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Kelley AT, Incze MA, Baumgartner M, Campbell ANC, Nunes EV, Scharfstein DO. Predictors of urine toxicology and other biologic specimen missingness in randomized trials of substance use disorders. Drug Alcohol Depend 2024; 261:111368. [PMID: 38896944 DOI: 10.1016/j.drugalcdep.2024.111368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 04/08/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND High levels of missing outcome data for biologically confirmed substance use (BCSU) threaten the validity of substance use disorder (SUD) clinical trials. Underlying attributes of clinical trials could explain BCSU missingness and identify targets for improved trial design. METHODS We reviewed 21 clinical trials funded by the NIDA National Drug Abuse Treatment Clinical Trials Network (CTN) and published from 2005 to 2018 that examined pharmacologic and psychosocial interventions for SUD. We used configurational analysis-a Boolean algebra approach that identifies an attribute or combination of attributes predictive of an outcome-to identify trial design features and participant characteristics associated with high levels of BCSU missingness. Associations were identified by configuration complexity, consistency, coverage, and robustness. We limited results using a consistency threshold of 0.75 and summarized model fit using the product of consistency and coverage. RESULTS For trial design features, the final solution consisted of two pathways: psychosocial treatment as a trial intervention OR larger trial arm size (complexity=2, consistency=0.79, coverage=0.93, robustness score=0.71). For participant characteristics, the final solution consisted of two pathways: interventions targeting individuals with poly- or nonspecific substance use OR younger age (complexity=2, consistency=0.75, coverage=0.86, robustness score=1.00). CONCLUSIONS Psychosocial treatments, larger trial arm size, interventions targeting individuals with poly- or nonspecific substance use, and younger age among trial participants were predictive of missing BCSU data in SUD clinical trials. Interventions to mitigate missing data that focus on these attributes may reduce threats to validity and improve utility of SUD clinical trials.
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Affiliation(s)
- A Taylor Kelley
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA; Greater Intermountain Node, National Institute on Drug Abuse Clinical Trial Network, Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA; Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA; Vulnerable Veteran Patient-Aligned Care Team, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
| | - Michael A Incze
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA; Greater Intermountain Node, National Institute on Drug Abuse Clinical Trial Network, Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Aimee N C Campbell
- New York State Psychiatric Institute, Division on Substance Use Disorders, New York, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Edward V Nunes
- New York State Psychiatric Institute, Division on Substance Use Disorders, New York, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Daniel O Scharfstein
- Division of Biostatistics, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
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Higgins ST, Erath T, Chen FF. Examining U.S. disparities in smoking among rural versus urban women of reproductive age: 2002-2019. Prev Med 2024; 185:108054. [PMID: 38914268 PMCID: PMC11269002 DOI: 10.1016/j.ypmed.2024.108054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 06/26/2024]
Abstract
OBJECTIVE This study is part of a programmatic investigation of rural disparities in cigarette smoking examining disparities in smoking prevalence and for the first-time quit ratios among adult women of reproductive age (18-44 years), a highly vulnerable population due to risk for multigenerational adverse effects. METHODS Data came from 18 years (2002-2019) of the U.S. National Survey on Drug Use and Health (NSDUH) among women (n = 280,626) categorized by rural-urban residence, pregnancy status, using weighted logistic regression models testing time trends and controlling for well-established sociodemographic predictors of smoking (race/ethnicity, education, income). Concerns regarding changes in survey methods used before 2002 and after 2019 precluded inclusion of earlier and more recent survey years in the present study. RESULTS Overall smoking prevalence across years was greater in rural than urban residents (adjusted odds ratio [AOR] = 1.11; 95%CI, 1.07-1.15; P < .001) including those not-pregnant (AOR = 1.10; 1.07-1.14; P < .001) and pregnant (AOR = 1.29; 1.09-1.52; P < .001). Overall quit ratios across years were lower in rural than urban residents (AOR = 0.93; 0.87-0.99; P < .001) including those not-pregnant (AOR = 0.93; 0.88-1.00, P = .035) and pregnant (AOR = 0.78; 0.62-0.99; P = .039). Interactions of rural versus urban residence with study years for prevalence and quit ratios overall and by pregnancy status are detailed in the main text. CONCLUSIONS These results support a longstanding and robust rural disparity in smoking prevalence among women of reproductive age including those currently pregnant and provides novel evidence that differences in smoking cessation contribute to this disparity further underscoring a need for greater access to evidence-based tobacco control and regulatory interventions in rural regions.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States; Department of Psychological Science, University of Vermont, United States.
| | - Tyler Erath
- Vermont Center on Behavior and Health, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | - Fang-Fang Chen
- Vermont Center on Behavior and Health, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
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Winkler-Schor S, Brauer M. What Happens When Payments End? Fostering Long-Term Behavior Change With Financial Incentives. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2024:17456916241247152. [PMID: 38767968 DOI: 10.1177/17456916241247152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Financial incentives are widely used to get people to adopt desirable behaviors. Many small landholders in developing countries, for example, receive multiyear payments to engage in conservation behaviors, and the hope is that they will continue to engage in these behaviors after the program ends. Although effective in the short term, financial incentives rarely lead to long-term behavior change because program participants tend to revert to their initial behaviors soon after the payments stop. In this article, we propose that four psychological constructs can be leveraged to increase the long-term effectiveness of financial-incentive programs: motivation, habit formation, social norms, and recursive processes. We review successful and unsuccessful behavior-change initiatives involving financial incentives in several domains: public health, education, sustainability, and conservation. We make concrete recommendations on how to implement the four above-mentioned constructs in field settings. Finally, we identify unresolved issues that future research might want to address to advance knowledge, promote theory development, and understand the psychological mechanisms that can be used to improve the effectiveness of incentive programs in the real world.
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Affiliation(s)
| | - Markus Brauer
- Department of Psychology, University of Wisconsin-Madison
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4
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Corrêa R, Tabak BM. The Influence of Behavioral Sciences on Adherence to Physical Activity and Weight Loss in Overweight and Obese Patients: A Systematic Review of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:630. [PMID: 38791844 PMCID: PMC11121225 DOI: 10.3390/ijerph21050630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024]
Abstract
In recent years, weight gain and reduced physical activity in the general population have contributed to the development of obesity and other health problems; on the other hand, studies in behavioral sciences have been used to modify behaviors for a healthier life, so the objective of this study was to identify the evidence of interventions in behavioral sciences on adherence to physical activity and weight loss in obese patients. This systematic review study is based on a search of the electronic databases PubMed, Web of Science, Scopus, and Cochrane. Studies assessed the evidence from intervention studies that assessed the influence of intervention studies of behavioral sciences on public health. The articles were published between 2013 and 2023. The systematic search of the databases identified 2951 articles. The review analyzed 10 studies. Behavioral science interventions presented evidence through strategies such as multicomponent interventions, lottery and financial incentives, message framing, message framing with financial incentive and physical activity, and psychological satisfaction, demonstrating results in weight loss and maintenance and increased physical activity. This study presents scientific evidence through healthy behavior change methodologies, and future studies can explore these strategies in conjunction with public health technologies in the search for public-private partnerships to promote physical activity in adults.
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Affiliation(s)
- Rafael Corrêa
- School of Public Policy and Government, Getulio Vargas Foundation, SGAN 602 Módulos A,B,C, Asa Norte, Brasília 70830-020, Brazil;
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Wernimont SA, Fleener D, Summers KM, Deonovic B, Syrop CH, Andrews JI. The Effect of Financial Incentives on Adherence to Glucose Self-Monitoring during Pregnancy among Patients with Insulin-Requiring Diabetes: A Randomized Clinical Trial. Am J Perinatol 2024; 41:e259-e266. [PMID: 35777732 PMCID: PMC11093650 DOI: 10.1055/a-1889-7765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/03/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Glucose self-monitoring is critical for the management of diabetes in pregnancy, and increased adherence to testing is associated with improved obstetrical outcomes. Incentives have been shown to improve adherence to diabetes self-management. We hypothesized that use of financial incentives in pregnancies complicated by diabetes would improve adherence to glucose self-monitoring. STUDY DESIGN We conducted a single center, randomized clinical trial from May 2016 to July 2019. In total, 130 pregnant patients, <29 weeks with insulin requiring diabetes, were recruited. Participants were randomized in a 1:1:1 ratio to one of three payment groups: control, positive incentive, and loss aversion. The control group received $25 upon enrollment. The positive incentive group received 10 cents/test, and the loss aversion group received $100 for >95% adherence and "lost" payment for decreasing adherence. The primary outcome was percent adherence to recommended glucose self-monitoring where adherence was reliably quantified using a cellular-enabled glucometer. Adherence, calculated as the number of tests per day divided by the number of recommended tests per day×100%, was averaged from time of enrollment until admission for delivery. RESULTS We enrolled 130 participants and the 117 participants included in the final analysis had similar baseline characteristics across the three groups. Average adherence rates in the loss aversion, control and positive incentive groups were 69% (SE=5.12), 57% (SE = 4.60), and 58% (SE=3.75), respectively (p=0.099). The loss aversion group received an average of $50 compared with $38 (positive incentive) and $25 (control). CONCLUSION In this randomized clinical trial, loss aversion incentives tended toward higher adherence to glucose self-monitoring among patients whose pregnancies were complicated by diabetes, though did not reach statistical significance. Further studies are needed to determine whether use of incentives improve maternal and neonatal outcomes. KEY POINTS · Self-glucose monitoring is a critical part of diabetes management in pregnancy.. · Loss aversion financial incentives may increase adherence to glucose self-monitoring in pregnancy.. · The impact of testing incentives on maternal and neonatal outcomes requires further investigation..
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Affiliation(s)
- Sarah A Wernimont
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, Minnesota
- Division of Molecular Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Diedre Fleener
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Karen M Summers
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Benjamin Deonovic
- Department of Biostatistics, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Craig H Syrop
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Janet I Andrews
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, Minnesota
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Yang X, Galárraga O, Cao W, Lin H, Cao F, Chang C. Financial incentive interventions for smoking cessation among Chinese smokers: study protocol for a cluster randomised controlled trial. BMJ Open 2024; 14:e080344. [PMID: 38684254 PMCID: PMC11086505 DOI: 10.1136/bmjopen-2023-080344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/15/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION There is an urgent issue to relieve the burdens caused by tobacco use through feasible and effective smoking cessation interventions, particularly in a middle-income country with less accessible smoking cessation services and high demand for quitting smoking. Financial incentives have shown effective in changing health behaviours, thus needing to test its portability to a wider implementation and effectiveness of increasing smoking cessation rates. METHODS AND ANALYSIS This is a three-arm cluster randomised controlled trial. 462 eligible participants will be assigned to 2 financial incentive groups-rewards or deposits, or the control group. All participants including those in the control group will receive text messages to help quitting smoking developed by the US National Cancer Institute over a 3-month intervention period. In addition to text messages, reward group participants will be rewarded with CNY200 and CNY400 (CNY100 approximately US$15) for sustained smoking abstinence at 1 month and 3 months follow-up assessments; participants in the deposit group will accumulate CNY200 and CNY600 in the deposit accounts after verified smoking abstinence at 1 month and 3 months follow-up assessments, and all the deposits will be given at once right after the 3-month follow-up visit. The primary outcome is biochemically verified smoking abstinence rate sustained for 6 months after enrolment. ETHICS AND DISSEMINATION This trial protocol has been approved by the Ethics Committee of Peking University Health Science Centre (date: 23 February 2023; ethical approval number: IRB00001052-22172). Results and findings of this trial will be disseminated in peer-reviewed journals and professional conferences. TRIAL REGISTRATION NUMBER ChiCTR-IOR-2300069631.
