Category Archives: Tina Rosenberg

Two recent articles on the importance of groups for health

Flickr/EdsonHong

Tina Rosenberg (author of the recently blogged about Join the Club) had two recent opinion pieces in the New York Times in November on how groups play a key role in healthy outcomes.

One “Fixes: For Weight Loss, a Recipe of Teamwork and Trust” (11/15/11) focuses on how patients are much more successful in trying to lose weight when they are in groups.

Another “Fixes: At a Big Church, a Small Group Health Solution”
discusses how Saddleback Church (also featured in Bob Putnam and Lew Feldstein’s Better Together) uses small-groups to encourage more healthy lifestyles of their members.

Tip o’ the hat to Lew Feldstein for these articles.

Peer pressure as social cure; Rosenberg’s “Join The Club”

Pulitzer Prize-winning journalist, MacArthur “genius grant” winner and New York Times magazine writer Tina Rosenberg has a new engaging book out called “Join The Club: How Peer Pressure Can Transform the World” about how peer groups and their social ties can be used to cure social problems (“the social cure”).
She chronicles peer groups that spread information and promote positive lifestyles for group members; examples include how Florida fought teen smoking through teen groups taking on tobacco companies through the Truth Campaign; how students effectively protested against Serbian dictator Milosevic by using street theater in a group called Otpor; how LoveLife, a peer group in S. Africa, made AIDS awareness part of an aspirational lifestyle for teens; how the Chicago-based Willow Creek Community Church tries to change lives over small neighborhood-based Table groups; how a village-health worker group in Jamkhed, India is teaching Untouchables to have self-respect; how a peer-based group successfully taught calculus to poor Latino students (“Emerging Scholars“) through nightly study groups; and even how a community drop-in center in Brixton, England for Muslim teens might be effective in anti-terrorism efforts in the UK.
We applaud Ms. Rosenberg on her campaign although much of this “social cure” is old wine in new bottles. Sociologists have known for a long time how social settings can effect our choices for good or ill (see experiments of Asch or Milgram).  And many groups for a long time have thus used the power of peers to increase their effectiveness.
This is after all why many weight loss groups are formed (because the social bonds help people keep weight loss promises) or why Al-Anon uses 12-step group methods to overcome addictions; it is why micro-lending programs (like the Grameen Bank) are organized in groups (to increase repayment rates).
Basically these groups are using social capital.  Social Capital achieves its impact through five main paths: 1) providing increased access to information (like learning of potential project partners or job leads); 2) providing increased sense of meaning that individuals find from social engagement; 3) developing stronger group social norms (e.g., I do something that I might not on my own because I’m worried about my social standing in the group) that members feel pressure to conform to; 4) aiding reciprocity (e.g., I do something for someone else in the group now without expecting any immediate repayment because I expect that they, or someone else will do something for me down the road); and 5) the facilitation of collective action (just jargon for saying it makes it easier to do things that require collaboration and concerted response).  The power that Rosenberg finds in “peer pressure” in these various groups is primarily a function of these paths.
For example, people in a weight loss group stick to their weight loss regimen better because they care about others in the group and what they think and they worry that they will sacrifice these friendships or be embarrassed if they have to admit in the group what caloric foods they snacked on or how they missed their weight loss target.
What is perhaps new or unusual about the book is the acknowledgement of the role of marketing and Rosenberg’s belief that the message has to be positive.
First, marketing can be a powerful reinforcer of group ties and social norms and the desire to be in a group in the first place.  In the South African , although AIDS awareness was a primary goal of LoveLife, they didn’t wear this on their sleeve.  Countless billboards, public service announcements, games and concerts got teens convinced that being part of LoveLife was important.  Teens often exhibit flock tendencies, where the desire of doing something rises as the number of your peers are doing this as well.  LoveLife benefited from this, and AIDS awareness was a less visible but core part of the LoveLife message.  It’s unclear what the relative weights were on the attractive message and marketing, the friendships, and the social norms in what got people to join, stay with and achieve LoveLife goals.
A second one of Rosenberg’s messages is that the approach has to be positive and not based out of fear.  One has to make joining hip and fun rather than like castor oil or broccoli.   We argued something similar in the BetterTogether report.
As Rosenberg notes, “If you want to help someone change their behavior to accomplish a social goal, don’t give them new information and don’t use appeals based on fear. The most effective way is to provide them with a new peer group of people who they can identify with and who can hold them accountable. If you can get people to be active and to overcome their fear, fatalism and passivity, then you’ve gone a long way towards what you want to do.” Rosenberg acknowledges that she didn’t invent the power of groups, but she thinks they could be more widely used and enhanced with these positive lifestyle messages, maybe even for something like tackling global warming.  This approach has its merits, although it should be noted that there are many successful groups like “Mothers Against Drunk Driving” (MADD) that were not about forming a positive lifestyle “Mothers For Sober Drivers” but aligned in their opposition to an evil, so it’s not clear that Rosenberg’s “be positive” message helpfully describes what efforts succeed or fail.

