aggravate and even lead to other medical and psychologic problems, as noted in Chapter 2.

Behavioral Economics

Over the last 2 decades, a burgeoning literature at the intersection of psychology and economics has produced consistent evidence of situations in which competent, often well-informed people behave in ways that are more detrimental to them than slightly changed behavior would be. Such findings of “bounded rationality” have clear implications for policies toward tobacco that are applicable to military and veteran populations (Thaler and Sunstein, 2008).

The first finding, documented repeatedly in behavioral economics, stems from “status quo bias,” the idea that people make choices regarding policies, consumption, and other decisions without a compelling incentive even though change would be beneficial and nearly cost-free. For example, for many people, the probability of participating in an employer-sponsored tax-deferred savings account rests on whether the employer automatically enrolls employees in such an account, despite the fact that most people say that they want to contribute to tax-deferred retirement savings plans. The second finding is that the “framing” of situations matters; people often act on information that, if their decision-making was rational, should be irrelevant. People respond in dramatically different ways to messages that convey the same information, depending on how the information is presented. Third, behavioral economists describe the “present-biased preference,” the tendency to overestimate the value of short-run benefits (continued smoking relieves boredom or stress today) and underestimate the long-run benefits of quitting (quitting smoking will improve my military performance in the coming months and my long-term health). Economists and others have suggested responding to those tendencies by designing policies that preserve choice but make the “optimal” or greatest-welfare options for a person easier to select (Camerer et al., 2003).

There are several ways in which these predictable “errors” may play a role in tobacco use among military and veteran populations, as elsewhere. Status quo bias seems to exist for new recruits, and, in the short term, evidence suggests that it helps them to avoid tobacco. In an organization in which smoking was historically a behavior of the majority, the practice of tobacco-free basic training was phased in without incident, and it occurs today with little complaint from recruits and virtually 100% compliance. Those who smoked before basic training seem to have little trouble with the change to a nonsmoking environment. Thus, as the military makes nonsmoking the status quo, people may find



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