive would either definitely undermine intrinsic motivation and cause people to practice the healthy behavior just for the money (which is still good because they are being healthier either way) or have the opposite effect with people refusing the incentive and wanting to do it without feeling like they are only doing it for the money and wanting to uphold their values. There doesnt seem to be very much middle ground in this scenario

    18. Parke, Ashcroft, Brown, Marteau, & Seale, 2011; Promberger, Brown, Ashcroft, & Marteau, 2011

      Another potential source we could review to compare results to those we already knew

    19. The existing evidence does not warrant a priori predictions that an undermining effect would be found for health-related behaviors.

      If this is true and people really are motivated to be better rather than being motivated solely by the incentive, then this could be very promising evidence for the continued usage of incentives for increasing healthy behaviors

    20. In the psychological literature, we find strong evidence for an undermining effect of tangible rewards on intrinsic motivation for simple tasks when motivation manifest in behavior is initially high.

      This keeps in line with the previous fears presented in other articles

    1. Pay-for-performance (P4P) where providersreceive financial incentives to carry out specific care orimprove clinical outcome

      This is risky because it could lead to providers issuing unnecessary tests and care procedures just to hit their mark

    2. incentives are also frequently used to target pro-vider behavior as a means to improve quality of care

      None of the articles we used looked at healthcare providers opinions on incentives, this is something we could try to explore

    3. Employers canimprove the effectiveness of such programs by incorpor-ating the behavioral economics principles discussed inthis article

      With the insurance system and how corporations operate in America, I doubt many places would do things like this

    4. ‘if you vaccinate your child, we will enter your nameinto a lottery, and you just might win a lot of money’

      I feel like with how divisive and political the issue of vaccination has become, this would not work in changing the mind of those who are anti vax and could honestly have the opposite effect than intended

    5. The reasons for this unexpected resultwere not clear,

      It could be because the participants felt as though they were being manipulated, or that they would be looked on as lesser for needing to take money in order to do something to help themselves.

    6. There is also evidence that the publicsupports incentive schemes that are cost-effective

      We saw from other articles that not everyone is in support of this if it means adding money to their own insurance costs

    7. fferingpeople a reward/incentive helps them to align their ac-tions with such preferences.

      It aligns their actions, but how indicative of their true motivations are their actions when they are doing it for money?

    8. Financial incentives are increasingly seen as animportant vehicle to bring about changes in behaviorthat lead to healthier lifestyles and supporters and criticsalike can be passionate about their use

      Based on some of the articles already annotated, the reaction to incentives are much more mixed than this and actually might be seen as a negative by most of the population

    9. It has been demonstrated that the immediacy of anincentive can influence outcome of voucher-based incen-tive programmes for substance misuse

      Drug addicts are perhaps the greatest example of valuing instant gratification more than anything else, so this makes sense

    10. Although the ten-dency to overweight the probability of unlikely but sali-ent outcomes can lead to problem gambling [44], it canalso be used to positive effect using lottery based publicpolicy interventions

      Taking advantage of the addictive parts of gambling doesnt necessarily seem like the best idea, since problem gambling has been shown to have other unrelated negative side effects such as mental health issues

    11. This approach resulted in in-creases in math test scores for the loss condition

      This is a good example of what I was talking about earlier since it showcases that humans love instant gratification, as well as reinforcing what the article discusses about loss aversion

    12. it may be more ef-fective to provide £100 at the end of the programme,with all missed sessions attracting a more salient andpainful £10 loss.

      I dont actually know that this would work as much because the effects wouldnt hit people until the very end. Humans are very driven by instant gratification if they can help it, so providing them with 10$ at the end of each week while not giving them it at the end of the week if they dont hit the goal would probably work better, in my opinion.

    13. but inducing somefeeling of loss if they fail to do something may be moremotivating than rewarding them by the same amount.

      There was ethical concerns regarding using this tactic on more vulnerable groups in a previous article

    14. The finding being thatsmall changes in context (nudges) can affect behavior asmuch as large price changes

      This is a good comparison to show that though money is a very strong influence on behavior, the things around you and situations you are in will influence you more because it makes you think about how you will be perceived by those around you

    15. The reward may be given for attendingclasses and it could be given at the beginning of theprogramme, at its completion or in increasing or decreasingincrements as classes are attended. Alternatively, the incen-tive could be given dependent on actual weight loss targetsthat result from following the programme.

      I would be interested in seeing which one yields higher results. I would assume the goal based system rather than just attending the classes would work best because it tracks actual progress

    16. In a series of school based randomized trials, incen-tives were only found to be effective when they were givenfor inputs to the educational production function.

      This could also be due to the fact that college kids often dont have a lot of income, and it is more likely to work on lower income individuals

    17. Changing health behaviors using financialincentives: a review from behavioraleconomics

      Some of the things stated in this article are very similar to findings already detailed in articles I have already annotated, so I will highlight things that are similar to things already covered

    18. Schedules ofcontingent reinforcement are also a key to the success ofrewards (materialised incentives) and often used in behav-ioral psychology circles.

      This can also be what reinforces bad behavior and causes people to start practicing a bad habit only to take themselves off of it in order to game the system

    19. Incontrast to economic models of rational choice suggest-ing that we respond to information and price signals,insights from across the behavioral sciences suggest thathuman behavior is actually influenced greatly by thecontext or environment within which many of our deci-sions are taken.

