The Healthy Nudge

February 2025

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. See our 5 top stories below.

1) How to apply behavioral insights at an organization-level

A CHIBE Q&A with Elizabeth Linos, PhD, Faculty Director of The People Lab at the Harvard Kennedy School of Government

• Tip from Dr. Linos: "The best advice I have for applying behavioral insights at an organization or system level is to start with the problem, the experience, and the people navigating it every day. The behavioral nudge should come last."

• What to be mindful of: "I encourage anyone working in this space to be patient with the number of constraints that organizational leaders face and to become more comfortable with incremental but consistent tweaks. If an obvious, high-impact solution hasn’t been implemented yet, there’s usually a reason—whether it’s resource limitations, legal barriers, or competing priorities. The most effective change may happen through sustained, iterative improvements rather than one sweeping fix."

2) How to increase lipid screening

A JAMA Cardiology study led by Catherine Pollak, PhD; with CHIBE affiliates Samantha Coratti, BA; Laurie Norton, MA, MBE; Catherine Reitz, MPH; Lin Xu, MS; Zakiya Walker, BA; Mary E. Putt, ME, PhD, ScD; Kevin G. Volpp, MD, PhD; Shivan J. Mehta, MD, MBA, MSHP; and colleagues

• The question: Can bulk ordering and texts with behavioral insights boost the effectiveness of lipid screening outreach?

• The findings: In this trial with 1,000 participants, patient outreach with bulk ordering resulted in higher lipid screening uptake than usual care.

• What else to know: Adding behaviorally informed texts did not significantly increase uptake.

3) I want to work out, but...

A New York Times article featuring CHIBE affiliate Katy Milkman, PhD

• Skip the self-criticism: What's stopping you from exercising? I’m tired. It’s cold outside. I don’t want to spend money on a class. Stop thinking of these mental blocks as “excuses.” Using that word can suggest you failed and should feel bad about your willpower. Research has shown that self-criticism and shame can stop you from meeting your goals, Dr. Katy Milkman said.

• What to do instead, according to Dr. Milkman:
• Reframe the reasons you aren’t exercising as genuine obstacles and devise a plan to overcome them
• Prioritize fun in movement
• Use "temptation bundling" like watching your favorite show or listening to your favorite podcast only when you're exercising

4) Interventions to increase HPV vaccination

A Pediatrics paper co-led by Peter G. Szilagyi, MD, MPH, and CHIBE affiliate Alexander G. Fiks, MD, MSCE, and colleagues

• The problem: HPV vaccination rates are suboptimal.

• The question: Experts recommend multi-component interventions to address vaccination barriers simultaneously. But do bundled interventions have a larger impact than individual ones?

• What this study finds: A 3-component intervention improved initial HPV vaccination rates by 4.8% points and subsequent HPV vaccinations by 2.2% points at well child care visits.

• How does this compare to single interventions? The magnitude of the effect in this bundled intervention was similar to the effect of a single communication training intervention. (Although this bundled intervention was done after the pandemic when vaccine hesitancy may be higher.)

• What's next: The results support either communication training for clinicians alone or communication training plus feedback and prompts, which may add a bit more impact.

5) Five takeaways from the evidence on sweetened beverage taxes

An LDI summary of a recent policy brief by CHIBE affiliates Alyssa Moran, ScD, MPH; and Christina Roberto, PhD; and colleague Jim Krieger, MD, MPH

• The highlights: Sweetened beverage taxes are associated with:
• Reduced sugary drink purchases
• Less sugar intake
• Improvements in weight status
• Better oral health
• Improved pregnancy and birth outcomes