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Ang G, Tan CS, Lim N, Tan J, Müller-Riemenschneider F, Cook AR, Chen C. Hourly step recommendations to achieve daily goals for working and older adults. COMMUNICATIONS MEDICINE 2024; 4:132. [PMID: 38971929 PMCID: PMC11227519 DOI: 10.1038/s43856-024-00537-4] [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: 07/15/2023] [Accepted: 05/31/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND The widespread use of physical activity trackers enables the collection of high-resolution health data, such as hourly step counts, to evaluate health promotion programmes. We aim to investigate how participants meet their daily step goals. METHODS We used 24-h steps data from the National Steps ChallengeTM Season 3, wherein participants were rewarded with vouchers when achieving specified goals of 5000, 7500, and 10,000 steps per day. We extracted data from 3075 participants' including a total of 52,346 participant-days. We modelled the hourly step counts using a two-part model, in which the distribution for step counts was allowed to depend on the sum of step counts up to the previous hour and participant demographics. RESULTS Participants have a mean age of 44.2 years (standard deviation = 13.9), and 40.4% are males. We show that on weekdays, the hourly mean step counts among participants aged 60 and above are higher than participants aged 30 to 59 from the start of the day till 6 p.m. We also find that participants who accumulate at least 7000 steps by 7 p.m. are associated with higher success of achieving 10,000 steps. CONCLUSIONS We provide recommendations on the hourly targets to achieve daily goals, based on different participants' characteristics. Future studies could experimentally test if prompts and nudges at the recommended times of day could promote reaching step goals.
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Affiliation(s)
- Gregory Ang
- Department of Statistics and Data Science, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicole Lim
- Health Promotion Board, Ministry of Health, Singapore, Singapore
| | - Jeremy Tan
- Health Promotion Board, Ministry of Health, Singapore, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Digital Health Center, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alex R Cook
- Department of Statistics and Data Science, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA.
- Department of Non-Communicable Disease Epidemiology, The London School of Hygiene & Tropical Medicine, London, UK.
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Uebelacker LA, Braun TD, Taylor LE, Saper R, Baldwi M, Abrantes A, Tremont G, Toribio A, Kirshy S, Koch R, Lorin L, Van Noppen D, Anderson B, Roseen EJ, Stein MD. Evaluation of intervention components to maximize yoga practice among people with chronic pain taking opioid agonist therapy: A factorial experiment using the multiphase optimization strategy framework. Contemp Clin Trials 2024; 137:107411. [PMID: 38103784 PMCID: PMC10922864 DOI: 10.1016/j.cct.2023.107411] [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: 07/17/2023] [Revised: 11/01/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Chronic pain affects up to half of individuals taking opioid agonist therapy (OAT; i.e., methadone and buprenorphine) for opioid use disorder (OUD), and yoga-based interventions may be useful for decreasing pain-related disability. Whereas more yoga practice (i.e., higher "dosage") may improve pain-related outcomes, it can be challenging for people with chronic pain taking OAT to attend class regularly and sustain a regular personal yoga practice. Therefore, we plan to optimize a yoga-based intervention (YBI) package in order to support class attendance and personal practice, thus maximizing the yoga dose received. STUDY DESIGN Using the Multiphase Optimization Strategy (MOST) framework, we will conduct a factorial experiment to examine four intervention components that may be added to a weekly yoga class as part of a YBI. Components include: 1) personal practice videos featuring study yoga teachers, 2) two private sessions with a yoga teacher, 3) daily text messages to inspire personal practice, and 4) monetary incentives for class attendance. The primary outcome will be minutes per week engaged in yoga (including class attendance and personal practice). We plan to enroll 192 adults with chronic pain who are taking OAT for OUD in this 2x2x2x2 factorial experiment. CONCLUSION Results of the study will guide development of an optimized yoga-based intervention package that maximizes dosage of yoga received. The final treatment package can be tested in a multisite efficacy trial of yoga to reduce pain interference in daily functioning in people with chronic pain who are taking OAT. TRIAL REGISTRATION Pre-registration of the study was completed on ClinicalTrials.gov (identifier: NCT04641221).
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Affiliation(s)
- Lisa A Uebelacker
- Alpert Medical School of Brown University, Providence, RI, United States of America; Butler Hospital, Providence, RI, United States of America.
| | - Tosca D Braun
- Alpert Medical School of Brown University, Providence, RI, United States of America; Butler Hospital, Providence, RI, United States of America.