      This is what is interesting to me, since money seems to warp rational decisionmaking and increase chances of making quick decisions

    20. ‘Give It Up For Baby’ programme in Tayside, Scotland toencourage pregnant smokers to quit the habi

      As I mentioned in different articles, the fact that we have had to set up programs to stop people from ruining their childs health before theyre even born is a true testament to the stranglehold addiction can have on humans, and also one of the more controversial incentives in terms of the argument that it reinforces bad behavior

    21. ash or alternativelyvouchers that can then be exchanged for desirable items.

      We know from previous articles that cash generally works better than vouchers, but maybe this article will provide a different result

    22. 0% of prematuredeaths in the developed world are attributable tounhealthy behaviors, such as smoking, poor diet andsedentary lifestyle

      Truly unfortunate that 40% of deaths are from almost completely preventable behaviors

    23. Behavioral economics

      This is not a term I had heard of before this paper, but this seems very interesting to me because money is one of the biggest driving factors in changing the way people think and influencing their behavior, so this is something I might look into more after reading this

  2. Jun 2025
    1. Group-based incentives were considered as useful in fostering peer support, but there was also a concern that this could lead to some individuals being alienated.

      that could work, as peer influence and the human urge to fit in with others could be enough to keep everyone else in line if they knew everyone else was depending on them

    2. There was also a view that vouchers would encourage recipients to “save up” rewards to purchase a larger item, rather than “fritter away” small amounts of cash.

      i get not wanting them to buy cigarettes or other harmful things, but why would they care about saving up vs spending right away? the point of the study is to get them to practice the healthy behavior, as long as they are doing that and not actively harming themselves in other ways, who cares what they do with the money?

    3. This was mainly because they felt rewards provided a positive recognition of the effort made by individuals attempting behaviour change.

      i believe there is evidence that suggests positive reinforcement is the best thing to encourage change in a persons life

    4. HPFI may generate a “culture of entitlement” encouraging a belief that healthy behaviours should be instantly rewarding, and that HPFI discriminate against those who already pursue healthy behaviours.

      in a way this is similar to the modern parenting techniques that arent healthy, as it can be seen as the same thing as a parent giving their child an iPad when they are fussing and using it to calm them down

    5. vouchers were perceived to be more acceptable to other stakeholders and so preferable.

      obviously they are going to be more preferable since they objectively have a lower value, but you should be doing whatever is best for the public, even if it means taking a slightly worse deal on your end

    6. you’d like to think that adults could be better educated earlier on in say the schooling years to become aware of healthier options, healthier choices.

      I can attest from my years of schooling that were taking place during this study that they are attempting to do this with things such as the DARE program and fitness tests in elementary schools, but the UK could be different

    7. HPFI were identified as a “sticking plaster”, rather than a longer term solution.

      True, but it should allow enough time for policymakers to work on a long term solution. Health of the public is literally these peoples specialty, anything that improves their health even for the time being long enough to figure something out should be taken advantage of

    8. This led to discussions about whether health behaviours could ever be monitored well enough to ensure that all gaming was identified.

      watching the behaviors would mean a lot of micromanaging and a lot of people needed to check on every individual person, which could run up costs and deter many from wanting to encourage these programs

    9. ‘snowballing’ – that is, asking recruited participants to suggest others who met the inclusion criteria and might be interested in taking part in the research.

      snowballing can create a large amount of bias, but when the search is limited to English policymakers, it limits the possibility of bias since the number of people able to participate in the study isnt very large in the first place

    10. May-July 2015

      10 years is a long time, generally with health related things I personally am more apprehensive to trust things from so long ago, especially when it is possible that these policymakers could have retired by now or had their opinions changed by the pandemic or other external factors

    11. Non-systematic reviews have reported that HPFI are more effective for ‘one off’ behaviours such as attending for screening and vaccination, than more complex behaviours such as smoking cessation

      this would make sense since humans are naturally lazy and want to do as little as possible, which is normal, so it would be expected that they would more often go for the one time measures rather than the prolonged measures. the complex behavior discussed is also intertwined with addiction, which is a problem that requires much more than just financial incentive to stop in most cases

    12. Background

      after reading these sections, they discuss a lot of the same things previously annotated, so to avoid repeating myself over and over, I wont have as many notes on this section as normal

    13. potential ‘gaming’

      this seems to be the main concern for a lot of policymakers as they see so many people game things and work around their policies on technicalities that they are more cautious about such things, especially when they dont stand to actually benefit themselves from them in most cases

    14. Firstly, a tension between wanting to trust individuals and promote responsibility; and distrust around the potential for ‘gaming the system’.

      this would be my main tension as well

    15. address the underlying causes of unhealthy behaviours.

      it sounds like their main worry is people not doing it for their own betterment, but only doing it for the money, which could lead to people faking or even creating their own problems just to reap the rewards of "improving" their health thereafter, which is a valid criticism

    16. England

      Another article I annotated brought another thing to my attention to keep in mind that could affect the policymaking, and thats the fact that places in these studies such as the UK have universal healthcare. This could affect the policy decisions in ways that we dont see in the USA and is something to keep in mind with these studies

    17. We are not aware of any previous work that has focused particularly on the views of public health policymakers.

      Focusing on the policymakers decisionmaking instead of the people benefitting from the policies themselves is an interesting new way to look at things and provides new perspective on how these policies will affect everyone involved

    1. The scenarios we used can be seen as less controversial than some settings for incentives aimed at recipients of healthcare that are currently used or considered, such as paying for testing, paying for immunisation, or paying for adherence to a medication regimen with possible side effects.

      the reality is, when youre incentivizing any behavior in this context, it will always be controversial on some level

    2. At the other extreme, opposition to ‘rewarding bad behaviour’ might translate into the very tangible consequence of corroding the goodwill, and eroding the good behaviour, of those not rewarded for their virtue.

