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Friends of the Behavioral Economics Blog, this week we present the paper “Economic burden of attention-deficit/hyperactivity disorder among children and adolescents in the United States: a societal perspective”, by Schein, J.; Adler, L. A.; Childress, A.; Cloutier, M.; Gagnon-Sanschagrin, P.; Davidson, M.; Kinkead, F.; Guerin, A. and Lefebvre, P. (2022), in which authors carry out an investigation to know, from a societal perspective, what is the cost derived from living with an attention-deficit/hyperactivity disorder. 

Attention deficit/hyperactivity disorder (ADHD, hereinafter) is one of the most common neurobehavioral disorders in childhood, characterized by levels of inattention, impulsiveness, and hyperactivity that are not appropriate or beneficial to the child’s stage of development.

ADHD is most often diagnosed in children, however, it can occur at any stage of life.

The percentage of people with ADHD in the United States is between 10 and 6.5% for children and 4.4% for adults.

People living with this disorder may have functional and psychosocial deficiencies in the academic and/or work environment.

Furthermore, the burden borne by children and adolescents extends to their parents and caregivers as well. For example, parents of children with ADHD must spend their money on doctors, special education, or extra care services for their children, as well as other indirect losses related to absences from work, if they are necessary to care for their children.

In addition, the difficulties children with ADHD face are likely to continue into adolescence if their symptoms are not properly identified or managed early on.

Teens with ADHD generally face greater academic, work, and social demands, and may also be more vulnerable to substance use or traffic accidents.

In addition, it is known that ADHD can become a chronic problem for patients, with a percentage that varies between 35-78% of children and adolescents who maintain symptoms in adulthood. Therefore, adolescents with ADHD are at risk of experiencing adverse conditions associated with the disorder during their transition to adulthood.

Since the manifestation of ADHD often has direct implications for how patients interact with society, it is imperative to consider the full societal costs associated with this condition in order to understand the true economic burden from a societal perspective.

However, despite the extensive body of research conducted on children and adolescents with ADHD, previous studies that have attempted to quantify the economic impact have mostly been from a payer perspective, assessing only direct health care costs, or have focused on one or just a few components of ADHD.

In this article, the goal was to provide a comprehensive assessment of the economic burden of children with ADHD on the one hand and adolescents with ADHD on the other. The main cost components that contribute to the associated social economic burden were sought, which can help promote new clinical and social policies to mitigate the impact of the disorder on patients, their relatives and, in general, society.

The applied approach was based on prevalence, mainly with a “bottom-up” method, to estimate the excess costs incurred by a person with ADHD compared to a person with neurotypical development.

The obtained data comes from different places. For example, direct health care costs come from health insurance, while the prevalence of ADHD in children and adolescents was obtained from the 2018 US National Survey of Children’s Health.

The results obtained indicated that the total social costs associated with ADHD in the United States in 2018 were 19.4 million dollars for children and 13.8 million for adolescents. These results are further developed by area in the article.

The findings show that the economic burden of living with ADHD is important, so it is necessary to seek solutions. 

Education costs accounted for approximately half of the total figure, standing at around 11.6 million for children and 6.7 million for adolescents. This may be because there are costs that may be related to tutoring, the use of specialized teachers, as well as expenses associated with material items (books, technological support, etc.).

Authors conclude that the development of improved intervention strategies and ADHD awareness policies are needed to overcome diagnostic barriers, improve treatment adherence, alleviate educational and medical difficulties, and minimize stigma. .

If you want to know more about Behavioral Economics and how to apply it to human behavior, take a look to our Certificate in Behavioral Economics, a formative program, in English or Spanish, 100% online and certified by Heritage University (USA). Now, with discounts for members of this club.

Friends of the Behavioral Economics Club, this week we present the paper “Wealth, Financial Literacy and Behavioral Biases in Japan: the effects of various types of financial literacy”, by Sekita, S.; Kakkar, V. and Ogaki, M. (2022), in which authors analyze the results of a big survey carried out in Japan in 2016 to know what is the level of financial education of the Japanese population, and deeply study what this level of knowledge implies. 

There is a growing body of literature documenting that levels of financial education measured around the world are alarmingly low, even in economically advanced countries.

With life expectancy increasing around the world, the responsibility for accumulating retirement savings shifts from employers to employees. Along with the increasing sophistication and complexity of financial products and services, these low levels of finance lead to significantly lower levels of well-being, obtained through poor economic decisions.

The evidence from surveys conducted on the subject shows that many adults do not have a retirement plan, and that savings are insufficient for retirement, so that the usefulness of families’ economic capital is not maximized and optimally enjoy the cycle of life.

This article explores the impact of financial education on a key economic variable with important consequences for general well-being: accumulated wealth per home.

