Behavioral Economic Attributes of Recreation

Behavioral risk factors such as poor diet, physical inactivity, and tobacco and alcohol abuse account for a significant proportion of chronic disease incidence in the U.S. and globally. Understanding the processes that drive engagement in these behaviors could inform individual-level and societal interventions aimed at reducing cardiometabolic risk. Behavioral economics offers several key insights that could be leveraged for this purpose. Contemporary behavioral economic models identify three processes that drive problematic levels of engagement in cardiometabolic risk behaviors:

Demand - the degree to which a behavior is valued or desirable Discounting - immediate rewards are preferred to delayed rewards Choice context - behaviors are selected from the landscape of available options

Individuals vary in the subjective value they place on different rewarding activities. People who find alcohol, drugs of abuse, junk food, and sedentary activity most reinforcing (demonstrate the greatest demand) engage in these behaviors more often. Delay discounting refers to the human preference for immediate rewards, which can lead to instances in which people select less preferred, immediately available options over more valued delayed alternatives. Such occurrences are called preference reversals. Preference reversals lead to engaging in behaviors that provide immediate gratification but increase cardiometabolic risk (e.g., smoking, binge watching TV) for two reasons. First, long-term health outcomes are highly devalued as they always occur months to years in the future relative to the point of decision. Second, competing options that might displace risk behaviors often require planning or preparation, and are therefore less immediately accessible (and therefore discounted in value) at key decision points. For example, the need to plan and prepare to go fishing, engage in a hobby, or socialize with a friend is not trivial compared to the virtually instant access to screens and junk food that most adults have. A third hypothesized influence on cardiometabolic risk behavior is the choice context, or the "reward landscape". Access to alternative reinforcers in the environment can dramatically affect the rate of engaging in target behaviors, particularly if those alternative reinforcers are "behavioral substitutes" that tend to displace the target behavior. A key implication of this behavioral economic model is that increasing access to compelling, immediately available alternative sources of reinforcement may displace engagement in unhealthy behaviors.

To date, interventions based on these insights have mostly focused on reducing substance use. The Icelandic Prevention Model achieved substantial reductions in adolescent substance use at the national level by increasing access to after school recreational programming in local communities. The substance-free activity session is a 2-session intervention that reduces problematic alcohol use by encouraging individuals to identify rewarding alternative behaviors (social activity, recreation, etc). Few studies have applied this approach to improve cardiometabolic health, despite the relevance of the behavioral economic model to eating, sedentary activity, tobacco use, and potentially other cardiometabolic risk factors such as poor sleep, depression, and physical activity.

We recently reported that promoting recreational activities (arts and crafts, puzzles, games, hobbies) as alternative sources of reinforcement reduced children's intake of junk food and use of electronic entertainment in a pilot study with 60 families. Similar studies in adults are lacking. Presumably, recreational activities (broadly defined) represent equally potent alternatives for displacing cardiometabolic risk behaviors in adults.

Interventions that leverage recreation to displace cardiometabolic risk behaviors have strong theoretical support, but further development is needed prior to their implementation. Specifically, intervention development would benefit from a more detailed characterization of the "reward landscapes" of the U.S. adult population. It is known that palatable food and screens dominate most choice contexts, but less is known about the accessibility, cost, and level of demand for various alternative rewarding behaviors, including those available in community settings vs. at home. The Behavioral Economic Attributes of Recreation (BEAR) pilot study includes an observational cohort component aimed at developing methods to characterize the reward landscapes of U.S. adults, and a pilot RCT designed to test preliminary effects of leveraging recreation to displace cardiometabolic risk behaviors.

The following specific aims are proposed:

1. Test whether limited access to alternative reinforcing activities such as recreation is a risk factor for cardiometabolic health
2. Characterize the association between access to alternative reinforcing activities and Life's Essential 8 (LE8) scores
3. Identify specific behavioral pathways (diet, physical activity, sedentary time, sleep) linking recreation to health
4. Test whether access to recreation accounts for socioeconomic differences in LE8 scores and cardiometabolic health behaviors
5. Determine the relative contribution of community/neighborhood based vs. personal forms of recreation to health
6. Examine whether uptake of recreation leads to a reduction in discounting rates or demand for cardiometabolic risk behaviors
7. Evaluate the impact of recreation uptake on markers of cardiometabolic health
8. Demonstrate the feasibility of relevant methods
9. Develop and validate a theoretically meaningful framework for categorizing recreational activities
10. Develop and refine a reliable methodology for documenting recreation-related expenditures