      I can agree with this, but it does get to a certain point such as paying women not to smoke during pregnancy that the rewards simply shouldnt be doled out for doing something they should never be considering doing in the first place

    3. As noted above, rejection of incentives may be based on beliefs about effectiveness or about unintended consequences, beliefs that can be challenged by evidence.

      evidence such as articles we have annotated for this project already

    4. For example, although we had instructed participants to assume that all interventions were equally effective in improving outcomes, it is possible that participants did not accept this assumption, resulting in perceived differences in effectiveness explaining differences in perceived acceptability.

      this is a good thing to acknowledge, since bias is impossible to completely eliminate, and people who know those who have been impacted by smoking are likely to have different views than those who dont

    5. Concerning the nature of the incentive, it is possible that incentives that are less exchangeable (eg, vouchers or vouchers prespecified only for exchange of goods related to improved health) may be more acceptable.

      This does seem to be true in theory, however, we know from other studies done for this project that vouchers are far less effective than money

    6. It may stem from a violation of a cultural norm, namely the use of money in the relationship between a doctor or healthcare provider and a patient.

      I think this would be the root of the problem, as well as money causing a lot of people to be greedy. Money is not unlimited, and when so many people join a program to gain money for losing weight and you cannot pay everyone, then the program becomes ineffective and people get upset because you cannot pay everyone

    7. Given equal effectiveness, financial incentives, whether rewards or penalties, are judged as less acceptable than medical interventions.

      In line with the predictions from earlier

    8. Participants from both countries favoured rewards over penalties in the contexts of helping patients who are overweight lose weight and of outpatient services for patients with mental health issues.

      I expected this for mental health but not for weight loss. Sure there are people with medical conditions that cannot help it, but a lot of the time, they are perceived as being able to help themselves, so I would have expected the rewards to not be favored in this scenario.

    9. Financial incentives were perceived by UK and US participants as less fair than medical interventions.

      This is in line with the predictions I had too, many people would want to tackle the root of the problem and actually help rather than use money as a motivator

    10. Table 1

      The prediction of some illnesses drawing more sympathy than others seems to be true and in line with what I predicted would happen, but the US seems to have a generally more negative tone than the UK in terms of doing things to help others across the board, which is the opposite of what I thought would happen.

    11. As predicted, a weekly injection was judged to be less pleasant (UK: M=−1.23, SD=1.33; US: M=−1.10, SD=1.50) than a weekly pill (UK: M=0.69, SD=1.49; t(87)=−11.07; p<0.001; US: M=0.72, SD=1.44; t(99)=−10.41; p<0.001), and a penalty was judged as less pleasant (UK: M=−1.82, SD=1.31; US: M=−2.07, SD=1.43) than a reward (UK: M=2.18, SD=1.25; t(87)=−17.59; p<0.001; US: M=2.06, SD=1.47; t(99)=−17.76; p<0.001).

      this also lines up with what I thought, though the reaction to the pill seems to be a bit more positive than I thought, but that could just be because its in junction with the injection

    12. Imagine your country has a national health insurance programme.

      I didnt even consider the fact that the different healthcare programs could change the outcome from the UK to the US. Universal healthcare vs privatized healthcare might make it more likely that the US would favor incentives because they are so used to having to pay more for medical treatments so they have higher sympathy for the people suffering from illnesses.

    13. 18 and 81 years

      I would predict the older people to favor penalties more while the younger people favor incentives more based on different upbringings and economic views. I also would predict that the older crowd has different views on things such as smoking and mental illness as they grew up in a time period where these things were either very common or brushed off as nothing, respectively.

    14. 1200 participants

      I dont know that this would be enough people for the test to be fully representative of the population, as I have to imagine there are far more people who fulfill each of the criteria mentioned in the US and UK

    15. smoking cessation, mental illness, drug addiction, weight loss, physical therapy

      smoking, drug addiction, and weight loss would be my prediction for those where the penalties would be favored. Mental illness and physical therapy would favor the incentives

    16. More specifically, we predicted that penalties would be favoured over rewards when recipients were deemed responsible for their condition, and vice versa.

      This is what I would predict, too. The subjects would have more sympathy for the people who cannot help it, but want to penalize those who got themselves into their own situation

    17. Introduction

      This introduction says a lot of the same stuff as a lot of the other articles previously looked at. Not necessarily bad or useless information, but I dont have a lot of notes to make because I have already made them on other annotations

    18. for smoking cessation in pregnancy.1 7

      As I mentioned before in another annotation, there shouldnt need to be a program for this. This is where I would agree with the many detractors that say we shouldnt incentivize bad behavior

    19. These results reveal a striking similarity in negative attitudes towards the use of financial incentives, rewards as well as penalties

      No matter the context, people are almost always against using incentives for others, a trend that follows from other studies

    20. Overall, participants supported funding more strongly for interventions when they judged members of the target group to be less responsible for their condition, and vice versa.

