Selection by consequences: one unifying principle for a transdisciplinary science of prevention

Variable Magnitude and Frequency Financial Reinforcement is Effective at Increasing Adults' Free-Living Physical Activity

Financial rewards can increase health behaviors, but little research has quantified the effects of different reinforcement schedules on this process. This analysis compares the average moderate-to-vigorous physical activity (MVPA) associated with six distinct positive reinforcement schedules implemented within a physical activity promotion clinical trial. In this trial, participants (N = 512) wore an accelerometer for 1 year and were prescribed one of two types of MVPA goals: a static 30-min goal or an adaptive goal based on the MVPA produced over the previous 9 days. As participants met goals, they transitioned through a sequence of reinforcement stages, beginning with a continuous-fixed magnitude (CRF-FM), then CRF-variable magnitude (CRF-VM), followed by a series of variable ratio-VM (VR-VM) schedules. The average accumulation of MVPA bouts over the last 24 days of each stage was compared to each other. Average MVPA during stage transitions was also examined. The results indicated that immediate reinforcement resulted in more MVPA relative to a comparison group and that the relative effectiveness of adaptive versus static goals was dependent on the magnitude of daily MVPA goals. Schedule effects were qualitatively different for individuals who frequently met their daily goals (Large Intervention Effect subgroup) versus those who did not (Small Intervention Effect subgroup). For the Large Intervention Effect group, the CRF-VM schedule produced the most MVPA, in particular within the adaptive goal condition, with increases observed immediately upon encountering this schedule. In contrast, the CRF-FM schedule produced small amounts of MVPA. This pattern was reversed for the Small Intervention Effect subgroup, where the most MVPA was associated with the CRF-FM stage. Future interventions should focus on discriminating small versus large intervention effects as quickly as possible so that the optimal reinforcement schedule can be used.

Rationale, design, and baseline characteristics of WalkIT Arizona: A factorial randomized trial testing adaptive goals and financial reinforcement to increase walking across higher and lower walkable neighborhoods

Little change over the decades has been seen in adults meeting moderate-to-vigorous physical activity (MVPA) guidelines. Numerous individual-level interventions to increase MVPA have been designed, mostly static interventions without consideration for neighborhood context. Recent technologies make adaptive interventions for MVPA feasible. Unlike static interventions, adaptive intervention components (e.g., goal setting) adjust frequently to an individual's performance. Such technologies also allow for more precise delivery of "smaller, sooner incentives" that may result in greater MVPA than "larger, later incentives". Combined, these factors could enhance MVPA adoption. Additionally, a central tenet of ecological models is that MVPA is sensitive to neighborhood environment design; lower-walkable neighborhoods constrain MVPA adoption and maintenance, limiting the effects of individual-level interventions. Higher-walkable neighborhoods are hypothesized to enhance MVPA interventions. Few prospective studies have addressed this premise. This report describes the rationale, design, intervention components, and baseline sample of a study testing individual-level adaptive goal-setting and incentive interventions for MVPA adoption and maintenance over 2 years among adults from neighborhoods known to vary in neighborhood walkability. We scaled these evidenced-based interventions and tested them against static-goal-setting and delayed-incentive comparisons in a 2 × 2 factorial randomized trial to increase MVPA among 512 healthy insufficiently-active adults. Participants (64.3% female, M age = 45.5 ± 9.1 years, M BMI = 33.9 ± 7.3 kg/m2, 18.8% Hispanic, 84.0% White) were recruited from May 2016 to May 2018 from block groups ranked on GIS-measured neighborhood walkability and socioeconomic status (SES) and classified into four neighborhood types: "high walkable/high SES," "high walkable/low SES," "low walkable/high SES," and "low walkable/low SES." Results from this ongoing study will provide evidence for some of the central research questions of ecological models.

