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PubMed2002

National health insurance, physician financial incentives, and primary cesarean deliveries in Taiwan.

OBJECTIVES: Taiwan's National Health Insurance Program (NHI) was implemented on March 1, 1995. This study analyzed the influences of the Case Payment method of reimbursement for inpatient care and of physician financial incentives on a woman's choice for primary cesarean delivery. METHODS: Logistic regressions were used to analyze 11 788 first-time deliveries in a nonprofit hospital system between March 1, 1994, and February 29, 1996. RESULTS: After implementation of the NHI's Case Payment scheme, the likelihood that a woman would choose primary cesarean delivery increased by four to five times compared with the choice behavior of uninsured individuals prior to NHI (P <.0001). CONCLUSION: Out-of-pocket payment discourages the selection of primary cesarean delivery. No robust statistics were found relating physician financial incentives to delivery choice.

Adult↗
PubMed2000

Urban issues in health promotion strategies.

The powerful influence of behavioral choices on health status is well established. The implications and challenges for urban populations are formidable. Understanding urban environments will better prepare health promotion professionals to deal effectively with the forces affecting health-related behaviors. In thinking about urban health promotion in the United States, researchers often distinguish between 2 frameworks; one contending with urbanization, which affects most of us, and another contending with inner-city environments, where many of the deepest needs are. Urbanization confers both benefits and liabilities, but the single greatest challenge for health promotion may lie in reestablishing positive social connections. In contrast, 2 key features of the inner-city environment may be the negative ecological forces within neighborhoods and the lack of control over one's fate. Too often, prescriptions for the inner city stereotype its problems and ignore its strengths. For the inner city, important foundation stones for the future include ways to build on these strengths through positive connections and increased community control through coalition building.

Health Promotion↗
PubMed1992

Self-concept change and self-presentation: the looking glass self is also a magnifying glass.

Studies 1 and 2 showed that identical behaviors had greater impact on the self-concept when performed publicly rather than privately. That is, the self-concept is more likely to change by internalizing public behavior than by internalizing behavior that is identical but lacks the interpersonal context. The self-concept change extends even to behavioral changes and occurs even when participants are unaware of being observed. In addition, those who are high in self-monitoring are more likely to internalize their behavior than those who are low in self-monitoring. Study 3 provided evidence about what components of a public situation affect the internalization of behavior. Choice about making the self-portrayal, drawing on episodes from one's own past rather than relying on a yoked script, and expecting future interaction with the audience all increased the internalization of a public behavior.

Adaptation, Psychological↗
PubMed2005

Decision counseling in cancer prevention and control.

Informed and shared decision making are hallmarks of quality medical care. Although decision aids (e.g., brochures, decision boards, videos, interactive computer programs) can impart useful information, there is a dearth of work on theory-based approaches that help people clarify preferences and select a favored alternative. Decision counseling is a novel method that has been developed to address this need. In a decision counseling session, provider and patient identify personal values associated with decision alternatives, weigh the influence of relevant factors, clarify preference, and select an option from available alternatives. Decision counseling is described here in relation to 3 decision-making situations (i.e., having cancer screening, being tested for cancer risk, and joining a cancer chemoprevention trial). Preliminary findings suggest that decision counseling can help to clarify personal preferences related to health behavior choices and, thus, facilitate achievement of the ideals of informed and shared decision making.

Colorectal Neoplasms↗
PubMedDate not supplied

It's all sacred: African American women's perspectives on spirituality.

In this study, we examined the meaning and function of spirituality for a group of African American women. Participants had been recruited for a focus group study exploring the significance of mother-daughter-sister relationships to the well being and health behavior choices of women. Women developed individually defined concepts of spirituality by combining Judeo-Christian traditions and African cosmology. Spirituality was a cornerstone of many participants' daily lives. It influenced women's decision-making and behavior across many realms. For example, many women came to the conclusion that domestic violence was not part of God's plan for their lives. Spiritual-based strategies may provide a rich foundation for innovative and efficacious health promotion interventions targeting African American women. Clinicians can assist in the co-creation of sacred spaces where women can connect with themselves and each other.

Adult↗
PubMed2002

Position of the American Dietetic Association: the role of dietetics professionals in health promotion and disease prevention.

In the United States, the leading determinants of morbidity and mortality are rooted in behavioral choices related to eating habits, exercise, tobacco, alcohol consumption, and stress reduction. Scientific data consistently provide evidence that diet plays an important role in health promotion and disease prevention. Healthy eating habits--coupled with other healthful lifestyle behaviors--have the potential to reduce the risk of chronic disease. Health care typically assumes a curative or treatment role in the United States. However, dietetics professionals are shaping an alternate view of health, which includes developing healthy public policies, creating safe and supportive environments, building communities and coalitions, and reorienting health services to include health promotion as a primary approach to delivering health care. Individual-level approaches, such as counseling and group education, have been employed most often in modifying health behaviors. However, population-level approaches that affect availability of or access to healthy foods, opportunities for physical activity, and other healthy lifestyle determinants also are important. Dietetics professionals have pivotal roles in both individual- and population-level approaches.