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Affiliation(s)
- Xiaochen Yang
- Peking University Department of Social Medicine and Health Education, Beijing, Beijing, China
| | - Omar Galárraga
- Brown University School of Public Health, Providence, UK
| | - Wangnan Cao
- Department of Social Medicine and Health Education, Peking University, Beijing, China
| | - Haoxiang Lin
- Peking University Institute for Global Health and Development, Beijing, China
| | - Fei Cao
- Department of Marketing, Tianjin University of Finance and Economics, Tianjin, China
| | - Chun Chang
- Peking University Department of Social Medicine and Health Education, Beijing, Beijing, China
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Kim YG, Brandt L, Cheung K, Nunes EV, Roll J, Luo SX, Liu Y. Optimizing Contingency Management with Reinforcement Learning. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.28.24305031. [PMID: 38585900 PMCID: PMC10996730 DOI: 10.1101/2024.03.28.24305031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Contingency Management (CM) is a psychological treatment that aims to change behavior with financial incentives. In substance use disorders (SUDs), deployment of CM has been enriched by longstanding discussions around the cost-effectiveness of prized-based and voucher-based approaches. In prize-based CM, participants earn draws to win prizes, including small incentives to reduce costs, and the number of draws escalates depending on the duration of maintenance of abstinence. In voucher-based CM, participants receive a predetermined voucher amount based on specific substance test results. While both types have enhanced treatment outcomes, there is room for improvement in their cost-effectiveness: the voucher-based system requires enduring financial investment; the prize-based system might sacrifice efficacy. Previous work in computational psychiatry of SUDs typically employs frameworks wherein participants make decisions to maximize their expected compensation. In contrast, we developed new frameworks that clinical decision-makers choose actions, CM structures, to reinforce the substance abstinence behavior of participants. We consider the choice of the voucher or prize to be a sequential decision, where there are two pivotal parameters: the prize probability for each draw and the escalation rule determining the number of draws. Recent advancements in Reinforcement Learning, more specifically, in off-policy evaluation, afforded techniques to estimate outcomes for different CM decision scenarios from observed clinical trial data. We searched CM schemas that maximized treatment outcomes with budget constraints. Using this framework, we analyzed data from the Clinical Trials Network to construct unbiased estimators on the effects of new CM schemas. Our results indicated that the optimal CM schema would be to strengthen reinforcement rapidly in the middle of the treatment course. Our estimated optimal CM policy improved treatment outcomes by 32% while maintaining costs. Our methods and results have broad applications in future clinical trial planning and translational investigations on the neurobiological basis of SUDs.
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Affiliation(s)
- Young-Geun Kim
- Mailman School of Public Health, Department of Biostatistics, New York, NY, USA
- Columbia University Irving Medical Center, Department of Psychiatry, New York, NY, USA
| | - Laura Brandt
- City College of New York, Department of Psychology, New York, NY, USA
| | - Ken Cheung
- Mailman School of Public Health, Department of Biostatistics, New York, NY, USA
| | - Edward V Nunes
- Columbia University Irving Medical Center, Department of Psychiatry, New York, NY, USA
- New York State Psychiatric Institute, Division on Substance Use Disorders, New York, NY, USA
| | - John Roll
- Washington State University, Department of Community and Behavioral Health, Spokane, WA, USA
- Washington State University, Program of Excellence in Addictions Research, Spokane, WA, USA
| | - Sean X Luo
- Columbia University Irving Medical Center, Department of Psychiatry, New York, NY, USA
- New York State Psychiatric Institute, Division on Substance Use Disorders, New York, NY, USA
| | - Ying Liu
- Columbia University Irving Medical Center, Department of Psychiatry, New York, NY, USA
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Li Y, Gao L, Chao Y, Wang J, Qin T, Zhou X, Chen X, Hou L, Lu L. Effects of interventions on smoking cessation: A systematic review and network meta-analysis. Addict Biol 2024; 29:e13376. [PMID: 38488699 PMCID: PMC11061851 DOI: 10.1111/adb.13376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/17/2023] [Accepted: 01/16/2024] [Indexed: 03/19/2024]
Abstract
A network meta-analysis (NMA) including randomized controlled trials (RCTs) was conducted to evaluate the effects of different interventions on smoking cessation. Studies were collected from online databases including PubMed, EMBASE, Cochrane Library, and Web of Science based on inclusion and exclusion criteria. Eligible studies were further examined in the NMA to compare the effect of 14 interventions on smoking cessation. Thirty-four studies were examined in the NMA, including a total of 14 interventions and 28 733 participants. The results showed that health education (HE; odds ratio ([OR] = 200.29, 95% CI [1.62, 24 794.61])), other interventions (OI; OR = 29.79, 95% CI [1.07, 882.17]) and multimodal interventions (MUIs; OR = 100.16, 95% CI [2.06, 4867.24]) were better than self-help material (SHM). HE (OR = 243.31, 95% CI [1.39, 42531.33]), MUI (OR = 121.67, 95% CI [1.64, 9004.86]) and financial incentive (FI; OR = 14.09, 95% CI [1.21, 164.31]) had positive effects on smoking cessation rate than smoking cessation or quitting APP (QA). Ranking results showed that HE (83.6%) and motivation interviewing (MI; 69.6%) had better short-term effects on smoking cessation. HE and MUI provided more smoking cessation benefits than SHM and QA. FI was more effective at quitting smoking than QA. Also, HE and MI were more likely to be optimal smoking cessation interventions.
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Affiliation(s)
- Ying Li
- College of Sports ScienceJishou UniversityJishouChina
| | - Lei Gao
- School of NursingDalian UniversityDalianChina
| | - Yaqing Chao
- Ophthalmology DepartmentXuzhou First People's HospitalXuzhouChina
| | - Jianhua Wang
- College of NursingWeifang University of Science and TechnologyWeifangChina
| | - Tianci Qin
- College of Sports ScienceJishou UniversityJishouChina
| | | | - Xiaoan Chen
- College of Sports ScienceJishou UniversityJishouChina
| | - Lingyu Hou
- Nursing DepartmentPeking University Shenzhen HospitalShenzhenChina
| | - linlin Lu
- Nursing DepartmentPeking University Shenzhen HospitalShenzhenChina
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Suzuki T, Rewley J, Sugibuchi K, Suzuki Y, Suzumura S, Tsurugi N, Okamura D, Node K, Mizuno A. Feedbacks Using behaviOral econOmic theories on STEP countS in Cardiovascular Disease Patients (FOOTSTEPS) Using Novel Daily Step Counts Retrieving System. Int Heart J 2024; 65:100-108. [PMID: 38296562 DOI: 10.1536/ihj.23-415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
The effectiveness of gamification-based feedback systems that utilize non-monetary points to promote exercise among cardiovascular disease (CVD) patients has not been fully evaluated. This study aimed to evaluate the effectiveness of a gamification program using non-monetary points on the daily step counts in CVD patients. We collected 30 patients with a history of heart failure or myocardial infarction at a single tertiary center between January 9, 2023, and April 13, 2023. The primary outcome was the change in daily step counts. The baseline step counts were compared with those during the 4-week gamification and the 1-week follow-up period. A total of 29 participants with a mean age of 64.6 years were finally enrolled, and 8 (27.6%) were female. Among them, 23 (79.3%) had a history of old myocardial infarction, and 9 (31.0%) had a history of chronic heart failure. During the intervention period, the average daily step counts increased significantly from baseline in weeks 1-5 (week 1: 1165 steps; 95% CI, 319-2011; P = 0.009, week 2: 1508; 635-2382; P = 0.001, week 3: 1321; 646-1996; P < 0.001, week 4: 1436; 791-2081; P < 0.001, week 5:1148; 436-1860; P < 0.001). Higher body mass index was statistically associated with the smaller difference in step counts from the baseline, and the lower proportion of achievement of step count goals. Female sex was significantly associated with the higher proportion of achievement of step count goals. In conclusion, this pilot prospective interventional study demonstrated the effectiveness of gamification-based feedback systems that utilize non-monetary points to increase daily step counts in CVD patients.
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Affiliation(s)
- Takahiro Suzuki
- Department of Cardiovascular Medicine, St. Luke's International Hospital
| | | | | | - Yoko Suzuki
- Cardiovascular Nursing, St. Luke's International Hospital
| | | | - Nanami Tsurugi
- Department of Rehabilitation, St. Luke's International Hospital
| | - Daisuke Okamura
- Department of Rehabilitation, St. Luke's International Hospital
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Atsushi Mizuno
- Department of Cardiovascular Medicine, St. Luke's International Hospital
- Leonard Davis Institute for Health Economics, University of Pennsylvania
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de Buisonjé DR, Reijnders T, Cohen Rodrigues TR, Santhanam P, Kowatsch T, Breeman LD, Janssen VR, Kraaijenhagen RA, Kemps HMC, Evers AWM. Less stick more carrot? Increasing the uptake of deposit contract financial incentives for physical activity: A randomized controlled trial. PSYCHOLOGY OF SPORT AND EXERCISE 2024; 70:102532. [PMID: 37678644 DOI: 10.1016/j.psychsport.2023.102532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 06/05/2023] [Accepted: 09/04/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Financial incentives are a promising tool to help people increase their physical activity, but they are expensive to provide. Deposit contracts are a type of financial incentive in which participants pledge their own money. However, low uptake is a crucial obstacle to the large-scale implementation of deposit contracts. Therefore, we investigated whether (1) matching the deposit 1:1 (doubling what is deposited) and (2) allowing for customizable deposit amounts increased the uptake and short term effectiveness of a deposit contract for physical activity. METHODS In this randomized controlled trial, 137 healthy students (age M = 21.6 years) downloaded a smartphone app that provided them with a tailored step goal and then randomized them to one of four experimental conditions. The deposit contract required either a €10 fixed deposit or a customizable deposit with any amount between €1 and €20 upfront. Furthermore, the deposit was either not matched or 1:1 matched (doubled) with a reward provided by the experiment. During 20 intervention days, daily feedback on goal progress and incentive earnings was provided by the app. We investigated effects on the uptake (measured as agreeing to participate and paying the deposit) and effectiveness of behavioral adoption (measured as participant days goal achieved). FINDINGS Overall, the uptake of deposit contracts was 83.2%, and participants (n = 113) achieved 14.9 out of 20 daily step goals. A binary logistic regression showed that uptake odds were 4.08 times higher when a deposit was matched (p = .010) compared to when it was not matched. Furthermore, uptake odds were 3.53 times higher when a deposit was customizable (p = .022) compared to when it was fixed. Two-way ANCOVA showed that matching (p = .752) and customization (p = .143) did not impact intervention effectiveness. However, we did find a marginally significant interaction effect of deposit matching X deposit customization (p = .063, ηp2 = 0.032). Customization decreased effectiveness when deposits were not matched (p = .033, ηp2 = 0.089), but had no effect when deposits were matched (p = .776, ηp2 = 0.001). CONCLUSIONS We provide the first experimental evidence that both matching and customization increase the uptake of a deposit contract for physical activity. We recommend considering both matching and customization to overcome lack of uptake, with a preference for customization since matching a deposit imposes significant additional costs. However, since we found indications that customizable deposits might reduce effectiveness (when the deposits are not matched), we urge for more research on the effectiveness of customizable deposit contracts. Finally, future research should investigate which participant characteristics are predictive of deposit contract uptake and effectiveness. PRE-REGISTRATION OSF Registries, https://osf.io/cgq48.
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Affiliation(s)
- David R de Buisonjé
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands.
| | - Thomas Reijnders
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands; Department of Human-Centered Design, Faculty of Industrial Design Engineering, TU Delft, Delft, the Netherlands
| | - Talia R Cohen Rodrigues
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Prabhakaran Santhanam
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland; Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland; School of Medicine, University of St.Gallen, St.Gallen, Switzerland
| | - Linda D Breeman
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Veronica R Janssen
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Hareld M C Kemps
- Department of Cardiology, Máxima Medical Center, Veldhoven, the Netherlands; Department of Industrial Design, Eindhoven University of Technology, the Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands; Leiden University, Technical University Delft, and Erasmus University, Rotterdam, the Netherlands
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Hamm RF, Levine LD, Quigley E, Beidas RS. An evaluation of implementation climate in inpatient maternity care: a cross-sectional survey study. J Matern Fetal Neonatal Med 2023; 36:2185119. [PMID: 36863714 PMCID: PMC10207965 DOI: 10.1080/14767058.2023.2185119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE Researchers in obstetrics and gynecology are continuously generating new evidence to inform clinical care delivery. Yet, much of this newly emerging evidence fails to be rapidly and effectively integrated into routine clinical practice. Implementation climate refers to clinicians' perceptions of to what degree organizations support and reward use of an evidence-based practice (EBP) and is an important construct in the science of implementation in healthcare. Little is known about implementation climate for EBPs in maternity care. Thus, we aimed to (a) determine the reliability of the Implementation Climate Scale (ICS) for use in inpatient maternity care, (b) describe implementation climate in inpatient maternity care overall, and (c) compare individual perceptions of implementation climate between physician and nursing clinicians on these units. STUDY DESIGN We performed a cross-sectional survey of clinicians in inpatient maternity units across 2 urban, academic hospitals in the northeastern United States in 2020. Clinicians completed the 18-question validated ICS [scored 0-4]. Scale reliability by role was evaluated using Cronbach's α. Subscale and total scores were described overall and compared by physician versus nursing role using independent t-tests, as well as linear regression to control for confounders. RESULTS 111 clinicians completed the survey (physicians = 65; nursing = 46). Physicians were less likely to identify as female (75.4% vs. 100.0%, p < .001), but were of similar age and years of experience as nursing clinicians. Reliability of the ICS was excellent, with Cronbach's α of 0.91 and 0.86 among physicians and nursing clinicians, respectively. Scores were notably low for implementation climate in maternity care overall and for all subscales. ICS total scores were also higher among physicians as compared to nurses (2.18(±0.56) vs. 1.92(±0.50), p = .02), which remained significant in multivariable modeling (p = .02). Unadjusted subscale scores were higher among physicians in Recognition for EBP (2.68(±0.89) vs. 2.30(±0.86), p = .03) and Selection for EBP (2.24(±0.93) vs. 1.62(±1.04), p = .002). After adjustment for potential confounders, subscale scores for Focus on EBP (p = .04) and Selection for EBP (p = .002) were all higher among physicians. CONCLUSIONS This study supports the ICS as a reliable scale for measuring implementation climate in the inpatient maternity care setting. Notably lower implementation climate scores across subscales and roles compared to other settings may underlie the vast evidence to practice gap in obstetrics. In order to successfully implement practices that reduce maternal morbidity, we may need to focus on building educational support and rewarding EBP utilization on labor and delivery units, with an emphasis on nursing clinicians.
