Hostname: page-component-6766d58669-mzsfj Total loading time: 0 Render date: 2026-05-20T01:00:02.798Z Has data issue: false hasContentIssue false
  • English
  • Français

Public acceptability of nudges targeting parents and children to improve children's health outcomes: results from an online experiment

Published online by Cambridge University Press:  11 August 2020

OLIVIER DROUIN Open the ORCID record for OLIVIER DROUIN [Opens in a new window]
OLIVIER DROUIN*
Affiliation:
Université de Montréal, Montréal, Canada
*
*Correspondence to: CHU Sainte-Justine, Division of General Pediatrics, 3175 chemin de la Côte-Sainte-Catherine, 7e étage, bloc 9. Montréal, Québec H3T 1C5, Canada. E-mail: o.drouin@UMontreal.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

There is great potential for nudges to make gains in child health through improvement of lifestyle behaviors. In this study, I use an online sample of adults to test the acceptability of two nudges (one to address teenage smoking and the other to address pediatric obesity) when targeting one of three populations: adults, parents or children. The study shows that a majority of adult respondents would accept the use of nudges aimed at parents and children. The findings show that nudging parents or children directly has the same acceptability as nudging adults. These results suggest that when the objective of a nudge is to improve children's health, it is acceptable to target parents or children themselves. These results open the door to testing the efficacy of nudges in pediatric public health.

Information

Type
New Voices
Information
Behavioural Public Policy , Volume 7 , Issue 2 , April 2023 , pp. 470 - 487
Copyright
Copyright © The Author(s) 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Aggarwal, A., Davies, J. and Sullivan, R. (2014), “Nudge” in the clinical consultation – an acceptable form of medical paternalism?’, BMC Med Ethics, 15: 31.CrossRefGoogle ScholarPubMed
Barlow, S. and Dietz, W. (2002), ‘Management of Child and Adolescent Obesity: Summary and Recommendations based on Reports From Pediatricians, Pediatric Nurse Practictionners and Registered Dietitians’, Pediatrics, 110: 236–238.CrossRefGoogle ScholarPubMed
Blumenthal-Barby, J. S. and Burroughs, H. (2012), ‘Seeking better health care outcomes: the ethics of using the “nudge”’, Am J Bioeth, 12: 1–10.CrossRefGoogle ScholarPubMed
Blumenthal-Barby, J. and Opel, D. J. (2018), ‘Nudge or Grudge? Choice Architecture and Parental Decision-Making’, Hastings Center Report, 48: 33–39.CrossRefGoogle ScholarPubMed
Bubb, R. and Pildes, R. H. (2013), ‘How behavioral economics trims its sails and why’, Harv. L. Rev., 127: 1593.Google Scholar
Buhrmester, M., Kwang, T. and Gosling, S. D. (2011), ‘Amazon's Mechanical Turk: A New Source of Inexpensive, Yet HIgh-Quality, Data?’, Perspectives on Psychological Sciences, 6: 3–5.CrossRefGoogle Scholar
Chadi, N., Winickoff, J. P. and Drouin, O. (2019), Parental optimism and perceived control over children's future use of tobacco, marijuana and opioids. Under review.CrossRefGoogle Scholar
Chen, J. and Millar, W. J. (1998), ‘Age of smoking initiation: implications for quitting’, Health Rep, 9: 39–46(Eng); 39–48(Fre).Google ScholarPubMed