| | - Lynn E Taylor
- University of Rhode Island, Kingston, RI, United States of America
| | - Robert Saper
- Cleveland Clinic, Cleveland, OH, United States of America
| | - Marielle Baldwi
- Boston University Chobanian & Avedision School of Medicine, Boston, MA, United States of America; Boston Medical Center, Boston, MA, United States of America
| | - Ana Abrantes
- Alpert Medical School of Brown University, Providence, RI, United States of America; Butler Hospital, Providence, RI, United States of America
| | - Geoffrey Tremont
- Alpert Medical School of Brown University, Providence, RI, United States of America; The Boston University School of Public Health, Boston, MA, United States of America
| | - Alisha Toribio
- Boston University Chobanian & Avedision School of Medicine, Boston, MA, United States of America; Boston Medical Center, Boston, MA, United States of America
| | - Shannon Kirshy
- Butler Hospital, Providence, RI, United States of America
| | - Ryan Koch
- Butler Hospital, Providence, RI, United States of America
| | - Lucy Lorin
- Boston University Chobanian & Avedision School of Medicine, Boston, MA, United States of America; Boston Medical Center, Boston, MA, United States of America
| | | | | | - Eric J Roseen
- Boston University Chobanian & Avedision School of Medicine, Boston, MA, United States of America; Boston Medical Center, Boston, MA, United States of America
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Willms A, Rhodes RE, Liu S. Effects of Mobile-Based Financial Incentive Interventions for Adults at Risk of Developing Hypertension: Feasibility Randomized Controlled Trial. JMIR Form Res 2023; 7:e36562. [PMID: 36961486 PMCID: PMC10131910 DOI: 10.2196/36562] [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: 01/17/2022] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hypertension is the leading modifiable risk factor for cardiovascular disease and mortality. Adopting lifestyle modifications, like increasing physical activity (PA), can be an effective strategy in blood pressure (BP) control, but many adults do not meet the PA guidelines. Financial incentive interventions have the power to increase PA levels but are often limited due to cost. Further, mobile health technologies can make these programs more scalable. There is a gap in the literature about the most feasible and effective financial incentive PA framework; thus, pay-per-minute (PPM) and self-funded investment incentive (SFII) frameworks were explored. OBJECTIVE The aims were to (1) determine the feasibility (recruitment, engagement, and acceptability) of an 8-week mobile-based PPM and SFII hypertension prevention PA program and (2) explore the effects of PPM and SFII interventions relative to a control on the PA levels, BP, and PA motivation. METHODS In total, 55 adults aged 40-65 years not meeting the Canadian PA guidelines were recruited from Facebook and randomized into the following groups: financial incentive groups, PPM or SFII, receiving up to CAD $20 each (at the time of writing: CAD $1=US $0.74), or a control group without financial incentive. PPM participants received CAD $0.02 for each minute of moderate-to-vigorous PA (MVPA) per week up to the PA guidelines and the SFII received CAD $2.50 for each week they met the PA guidelines. Feasibility outcome measures (recruitment, engagement, and acceptability) were assessed. Secondary outcomes included changes in PA outcomes (MVPA and daily steps) relative to baseline were compared among PPM, SFII, and control groups at 4 and 8 weeks using linear regressions. Changes in BP and relative autonomy index relative to baseline were compared among the groups at follow-up. RESULTS Participants were randomized to the PPM (n=19), SFII (n=18), or control (n=18) groups. The recruitment, retention rate, and engagement were 77%, 75%, and 65%, respectively. The intervention received overall positive feedback, with 90% of comments praising the intervention structure, financial incentive, and educational materials. Relative to the control at 4 weeks, the PPM and SFII arms increased their MVPA with medium effect (PPM vs control: η2p=0.06, mean 117.8, SD 514 minutes; SFII vs control: η2p=0.08, mean 145.3, SD 616 minutes). At 8 weeks, PPM maintained a small effect in MVPA relative to the control (η2p=0.01, mean 22.8, SD 249 minutes) and SFII displayed a medium effect size (η2p=0.07, mean 113.8, SD 256 minutes). Small effects were observed for PPM and SFII relative to the control for systolic blood pressure (SBP) and diastolic blood pressure (DBP) (PPM: η2p=0.12, Δmean SBP 7.1, SD 23.61 mm Hg; η2p=0.04, Δmean DBP 3.5, SD 6.2 mm Hg; SFII: η2p=0.01, Δmean SBP -0.4, SD 1.4 mm Hg; η2p=0.02, Δmean DBP -2.3, SD 7.7 mm Hg) and relative autonomy index (PPM: η2p=0.01; SFII: η2p=0.03). CONCLUSIONS The feasibility metrics and preliminary findings suggest that a future full-scale randomized controlled trial examining the efficacy of PPM and SFII relative to a control is feasible, and studies with longer duration are warranted.