      Does this mean they support funding more strongly for financial incentives when people are more responsible for their condition? If so, that seems backwards and like it contradicts a lot of previous studies done on this matter that say people dont want to incentivize bad behavior

    1. Third, we find that both financial subsidies and exercise nudges encouraging active commuting are likely to be ineffective in polluted contexts.

      a good example of the risk averse behaviors discussed earlier

    2. citizens may not have adequate scientific knowledge to precisely compare health impacts across two dimensions

      however, most have access to articles such as this one that detail the comparison of effects, they just choose not to

    3. Second, our results suggest that people may overestimate the health risks of air pollution as compared to the health benefits of physical activity

      this is expected, since humans are so loss averse, naturally and selfishly wanting to preserve our own health from getting worse rather than actively making it better, causing us to exaggerate the bad effects of low air quality and brush off the benefits of active commuting

    4. In developing country cities, ambient pollution levels are much higher than in Europe or the US and non-transportation sources

      its interesting to see china classified as a developing country because of their large population and technological advancement compared to the West in many ways, but the heavy reliance on unhealthy factories places them far behind the rest of the world, with that same population slowing them down in terms of development

    5. Our results indicate that if people are informed about their personalized pollution exposure risk by commuting modes, active commuting would further decrease by 8.4 percentage points, while automobile commuting increases by 14.7 percentage points, creating a double challenge to both public health and pollution mitigation.

      the unfortunate truth is that, in a city and country so reliant on factories and industries, there isnt really a correct answer for improving personal health on this level. You basically have a choice between commuting via car or public transport and further polluting the air with the gasoline burned by the engine, or walking/cycling and further exposing yourself to the pollutants produced by the very factory you are commuting to at a detriment to your personal health. This study provides an interesting look in self preservation of health vs environmental preservation.

    6. yet had much smaller and insignificant effect under polluted day for people with all commuting times

      however, this is a good example of how the effects of the pollution on the body can counteract the benefits of exercise

    7. Similarly, our exercise nudge, informing participants about calorie burnt and expected weight losses, successfully increased active commuting by 9.7% points

      people naturally look for motivation for reasons to do things that require more effort, and there are few motivators better than telling people how much better they would make themselves. It instills confidence in them and makes them think about how they are currently perceived by others and if the strategy in question would improve their social standing, one of the most powerful things you can appeal to in psychology

    8. Financial incentives such as taxes and subsidies are common policies to encourage active commute and have been extensively studied

      Incentivizing people to walk and decrease pollution when the clear cause of a majority of the pollution issues is the factories they are walking to is a pretty bad misuse of funds in my opinion. Focus those funds on finding a cleaner energy source

    9. Encouraging active commuting has been an important policy target to promote physical and psychological health

      Many cities in Europe already do this, but it is less straightforward for such an industrial country like China where the factories pollute the air and potentially offset the health benefits that walking or biking brings to the average commuter

    10. Figure 3.

      Its interesting to see that a clean day doesnt yield a higher number of active commuters, but I suppose it makes sense that so many people would choose not to walk to work if the average commute is 5 miles. Other than that, its interesting to note that pollution doesnt really make a difference in the amount of people that active commute, as well as noticing the effect that being informed about the pollution statistics has on people since it seems like they try to correct themselves by trying to choose cleaner options rather than the public transit. However, most of these people ended up choosing automobiles, which actually worsens the issue by making more people driving cars and polluting the air rather than piling so many people into one like in a bus or subway.

    11. The average home-job walking distance is 7.92 km

      this is nearly 5 miles, which is honestly incredible that the average commuter walks that far to work every single day. this would take the average person well over an hour

    12. Our final sample contained 2285 non-automobile commuters, of whom approximately 20% typically commute using active modes

      similarly to the previous point, i dont know that this number would be anywhere near the 30% rule based on the sheer amount of people in the city that could satisfy this threshold

    13. We visited 95 local companies

      with how many companies there are in a huge country such as China, this may not be sufficiently representative of the population regardless of how many sectors they cover.

    14. Zhengzhou local government has made extensive efforts to combat air pollution, with a strong emphasis on active travel.

      while it is good to see that the local government cares and is trying to help, simply emphasizing active travel rather than placing restrictions on factories or trying to research cleaner ways to make their products makes it seem like they could be doing more.

    15. to what extend

      any spelling mistake in a supposedly scholarly article makes me slightly skeptical as to the credibility of the work, but this seems to be good so far

    16. motor vehicles are favored for the protection they provide against pollution exposure.

      how much do they truly protect from exposure vs create a bigger issue?

    17. Both observational studies (Flint et al 2014, Flint and Cummins 2016) and randomized controlled trials (RCTs) (Møller et al 2011, Quist et al 2018) have demonstrated the effectiveness of active commuting (i.e. walking and biking) on promoting desirable health outcomes

      this sets the stage for an interesting article topic: weighing the benefits and risks of being more healthy by being more physically active while also decreasing health by inhaling pollutants in the air.

    18. accompanied by a 14.7 percentage points (95% CI: 10.7, 18.3) increase in automobile commuting

      again, its interesting that people are sort of forced to do this to avoid adverse health risks of simply being outside since it creates even more pollution in the city

    19. indoor commuting modes on polluted days

      its interesting that a city can be so polluted that it has designated polluted days that cause their workers to work from home instead of risk exposure to horrendous air quality, a testament to the sheer difference in industrialization between countries. The US is a very industrialized company, but as far as I know, it has never been that bad in a city before.

    20. Yet, in polluted regions, it can also cause additional health risks by increasing riders' pollution exposure and raising their inhalation rate.

      This creates an interesting paradox, because since the factories pollute the city so much, people choose not to walk to work, increasing the pollution by means of an increase of people taking the bus or driving instead.

