dark nudges and sludge in big alcohol behavioral economics cognitive biases and alcohol CORD-Papers-2022-06-02 (Version 1)

Title: Dark Nudges and Sludge in Big Alcohol: Behavioral Economics Cognitive Biases and Alcohol Industry Corporate Social Responsibility
Abstract: POLICY POINTS: Nudges steer people toward certain options but also allow them to go their own way. Dark nudges aim to change consumer behavior against their best interests. Sludge uses cognitive biases to make behavior change more difficult. We have identified dark nudges and sludge in alcohol industry corporate social responsibility (CSR) materials. These undermine the information on alcohol harms that they disseminate and may normalize or encourage alcohol consumption. Policymakers and practitioners should be aware of how dark nudges and sludge are used by the alcohol industry to promote misinformation about alcohol harms to the public. CONTEXT: Nudges and other behavioral economic approaches exploit common cognitive biases (systematic errors in thought processes) in order to influence behavior and decisionmaking. Nudges that encourage the consumption of harmful products (for example by exploiting gamblers cognitive biases) have been termed dark nudges. The term sludge has also been used to describe strategies that utilize cognitive biases to make behavior change harder. This study aimed to identify whether dark nudges and sludge are used by alcohol industry (AI)funded corporate social responsibility (CSR) organizations and if so to determine how they align with existing nudge conceptual frameworks. This information would aid their identification and mitigation by policymakers researchers and civil society. METHODS: We systematically searched websites and materials of AI CSR organizations (e.g. IARD Drinkaware Drinkwise duc'alcool); examples were coded by independent raters and categorized for further analysis. FINDINGS: Dark nudges appear to be used in AI communications about responsible drinking. The approaches include social norming (telling consumers that most people are drinking) and priming drinkers by offering verbal and pictorial cues to drink while simultaneously appearing to warn about alcohol harms. Sludge such as the use of particular fonts colors and design layouts appears to use cognitive biases to make healthrelated information about the harms of alcohol difficult to access and enhances exposure to misinformation. Nudgetype mechanisms also underlie AI mixed messages in particular alternative causation arguments which propose nonalcohol causes of alcohol harms. CONCLUSIONS: Alcohol industry CSR bodies use dark nudges and sludge which utilize consumers cognitive biases to promote mixed messages about alcohol harms and to undermine scientific evidence. Policymakers practitioners and the public need to be aware of how such techniques are used to nudge consumers toward industry misinformation. The revised typology presented in this article may help with the identification and further analysis of dark nudges and sludge.
Published: 2020-09-15
Journal: Milbank Q
DOI: 10.1111/1468-0009.12475
DOI_URL: http://doi.org/10.1111/1468-0009.12475
Author Name: PETTICREW MARK
Author link: https://covid19-data.nist.gov/pid/rest/local/author/petticrew_mark
Author Name: MAANI NASON
Author link: https://covid19-data.nist.gov/pid/rest/local/author/maani_nason
Author Name: PETTIGREW LUISA
Author link: https://covid19-data.nist.gov/pid/rest/local/author/pettigrew_luisa
Author Name: RUTTER HARRY
Author link: https://covid19-data.nist.gov/pid/rest/local/author/rutter_harry
Author Name: VAN SCHALKWYK MAY CI
Author link: https://covid19-data.nist.gov/pid/rest/local/author/van_schalkwyk_may_ci
sha: b00a20f3b197ab9e3d9861a3e3cca814bbaf03fc
license: cc-by-nc
license_url: https://creativecommons.org/licenses/by-nc/4.0/
source_x: Medline; PMC
source_x_url: https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/
pubmed_id: 32930429
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/32930429
pmcid: PMC7772646
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772646
url: https://doi.org/10.1111/1468-0009.12475 https://www.ncbi.nlm.nih.gov/pubmed/32930429/
has_full_text: TRUE
Keywords Extracted from Text Content: alcohol Nudges people Drinkaware Ireland's gray bodies Facts Enjoy Drinkaware IARD lcohol Kahneman Drinkware Drinkaware UK ductal cancer lobular cancer 15(p88 wine over-thecounter harms-one lobular TIPPME liver ductal cancers fetal alcohol lager women nonalcohol F-shaped wines alcohol consumption-is cardiovascular CSRs Drinkfreedays breast 80,81 green difficult-to-read color/text/font behaviors-for Wine Sector counter-messages Druckman breast cancer Nudges 1 System 1 alcoholic beverages web-designers people people's attention) 7 59(p25 let anti-vaccine toasting Alcohol difficult-to-read color beer belly gastritis pee UK tobacco 23(p4 leaflet Figure 1 Éduc'alcool woman ... Sivanathan body Eve Diageo human auditory eye it-or Drinkwise ...people's WYSIATI MP cancer Wine Information Council olfactory messenger/source Governmentn SOUP 95(p9 language/arguments bladder cancer easiest-to-reach line less-legible sections Eve in 2019 Blue COVID-19 cancers grandparents alcohol Nudges colorectal cancer UK Government's men benign breast lump System 2 Facebook Cialdini's seminal books Pernod Ricard's lung cancer