Using data from Japan’s first large-scale survey of the financial literacy of its population, the article contributes to the emerging literature on the relationship between financial education and wealth accumulation.

For a little less than thirty years, the importance of financial knowledge has been highlighted to explain the importance of saving behavior. In addition, a large amount of research has been carried out on the measurement of financial education and its effects on different household behaviors.

Some of these studies find that financial education is related to a greater tendency to planning the retirement, less anxiety about life in retirement, a greater tendency to save for emergencies, greater possession of cash, less tendency to access indebtedness, less tendency to gamble, and even less tendency to smoke.

On the other hand, in 2021 it was discovered that people with high levels of financial education tend to make speculative investments, take on excessive debt and have somewhat resourceful financial attitudes.

So, is there really a difference between having financial knowledge or not? Authors believe that there is, but even if people are financially educated, they should be careful not to engage in bold and reckless behavior,  and mustn’t think that being financially educated is inherent in being always less vulnerable.

To review all of this data and to find out if this is indeed the case, authors used the 2016 Financial Literacy Survey that was conducted in Japan by the Japanese Central Financial Services Information Council.

It was the first large-scale survey conducted in Japan with the aim of assessing the financial knowledge and decision-making skills of Japanese adults. About 25,000 people between the ages of 18 and 79 participated.

The findings confirm that improvements in financial education can have large benefits for Japanese households and increase their financial asset balances.

It’s important to mention that it is useful to distinguish between different types of financial education, as they have different impacts. For example, knowledge of deposits, risk and debt has a greater impact when it comes to insurance.

The need to include financial education in the study plan of schools is pointed out and, not only that, but also to ensure that classes are taught effectively.

If you want to know more about Behavioral Economics and how to apply it to human behavior, take a look to our Certificate in Behavioral Economics, a formative program, in English or Spanish, 100% online and certified by Heritage University (USA). Now, with discounts for members of this club.

Friends of the Behavioral Economics Club, this week we present the paper “Effects of a Behavioral Economics Intervention on Food Choice and Food Consumption in Middle-School and High-School Cafeterias” by Quinn, E. L.; Johnson, D. B.; Podrabsky, M.; Saelens, B. E.; Bignell, W. and Krieger, J. (2018), in which authors revise the obtained results of applying behavioral economics’ techniques to improve the food choice and the food consumption in school cafeterias.

We know that one of the most serious problems of public health around the world is child obesity. Improving the eating style of children is urgent to prevent diseases associated with obesity.

And here, school cafeterias offer lots of information to contribute, since school meals reach more than 31 million American students on a daily basis, and more than 70% of them are children who belong to families with few economic resources.

Nutritious and healthy school meals can reduce the risk of disease, so by improving the diet, we improve the health of students.

In the past few years, the United States has implemented policies to increase the availability of healthy foods in schools, but are these foods being consumed?

The architecture of choice based on the principles of behavioral economics can be used to encourage children and young people to make healthy food choices in school.

It would consist of small, low-cost changes related to the coexistence, attractiveness and visibility of food to promote healthier options. For example, offering healthy pick-and-play foods with creative names in multiple locations.

Choice architecture can improve students’ selection and consumption of healthy foods, but studies on it are few and inconclusive, and many use very small samples.

In this article, authors investigate whether a one-year intervention of choice architecture in various schools changed the selection and consumption of healthy foods by students.

Staff from the schools selected for intervention participated in an initial workshop in 2013 and one more in 2014. They were facilitated by experts in behavioral economics. The workshop presented the principles of this discipline and also strategies, such as displaying items in attractive containers, offering pre-cut fruits, using creative names, using signs, placing food strategically (at eye level, for example), etc.

For the study, authors compared the selection and consumption, by students, of fruits, vegetables, and low-fat white milk, at the beginning and end of the school year, in 6 schools whose staff had previously participated in the workshops, and in 5 control schools.

The data collectors looked at the type and number of items selected by each student, recorded this on a card, and pasted the card on the student’s tray. The collector would then ask the student to bring his/her tray, with all the remaining wrappers and the uneaten food, to a designated shelf after he/she finished eating.

At first, food selection was similar between intervention groups and control groups, except for the proportion of students who selected vegetables, which was higher for the control group. In both groups, fruit, included in juice form, was the only category for which more than half of all students selected at least one item.

The proportion of students who selected fruits (not in juice form) and vegetables increased significantly in the intervention group schools from the beginning to the end of the study.

From the perspective of the general student population, while more students in the intervention groups consumed fruit in a format other than juice, there was no significant increase in the number of healthy items eaten.

The interest of behavioral economics to improve child nutrition programs has grown with the support of the authorities, in this case, the United States: many schools in the country are using these strategies today.