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Affiliation(s)
- Rebecca F. Hamm
- Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa D. Levine
- Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth Quigley
- Department of Nursing, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Rinad S. Beidas
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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12
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Mullen MT, Cucchiara BL, Messé SR, Zamzam A, Kasner SE. Randomized Trial of a Social Support Intervention to Improve Home Blood Pressure Monitoring in Patients With Cerebrovascular Disease. Neurologist 2023; 28:402-408. [PMID: 37582619 PMCID: PMC10627537 DOI: 10.1097/nrl.0000000000000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
BACKGROUND A pilot randomized trial evaluating whether a social support intervention improves adherence to home blood pressure (BP) monitoring among patients with cerebrovascular disease. METHODS Subjects with ischemic stroke, intracerebral hemorrhage, or transient ischemic attack within 5 years with BP >140/90, were given a centrally monitored home BP cuff and asked to check their BP twice a day for 90 ± 7 days. Subjects received text and/or email reminders for missed measurements and weekly reports on adherence/BP control. Subjects were randomized 1:1 to a social support intervention, in which close personal contact also received all study-related education and communications. The primary outcome was the proportion of requested measurements completed. A secondary outcome was a change in BP over time. RESULTS Thirty-three subjects were enrolled, 15 in the control arm and 18 in the social support arm. The social support arm completed a greater proportion of BP measurements at day 30 (88% vs 78%), day 60 (72% vs 54%), and day 83 (60% vs 40%), but none of these differences were statistically significant ( P > 0.05). Comparing the first 7 days of BP readings to the last 7 days across subjects, there was a nonsignificant decrease in BP over time (systolic BP = -2.8 mm Hg, P = 0.29 and diastolic BP = -1.7, P = 0.36). The social support intervention did not modify the change in BP over time. CONCLUSION A social support intervention may increase adherence to home BP monitoring. This pilot study provides important preliminary data to inform the design of larger more definitive trials utilizing self-monitoring of BP in patients with cerebrovascular disease.
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Affiliation(s)
| | - Brett L. Cucchiara
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Steven R. Messé
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Ahmad Zamzam
- Department of Neurology, Temple University School of Medicine
| | - Scott E. Kasner
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA
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13
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Stanisce L, Ahmad N, Solomon DH, Kolia N, Garcia LD, Spalla TC, Gaughan JP, Koshkareva Y. Improving Outpatient Follow-Up Rates for New In-Hospital Consults. Laryngoscope 2023; 133:2540-2545. [PMID: 36511340 DOI: 10.1002/lary.30519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/08/2022] [Accepted: 11/27/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE(S) This investigation aimed to define the rate of outpatient follow-up after in-hospital consultation, identify factors associated with establishing care, and evaluate an alternative scheduling process to improve outpatient adherence. METHODS Two-phase, prospective study at an academic, tertiary-care institution from March 2020 to August 2022. First, all patients not previously known to our practice encountered via inpatient consult who warranted outpatient follow-up were prospectively captured. Logistic regression analysis was used to identify demographic, disease, and practice factors predictive of follow-up. Second, a randomized control trial was performed to validate the effects of pre-assigning appointments prior to discharge. RESULTS Six hundred subjects were included in the final study cohort; 500 in phase-one, and 100 randomized during phase-two. In the phase-one cohort, 54% (n = 272) were lost to follow-up. Multivariate analysis showed increased odds of outpatient follow-up when appointments were pre-assigned before discharge (odds ratio [OR]: 3.69 [95% confidence interval [CI]: 2.29-5.96], p < 0.001), the primary reason for hospitalization was ENT and consult-related (OR: 3.29 [1.92-5.64], p < 0.001), and the diagnosis was one of Oncology (OR: 1.93 [1.02-3.69], p = 0.045) or Pediatrics (OR: 3.36 [1.41-7.98], p = 0.006) subspecialties. During phase-two, subjects randomized for pre-assigned appointments had higher outpatient follow-up (82%) compared to the control group (20%) (p < 0.001). CONCLUSION Hospital-based consultations represent an important referral pathway for new patients. Disease characteristics may identify patients less likely to follow-up upon discharge. Appointment scheduling protocols, including pre-assigning appointments, are modifiable targets for improving adherence to care. Laryngoscope, 133:2540-2545, 2023.
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Affiliation(s)
- Luke Stanisce
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - Nadir Ahmad
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - Donald H Solomon
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - Nadeem Kolia
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - Lucia D Garcia
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - Thomas C Spalla
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - John P Gaughan
- Cooper Research Institute, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - Yekaterina Koshkareva
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
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Philibert R, Hoffman RM. Assessing Our Will to Change. Chest 2023; 163:1360-1361. [PMID: 37295878 DOI: 10.1016/j.chest.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 06/12/2023] Open
Affiliation(s)
- Robert Philibert
- Department of Psychiatry, University of Iowa, Iowa City, IA; Behavioral Diagnostics LLC, Coralville, IA.
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15
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Tang J, Yang Z, Kee F, Congdon N. Time and risk preferences and the perceived effectiveness of incentives to comply with diabetic retinopathy screening among older adults with type 2 diabetes. Front Psychol 2023; 14:1101909. [PMID: 37138986 PMCID: PMC10149913 DOI: 10.3389/fpsyg.2023.1101909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
Behavioral economics has the potential to inform the design of incentives to improve disease screening programs by accounting for various behavioral biases. We investigate the association between multiple behavioral economics concepts and the perceived effectiveness of incentive strategies for behavioral change among older patients with a chronic disease. This association is examined by focusing on diabetic retinopathy screening, which is recommended but very variably followed by persons living with diabetes. Five time and risk preference concepts (i.e., utility curvature, probability weighting, loss aversion, discount rate, and present-bias) are estimated simultaneously in a structural econometric framework, based on a series of deliberately-designed economic experiments offering real money. We find that higher discount rates and loss aversion and lower probability weighting are significantly associated with lower perceived effectiveness of intervention strategies whereas present-bias and utility curvature have an insignificant association with it. Finally, we also observe strong urban vs. rural heterogeneity in the association between our behavioral economic concepts and the perceived effectiveness of intervention strategies.
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Affiliation(s)
- Jianjun Tang
- School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, China
| | - Ziwei Yang
- College of Economics and Management, Huazhong Agricultural University, Wuhan, China
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
- Orbis International, New York, NY, United States
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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16
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Wechsler PM, Liberman AL, Restifo D, Abramson EL, Navi BB, Kamel H, Parikh NS. Cost-Effectiveness of Smoking Cessation Interventions in Patients With Ischemic Stroke and Transient Ischemic Attack. Stroke 2023; 54:992-1000. [PMID: 36866670 PMCID: PMC10050136 DOI: 10.1161/strokeaha.122.040356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 02/17/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Smoking cessation rates after stroke and transient ischemic attack are suboptimal, and smoking cessation interventions are underutilized. We performed a cost-effectiveness analysis of smoking cessation interventions in this population. METHODS We constructed a decision tree and used Markov models that aimed to assess the cost-effectiveness of varenicline, any pharmacotherapy with intensive counseling, and monetary incentives, compared with brief counseling alone in the secondary stroke prevention setting. Payer and societal costs of interventions and outcomes were modeled. The outcomes were recurrent stroke, myocardial infarction, and death using a lifetime horizon. Estimates and variance for the base case (35% cessation), costs and effectiveness of interventions, and outcome rates were imputed from the stroke literature. We calculated incremental cost-effectiveness ratios and incremental net monetary benefits. An intervention was considered cost-effective if the incremental cost-effectiveness ratio was less than the willingness-to-pay threshold of $100 000 per quality-adjusted life-year (QALY) or when the incremental net monetary benefit was positive. Probabilistic Monte Carlo simulations modeled the impact of parameter uncertainty. RESULTS From the payer perspective, varenicline and pharmacotherapy with intensive counseling were associated with more QALYs (0.67 and 1.00, respectively) at less total lifetime costs compared with brief counseling alone. Monetary incentives were associated with 0.71 more QALYs at an additional cost of $120 compared with brief counseling alone, yielding an incremental cost-effectiveness ratio of $168/QALY. From the societal perspective, all 3 interventions provided more QALYs at less total costs compared with brief counseling alone. In 10 000 Monte Carlo simulations, all 3 smoking cessation interventions were cost-effective in >89% of runs. CONCLUSIONS For secondary stroke prevention, it is cost-effective and potentially cost-saving to deliver smoking cessation therapy beyond brief counseling alone.
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Affiliation(s)
- Paul M Wechsler
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Ava L Liberman
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Daniel Restifo
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Erika L Abramson
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Neal S Parikh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
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17
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Fanaroff AC, Coratti S, Halaby R, Sanghavi M, O'Quinn RP, Krishnan S, Glassberg H, Bajaj A, Adusumalli S, Chokshi N, Patel MS. Feasibility and outcomes from using a commitment device and text message reminders to increase adherence to time-restricted eating: A randomized trial. Am Heart J 2023; 258:85-95. [PMID: 36640862 PMCID: PMC11010633 DOI: 10.1016/j.ahj.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND Obesity is strongly associated with cardiovascular disease, particularly through its effects on blood pressure. Though maintaining a negative caloric balance leads to weight loss, many patients struggle to adhere to low calorie diets over the long term. Time-restricted eating, a subtype of intermittent fasting (IF), may be an easier dietary pattern for patients to initiate and maintain. We tested the feasibility of a bidirectional texting strategy to help patients with obesity and hypertension initiate and maintain time-restricted eating, and whether a commitment device, a pledge to behave in a certain way in the future while making nonadherence costlier, would increase adherence beyond bidirectional texting. METHODS Patients with obesity and hypertension seen in cardiology clinics were provided education on time-restricted eating and randomized to a commitment device versus attention control. Attention control consisted of daily bidirectional text messages asking whether patients adhered to IF and weekly text messages asking participants to send their weight and blood pressure. The commitment device involved the same text messages as attention control, plus a commitment contract, setting of implementation intentions with respect to details of time-restricted eating, and involvement of a support partner who received weekly updates on the participant's adherence to time-restricted eating. The intervention lasted 12 weeks, followed by a 6-week follow-up period. The primary outcome was days per week adherent to time-restricted eating over the 18-week study period, measured by daily self-report. We also compared change from baseline weight and blood pressure between randomized groups. RESULTS A total of 37 patients were randomized and started the study-20 to attention control and 17 to the commitment device. Mean age was 60 years old, and mean BMI was 38.4 kg/m2. Over the 18-week study period, the mean ± standard deviation (SD) number of days per week adherent to time-restricted eating was 4.7 ± 1.9 in the control arm and 5.4 ± 1.7 in the intervention arm (P = .23). Mean systolic blood pressure declined from 135 to 128 mm Hg among all participants (P = .006) with no difference between groups in change from baseline blood pressure (P = .74). Weight decreased from 229 to 223 pounds among all participants (P = .25) with no significant difference between groups in change from baseline weight (P = .84). CONCLUSIONS A bidirectional texting strategy was feasible for helping patients with obesity and hypertension initiate and adhere to time-restricted eating. Adding a commitment device to bidirectional texting did not increase adherence to time-restricted eating compared with attention control, nor were there significant between group changes in blood pressure or weight, but these comparisons were underpowered. A larger randomized trial of the effect of this scalable intervention, compared with usual care, on blood pressure and weight among patients with obesity and hypertension is warranted. CLINICAL TRIALS REGISTRATION clinicaltrials.gov; unique identifier: NCT04836312.