    1. Most participants did not support any smoking cessation treatment options.

      i wonder if this would be different nowadays with the advent of e cigarettes and so many more ways to consume smoking products. cigarette use itself may have declined, but without looking at data, i feel like general smoking rates have generally stayed the same

    2. 46% with a household income below $40,000.

      a lot of these studies focus very heavily on low income households, which is an interesting yet sometimes morally questionable way to obtain results

    3. 18% current smokers

      i feel like there could have been a larger portion of smokers in this study, 1 in 5 seems low when you are offering the smokers the incentive to do so. I feel like it would be more conducive to convincing results if they put more of an emphasis on smokers

    4. Participants indicated whether they would support a $25 increase in their annual health insurance premium to pay for the treatment

      interesting way of testing how much people truly support the end of smoking in the USA. There will likely be lots of people unwilling to do this because it isnt affecting them, but there is also lots of people who see smoking as a true evil who would be willing to do this in order to keep the air cleaner and work towards completely eliminating smoking

    1. In a cross-sectional sample, it is difficult to know if these differences reflect cohort effects or true age effects.

      i think age probably has a factor, but i dont know that gender does. It would make sense because different ages would have different upbringings and views towards money based on the financial climate they came up in, but i dont think that gender would have so much of an effect because money seems to affect genders the same regardless since it appeals equally to everyone

    2. Respondents may feel that there is less debate over the benefits of smoking cessation[62] and regular physical activity than attending for screening or vaccination

      this is a good way of summarizing what i was trying to say earlier. since there really is no benefit to these behaviors, it would just be trying to give them a lecture they have presumably heard many times before and will only criticize them, so they wont be as likely to take too kindly to it.

    3. face-to-face discussions with written information

      this is a very important part of the information because having information explained to you will resonate harder than just reading it

    4. However, one study found incentives for smoking cessation in pregnancy

      Having to incentivize not smoking during pregnancy is a really unfortunate thing and could be where I start to agree with the people that dont want to reward bad behavior even if it gets them to be healthier overall

    5. incentivised behaviours become less attractive.

      the idea that doing the behaviors only because of the incentives could be perceived as bad from those around you is a factor to keep in mind and could be why most people liked no incentive, as the driving force for humans remains their outward perception and how others think of them. People want to be accepted at all costs, and if there is more people worried about how them getting the incentive would look rather than prioritizing the healthy behavior, then the lower choice of the incentive would make sense.

    6. There is some evidence that UK respondents feel it is ‘unfair’ to be encouraged to take up a healthy behaviour in return for an incentive that you are not certain of receiving.[26]

      i dont understand this mindset, whats the downside? you practice a healthy behavior either way, why not take the chance that you might get something from it?

    7. The strong negative preference for lottery-type incentives is interesting given how common these are in research settings, particularly in the USA, and in Quit & Win contests.

      one possible cause that i would think relates to this is the relatively higher level of education in the people surveyed. Anyone is susceptible to liking gambling, but generally, higher educated people stay away from it because they better understand the odds are stacked against them

    8. Alternatively, it is possible, although unconfirmed, that social desirability bias operates in some research settings such that people feel it would be ‘improper’ or ‘greedy’ to endorse financial incentives in face to face settings.

      i guess this is why most people actually preferred no incentive. they dont want to feel like inactive behavior is rewarded, but it still is interesting to see that people would turn down the free incentive rather than just accepting what is offered

    9. One previous DCE found that acceptability of financial incentives increased as stated effectiveness increased.

      a good showcase of how framing can skew results

    10. it is not clear that respondents’ preferences stated during an on-line survey reflect their true preferences if faced with similar choices in real life.

      this is because with issues such as health and how productive you feel, people are more inclined to lie to make themselves seem healthier and feel better about themselves rather than telling the truth. Even though the survey is online and totally anonymous, people have a natural fear of being judged and often lie to improve their own self confidence.

    11. Participants were less likely to be at the extremes of age; were more educated; less likely to currently, or have ever, smoked; and less likely to be regularly physically active than the population as a whole.

      this is maybe because these factors are generally the minority of the population; more and more people are educated nowadays, smoking is at lower levels than in the past, etc.

    12. have resulted in very low response rates—which are leads to limited representativeness.

      its better to get more responses that limit the representability than it is to get less responses that are more representative because its easier to build with more responses as long as youre careful with the generalizations and representability. it allows for better, more careful examination

    13. Men were more likely than women to prefer any incentive to none, face-to-face discussions alongside incentives for some behaviours, and incentives targeted at those living in low-income households.

      In my experience, these would be my answers as well except for the targeted at low income households, since I think it should be available to everyone

    14. In general, younger people were more likely than older people to prefer any financial incentive to none

      younger people are usually more in need of money to stabilize themselves than older people, so that tracks

    15. but not for smoking and physical activity

      This is very interesting to me. Smokers and people who dont work out regularly dont like being told to change their lifestyle if it means they have to do something consistently rather than a 1 time thing. This is a great showcase of how a lot of people are usually too lazy to bring themselves to get better, even when they know what they have to do. Its a testament to the human nature of wanting to exert as little effort as possible, even if it truly hurts you

    16. Participants preferred financial incentives available to everyone rather than those targeted only at pregnant women or people living in low-income households.

      this makes sense, people should want more accessibility, not less

    17. However, there was a consistent preference for no financial incentive compared to a lottery ticket incentive.

      this is promising and shows that not everyone has a strong preference to gambling and the addictive tendencies it comes with

    18. A small number of participants consistently chose the ‘routine practice’ option over either of the financial incentive scenarios.

