Appendix M

Behavioral Approaches in WIC as a Potential Action

The decision tree in Chapter 5, Figure 5-1, includes behavioral approaches as a possible option for addressing low consumption of nutrients or food groups. Behavioral approaches may overcome some challenges that prevent individuals from making the choice that best aligns with the Dietary Guidelines for Americans (DGA). These approaches to reducing cognitive load (the amount of information that must be processed at one time) have been demonstrated to improve individual food choice behavior.

Consumers frequently behave in ways (e.g., make decisions about foods) that contradict standard assumptions of economic theory (Just and Payne, 2009). Individuals often exhibit biases, a prime example being loss aversion (Kahneman and Tversky, 1984), when making choices. Loss aversion refers to the tendency to treat losses differently than gains, that is, people will pay less for an object they do not already have compared to what they will accept to give that object up. People also exhibit a tendency to remain within the status quo, even if choosing an alternative action seems clearly better. The implication for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is that there may be ways to frame food package choices to influence participant decisions, for example to make the breastfeeding package the status quo or “default” choice, or alternatively, to make it clear that when one chooses the partial or nonbreastfeeding package, the mother receives less food. There is evidence to suggest that, when individuals select new goods, they tend to focus on utilitarian characteristics (functional features of a good; an example for food is “healthful”). However, when individuals decide what to give up, they focus instead on hedonic characteristics (experiential features of a

good; an example for food is taste) (Dhar and Wertenbroch, 2000; USDA/ERS, 2007). Thus, individuals might be willing to consider healthfulness when adding foods to their diet, but be less willing to give up a food that is perceived as tasting good. In the context of WIC, an example would be a greater willingness to add low-fat yogurt compared to giving up higher-fat milk. The U.S. Department of Agriculture’s Economic Research Service (USDA-ERS) also reviewed research showing that specific cues (i.e., appearance, brand, name, price, and information) can influence product choices, which may be relevant for the labeling of food items (USDA/ERS, 2007).

Additionally, there is considerable evidence from the field of behavioral economics that the present time is valued more than future time and that individuals respond differently when asked what they would trade “now” for $10 provided in 2 weeks compared to what they would trade 1 month from now for $10 provided in 6 weeks (Loewenstein, 1988).¹ In the context of this decision being faced by a new WIC woman participant, the trade-off would be what the participant might receive now compared to the value of what would be received later. The choice now is the value of 806 fluid ounces of formula right away and less food in her package compared to the value of the breastfeeding package now (extra food in the package for the mother and nothing for the infant). The option (choice) later in the period of 6 to 12 months from now is the relatively lower value of the formula package but no benefits for the mother compared to the value of the breastfeeding package (maternal food and some additional food [meats] for the infant). The participant might be inclined to select the breastfeeding package at higher rates than if she had made the decision at some point before the baby was born, over both choices that occur in the future. Recommitment has been suggested as a strategy to address this tendency, or present bias. In the WIC program, periodic WIC office visits and breastfeeding peer counseling offer participants continuing opportunity for (re)commitment.

Although the field of behavioral economics is relatively new, there is evidence from intervention studies that indicates that incentives can induce behavior change. For example, the Health Incentives Pilot study conducted in Massachusetts provided Supplemental Nutrition Assistance Program recipients with an additional benefit of 30 cents for every dollar spent on specific vegetables and fruits. Participants who received the benefits consumed 26 percent more of the targeted vegetables and fruits compared to the group that did not receive the extra benefit (USDA/FNS, 2014). A number of other behavioral economics studies of potential relevance to

__________________

¹ There is a body of literature that suggests food assistance recipients consume more of their allotment right around the time the benefits are disbursed (e.g., Wilde and Ranney, 2000). One explanation for this is that recipients have a high personal discount rate and value the present much more than the future.

WIC are currently under way, funded through the Behavioral Economics Research Center at Duke University (BECR, 2016). Outcomes of this and future work may yield practically applicable strategies for improving WIC participant redemption and intake of foods provided in the food packages.

REFERENCES

This page intentionally left blank.