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Affiliation(s)
- Amanda Willms
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Ryan E Rhodes
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
- Department of Psychology, University of Victoria, Victoria, BC, Canada
| | - Sam Liu
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
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Ladapo JA, Orstad SL, Wali S, Wylie-Rosett J, Tseng CH, Chung UYR, Cuevas MA, Hernandez C, Parraga S, Ponce R, Sweat V, Wittleder S, Wallach AB, Shu SB, Goldstein NJ, Jay M. Effectiveness of Goal-Directed and Outcome-Based Financial Incentives for Weight Loss in Primary Care Patients With Obesity Living in Socioeconomically Disadvantaged Neighborhoods: A Randomized Clinical Trial. JAMA Intern Med 2023; 183:61-69. [PMID: 36469353 PMCID: PMC9857219 DOI: 10.1001/jamainternmed.2022.5618] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/16/2022] [Indexed: 12/12/2022]
Abstract
Importance Financial incentives for weight management may increase use of evidence-based strategies while addressing obesity-related economic disparities in low-income populations. Objective To examine the effects of 2 financial incentive strategies developed using behavioral economic theory when added to provision of weight management resources. Design, Setting, and Participants Three-group, randomized clinical trial conducted from November 2017 to May 2021 at 3 hospital-based clinics in New York City, New York, and Los Angeles, California. A total of 1280 adults with obesity living in low-income neighborhoods were invited to participate, and 668 were enrolled. Interventions Participants were randomly assigned to goal-directed incentives, outcome-based incentives, or a resources-only group. The resources-only group participants were given a 1-year commercial weight-loss program membership, self-monitoring tools (digital scale, food journal, and physical activity monitor), health education, and monthly one-on-one check-in visits. The goal-directed group included resources and linked financial incentives to evidence-based weight-loss behaviors. The outcome-based arm included resources and linked financial incentives to percentage of weight loss. Participants in the incentive groups could earn up to $750. Main Outcomes and Measures Proportion of patients achieving 5% or greater weight loss at 6 months. Results The mean (SD) age of the 668 participants enrolled was 47.7 (12.4) years; 541 (81.0%) were women, 485 (72.6%) were Hispanic, and 99 (14.8%) were Black. The mean (SD) weight at enrollment was 98.96 (20.54) kg, and the mean body mass index (calculated as weight in kilograms divided by height in meters squared) was 37.95 (6.55). At 6 months, the adjusted proportion of patients who lost at least 5% of baseline weight was 22.1% in the resources-only group, 39.0% in the goal-directed group, and 49.1% in the outcome-based incentive group (difference, 10.08 percentage points [95% CI, 1.31-18.85] for outcome based vs goal directed; difference, 27.03 percentage points [95% CI, 18.20-35.86] and 16.95 percentage points [95% CI, 8.18-25.72] for outcome based or goal directed vs resources only, respectively). However, mean percentage of weight loss was similar in the incentive arms. Mean earned incentives was $440.44 in the goal-directed group and $303.56 in the outcome-based group, but incentives did not improve financial well-being. Conclusions and Relevance In this randomized clinical trial, outcome-based and goal-directed financial incentives were similarly effective, and both strategies were more effective than providing resources only for clinically significant weight loss in low-income populations with obesity. Future studies should evaluate cost-effectiveness and long-term outcomes. Trial Registration ClinicalTrials.gov Identifier: NCT03157713.
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Affiliation(s)
- Joseph A. Ladapo
- Department of Medicine, University of Florida College of Medicine, Gainesville
| | - Stephanie L. Orstad
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York
| | - Soma Wali
- Department of Medicine, Olive View–UCLA Medical Center, Sylmar, California
| | - Judith Wylie-Rosett
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Un Young Rebecca Chung
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Miguel A. Cuevas
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Christina Hernandez
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York
| | - Susan Parraga
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York
| | - Robert Ponce
- Department of Medicine, Olive View–UCLA Medical Center, Sylmar, California
| | - Victoria Sweat
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York
| | - Sandra Wittleder
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York
| | - Andrew B. Wallach
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York
- Bellevue Hospital Center, New York, New York
| | - Suzanne B. Shu
- Cornell Dyson School of Applied Economics and Management, Ithaca, New York
| | | | - Melanie Jay
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York
- New York Harbor Veterans Health Affairs, New York, New York
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Hulbert LR, Michael SL, Charter-Harris J, Atkins C, Skeete RA, Cannon MJ. Effectiveness of Incentives for Improving Diabetes-Related Health Indicators in Chronic Disease Lifestyle Modification Programs: a Systematic Review and Meta-Analysis. Prev Chronic Dis 2022; 19:E66. [PMID: 36302383 PMCID: PMC9616129 DOI: 10.5888/pcd19.220151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction We examined the effectiveness of providing incentives to participants in lifestyle modification programs to improve diabetes-related health indicators: body weight, body mass index (BMI), blood pressure, cholesterol, and hemoglobin A1C (HbA1C). We also examined the potential effect of 4 different incentive domains (ie, type, monetary value, attainment certainty, and schedule) on those indicators. Methods We searched Medline, Embase, PsycINFO, and Cochrane Library to identify relevant studies published from January 2008 through August 2021. We used a random-effects model to pool study results and examine between-study heterogeneity by using the I2 statistic and the Cochran Q test. We also conducted moderator analyses by using a mixed-effects model to examine differences between subgroups of incentive domains (eg, incentive type [cash vs other types]). Results Our search yielded 10,965 articles, of which 19 randomized controlled trials met our selection criteria. The random-effects model revealed that, relative to the control group, the incentive group had significant reductions in weight (−1.85kg; 95% CI, −2.40 to −1.29; P < .001), BMI (−0.47kg/m2; 95% CI, −0.71 to −0.22; P < .001), and both systolic blood pressure (−2.59 mm HG; 95% CI, −4.98 to −0.20; P = .03) and diastolic blood pressure (−2.62 mm Hg; 95% CI, −4.61 to −0.64; P = .01). A reduction in cholesterol level was noted but was not significant (−2.81 mg/dL; 95% CI, −8.89 to −3.28; P = .37). One study found a significant reduction in hemoglobin A1c (−0.17%; 95% CI, −0.30% to −0.05%; P < .05). The moderator analyses showed that the incentive effect did not vary significantly between the subgroups of the incentive domains, except on weight loss for the attainment certainty domain, suggesting that a variety of incentive subgroups could be equally useful. Conclusion Providing incentives in lifestyle modification programs is a promising strategy to decrease weight, BMI, and blood pressure.