      This is promising and shows that not everyone is always motivated only by money

    19. There was a universal, and strong, preference for incentives offered to all eligible individuals, rather than those targeted at individuals living in low income households or pregnant women.

      this would make sense, but i still dont understand why the lower incentive would be preferred to the higher incentive

    20. Respondents preferred that incentives were not accompanied by written information for physical activity and smoking;

      this could be due to the bombardment of information making them feel like they are being shamed by the surveyors and overloaded with information

    21. However, there were no statistically significant differences in preferences for shopping voucher rewards compared to no rewards for all behaviours, and for cash rewards compared to no rewards for all behaviours except vaccination.

      no different between no reward and shopping voucher does not surprise me, but no difference between cash to no rewards does surprise me. cash is normally one of the strongest factors in influencing behavior, so i would think the reward probably was not high enough to convince people to leave their house and go to the doctor for whatever reason

    22. Compared to the UK adult population, participants were more likely to be aged 30–79 years, had a higher educational attainment, were less likely to be current or ex-smokers, and less likely to be regularly physically active

      If their emphasis was still on pregnant women and lower income households, this shouldn't affect the results too heavily. Being less physically active also could help the results since they are less likely to practice the healthy behaviors mentioned earlier

    23. A total of 356 individuals completed the DCE and were included in the analysis—more than twice as many as indicated by our sample size calculation.

      Certainly a strong enough sample size to draw conclusions from, could also depend on how much of each demographic were surveyed.

    24. Box 1. Data analysis

      statistics is not my strong suit, but this model seems like it does a good job of providing an objective way to look at subjective data.

    25. participants received small (£2; ~$US3) shopping voucher incentives to take part.

      This seems like too low of an offer to seem truly enticing to anyone, and I dont know that the responses would be convincing enough to confidently say that the vouchers caused the participation

    26. Each choice set of experimental scenarios was combined with a third scenario including no incentive but both written information and an opportunity for a face-to-face discussion on the benefits of healthy behaviours and strategies for performing them

      This is a great way to compare how people actually change based on getting through to them versus just changing what they are doing solely for monetary reasons, and it would be interesting to see it performed on the same group that is offered the incentives, though there would be issues with doing this

    27. Finally, various potentially vulnerable groups—particularly pregnant women and people living in low income households—have been identified in both qualitative and quantitative work in whom financial incentives may be considered more acceptable.

      Like I was stating earlier, the ethical concerns honestly come into play for me more than anything here, so I am surprised by their quote stating they may be considered more acceptable. While yes, you're offering them money and the chance to be more healthy and improve their lives, it can also feel somewhat dystopian and like you're using the economical disparities between yourself and the subject as a way of treating them only as a test subject of sorts. Though I personally don't agree with this and see the merit of performing the experiment this way, this idea is the one that I understand the most if it were to make people unhappy with the experiment

    28. e also included one very large incentive value (£1000; ~$US1540) to capture if people could be ‘bought’ into a behaviour at all or if even large amounts would not be effective in motivating a behaviour change.

      This is where I could see the morality concerns coming into play, since using large sums of money to change people's decisions (especially when theres an emphasis on pregnant women and low income residents) could be dangerous. It also likely wouldnt be very effective in changing the way of thinking of the people it is offered to since they would be more likely to do it solely motivated by the money and not because the behavior is better for them.

    29. smoking cessation, regular physical activity, attending a primary care provider for disease screening, and attending a primary care provider for adult vaccination.

      It's good to pick all easily preventable bad habits to avoid preying on people who genuinely can't help it, as well as being a good opportunity to showcase the effects that addiction can have on the general population.

    30. In the context of a publically funded healthcare system, such as the UK, where any large scale financial incentive programme is likely to be publically funded, wider acceptability of financial incentives to the general public as a whole, and not just potential recipients, is also important.

      This is an interesting thing to explore and see if acceptability varies based on countries and country policy towards healthcare, since a privatized healthcare system such as the USA is less likely to offer incentives, which can lead to unhealthier populations overall. However, is disparities in health due to differences in healthcare programs and their offerings, or is does one country simply seem unhealthier than the other because of the much larger population in the USA that gives more available examples when you think of health in said country?

    31. perception that they reward ‘bad’ behaviour, are socially divisive and ineffective, and that they are too easy for participants to manipulate or ‘game’

      This is a valid viewpoint as it could be seen as another way for lazy, unhealthy people to profit off of their bad habits, but at the end of the day, taking the vaccine is better than not taking it regardless of the method

    32. there are concerns that financial incentives remain unacceptable to the public

      This doesn't make sense to me. Why would people oppose it? If they can't be motivated by themselves to do it and wont change their ways on their own, is there really that big of an issue with incentivizing it? Obviously you would want them to change without intervention, but if they really are not willing to do anything without incentive, whats the issue with offering a small one? The alternative is people not being as healthy and spreading deadly diseases more frequently, which seems to be much worse than paying people to take vaccines.

    33. On-line, websites such as www.stickk.com allow users to incentivise themselves to achieve almost anything, including their health behaviour goals.

      This is what I mean; there are plenty of encouraging websites, apps, and other programs that encourage people to be better along with the entirety of google available to look up healthy habits, eating programs, exercises, and much more, yet people still need to be convinced with money over everything.

    34. One method of encouraging healthier behaviours, that has received significant recent attention, is personal financial incentives.

      On one hand, its good that people are trying to be healthier no matter what, but on the other hand, it is very concerning and telling of modern standards that financial incentives is the only way to encourage them to do so

    35. Cash or shopping voucher incentives were preferred as much as, or more than, no incentive in all cases.

      This makes sense but obviously isn't groundbreaking or anything, of course people would be more motivated to do something when theres a prize in it for them

    36. There is concern that financial incentives may be unacceptable to the public

      The only concerns I can think of would be morality concerns with specific people, but I fail to see how it would be any different than offering any other kind of reward

    37. but many people find it difficult to perform these behaviours.