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Affiliation(s)
- Alexander C Fanaroff
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, PA; Institute for Translational Medicine and Therapeutics, University of Pennsylvania, Philadelphia, PA; Center for Health Economics and Behavioral Economics, University of Pennsylvania, Philadelphia, PA; Penn Center for Digital Cardiology, University of Pennsylvania, Philadelphia, PA.
| | - Samantha Coratti
- Center for Health Economics and Behavioral Economics, University of Pennsylvania, Philadelphia, PA
| | - Rim Halaby
- National Institutes of Health, Bethesda, MD
| | - Monika Sanghavi
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rupal P O'Quinn
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA; Penn Center for Digital Cardiology, University of Pennsylvania, Philadelphia, PA
| | - Sheela Krishnan
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA
| | - Helene Glassberg
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA
| | - Archna Bajaj
- Division of Translational Medicine & Human Genetics, University of Pennsylvania, Philadelphia, PA
| | - Srinath Adusumalli
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA; Penn Center for Digital Cardiology, University of Pennsylvania, Philadelphia, PA; CVS Health, Woonsocket, RI
| | - Neel Chokshi
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA; Penn Center for Digital Cardiology, University of Pennsylvania, Philadelphia, PA
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Patten CA, Koller KR, King DK, Prochaska JJ, Sinicrope PS, McDonell MG, Decker PA, Lee FR, Fosi JK, Young AM, Sabaque CV, Brown AR, Borah BJ, Thomas TK. Aniqsaaq (To Breathe): Study protocol to develop and evaluate an Alaska Native family-based financial incentive intervention for smoking cessation. Contemp Clin Trials Commun 2023; 33:101129. [PMID: 37091507 PMCID: PMC10120296 DOI: 10.1016/j.conctc.2023.101129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/27/2023] [Accepted: 04/01/2023] [Indexed: 04/05/2023] Open
Abstract
Background Alaska Native and American Indian (ANAI) communities in Alaska are disproportionately affected by commercial tobacco use. Financial incentive interventions promote cigarette smoking cessation, but family-level incentives have not been evaluated. We describe the study protocol to adapt and evaluate the effectiveness and implementation of a remotely delivered, family-based financial incentive intervention for cigarette smoking among Alaskan ANAI people. Methods The study has 3 phases: 1) qualitative interviews with ANAI adults who smoke, family members, and stakeholders to inform the intervention, 2) beta-test of the intervention, and 3) randomized controlled trial (RCT) evaluating intervention reach and effectiveness on verified, prolonged smoking abstinence at 6- and 12-months post-treatment. In the RCT, adult dyads (ANAI person who smokes [index participant] and family member) recruited throughout Alaska will be randomized to a no-incentives control condition (n = 328 dyads) or a 6-month incentive intervention (n = 328 dyads). All dyads will receive cessation support and family wellness materials. Smoking status will be assessed weekly for four weeks and at three and six months. Intervention index participants will receive escalating incentives for verified smoking abstinence at each time point (maximum $750 total); the family member will receive rewards of equal value. Results A community advisory committee contributed input on the study design and methods for relevance to ANAI people, particularly emphasizing the involvement of families. Conclusion Our study aligns with the strength and value AIAN people place on family. Findings, processes, and resources will inform how Indigenous family members can support smoking cessation within incentive interventions. Clinical Trials Registry NCT05209451.
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de Buisonjé DR, Brosig F, Breeman LD, Bloom EL, Reijnders T, Janssen VR, Kraaijenhagen RA, Kemps HMC, Evers AWM. Put your money where your feet are: The real-world effects of StepBet gamified deposit contracts for physical activity. Internet Interv 2023; 31:100610. [PMID: 36873308 PMCID: PMC9982638 DOI: 10.1016/j.invent.2023.100610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/14/2023] [Accepted: 02/20/2023] [Indexed: 02/27/2023] Open
Abstract
Background Gamification and deposit contracts (a financial incentive in which participants pledge their own money) can enhance effectiveness of mobile behavior change interventions. However, to assess their potential for improving population health, research should investigate implementation of gamified deposit contracts outside the research setting. Therefore, we analyzed data from StepBet, a smartphone application originally developed by WayBetter, Inc. Objective To perform a naturalistic evaluation of StepBet gamified deposit contracts, for whom they work best, and under which conditions they are most effective to help increase physical activity. Methods WayBetter provided data of StepBet participants that participated in a stepcount challenge between 2015 and 2020 (N = 72,974). StepBet challenges were offered on the StepBet smartphone application. The modal challenge consisted of a $40 deposit made prior to a 6-week challenge period during which participants needed to reach daily and weekly step goals in order to regain their deposit. Participants who met their goals also received additional earnings which were paid out from the money lost by those who failed their challenge. Challenge step goals were tailored on a 90-day historic step count retrieval that was also used as the baseline comparison for this study. Primary outcomes were increase in step count (continuous) and challenge success (dichotomous). Results Overall, average daily step counts increased by 31.2 % (2423 steps, SD = 3462) from 7774 steps (SD = 3112) at baseline to 10,197 steps (SD = 4162) during the challenge. The average challenge success rate was 73 %. Those who succeeded in their challenge (n = 53,281) increased their step count by 44.0 % (3465 steps, SD = 3013), while those who failed their challenge (n = 19,693) decreased their step count by -5.3 % (-398 steps, SD = 3013). Challenges started as a New Year's resolution were slightly more successful (77.7 %) than those started during the rest of the year (72.6 %). Discussion In a real-world setting, and among a large and diverse sample, participating in a gamified deposit contract challenge was associated with a large increase in step counts. A majority of challenges were successful and succeeding in a challenge was associated with a large and clinically relevant increase in step counts. Based on these findings, we recommend implementing gamified deposit contracts for physical activity where possible. An interesting avenue for future research is to explore possible setback effects among people who fail a challenge, and how setbacks can be mitigated. Pre-registration Open Science Framework (doi:10.17605/OSF.IO/D237C).
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Affiliation(s)
- David R de Buisonjé
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Fiona Brosig
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Linda D Breeman
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | | | - Thomas Reijnders
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands.,Department of Human-Centered Design, Faculty of Industrial Design Engineering, TU Delft, Delft, the Netherlands
| | - Veronica R Janssen
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands.,Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Hareld M C Kemps
- Department of Cardiology, Máxima Medical Center, Veldhoven, the Netherlands.,Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands.,Medical Delta, Leiden University, TU Delft, and Erasmus University, the Netherlands
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1209] [Impact Index Per Article: 1209.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Testing the efficacy of real-time fMRI neurofeedback for training people who smoke daily to upregulate neural responses to nondrug rewards. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2023; 23:440-456. [PMID: 36788202 DOI: 10.3758/s13415-023-01070-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 02/16/2023]
Abstract
Although the use of nondrug rewards (e.g., money) to facilitate smoking cessation is widespread, recent research has found that such rewards may be least effective when people who smoke cigarettes are tempted to do so. Specifically, among people who smoke, the neural response to nondrug rewards appears blunted when access to cigarettes is anticipated, and this blunting is linked to a decrease in willingness to refrain from smoking to earn a monetary incentive. Accordingly, methods to enhance the value of nondrug rewards may be theoretically and clinically important. The current proof-of-concept study tested if real-time fMRI neurofeedback training augments the ability to upregulate responses in reward-related brain areas relative to a no-feedback control condition in people who smoke. Adults (n = 44, age range = 20-44) who reported smoking >5 cigarettes per day completed the study. Those in the intervention group (n = 22, 5 females) were trained to upregulate brain responses using feedback of ongoing striatal activity (i.e., a dynamic "thermometer" that reflected ongoing changes of fMRI signal intensity in the striatum) in a single neurofeedback session with three training runs. The control group (n = 22, 5 females) underwent a nearly identical procedure but received no neurofeedback. Those who received neurofeedback training demonstrated significantly greater increases in striatal BOLD activation while attempting to think about something rewarding compared to controls, but this effect was present only during the first training run. Future neurofeedback research with those who smoke should explore how to make neurofeedback training more effective for the self-regulation of reward-related brain activities.
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22
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Hodson N. Commitment devices: beyond the medical ethics of nudges. JOURNAL OF MEDICAL ETHICS 2023; 49:125-130. [PMID: 35217529 DOI: 10.1136/medethics-2021-107967] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/15/2022] [Indexed: 06/14/2023]
Abstract
Commitment devices (CDs) can help people overcome self-control problems to act on their plans and preferences. In these arrangements, people willingly make one of their options worse in order to change their own future behaviour, often by setting aside a sum of money that they will forfeit it if they fail to complete the planned action. Such applications of behavioural science have been used to help people stick to healthier lifestyle choices, overcome addictions and adhere to medication; they are acceptable to many patients and even relatively small sums can be effective. Some authors have objected to the use of nudges in healthcare. Engelen has listed nine potential objections to nudges in relation to means (why nudge rather than persuade?), ends (what action is being promoted?) and agents (who is nudging whom?). These objections are shown to lack force in the context of CDs. Instead, an analysis specific to the ethical issues in CDs is employed. CDs exclude certain groups including so-called 'naifs' and risk increasing health inequality. CDs may promote the wrong behaviour and people might legitimately change their minds. Intermediaries might encounter perverse incentives. Approaches to overcoming these problems are described and eight key ethical considerations for those considering implementing CDs in the future are described. Altogether this paper illustrates the advantages of appraising the ethics of behavioural science in medicine on a case-by-case basis.
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Affiliation(s)
- Nathan Hodson
- Mental Health and Wellbeing, Warwick Medical School, Coventry, UK
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23
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Buttenheim A, Castillo-Neyra R, Arevalo-Nieto C, Shinnick JE, Sheen JK, Volpp K, Paz-Soldan V, Behrman JR, Levy MZ. Do Incentives Crowd Out Motivation? A Feasibility Study of a Community Vector-Control Campaign in Peru. Behav Med 2023; 49:53-61. [PMID: 34847825 PMCID: PMC9869690 DOI: 10.1080/08964289.2021.1977603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 06/20/2021] [Accepted: 08/22/2021] [Indexed: 01/28/2023]
Abstract
Incentives are a useful tool in encouraging healthy behavior as part of public health initiatives. However, there remains concern about motivation crowd out-a decline in levels of motivation to undertake a behavior to below baseline levels after incentives have been removed-and few public health studies have assessed for motivation crowd out. Here, we assess the feasibility of identifying motivation crowd out following a lottery to promote participation in a Chagas disease vector control campaign. We look for evidence of crowd out in subsequent participation in the same behavior, a related behavior, and an unrelated behavior. We identified potential motivation crowd out for the same behavior, but not for related behavior or unrelated behaviors after lottery incentives are removed. Despite some limitations, we conclude that motivation crowd out is feasible to assess in large-scale trials of incentives.
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Affiliation(s)
- Alison Buttenheim
- Department of Family and Community Nursing, University of Pennsylvania, Philadelphia, USA
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, USA
| | - Ricardo Castillo-Neyra
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, Philadelphia, USA
- Department of Health Management, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Claudia Arevalo-Nieto
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, Philadelphia, USA
- Department of Health Management, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Julianna E. Shinnick
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, Philadelphia, USA
| | - Justin K. Sheen
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, Philadelphia, USA
| | - Kevin Volpp
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, USA
| | - Valerie Paz-Soldan
- Department of Health Management, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
- Asociasión Benéfica PRISMA, Lima, Peru
| | - Jere R. Behrman
- Departments of Economics and Sociology, University of Pennsylvania, Philadelphia, USA
| | - Michael Z. Levy
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, Philadelphia, USA
- Department of Health Management, Universidad Peruana Cayetano Heredia, Lima, Peru
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24
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Batchelder SR, Van Heukelom JT, Proctor K, Washington WD. Escalating schedules of incentives increase physical activity with no differences between deposit and no-deposit groups: A systematic replication. J Appl Behav Anal 2023; 56:201-215. [PMID: 36454882 PMCID: PMC10108095 DOI: 10.1002/jaba.964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 11/06/2022] [Indexed: 12/03/2022]
Abstract
Physical inactivity has increasingly affected public health in the United States during the COVID-19 pandemic as it is associated with chronic diseases such as arthritis, cancer, and heart disease. Contingency management has been shown to increase physical activity. Therefore, the present study sought to evaluate the effects of an escalating schedule of monetary reinforcement with a reset contingency on physical activity, as compared between 2 counterbalanced groups in which a monetary deposit of $25 was either required (deposit group) or not (no-deposit group). Twenty-five adults wore Fitbit accelerometers to monitor step counts. An ABA reversal design was used; in the 2 baseline phases, no programmed contingencies were in place for step counts. During intervention, step goals were set using a modified 70th percentile schedule with a 7-day window: Reaching the first goal would result in $0.25, and incentives increased by $0.25 for each subsequent day in which the goal was met. Failure to reach a goal resulted in a reset of the monetary incentive value to $0.25. Ten out of 12 participants from the deposit group were determined to be responders to intervention, whereas 8 out of 13 participants from the no-deposit group were determined to be responders to intervention. Overall, there were no significant differences between the groups' step counts. However, the deposit group's intervention was cheaper to implement, which suggests that deposit contracts are a viable modification for physical activity interventions.