Dietetics↗
PubMed1995

Fertility management in Taiwanese and African-American women.

This article describes the fertility management experiences of two groups of women that are of cultures close to but different from dominant, mainstream American culture. A discussion of fertility management necessarily must occur within the context of such issues as the values and norms regarding sexual behavior, choice of partners, and childbearing patterns, and the support and resources offered by the social environment.

Black or African American↗
PubMed1995

[Characteristics of smoking, drinking, dietary habits, and physical exercise in health behavioral models].

Various kinds of preventive health behaviors are promoted by health education. The extent of behavioral modification achieved, however, obviously differs from individual to individual according to habits, one of the reasons being the characteristics of various health habits are perceived differently. This cross-sectional study examined the association of indices representing health behavior models with smoking, drinking, dietary habits, and physical exercise. The indices and their meaning were as follows; health locus of control (HLC) and saliency of health are thought to cause the most active behavioral change, health norm relatively passive change, and vulnerability to illness the most passive change. The indices and lifestyle (health related practices) were surveyed by a self-administered questionnaire in a rural town in March 1994. The study sample consisted of 1,010 males and 1,055 females aged 20 years or older who responded to all questions related to the indices. Results are as follows: 1) Smoking and alcohol drinking were associated with vulnerability to illness, suggesting that people who quit smoking or alcohol drinking do so because of perception of their association with illness. Alcohol drinking seemed to have a higher magnitude of being associated with becoming ill or with fear of illness than smoking. 2) Consuming green-yellow vegetables and fresh fish, and physical fitness were associated with internal HLC, saliency of health, and health norm. These habits appeared to be easy to modify by active personal behavior choice. 3) Consuming milk, yogurt, boiled beans, tofu, oranges, and other fruits were associated with saliency of health. These habits seemed to relate to personal sense of being "healthy". 4) It seemed that younger people more likely changed their behavior by active self-management, while, older people changed due to their sense of value or norm. While it is important for health education to promote "self-management of health" by active behavioral change, certain habits are more resistant to change despite educational efforts possibly because of their characteristics in health behavioral models. For cases such as these, techniques promoting passive behavioral change should be considered.

Adult↗
PubMed1992

Sexual pheromones in lipids and other fractions from urine of the male mole rat, Spalax ehrenbergi.

Spalax ehrenbergi mole rats are blind, solitary, territorial, aggressive, subterranean rodents with a yearly breeding season that peaks in December and January. We confirm here an earlier report that estrous females are attracted to substances present in the urine of homospecific as compared to heterospecific adult males. We have also found that nonestrous female mole rats show avoidance behavior to the same homospecific urine. Our objective was to ascertain the nature of the pheromone(s) and gain insight as to its possible role in reproductive isolation and speciation. An active principle, detected in either two- or three-choice behavior tests, was found to be extractable from urine by methylene chloride (CH2Cl2) and mainly found in the neutral lipid fraction. Total lipids were chromatographed by thin layer chromatography on silica gel G60 plates. Most of the activity was found in a zone bounded by Rfs 0.2 and 0.7. Cholesterol, other sterols, and ethyl esters of fatty acids chromatographed in this zone as determined by standards and staining. Ethyl esters of fatty acids were also detected in this fraction by GC/MS analysis. Although a large amount of activity was found in lipids, it only accounted for about 1% of that found in urine. Some activity may have been destroyed or lost during the extraction procedure and some may remain in a lipid insoluble form. Preliminary tests of lipid extracts of various portions of the male urogenital tract revealed pheromonal activity present, particularly in tissues associated with testes, epididymis, prostate, and bladder.

Animals↗
PubMed2005

The role of the GABA(A) agonist muscimol on memory performance: reward contingencies determine the nature of the deficit.

