CADMA has sponsored seminars and symposia to facilitate widespread knowledge transfer, stimulate new collaborations, and raise awareness of the broad range of research conducted at Stanford that is relevant to CADMA’s mission. Among them, each seed investigator has presented work at research in progress seminars held at the Center for Primary Care and Outcomes Research as well as the Department of Health Research and Policy at Stanford University.
Of note, CADMA with SCL funded the first of the Longevity Distinguished Lecture Series. The inaugural speaker was Jack Rowe, professor of health policy and management, Columbia University Mailman School of Public Health and former CEO of Aetna Inc. Rowe’s lecture, “Myths and Realities of an Aging Society,” was held on April 13, 2010 at Stanford University. Barbara Strauch, Science Editor at The New York Times and author of The Secret Life of the Grown-Up Brain and The Primal Teen: What the New Discoveries About the Teenage Brain Tell Us About Our Kids, was the second speaker in the Stanford Center on Longevity Distinguished Lecture Series. The third speaker was Marc Freedman, Founder and CEO of Civic Ventures, and author of a new book called The Big Shift: Navigating the New Stage Beyond Midlife. The next lecture, scheduled for May 17th, 2012, will be given by Robert Lustig from University of California at San Francisco. A national recognized authority in the field of neuroendocrinology, Dr. Lustig is currently investigating the contribution of biochemical, neural, hormonal, and genetic influences in the expression of the current obesity epidemic.
Additionally, CAMDA, SCL and other collaborators are developing a simulation game to demonstrate the economic and health trade-offs of various national policy choices, especially those related to the healthcare system. The game will be accessible to the public, and aims for players to take away some understanding of the implications of different approaches currently under consideration to address the federal debt situation.
CADMA has funded numerous pilot studies, including the following two projects that address important topics of aging – retirement savings and exercise.
Connecting to the Future Self: Using Web-based Virtual Reality to Increase Retirement Saving. [2009-2011], Jeremy Bailenson, PhD, Mentor: Laura Carstensen, PhD.
With regard to retirement planning, people often fail to save what they need to. Economists believe that shortcomings in this domain are related to temporal discounting, or the tendency to value rewards that will occur in the future less than rewards that occur in the present. One of the reasons why such discounting occurs is because people may often have a difficult time vividly imagining future wants and desires. To the extent that people can more vividly imagine how badly they will feel in the future with little to no retirement savings, they should be motivated to save more money now.
Using survey recruitment firm Polymetrix for two different studies, the researchers recruited 160 healthy community dwelling younger (age 18-25) adults from the San Francisco Bay Area. All subjects underwent a neuropsychological test battery designed to assess potentially relevant cognitive and affective variables, and completed a measure of socioeconomic status. Researchers predicted that participants who are exposed to their older selves would allocate more money to both hypothetical and actual retirement saving accounts. The researchers ran a virtual reality paradigm and showed subjects either images of themselves or images of a gender and race-matched aged other. They also gave their subjects several different types of saving tasks, some of which had real rewards associated with them. Results show that seeing the aged self leads to significantly more saving behavior than simply seeing an aged other. In collaborative work with Dan and Bill Sharpe, they have created a more accessible tool that both enhanced the vividness of the future self and the vividness of decision-making consequences.
The impact of this seed project has been considerable. The data collected during the first two years of the project has been featured in The New York Times, ABC Nightly News, The Wall Street Journal, CBS, Wired magazine and literally over a dozen other news outlets. The leads of this project (Bailenson, Carstensen, and Ersner-Hershfield) get calls regularly to talk about this research with industry consultants, media outlets, and other researchers. On the academic outreach side, the work has been accepted at the Journal of Market Research. They have also been designing other studies to follow up this research, for example looking at energy consumption in terms of how it relates to the future self.
Supporting Decision Making for Sustainable Weight Loss [2009-2011], Jeremy Goldhaber-Fiebert, PhD; Mentor: Alan Garber, MD, PhD.
Regular exercise promotes sustained weight loss, cardiovascular fitness, and better health outcomes, especially for individuals moving from middle to older ages. For those individuals who do not currently exercise, the challenge is to adopt a sustainable exercise regimen and stick to it – making it a part of their lifestyle in the long-term. Such changes are particularly difficult because long-term exercise plans can be disrupted by the necessities, distractions, and temptations of every-day life. Behavioral economic devices like commitment contracts are used to increase individuals’ follow through by agreeing to a repeated activity for the future along with penalties for failing to follow through. The researchers used exercise commitment contracts and nudges of the duration of the contracts to examine how more exercise increases exercise habit formation in a randomized design.
The research was conducted in two phases: 1) a pilot phase designed to test the feasibility of changing duration defaults and the expected shift in chosen contract values based on changes in these defaults; 2) an implementation phase designed to test changes in successful contract completion based on shifts in the duration and frequency of the contract and its link to longer-term success in continuing to exercise. The research evaluated optimal commitment contracts for promoting long-term sustained exercise and formed the basis of examining the more general question of whether more exercise leads to long-term habitual patterns of exercise.
In the fully-implemented study, 70% of participants considering exercise contracts ultimately signed the contract. Average contract duration chosen was 13.0 weeks for the 8 week default nudge randomization condition and increased to 18.3 weeks for the 20 week default nudge condition. Longer default contract duration nudges did not cause reductions in the number of contracted days of exercise per week or the use of financial penalties. Accepting the exact default nudge value was correlated with, but did not cause, early drop-out, as rates of early-drop out for those choosing the default were the same across the 8 week, 12 week, and 20 week default nudge randomization conditions. Those individuals not dropping out who chose longer contracts because of longer default nudges (i.e., the 20 week default nudge condition) were as successful as individuals choosing longer contracts in randomization conditions without longer default nudges.
Previously, the researchers analyzed a pilot sample of baseline information (n=700) which was published as a National Bureau of Economics Research (NBER) working paper and was picked up by the New York Times Freakonomic blog and by VoxEU (an online outlet describing cutting edge economics work). The researchers presented the work as a plenary session talk for top-ranked abstracts to the 2011 Society for Medical Decision Making conference whose theme this year was behavioral economics. The researchers also expect to produce another NBER working paper and a separate manuscript for submission to a medical/public health journal. They have made connections with researchers at NIDDK (National Institute for Diabetes and Digestive and Kidney Diseases) regarding converting exercise changes into potential weight loss using their physiological models. They have submitted a brief proposal for additional research on post-contract exercise in response to a recent Robert Wood Johnson Foundation call for proposals relating to the behavioral economics of obesity prevention. They are currently planning an R01 (and also potentially an R03) submission to use this work in the context of large employee wellness programs.