The Healthy Nudge
July 2019
Welcome to The Healthy Nudge . Each month, we'll get you up to speed on the latest developments in policy-relevant health behavioral economics research at CHIBE. Want more frequent updates? Follow us on Twitter @PennCHIBE and visit our website .
"How Goes the Behavior-Change Revolution?"
Freakonomics recently recorded an episode with CHIBE-affiliated members Katy Milkman, PhD , and Angela Duckworth, PhD, MA, MsC , in Philadelphia. They discussed their Behavior Change for Good initiative, which has united an interdisciplinary team of scientists and leading practitioners with a mission to make behavior change stick. Read more or listen in about their randomized controlled trial using 63,000 members of 24-Hour Fitness gyms here .
Overall Vaccination Rates Increase in California Following Interventions
Did California’s three interventions (two laws and an educational campaign) increase uptake of vaccines and vaccination status for kindergartners? A new JAMA study by CHIBE Interim Director Alison Buttenheim, MBA, PhD , found that they did. In this observational study of school-level data from kindergartners who started attending school between 2000 and 2017, the rate of kindergartners without up-to-date vaccination status decreased from 9.84% during 2013 (before the interventions) to 4.87% during 2017 (after the interventions). Read more coverage in CNN and Huffington Post.

In other vaccine news, three studies authored by CHIBE members were cited in a Forbes article about Bob Sears, MD, a physician who is facing an accusation from the Medical Board of California over his filing of vaccination exemptions for a pair of siblings with no medically recognized contraindications for any vaccines. Read more here .
New Payment System in Hawaii Shows Promise
Hawaii Medical Service Association, the Blue Cross Blue Shield of Hawaii, introduced a new system, Population-Based Payments for Primary Care (3PC), in 2016, and CHIBE researchers have found that in its first year, 3PC was associated with improvements in quality. Lead study author and CHIBE Associate Director Amol Navathe, MD, PhD , said, "One of the most exciting aspects of the 3PC model and its results is the similarities it shares with Medicare's new ‘Primary Care First’ model. The fact that PCPs effectively changed how they practice while improving quality is suggestive of further future benefits. This is good news for Medicare's model too." Read more in JAMA or see coverage in HealthLeaders .
CHIBE Profile: Steven Schroeder, MD
Steve Schroeder, MD , a CHIBE External Advisory Board member and Director of the Smoking Cessation Leadership Center at University of California San Francisco (UCSF), was recently interviewed for a UCSF piece called “A Life in Medicine: People Shaping Health Care Today.” View the video interview here , and read our Q&A below.
You’re known for being a great mentor. What advice or guidance did your mentor provide to you that was helpful? 
I never really had a mentor, but I watched a lot of leaders very closely and tried to learn from them. In some cases they had characteristics that I was not capable of emulating but would have liked to. In other cases they exhibited behavior, such as not honoring commitments, that I tried never to emulate. And in some cases they showed me better ways of doing things that I could appropriate into my own behavior.

What career achievement are you most proud of?  
As I mentioned in the interview, my greatest pride stems from our two adult sons. Regarding career, I have been very fortunate in having a lot of wonderful experiences. If forced to choose, I would select the founding of the Division of General Internal Medicine at UCSF in 1980.

Tell us about a moment in your career when you failed and what you learned from that experience.
I was passed over for a job that I wanted, and it forced me to examine my priorities. I was offered leadership jobs in two other institutions, but there were issues surrounding those positions that caused me to stay where I was for a while. 

What excites you about the work CHIBE is doing?  
I am pleased that CHIBE tries to use the principles of behavioral economics to grapple with vexing social issues.
CHIBE In the News
Blog Spotlight
Run by three Penn Medicine researchers, including CHIBE's Rinad Beidas, PhD , the Masters of Science in Health Policy Research (MSHP) Implementation Science Institute is pulling in interested attendees from across the country. The intense three-day curriculum is essentially a crash course in the concepts and methods of implementation science research. In its third year being offered, the course sold out in advance. Read more in LDI .
New Publications

Full, K.M., Moran, K., Carlson, J., Godbole, S., Natarajan, L., Hipp, A., Glanz, K., Mitchell, J., Laden, F.,James, P., & Kerr, J. Latent Profile Analysis Of Accelerometer-Measured Sleep, Physical Activity, And Sedentary Time And Differences In Health Characteristics In Adult Women . PLOS ONE.

Beidas, R. S., Williams, N. J., Becker-Haimes, E. M., Aarons, G. A., Barg, F. K., Evans, A. C., Jackson, K., Jones, D., Hadley, T., Hoagwood, K., Neimark, G., Rubin, R.M., Schoenwald, S.K., Adams, D.R., Walsh, L.M., Zentgraf, K., Mandell, D.S. & Marcus, S. C. A Repeated Cross-Sectional Study Of Clinicians’ Use Of Psychotherapy Techniques During 5 Years Of A System-Wide Effort To Implement Evidence-Based Practices In Philadelphia . Implementation Science .

Gilman, A., Bruneau Jr, M., Kral, T., Milliron, B. J., Shewokis, P., & Volpe, S. Effect of a Multi-Component, School-Based Intervention on Health Behaviors of Elementary School Students (FS16-04-19). Current Developments in Nutrition.

John, L. K., Blunden, H., & Liu, H. Shooting the Messenger . Journal of Experimental Psychology: General.

Jenssen, B., Leone, F., Evers-Casey, S., Beidas, R., & Schnoll, R. Building Systems to Address Tobacco Use in Oncology: Early Benefits and Opportunities From the Cancer Center Cessation Initiative . Journal of the National Comprehensive Cancer Network.
The Center for Health Incentives and Behavioral Economics (CHIBE) at the University of Pennsylvania conducts behavioral economics research aimed at reducing the disease burden from major U.S. public health problems. Originally founded within the Leonard Davis Institute of Health Economics , our mission is to inform health policy, improve health care delivery, and increase healthy behavior.