Rosenberg believes there are limits to the “peer pressure” approach. It is time-consuming and she thinks it is less effective at persuasive education about societal facts and trends.

Rosenberg acknowledges that “peer pressure” has gotten its bad image because much of what teens use social pressure to enhance are negative goals: pressure others to buy Ugg boots or silly bandz, or bully an unpopular schoolmate, or pressure other teens to use drugs.  Although she stresses that outside groups (non-profits or government) could use this peer pressure for good, corporations or non-profits could just as well use it for negative ends, something that we openly admit in our writings and Bob (Putnam) has discussed in Bowling Alone.  And social groups might help promote goals about which there is societal disagreement:  teens might be urged to join small religious groups to promote”covenant marriage” (sticking with a marriage even when things get really bad) or to put pressure on teens not to get an abortion, or a corporation might use social networks to sell more products.

Social Capital Nudges [UPDATED 3/27/13]

In Cass Sunstein and Richard Thaler‘s wonderful book Nudge (2008), they note that individuals’ choices can be influenced by countless factors that people are unaware of (where food is positioned in a cafeteria or a grocery store, what the default settings are on an iPhone, whether programs like retirement contributions are opt-out or opt-in, etc.).  The authors advocate libertarian paternalism: that American leaders be choice architects, trying to arrange society so that Americans maximize good outcomes, but enabling Americans to opt out of these arrangements if they disagree.

Reading the book made me wonder how “choice architects” trying to maximize social capital (social interaction) or civic engagement in society would arrange affairs.

1) Physical space: Architects, as Nudge points out, often are choice architects.  Architects can influence anything from how comfortable we are in our homes or communities to how efficiently we move, to how much we interact.  On the latter, think about front porches or stoops, walkable streets, vibrant public squares, or farmers’ markets as only a few examples of this.  The Forum at Harvard Kennedy School (where public and private leaders come to give talks) was designed based on the Roman Forum and Greek agorae.  It has little nooks along staircases that take you to higher floors, maximizing the chances for interacting, encountering others and conversing.  Of course there are limits to this, as can be seen in “Social Capital and New Urbanism: Leading a Civic Horse to Water?

2) Asking people their intentions in advanceNudge points out that asking people about their intentions (“priming”), increases their chance of doing so.  See this earlier blog post about asking people of their intention to vote to increase voting.   One can also increase the likelihood of voting by having them draw a map of how to get from their home to their voting location.  One wonders what other civic actions we could effectively prime: volunteering, attending a public meeting that discussed town affairs, joining a group, attending a block party, etc.

3) Social norming:  I’ve written about this earlier, but publicizing that most people do things differently than individuals expect can nudge people toward the actual norm. For example, administrators  found that describing the actual infrequency of  college binge drinking (lower than what most college students had believed), lowered the rate of binge drinking further among those who were binge drinking. What are the opportunities to capitalize on this for civic engagement.  We could observe that 40% of Americans attend a house of worship weekly or more frequently and close to three quarters attend at least monthly. We could tell Americans that 62 million fellow Americans volunteer, contributing 8 billion hours of volunteer service worth $162 billion.  And there are undoubtedly other facts we should bring to their attention to increase civic behavior.  [One does have to worry that the folks who are doing a civic behavior far more than the average may be induced to lower their behavior.]  [For an article on social norming, see Tina Rosenberg, ‘The Destructive Influence of Imaginary Peers“, New York Times, 3/27/13]

Another example of this is OPower that is trying to induce people to use less electricity by pointing out how energy conscious their neighbors are.

4) Offer rewards for civic behavior?  We might provide a deduction on health insurance rates for those participating in community groups (a la Samaritan Ministries’ self-insurance or discounts for health club memberships). Similarly, neighborhood stores might offer discounts or coupons for students engaged in regular community service.  Tax deductions are likely more controversial.

5) Civility check: Sunstein/Thaler recommend in Nudge an invention that detects an uncivil e-mail that a user is considering sending and asks the user if he/she is willing to have a 12 hour cooling off period and see if he/she still wants to send the message as is.  [This is reminiscent of Google Mail Goggles which was set up to avoid people sending embarrassing e-mails when drunk.]

