A Randomized Trial of Behavioral Nudges Delivered Through Text Messages to Increase Influenza Vaccination Among Patients With an Upcoming Primary Care Visit.

PURPOSE: To evaluate if nudges delivered by text message prior to an upcoming primary care visit can increase influenza vaccination rates. DESIGN: Randomized, controlled trial. SETTING: Two health systems in the Northeastern US between September 2020 and March 2021. SUBJECTS: 74,811 adults. INTERVENTIONS: Patients in the 19 intervention arms received 1-2 text messages in the 3 days preceding their appointment that varied in their format, interactivity, and content. MEASURES: Influenza vaccination. ANALYSIS: Intention-to-treat. RESULTS: Participants had a mean (SD) age of 50.7 (16.2) years; 55.8% (41,771) were female, 70.6% (52,826) were White, and 19.0% (14,222) were Black. Among the interventions, 5 of 19 (26.3%) had a significantly greater vaccination rate than control. On average, the 19 interventions increased vaccination relative to control by 1.8 percentage points or 6.1% (P = .005). The top performing text message described the vaccine to the patient as "reserved for you" and led to a 3.1 percentage point increase (95% CI, 1.3 to 4.9; P < .001) in vaccination relative to control. Three of the top five performing messages described the vaccine as "reserved for you." None of the interventions performed worse than control. CONCLUSIONS: Text messages encouraging vaccination and delivered prior to an upcoming appointment significantly increased influenza vaccination rates and could be a scalable approach to increase vaccination more broadly.

Lifestyle and mental health 1 year into COVID-19.

In previous work, Giuntella et al. (Proc Natl Acad Sci 118:e2016632118, 2021), we documented large disruptions to physical activity, sleep, time use and mental health among young adults at the onset of the COVID-19 pandemic in Spring 2020. This study explores the trends 1 year into COVID-19, as vaccines began to roll out, COVID-19 deaths declined, and social distancing measures eased in the United States. We combine biometric and survey data from multiple cohorts of college students spanning Spring 2019 through Spring 2021 (N = 1179). Our results show persistent impacts of the pandemic on physical activity and mental health. One year into the pandemic, daily steps averaged about 6300 per day compared to about 9800 per day prior to the pandemic, a 35% decline. Almost half of participants were at risk of clinical depression compared to a little over one-third prior to the pandemic, a 36% increase. The impacts on screen time, social interactions and sleep duration at the onset of COVID-19 largely dissipated over the course of the pandemic, though screen time remained significantly higher than pre-pandemic levels. In contrast to the sharp changes in lifestyle and mental health documented as the pandemic emerged in March 2020, we do not find evidence of behavioral changes or improvements in mental well-being over the course of Spring 2021 as the pandemic eased.

Behavioural nudges increase COVID-19 vaccinations.

Enhancing vaccine uptake is a critical public health challenge1. Overcoming vaccine hesitancy2,3 and failure to follow through on vaccination intentions3 requires effective communication strategies3,4. Here we present two sequential randomized controlled trials to test the effect of behavioural interventions on the uptake of COVID-19 vaccines. We designed text-based reminders that make vaccination salient and easy, and delivered them to participants drawn from a healthcare system one day (first randomized controlled trial) (n = 93,354 participants; clinicaltrials number NCT04800965) and eight days (second randomized controlled trial) (n = 67,092 individuals; clinicaltrials number NCT04801524) after they received a notification of vaccine eligibility. The first reminder boosted appointment and vaccination rates within the healthcare system by 6.07 (84%) and 3.57 (26%) percentage points, respectively; the second reminder increased those outcomes by 1.65 and 1.06 percentage points, respectively. The first reminder had a greater effect when it was designed to make participants feel ownership of the vaccine dose. However, we found no evidence that combining the first reminder with a video-based information intervention designed to address vaccine hesitancy heightened its effect. We performed online studies (n = 3,181 participants) to examine vaccination intentions, which revealed patterns that diverged from those of the first randomized controlled trial; this underscores the importance of pilot-testing interventions in the field. Our findings inform the design of behavioural nudges for promoting health decisions5, and highlight the value of making vaccination easy and inducing feelings of ownership over vaccines.

Lifestyle and mental health disruptions during COVID-19.

Using a longitudinal dataset linking biometric and survey data from several cohorts of young adults before and during the COVID-19 pandemic ([Formula: see text]), we document large disruptions to physical activity, sleep, time use, and mental health. At the onset of the pandemic, average steps decline from 10,000 to 4,600 steps per day, sleep increases by 25 to 30 min per night, time spent socializing declines by over half to less than 30 min, and screen time more than doubles to over 5 h per day. Over the course of the pandemic from March to July 2020 the proportion of participants at risk for clinical depression ranges from 46% to 61%, up to a 90% increase in depression rates compared to the same population just prior to the pandemic. Our analyses suggest that disruption to physical activity is a leading risk factor for depression during the pandemic. However, restoration of those habits through a short-term intervention does not meaningfully improve mental well-being.

Lifestyle and Mental Health Disruptions During COVID-19

From the Abstract: "COVID-19 [coronavirus disease 2019] has affected daily life in unprecedented ways. Using a longitudinal dataset linking biometric and survey data from several cohorts of young adults before and during the pandemic (N=685), we document large disruptions to physical activity, sleep, time use, and mental health. At the onset of the pandemic, average steps decline from 9,400 to 4,600 steps per day, sleep increases by about 25-30 minutes per night, time spent socializing declines by over half to less than 30 minutes, and screen time more than doubles to over 5 hours per day. The proportion of participants at risk of clinical depression increases to 65%, over twice the rate in the same population prior to the pandemic. Our analyses suggest that disruption to physical activity is a leading risk factor for depression during the pandemic. However, restoration of those habits-either naturally or through policy intervention-has limited impact on restoring mental well-being."