Conly, S. (2012), Against Autonomy: Justifying Coercive Paternalism, Cambridge University Press.CrossRefGoogle Scholar
Cornell, N. (2014), ‘A third theory of paternalism’, Mich. L. Rev., 113: 1295.Google Scholar
Crump, M. J., McDonnell, J. V. and Gureckis, T. M. (2013), ‘Evaluating Amazon's Mechanical Turk as a Tool for Experimental Behavioral Research’, PLoS One, 8: e57410.CrossRefGoogle Scholar
Cullerton, K., Donnet, T., Lee, A. and Gallegos, D. (2016), ‘Playing the policy game: a review of the barriers to and enablers of nutrition policy change’, Public Health Nutr, 19: 2643–53.CrossRefGoogle Scholar
Davidai, S. and Shafir, E. (2018), ‘Are ‘nudges’ getting a fair shot? Joint versus separate evaluation’, Behavioural Public Policy, 1–19.Google Scholar
Doss, C. J., Fahle, E. M., Loeb, S. and York, B. N. (2018), More than just a nudge: Supporting kindergarten parents with differentiated and personalized text-messages. National Bureau of Economic Research.CrossRefGoogle Scholar
Drouin, O., Winickoff, J. P. and Thorndike, A. N. (2019a), ‘Parental Optimism About Children's Risk of Future Tobacco Use and Excessive Weight Gain’, Acad Pediatr, 19: 90–96.CrossRefGoogle ScholarPubMed
Drouin, O., Winickoff, J. P. and Thorndike, A. N. (2019b), ‘Parents’ social norms and children's exposure to three behavioral risk factors for chronic disease’, Journal of Behavioral Public Administration, 2.CrossRefGoogle Scholar
Drouin, O., Young, M. and King, N. (2018), ‘Message framing and counseling of parents on children's physical activity–an experimental study’, Health Psychology and Behavioral Medicine, 6: 214–225.CrossRefGoogle ScholarPubMed
Evans, W. D., Finkelstein, E. A., Kamerow, D. B. and Renaud, J. M. (2005), ‘Public perceptions of childhood obesity’, Am J Prev Med, 28: 26–32.CrossRefGoogle ScholarPubMed
Hahn, A. and Renner, B. (1998), ‘Perception of health risks: How smoker status affects defensive optimism. Anxiety’, Stress and Coping, 11: 93–112.CrossRefGoogle Scholar
Halfon, N. and Hochstein, M. (2002), ‘Life course health development: an integrated framework for developing health, policy, and research’, Milbank Q, 80: 433–79, iii.CrossRefGoogle ScholarPubMed
Halpern, S. D., Asch, D. A. and Volpp, K. G. (2012), ‘Commitment contracts as a way to health’, BMJ, 344: e522.CrossRefGoogle ScholarPubMed
Halpern, S. D., French, B., Small, D. S., Saulsgiver, K., Harhay, M. O., Audrain-McGovern, J., Loewenstein, G., Brennan, T. A., Asch, D. A. and Volpp, K. G. (2015), ‘Randomized trial of four financial-incentive programs for smoking cessation’, New England Journal of Medicine, 372: 2108–2117.CrossRefGoogle ScholarPubMed
Halpern, S. D., Ubel, P. A. and Asch, D. A. (2007), ‘Harnessing the power of default options to improve health care’, N Engl J Med, 357: 1340–4.CrossRefGoogle ScholarPubMed
Hammitt, J. K. and Haninger, K. (2010), ‘Valuing fatal risks to children and adults: Effects of disease, latency, and risk aversion’, J Risk Uncertain, 40: 57–83.CrossRefGoogle Scholar
Hansen, P. G. and Jespersen, A. M. (2013), ‘Nudge and the manipulation of choice: A framework for the responsible use of the nudge approach to behaviour change in public policy’, Eur. J. Risk Reg., 3.Google Scholar
