What is the Future for Wearable Fitness Devices?

When I was in 3rd grade, I got a calculator watch. It was awesome. I was already on my way to being a nerd by having this black plastic wristwatch that allowed me to add, subtract, multiply and divide using the tiny buttons. A bunch of my friends had them too. It was actually cool to have a calculator watch because it was a new gadget that kids wanted. But then something happened.

Jawbone Up.

Jawbone Up.

The idea of the watch got old. While it was cool having those little buttons to do math, I actually didn't need to do math all that often. And the little buttons didn't make it easy for me to do math anyway. It was easier to use a real calculator. So I stopped wearing the calculator watch. And so did the other kids in my school who had one.

Basis Band

Basis Band

Wearable devices, like Fitbits, Basis Bands, and Jawbones, aren't that different from the calculator watch right now. They have a lot of potential, but they haven't yet reach that potential. They're cool gadgets, but that's about it. And that's why people stop using them within a few months of getting them. What can be done so that people keep wearing them?

They can be made more useful. They can incorporate the science of how to change behavior.

Fitbit Wearable Devices.

Fitbit Wearable Devices.

Psychologists have come a long way in understanding how to change human behavior. We started by studying habits in rats and cats 100 years ago, to studying social groups, and more recently how the brain and people’s social networks affect them.

Right now wearable devices track behavior. Many even incorporate gamification. But they're still in the early stages because they aren't yet tailored for what people need to change behavior.

Wearable fitness devices have tremendous potential to make people healthier, save healthcare costs, and make health easier. But to do that, the devices need to be useful. They need to be built using advancements in behavior change science, like the science of social.

The Daily Practice of New Year's Resolutions

With New Year's coming tomorrow, people are busy making their resolutions. It's time to plan how to become better people in the coming year. Exercise more, quit smoking, improve your diet. People make resolution resolutions too like finding a boy or girlfriend, improving their relationship, or dating more often too. There are also business resolutions like being more successful and making new connections.

I'm Jewish. Like many other cultures, Jews have their own new year, Rosh Hashanah. That means I get 2 New Years, or 2 chances to make resolutions of how I'm going to become a better person. That brings up the question, why do we have such a limited number of days to make resolutions to be better people? Why can't we make this a more frequent ritual?

We can.

The New Year is a time for optimism and rebirth, but it doesn't only have to be on January 1. We can make this a part of our lives every month, week, or day. Just like there are ritual practices like meditation and yoga, the process of bettering ourselves like we do on new years can be come a practice. Instead of waiting for next year to make resolutions on how to improve ourselves, let's make this a frequent ritual. 

The Psychology behind the Naked Selfie

                          Photo courtesy of http://en.wikipedia.org/wiki/Selfie

If you're building a tech product that has anything to do with photos then you're probably feeling an uncomfortable sense of déjà vu lately, and it has to do with data security.

It's become so routine that it's hard to imagine a Monday without hearing about another set of iCloud photos that got hacked during the weekend. These aren't just pictures of the girl down the street and her new Black Labrador puppy though. Instead, many of them are more likely to be pictures of her using the puppy as a prop in a nude selfie. And it's not just Apple/iCloud products that are at risk for getting hacked. So is Snapchat, and probably all other major sites hosting photos. Scandals are popping up AGAIN and AGAIN around hacked photos, especially nude ones. Why do we keep seeing these scandals?

There are two opposing camps trying to explain why we're having nude photo leaks, but who's right?

One group says, "Enough, children. Want to stop nude photos from getting hacked?  Keep your clothes on in selfies and the problem will go away by itself."  Those on the other side of the debate insist we must not blame the victim and instead should demand better privacy protections for iCloud and other digital storage accounts. 

Sound familiar? That's because it is. We've had scandals about hacked photos going back every year for almost 10 years, and people keep writing these same reactions after each one.

Annually rehashing this debate for a decade hasn't gotten us too far.  While we should expect companies to update security features, we can also expect hackers will continue improving their toolkits. And as for warning people to not take nude selfies, since when has issuing warnings been the key to changing behavior? 

Take smoking behavior or drunk driving. Even with the enormous anti-smoking campaigns and Surgeon General’s Warning emblazoned on cigarette packs, smoking continues to kill more people than AIDS, alcohol, car accidents, illegal drugs, murders and suicides combined. People know the physical and legal dangers of drunk driving, yet, alcohol-impaired drivers are causing 30 fatalities per day.  The point is, education and warnings won't solve problems unless the problems were caused by lack of knowledge.

Why, then, do young(ish) people keep taking naked digital pictures of themselves that are bound to get hacked? They were probably aware of the other  nude photo scandals that occurred so it's not that they don't know what's going on.  Is the answer then that all of these people taking naked pictures are just really stupid and have too much time on their hands?

