a b s t r a c tPreventive health behaviors like flu vaccination have important benefits, but compliance is poor, and the reasons are not fully understood. We conducted a large study across six colleges (N = 9358), with a methodology that offers an unusual opportunity to look at three potential factors: inattention to information, informed intentions to not comply, and problems following through on intentions. We also tested three interventions in an RCT. We find that inattention to information is not the primary driver of low take-up, while informed decisions to not get the vaccine, but also lack of follow-through, are important factors. A financial intervention increased take-up and had persistent, positive effects on intentions for vaccination in future years. Two low-cost "nudges" did not increase vaccination rates, although the peer endorsement nudge increased exposure to information, especially if aligned with social networks.

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Elevated blood pressure is the leading cause of death worldwide; however, treatment and control rates for hypertension are low. Here, we analyze the relationship between physician and nurse density and hypertension treatment rates worldwide. Data on hypertension treatment rates were collected from the STEPwise approach to Surveillance country reports, individual studies resulting from a PubMed search for articles published between 1990 and 2010, and manual search of the reference lists of extracted studies. Data on health care worker density were obtained from the Global Atlas of the Health Workforce. We controlled for a variety of variables related to population characteristics and access to health care, data obtained from the World Bank, World Development Indicators, United Nations, and World Health Organization. We used clustering of standard errors at the country level. Full data were available for 154 hypertension treatment rate values representing 68 countries between 1990-2010. Hypertension treatment rate ranged from 3.4% to 82.5%, with higher treatment rates associated with higher income classification. Physician and nurse/midwife generally increased with income classification. Total health care worker density was significantly associated with hypertension treatment rate in the unadjusted model (p < 0.001); however, only nurse density remained significant in the fully adjusted model (p = 0.050). These analyses suggest that nurse density, not physician density, explains most of the relationship with hypertension treatment rate, and remains significant even after adjusting for other independent variables. These results have important implications for health policy, health system design, and program implementation.

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