Corrupção e seleção por consequências: uma análise comportamental

Resumo A corrupção é um fenômeno global. Sob os parâmetros teóricos e metodológicos da Análise Comportamental da Cultura, constitui nosso objetivo compor um panorama descritivo-explicativo da corrupção como prática cultural, mediante uma análise funcional de contingências implicadas em sua instalação e manutenção, particularmente no contexto brasileiro. Examinamos as origens etimológicas do termo corrupção, apresentamos um levantamento histórico sobre o tema nas ciências sociais e na Análise do Comportamento, delineamos o modelo de seleção por consequências e analisamos três situações hipotéticas de corrupção: (1) um exemplo de política institucional; (2) um exemplo de corporação privada em relação com o poder público; e (3) um exemplo de corrupção cotidiana. Concluímos apontando possíveis contribuições da Análise Comportamental da Cultura para prevenção e combate a práticas culturais corruptas.

From Dynamics to Function

A vast majority of psychological science focuses on snapshots of individuals. Clinical outcome studies may integrate multiple snapshots, typically with yearly intervals. However, there is much to learn about psychological processes as they unfold over real time, including minutes, days, weeks, and months. This special issue contains several articles that make significant advances in real-time assessment of psychological processes using state-of-the-art measurement. This is a brief summary of the specific innovations of this special issue. The summary includes suggestions for applying these measurement innovations to the study of functional dynamics that lead to clinically and socially significant events. Several examples provide ways in which a dynamical analysis of function may be revealing. Most important, the assessment of dynamic mechanisms underlying the amplification of psychopathology seems especially useful for tailoring clinical interventions to meet clients' specific needs.

Adaptive goal setting and financial incentives: a 2 × 2 factorial randomized controlled trial to increase adults' physical activity

Background

Emerging interventions that rely on and harness variability in behavior to adapt to individual performance over time may outperform interventions that prescribe static goals (e.g., 10,000 steps/day). The purpose of this factorial trial was to compare adaptive vs. static goal setting and immediate vs. delayed, non-contingent financial rewards for increasing free-living physical activity (PA).

Methods

A 4-month 2 × 2 factorial randomized controlled trial tested main effects for goal setting (adaptive vs. static goals) and rewards (immediate vs. delayed) and interactions between factors to increase steps/day as measured by a Fitbit Zip. Moderate-to-vigorous PA (MVPA) minutes/day was examined as a secondary outcome.

Results

Participants (N = 96) were mainly female (77%), aged 41 ± 9.5 years, and all were insufficiently active and overweight/obese (mean BMI = 34.1 ± 6.2). Participants across all groups increased by 2389 steps/day on average from baseline to intervention phase (p < .001). Participants receiving static goals showed a stronger increase in steps per day from baseline phase to intervention phase (2630 steps/day) than those receiving adaptive goals (2149 steps/day; difference = 482 steps/day, p = .095). Participants receiving immediate rewards showed stronger improvement (2762 step/day increase) from baseline to intervention phase than those receiving delayed rewards (2016 steps/day increase; difference = 746 steps/day, p = .009). However, the adaptive goals group showed a slower decrease in steps/day from the beginning of the intervention phase to the end of the intervention phase (i.e. less than half the rate) compared to the static goals group (−7.7 steps vs. -18.3 steps each day; difference = 10.7 steps/day, p < .001) resulting in better improvements for the adaptive goals group by study end. Rate of change over the intervention phase did not differ between reward groups. Significant goal phase x goal setting x reward interactions were observed.

Conclusions

Adaptive goals outperformed static goals (i.e., 10,000 steps) over a 4-month period. Small immediate rewards outperformed larger, delayed rewards. Adaptive goals with either immediate or delayed rewards should be preferred for promoting PA.

Trial Registration

ClinicalTrials.gov ID: NCT02053259 registered prospectively on January 31, 2014.

