John A. List and Anya C. ( Savikhin ) Samak

1. The Behavioralist as Dietician: Leveraging Behavioral Economics to Improve Child Food Choice and Consumption John A. List and Anya C. (Savikhin) Samak Thanks to the Greater Chicago Food Depository and the Kenneth and Anne Griffin Foundation for generous funding of this research. The views expressed in this paper do not represent the views of our funding sources. November, 2012

2. MOTIVATION | FIELD EXPERIMENT | RESULTS | CONCLUSIONS & IMPLICATIONS Need to Address Decision-Making by Children and Adolescents • Tendency to consume an unhealthy diet is learned at a young age (Smith and Tasnadi, 2007) • Lack of proper nourishment, such as not meeting RDA for F/V, affects health and hampers growth, can result in poor school performance (Whitaker et al., 2006) • 17% of nation’s youth have BMI at or above recommended 95th percentile (NIH, 1998) • Children from low income familiesare at higher risk! • Teachable moment: children consume food outside of the home on a regular basis • Lunch • USDA sponsored food programs (low income)

3. MOTIVATION | FIELD EXPERIMENT | RESULTS | CONCLUSIONS & IMPLICATIONS Role of Behavioral Approach • Incentives can Motivate Behavior Change • Agents value even small incentives to shift health behavior – weight loss, smoking cessation (Volpp et al., 2008; 2009) • Value of incentives for child food choice (Just and Price, 2011) • Gain and Loss Framing • According to Kahneman and Tversky’s (1991) model of loss aversion, incentives framed as losses are more effective than incentives framed as gains • Long-term impact • Negative rebound effect (Lepper et al., 1973) • Habit formation (Gneezy et al., 2011) • Educational Messages • Long-term, in-depth educational interventions have some effect • Simple verbal prompts have effect (Schwartz, 2007; Perry, 2004)

4. MOTIVATION | FIELD EXPERIMENT | RESULTS | CONCLUSIONS & IMPLICATIONS Field Experiment • Kids Cafe program – after school program in low-income areas of Chicago, including suburbs • Majority of children in these areas eligible for the Free or Reduced School Lunch Program • Sites are at schools, community centers, churches • 1,616 separate participants ages 6 to 18 across 24 different sites • Kids visit daily, several times a week, or sporadically • Two phases: February-March, 2011; April-May, 2011 • Experimenters (3-6 per site) visited 2x per week and asked children to choose between 1 cookie or 1 dried fruit cup

5. MOTIVATION | FIELD EXPERIMENT | RESULTS | CONCLUSIONS & IMPLICATIONS Meeting Daily Fruit Requirements Daily Fruit Intake (24-Hour Recall)

6. MOTIVATION | FIELD EXPERIMENT | RESULTS | CONCLUSIONS & IMPLICATIONS On-Site Procedures • “Framed” field experiment in the sense that participants know they are in an experiment (Harrison and List, 2004) • Choice is made after the “meal” is served and children have ID stickers on • Experimenter reads the standard message • At least one of each is always available • Can only choose one • Cannot share it • Should eat it on site (can’t take it with) • Site can’t keep the remaining desserts to serve on other days • Experimenter reads treatment-specific message (if any) • Experimenters record child’s ID, choice, and consumption

7. MOTIVATION | FIELD EXPERIMENT | RESULTS | CONCLUSIONS & IMPLICATIONS Field Experiment Design • Summary of Treatments 2x per week – 9 times total B, T, T, T, T, T, B, B, B 2x per week – 5 times total B, T, B, B, B Choice of Fruit Cup or Cookie Get a prize for eating Fruit Educational message Combination Treatment

8. MOTIVATION | FIELD EXPERIMENT | RESULTS | CONCLUSIONS & IMPLICATIONS Incentives – “Gain Frame” • If you choose the dried fruit cup, and eat all of it today, you will also get to pick a gift immediately after you finish eating it! You can choose ONE of these gifts.