Hansen, P. G., Skov, L. R. and Skov, K. L. (2016), ‘Making Healthy Choices Easier: Regulation versus Nudging’, Annu Rev Public Health.CrossRefGoogle ScholarPubMed
Harbach, M. J. (2016), ‘Nudging Parents’, J. Gender Race & Just., 19: 73.Google Scholar
Jamal, A., Phillips, E., Gentzke, A. S., Homa, D. M., Babb, S. D., King, B. A. and Neff, L. J. (2018), ‘Current cigarette smoking among adults—United States, 2016’, Morbidity and Mortality Weekly Report, 67: 53.CrossRefGoogle Scholar
Janssen, I. (2013), ‘The public health burden of obesity in Canada’, Can J Diabetes, 37: 90–6.CrossRefGoogle ScholarPubMed
Jeffrey, J., Whelan, J., Pirouz, D. M. and Snowdon, A. W. (2016), ‘Boosting safety behaviour: Descriptive norms encourage child booster seat usage amongst low involvement parents’, Accid Anal Prev, 92: 184–8.CrossRefGoogle ScholarPubMed
Jenssen, B. P., Buttenheim, A. M. and Fiks, A. G. (2019), ‘Using Behavioral Economics to Encourage Parent Behavior Change: Opportunities to Improve Clinical Effectiveness’, Acad Pediatr, 19: 4–10.CrossRefGoogle ScholarPubMed
John, L. K., Loewenstein, G., Troxel, A. B., Norton, L., Fassbender, J. E. and Volpp, K. G. (2011), ‘Financial incentives for extended weight loss: a randomized, controlled trial’, J Gen Intern Med, 26: 621–6.CrossRefGoogle ScholarPubMed
Lee, M. M., Falbe, J., Schillinger, D., Basu, S., McCulloch, C. E. and Madsen, K. A. (2019), ‘Sugar-Sweetened Beverage Consumption 3 Years After the Berkeley, California, Sugar-Sweetened Beverage Tax’, Am J Public Health, 109: 637–639.CrossRefGoogle ScholarPubMed
Li, M. and Chapman, G. B. (2013), ‘Nudge to health: Harnessing decision research to promote health behavior’, Social and Personality Psychology Compass, 7: 187–198.CrossRefGoogle Scholar
Lipnowski, S., Leblanc, C. M. & Canadian Paediatric Society, Healthy Active Living and Sports Medicine Committee (2012), ‘Healthy active living: Physical activity guidelines for children and adolescents’, Paediatr Child Health, 17: 209–12.CrossRefGoogle ScholarPubMed
Loewenstein, G., Asch, D. A., Friedman, J. Y., Melichar, L. A. and Volpp, K. G. (2012), ‘Can behavioural economics make us healthier?’, BMJ, 344: e3482.CrossRefGoogle ScholarPubMed
Loewenstein, G., Price, J. and Volpp, K. (2016), ‘Habit formation in children: Evidence from incentives for healthy eating’, Journal of health economics, 45: 47–54.CrossRefGoogle ScholarPubMed
Lykke, M., Pisinger, C. and Glumer, C. (2016), ‘Ready for a goodbye to tobacco? - Assessment of support for endgame strategies on smoking among adults in a Danish regional health survey’, Prev Med, 83: 5–10.CrossRefGoogle Scholar
Marteau, T. M., Ogilvie, D., Roland, M., Suhrcke, M. and Kelly, M. P. (2011), ‘Judging nudging: can nudging improve population health?’, BMJ, 342: d228.CrossRefGoogle ScholarPubMed
Metcalf, B., Henley, W. and Wilkin, T. (2012), ‘Effectiveness of intervention on physical activity of children: systematic review and meta-analysis of controlled trials with objectively measured outcomes (EarlyBird 54)’, BMJ, 345: e5888.CrossRefGoogle ScholarPubMed
Milkman, K. L., Minson, J. A. and Volpp, K. G. (2013), ‘Holding the Hunger Games hostage at the gym: An evaluation of temptation bundling’, Management science, 60: 283–299.CrossRefGoogle Scholar