The Need for a More Effective Science of Cultural Practices

Behavior analysis has produced a robust theoretical analysis of the contingencies involved in cultural evolution. Yet, thus far, the empirical yield of this work remains quite limited. With this paper, I attempt to provide specific examples of the ways to advance an experimental analysis of the contingencies involved in cultural evolution. I begin with a review of the theoretical analyses developed by behavior analysts and other contextually oriented scientists. Next, I submit that, if the goal of our science is both predicting and influencing cultural phenomena, we must produce experimental analyses of the impact of meta-contingencies on organizations' practices. There is no more pressing reason for doing this than the threat of climate change posed by the continuing growth in human use of fossil fuels. Therefore, the paper provides an analysis of the contingencies influencing organizational practices now affecting continued use of fossil fuels and the contingencies for organizations seeking to prevent their use. One concrete step to advance a science of cultural change relevant to climate change would be to create a database of organizations that are promoting vs. working to prevent fossil fuel consumption and the consequences that seem to maintain their practices. I call for experimental analysis of the impact of altering consequences for these practices and for experimental analyses of interventions intended to change the norms, values, and behavior of organizational leaders who can influence fossil fuel consumption. I then discuss the role of prosocial behavior and values in affecting behavior relevant to reducing fossil fuel consumption because the empirical evidence shows that prosociality favors more "green" behavior. Recent advances in prevention research have identified interventions to promote prosociality, but we need experimental analyses of how advocacy organizations can be more effective in getting these interventions widely adopted.

Contextual analysis and the success of translational research

The success of translational research can ultimately be judged by the degree to which it reduces the incidence and prevalence of psychological, behavioral, and physical disorders and the major factors influencing them. In our view, we currently place insufficient emphasis on assessing our impact on the social determinants of disorders. As a result, we are failing to affect the incidence and prevalence of critical disorders. Moreover, translational research fails to take into account the full range of interventions that could significantly reduce the incidence and prevalence of our most pressing disorders. These include policy changes, media, and broad cultural change movements. In this paper, we discuss the momentous achievements the tobacco prevention movement made over the last half-century, describe how the lessons gleaned from this success can apply to other prevention efforts, and contrast this success with progress made in battling other major public health concerns. We call for an expansion of the translational research agenda to develop and evaluate broader and more comprehensive strategies to affect well-being in entire populations.

Heterogeneous dose-response and college student drinking: examining problem risks related to low drinking levels

BACKGROUND AND AIMS

Previous research demonstrates that the number of problems related to each additional drink consumed on any drinking occasion, dose-response, varies non-linearly across average drinking quantities. We test predictions from a dynamic model of drinking behavior that locates this heterogeneity in drinkers' efforts to equilibrate between costs and benefits of use.

DESIGN

Equations derived from the theoretical model are used to assess dose-response across drinking quantity subgroups using censored regressions.

SETTING

Fourteen California, USA, college campuses surveyed from 2003 to 2011.

PARTICIPANTS

A total of 37 762 undergraduate college students 18 years of age and older.

MEASUREMENTS

Drinking patterns, five physiological problems related to alcohol use (hangover, memory loss, medical treatment for overdose, nausea/vomiting, passing out) and student demographics.

FINDINGS

The number of physiological problems related to each additional drink consumed was an inverse function of average drinking quantities (b = 0.2947, Z = 21.92, P<0.001), differed by drinker age (of-age drinker b = -0.1144, Z = -3.95, P < 0.001) and gender (male b = -0.3379, Z = -18.56, P<0.001) and, at the population level, drinking three drinks per occasion was associated with the greatest number of problems.

CONCLUSIONS

Among US college students, all drinkers exhibit greater risks for physiological problems related to alcohol use (hangover, memory loss, medical treatment for overdose, nausea/vomiting, passing out) when drinking greater amounts of alcohol, but heavier drinkers (those who consume more on average) exhibit fewer problems for each additional drink consumed (less dose-response) than light and moderate drinkers. Light and moderate drinkers exhibit greater dose-response, with three drinks per occasion associated with the greatest number of problems.

Prevention of problem behavior through annual family check-ups in early childhood: intervention effects from home to early elementary school