      In my opinion, this is where a lot of issues nowadays arise. With modern technology, people have access to any information they want, including how to live a life as healthy as possible, yet that same technology often makes them too lazy to act on these things.

    1. One year after the campaign the difference in percentage points for HPV vaccination initiation between intervention and control groups varied between 18.5 % (z = 3.65, p = 0.0002) and 5.1 % (z = 1.12, p = 0.26).

      i would expect that the age groups specified would mean the incentives worked better on the older kids than the younger kids

    2. The personal information campaign significantly increased vaccination initiation, with older girls reacting faster.

      this is interesting and a good argument for the fact that a lot of teenagers value what others are doing and what they think of themselves over money at that stage in their life. An incentive would help, but if an ad targets them and says this vaccine will help improve their health and make them look and feel better, they might be more inclined to take it for that reason

    3. aged 12–18

      focus on this age might give inaccurate results about the intention of the vaccine because these children are almost never the ones deciding to get the vaccine, they just do as their parents say, so this study could just be a reflection of the parents

    1. perhaps offering $100 for the first injection and $200 for the second if completed within the recommended time frame would be a good starting place

      upping the amount for the second dose is a great way to ensure people come back to be fully vaccinated, and making the second dose such a great deal more than the other is phenomenal framing of the reward. It could be interesting to see how different amounts offered at each dosage would affect the amount of people that come back for the second dose, such as $50 and $250, etc.

    2. The extant literature would suggest that the $1,000-$1,500 incentives proposed by Delaney, Yang, and others would likely be highly effective, but also perhaps unnecessarily excessive

      this was supported by the other studies that proved 25$ to be effective on certain populations

    3. Financial incentives, perhaps targeted at disadvantaged populations, in combination with the type of naturalistic incentives discussed by Loewenstein and Cryder (2020), may be a prudent course to take.

      this is especially true because statistically, economically disadvantaged populations have an increased risk factor to fall victim to drug addiction as well

    4. it too is extensive dating back to the 1970s and consistently positive

      this could be interesting to see how the offers of incentive amount change throughout the decades and how much more positive or negative the general response became

    5. Importantly, the efficacy of modest financial incentives for improving vaccine adherence described above is consistent with a considerably larger body of evidence supporting their efficacy in promoting abstinence from addictive drug use (Davis et al., 2016) and weight loss

      it would be interesting to see a comparison of what motivates people more: financial gain or self improvement

    6. Yet that is the group in which there is the greatest amount of sound scientific evidence that modest financial incentives can indeed enhance vaccine adherence.

      this could be due to them having more addictive personality types due to the way their brain is wired with their reward system

    7. making air travel or access to large public events contingent on evidence of being vaccinated

      they did this with international flights as i remember needing a vaccine card to leave the country, but implementing this domestically is where many citizens start to get apprehensive about it and whether or not it infringes on their rights

    8. U.S. Presidential candidates John Delaney and Andrew Yang have recommended offering a $1,500 stimulus check for being vaccinated while economists Robert Litan and N. Gregory Mankiw have opined that an incentive of at least $1,000 would be necessary

      this is a large jump from the minimum of 25$ that the previous studies used and proved effective, how could they have overestimated the amount necessary by so much?

    9. vaccines requiring multiple injections separated in time

      this is probably one of the biggest and most overlooked factors from a passing glance; so many people just decide not to get the vaccine because they cant be bothered to show up at a clinic more than once for an appointment

    10. Additionally, to achieve heard immunity, infectious disease policy experts estimate that between 70-90% of the population will need to be inoculated (McNeil Jr, 2020,

      with a nation so divided essentially 50/50 on every important issue, this mark seems nearly insurmountable to reach

    11. Financial incentives were most effective resulting in a 7-fold increase in adherence to the vaccination regimen relative to no financial incentives

      being as this now provides evidence that it can work with the influenza vaccine as well as another vaccine, this adds another layer of credibility to saying with more confidence that it would work for COVID as well. However it is important to keep in mind that COVID is a much bigger political and social issue than either of the other 2, which skews the publics view of it and usually drives people to extremes: wanting to get it, or wanting to stay away from it, with few divided people in the middle. This is a large factor that can change the outcome of the study

    12. There is a body of controlled trials on incentivizing vaccine adherence, mostly to the hepatitis B virus (HBV) vaccine among injection drug users (IDUs)

      this could provide different insight compared to the other studies which seem to compare it only to the influenza vaccine

    13. COVID-19 vaccination efforts are underway offering hope for saving lives and eliminating the pandemic.

      this study is from April 2021, right when the first wave of vaccines were widely distributed, so the information regarding reactions to the vaccine should be extremely relevant

    1. Second, many of the efforts that have proved popular in the past and in other contexts, including small financial incentives, are unlikely to convince a substantial share of the COVID-19 vaccine hesitant to get vaccinated.

      when an issue is as highly publicized and scrutinized as COVID was, it will be harder to convince them to do something that they hear so many conflicting viewpoints about in the media, so this makes sense

    2. Second, given subjects were recruited from a single public Medicaid managed care plan and a single state, our findings may not generalize beyond our subject population.

      it would be interesting to see how this would vary in different states with different dominant political ideologies, as that seemed to be a driving factor in what could affect intake and/or intention

    3. participants had to have internet access and either an email account or mobile phone capable of receiving text messages.

      This is likely to be a problem since the survey is centered around low income households, but since technology is so dominant nowadays, more and more households have this technology regardless of income so it may not be as big of a roadblock as it was in previous years

    4. we found the link between an individual’s COVID-19 vaccination intention and actual vaccination status appears weak.

      it makes me think about why some people could be pro all vaccinations other than the COVID vaccine; how is it any different?