Additional evaluations are needed to learn how school professionals translate their knowledge about behavioral economics from research into practice. For example, they may find strategies easier to apply.

These findings can help school nutrition and public health services understand how subtle changes in cafeteria environments can influence student choices and promote the selection of some healthy foods.

If you want to know more about Behavioral Economics and how to apply it to human behavior, take a look to our Certificate in Behavioral Economics, a formative program, in English or Spanish, 100% online and certified by Heritage University (USA). Now, with discounts for members of this club.

Friends of the Behavioral Economics Club, this week we present the paper “Behavioral Economic Demand and Delay Discounting are Differentially Associated with Cigarette Dependance and Use in Adolescents”, by Cassidy, R. N.; Aston, E. R.; Tidey, J. W. and Colby, S. M. (2020), in which authors study whether a relation between the use of cigarettes in adolescents and behavioral economics exists, and if it is so, how can the latter help to reduce the number of young addicts.

Smoking is one of the most accepted forms of drug addiction in society. However, like alcoholism, the dimension of its magnitude is growing.

A matter of particular concern is how young people acquire this habit from such an early age.

Although it may surprise us, cigarette smoking by teenagers has reduced its rate to the lowest in decades. Only 9% of teens reported smoking daily in 2016.

Authors believe that this decline in youth smoking rates is due to tobacco control interventions, such as educational campaigns in the media.

The key would be in a decreasement in the initiation of smoking and not in the cessation of smoking.

However, increased use of electronic cigarettes or vapers has been shown to be associated with the onset of smoking. Therefore, these rates that until now have been decreasing, may be reversed in the future.

For this reason, authors consider that research on the behavioral mechanisms of young people who smoke is still very important. In addition, they consider that it is possible from behavioral economics to obtain explanations to better understand these mechanisms.

There is the called “Reinforcing Pathology model”. This model describes how two economic behavioral processes, such as a greater sensitivity to immediate rewards (discount for delay) and an excessive reward derived from the consumption of a substance (demand), relate to problematic patterns such as substance use.

This model proposes that people with substance use disorders may continuously experience the effects of delay discounting and demand. This is manifested by giving a high value to the substance together with the preference to receive it and use it immediately to receive the reward of consumption as soon as possible.

However, how this relates to the different faces of youth cigarette smoking has not been established.

Authors consider it necessary to point out that there is a conceptual difference between cigarette consumption and dependence. Consumption is a characteristic of dependence, but dependence is not just consumption: it is characterized by physical tolerance, abstinence symptoms if consumption is discontinued, and so on.

Although the role of these elements in adolescent cigarette smoking has not been investigated, there is previous literature on cannabis use in adults. In those studies, the frequency of consumption was significantly associated with the demand for cannabis, and dependence was associated with the discount for delay (that is, with the preference to receive the reward of consumption immediately).

The objective of the authors with their study was to test the hypotheses that arise because of the Reinforcing Pathology model. This hypothesis says that higher demand would be associated with both higher dependence and higher smoking, and a more pronounced delay discount would be associated with higher dependence, but not necessarily with higher smoking.

To do this, they gathered a sample of 50 adolescents who use tobacco daily. These young people were recruited through online advertisements, advertisements on buses, and sessions in high schools. They were between 15 and 19 years old, with an average age of 17.7.

They had to report their cigarettes smoked per day during the last month. In addition, they carried out a series of tests whose origin is found in tools of behavioral economics.

The results were very interesting. Although demand for cigarettes was associated with severity and consumption, the delay discount was an important predictor only for dependence. That is, only those young people with a strong dependence on tobacco significantly looked for the immediate reward of consumption.

The delay discount is based on the preference for immediate rewards over delayed rewards, which do not necessarily have to be the result of cigarette smoking.

Authors’ study suggests that the discount is related to the level of dependency, and this is consistent with the idea that a higher discount for delay can predict poorer treatment outcomes for young people, and a greater severity of dependency for adults.

However, while the delay discount is not an important predictor for demand, it does influence it in some way. Therefore, the discount would affect dependency in the first instance and demand secondarily.

Finally, authors add some last information: a greater amplitude of demand was associated with a higher level of consumption.

One limitation of the study is that the sample size is relatively small. Future research should replicate these findings with a larger sample.

Because adolescent smokers may be more susceptible to changes in their smoking trajectory, since their behavior may be more malleable due to their developmental stage, it is critical that there are new ways of understanding the onset, maintenance, and progression of smoking in them.

Behavioral economics suggests ways of treating and understanding the phenomenon that would undoubtedly be very useful for intervening with these young people.

If you want to know more about Behavioral Economics and how to apply it to human behavior, take a look to our Certificate in Behavioral Economics, a formative program, in English or Spanish, 100% online and certified by Heritage University (USA). Now, with discounts for members of this club.

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