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Affiliation(s)
- LaShonda R. Hulbert
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- CyberData Technologies, Inc, Herndon, Virginia
| | - Shannon L. Michael
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jasmine Charter-Harris
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Charisma Atkins
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Michael J. Cannon
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Vetrovsky T, Borowiec A, Juřík R, Wahlich C, Śmigielski W, Steffl M, Tufano JJ, Drygas W, Stastny P, Harris T, Małek Ł. Do physical activity interventions combining self-monitoring with other components provide an additional benefit compared with self-monitoring alone? A systematic review and meta-analysis. Br J Sports Med 2022; 56:1366-1374. [DOI: 10.1136/bjsports-2021-105198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 11/03/2022]
Abstract
ObjectiveTo determine the net effect of different physical activity intervention components on step counts in addition to self-monitoring.DesignA systematic review with meta-analysis and meta-regression.Data sourcesFive databases (PubMed, Scopus, Web of Science, ProQuest and Discus) were searched from inception to May 2022. The database search was complemented with backward and forward citation searches and search of the references from relevant systematic reviews.Eligibility criteriaRandomised controlled trials comparing an intervention using self-monitoring (active control arm) with an intervention comprising the same treatment PLUS any additional component (intervention arm).Data extraction and synthesisThe effect measures were mean differences in daily step count. Meta-analyses were performed using random-effects models, and effect moderators were explored using univariate and multivariate meta-regression models.ResultsEighty-five studies with 12 057 participants were identified, with 75 studies included in the meta-analysis at postintervention and 24 at follow-up. At postintervention, the mean difference between the intervention and active control arms was 926 steps/day (95% CI 651 to 1201). At a follow-up, the mean difference was 413 steps/day (95% CI 210 to 615). Interventions with a prescribed goal and involving human counselling, particularly via phone/video calls, were associated with a greater mean difference in the daily step count than interventions with added print materials, websites, smartphone apps or incentives.ConclusionPhysical activity interventions that combine self-monitoring with other components provide an additional modest yet sustained increase in step count compared with self-monitoring alone. Some forms of counselling, particularly remote phone/video counselling, outperformed other intervention components, such as websites and smartphone apps.PROSPERO registered numberCRD42020199482.
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You W, Yuan Y, Boyle KJ, Michaud TL, Parmeter C, Seidel RW, Estabrooks PA. Examining Ways to Improve Weight Control Programs' Population Reach and Representativeness: A Discrete Choice Experiment of Financial Incentives. PHARMACOECONOMICS - OPEN 2022; 6:193-210. [PMID: 34757584 PMCID: PMC8864042 DOI: 10.1007/s41669-021-00310-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Both theoretical and empirical evidence supports the potential of modest financial incentives to increase the reach of evidence-based weight control programs. However, few studies exist that examine the best incentive design for achieving the highest reach and representativeness at the lowest cost and whether or not incentive designs may be valued differentially by subgroups that experience obesity-related health disparities. METHODS A discrete choice experiment was conducted (n = 1232 participants; over 90% of them were overweight/obese) to collect stated preference towards different financial incentive attributes, including reward amount, program location, reward contingency, and payment form and frequency. Mixed logit and conditional logit models were used to determine overall and subgroup preference ranking of attributes. Using the National Health and Nutrition Examination Survey data sample weights and the estimated models, we predicted US nationally representative participation rates by subgroups and examined the effect of offering more than one incentive design. External validity was checked by using a completed cluster randomized control trial. RESULTS There were significant subgroup differences in preference toward incentive attributes. There was also a sizable negative response to larger incentive amounts among African Americans, suggesting that higher amounts would reduce participation from this population. We also find that offering participants a menu of incentive designs to choose from would increase reach more than offering higher reward amounts. CONCLUSIONS We confirmed the existence of preference heterogeneity and the importance of subgroup-targeted incentive designs in any evidence-based weight control program to maximize population reach and reduce health disparities.