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Affiliation(s)
- Sydney R Batchelder
- Department of Psychology, University of North Carolina Wilmington.,Vermont Center on Behavior and Health, University of Vermont
| | | | - Kaitlyn Proctor
- Department of Psychology, University of North Carolina Wilmington
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25
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Chen X, Giles J, Yao Y, Yip W, Meng Q, Berkman L, Chen H, Chen X, Feng J, Feng Z, Glinskaya E, Gong J, Hu P, Kan H, Lei X, Liu X, Steptoe A, Wang G, Wang H, Wang H, Wang X, Wang Y, Yang L, Zhang L, Zhang Q, Wu J, Wu Z, Strauss J, Smith J, Zhao Y. The path to healthy ageing in China: a Peking University-Lancet Commission. Lancet 2022; 400:1967-2006. [PMID: 36423650 PMCID: PMC9801271 DOI: 10.1016/s0140-6736(22)01546-x] [Citation(s) in RCA: 141] [Impact Index Per Article: 70.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/07/2022] [Accepted: 08/12/2022] [Indexed: 11/22/2022]
Abstract
Around the world, populations are ageing at a faster pace than in the past and this demographic transition will have impacts on all aspects of societies. In May 2020, the UN General Assembly declared 2021–2030 the Decade of Healthy Ageing, highlighting the importance for policymakers across the world to focus policy on improving the lives of older people, both today and in the future. While rapid population ageing poses challenges, China’s rapid economic growth over the last forty years has created space for policy to assist older persons and families in their efforts to improve health and well-being at older ages. As China is home to 1/5 of the world’s older people, China is often held up as an example for other middle-income countries. This Commission Report aims to help readers to understand the process of healthy ageing in China as a means of drawing lessons from the China experience. In addition, with the purpose of informing the ongoing policy dialogue within China, the Commission Report highlights the policy challenges on the horizon and draws lessons from international experience.
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Affiliation(s)
- Xinxin Chen
- Institute of Social Science Survey, Peking University, Beijing, China
| | | | - Yao Yao
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Winnie Yip
- Department of Global Health and Population, Harvard University, Boston, MA, USA
| | - Qinqin Meng
- Institute of Social Science Survey, Peking University, Beijing, China
| | - Lisa Berkman
- Harvard Center for Population and Development Studies, Harvard University, Boston, MA, USA; Division of Geriatric Medicine, UCLA, Los Angeles, CA, USA
| | - He Chen
- School of Public Administration and Policy, Renmin University of China, Beijing, China
| | - Xi Chen
- Department of Health Policy and Management, Department of Economics, Yale School of Public Health, New Haven, CT, USA
| | - Jin Feng
- School of Economics, Fudan University, Shanghai, China
| | | | | | - Jinquan Gong
- Institute of Social Science Survey, Peking University, Beijing, China
| | - Perry Hu
- Division of Geriatric Medicine, UCLA, Los Angeles, CA, USA
| | - Haidong Kan
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | - Xiaoyan Lei
- National School of Development, Peking University, Beijing, China
| | - Xiao Liu
- School of Labor Economics, Capital University of Economics and Business, Beijing, China
| | - Andrew Steptoe
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Gewei Wang
- Institute of Social Science Survey, Peking University, Beijing, China
| | - Harold Wang
- Program in Bioinformatics, UCLA, Los Angeles, CA, USA
| | - Huali Wang
- Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
| | - Xiaoyu Wang
- Institute of Population and Labor Economics, Chinese Academy of Social Sciences, Beijing, China
| | - Yafeng Wang
- Institute of Social Science Survey, Peking University, Beijing, China
| | - Li Yang
- Department of Health Policy and Management, Peking University, Beijing, China
| | - Luxia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital and National Institute of Health Data Science, Peking University, Beijing, China
| | - Quan Zhang
- National School of Development, Peking University, Beijing, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - John Strauss
- Department of Economics, University of Southern California, Los Angeles, CA, USA
| | | | - Yaohui Zhao
- National School of Development, Peking University, Beijing, China.
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26
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Philibert R, Dawes K, Moody J, Hoffman R, Sieren J, Long J. Using Cg05575921 methylation to predict lung cancer risk: a potentially bias-free precision epigenetics approach. Epigenetics 2022; 17:2096-2108. [PMID: 35920547 PMCID: PMC9665144 DOI: 10.1080/15592294.2022.2108082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/25/2022] [Indexed: 01/25/2023] Open
Abstract
The decision to engage in lung cancer screening (LCS) necessitates weighing benefits versus harms. Previously, clinicians in the United States have used the PLCOM2012 algorithm to guide LCS decision-making. However, that formula contains race and gender-based variables. Previously, using data from a European study, Bojesen and colleagues have suggested that cg05575921 methylation could guide decision-making. To test this hypothesis in a more diverse American population, we examined DNA and clinical data from 3081 subjects from the National Lung Screening Trial (NLST) study. Using survival analysis, we found a simple linear predictor consisting of age, pack-year consumption and cg05575921, to have the best predictive power among several alternatives (AUC = 0.66). Results showed that the highest quartile of risk was more than 2-fold more likely to develop lung cancer than those in the lowest quartile. Race, ethnicity, and gender had no effect on prediction with both cg05575921 and pack years contributing equally (both p < 0.003) to risk prediction. Current smokers had considerably lower methylation than former smokers (46% vs 67%; p < 0.001) with the average methylation of those who quit approaching 80% after 25 years of cessation. Finally, current male smokers had lower mean cg05575921 percentage than female smokers (46% vs 49%; p < 0.001). We conclude that cg05575921 (along with age and pack years) can be used to guide LCS decision-making, and additional studies might focus on how best to use methylation to inform decision-making.
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Affiliation(s)
- Rob Philibert
- Behavioural Diagnostics LLC, Coralville, IA, USA
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Kelsey Dawes
- Behavioural Diagnostics LLC, Coralville, IA, USA
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Joanna Moody
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Richard Hoffman
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Jessica Sieren
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
- Department of Radiology, University of Iowa, Iowa City, IA, USA
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Jeffrey Long
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
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27
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Boonmanunt S, Pattanaprateep O, Ongphiphadhanakul B, McKay G, Attia J, Vlaev I, Thakkinstian A. Evaluation of the Effectiveness of Behavioral Economic Incentive Programs for Goal Achievement on Healthy Diet, Weight Control and Physical Activity: A Systematic Review and Network Meta-analysis. Ann Behav Med 2022; 57:277-287. [PMID: 36367428 PMCID: PMC10094952 DOI: 10.1093/abm/kaac066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Healthy diet, weight control and physical activity to reduce obesity can be motivated by financial incentives (FI). Behavioral-economic approaches may improve the incentivization effectiveness. This study compares and ranks the effectiveness of standard and behavioral incentivization for healthy diet, weight control, and physical activity promotion.
Purpose
To investigate whether behavioral-economic insights improve incentivization effectiveness.
Methods
A systematic search of Medline and Scopus was performed from database inception to December 2020. Study characteristics, program designs, and risk ratio (RR) were extracted. A two-stage network meta-analysis pooled and ranked intervention effects.
Results
There were 35 eligible RCTs. For diet-weight control, standard FI, deposit contract (deposit), lottery-based incentive (lottery), and standard-FI + lottery increased goal achievement compared to no-FI but only deposit was statistically significant with pooled RRs and 95% confidence intervals (CI) of 1.21 (0.94, 1.56), 1.79 (1.04, 3.05), 1.45 (0.99, 2.13), and 1.73 (0.83, 3.63). For physical activity, standard-FI, deposit, and lottery significantly increased goal achievement compared to no-FI, with pooled RRs of 1.38 (1.13, 1.68), 1.63 (1.24, 2.14) and 1.43 (1.14, 1.80), respectively. In a follow-up period for physical activity, only deposit significantly increased goal achievement compared to no-FI, with pooled RRs of 1.39 (1.11, 1.73).
Conclusion
Deposit, followed by lottery, were best for motivating healthy diet, weight control and physical activity at program end. Post-intervention, deposit then standard-FI were best for motivating physical activity. Behavioral insights can improve incentivization effectiveness, although lottery-based approaches may offer only short-term benefit regarding physical activity. However, the imprecise intervention effects were major concerns.
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Affiliation(s)
- Suparee Boonmanunt
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University , 270 Rama VI Road, Pyathai, Bangkok 10400 , Thailand
| | - Oraluck Pattanaprateep
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University , 270 Rama VI Road, Pyathai, Bangkok 10400 , Thailand
| | - Boonsong Ongphiphadhanakul
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University , 270 Rama VI Road, Pyathai, Bangkok 10400 , Thailand
| | - Gareth McKay
- Centre for Public Health, School of Medicine, Dentistry, and Biomedical Sciences, Queen’s University Belfast , 97 Lisburn Road, Whitla Medical Building, BT9 7BL Belfast , UK
| | - John Attia
- School of Medicine and Public Health, University of Newcastle , Kookaburra Circuit, John Hunter Hospital Campus, New Lambton, NSW 2305 , Australia
- Hunter Medical Research Institute , Kookaburra Circuit, John Hunter Hospital Campus, New Lambton, NSW 2305 , Australia
| | - Ivo Vlaev
- Warwick Business School, University of Warwick , Coventry CV4 7AL , UK
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University , 270 Rama VI Road, Pyathai, Bangkok 10400 , Thailand
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28
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Text Message–Based Breastfeeding Support Compared With Usual Care. Obstet Gynecol 2022; 140:853-860. [DOI: 10.1097/aog.0000000000004961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 07/28/2022] [Indexed: 11/06/2022]
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29
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Xiao C, Sluijs EV, Ogilvie D, Patterson R, Panter J. Shifting towards healthier transport: carrots or sticks? Systematic review and meta-analysis of population-level interventions. Lancet Planet Health 2022; 6:e858-e869. [PMID: 36370724 DOI: 10.1016/s2542-5196(22)00220-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/08/2022] [Accepted: 09/08/2022] [Indexed: 05/26/2023]
Abstract
BACKGROUND Promoting active travel can be beneficial for both health and the environment. However, evidence about the most effective strategies is inconsistent. We aimed to compare the effectiveness of interventions with positive (ie, carrot), negative (ie, stick), or a combination of strategies on changing population-level travel behaviour. We also aimed to identify which intervention functions, or mechanisms of how interventions seek to alter behaviour (eg, by addressing safety or accessibility), affect transport outcomes. METHODS For this systematic review and meta-analysis, we searched eight online databases for studies published before March 28, 2022: Web of Science, MEDLINE, Scopus, Applied Social Sciences Index and Abstracts, Global Health, PsycINFO, CINAHL, and Transport Research International Documentation. We did not restrict searches by language or publication date. We included controlled before-and-after studies of population-level interventions and travel behaviours (ie, driving, public transport, walking, and cycling) from adults in the general population. We categorised interventions according to their function. Depending on whether gains or losses due to intervention function could occur, we classified interventions as carrot (eg, new bike-share programmes), stick (eg, congestion charging), or combined carrot-and-stick interventions (eg, pedestrianising areas by use of reallocated parking space). We used harvest plots to summarise the findings and guide narrative synthesis. Where possible, we converted outcomes into standardised mean differences and did random-effects meta-analyses. FINDINGS From 38 916 records screened, 102 reports describing 121 interventions met the inclusion criteria. 79 interventions were carrots, 22 were carrot-and-sticks, and 20 were sticks. Results for carrot interventions were less consistent than for stick or combined interventions. Findings from the meta-analysis (64 reports describing 67 interventions) agreed with those in the narrative synthesis; although effects were statistically non-significant, for driving outcomes, interventions with stick strategies (standardised mean difference [SMD] -0·17, 95% CI -0·36 to 0·02) and combined carrot-and-stick strategies (-0·13, -0·47 to 0·20) had point estimates of greater magnitude than those for interventions with carrot strategies (-0·10, -0·23 to 0·03). Likewise, for active travel outcomes, combined carrot-and-stick strategies had a higher point estimate (0·33, -0·01 to 0·68) compared with carrot interventions (0·08, -0·05 to 0·21). Functions thought to change behaviour using financial means were effective at decreasing driving behaviour, whereas those improving access, safety, and space were effective for increasing active travel outcomes. INTERPRETATION This Article found that, although transport interventions with only positive strategies are more commonly evaluated, interventions that combine both positive and negative strategies might be more effective at encouraging alternatives to driving at the population level. Further research is needed for interventions involving a stick strategy, which remain less widely implemented or well studied than those with only carrot strategies. FUNDING Medical Research Council, Cambridge Trust.