This randomized intervention trial examined the effects of yearly Family Check-Ups (FCUs) and tailored parent management training on parent report of problem behavior from age 2 to 5 years and teacher report of oppositional behavior at age 7.5. A multiethnic risk sample of 731 families in 3 distinct geographical settings who were receiving assistance from the Women, Infants, and Children Nutritional Supplement (WIC) program were randomly assigned to a yearly FCU. Intention to treat (ITT) analyses were used to examine overall intervention effects, and complier average causal effect (CACE) modeling was used to examine the effects of annual intervention engagement in the FCU on parent reports of child problem behavior from age 2 to 5 and teacher reports of problem behavior at age 7.5. ITT intervention effects were found regarding parent report at ages 2 to 5 and teacher report at age 7.5, indicating less growth in problem behavior for children in the intervention group than for those in the control group. CACE modeling of intervention engagement revealed that the effect sizes on parent- and teacher-reported problem behavior increased as a function of the number of yearly FCUs caregivers participated in. Findings suggest that embedding yearly FCU services within the context of social, health, and educational services in early childhood can potentially prevent early-onset trajectories of antisocial behavior. The increases in effect size with successive FCU engagement underscores the importance of a motivational approach to parenting support among high-risk families.

Evolving the future: toward a science of intentional change

Humans possess great capacity for behavioral and cultural change, but our ability to manage change is still limited. This article has two major objectives: first, to sketch a basic science of intentional change centered on evolution; second, to provide examples of intentional behavioral and cultural change from the applied behavioral sciences, which are largely unknown to the basic sciences community. All species have evolved mechanisms of phenotypic plasticity that enable them to respond adaptively to their environments. Some mechanisms of phenotypic plasticity count as evolutionary processes in their own right. The human capacity for symbolic thought provides an inheritance system having the same kind of combinatorial diversity as does genetic recombination and antibody formation. Taking these propositions seriously allows an integration of major traditions within the basic behavioral sciences, such as behaviorism, social constructivism, social psychology, cognitive psychology, and evolutionary psychology, which are often isolated and even conceptualized as opposed to one another. The applied behavioral sciences include well-validated examples of successfully managing behavioral and cultural change at scales ranging from individuals to small groups to large populations. However, these examples are largely unknown beyond their disciplinary boundaries, for lack of a unifying theoretical framework. Viewed from an evolutionary perspective, they are examples of managing evolved mechanisms of phenotypic plasticity, including open-ended processes of variation and selection. Once the many branches of the basic and applied behavioral sciences become conceptually unified, we are closer to a science of intentional change than one might think.

An adaptive physical activity intervention for overweight adults: a randomized controlled trial

Background

Physical activity (PA) interventions typically include components or doses that are static across participants. Adaptive interventions are dynamic; components or doses change in response to short-term variations in participant's performance. Emerging theory and technologies make adaptive goal setting and feedback interventions feasible.

Objective

To test an adaptive intervention for PA based on Operant and Behavior Economic principles and a percentile-based algorithm. The adaptive intervention was hypothesized to result in greater increases in steps per day than the static intervention.

Methods

Participants (N = 20) were randomized to one of two 6-month treatments: 1) static intervention (SI) or 2) adaptive intervention (AI). Inactive overweight adults (85% women, M = 36.9±9.2 years, 35% non-white) in both groups received a pedometer, email and text message communication, brief health information, and biweekly motivational prompts. The AI group received daily step goals that adjusted up and down based on the percentile-rank algorithm and micro-incentives for goal attainment. This algorithm adjusted goals based on a moving window; an approach that responded to each individual's performance and ensured goals were always challenging but within participants' abilities. The SI group received a static 10,000 steps/day goal with incentives linked to uploading the pedometer's data.

Results

A random-effects repeated-measures model accounted for 180 repeated measures and autocorrelation. After adjusting for covariates, the treatment phase showed greater steps/day relative to the baseline phase (p<.001) and a group by study phase interaction was observed (p = .017). The SI group increased by 1,598 steps/day on average between baseline and treatment while the AI group increased by 2,728 steps/day on average between baseline and treatment; a significant between-group difference of 1,130 steps/day (Cohen's d = .74).

Conclusions

The adaptive intervention outperformed the static intervention for increasing PA. The adaptive goal and feedback algorithm is a “behavior change technology” that could be incorporated into mHealth technologies and scaled to reach large populations.