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Affiliation(s)
- Wen You
- Department of Public Health Science, School of Medicine, University of Virginia, University of Virginia Cancer Center, Charlottesville, VA USA
| | | | - Kevin J. Boyle
- Department of Agricultural and Applied Economics, Willis Blackwood Real Estate, Virginia Tech, Blacksburg, VA USA
| | - Tzeyu L. Michaud
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE USA
| | - Chris Parmeter
- Department of Economics, University of Miami, Miami, FL USA
| | - Richard W. Seidel
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA USA
| | - Paul A. Estabrooks
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE USA
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Totally Excited about Moving Mobility and Exercise (TEAM Me): A Successful Multidisciplinary Exercise Quality Improvement Initiative for Pediatric and Young Adult Oncology and Stem Cell Transplant Inpatients. CHILDREN 2022; 9:children9020186. [PMID: 35204907 PMCID: PMC8870635 DOI: 10.3390/children9020186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 01/31/2023]
Abstract
Background: Pediatric, adolescent and young adult (PAYA) patients are less active than their healthy counterparts, particularly during inpatient stays. Methods: We conducted a quality improvement initiative to increase activity levels in patients admitted to our pediatric oncology and cellular therapy unit using a Plan-Do-Study-Act (PDSA) model. An interdisciplinary team was assembled to develop an incentive-based inpatient exercise and activity program titled Totally Excited About Moving Mobility and Exercise (TEAM Me). As part of the program, patients were encouraged by their care team to remain active during their inpatient stay. As an additional incentive, patients earned stickers to display on TEAM Me door boards along with tickets that could be exchanged for prizes. Activity was assessed by documentation of physical therapy participation, tests of physical function, and surveys of staff perceptions of patient activity levels, motivations, and barriers. Results: Compared to baseline, patient refusals to participate in physical therapy decreased significantly (24% vs. 2%) (p < 0.02), and staff perceptions of patient motivation to stay active increased from 40% to 70% in the post implementation period. There were no changes in physical function tests. Conclusions: An incentive-based exercise program for young oncology inpatients greatly improved patient activity levels, participation in physical therapy and influenced professional caregivers’ beliefs.
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Glover M, Kira A, McRobbie H, Kruger R, Funaki-Tahifote M, Stephen J, Breier BH, Kira G. Outcomes of a culturally informed weight-loss competition for New Zealand Indigenous and Pacific peoples: a quasi-experimental trial. BMC Nutr 2021; 7:52. [PMID: 34503549 PMCID: PMC8431855 DOI: 10.1186/s40795-021-00457-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 07/20/2021] [Indexed: 11/30/2022] Open
Abstract
Background Reducing obesity prevalence among marginalised subgroups with disproportionately high obesity rates is challenging. Given the promise of incentives and group-based programmes we trialled a culturally tailored, team-based weight-loss competition with New Zealand Māori (Indigenous) and Pacific Island people. Methods A quasi-experimental 12-months trial was designed. The intervention consisted of three six-months competitions, each with seven teams of seven members. Eligible participants were aged 16 years and older, with a BMI ≥30 kg/m2 and being at risk of or already diagnosed with type-2 diabetes or cardiovascular disease. Height, weight and waist circumference were measured at baseline, 6 and 12 months. Results Recruitment of a control group (n = 29) versus the intervention (n = 132) was poor and retention rates were low (52 and 27% of intervention participants were followed-up at six and 12 months, respectively). Thus, analysis of the primary outcome of individual percentage weight loss was restricted to the 6-months follow-up data. Although not significant, the intervention group appeared to lose more weight than the control group, in both the intention to treat and complete-case analyses. Conclusions The intervention promoted some behaviour change in eating behaviours, and a resulting trend toward a reduction in waist circumference. Trial registration ACTRN12617000871347 Registered 15/6/2017 Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-021-00457-9.
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Affiliation(s)
- Marewa Glover
- School of Health Sciences, College of Health, Massey University, Auckland, New Zealand.
| | | | - Hayden McRobbie
- Lakes District Health Board, New Zealand and National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
| | - Rozanne Kruger
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, New Zealand
| | | | - Jane Stephen
- School of Health Sciences, College of Health, Massey University, Auckland, New Zealand
| | - Bernhard H Breier
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, New Zealand
| | - Geoff Kira
- School of Health Sciences, College of Health, Massey University, Auckland, New Zealand
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Bialowolski P, Weziak-Bialowolska D, McNeely E. A socially responsible financial institution - The bumpy road to improving consumer well-being. EVALUATION AND PROGRAM PLANNING 2021; 86:101908. [PMID: 33588144 DOI: 10.1016/j.evalprogplan.2021.101908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 11/20/2020] [Accepted: 01/18/2021] [Indexed: 06/12/2023]
Abstract
There is a strong belief that in addition to making a profit, companies should act for the benefit of the society. This research has evaluated a novel cooperation model between a non-profit financial institution and a community service provider (a local YMCA) with the overarching aim of advancing customers' well-being. By offering a financial incentive (a savings account with higher interest payouts, contingent on account holders' increased participation in YMCA activities), the financial institution and the YMCA partnered to improve consumers' financial standing, positive health behaviors, and overall well-being. The collaboration exemplified a business engagement in the community that goes beyond philanthropy. Participation in YMCA activities was found not to be influenced by the financial incentive. However, households participating in the program swiftly transferred their financial resources to the incentivized account and along with that increased their activity in YMCA to boost the interest rate. Sport-related YMCA visits had some positive effects on momentary well-being, but none were observed for non-sport-related activities. Furthermore, the incentivized activities did not translate into improved well-being outcomes but had a potential to positively contribute to emergency savings. The evidence from qualitative feedback from in-depth participant interviews pointed to a reverse effect of the incentive, where YMCA engagement was a trigger for setting up the savings account. The findings have corroborated the understanding that designing interventions that target customers' well-being is not a straightforward task.