9. MOTIVATION | FIELD EXPERIMENT | RESULTS | CONCLUSIONS & IMPLICATIONS “Loss Frame” • “But before you choose a dessert, you should come up and pick a gift. You can choose ONE of these gifts.” • “We’ll put the gift in a closed box for you with your name on it, and you get to take it back to your table.” • “If you eat the fruit cup, we’ll open the box for you and you will keep the gift you picked up.” • “If you don’t finish eating all of it, you will have to give the box back to us and you will not keep the gift you picked…”

10. MOTIVATION | FIELD EXPERIMENT | RESULTS | CONCLUSIONS & IMPLICATIONS Short Education Message • Based on USDA Requirements • …the Food Pyramid…reminds us to make healthy food choices. Do you notice that some of the stripes are wider than others? The different sizes remind you to choose foods from the widest stripes… • Eating just one new, good thing everyday will make a big difference! • The fruits group has a pretty wide stripe… • What about cookies? Cookies aren’t on the pyramid…

11. MOTIVATION | FIELD EXPERIMENT | RESULTS | CONCLUSIONS & IMPLICATIONS Result Summary – “Short” Sessions

12. MOTIVATION | FIELD EXPERIMENT | RESULTS | CONCLUSIONS & IMPLICATIONS Result Summary – “Long” Sessions

13. MOTIVATION | FIELD EXPERIMENT | RESULTS | CONCLUSIONS & IMPLICATIONS Period 1 versus Period 2 • Comparing a “baseline” visit to a “treated” visit • Compare both “between subject” and “within subject” to test for treatment effects

14. MOTIVATION | FIELD EXPERIMENT | RESULTS | CONCLUSIONS & IMPLICATIONS Baseline and Treatment Comparison • Result 1: Incentives significantly increase the proportion of children selecting fruit

15. MOTIVATION | FIELD EXPERIMENT | RESULTS | CONCLUSIONS & IMPLICATIONS Comparing the Incentives • Result 2: The gain and loss treatment are equally effective at moving children to choose the healthy option • Result 3: Education alone does not have a significant effect, but education paired with incentive is more effective than education alone

16. MOTIVATION | FIELD EXPERIMENT | RESULTS | CONCLUSIONS & IMPLICATIONS Consumption • Direct link between choice of food to consumption cannot be taken for granted • Example: Just et al. (2011) find that in the lunchroom, over 44% of items taken by students are wasted • We provide a link between selection and consumption • We have detailed consumption data for 73% of choices on average – level of 1/4s

17. MOTIVATION | FIELD EXPERIMENT | RESULTS | CONCLUSIONS & IMPLICATIONS Proportion Consumed • Result 4: The loss treatments result in increased consumption of fruit more than the gain incentive, but the education treatment results in a decreased consumption of fruit relative to baseline

18. MOTIVATION | FIELD EXPERIMENT | RESULTS | CONCLUSIONS & IMPLICATIONS Summary of Findings • Incentives are very effective in the short-term (immediate) in increasing both fruit choice and consumption • Incentives provide a reduction in food waste compared to education alone • Gain and loss frame incentives similar in value • Incentives combined with education most effective • No ‘rebound’ effect; could be implemented at relatively low cost in practice

19. White Milk vs. Chocolate • Utility-maximizing individual makes tradeoff between • Expected enjoyment of food eaten in the present • Expected future potential health consequences • Present and future • Individuals generally discount the future • Health consequences take time to appear • Facing uncertainty • May be unsure about taste (if haven’t tasted recently) • May be unsure about health benefits/consequences • Health consequences not tied directly to one consumption

20. MOTIVATION | FIELD EXPERIMENT | RESULTS | CONCLUSIONS & IMPLICATIONS Summary of Treatments • Effect of different prompts in the school lunch-line • “healthy” – changes belief about future benefit • “tasty” – changes belief about current benefit • Incentive – changes current benefit directly

21. Stats Number of Schools: 9 Separate Kids: 2,200 Milk Consumed: 690 gallons Total Trays Weighed: 19,000

22. K-3rd versus 4th-8th

23. Summary of Preliminary Results • All prompts significantly increase white milk choice in round 1 • Incentives more effective than prompts • Health and Taste prompts work for younger children • Taste and Prompt, but not Health, works for older children • Prompt effectiveness decreases over time (as expected – children form greater beliefs)

24. Future Work • Effect of incentivizing parents vs. children to improve child food choice • Effect of coupons and pre-commitment at grocery stores in ‘food deserts’ • Changing the incentives in the ‘a la carte’ line

25. Thank you! Anya C. Samak asamak@wisc.edu

26. MORE INFORMATION Timeline of Implementation

27. MORE INFORMATION Fruits and Cookies Served

28. MOTIVATION | FIELD EXPERIMENT | RESULTS | CONCLUSIONS & IMPLICATIONS | RELATED WORK Demographics & Food Security • Have data on 280 children across all sites • Food security, Child age • Low Income