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Affiliation(s)
- Christina Xiao
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
| | - Esther van Sluijs
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - David Ogilvie
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Richard Patterson
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Jenna Panter
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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30
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Guinart D, Sobolev M, Patil B, Walsh M, Kane JM. A Digital Intervention Using Daily Financial Incentives to Increase Medication Adherence in Severe Mental Illness: Single-Arm Longitudinal Pilot Study. JMIR Ment Health 2022; 9:e37184. [PMID: 36222818 PMCID: PMC9607890 DOI: 10.2196/37184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 07/21/2022] [Accepted: 08/03/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Medication nonadherence is prevalent in severe mental illness and is associated with multiple negative outcomes. Mobile technology and financial incentives show promise to improve medication adherence; however, studies in mental health, especially with oral medications, are lacking. OBJECTIVE The aim of this paper is to assess the feasibility and effectiveness of offering financial incentives through a mobile app based on behavioral economics principles to improve medication adherence in severe mental illness. METHODS A 10-week, single-arm longitudinal pilot study was conducted. Patients earned rewards in the context of app-based adherence incentives. The reward was split into biweekly payments made in increments of US $15, minus any US $2 per day penalties for missed check-ins. Time-varying effect modeling was used to summarize the patients' response during the study. RESULTS A total of 25 patients were enrolled in this pilot study, of which 72% (n=18) were female, and 48% (n=12) were of a White racial background. Median age was 24 (Q1-Q3: 20.5-30) years. Participants were more frequently diagnosed with schizophrenia and related disorders (n=9, 36%), followed by major depressive disorder (n=8, 32%). App engagement and medication adherence in the first 2 weeks were higher than in the last 8 weeks of the study. At study endpoint, app engagement remained high (n=24, Z=-3.17; P<.001), but medication adherence was not different from baseline (n=24, Z=-0.59; P=.28). CONCLUSIONS Financial incentives were effectively delivered using an app and led to high engagement throughout the study and a significantly increased medication adherence for 2 weeks. Leveraging behavioral economics and mobile health technology can increase medication adherence in the short term. TRIAL REGISTRATION ClinicalTrials.gov NCT04191876; https://clinicaltrials.gov/ct2/show/NCT04191876.
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Affiliation(s)
- Daniel Guinart
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, United States.,Institute of Behavioral Science, The Feinstein Institutes for Medical Reseach, Manhasset, NY, United States.,Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.,Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
| | - Michael Sobolev
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, United States.,Cornell Tech, Cornell University, New York, NY, United States
| | - Bhagyashree Patil
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, United States
| | - Megan Walsh
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, United States
| | - John M Kane
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, United States.,Institute of Behavioral Science, The Feinstein Institutes for Medical Reseach, Manhasset, NY, United States
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31
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de Buisonjé DR, Reijnders T, Cohen Rodrigues TR, Prabhakaran S, Kowatsch T, Lipman SA, Bijmolt THA, Breeman LD, Janssen VR, Kraaijenhagen RA, Kemps HMC, Evers AWM. Investigating Rewards and Deposit Contract Financial Incentives for Physical Activity Behavior Change Using a Smartphone App: Randomized Controlled Trial. J Med Internet Res 2022; 24:e38339. [PMID: 36201384 DOI: 10.2196/38339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 08/04/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Financial incentive interventions for improving physical activity have proven to be effective but costly. Deposit contracts (in which participants pledge their own money) could be an affordable alternative. In addition, deposit contracts may have superior effects by exploiting the power of loss aversion. Previous research has often operationalized deposit contracts through loss framing a financial reward (without requiring a deposit) to mimic the feelings of loss involved in a deposit contract. OBJECTIVE This study aimed to disentangle the effects of incurring actual losses (through self-funding a deposit contract) and loss framing. We investigated whether incentive conditions are more effective than a no-incentive control condition, whether deposit contracts have a lower uptake than financial rewards, whether deposit contracts are more effective than financial rewards, and whether loss frames are more effective than gain frames. METHODS Healthy participants (N=126) with an average age of 22.7 (SD 2.84) years participated in a 20-day physical activity intervention. They downloaded a smartphone app that provided them with a personalized physical activity goal and either required a €10 (at the time of writing: €1=US $0.98) deposit up front (which could be lost) or provided €10 as a reward, contingent on performance. Daily feedback on incentive earnings was provided and framed as either a loss or gain. We used a 2 (incentive type: deposit or reward) × 2 (feedback frame: gain or loss) between-subjects factorial design with a no-incentive control condition. Our primary outcome was the number of days participants achieved their goals. The uptake of the intervention was a secondary outcome. RESULTS Overall, financial incentive conditions (mean 13.10, SD 6.33 days goal achieved) had higher effectiveness than the control condition (mean 8.00, SD 5.65 days goal achieved; P=.002; ηp2=0.147). Deposit contracts had lower uptake (29/47, 62%) than rewards (50/50, 100%; P<.001; Cramer V=0.492). Furthermore, 2-way analysis of covariance showed that deposit contracts (mean 14.88, SD 6.40 days goal achieved) were not significantly more effective than rewards (mean 12.13, SD 6.17 days goal achieved; P=.17). Unexpectedly, loss frames (mean 10.50, SD 6.22 days goal achieved) were significantly less effective than gain frames (mean 14.67, SD 5.95 days goal achieved; P=.007; ηp2=0.155). CONCLUSIONS Financial incentives help increase physical activity, but deposit contracts were not more effective than rewards. Although self-funded deposit contracts can be offered at low cost, low uptake is an important obstacle to large-scale implementation. Unexpectedly, loss framing was less effective than gain framing. Therefore, we urge further research on their boundary conditions before using loss-framed incentives in practice. Because of limited statistical power regarding some research questions, the results of this study should be interpreted with caution, and future work should be done to confirm these findings. TRIAL REGISTRATION Open Science Framework Registries osf.io/34ygt; https://osf.io/34ygt.
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Affiliation(s)
- David R de Buisonjé
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Thomas Reijnders
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, Netherlands
- Department of Human-Centered Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Talia R Cohen Rodrigues
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Santhanam Prabhakaran
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Stefan A Lipman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Tammo H A Bijmolt
- Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
| | - Linda D Breeman
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Veronica R Janssen
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Hareld M C Kemps
- Department of Cardiology, Máxima Medical Center, Veldhoven, Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, Netherlands
- Medical Delta, Leiden University, Technical University Delft, Erasmus University, Delft, Netherlands
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Bloom EL, Japuntich SJ, Pierro A, Dallery J, Leahey TM, Rosen J. Pilot trial of QuitBet: A digital social game that pays you to stop smoking. Exp Clin Psychopharmacol 2022; 30:642-652. [PMID: 34110881 PMCID: PMC10259805 DOI: 10.1037/pha0000487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Contingency management is an effective treatment for cigarette smoking cessation but feasibility and acceptability concerns have been barriers to implementation. We conducted a pilot test of QuitBet, a commercial, digital (smartphone) social game for smoking cessation during which participants earned financial incentives for abstinence. QuitBet included a social feed for posting messages and entirely participant-funded incentives in the form of a deposit contract (the "bet"). QuitBet had a bet of $30 and lasted for 28 days. After a week to prepare for quitting, the quit day was Day 8. Between Day 9-28 (a 20-day period), participants earned back $1 of their $30 bet for each day of carbon monoxide (CO)-verified abstinence (≤ 6 ppm). Remaining bet money was pooled into a "grand prize" pot. Participants who were abstinent on at least 19 of the 20 days (1 "lapse" day allowed) were declared "winners" and split the grand prize pot equally. A game host posted a daily message containing evidence-based education about smoking cessation or a discussion topic. Recruitment goals were met. Among the players (N = 50 U.S. adults, 78% female), 17 (34%) were winners. Thirty-seven participants (74%) responded to a post-QuitBet survey, of whom 95% said they would be interested in playing another QuitBet and would recommend QuitBet to others. Overall, feedback was positive with some suggestions for improvement. In conclusion, a digital social game for smoking cessation with a deposit contract was feasible and acceptable. Next steps include conducting a randomized trial to establish efficacy and a sustainable business model. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Erika Litvin Bloom
- Behavioral and Policy Sciences, RAND Corporation, Boston, Massachusetts, United States
| | - Sandra J. Japuntich
- Department of Clinical Pharmacology and Toxicology, Hennepin Healthcare, Minneapolis, Minnesota, Hennepin
- Department of Medicine, University of Minnesota Medical School
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Assessing the effectiveness of COVID-19 vaccine lotteries: A cross-state synthetic control methods approach. PLoS One 2022; 17:e0274374. [PMID: 36170293 PMCID: PMC9518920 DOI: 10.1371/journal.pone.0274374] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/25/2022] [Indexed: 11/20/2022] Open
Abstract
Vaccines are the most effective means at combating sickness and death caused by COVID-19. Yet, there are significant populations within the United States who are vaccine-hesitant, some due to ideological or pseudo-scientific motivations, others due to significant perceived and real costs from vaccination. Given this vaccine hesitancy, twenty state governors from May 12th to July 21st 2021 implemented some form of vaccination lottery aiming to increase low vaccination rates. In the aftermath of these programs, however, the critical question of whether these lotteries had a direct effect on vaccination remains. Previous literature on financial incentives for public health behaviors is consistent: Financial incentives significantly increase incentivized behaviors. Yet, work done specifically on state vaccine lotteries is both limited in scope and mixed in its conclusions. To help fill this gap in the literature, we use synthetic control methods to analyze all 20 states and causally identify, for eighteen states, the effects of their lotteries on both first-dose and complete vaccination rates. Within those eighteen states, we find strong evidence that all but three states’ lotteries had positive effects on first-dose vaccination. We find for complete vaccinations, however, over half the states analyzed had negative or null effects. We explore possibilities related to these mixed results including the states’ overall partisanship, vaccine hesitancy, and the size of their lotteries finding null effects for each of these explanations. Therefore, we conclude that the design of these programs is likely to blame: Every state lottery only incentivized first-doses with no additional or contingent incentive based on a second dose. Our findings suggest that the design of financial incentives is critical to their success, or failure, but generally, these programs can induce an uptake in vaccination across diverse demographic, ideological, and geographic contexts in the United States.
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Nobel N. Interplay between benefit appeal and valence framing in reducing smoking behavior: Evidence from a field experience. JOURNAL OF BEHAVIORAL DECISION MAKING 2022. [DOI: 10.1002/bdm.2301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nurit Nobel
- Department of Marketing and Strategy Stockholm School of Economics Stockholm Sweden
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Lee D, Agarwal A, Ali Z, Xiong R, Spencer E, Hemmons J, Lacko H, Delgado MK. Real-Time Measurement of Patient Reported Outcomes and Opioid Use Following Urologic Procedures using Automated Text Messaging. Urology 2022; 170:83-90. [PMID: 36115429 DOI: 10.1016/j.urology.2022.07.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/06/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate opioid consumption and patient-reported pain intensity following urologic procedures. METHODS Adult patients were consented following a urologic procedure, and data was collected through post-operative day 28 in a large tertiary care academic health system. An automated text messaging platform was used to collect patient reported pain intensity, ability to manage pain, and opioid use measured in oxycodone 5 mg tablet equivalents. Outcomes were weighted based on the inverse probability of response to yield representative estimates. RESULTS 1015 (51.8%) patients responded to the text-message survey. The median number of pills prescribed was 10 (IQR 6-10), and the median number of pills taken was 2 (IQR 0-6). By postoperative day 7, the median tablets taken overall was 0. Over the study period, 60.1% (6566) of all tablets prescribed were left unused, and 38.4% of patients did not use any of the prescribed opioids. Across urologic procedures, 6 tablets would accommodate the 75th percentile of patient-reported use, with the exception of major open procedures. CONCLUSIONS In this study utilizing real-time measurement of opioid use and pain levels with text messaging, there was evidence of dramatic over-prescription of opioids relative to use and pain levels. Patient-reported data, collected via text messaging, can support clinicians and policy leaders in forming national guidelines on evidence-based best practices, personalizing prescriptions and guide shared decision making to decrease opioid excess.
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Affiliation(s)
- Daniel Lee
- Division of Urology, University of Pennsylvania Health System, Philadelphia, PA; Corporal Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
| | - Anish Agarwal
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA; Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA; Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA
| | - Zarina Ali
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA
| | - Ruiying Xiong
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA
| | - Evan Spencer
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jessica Hemmons
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hannah Lacko
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Mucio K Delgado
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA; Department of Emergency Medicine, Philadelphia Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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Predictors of Counseling Participation Among Low-Income People Offered an Integrated Intervention Targeting Financial Distress and Tobacco Use. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 24:525-534. [PMID: 35932394 PMCID: PMC9361947 DOI: 10.1007/s11121-022-01416-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 11/04/2022]
Abstract
Introduction Although prevalence of smoking in the USA has been decreasing for decades, smoking rates among low-income individuals remain elevated. Theories from behavioral economics and prior research suggest that financial stress may contribute to the difficulty that low-income smokers face in quitting. The present work is a secondary analysis of a randomized controlled trial that incorporated financial coaching and social services referrals into smoking cessation treatment. Primary analyses showed that participants randomized to the intervention (N = 208) were significantly more likely not to smoke, to have lower financial stress, and to be able to afford leisure activities (p < .05) than were control participants (N = 202). Methods This paper investigates subgroup discrepancies in attendance of intervention sessions and in uptake of various components of this intervention through exploratory analysis. Results Analysis using logistic regression indicated that decreased age, not having received higher education, and having income less than $1000 per month were predictive of decreased counseling attendance (p < .05). Few demographic factors were predictive of uptake of counseling components among those who attended counseling. Conclusions These results can guide future efforts to increase participant engagement in the intervention. Trial Registration ClinicalTrials.gov Identifier: NCT03187730.
