Healthier Together: SocialApproaches to Health and Wellness           Paul Resnick
Outline• My Story  – Collaborations with people who had    complementary expertise• Advice• Social Nudges for Health Behav...
MY STORY
College• Math SB, 1985
Grad School• Computer Science, SM 1988, PhD 1992
LEARNING FROM COLLABORATIONS
Community     DevelopmentMel King
Human Factors                Bob Virzi
Distributed Systems                      John Riedl
Law and Policy             Larry Lessig
Political ScienceBob Putnam             Brendan Nyhan
Saguaro Seminar 1997
Saguaro Seminar 1997
Saguaro Seminar 1997
Saguaro Seminar 1997
Economics            Richard            Zeckhauser
Economics            Eric Friedman
Computer Science TheoryRahul Sami
Social PsychologyBob Kraut                Sara Kiesler
CommunityLab
Advice• Collaborate with complementary experts• Go deep in fields you cross into  – (not necessarily broad)• Learn math an...
Wisdom from Kurt Lewin“There is nothing so practicalas a good theory”“If you want to understandsomething, try to change it”
Advice• Collaborate with complementary experts• Go deep in fields you cross into  – (not necessarily broad)• Learn math an...
SOCIAL NUDGES FOR HEALTHBEHAVIOR CHANGE
THE OBESITY EPIDEMIC
Costs of Obesity• In human terms  – Heart disease  – Stroke  – Type 2 diabetes• In economic terms  – $147 billion estimate...
Obesity Trends* Among U.S. Adults                             BRFSS, 1985                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 1986                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 1987                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 1988                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 1989                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 1990                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 1991                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 1992                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 1993                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 1994                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 1995                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 1996                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 1997                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 1998                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 1999                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 2000                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 2001                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                            BRFSS, 2002                 (*BMI ≥30, or ~ 30 lbs. overweigh...
Obesity Trends* Among U.S. Adults                             BRFSS, 2003                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 2004                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 2005                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 2006                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 2007                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 2008                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 2009                 (*BMI ≥30, or ~ 30 lbs. overweig...
Obesity Trends* Among U.S. Adults                             BRFSS, 2010                 (*BMI ≥30, or ~ 30 lbs. overweig...
HealthierTogether.info
Collaborators•   Caroline Richardson   • Sean Munson•   Mark Newman           • Debra Lauterbach•   Margaret Morris•   Eri...
SELF-TRACKINGThe Quantified Self
Sleep
Physical Activity
Food
Moods
+ Gamification (Points + Levels)
THE POWER OF SHARING
BEHAVIOR CHANGE:MAKING ACTIVITY FUN
Team QuestsBuis, L., T. Poulton, R. Holleman, A. Sen, P. Resnick, D. Goodrich, L. Palma-Davis and C.Richardson (2009). "Ev...
Making the Behavior Social
Making the Tracking Social• Richardson et al• J Med Internet Res  2010;12(4):e71• Individual tracking  only   – 66% comple...
BEHAVIOR CHANGE:MAKING ACTIVITY REWARDING
Encouragement from Others: Nike+
Helping Others• Helping others may be very motivating• Study design  – Obese teens  – Gift cards for completing walking go...
BEHAVIOR CHANGE:ACCOUNTABILITY TO OTHERS
Feedback from Others
Accountability: Interventions• OneRecovery
Accountability: Monitors• Stickk
Accountability: Social Punishments• Steps Commitments
DETOUR: POWER ANALYSIS ANDEXPERIMENT DESIGN
Experimental Conditions: 2x2•   Private commitments and results•   Public commitments; private results•   Private commitme...
Design 1: Between Subjects• Each subject randomly assigned to one  condition• Stay in the that condition for 14 weeks• Ana...
Power Analysis via Simulation• Each of K times, run a simulated experiment with n  subjects   – For each subject      • Dr...
Design 1: Between Subjects• Each subject randomly assigned to one  condition• Stay in the that condition for 14 weeks• Ana...
Design 2: Partially Within-Subjects                Design• Each subject starts with a no commitments  baseline for a few w...