Not quite. There's actually a science behind why we keep seeing these repeated nude photo scandals—the science of social

The truth is, sexting—sending sexually suggestive photos or videos via cell phone—is increasingly common among this age group.  According to a recent Pew Report, 15% of adults ages 18 to 24 and 22% of adults ages 25 to 34 admit to having sent such a message. Knowing that, it's less of a surprise that in the past year thousands of young people have had their nude photos hacked, including famous ones like Jennifer Lawrence and Mila Kunis. 

Are we saying, then, that this is simply a case of peer pressure? Nope, that's not it.

Our research at the UCLA Center for Digital Behavior has taught that our perceptions of what is normal in our social networks affects our behavior.  In one study, college students viewed a selection of Facebook photos of their peers and were then asked to estimate the percentage of students who engaged in sex without condoms and sex with strangers, and whether they themselves behave this way.  When students saw more sexually-suggestive photos of their peers (e.g., kissing, flirting with the camera, wearing revealing clothing), they reasoned that more of their peers were having unprotected sex and sex with strangers. They also said that they themselves planned on having more sex without condoms and sex with strangers. 

The point is, what people think their peers are doing (regardless of what they are actually doing) influences their behavior. If people think their friends are taking naked selfies and putting these pics online (even if the truth is that their friends are sitting at home chatting with mom), then they will start uploading selfies in the buff.  And this psychology isn't unique to only youth. It affects all of human behavior.

So what should you do if you're working on a photo-related technology and want a solution other than more data security to keep your product out of the hacking spotlight? My advice, as a behavioral psychologist, is that adding another few lines to your legal page or slapping on a data security warning pop-up about the risks of photo hacking won’t work, just like it doesn’t work for smoking, alcohol use, or most other behaviors. You've got to change the social environment to change the behavior. The short answer to change user behavior is, build a community around how people upload and share pictures. Create a social norm on what types of photos should be taken and shared using your technology. It might sound difficult, but there's a science behind how to create a community for positive social change, and you can find that information right here.

Effective behavior change campaigns work by understanding and changing the social environment.  To combat the increasing trend of sexting, we must similarly apply this science of social.

Sean Young, PhD, MS is the Executive Director of the UCLA Center for Digital Behavior and a Medical School Professor in the UCLA Department of Family Medicine.

UCLA Hackathon, Oct. 17-18th

Photo courtesy of Techcrunch

Photo courtesy of Techcrunch

The UCLA Center for Digital Behavior is co-sponsoring an "inventathon" at UCLA with the Business of Science Center and UCLA's Center for Advanced Surgical and Interventional Technology (CASIT).

We've already got people signed up from all over the country, including entrepreneurs from different parts of California, and students from UCLA, USC, CSUN, UCI, IIT, Berkeley, Santa Monica College, Pomona College, Harvard, ASU, Cal State Dominguez Hills, Penn State, Harrisburg, California Institute of Integral Studies, CalTech, Stanford, Emory / GA Tech, University of British Columbia, and Simon Bolivar University.

Participation is open to people from all backgrounds, ranging from engineering, to business, to biomedical research, to art and design.  The goal of this event is to stimulate innovation in healthcare, and generate ideas, products, and IP that can help change the world of health and medicine.  Interdisciplinary participant teams will be challenged to devise a solution, design, and build their inventions within a 24-hour period. Industry professionals will be available during the 24-hour event to answer questions and act as mentors to the student teams. Cash and in-kind prizes will be awarded to the first, second, and third place teams.

You can get more information about the event here.

The way of the wearable

Wearable self-tracking devices are quite likely the top health and wellness trend of 2014.  There is growing hype for wristbands, clothing, patches, and even ingestible pills measuring physical activity, sleep quality, and other physiological measures.  Their popularity is part of the larger Quantified Self Movement, the motto of which is “self-knowledge through numbers”.  But does self-knowledge necessarily lead to self-improvement?

Consumers are buying products like Fitbit and Jawbone UP with the hope that tracking health-related data will give them the insights and motivation needed to accomplish health goals.  However, according to a survey earlier this year, one-third of people who buy such a product stop using it quickly - within the first six months. 

Consumers quickly ditched the Nike+ FuelBand, finding the FuelPoints system confusing and inaccurate. Nearly one-third of Samsung Galaxy Gears purchased at Best Buy were returned after widespread complaints about its clunkiness, compatibility problems, and lack of useful features.

Because people are (somewhat) rational, the benefit of wearing the device must outweigh its inconvenience.  Wearables are beginning to improve ease of use, with more compact and sleek designs and more automated versus manual data collection.  But improving practicality and adding new measurement features will not be enough to boost long-term user engagement.  Providing health data alone is not likely to outweigh discomfort or the burden of remembering to wear, charge, and sync the device.  The wearable device must both provide and help improve the data.  When a wearable fails to help accomplish a user’s health goals, the user will not feel motivated to continue wearing the device.