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Xiao CS, Sharp SJ, van Sluijs EMF, Ogilvie D, Panter J. Impacts of new cycle infrastructure on cycling levels in two French cities: an interrupted time series analysis. Int J Behav Nutr Phys Act 2022; 19:77. [PMID: 35799166 PMCID: PMC9260999 DOI: 10.1186/s12966-022-01313-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 06/07/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Cities globally have started to make substantial investment in more sustainable forms of transportation. We aimed to evaluate whether the construction of new cycling infrastructure in Paris and Lyon, France, affected population cycling activity along new or improved routes. METHODS Routinely collected cycle count data from January 2014 to March 2020 were acquired for the cities of Paris and Lyon. Improvements were identified at 15 locations with 6 months of pre- and post-intervention data. Comparison streets were chosen within Paris or Lyon for which pre-intervention trends in cycling were similar to those at intervention sites. Controlled interrupted time series analyses and autocorrelation were performed adjusting for seasonality. Random-effects meta-analysis combined results across streets within each city and overall. RESULTS On average, cycling counts/day increased on both intervention and control streets in Paris and Lyon. In general, results of the ITS analysis indicated no significant change in the level or trend as a result of the improvements in either city. Meta-analysis suggested that intervention streets in Paris had a larger positive pooled effect size for level change (218 cycle counts, 95% CI -189, 626, I2 = 0%) compared to Lyon (34, 95% CI -65, 133, I2 = 14%); however, confidence intervals for both cities were wide and included no effect. CONCLUSIONS The findings suggest that improving or constructing new cycle lanes may be necessary but not sufficient to induce significant changes in cycling levels. There is a need to understand how context, intervention design and other complementary interventions can improve the effectiveness of new cycling infrastructure.
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Affiliation(s)
- Christina S. Xiao
- grid.5335.00000000121885934MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Stephen J. Sharp
- grid.5335.00000000121885934MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Esther M. F. van Sluijs
- grid.5335.00000000121885934MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - David Ogilvie
- grid.5335.00000000121885934MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Jenna Panter
- grid.5335.00000000121885934MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Littman D, Sherman SE, Troxel AB, Stevens ER. Behavioral Economics and Tobacco Control: Current Practices and Future Opportunities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8174. [PMID: 35805833 PMCID: PMC9266334 DOI: 10.3390/ijerph19138174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/21/2022] [Accepted: 07/02/2022] [Indexed: 11/17/2022]
Abstract
Despite considerable progress, smoking remains the leading preventable cause of death in the United States. To address the considerable health and economic burden of tobacco use, the development of improved tobacco control and treatment interventions is critical. By combining elements of economics and psychology, behavioral economics provides a framework for novel solutions to treat smokers who have failed to quit with traditional smoking cessation interventions. The full range of behavioral economic principles, however, have not been widely utilized in the realm of tobacco control and treatment. Given the need for improved tobacco control and treatment, the limited use of other behavioral economic principles represents a substantial missed opportunity. For this reason, we sought to describe the principles of behavioral economics as they relate to tobacco control, highlight potential gaps in the behavioral economics tobacco research literature, and provide examples of potential interventions that use each principle.
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Affiliation(s)
- Dalia Littman
- Department of Population Health, NYU Langone Health, New York, NY 10016, USA; (D.L.); (S.E.S.); (A.B.T.)
| | - Scott E. Sherman
- Department of Population Health, NYU Langone Health, New York, NY 10016, USA; (D.L.); (S.E.S.); (A.B.T.)
- Department of Medicine, VA New York Harbor Healthcare System, New York, NY 10010, USA
| | - Andrea B. Troxel
- Department of Population Health, NYU Langone Health, New York, NY 10016, USA; (D.L.); (S.E.S.); (A.B.T.)
| | - Elizabeth R. Stevens
- Department of Population Health, NYU Langone Health, New York, NY 10016, USA; (D.L.); (S.E.S.); (A.B.T.)
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García-Fernández G, Krotter A, García-Pérez Á, Aonso-Diego G, Secades-Villa R. Pilot randomized trial of cognitive-behavioral treatment plus contingency management for quitting smoking and weight gain prevention among smokers with overweight or obesity. Drug Alcohol Depend 2022; 236:109477. [PMID: 35525238 DOI: 10.1016/j.drugalcdep.2022.109477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Post-cessation weight gain is a risk factor for relapse among quitters. The primary study aim was to evaluate, among smokers with overweight or obesity, the feasibility and acceptability of a cognitive-behavioral treatment (CBT) plus contingency management (CM) for quitting smoking and weight control. The secondary aim was to examine preliminary tobacco abstinence and weight change outcomes. METHODS In an 8-week pilot randomized clinical trial, 41 participants (Mage = 52.73, SD = 10.91, 56.1% females) with overweight or obesity (MBMI = 31.86, SD = 4.7) received a CBT for both quitting smoking and weight gain prevention (n = 24) or the same treatment plus CM (n = 17), consisting of providing incentives contingent upon smoking abstinence biochemically verified. RESULTS Recruitment success rate was 80.39% (41/51), completion rate was 90.24% (37/41), and mean number of sessions attended (out of 15 possible) was 13.20 (SD = 3.1). Mean satisfaction rating for the treatment (1-10 likert-type scale with 10 being most satisfactory) was 9.73 (SD =.61). Preliminary efficacy data indicated that the CM group achieved higher abstinence rates compared with the CBT condition (100% vs. 58.33%, p = .007). Abstinent participants increased 1.25 kg (SD = 1.79) their baseline body weight at the end of treatment (p = .001). CONCLUSIONS Providing weight gain prevention strategies and CM within a smoking cessation treatment seems feasible and acceptable. Preliminary data indicated that including CM facilitates tobacco abstinence rates, nevertheless no advantage for CM was found for weight control.
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Affiliation(s)
- Gloria García-Fernández
- Department of Psychology, Addictive Behaviours Research Group, University of Oviedo, Plaza Feijoo S-N, Oviedo 33003, Spain.
| | - Andrea Krotter
- Department of Psychology, Addictive Behaviours Research Group, University of Oviedo, Plaza Feijoo S-N, Oviedo 33003, Spain
| | - Ángel García-Pérez
- Department of Psychology, Addictive Behaviours Research Group, University of Oviedo, Plaza Feijoo S-N, Oviedo 33003, Spain
| | - Gema Aonso-Diego
- Department of Psychology, Addictive Behaviours Research Group, University of Oviedo, Plaza Feijoo S-N, Oviedo 33003, Spain
| | - Roberto Secades-Villa
- Department of Psychology, Addictive Behaviours Research Group, University of Oviedo, Plaza Feijoo S-N, Oviedo 33003, Spain
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Triyana M, White JS. Non-monetary incentives for tobacco prevention among youth in Indonesia. JOURNAL OF HEALTH ECONOMICS 2022; 83:102620. [PMID: 35487104 DOI: 10.1016/j.jhealeco.2022.102620] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 02/25/2022] [Accepted: 03/31/2022] [Indexed: 06/14/2023]
Abstract
We provide evidence on the effectiveness of a school-based program that uses a non-monetary penalty and regular monitoring to prevent risky behavior among adolescents in Indonesia. The field experiment invited students to sign a pledge to abstain from tobacco use and a similar pledge for parents to monitor their children. To test group incentives, a subset of treated schools also competed against each other for the highest tobacco abstinence rates. We find that the individual pledge increases biochemically verified tobacco abstinence by 5 percentage points. This effect is sustained 3 months after the program ended. School competition has no additional impact on tobacco abstinence. Our findings highlight the effectiveness of non-monetary incentives to curb risky behaviors among adolescents who face limited self-control and peer pressure.
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Affiliation(s)
| | - Justin S White
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, United States.
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Improving Post-Release Care Engagement for People Living with HIV Involved in the Criminal Justice System: A Systematic Review. AIDS Behav 2022; 26:1607-1617. [PMID: 34705154 DOI: 10.1007/s10461-021-03513-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2021] [Indexed: 10/20/2022]
Abstract
Given sub-optimal HIV care outcomes for people living with HIV (PLWH) post-release from incarceration, we systematically searched peer-reviewed literature (2010-2021) describing controlled trial interventions aimed at improving Antiretroviral Therapy (ART) adherence and care linkage following release from correctional facilities for PLWH. Of 392 studies, 16 (4%) met the inclusion criteria. All studies were conducted in the United States and involved some form of intensive case management. Trials that scored highest in terms of study quality provided cell phones for engagement, reported sustained viral load suppression as a measurable outcome to infer ART adherence, and measured longitudinal data collected for at least 3-to-6 months following release. The two trials that demonstrated improved HIV viral load suppression involved Peer Navigators, and incentivized undetectable viral load, respectively. Facilitating support for addictions and addressing other social and structural barriers to achieving optimal health is also of vital importance in bridging care gaps for PLWH.
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Singh PN, Moses O, Shih W, Hubbard M. Cohort profile for the Loma Linda University Health BREATHE programme: a model to study continuously incentivised employee smoking cessation. BMJ Open 2022; 12:e053303. [PMID: 35450892 PMCID: PMC9024252 DOI: 10.1136/bmjopen-2021-053303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of the Loma Linda University Health (LLUH) BREATHE cohort is to test the efficacy of a novel method of continuously incentivising participation in workplace smoking cessation on participation, long-term abstinence, health outcomes, healthcare costs and healthcare utilisation. PARTICIPANTS In 2014, LLUH-a US academic medical centre and university-incentivised participation in a workplace smoking cessation programme (LLUH BREATHE) by lowering health plan costs. Specifically, LLUH introduced a Wholeness Health Plan (WHP) option that, for the smokers, continuously incentivises participation in nicotine screening and the LLUH BREATHE smoking cessation programme by offering an 'opt-in wellness discount' that consisted of 50%-53% lower out of pocket health plan costs (ie, monthly employee premiums, copayments). This novel 'continuously incentivised' model lowers annual health plan costs for smokers who, on an annual basis, attempt or maintain cessation from tobacco use. The annual WHP cost savings for smokers far exceed the value of short-term incentives that have been tested in workplace cessation trials to date. This ongoing health plan option offered to over 16 000 employees has created an open, dynamic LLUH BREATHE cohort of current and former smokers (n=1092). FINDINGS TO DATE Our profile of the LLUH BREATHE cohort indicates that after 5 years of follow-up in a prospective cohort study (2014-2019), continuously incentivised smoking cessation produced a 74% participation (95% CI (71% to 77%)) in employer-sponsored smoking cessation attempts that were occurring less than a year after the incentive was offered. The cohort can be purposed to examine the effect of continuously incentivised cessation on cessation outcomes, health plan utilisation/costs, use of electronic nicotine delivery systems, and COVID-19 outcomes.
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Affiliation(s)
- Pramil N Singh
- Loma Linda University Cancer Center-Transdisciplinary Tobacco Research Program, Loma Linda University Health, Loma Linda, California, USA
- School of Public Health, Loma Linda University Health, Loma Linda, California, USA
| | - Olivia Moses
- School of Public Health, Loma Linda University Health, Loma Linda, California, USA
- Risk Management, Loma Linda University Health, Loma Linda, California, USA
| | - Wendy Shih
- School of Public Health, Loma Linda University Health, Loma Linda, California, USA
| | - Mark Hubbard
- Risk Management, Loma Linda University Health, Loma Linda, California, USA
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Kenyon CC, Flaherty C, Floyd GC, Jenssen BP, Miller VA. Promoting Healthy Childhood Behaviors With Financial Incentives: A Narrative Review of Key Considerations and Design Features for Future Research. Acad Pediatr 2022; 22:203-209. [PMID: 34403802 PMCID: PMC8844312 DOI: 10.1016/j.acap.2021.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/15/2021] [Accepted: 08/10/2021] [Indexed: 11/24/2022]
Abstract
In the last decade, there has been a robust increase in research using financial incentives to promote healthy behaviors as behavioral economics and new monitoring technologies have been applied to health behaviors. Most studies of financial incentives on health behaviors have focused on adults, yet many unhealthy adult behaviors have roots in childhood and adolescence. The use of financial incentives is an attractive but controversial strategy in childhood. In this review, we first propose 5 general considerations in designing and applying incentive interventions to children. These include: 1) the potential impact of incentives on intrinsic motivation, 2) ethical concerns about incentives promoting undue influence, 3) the importance of child neurodevelopmental stage, 4) how incentive interventions may influence health disparities, and 5) how to finance effective programs. We then highlight empirical findings from randomized trials investigating key design features of financial incentive interventions, including framing (loss vs gain), timing (immediate vs delayed), and magnitude (incentive size) effects on a range of childhood behaviors from healthy eating to adherence to glycemic control in type 1 diabetes. Though the current research base on these subjects in children is limited, we found no evidence suggesting that loss-framed incentives perform better than gain-framed incentives in children and isolated studies from healthy food choice experiments support the use of immediate, small incentives versus delayed, larger incentives. Future research on childhood incentives should compare the effectiveness of gain versus loss-framing and focus on which intervention characteristics lead to sustained behavior change and habit formation.