Morain, S. R., Winickoff, J. P. and Mello, M. M. (2016), ‘Have Tobacco 21 Laws Come of Age?’, N Engl J Med, 374: 1601–4.CrossRefGoogle ScholarPubMed
Navin, M. C. (2017), ‘The Ethics of Vaccination Nudges in Pediatric Practice’, HEC Forum, 29: 43–57.CrossRefGoogle ScholarPubMed
Office of Disease Prevention and Health Promotion. (2014), Healthy People 2020 Topics and Objectives [Online]. Washington D.C. Available: http://www.healthypeople.gov/2020/topics-objectives [Accessed November 23rd 2015].Google Scholar
Ostbye, T., Malhotra, R., Stroo, M., Lovelady, C., Brouwer, R., Zucker, N. and Fuemmeler, B. (2013), ‘The effect of the home environment on physical activity and dietary intake in preschool children’, Int J Obes (Lond), 37: 1314–21.CrossRefGoogle ScholarPubMed
Peirson, L., Ali, M. U., Kenny, M., Raina, P. and Sherifali, D. (2016), ‘Interventions for prevention and treatment of tobacco smoking in school-aged children and adolescents: A systematic review and meta-analysis’, Prev Med, 85: 20–31.CrossRefGoogle ScholarPubMed
Petrescu, D. C., Hollands, G. J., Couturier, D. L., Ng, Y. L. and Marteau, T. M. (2016), ‘Public Acceptability in the UK and USA of Nudging to Reduce Obesity: The Example of Reducing Sugar-Sweetened Beverages Consumption’, PLoS One, 11: e0155995.CrossRefGoogle ScholarPubMed
Pew Research Center. (2018), Trends in party affiliation among demographic groups [Online]. Available: https://www.people-press.org/2018/03/20/1-trends-in-party-affiliation-among-demographic-groups/ [Accessed February 25th 2020].Google Scholar
Plourde, G. (2006), ‘Preventing and managing pediatric obesity. Recommendations for family physicians’, Can Fam Physician, 52: 322–8.Google ScholarPubMed
Rebonato, R. (2014), ‘A critical assessment of libertarian paternalism’, Journal of Consumer Policy, 37: 357–396.CrossRefGoogle Scholar
Reisch, L. A., Sunstein, C. R. and Gwozdz, W. (2017), ‘Beyond carrots and sticks: Europeans support health nudges’, Food Policy, 69: 1–10.CrossRefGoogle Scholar
Reynolds, J., Archer, S., Pilling, M., Kenny, M., Hollands, G. J. and Marteau, T. (2019), ‘Public acceptability of nudging and taxing to reduce consumption of alcohol, tobacco, and food: A population-based survey experiment’, Social Science & Medicine, 236: 112395.CrossRefGoogle ScholarPubMed
Sahoo, K., Sahoo, B., Choudhury, A. K., Sofi, N. Y., Kumar, R. and Bhadoria, A. S. (2015), ‘Childhood obesity: causes and consequences’, Journal of Family Medicine and Primary Care, 4: 187–192.Google ScholarPubMed
Sikorski, C., Luppa, M., Schomerus, G., Werner, P., Konig, H. H. and Riedel-Heller, S. G. (2012), ‘Public attitudes towards prevention of obesity’, PLoS One, 7: e39325.CrossRefGoogle ScholarPubMed
Skinner, A. C., Ravanbakht, S. N., Skelton, J. A., Perrin, E. M. and Armstrong, S. C. (2018), ‘Prevalence of Obesity and Severe Obesity in US Children, 1999–2016’, Pediatrics, 141.CrossRefGoogle ScholarPubMed
Skinner, A. C., Perrin, E. M., Moss, L. A. and Skelton, J. A. (2015), ‘Cardiometabolic Risks and Severity of Obesity in Children and Young Adults’, N Engl J Med, 373: 1307–17.CrossRefGoogle ScholarPubMed
Statistics Canada. (2005), The Daily, Catalogue 11-001-XIE, 2.Google Scholar