Successful wearable design should optimize not only data collection capability, but also incorporate methods from behavior change science.  For example, according to Social Cognitive Theory, the social context has substantial influence on behavior.  Applying this theory, wearables could incorporate peer-to-peer feedback and encouragement.  When users see themselves or others making improvements and receiving praise, they will feel motivated to sustain their improved behavior and wear the device.

We can look to behavior change science to ensure future wearables go the way of the smartphone (an everyday necessity) and not the way of the calculator watch and flip camera (the junk drawer).

Update on UCLA Mobile Health and HIV Conference

I will be Chairing a UCLA CHIPTS-sponsored, free, one-day conference on the use of technology among at-risk communities on Thursday, January 23, 2014 at the California Endowment in Los Angeles.  The purpose of the conference is to bring together researchers, entrepreneurs, representatives of technology companies, public policy makers, community service providers, and members of the community to share cutting-edge research and real-world application of social media, web-based, and mobile technologies among at-risk communities, particularly for HIV prevention and care. 

The conference will include a keynote presentation from Dr. Indu Subaiya, CEO and Co-Founder at Health 2.0, as well as presentations from leading community research experts such as Dr. Brian Mustanski of Northwestern University and Dr. Marguerita Lightfoot of the Center for AIDS Prevention Studies at the University of California, San Francisco,  Drs. Eric Rice and Lynn Miller of the University of Southern California.

There will also be a panel discussion addressing implementation, funding, policy and privacy issues inherent to the use of technology.  Panelists include Mr. Brad Sears of UCLA Charles L. Williams Institute, Mr. Ramin Bastani of Hula (www.GetHula.com ), Dr. Tina Henderson of JWCH Institute,  Ms. Risa Flynn of the Los Angeles Gay & Lesbian Center, and others.

Immediately following the conference will be a networking reception.  This reception is being organized specifically to give our conference presenters, researchers, participants, exhibitors, and other stakeholders an opportunity to meet one another with the goal of developing new collaborations, partnerships, and ideas. The reception is also free and open to all conference attendees, but advance RSVP is required.

Join us: Innovative Use of Technology for HIV Prevention & Care - January 23, 2014

I am chairing a one-day UCLA conference on Thursday, January 24, 2014 on current and future ways to use technologies among communities at risk for HIV. The conference, sponsored by CHIPTS and the UCLA AIDS Institute, will focus on how social media and mobile technologies are being used to address community health disparities, especially focused on HIV and drug-related prevention and treatment.

A keynote speaker (TBA) will present on the current future ways that technologies are being integrated into community health. We'll then have panel discussions on researchers presenting their work on how social media and health can be used for community-level HIV prevention, followed by debates between developers and community activists/policy researchers on the privacy and ethical issues that need to be addressed when using these technologies.

The event will take place at the California Endowment at 1000 N. Alameda Street from 8:00 AM to 4:00 PM. Please email me if you're interested in requesting an invite or want more information.

Behavior Change: Step 1

I have to credit this post to Eric Eldon of Techcrunch, who told me to let people know about the potential harms associated with changing behavior so that we use behavior change science to improve people's lives. And he's right, before we start thinking about the mechanics of behavior change and how to implement them, its important that we first ask ourselves why we are trying to change behavior. Psychology and behavior change science is pretty powerful, and I'm sure you can think of examples of how it could be for good as well as evil, or, where it was initially intended to be used for good but ended up causing unintended negative consequences. The White House recently decided to follow Britain's lead in bringing on a "behavioral insights team" of psychologists to change behavior. With the recent privacy concerns resulting from government security, we can all imagine how this team of experts might end up providing more harm than benefit.

Psychologists and ethicists use a few different methods for evaluating whether intended outcomes would benefit others. They frequently rely on group consensus (asking other other people), looking for historical examples of what happened in similar situations, and turning to get input from experts and/or people who would be potentially at risk. However, all of these methods can be flawed. For example, people are notoriously bad at predicting how they feel in future situations, and so asking them how an event might impact them is not the best way to know how it will actually make them feel.

The take home point here is that we need to consider our motives before using behavior change science to change other people. We don't have a easy rule for guaranteeing that our objectives will be good for the world or improve people's lives in some way, so we'll have to individually determine whether it our intentions are good and ethical. I think it's important for us to spending time thinking about this question, and possibly exploring some of the methods presented here, before moving forward full force and learning how to change behavior to achieve those objectives.  


Seeking Presenters for UCLA 1-day mHealth Conference

UCLA asked me to chair an invite-only 1-day mHealth event to take place on January 23, 2014. The meeting will gather a mix of academic researchers, entrepreneurs, community groups, corporate leaders, and policymakers to help shape how mobile technologies can be used to improve health among under-served populations. We have a small number of openings for speakers/presenters, so please pass this on to mHealth and mobile technology experts and enthusiasts who would be interested. 

