Paul Resnick, "Healthier Together: Social Approaches to Health and Wellness"
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  • 1. Healthier Together: SocialApproaches to Health and Wellness Paul Resnick
  • 2. Outline• My Story – Collaborations with people who had complementary expertise• Advice• Social Nudges for Health Behavior
  • 3. MY STORY
  • 4. College• Math SB, 1985
  • 5. Grad School• Computer Science, SM 1988, PhD 1992
  • 6. LEARNING FROM COLLABORATIONS
  • 7. Community DevelopmentMel King
  • 8. Human Factors Bob Virzi
  • 9. Distributed Systems John Riedl
  • 10. Law and Policy Larry Lessig
  • 11. Political ScienceBob Putnam Brendan Nyhan
  • 12. Saguaro Seminar 1997
  • 13. Saguaro Seminar 1997
  • 14. Saguaro Seminar 1997
  • 15. Saguaro Seminar 1997
  • 16. Economics Richard Zeckhauser
  • 17. Economics Eric Friedman
  • 18. Computer Science TheoryRahul Sami
  • 19. Social PsychologyBob Kraut Sara Kiesler
  • 20. CommunityLab
  • 21. Advice• Collaborate with complementary experts• Go deep in fields you cross into – (not necessarily broad)• Learn math and programming in grad school• Theory, Practice, and the Design Perspective
  • 22. Wisdom from Kurt Lewin“There is nothing so practicalas a good theory”“If you want to understandsomething, try to change it”
  • 23. Advice• Collaborate with complementary experts• Go deep in fields you cross into – (not necessarily broad)• Learn math and programming in grad school• Understand Change
  • 24. SOCIAL NUDGES FOR HEALTHBEHAVIOR CHANGE
  • 25. THE OBESITY EPIDEMIC
  • 26. Costs of Obesity• In human terms – Heart disease – Stroke – Type 2 diabetes• In economic terms – $147 billion estimated in 2008 – Mean $1,429/person per year more than normal weight
  • 27. Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14%
  • 28. Obesity Trends* Among U.S. Adults BRFSS, 1986 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14%
  • 29. Obesity Trends* Among U.S. Adults BRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14%
  • 30. Obesity Trends* Among U.S. Adults BRFSS, 1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14%
  • 31. Obesity Trends* Among U.S. Adults BRFSS, 1989 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14%
  • 32. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14%
  • 33. Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19%
  • 34. Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19%
  • 35. Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19%
  • 36. Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19%
  • 37. Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19%
  • 38. Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19%
  • 39. Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% ≥20%
  • 40. Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% ≥20%
  • 41. Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% ≥20%
  • 42. Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% ≥20%
  • 43. Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
  • 44. Obesity Trends* Among U.S. Adults BRFSS, 2002 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
  • 45. Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
  • 46. Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
  • 47. Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
  • 48. Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
  • 49. Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
  • 50. Obesity Trends* Among U.S. Adults BRFSS, 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
  • 51. Obesity Trends* Among U.S. Adults BRFSS, 2009 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
  • 52. Obesity Trends* Among U.S. Adults BRFSS, 2010 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
  • 53. HealthierTogether.info
  • 54. Collaborators• Caroline Richardson • Sean Munson• Mark Newman • Debra Lauterbach• Margaret Morris• Erin Krupka
  • 55. SELF-TRACKINGThe Quantified Self
  • 56. Sleep
  • 57. Physical Activity
  • 58. Food
  • 59. Moods
  • 60. + Gamification (Points + Levels)
  • 61. THE POWER OF SHARING
  • 62. BEHAVIOR CHANGE:MAKING ACTIVITY FUN
  • 63. Team QuestsBuis, L., T. Poulton, R. Holleman, A. Sen, P. Resnick, D. Goodrich, L. Palma-Davis and C.Richardson (2009). "Evaluating Active U: an internet-mediated physical activity program."BMC Public Health 9(1): 331.