Extracted Text Content in Record: First 5000 Characters:r Nudges steer people toward certain options but also allow them to go their own way. "Dark nudges" aim to change consumer behavior against their best interests. "Sludge" uses cognitive biases to make behavior change more difficult. r We have identified dark nudges and sludge in alcohol industry corporate social responsibility (CSR) materials. These undermine the information on alcohol harms that they disseminate, and may normalize or encourage alcohol consumption. r Policymakers and practitioners should be aware of how dark nudges and sludge are used by the alcohol industry to promote misinformation about alcohol harms to the public. Context: "Nudges" and other behavioral economic approaches exploit common cognitive biases (systematic errors in thought processes) in order to influence behavior and decision-making. Nudges that encourage the consumption of harmful products (for example, by exploiting gamblers' cognitive biases) have been termed "dark nudges." The term "sludge" has also been used to describe strategies that utilize cognitive biases to make behavior change harder. This study aimed to identify whether dark nudges and sludge are used by alcohol industry (AI)-funded corporate social responsibility (CSR) organizations, and, if so, to determine how they align with existing nudge conceptual frameworks. This information would aid their identification and mitigation by policymakers, researchers, and civil society. We systematically searched websites and materials of AI CSR organizations (e.g., IARD, Drinkaware, Drinkwise, Éduc'alcool); examples were coded by independent raters and categorized for further analysis. Findings: Dark nudges appear to be used in AI communications about "responsible drinking." The approaches include social norming (telling consumers that "most people" are drinking) and priming drinkers by offering verbal and pictorial cues to drink, while simultaneously appearing to warn about alcohol harms. Sludge, such as the use of particular fonts, colors, and design layouts, appears to use cognitive biases to make health-related information about the harms of alcohol difficult to access, and enhances exposure to misinformation. Nudge-type mechanisms also underlie AI mixed messages, in particular alternative causation arguments, which propose nonalcohol causes of alcohol harms. Conclusions: Alcohol industry CSR bodies use dark nudges and sludge, which utilize consumers' cognitive biases to promote mixed messages about alcohol harms and to undermine scientific evidence. Policymakers, practitioners, and the public need to be aware of how such techniques are used to nudge consumers toward industry misinformation. The revised typology presented in this article may help with the identification and further analysis of dark nudges and sludge. Keywords: behavioral economics, nudge, sludge, commercial determinants of health, public health, alcohol. A lcohol consumption is a major contributor to global death and disability, accounting for nearly 10% of global deaths among populations aged 15-49 years 1 and contributing to both communicable and noncommunicable diseases. 1, 2 For most alcoholrelated diseases and injuries, there is a dose-response relationship between the volume of alcohol consumed and the risk of a given harm. 3 Among those aged 50 years and older, cancers account for a large proportion of total alcohol-attributable deaths; 27.1% of total alcoholattributable female deaths and 18.9% of male deaths. 1 The link with cancer in particular has been an extensive target of AI misinformation. [4] [5] [6] The evidence on alcohol harms has led to calls for strong alcohol control policies to protect public health. Among the cost-effective approaches is regulation of advertising and marketing. 3 Alcohol marketing is an important target because of its influence on the amount, frequency, timing, and contexts of alcohol consumption, and because it takes place through an increasingly wide variety of venues and formats, including the internet and social media, as well as traditional media. 2, 7 It has also long been known that marketing does not need to rely on the conscious awareness of the consumer to be effective, and often exploits cognitive biases (systematic errors in our thought processes) and information deficits, drawing on nudge-type approaches to changing behavior, and behavioral economics theory more generally. [8] [9] [10] Thaler and Sunstein describe nudges as liberty-preserving approaches that steer people toward certain options but also allow them to go their own way: A nudge, as we will use the term, is any aspect of the choice architecture that alters people's behavior in a predictable way without forbidding any options or significantly changing their economic incentives. 8 Thaler, Sunstein, and other behavioral economists have also discussed how companies exploit our cognitive biases and information deficits. 11 Such approaches are well documented in the marketing literature, which
Keywords Extracted from PMC Text: well‐established beer belly System 2 vaccine refusal.77 eye Drinkaware UK Petticrew campaign."74 A breast messenger/source Schalkwyk Wine Sector IARD WYSIATI Eve " people human Pernod Ricard's Cialdini Éduc'alcool SABMiller men SOUP opinion.61 toasting cancers liver over‐the‐counter Sivanathan Drinkfreedays" vaping89 Facts COVID‐19 Wine Information Council National Health Service nudge‐type Facebook line gray System 1 people" Conflicts fetal alcohol less‐legible woman AI.49 Drinkaware Ireland.94 grandparents UK Alcohol wine colorectal cancer ductal cancer health‐supporting Kakkar69 Public Health Agency [NI]) individual‐level lobular ductal cancers CSRs Kahneman looks?"68 marketing‐type MP face."59 people do:70 Drinkware women Care Research Wales ‐ " Funding/Support misinformation.65‐67 p330 directors alcohol lobular cancer F‐shaped Drinkaware bodies efforts."72 UK Government's cancers" alcoholic beverages Entman notes cancer champagne?"73 " funding.90 leaflet watered‐down website).Sludge harms.76 gastritis" p70 life."75 wines green tobacco breast cancer pee Drinkaware Ireland's p25 Druckman p9 ...people's TIPPME Good,"80,81 ... marketing‐style restaurants Figure 1 people Drinkwise bladder cancer Governmentn AI,79 sections population."95