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Affiliation(s)
- Piotr Bialowolski
- Sustainability and Health Initiative (SHINE), Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
| | - Dorota Weziak-Bialowolska
- Sustainability and Health Initiative (SHINE), Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
| | - Eileen McNeely
- Sustainability and Health Initiative (SHINE), Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
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Heise TL, Frense J, Christianson L, Seuring T. Using financial incentives to increase physical activity among employees as a strategy of workplace health promotion: protocol for a systematic review. BMJ Open 2021; 11:e042888. [PMID: 33674371 PMCID: PMC7938995 DOI: 10.1136/bmjopen-2020-042888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/25/2021] [Accepted: 02/19/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Shifts towards sedentary occupations in high-income countries (HIC) over the last decades and the health burden associated with physical inactivity have led to innovative strategies to promote physical activity (PA) among the working population. Financial rewards have been proposed to incentivise participation in programmes promoting PA or the achievement of PA-related goals. This review will assess (1) effects of financial incentives provided by employers to promote PA on programme adherence/compliance, PA and closely linked outcomes (eg, days of sick leave), (2) effects according to age, gender, implementation and study quality and (3) intervention costs and cost-effectiveness. METHODS AND ANALYSIS We will search for relevant studies in eight academic databases, two grey literature resources, two trial registers and on five organisational websites (oldest record/content to present). We will include (cluster) randomised controlled studies with a financial incentive to promote PA as intervention (≥1 months), conducted among employees in HIC and reporting data on at least one primary outcome in stages of screening (title/abstract, full text). To assess study quality and potential bias, we will use the revised Cochrane risk-of-bias tool (RoB 2). We will extract study data into prepiloted extraction sheets. Each task in screening, quality assessment and data extraction will be done by two authors independently. If a sufficient number of studies provide homogeneous data (ie, similar follow-up) for primary outcomes, meta-analyses will be carried out. We will report GRADE ratings to provide information on the certainty of the evidence. ETHICS AND DISSEMINATION For this review, no ethical approval will be required because only data of studies in which informed consent was obtained will be considered and analysed. The final review manuscript will be published in an Open Access journal. To ensure effective promotion of this review project, we will disseminate major findings through relevant communication channels. PROSPERO REGISTRATION NUMBER CRD42020184345.
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Affiliation(s)
- Thomas Leonhard Heise
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Institute for Public Health and Nursing Research, Health Sciences, University of Bremen, Bremen, Germany
| | - Jennifer Frense
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Lara Christianson
- Administration, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Till Seuring
- Department of Living Conditions, Luxembourg Institute of Socio-Economic Research, Esch-sur-Alzette, Luxembourg
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12
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Ellis JD, Struble CA, Fodor MC, Cairncross M, Lundahl LH, Ledgerwood DM. Contingency management for individuals with chronic health conditions: A systematic review and meta-analysis of randomized controlled trials. Behav Res Ther 2020; 136:103781. [PMID: 33302054 DOI: 10.1016/j.brat.2020.103781] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/24/2020] [Accepted: 11/16/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Contingency management (CM) interventions involve providing reinforcement for engaging in a desired behavior, and have been shown to increase treatment adherence and promote abstinence in the treatment of substance use disorders. This review was conducted to systematically review the literature on the effectiveness of CM when applied to a range of medical conditions outside of substance use disorders. METHOD The authors identified a total of 24 randomized studies examining the effects of CM on four outcomes: weight change, physical activity, medication/device adherence, and viral load that were included in the qualitative summary, and 20 studies included in the meta-analysis. RESULTS CM was associated with positive outcomes for physical activity and medication/device adherence compared to control conditions. Findings with weight loss and viral load were more mixed, and evidence for publication bias was found for both outcomes. The effects of CM tend to dissipate when the contingency is removed. Heterogeneity was observed across most outcomes. LIMITATIONS AND CONCLUSIONS This review provides preliminary support for the use of CM in increasing physical activity and improving adherence to medication for chronic health conditions while reinforcement is ongoing. Future studies should examine potential moderators and identify strategies to maintain these changes over time.
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Affiliation(s)
- Jennifer D Ellis
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA; Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, USA
| | - Cara A Struble
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA
| | - Marina C Fodor
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA
| | - Molly Cairncross
- Division of Physical Medicine and Rehabilitation, The University of British Columbia, Canada
| | - Leslie H Lundahl
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA
| | - David M Ledgerwood
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA.
