Association for Behavior Analysis International

Over the past few decades, economic and other research has clearly demonstrated the role of price in influencing a variety of health-related behaviors. These include several unhealthy behaviors that, at least in part, arise from imperfect information, time-inconsistent preferences, and addiction that impose costs on those not engaged in the behavior. Together, these suggest that government intervention to manipulate prices through taxes and subsidies can significantly affect these health behaviors and help correct the market failures associated with them. This presentation will review the effectiveness of taxation and other pricing policies in promoting healthy behaviors. The extensive research documenting the impact of tobacco and alcoholic beverage excise taxes on tobacco use, drinking, and their consequences will be reviewed, along with the more limited evidence on the impact of other policies that influence the price of tobacco products and alcoholic beverages. Drawing on these experiences, the potential for using pricing policies to promote healthier eating, physical activity, and to curb obesity will be discussed. Recent trends in food/beverage prices and weight outcomes will be described and findings from the emerging research on price and obesity will be reviewed.

Losing weight requires a series of choices to eat healthier and be more active. Behavioral economics is a theoretical approach to understanding how people make decisions about how to allocate their time among alternatives and how to set priorities. Behavioral choice theory incorporates multiple levels of analysis, ranging from basic neuroscience and genetic research, field and clinical studies, and environmental analyses. Basic research will be reviewed that demonstrates the central role of choice in determining motivation to engage in behaviors, and these basic paradigms will be applied to human eating and physical activity. The interaction of genetic factors that may influence the motivation to eat, and how these genetic polymorphisms interact with behavioral phenotypes to influence the choice to eat are presented. These basic principles are extended to clinical research on weight loss in children, and prevention research to assess the role of reducing television on weight change in young children. The potential role of environmental changes that favor healthier eating and greater access to physical activity, such as pricing, are noted. These studies highlight the importance of integrating basic and clinical research, and the potential for multidisciplinary approaches to improve healthy behaviors.

There is growing recognition and concern that many individuals persist in behavior patterns (substance abuse, physical inactivity, unhealthy food choices, medication non-adherence) that are strikingly harmful to their long-term health and a staggering financial burden on the U.S. health care system. Indeed, unhealthy personal behavior patterns are estimated to contribute to 40% of all premature deaths in the U.S. annually, with cigarette smoking alone being responsible for approximately 435,000 deaths/year and physical inactivity and obesity contributing to another 365,000 deaths/year. These behavior patterns increase risk for numerous chronic diseases, including cardiovascular disease, stroke, site-specific cancers, and type-2 diabetes. Our group has been investigating the systematic use of financial incentives to promote behavior change among addicted individuals. In this presentation I will review a program of research we have conducted with pregnant women who are still smoking cigarettes upon entry into prenatal care. I will review results from studies demonstrating that providing these women with vouchers exchangeable for retail items in the community contingent on objectively verified abstinence from recent smoking can significantly increase abstinence levels and improve birth outcomes. These positive results are congruent with a larger body of evidence demonstrating that financial incentives can be effective in promoting health-related behavior change and improving health outcomes.

A fundamental tenant of behavior analysis is that operant behavior is strengthened by its consequences and that the strength of a reinforcer determines the strength of the behavior it supports. Behavioral economics provides a framework for understanding and measuring reinforcer strength, and by implication, the strength of the behavior it supports. At the same time, government policy is often directed toward creating conditions that encourage changes in the strength of certain behaviors, such as substance abuse, unhealthy dietary habits, cigarette smoking, wasteful use of energy resources, and excessive use of hydrocarbon products. Behavior analysis provides empirical tools for measuring behavioral strength and demand for reinforcers. An empirical model of demand defines how reinforcer consumption varies as a function of the requirements to obtain the reinforcer (price) and a number of recent studies have verified the feasibility of measuring empirical demand functions in human volunteers. Behavioral economics provides a conceptual link between empirical studies of behavioral strength and how government policy might alter that strength. Effective government policy can apply this knowledge to alter community behavior by arranging various conditions that affect the costs and benefits of selected behaviors, through penalties, taxes, refunds, tax deductions, or opportunity costs. Taken together, behavior analysis provides the empirical tools and behavioral economics provides the bridge between behavioral data and the economic implications for regulatory initiatives.

Frank Chaloupka, Leonard Epstein, Stephen Higgins, and Steven Hursh will participate in a panel discussion and answer questions on the topics presented in Cluster 1.

Session Moderator: Steven Hursh

Certified behavior analysts, behavioral consultants, behavioral therapists, psychologists, and university faculty.