  • 64. Making the Behavior Social
  • 65. Making the Tracking Social• Richardson et al• J Med Internet Res 2010;12(4):e71• Individual tracking only – 66% completed program• With forums – 79% completed• Same step count increases – 4468 6948 per day
  • 66. BEHAVIOR CHANGE:MAKING ACTIVITY REWARDING
  • 67. Encouragement from Others: Nike+
  • 68. Helping Others• Helping others may be very motivating• Study design – Obese teens – Gift cards for completing walking goals • You • A friend you pick • Split between you and friend
  • 69. BEHAVIOR CHANGE:ACCOUNTABILITY TO OTHERS
  • 70. Feedback from Others
  • 71. Accountability: Interventions• OneRecovery
  • 72. Accountability: Monitors• Stickk
  • 73. Accountability: Social Punishments• Steps Commitments
  • 74. DETOUR: POWER ANALYSIS ANDEXPERIMENT DESIGN
  • 75. Experimental Conditions: 2x2• Private commitments and results• Public commitments; private results• Private commitments; public results• Public commitments; public results
  • 76. Design 1: Between Subjects• Each subject randomly assigned to one condition• Stay in the that condition for 14 weeks• Analysis: more walking in some conditions than others?
  • 77. Power Analysis via Simulation• Each of K times, run a simulated experiment with n subjects – For each subject • Draw results from an assumed distribution – (e.g., condition 2 has 500 steps/day more on average than condition 1; some assumed variance between people, between days) – Run data analysis on the dataset • Record whether difference between conditions is statistically significant or not• Power = percentage of simulated experiments with significant results• Try different values for n, to see how many subjects you need
  • 78. Design 1: Between Subjects• Each subject randomly assigned to one condition• Stay in the that condition for 14 weeks• Analysis: more walking in some conditions than others?• Power analysis: even 90 subjects per condition not enough!
  • 79. Design 2: Partially Within-Subjects Design• Each subject starts with a no commitments baseline for a few weeks• Then randomly assigned to one of the four conditions• Analysis: compare difference from baseline, between conditions – Factors our individual• Power analysis: 65 subjects per condition 90% power
  • 80. BARRIERS TO OVERCOME
  • 81. Embarrassment“I got people, you know, from my high schoolthat I am friends with that I havent talked toin 25 years. And I have no desire for them toknow about my weight issues or weight status.”“… I did not put that on because I didnt wanteverybody on Facebook knowing that my buttmuscle hurt today.”Newman, M. W., D. Lauterbach, S. A. Munson, P. Resnick and M. E. Morris (2011). Its notthat i dont have problems, Im just not putting them on Facebook: challenges andopportunities in using online social networks for health. Proceedings of the ACM 2011conference on Computer supported cooperative work. Hangzhou, China, ACM: 341-350.
  • 82. Spamming“…mostly when I make things private, it’s morebecause I think they’d be boring orinsignificant to my friends, not because they’reactually things I wouldn’t want myfriends to know about. I just don’t want to clog uptheir Facebook with it.”Munson, S., D. Lauterbach, M. Newman and P. Resnick (2010). HappierTogether: Integrating a Wellness Application into a Social Network Site.Persuasive Technology. T. Ploug, P. Hasle and H. Oinas-Kukkonen, SpringerBerlin / Heidelberg. 6137: 27-39.
  • 83. Comparison and Competition Avoidance• Comparisons can demotivate• Some people avoid them• Active U – 1 point increase in BMI 1% decrease in likelihood to join a teamBuis, L., T. Poulton, R. Holleman, A. Sen, P. Resnick, D. Goodrich, L. Palma-Davis and C. Richardson (2009). "Evaluating Active U: an internet-mediatedphysical activity program." BMC Public Health 9(1): 331.
  • 84. Unhelpful Responses• “Oh, you are counting calories? That will never work, you have to count carbs/fat/fiber etc...”• “Oh, come on, its a birthday party, you can have ONE piece of cake...”• “Oh, youre fine the way you are, your husband loves you anyway, why put yourself through this?”Fromhttp://www.sparkpeople.com/resource/article_comments.asp?id=87&type=1
  • 85. Summary• Benefits of tracking together – Behavior change – (Support) – (Decision-making)• Design Challenges – Sharing the right stuff with the right people – Matching social elements to individual needs
  • 86. Conclusion• Advice – Collaborate with complementary experts – Go deep in fields you cross into – Learn math and programming in grad school – Understand Change