Extracted PMC Text Content in Record: First 5000 Characters:Thaler and Sunstein point to ten broad types of nudges (Box 1). 8 Nudges typically exploit a wide range of cognitive biases in human information processing. These biases arise because human judgments are often fast and automatic. In this context, Kahneman and others have referred to two mental systems that govern human information processing: System 1, which operates quickly and automatically, with little or no effort and no sense of voluntary control, 15 and System 2, which allocates attention to effortful mental activities that demand it, such as performing complex computations and checking the validity of complex logical arguments. System 2 is associated with the subjective experience of agency, choice, and concentration. 15 In some circumstances, particularly when people are cognitively overloaded, System 1 is in operation and rapid decisions are based on unconscious rules of thumb (heuristics). While often necessary for day‐to‐day functioning, these heuristics are often susceptible to cognitive biases and errors. Proponents of nudging argue that a nudge can be used to work with individuals' cognitive biases to achieve the desired behavior. 8 Nudges typically take the form of changes to the choice architecture, which involves designing the context in which people make choices, to influence decision‐making and make certain choices easier. 8 , 16 Examples include changes to the physical environment, such as putting fruit at eye level in a cafeteria to prompt purchase and presenting information in different ways to influence decisions. 16 , 17 , 18 Marteau and colleagues have noted that nudging builds on a long tradition of psychological and sociological theory explaining how environments shape and constrain human behavior. It draws on the more novel approaches of behavioral economics and social psychology and in doing so challenges the rational behavior model of classical economics. 19 Hollands and colleagues have developed a typology of nudge‐type interventions, called the Typology of Interventions in Proximal Physical Micro‐Environments (TIPPME), that involve changing the environment in which they are available (placement), within settings such as shops, restaurants, bars, and workplaces, and the characteristics of products themselves (properties). 16 Examples from this typology include providing additional healthier options to select from, placing less healthy options further away from potential consumers, and/or altering the portion size of food, alcohol, and tobacco products. 16 Their typology identifies six different choice architecture intervention types, namely availability, position, functionality, presentation, size, and information (Table 1). Much of the academic discussion of nudges, particularly in the field of public policy, focuses on how they may be used to benefit individuals, such as public health policy to promote healthier lifestyles. However, nudge and behavioral economics more broadly also provide a valuable framework for understanding and analyzing how activities of harmful industries can promote actions that harm health. Newall provides an example from gambling research, where he has identified a range of dark nudges. 20 He describes how the industry exploits gamblers' cognitive biases, for example by framing losses as wins, or by removing friction from the gambling experience through touchscreen buttons that minimize the physical effort of long gambling sessions. Similarly, Schull's ethnography Addiction by Design details how characteristics of casinos and gambling machines are explicitly designed to keep people gambling, from the physical architecture (e.g., designing passageways to guide people toward machines) to sensory characteristics of the gambling environments (temperature, light, sound, and color) and gambling machines (slant of the screen; use of symbols, characters, and bonus wins). 21 Sludge also utilizes cognitive biases, but rather than encourage behavior change it aims to restrict it through the use of cognitive biases that favor the status quo and default options. Sludge has been defined by Sunstein as "excessive or unjustified frictions, such as paperwork burdens, that cost time or money; that may make life difficult to navigate; that may be frustrating, stigmatizing, or humiliating; and that might end up depriving people of access to important goods, opportunities, and services." 22 Friction can make choices and behavior change more difficult. The UK Government's Behavioural Intervention Team (jointly owned by the UK Cabinet Office and the innovation charity Nesta and its employees) notes: Requiring even small amounts of effort ('friction costs') can make it much less likely that a behavior will happen. For example, making it just slightly more difficult to obtain large amounts of over‐the‐counter drugs has been shown to greatly reduce overdoses. 23 Sludge has been observed in relation to the gambling industry's voluntary self‐exclusion sch
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