    5. However, we do find suggestive evidence that negatively framed public health messages delivered by a gender discordant messenger reduce vaccinations for some groups, especially for men, Latinos, and adults under age 40.

      these demographics being men could be due to a subconscious superiority complex that a lot of men seem to have over women, though it surprises me that adults under 40 have this outcome since this belief is generally more old fashioned and found in older generations rather than younger

    6. Although some public health messages increased vaccination intentions, none of the interventions meaningfully changed COVID-19 vaccination rates among the vaccine hesitant.

      This is interesting and provides the idea that incentives lead to increase in intake and no effect or decrease in intention, while the opposite happens for messages.

    7. Results

      There was not conclusive evidence to suggest that the videos increased vaccination rates, but many studies did show an increase in vaccination rate individually. . For participants aged 40 and over and/or Republican, however, the rate decreased. Gender concordant video watchers increased vaccination rates, while gender discordant video watchers decreased vaccination rates. Different races, genders, and framing of the message had varying effects on intake and were generally positive with some exceptions, but these exceptions were mitigated by a gender concordant presenter. As for vaccine intention, there was a significant increase following the videos. Regardless of race, gender, or demographic, the negatively framed messages increased the intention much more than positively framed messages.

    8. Vaccination intentions increased by 5.5 percentage points (p = 0.002) in response to the safety videos and 8.6 percentage points (p < 0.001) in response to the health consequences videos

      This is more or less what i expected, people respond stronger to fear

    9. For respondents who indicated they supported Trump, the $50 incentive decreased vaccination rates by 4.2 percentage points (p = 0.047).

      this is what i would have expected as Republicans tend to be more skeptical about vaccines, from what I have noticed, and the offering of an incentive isnt likely to change their mind. They are usually more apprehensive about government involvement in things, from what I have noticed in my experience.

    10. Interventions

      After reading, this seems to be a very well thought out and strong plan that should produce conclusive evidence if everything is conducted as described

    11. One of the messages highlighted the safety of the COVID-19 vaccines (“safety” message)

      this may not work as well since many people are naturally skeptical, especially in a time as tumultuous as the pandemic, and they would likely be more inclined to trust the news sources they follow rather than this message.

    12. The first message, which we refer to as the “emotion” video, focused on getting back to normal was a publicly available video from the California Department of Public Health (CDPH message)

      nostalgia is a very, very powerful thing, even if it is for things as simple as not wearing a mask in public anymore or not having to sit further away from people in public. reminding people of what they once had and making them want to go back to the way things were can be a very effective strategy for advertisers, and this is no different. I would expect this would work decently well.

    13. focused on the negative health consequences of remaining unvaccinated (“consequences” message).

      in my limited experience and education with psychology, it seems that people usually respond more to negative messages such as this one because they are more focused on loss prevention than anything else. I would predict that this message would work the best since fear can be a very effective motivator, especially in a time with so many unknowns.

    14. By design, our study focused on individuals who had delayed vaccination despite weeks of eligibility and ample supply of vaccine.

      this increases the chances that you will find someone that is on the fence and needs convincing, a solid way to achieve the target demographic

    15. Financial incentives [19], default appointment scheduling [20], implementation prompts [21] and reminder messages [22], [23], [24], [25], [26] all increase influenza vaccinations.

      The fact that it works for the flu and not for COVID is pretty solid evidence that a lot of the issue is a political and social dispute

    16. lotteries with grand prizes of $1 million or more

      Just like the last study, this being so effective makes me want to learn more about why humans are so drawn in by the concept of a lottery compared to guaranteed money.

    17. mistrust of government

      this is unfortunately more of a driving factor than anything with vaccine hesitancy, in my opinion. From what I see, vaccines are turned into a political argument because specific people in power do not trust them for some reason. This makes the population of people who have aligning viewpoints to these people in other subjects also blindly trust them on this subject without doing any sort of research on their own time from the FDA or CDC.

    18. knowledge gaps about vaccine safety and effectiveness,

      lots of people claim this but often are just too lazy to do their own research with trusted sources that have devoted years of research to this

    19. California, where our trial took place, offered free transportation to vaccination sites, home vaccinations and multi-lingual materials about COVID-19 vaccinations

      Making the vaccine accessible for anyone so that they dont have to go out of their way to get it could hypothetically be better for increasing intake than offering incentives in some cases

    20. Despite ample supply of COVID-19 vaccines and strong evidence that vaccines protect against severe disease and death [1], many Americans remained unvaccinated more than nine months after FDA approval

      A lot of this stems from media and political bias that people usually choose to believe without doing their own research or using faulty sources for their research

    21. While messages increased vaccination intentions, none of the interventions increased vaccination rates.

      interesting that this has the opposite effect of the first study, but it makes more sense that a message from medical professionals would increase vaccine intentions. I am curious why this wouldnt help with the vaccine intake rates, however.

    22. Medicaid managed care

      Medicaid is based largely on income, so the participants in this study will most likely be from lower income houses, and therefore more likely to be persuaded easier with an incentive

    23. In mid-2021, months after vaccines were widely available, we evaluated vaccination intentions and vaccine uptake using a randomized control trial.

      Extremely relevant data, since this would be taken during the height of the skepticism towards the vaccine right when it was released.

    24. COVID-19 vaccinations in the United States stalled within a few months of widespread rollout in 2021

      What was the driving force behind the sudden stalling of vaccine intake? Was it really just people believing whatever media they see without checking credibility and spreading the things they see to their peers?