“What if life came with little reminders to make healthy choices?”
This intriguing question headlined an article about research into the power of those little reminders or “nudges” when it comes to incidental physical activity like stair-climbing.
The “nudge” in this case refers to signage. In an airport, would people be influenced by signs encouraging them to take the stairs or would they take the escalators located parallel to the stairs (in a set-up similar to the photo at left)? This question has even more salience than it normally would because “little reminders” or “nudges” are a major issue in the work of Dr. Richard Thaler, a recent Nobel Prize winner for his work in behavioral economics. (With Cass Sunstein, Thaler also wrote the book, Nudge: Improving Decisions About Health, Wealth, and Happiness.)
In a fascinating study published online on Sept. 21, 2017, in the Journal of Primary Prevention, author John Bellettiere and his colleagues used a stairs/escalator set-up at the San Diego International Airport to see what would happen. The stairway consisted of 34 steps with a landing midway up.
Since previous studies have shown that signage does increase stair use in settings other than airports (such as shopping malls and train stations), one might predict that the signs would influence people to take the stairs. On the other hand, people carrying luggage in a busy airport might decide that the escalators are a more sensible choice under the circumstances.
For the experiment, a team of San Diego State University public health researchers posted one of five signs reminding people of the health benefits of taking the stairs. These signs were located at the “point of choice," the stairs/escalator conjunction, and were strategically placed to maximize exposure. The signs read:
The signs were posted every other day for 10 days. No signs were posted at all on alternating days.
The researchers counted stair use versus escalator use on signage and non-signage days. They also conducted brief interviews of “the ascenders” of both stairs and escalators, asking questions about demographics, exercise routines, and health habits.
On “sign days,” about twice as many people took the stairs as on “no-sign days.”
The presence of signs prompted both regular exercisers and those who exercised little or not at all to take the stairs, with the odds of stair-climbing only slightly higher for the exercisers.
According to Dr. Bellettiere, the success of the signage prompts are encouraging as a possible public health intervention. Physical activity, even in small increments such as climbing stairs, has well-documented health benefits. Health benefits include preventing or slowing the development of chronic diseases such as heart disease and stroke, type 2 diabetes, certain types of cancer, depression, and many others. It is gratifying to note that a simple and low-cost intervention like signage could have such a powerful effect.
Moreover, “small wins” such as taking the stairs could lead individuals to take other small exercise actions even when not prompted to do so. Previous research has suggested that this ripple effect is real. And when people choose the stairs instead of the escalator, it has a "monkey see-monkey do" effect on those who are watching, who themselves are then more likely to do the same.
Why the Signs Work
Why is point-of-choice signage such an effective motivator for increasing physical activity?
One possible answer, backed by research in other areas: Signs like those placed in the airport provide quick reminders of values and goals that are significant to many people. These meaningful values and goals can be forgotten in the hurly-burly of daily life, but they can be reactivated with nudges and cues. As I write here, “Reminding yourself of core values—such as family, health, helping others, and so on—can activate your sense of purpose and thus boost your motivation to change.” In this case, reminders of the value of "health," "beauty," and "feeling youthful" may have prompted greater use of stairs.
Various studies provide examples of the power of reminding oneself of values. For example, research suggests that reflecting on core values helped people become more open-minded to health advice, perform better under stress, and even exert more self-control.
Second, I’m going to speculate that the signs also provide a sense of challenge, surprise, and fun in a situation not usually associated with happiness—trying to get to one’s terminal.
A Personal Note
When I first read this study, I had to admit to myself that I probably would not have taken the stairs. Although I’m a dedicated exerciser and pride myself on being “functionally fit,” I find that lugging my carry-on up a set of stairs in an airport is not a fun way to exercise. I won’t mention the airport (hint: the code is EWR), but sometimes I am forced to haul my carry-on up a dark, narrow staircase to get from one terminal to another without going through security again. Exhausting and annoying.
However, upon further review, I realized that there was one sign that might have influenced me to take the stairs: “Please reserve the escalator for those who need it.” This sign would have tapped into my "helping" values and provoked a little guilt about unnecessarily hogging the escalator.
Unfortunately, there was not enough data to measure the relative effectiveness of each sign. I would have like to have known which sign was linked with the most stair-climbers—the guilt-provoking sign (1), the health-reminder signs (2,3), the vanity sign (4), or the age-defying sign (5). I’m looking forward to further research on those messages. But perhaps the medium was more important than the message, as any of the signs could have reminded someone of his or her own personal reason for being more active and taking the stairs.
Promote Health With "Environmental Engineering"
The authors note that stairways are often less attractive than escalators, an observation I made during my trials at EWR Airport. Some of their ideas to correct this problem include:
This environmental engineering could reinforce the decision to take the stairs by giving stair-climbers a pleasant experience while improving their heart health.
The benefits of a small choice like taking the stairs may seem small. But benefits accrue over time, both for individuals and for the population as a whole. To quote the study: "The promotion of stair use in public places is consistent with the logic that small changes among a large proportion of the population may have a greater impact on population health than large changes among a small proportion of the population."
© Meg Selig, 2017
Special thanks to Dr. John Bellettiere for sending me a copy of the study discussed in this blog. Dr. Bellettiere is a post-doctoral researcher at the University of California at San Diego. His team of public health researchers hails from San Diego State University.
John Bellettiere, Sandy Liles, Yael BenPorat, Natasha Bliss, Suzanne C. Hughes, Brent Bishop, Kristi Robusto, Melbourne F. Hovell. And She’s Buying a Stairway to Health: Signs and Participant Factors Influencing Stair Ascent at a Public Airport. The Journal of Primary Prevention, 2017; DOI: 10.1007/s10935-017-0491-6
San Diego State University. (2017, October 13). Making healthier decisions, step by step: What if life came with little reminders to make healthy choices?. ScienceDaily. Retrieved October 23, 2017 from www.sciencedaily.com/releases/2017/10/171013095243.htm
Selig, M. “Use One Good Thought to Change Your Harmful Habit,” https://www.psychologytoday.com/blog/changepower/201502/use-one-good-thought-change-your-harmful-habit