A matching-to-position (MTP) paradigm was altered to influence the type of associations a rat would use to solve the task. Our main behavioral manipulation was the application of the differential outcomes procedure (DOP). The DOP involves correlating each to-be-remembered event with a distinct reward condition. This procedure results in the development of unique reward expectancies that enhance and guide choice behavior. Such distinct reward expectancies are not formed when either a common or random assignment of reward is used (a non-differential outcomes procedure [NOP]). Intracerebroventricular infusions of the amnestic agent muscimol (GABA(A) agonist) or aCSF were delivered to male rats trained on a delayed MTP task that implemented either the DOP or the NOP. Muscimol impaired performance in a dose dependent fashion in both groups--but the nature of the deficit differed as a function of reinforcement contingencies. Rats trained with the DOP displayed a non-mnemonic delay-independent impairment: performance at all delay intervals was disrupted. In contrast, NOP-trained rats displayed a delay-dependent impairment demonstrating that muscimol can also have memory-disrupting effects. The difference in pattern of impairment appears to be a function of the associations formed during training and the type of cognitive strategies involved in maintaining behavior on a conditional delayed discrimination task when reinforcement contingencies are varied. Thus, these results demonstrate that increasing GABA(A) receptor activation impairs a range of associative and memory functions.

Animals↗
PubMed2005

Neural systems responding to degrees of uncertainty in human decision-making.

Much is known about how people make decisions under varying levels of probability (risk). Less is known about the neural basis of decision-making when probabilities are uncertain because of missing information (ambiguity). In decision theory, ambiguity about probabilities should not affect choices. Using functional brain imaging, we show that the level of ambiguity in choices correlates positively with activation in the amygdala and orbitofrontal cortex, and negatively with a striatal system. Moreover, striatal activity correlates positively with expected reward. Neurological subjects with orbitofrontal lesions were insensitive to the level of ambiguity and risk in behavioral choices. These data suggest a general neural circuit responding to degrees of uncertainty, contrary to decision theory.

Adult↗
PubMed2005

Neural activity in macaque parietal cortex reflects temporal integration of visual motion signals during perceptual decision making.

Decision-making often requires the accumulation and maintenance of evidence over time. Although the neural signals underlying sensory processing have been studied extensively, little is known about how the brain accrues and holds these sensory signals to guide later actions. Previous work has suggested that neural activity in the lateral intraparietal area (LIP) of the monkey brain reflects the formation of perceptual decisions in a random dot direction-discrimination task in which monkeys communicate their decisions with eye-movement responses. We tested the hypothesis that decision-related neural activity in LIP represents the time integral of the momentary motion "evidence." By briefly perturbing the strength of the visual motion stimulus during the formation of perceptual decisions, we tested whether this LIP activity reflected a persistent, integrated "memory" of these brief sensory events. We found that the responses of LIP neurons reflected substantial temporal integration. Brief pulses had persistent effects on both the monkeys' choices and the responses of neurons in LIP, lasting up to 800 ms after appearance. These results demonstrate that LIP is involved in neural time integration underlying the accumulation of evidence in this task. Additional analyses suggest that decision-related LIP responses, as well as behavioral choices and reaction times, can be explained by near-perfect time integration that stops when a criterion amount of evidence has been accumulated. Temporal integration may be a fundamental computation underlying higher cognitive functions that are dissociated from immediate sensory inputs or motor outputs.

Action Potentials↗
PubMed2006

Theory-based active ingredients of effective treatments for substance use disorders.

This paper describes four related theories that specify common social processes that protect individuals from developing substance use disorders and may underlie effective psychosocial treatments for these disorders: social control theory, behavioral economics and behavioral choice theory, social learning theory, and stress and coping theory. It then provides an overview of the rationale and evidence for four effective psychosocial treatments for substance use disorders: motivational interviewing and motivational enhancement therapy, 12-step facilitation treatment, cognitive-behavioral treatment and behavioral family counseling, and contingency management and community reinforcement approaches. The presumed active ingredients of these treatments are described in terms of how they exemplify the social processes highlighted by the four theories. The identified common components of effective treatment include support, goal direction, and structure; an emphasis on rewards that compete with substance use, a focus on abstinence-oriented norms and models, and attempts to develop self-efficacy and coping skills. Several issues that need to be addressed to enhance our understanding of the active ingredients involved in effective treatment are discussed, including how to develop measures of these ingredients, how well the ingredients predict outcomes and influence conceptually comparable aspects of clients' life contexts, and how much their influence varies depending upon clients' demographic and personal characteristics.

Cognitive Behavioral Therapy↗
PubMed2006

Working memory and decision-making biases in young adults with a family history of alcoholism: studies from the Oklahoma family health patterns project.