6) Get civic commitments up front: Nudge highlights the effectiveness of getting individuals to commit to take action and depositing monthly checks with a third party.  For every month that this commitment is not honored, a group reviled by this individual gets a contribution.  So for example, an advocate of women’s right to choose would deposit checks with this third party made out to the National Right to Life.  She would  vow to attend a book group every month or conversely to attend a church committee’s meetings each month.  Any month that she did attend, her check for that month would be ripped up.  Any month that she didn’t attend, her check would be sent to the NRL.

7) Using groups to reinforce promises:  Many studies have found that commitments made to groups are more likely to be honored.  That is why AlAnon or Weight Loss Groups or Self-Help groups have groups at their core.  We should pursue opportunities like the New Year’s Nudge to encourage people to stick to commitments and might have a Pledge Day where people pledged to take certain pro-civic or pro-social capital activities over the next year.

8) Hanging around other civic types: In James Fowler’s  and Nick Christakis’ Connected, they detail how many social practices are spread through social networks (drinking, depression, obesity, etc.).  It appears from their research that hanging around others who are civic works in the same way;  part of this effect may be the “social norming” effect described earlier, that being around lots of civicly active people changes one’s reference group for citizenship in the same was as being surrounded by overweight people changes one’s sense of how heavy or thin one is.

9) Behavioral placement.  Public health advocates like Jay Winsten were very successful in getting television shows to popularize behavior like “designated drivers.”  More recently, television programs have interwoven wellness behaviors (like exercise or eating right) into show themes.  These may be more effective since a viewer observes a character that the viewer likes or respect undertaking these behaviors.  (Note: it may not be advisable to have Homer Simpson displaying the civic behavior you want to encourage.)

10) metering people’s health and happiness benefits from civic engagement.  Not sure that the studies of the links between social capital and health and social capital and happiness are finely enough calibrated, but it is clear that people alter their behavior in response to more immediate feedback (e.g., the instantaneous MPG feedback on Toyota Priuses or on some GPS devices, the smart meter readouts in some homes of how much electricity they are using instantaneously).  What if there were an iPhone app where you daily plugged in your amount of socializing, volunteering, attendance at public meetings  on town affairs and club going? The iPhone app would generate an instantaneous readout with a face with differing expressions of how well you were doing (with a scowl showing the most displeasure and a smile showing the most) or a stylized body that looked healthier or less healthy depending on your habits.  [A Brazilian bar had an interesting experiment to make people aware of the hidden costs of drunk driving.]

11) Positive deviance: Learn from outliers so others can do the same.  We might do more studies of places that are unusually civic (like Minnesota) to understand what it is that they do differently from communities where there is far less civic behavior and whether nudges could help spur people towards the positively deviant (e.g. very civic community).

12) Setting up defaults.  Here is a graphic on how best to choose a default (not focused on civic engagement).  I haven’t thought of good ideas of how defaults could be used to boost civic engagement, but I’m sure this could be used more.

13) Take advantage of fact that people are  more willing to increase their civic behavior in the future. Sunstein and Thaler capitalize on research that shows that people give more when asked to make a donation in the future than if asked to make it today; they propose a project called “Give More Tomorrow“.  I haven’t seen any research on this but one wonders whether “Volunteer More Tomorrow” or “Coach Little League Tomorrow” or other civic or community engagement  would show similar patterns.

14) Publicize non-civic behavior.  “In a 2005 study, Alan Gerber of Yale got Michigan voters to increase their turnout an amazing 8.6% with a single peer-pressure mailer that listed the previous voting records of their neighbors and noted that a follow-up would be sent indicating who voted this time. (The Obama [presidential] campaign actually priced out a similar mailer but decided not to risk a backlash.)” (From Nudge Blog)

We welcome your thoughts about what nudges might have the biggest impact on increasing social capital or civic engagement/volunteering.   Sunstein and Thaler note that nudges are most helpful where: a) the consequences of bad decisions are delayed (true for many social capital decisions); b) the decision is complex or confusing; c) where you face overwhelming number of choices (true of how we spend our free time); d) where people would benefit from greater feedback from their decisions (true of many social capital decisions); and e) where such decisions are infrequent.

Read  long interview with Thaler here (Fall 2009 Yale School of Management), BBC interview (2009), a To The Point roundtable and Firedoglake conversation.

See “Cass Sunstein Wants to Nudge Us” (NYT Magazine section, 5/16/10)

Read the Nudge Blog.