1. Healthier Together: Social
Approaches 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
Development
Mel King

8. Human Factors
Bob Virzi

9. Distributed Systems
John Riedl

10. Law and Policy
Larry Lessig

11. Political Science
Bob Putnam Brendan Nyhan

12. Saguaro Seminar 1997

13. Saguaro Seminar 1997

14. Saguaro Seminar 1997

15. Saguaro Seminar 1997

17. Economics
Richard
Zeckhauser

18. Economics
Eric Friedman

19. Computer Science Theory
Rahul Sami

20. Social Psychology
Bob Kraut Sara Kiesler

21. CommunityLab

23. 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

25. Wisdom from Kurt Lewin
“There is nothing so practical
as a good theory”
“If you want to understand
something, try to change it”

26. Advice
• Collaborate with complementary experts
• Go deep in fields you cross into
– (not necessarily broad)
• Learn math and programming in grad school
• Understand Change

27. SOCIAL NUDGES FOR HEALTH
BEHAVIOR CHANGE

28. THE OBESITY EPIDEMIC

29. 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

30. Obesity Trends* Among U.S. Adults
BRFSS, 1985
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%

31. Obesity Trends* Among U.S. Adults
BRFSS, 1986
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%

32. Obesity Trends* Among U.S. Adults
BRFSS, 1987
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4”
person)
No Data <10% 10%–14%

33. Obesity Trends* Among U.S. Adults
BRFSS, 1988
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%

34. Obesity Trends* Among U.S. Adults
BRFSS, 1989
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%

35. Obesity Trends* Among U.S. Adults
BRFSS, 1990
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%

36. 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%

37. 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%

38. 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%

39. 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%

40. 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%

41. 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%

42. 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%

43. 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%

44. 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%

45. 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%

46. 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%

47. 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%

48. 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%

49. 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%

50. 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%

51. 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%

52. 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%

53. 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%

54. 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%

55. 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%

56. HealthierTogether.info

57. Collaborators
• Caroline Richardson • Sean Munson
• Mark Newman • Debra Lauterbach
• Margaret Morris
• Erin Krupka

58. SELF-TRACKING
The Quantified Self

59. Sleep

60. Physical Activity

61. Food

62. Moods

63. + Gamification (Points + Levels)

64. THE POWER OF SHARING

65. BEHAVIOR CHANGE:
MAKING ACTIVITY FUN

66. Team Quests
Buis, 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.

67. Making the Behavior Social

68. 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

69. BEHAVIOR CHANGE:
MAKING ACTIVITY REWARDING

70. Encouragement from Others: Nike+

71. 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

72. BEHAVIOR CHANGE:
ACCOUNTABILITY TO OTHERS

73. Feedback from Others

74. Accountability: Interventions
• OneRecovery

75. Accountability: Monitors
• Stickk

76. Accountability: Social Punishments
• Steps Commitments

77. DETOUR: POWER ANALYSIS AND
EXPERIMENT DESIGN

78. Experimental Conditions: 2x2
• Private commitments and results
• Public commitments; private results
• Private commitments; public results
• Public commitments; public results

79. 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?

80. 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

81. 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!

82. 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

83. BARRIERS TO OVERCOME

84. Embarrassment
“I got people, you know, from my high school
that I am friends with that I haven't talked to
in 25 years. And I have no desire for them to
know about my weight issues or weight status.”
“… I did not put that on because I didn't want
everybody on Facebook knowing that my butt
muscle hurt today.”
Newman, M. W., D. Lauterbach, S. A. Munson, P. Resnick and M. E. Morris (2011). It's not
that i don't have problems, I'm just not putting them on Facebook: challenges and
opportunities in using online social networks for health. Proceedings of the ACM 2011
conference on Computer supported cooperative work. Hangzhou, China, ACM: 341-350.

85. Spamming
“…mostly when I make things private, it’s more
because I think they’d be boring or
insignificant to my friends, not because they’re
actually things I wouldn’t want my
friends to know about. I just don’t want to clog up
their Facebook with it.”
Munson, S., D. Lauterbach, M. Newman and P. Resnick (2010). Happier
Together: Integrating a Wellness Application into a Social Network Site.
Persuasive Technology. T. Ploug, P. Hasle and H. Oinas-Kukkonen, Springer
Berlin / Heidelberg. 6137: 27-39.

86. 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 team
Buis, 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.

87. Unhelpful Responses
• “Oh, you are counting calories? That will never
work, you have to count carbs/fat/fiber etc...”
• “Oh, come on, it's a birthday party, you can
have ONE piece of cake...”
• “Oh, you're fine the way you are, your
husband loves you anyway, why put yourself
through this?”
From
http://www.sparkpeople.com/resource/article_comments.asp?id=87&type=1

88. 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

89. Conclusion
• Advice
– Collaborate with complementary experts
– Go deep in fields you cross into
– Learn math and programming in grad school
– Understand Change