BACKGROUND: Alcohol misuse is more common in persons with a family history of alcoholism (FH+) than in those with no such history (FH-). Among FH+, behavioral disinhibition and male sex seem to signal the presence of an increased risk. METHODS: This study examined cognitive and behavioral characteristics of 175 nonabusing 18- to 30-year-olds, 87 FH+ and 88 FH-, who were further characterized by their degree of behavioral disinhibition using the Sociability scale of the California Personality Inventory. Working memory and decision making were tested using the Stroop Color-Word Test and the Iowa Gambling Task, a simulated card game. RESULTS: Persons with a family history of alcoholism who were behaviorally disinhibited displayed significantly greater interference on the Stroop task than the other subgroups. On the Iowa Gambling Task, FH+ males, but not the females, were significantly more attentive to financial gains than other subgroups, and they had greater consistency in their choice behaviors. CONCLUSIONS: Persons with a family history of alcoholism, in combination with behavioral disinhibition, appears to signal working memory deficits and in combination with male sex indicates an attraction to the rewarding aspects of a risk-taking challenge. These findings are not secondary to heavy exposure to alcohol or other drugs, but instead reflect intrinsic risk-related familial and personal characteristics of the subjects.

Adolescent↗
PubMed1988

Gene-culture coevolution: a test of the steady-state hypothesis for gene-culture translation.

Although there has been considerable discussion of the gene-culture theory (GCT) approach to biocultural systems, relatively little critical attention has focused on the specific approximations used in GCT, or on their improvement. Here we consider the steady-state hypothesis used in GCT models to connect activity on the level of individual choice behavior to the level of societies taken as wholes. The hypothesis is tested by using Monte Carlo techniques to estimate solutions to the dynamical equation for social order. The steady-state hypothesis is found generally to be invalid for all the categories of choice function originally considered by Lumsden and Wilson, but acceptable for the highly restricted parameter ranges used in their treatments of the gene-frequency change. The implications for the development of improved gene-culture modeling techniques are discussed.

Computer Simulation↗
PubMed2000

A comparison of naïve and sophisticated subject behavior with game theoretic predictions.

We use an extensive form two-person game as the basis for two experiments designed to compare the behavior of two groups of subjects with each other and with the subgame perfect theoretical prediction in an anonymous interaction protocol. The two subject groups are undergraduates and advanced graduate students, the latter having studied economics and game theory. There is no difference in their choice behavior, and both groups depart substantially from game theoretic predictions. We also compare a subsample of the same graduate students with a typical undergraduate sample in an asset trading environment in which inexperienced undergraduates invariably produce substantial departures from the rational expectations prediction. In this way, we examine how robust are the results across two distinct anonymous interactive environments. In the constant sum trading game, the graduate students closely track the predictions of rational theory. Our interpretation is that the graduate student subjects' departure from subgame perfection to achieve cooperative outcomes in the two-person bargaining game is a consequence of a deliberate strategy and is not the result of error or inadequate learning.

Journal Article↗
PubMed2004

The ventral tegmental area is required for the behavioral and nucleus accumbens neuronal firing responses to incentive cues.

Reward-predictive cues exert powerful control over behavioral choice and may be a critical factor in drug addiction. Reward-seeking elicited by predictive cues is facilitated by the release of dopamine in the nucleus accumbens (NAc), yet the contribution of dopamine to the specific NAc firing patterns that underlie goal-directed behavior has remained elusive. We present evidence that subpopulations of NAc neurons that respond to predictive cues require the dopaminergic projection from the ventral tegmental area (VTA) to promote reward-seeking behavior. Rats trained to perform an operant response to a cue to obtain a sucrose reward were implanted with both multiunit recording electrodes in the NAc and microinjection cannulas in the VTA. Both the behavioral response to cues and the cue-evoked firing of NAc neurons were blocked by injection of the GABA(B) agonist baclofen into the VTA. An additional group of rats was trained on the same task and then implanted with microinjection cannulas in the NAc. Like VTA baclofen injection, injection of dopamine receptor antagonists into the NAc profoundly reduced cue-elicited reward seeking. Together, these results support the conclusion that both the behavioral response to the cue and the specific NAc neuronal firing that promotes the response depend on dopamine release within the NAc. Our findings suggest a neural mechanism by which the dopamine-dependent firing of NAc neurons mediates goal-directed behavior.

Animals↗
PubMed2005

Rewarding properties of visual stimuli.

The behavioral functions of rewards comprise the induction of learning and approach behavior. Rewards are not only related to vegetative states of hunger, thirst and reproduction but may also consist of visual stimuli. The present experiment tested the reward potential of different types of still and moving pictures in three operant tasks involving key press, touch of computer monitor and choice behavior in a laboratory environment. We found that all tested visual stimuli induced approach behavior in all three tasks, and that action movies sustained consistently higher rates of responding compared to changing still pictures, which were more effective than constant still pictures. These results demonstrate that visual stimuli can serve as positive reinforcers for operant reactions of animals in controlled laboratory settings. In particular, the coherently animated visual stimuli of movies have considerable reward potential. These observations would allow similar forms of visual rewards to be used for neurophysiological investigations of mechanisms related to non-vegetative rewards.

Animals↗