A major theme of the meeting will be on how to apply mobile technologies to help underserved populations in need of prevention and treatment for HIV and substance use. However, we are interested in having experts from various areas of mHealth present on insights from their work. The following are a list of potential examples of types of solicitations to give you a better idea:

  1. mHealth entrepreneurs and technologies providing important results on how their technologies can improve the delivery of mHealth, including tools for aggregating and/or analyzing big data,
  2. Researchers presenting work on novel and important findings related to mHealth, including behavioral and clinical trials, and development and testing of novel biosensors and health engineering tools,
  3. Use of mHealth for community and family medicine
  4. Policy and ethical considerations to be addressed when using mHealth technologies
  5.  mHealth technologies as tools that can be used for corporate partnerships and collaborations, as well as insurance companies' perspectives on use of mobile health technologies.

If you're interested in presenting, please email me at sdyoung@mednet.ucla.edu and include your title, affiliation, and an unstructured abstract (less than 350 words) of the topic you would wish to present. 


Will the quantified self movement change behavior?

The quantified self/self-tracking movement aims to give people the ability to track their health data and behaviors. For example, by wearing devices such as Fitbits to track exercise, and by entering information about stress levels, people will be better equipped to track trends in their health and well-being. The goal is that people will be able to use this information not just to show off their cool new gadgets, but to understand their health and improve it.

The question is, will giving people more information change their behavior? There are numerous reasons why people aren't engaging in healthy behaviors, for example, lack of knowledge, lack of access to people who can help them change, lack of willingness to change, lack of belief that they can change, and many others. Assuming people do have the drive to change their behavior and believe that they can do so, they still might not change it. Here's a research example to illustrate why:

I worked with a colleague to find out how methods of communicating information about medication side effects influence medication adherence. We told people about their risk for medication side effects using language commonly conveyed by pharmacists and doctors  (for example, "there is a low risk that you will experience headaches, nausea, etc") and then asked them to estimate the likelihood that they would actually experience those side effects. "Low risk" typically meant that, compared to taking a placebo, approximately 3 out of 10,000 people who take the medication would report side effects. However, instead of recognizing what pharmacists and pharmaceutical companies intended them to realize, people actually interpreted low risk to mean that about 33 out of 100 people would experience side effects (or over 1000 times greater chance of side effects than intended)! This means they dramatically overestimated their risk of side effects from medication. We then looked at whether presenting side effect information verbally ("low risk") versus through numbers (<0.03%, or 3 out of 10,000) would affect their intention to take the medicine. We found that changing the communication format not only helped them to better understand their risk but also improved their willingness to take the medication.

This illustrates one example of how giving people information might not change their behavior, as they might not understand that information unless it is presented correctly. Information about side effects is given both to satisfy regulatory guidelines and to give patients/consumers more information. Risk of side effects from medication is typically "very low," meaning that other things in their lives are much more  "risky." However, people misinterpreted the information about the side effects because it was not presented in a way that they could understand. Presentation of information is very important, and this feeds back into the quantified self movement where, in order to change behavior, we need to present information in a way that takes account of people's psychology.

Will the quantified self and big data movements get people to change behavior? The answer is maybe. It depends on whether the information is tailored to human psychology.


Using Technologies to Promote Health Behaviors

One of my former classmates from grad school at Stanford wants me to co-write a chapter on the health-related behavioral issues caused by new technologies -- how technologies have become effective and efficient forms of entertainment and fun, but have also reduced our motivation to engage in healthy behaviors, such as exercising. I have a tough time saying no to working with smart people on exciting ideas (so we're now working on this project). and i'm optimistic that we can take the principles that have made these technologies engaging and "reincorporate" them into new technologies to create engaging tools for promoting health behavior change.

For example, for most people, their work used to be their form of exercise. Who needed gyms? When work involved manual labor, we were working and exercising at the same time. Voltair's Candide wrote that "work keeps at bay three great evils: boredom, vice, and need." I think it also used to keep at bay wanting to sit on the couch all day playing video games and watching sports (although i'm looking forward to more great NBA finals this week!). During recent decades, technology development has not only improved efficiency and reduced our need to engage in the manual labor that used to be our exercise, but the creation of televisions, computers, and smartphones has allowed us to get our entertainment without having to move.

The good thing about these changes is that technology developers (especially game developers) are more interested in how to engage people and change behavior then ever before. Funding is spent on researching how to get people to click on buttons to download applications, how to incentivize them to keep using apps, and how to get people to invite their friends to participate. This research is all based on older psychology and behavior change principles and we're learning how to use these technologies to increase entertainment and engagement. In the very near future, I'm optimistic and confident that developers and entrepreneurs will soon address the market for health behavior change by incorporating these principles into health behavioral technologies to improve health and well being.