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Affiliation(s)
- Chén C. Kenyon
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia,Division of General Pediatrics, Children’s Hospital of Philadelphia,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania
| | - Carina Flaherty
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia
| | - G. Chandler Floyd
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia
| | - Brian P. Jenssen
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia,Division of General Pediatrics, Children’s Hospital of Philadelphia,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania
| | - Victoria A. Miller
- Division of Adolescent Medicine, Children’s Hospital of Philadelphia,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania
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44
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Crainich D. [Financial incentives to achieve health-related behavioral goals: State of play and unresolved questions]. Med Sci (Paris) 2022; 38:198-204. [PMID: 35179475 DOI: 10.1051/medsci/2022005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Programs providing monetary rewards to individuals who achieve a health-related goal (quitting smoking, losing weight, etc.) aim at promoting healthy behaviors. While these programs seem to achieve their objective in the short run, their ability to provoke lasting changes remains to be demonstrated. The identification of granting mechanisms likely to maximize the incentive effect of these rewards should be based on knowledge about individual attitudes evidenced by behavioral economics. As the latter has shown that preferences toward risk vary from one individual to another, these incentive mechanisms should be tailor-made according to individual preferences.
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Affiliation(s)
- David Crainich
- Univ. Lille, CNRS, IESEG School of management, UMR 9221 - LEM (Lille Économie Management), 3 rue de la Digue, F-59000 Lille, France
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Kohn R, Vachani A, Small D, Stephens-Shields AJ, Sheu D, Madden VL, Bayes BA, Chowdhury M, Friday S, Kim J, Gould MK, Ismail MH, Creekmur B, Facktor MA, Collins C, Blessing KK, Neslund-Dudas CM, Simoff MJ, Alleman ER, Epstein LH, Horst MA, Scott ME, Volpp KG, Halpern SD, Hart JL. Comparing Smoking Cessation Interventions among Underserved Patients Referred for Lung Cancer Screening: A Pragmatic Trial Protocol. Ann Am Thorac Soc 2022; 19:303-314. [PMID: 34384042 PMCID: PMC8867367 DOI: 10.1513/annalsats.202104-499sd] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/12/2021] [Indexed: 02/03/2023] Open
Abstract
Smoking burdens are greatest among underserved patients. Lung cancer screening (LCS) reduces mortality among individuals at risk for smoking-associated lung cancer. Although LCS programs must offer smoking cessation support, the interventions that best promote cessation among underserved patients in this setting are unknown. This stakeholder-engaged, pragmatic randomized clinical trial will compare the effectiveness of four interventions promoting smoking cessation among underserved patients referred for LCS. By using an additive study design, all four arms provide standard "ask-advise-refer" care. Arm 2 adds free or subsidized pharmacologic cessation aids, arm 3 adds financial incentives up to $600 for cessation, and arm 4 adds a mobile device-delivered episodic future thinking tool to promote attention to long-term health goals. We hypothesize that smoking abstinence rates will be higher with the addition of each intervention when compared with arm 1. We will enroll 3,200 adults with LCS orders at four U.S. health systems. Eligible patients include those who smoke at least one cigarette daily and self-identify as a member of an underserved group (i.e., is Black or Latinx, is a rural resident, completed a high school education or less, and/or has a household income <200% of the federal poverty line). The primary outcome is biochemically confirmed smoking abstinence sustained through 6 months. Secondary outcomes include abstinence sustained through 12 months, other smoking-related clinical outcomes, and patient-reported outcomes. This pragmatic randomized clinical trial will identify the most effective smoking cessation strategies that LCS programs can implement to reduce smoking burdens affecting underserved populations. Clinical trial registered with clinicaltrials.gov (NCT04798664). Date of registration: March 12, 2021. Date of trial launch: May 17, 2021.
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Affiliation(s)
- Rachel Kohn
- Palliative and Advanced Illness Research Center
- Department of Medicine
- Leonard Davis Institute of Health Economics
| | | | - Dylan Small
- Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | - Jannie Kim
- Palliative and Advanced Illness Research Center
| | - Michael K. Gould
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | | | - Beth Creekmur
- Department of Research and Evaluation, Kaiser Permanente Southern California, Riverside, California
| | | | | | - Kristina K. Blessing
- Investigator Initiated Research Operations, Geisinger Health System, Danville, Pennsylvania
| | | | - Michael J. Simoff
- Henry Ford Cancer Institute, and
- Department of Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, Michigan
| | | | - Leonard H. Epstein
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Michael A. Horst
- Lancaster General Health Research Institute, University of Pennsylvania Health System, Lancaster, Pennsylvania
| | - Michael E. Scott
- The Center for Black Health and Equity, Durham, North Carolina; and
| | - Kevin G. Volpp
- Department of Medicine
- Leonard Davis Institute of Health Economics
- Department of Medical Ethics and Health Policy, and
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Scott D. Halpern
- Palliative and Advanced Illness Research Center
- Department of Medicine
- Leonard Davis Institute of Health Economics
- Department of Biostatistics, Epidemiology and Informatics
- Department of Medical Ethics and Health Policy, and
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joanna L. Hart
- Palliative and Advanced Illness Research Center
- Department of Medicine
- Leonard Davis Institute of Health Economics
- Department of Medical Ethics and Health Policy, and
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2443] [Impact Index Per Article: 1221.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Behavioral Interventions to Improve Home-Based Office-Workers’ Health. TRENDS IN PSYCHOLOGY 2022. [PMCID: PMC8754544 DOI: 10.1007/s43076-021-00122-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Many organizations have traditionally supported their employees’ physical and mental health through a variety of office-based programs and interventions. The shift from in-office work to working from home, which has been accelerated by the COVID-19 pandemic, requires organizations to update their toolbox to continue supporting a healthy and happy workforce. In this paper, we review research on successful, evidence-based interventions in four key areas of physical and mental health: physical activity and sedentary behavior, nutrition, loneliness, and stress. We show how organizations could adapt these interventions to a home-based office environment and conclude by highlighting areas of future research, as well as by discussing the role of health professionals and policymakers in designing effective interventions for the future of work.
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Pisinger C, Toxværd CG, Rasmussen M. Are financial incentives more effective than health campaigns to quit smoking? A community-randomised smoking cessation trial in Denmark. Prev Med 2022; 154:106865. [PMID: 34740676 DOI: 10.1016/j.ypmed.2021.106865] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 10/20/2021] [Accepted: 10/30/2021] [Indexed: 11/18/2022]
Abstract
The aim of this community-randomised smoking cessation (SC) trial was to investigate both recruitment and SC-rates in three municipalities offering financial incentives (FIM) to smokers who stop smoking when attending a municipal SC-program and compare these with three municipalities investing in a campaign (CAM) that should encourage smokers to use the SC-program. Furthermore, in a non-randomised matched control design we investigated whether there was a difference in recruitment and SC-rates in the three FIM and the three CAM, comparing each with three matched control municipalities (MCM). Each municipality received approx. $16,000. The FIM rewarded persons who were abstinent when attending the municipal SC-program. The CAM spent the money on a campaign recruiting smokers to the SC-program. Two of three FIM were only partly active in recruiting smokers in the intervention year 2018. An intention-to-treat (ITT) approach was used in analyses. Complete case analyses and multiple imputation were used to address loss to follow-up. No difference in recruitment was found between the CAM and the FIM (p = 0.954), in adjusted analyses. In ITT analyses, FIM achieved significantly higher odds of validated abstinence from smoking at one-year follow-up (OR (95%CI): 1.63(1.1-2.4)), but not of self-reported continuous abstinence after six months than CAM. Compared with no intervention, campaigns increased the recruitment of smokers to the SC-program while financial incentives increased six months abstinence rates. In a randomised trial, no difference was demonstrated in the effect of financial incentives and campaigns to recruit smokers to a SC-program and financial incentives seemed superior to help smokers staying smoke-free for a year. TRIAL REGISTRATION: ClinicalTrials.Gov ID: NCT03849092.
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Affiliation(s)
- Charlotta Pisinger
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark; University of Copenhagen, Faculty of Health Sciences, Department of Public Health, Denmark; Danish Heart Foundation, Copenhagen, Denmark.
| | - Cecilie Goltermann Toxværd
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark.
| | - Mette Rasmussen
- WHO-CC, Clinical Health Promotion Centre, The Parker Institute, Bispebjerg & Frederiksberg Hospital, The Capital Region of Denmark, Denmark; Department of Health Sciences, Clinical Health Promotion Centre, WHO-CC, Lund University, Lund, Sweden.
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Russell LB, Volpp KG, Kwong PL, Cosgriff BS, Harhay MO, Zhu J, Halpern SD. Cost-Effectiveness of Four Financial Incentive Programs for Smoking Cessation. Ann Am Thorac Soc 2021; 18:1997-2006. [PMID: 33979562 PMCID: PMC8641815 DOI: 10.1513/annalsats.202012-1473oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 05/12/2021] [Indexed: 11/20/2022] Open
Abstract
Rationale: A trial of four financial incentive programs, conducted at CVS Caremark, a large employer, documented their effectiveness in promoting sustained abstinence from smoking, but their cost-effectiveness is unknown, and the significant up-front cost of the incentives is a deterrent to their adoption. Objectives: To determine the cost-effectiveness of these incentives from the healthcare sector and employer perspectives. Methods: This study examines a decision model built with trial data, supplemented by data from the literature. Life-expectancy gains for quitters were projected on the basis of U.S. life tables. The two individual-oriented programs paid $800 for smoking cessation at 6 months; one required participants to deposit $150 at baseline. Payments in the two group-oriented programs varied with the group's success; again, one required participants to deposit $150. Results: Life-years, quality-adjusted life-years (QALYs), costs (2012 dollars), and cost-effectiveness ratios are described. From the healthcare sector perspective, costs ranged from $3,200 per life-year ($2,500 per QALY) for the competitive deposit program, compared with usual care, to $6,500 per life-year ($5,100 per QALY) for the individual reward program. From the employer perspective, costs ranged from $256,600 per life-year gained for the individual deposit program to $1,711,100 per life-year gained for the individual reward program; the cost per QALY ranged from $65,300 for the competitive deposit program to $128,800 for the individual reward program. Cost-effectiveness from the employer perspective improved with longer decision horizons. Including future medical costs reduced cost-effectiveness from both perspectives. Conclusions: Four financial incentive programs that paid smokers to quit are very cost-effective from the healthcare sector perspective. They are more expensive from the employer perspective but may be cost-effective for employers with longer decision horizons.
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Affiliation(s)
- Louise B. Russell
- Department of Medical Ethics and Health Policy
- Center for Health Incentives and Behavioral Economics
- Leonard Davis Institute of Health Economics, and
| | - Kevin G. Volpp
- Department of Medical Ethics and Health Policy
- Department of Medicine, and
- Center for Health Incentives and Behavioral Economics
- Leonard Davis Institute of Health Economics, and
- Department of Health Care Management, Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Pui L. Kwong
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Health Incentives and Behavioral Economics
| | | | - Michael O. Harhay
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Health Incentives and Behavioral Economics
| | - Jingsan Zhu
- Department of Medical Ethics and Health Policy
- Center for Health Incentives and Behavioral Economics
| | - Scott D. Halpern
- Department of Medical Ethics and Health Policy
- Department of Medicine, and
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Health Incentives and Behavioral Economics
- Leonard Davis Institute of Health Economics, and
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Rendle KA, Beidas RS. Four strategic areas to advance equitable implementation of evidence-based practices in cancer care. Transl Behav Med 2021; 11:1980-1988. [PMID: 34850931 PMCID: PMC8634319 DOI: 10.1093/tbm/ibab105] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Katharine A Rendle
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104,USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104,USA
| | - Rinad S Beidas
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104,USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104,USA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104,USA
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Penn Implementation Science Center at the Leonard Davis Institute (PISCE@LDI), University of Pennsylvania, Philadelphia, PA 19104,USA
- Center for Health Incentives and Behavioral Economics (CHIBE), University of Pennsylvania, Philadelphia, PA 19104, USA
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