BARRIERS TO OVERCOME
Embarrassment“I got people, you know, from my high schoolthat I am friends with that I havent talked toin 25 years. And I ...
Spamming“…mostly when I make things private, it’s morebecause I think they’d be boring orinsignificant to my friends, not ...
Comparison and Competition                 Avoidance• Comparisons can demotivate• Some people avoid them• Active U    – 1 ...
Unhelpful Responses• “Oh, you are counting calories? That will never  work, you have to count carbs/fat/fiber etc...”• “Oh...
Summary• Benefits of tracking together  – Behavior change  – (Support)  – (Decision-making)• Design Challenges  – Sharing ...
Conclusion• Advice  – Collaborate with complementary experts  – Go deep in fields you cross into  – Learn math and program...
Paul Resnick, "Healthier Together: Social Approaches to Health and Wellness"
Paul Resnick, "Healthier Together: Social Approaches to Health and Wellness"
Paul Resnick, "Healthier Together: Social Approaches to Health and Wellness"
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Paul Resnick, "Healthier Together: Social Approaches to Health and Wellness"

  1. 1. Healthier Together: SocialApproaches to Health and Wellness Paul Resnick
  2. 2. Outline• My Story – Collaborations with people who had complementary expertise• Advice• Social Nudges for Health Behavior
  3. 3. MY STORY
  4. 4. College• Math SB, 1985
  5. 5. Grad School• Computer Science, SM 1988, PhD 1992
  6. 6. LEARNING FROM COLLABORATIONS
  7. 7. Community DevelopmentMel King
  8. 8. Human Factors Bob Virzi
  9. 9. Distributed Systems John Riedl
  10. 10. Law and Policy Larry Lessig
  11. 11. Political ScienceBob Putnam Brendan Nyhan
  12. 12. Saguaro Seminar 1997
  13. 13. Saguaro Seminar 1997
  14. 14. Saguaro Seminar 1997
  15. 15. Saguaro Seminar 1997
  16. 16. Economics Richard Zeckhauser
  17. 17. Economics Eric Friedman
  18. 18. Computer Science TheoryRahul Sami
  19. 19. Social PsychologyBob Kraut Sara Kiesler
  20. 20. CommunityLab
  21. 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. 22. Wisdom from Kurt Lewin“There is nothing so practicalas a good theory”“If you want to understandsomething, try to change it”
  23. 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. 24. SOCIAL NUDGES FOR HEALTHBEHAVIOR CHANGE
  25. 25. THE OBESITY EPIDEMIC
  26. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 53. HealthierTogether.info
  54. 54. Collaborators• Caroline Richardson • Sean Munson• Mark Newman • Debra Lauterbach• Margaret Morris• Erin Krupka
  55. 55. SELF-TRACKINGThe Quantified Self
  56. 56. Sleep
  57. 57. Physical Activity
  58. 58. Food
  59. 59. Moods
  60. 60. + Gamification (Points + Levels)
  61. 61. THE POWER OF SHARING
  62. 62. BEHAVIOR CHANGE:MAKING ACTIVITY FUN
  63. 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. 64. Making the Behavior Social
  65. 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. 66. BEHAVIOR CHANGE:MAKING ACTIVITY REWARDING
  67. 67. Encouragement from Others: Nike+
  68. 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. 69. BEHAVIOR CHANGE:ACCOUNTABILITY TO OTHERS
  70. 70. Feedback from Others
  71. 71. Accountability: Interventions• OneRecovery
  72. 72. Accountability: Monitors• Stickk
  73. 73. Accountability: Social Punishments• Steps Commitments
  74. 74. DETOUR: POWER ANALYSIS ANDEXPERIMENT DESIGN
  75. 75. Experimental Conditions: 2x2• Private commitments and results• Public commitments; private results• Private commitments; public results• Public commitments; public results
  76. 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. 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. 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. 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. 80. BARRIERS TO OVERCOME
  81. 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. 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. 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. 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. 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. 86. Conclusion• Advice – Collaborate with complementary experts – Go deep in fields you cross into – Learn math and programming in grad school – Understand Change

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