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Financial Incentives and Employer-Sponsored Health Activities. J Occup Environ Med 2020; 62:922-929. [PMID: 32826553 DOI: 10.1097/jom.0000000000002003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To understand how employer-sponsored incentives and participant-level characteristics drive health activity engagement. METHODS Multivariable hierarchical logistic regression models evaluated 283,365 individuals eligible for incentives through health savings accounts, health reimbursement accounts, health incentive accounts, gift cards, and other means, and estimated log odds of (1) completing a health survey; (2) participating in a biometric screening; (3) attaining a biometric target; (4) participating in a weight loss program; undergoing (5) breast, (6) colorectal, or (7) cervical cancer screening. RESULTS Larger incentives were associated with higher odds of participating in biometric screenings only (2% higher for every $25). Obesity, tobacco use, and lack of primary care were associated with lower odds. CONCLUSION Employers may wish to tailor incentive plans to the unique characteristics and needs of their populations to better drive participation in sponsored health activities.
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Adding Financial Incentives to Online Group-Based Behavioral Weight Control: An RCT. Am J Prev Med 2020; 59:237-246. [PMID: 32446752 PMCID: PMC8510645 DOI: 10.1016/j.amepre.2020.03.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/24/2020] [Accepted: 03/29/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Internet-delivered behavioral weight control is promising for expanding the reach and availability of weight management, but online programs produce lower weight losses than typically achieved in person. Financial incentives have been shown to increase weight losses. This study examined whether adding financial incentives for self-monitoring and achieving target weight losses increases weight losses attained in a fully online, group-based behavioral weight management program compared with the same program alone. STUDY DESIGN This study was an RCT. SETTING/PARTICIPANTS Adults with overweight and obesity (n=418; 91% female; 28% minority) were recruited from 2 clinical centers. INTERVENTION The intervention was a 24-session online group-based behavioral weight control program with weekly synchronous chat sessions (Internet-only) or the same program with weekly financial incentives for self-monitoring body weight and dietary intake daily and for achieving target weight losses at 2 and 6 months (Internet + incentives). MAIN OUTCOME MEASURES This study measured weight loss at 6 months and treatment engagement (attendance, self-monitoring of body weight, dietary intake, and physical activity). Data were collected between February 2016 and August 2018, and analyses were completed in 2019. RESULTS Participants randomized to the Internet + incentives group lost more weight (-6.4 [SD=5.5] kg) than those in the Internet-only group (-4.7 [SD=6.6] kg; p<0.01). Further, a higher proportion of the Internet + incentives group achieved ≥5% weight loss (55%) than those in the Internet-only group (40%; p<0.05). Treatment engagement was higher in the Internet + incentives condition, with greater self-monitoring of behaviors targeted by incentives, as well as higher rates of behaviors not targeted and higher self-reported physical activity. Study retention was higher among those in the Internet + incentives condition (91%) than those in the Internet-only condition (81%; p=0.003). CONCLUSIONS Adding financial incentives to a program delivered fully online increases weight losses compared with the program alone and can achieve weight losses comparable to in-person programs, offering potential for substantial geographic reach. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02688621.
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Luong MLN, Hall M, Bennell KL, Kasza J, Harris A, Hinman RS. The Impact of Financial Incentives on Physical Activity: A Systematic Review and Meta-Analysis. Am J Health Promot 2020; 35:236-249. [PMID: 32672050 DOI: 10.1177/0890117120940133] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the effects of financial incentives on physical activity (PA). DATA SOURCES MEDLINE, Embase, 7 other databases, and 2 trial registries until July 17, 2019. STUDY INCLUSION AND EXCLUSION CRITERIA Randomized controlled trials with adults aged ≥18 years assessing the effect of financial incentives on PA. Any comparator was eligible provided the only difference between groups was the incentive strategy. DATA EXTRACTION Two independent reviewers extracted data and assessed study quality. Of 5765 records identified, 57 records (51 unique trials; n = 17 773 participants) were included. DATA SYNTHESIS Random-effects models pooling data for each of the 5 PA domains. RESULTS Financial incentives increase leisure time PA (gym or class attendance; standardized mean difference [95% CI], 0.46 [0.28-0.63], n = 5057) and walking behavior (steps walked; 0.25 [0.13-0.36], n = 3254). No change in total minutes of PA (0.52 [-0.09 to 1.12], n = 968), kilocalories expended (0.19 [-0.06 to 0.44], n = 247), or the proportion of participants meeting PA guidelines (risk ratio [95% CI] 1.53 [0.53-4.44], n = 650) postintervention was observed. After intervention has ceased, incentives sustain a slight increase in leisure time PA (0.10 [0.02-0.18], n = 2678) and walking behavior (0.11 [0.00-0.22], n = 2425). CONCLUSIONS Incentives probably improve leisure time PA and walking at intervention end, and small improvements may be sustained over time once incentives have ceased. They lead to little or no difference in kilocalories expended or minutes of PA. It is uncertain whether incentives change the likelihood of meeting PA guidelines because the certainty of the evidence is low.