Trial Registration

ClinicalTrials.gov NCT01793064

A Framework for Intentional Cultural Change

We present a framework for a pragmatic science of cultural evolution. It is now possible for behavioral science to systematically influence the further evolution of cultural practices. As this science develops, it may become possible to prevent many of the problems affecting human wellbeing. By cultural practices, we refer to everything that humans do, above and beyond instinctual or unconditioned behaviors: not only art and literature, but also agriculture, manufacturing, recreation, war making, childrearing, science-everything. We can analyze cultural practices usefully in terms of the incidence and prevalence of individual behavior and group and organization actions. An effective science of intentional cultural evolution must guide efforts to influence the incidence and prevalence of individuals' behaviors and the actions of groups and organizations. In this paper, we briefly sketch advances in scientific understanding of the influences on individual behavior. Then we describe principles that could guide efforts to influence groups and organizations. Finally, we discuss legitimate concerns about the use and misuse of a science for intentional cultural change.

An ecological analysis of the effects of deviant peer clustering on sexual promiscuity, problem behavior, and childbearing from early adolescence to adulthood: an enhancement of the life history framework

The authors propose that peer relationships should be included in a life history perspective on adolescent problem behavior. Longitudinal analyses were used to examine deviant peer clustering as the mediating link between attenuated family ties, peer marginalization, and social disadvantage in early adolescence and sexual promiscuity in middle adolescence and childbearing by early adulthood. Specifically, 998 youths, along with their families, were assessed at age 11 years and periodically through age 24 years. Structural equation modeling revealed that the peer-enhanced life history model provided a good fit to the longitudinal data, with deviant peer clustering strongly predicting adolescent sexual promiscuity and other correlated problem behaviors. Sexual promiscuity, as expected, also strongly predicted the number of children by ages 22-24 years. Consistent with a life history perspective, family social disadvantage directly predicted deviant peer clustering and number of children in early adulthood, controlling for all other variables in the model. These data suggest that deviant peer clustering is a core dimension of a fast life history strategy, with strong links to sexual activity and childbearing. The implications of these findings are discussed with respect to the need to integrate an evolutionary-based model of self-organized peer groups in developmental and intervention science.

The role of parents and related factors on adolescent computer use

Background

Research suggested the importance of parents on their adolescents’ computer activity. Spending too much time on the computer for recreational purposes in particular has been found to be related to areas of public health concern in children/adolescents, including obesity and substance use.

Design and Methods

The goal of the research was to determine the association between recreational computer use and potentially linked factors (parental monitoring, social influences to use computers including parents, age of first computer use, self-control, and particular internet activities). Participants (aged 13-17 years and residing in the United States) were recruited via the Internet to complete an anonymous survey online using a survey tool. The target sample of 200 participants who completed the survey was achieved. The sample’s average age was 16 and was 63% girls.

Results

A set of regressions with recreational computer use as dependent variables were run.

Conclusions

Less parental monitoring, younger age at first computer use, listening or downloading music from the internet more frequently, using the internet for educational purposes less frequently, and parent’s use of the computer for pleasure were related to spending a greater percentage of time on non-school computer use. These findings suggest the importance of parental monitoring and parental computer use on their children’s own computer use, and the influence of some internet activities on adolescent computer use. Finally, programs aimed at parents to help them increase the age when their children start using computers and learn how to place limits on recreational computer use are needed.

Corporate externalities: a challenge to the further success of prevention science

The full benefit of prevention science will not be realized until we learn how to influence organizational practices. The marketing of tobacco, alcohol, and food and corporate advocacy for economic policies that maintain family poverty are examples of practices we must influence. This paper analyzes the evolution of such practices in terms of their selection by economic consequences. A strategy for addressing these critical risk factors should include: (a) systematic research on the impact of corporate practices on each of the most common and costly psychological and behavior problems; (b) empirical analyses of the consequences that select harmful corporate practices; (c) assessment of the impact of policies that could affect problematic corporate practices; and (d) research on advocacy organizations to understand the factors that influence their growth and to help them develop effective strategies for influencing corporate externalities.