Statistics Canada. (2013), Body mass index of children and youth, 2012 to 2013 [Online]. Available: https://www.statcan.gc.ca/pub/82-625-x/2014001/article/14105-eng.htm [Accessed].Google Scholar
Statistics Canada. (2018), Smoking, 2017 - Health Facts Sheet [Online]. Available: https://www150.statcan.gc.ca/n1/pub/82-625-x/2018001/article/54974-eng.pdf [Accessed December 16th 2019].Google Scholar
Steinberg, L. (2008), ‘A Social Neuroscience Perspective on Adolescent Risk-Taking’, Dev Rev, 28: 78–106.CrossRefGoogle ScholarPubMed
Stevens, J. (2014), ‘Topical review: Behavioral economics as a promising framework for promoting treatment adherence to pediatric regimens’, Journal of pediatric psychology, 39: 1097–1103.CrossRefGoogle Scholar
Sunstein, C. R. (2015), ‘The ethics of nudging’, Yale J. on Reg., 32: 413.Google Scholar
Sunstein, C. R. (2016a), ‘Do people like nudges’, Admin. L. Rev., 68: 177.Google Scholar
Sunstein, C. R. (2016b), ‘People prefer system 2 nudges (kind of)’, Duke LJ, 66: 121.Google Scholar
Sunstein, C. R., Reisch, L. A. and Rauber, J. (2018), ‘A worldwide consensus on nudging? Not quite, but almost’, Regulation & Governance, 12: 3–22.CrossRefGoogle Scholar
Sunstein, C. R. and Thaler, R. H. (2003), ‘Libertarian paternalism is not an oxymoron’, The University of Chicago Law Review, 1159–1202.CrossRefGoogle Scholar
Swindell, J., McGuire, A. L. and Halpern, S. D. (2010), ‘Beneficent persuasion: techniques and ethical guidelines to improve patients’ decisions’, The Annals of Family Medicine, 8: 260–264.CrossRefGoogle ScholarPubMed
Tannenbaum, D., Fox, C. R. and Rogers, T. (2017), ‘On the misplaced politics of behavioral policy interventions’, Nat. Hum. Behav., 1.CrossRefGoogle Scholar
Thaler, R. H. and Sunstein, C. R. (2008), Nudge: Improving decisions about health, wealth, and happiness, New Haven, CT: Yale University Press.Google Scholar
United States Census. (2018), Age & Sex [Online]. Available: https://data.census.gov/cedsci/table?q=Age and Sex&hidePreview=false&t=Age and Sex&tid=ACSST1Y2018.S0101 [Accessed February 25th 2020].Google Scholar
US Department of Health Human Services (2004), The health consequences of smoking: a report of the Surgeon General.Google Scholar
Vallgarda, S. (2012), ‘Nudge: a new and better way to improve health?’, Health Policy, 104: 200–3.CrossRefGoogle ScholarPubMed
Van Cleave, J., Gortmaker, S. L. and Perrin, J. M. (2010), ‘Dynamics of obesity and chronic health conditions among children and youth’, JAMA, 303: 623–630.CrossRefGoogle ScholarPubMed
Volpp, K. G., John, L. K., Troxel, A. B., Norton, L., Fassbender, J. and Loewenstein, G. (2008), ‘Financial incentive-based approaches for weight loss: a randomized trial’, JAMA, 300: 2631–7.CrossRefGoogle ScholarPubMed
Weinstein, N. D., Marcus, S. E. and Moser, R. P. (2005), ‘Smokers' unrealistic optimism about their risk’, Tob Control, 14: 55–9.CrossRefGoogle ScholarPubMed
Whalen, C. K., Henker, B., O'Neil, R., Hollingshead, J., Holman, A. and Moore, B. (1994), ‘Optimism in children's judgments of health and environmental risks’, Health Psychology, 13: 319.CrossRefGoogle ScholarPubMed
Whyte, K. P., Selinger, E., Caplan, A. L. and Sadowski, J. (2012), ‘Nudge, nudge or shove, shove-the right way for nudges to increase the supply of donated cadaver organs’, Am J Bioeth, 12: 32–9.CrossRefGoogle ScholarPubMed