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Affiliation(s)
- My-Linh Nguyen Luong
- Department of Physiotherapy, 549319Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Victoria, Australia
| | - Michelle Hall
- Department of Physiotherapy, 549319Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Victoria, Australia
| | - Kim L Bennell
- Department of Physiotherapy, 549319Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Victoria, Australia
| | - Jessica Kasza
- Biostatistics Unit, 161667School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Anthony Harris
- Centre for Health Economics, Monash Business School, Monash University, Victoria, Australia
| | - Rana S Hinman
- Department of Physiotherapy, 549319Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Victoria, Australia
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Rovniak LS, Adams MA, Sciamanna CN, Kong L, Sullivan N, Costalas S, Bopp M, Kuzmik A. Effects of Bluetooth-Enabled Desk Ellipticals on Office Work Performance: Rationale, Design, and Protocol for a Randomized Trial With Overweight and Obese Adults. JMIR Res Protoc 2020; 9:e16275. [PMID: 31934871 PMCID: PMC6996735 DOI: 10.2196/16275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 10/22/2019] [Accepted: 10/26/2019] [Indexed: 11/28/2022] Open
Abstract
Background Workplaces that provide opportunities for physical activity without requiring extra time for activity could help counteract the obesity epidemic. Desk ellipticals can contribute to activity-supportive workplace environments; however, the feasibility of engaging employees in pedaling ellipticals during simultaneous office work has not been well evaluated. Objective We aim to present the rationale and methods from an ongoing randomized trial with overweight and obese employees that will evaluate (1) the effects of pedaling a compact desk elliptical on work performance and (2) the influence of different incentive types and schedules on desk pedaling quantity. Methods Overweight and obese medical center employees are being recruited in dyads for a 2 (gift card type: healthier food vs Amazon) by 3 (gift card schedule: immediate incentive contingent on individual pedaling quantity; immediate incentive partially contingent on dyads’ joint pedaling quantity; and delayed noncontingent pedaling incentive) cluster randomized within-subjects factorial trial. All participants receive a Bluetooth-enabled desk elliptical for 4 weeks and access to a mobile app that provides real-time pedaling feedback. The primary aims are to assess (1) change in employee work performance from pre- to postelliptical installation via employee and supervisor ratings and (2) effects of gift card type and schedule on quantity of objectively measured desk pedaling completed. Results Data collection is ongoing. We expect to complete main outcome analyses in 2020. Conclusions This trial represents one of the earliest attempts to assess the effects of desk pedaling and pedaling-incentive types in real-world offices. It could help bridge the research-to-practice gap by providing evidence on whether desk pedaling can be sustained without compromising work performance. International Registered Report Identifier (IRRID) DERR1-10.2196/16275
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Affiliation(s)
- Liza S Rovniak
- Division of General Internal Medicine, Departments of Medicine and Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Marc A Adams
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Christopher N Sciamanna
- Division of General Internal Medicine, Departments of Medicine and Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Lan Kong
- Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Nicole Sullivan
- Division of General Internal Medicine, Departments of Medicine and Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Sara Costalas
- Division of General Internal Medicine, Departments of Medicine and Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Melissa Bopp
- Department of Kinesiology, Pennsylvania State University, State College, PA, United States
| | - Ashley Kuzmik
- Division of General Internal Medicine, Departments of Medicine and Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
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Weinstock J, Petry NM, Pescatello LS, Henderson CE, Nelson CR. Randomized clinical trial of exercise for nontreatment seeking adults with alcohol use disorder. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 34:65-75. [PMID: 31424244 DOI: 10.1037/adb0000506] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The vast majority of individuals with alcohol use disorder (AUD) do not seek professional help despite its significant consequences upon the individual and society. Current interventions for nontreatment seeking individuals with AUD (e.g., screening, brief intervention, and referral to treatment [SBIRT]) have limited efficacy and alternative nonstigmatizing approaches are needed. This randomized clinical trial examined the utility of exercise as an intervention for sedentary nontreatment seeking adults with AUD. Participants (N = 66) were randomized to receive (a) a 4-month YMCA gym membership only (MO) or (b) a 4-month YMCA gym membership plus a 16-week integrated motivational intervention for exercise consisting of motivational interviewing and contingency management (MI + CM). Participants in both study conditions significantly increased their exercise behavior compared to baseline, and the MI + CM participants exercised significantly more often and an overall larger volume of exercise than the MO participants (ds > 2.0). Significant reductions in drinking and alcohol-related consequences were noted over time but did not differ significantly by study condition and were not related to changes in exercise. Future interventions using exercise as an intervention for AUD may want to frame this type of intervention as "wellness," directly link the 2 behaviors, and compare this intervention to SBIRT. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Rummo PE, Elbel B. Using Multiple Financial Incentive Structures to Promote Sustainable Changes in Health Behaviors. JAMA Netw Open 2019; 2:e199859. [PMID: 31441932 DOI: 10.1001/jamanetworkopen.2019.9859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Pasquale E Rummo
- Section on Health Choice, Policy and Evaluation, Department of Population Health, New York University School of Medicine, New York
| | - Brian Elbel
- Section on Health Choice, Policy and Evaluation, Department of Population Health, New York University School of Medicine, New York
- Wagner Graduate School of Public Service, New York University, New York
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