INTEGRATED MODELS OF SCHOOL-BASED PREVENTION: LOGIC AND THEORY

School-based prevention programs can positively impact a range of social, emotional, and behavioral outcomes. Yet the current climate of accountability pressures schools to restrict activities that are not perceived as part of the core curriculum. Building on models from public health and prevention science, we describe an integrated approach to school-based prevention. These models leverage the most effective structural and content components of social-emotional and behavioral health prevention interventions. Integrated interventions are expected to have additive and synergistic effects that result in greater impacts on multiple student outcomes. Integrated programs are also expected to be more efficient to deliver, easier to implement with high quality and integrity, and more sustainable. We provide a detailed example of the process through which the PAX-Good Behavior Game and the Promoting Alternative Thinking Strategies (PATHS) curriculum were integrated into the PATHS to PAX model. Implications for future research are proposed.

The Role of Advocacy Organizations in Reducing Negative Externalities

An externality is a cost that a corporation's actions impose on society. For example, a power plant may emit mercury, but might not pay for the cost of that pollution to the people living near the plant. It is possible to analyze a diverse range of problems of society in these terms, including the health effects of corporate practices, the unsustainability of manufacturing processes, and marketing of products contributing to environmental damage, and economic policies that maintain high levels of poverty due to effective lobbying by the business community. This paper examines the problem of externalities in terms of metacontingencies. Externalities continue precisely because there is no cost to the organizations for practices that impose these costs on third parties. The paper describes the cultural practices needed to influence governments are motivated to make corporations bear the true costs of their practices-costs that are currently imposed on others.

Evolving prosocial and sustainable neighborhoods and communities

In this review, we examine randomized controlled trials of community interventions to affect health. The evidence supports the efficacy of community interventions for preventing tobacco, alcohol, and other drug use; several recent trials have shown the benefits of community interventions for preventing multiple problems of young people, including antisocial behavior. However, the next generation of community intervention research needs to reflect more fully the fact that most psychological and behavioral problems of humans are interrelated and result from the same environmental conditions. The evidence supports testing new comprehensive community interventions that focus on increasing nurturance in communities. Nurturing communities will be ones in which families, schools, neighborhoods, and workplaces (a) minimize biologically and socially toxic events, (b) richly reinforce prosocial behavior, and (c) foster psychological acceptance. Such interventions also have the potential to make neighborhoods more sustainable.

Acceptance and commitment: implications for prevention science

Recent research in behavior analysis and clinical psychology points to the importance of language processes having to do with the control of negative cognition and emotion and the commitment to valued action. Efforts to control unwanted thoughts and feelings, also referred to as experiential avoidance (EA), appear to be associated with a diverse array of psychological and behavioral difficulties. Recent research shows that interventions that reduce EA and help people to identify and commit to the pursuit of valued directions are beneficial for ameliorating diverse problems in living. These developments have the potential to improve the efficacy of many preventive interventions. This paper reviews the basic findings in these areas and points to some ways in which these developments could enhance the impact of preventive interventions.

The spatial ecology of alcohol problems: niche theory and assortative drinking

AIMS

This paper summarizes several theoretical perspectives that serve to explain observed associations between concentrations of alcohol outlets and alcohol-related problems. A critique of each perspective discusses how each addresses the social etiology of these problems; that is, how, where and why these problems arise in association with alcohol outlets?

METHODS

This theoretical work is based upon mathematical and computational models of the ecology of alcohol-related problems developed in the 'Ecosystems Modeling Project', an advanced research project of the National Institute on Alcohol Abuse and Alcoholism, United States.

RESULTS

Associations between outlets and problems are thought to arise from the concentration of individuals in drinking places ('flow models'), the attraction of some places for people at risk for problems ('gravity models'), or because outlets are located in high-risk neighborhoods and have negative social normative effects ('social contextual models'). None of these approaches explain how some outlets come to have more problems than others (e.g. violent outlets). An alternative social ecological model is introduced which asserts that the complementary processes of niche marketing and assortative drinking form the social dynamic that explains these relationships. Alcohol sellers 'niche market' to select social strata, drinkers return to establishments at which they find people like themselves, and consequent social stratification of the market-place increases the levels of related problems in some outlets.

CONCLUSIONS

The proposed mechanism is very general, and suggests that over-concentrations of outlets will lead to stratification of drinking groups and intensification of problems related to those outlets.