<b>BACKGROUND: </b>Compared with white persons, African Americans have a greater incidence of diabetes, decreased control, and higher rates of microvascular complications. A peer mentorship model could be a scalable approach to improving control in this population and reducing disparities in diabetic outcomes.<b>OBJECTIVE: </b>To determine whether peer mentors or financial incentives are superior to usual care in helping African American veterans decrease their hemoglobin A(1c) (HbA(1c)) levels.<b>DESIGN: </b>A 6-month randomized, controlled trial. (ClinicalTrials.gov registration number: NCT01125956)<b>SETTING: </b>Philadelphia Veterans Affairs Medical Center.<b>PATIENTS: </b>African American veterans aged 50 to 70 years with persistently poor diabetes control.<b>Intervention: </b>118 patients were randomly assigned to 1 of 3 groups: usual care, a peer mentoring group, and a financial incentives group. Usual care patients were notified of their starting HbA(1c) level and recommended goals for HbA(1c). Those in the peer mentoring group were assigned a mentor who formerly had poor glycemic control but now had good control (HbA(1c) level ≤7.5%). The mentor was asked to talk with the patient at least once per week. Peer mentors were matched by race, sex, and age. Patients in the financial incentive group could earn $100 by decreasing their HbA(1c) level by 1% and $200 by decreasing it by 2% or to an HbA(1c) level of 6.5%.<b>Measurements: </b>Change in HbA(1c) level at 6 months.<b>RESULTS: </b>Mentors and mentees talked the most in the first month (mean calls, 4; range, 0 to 30), but calls decreased to a mean of 2 calls (range, 0 to 10) by the sixth month. Levels of HbA(1c) decreased from 9.9% to 9.8% in the control group, from 9.8% to 8.7% in the peer mentor group, and from 9.5% to 9.1% in the financial incentive group. Mean change in HbA(1c) level from baseline to 6 months relative to control was -1.07% (95% CI, -1.84% to -0.31%) in the peer mentor group and -0.45% (CI, -1.23% to 0.32%) in the financial incentive group.<b>Limitation: </b>The study included only veterans and lasted only 6 months.<b>CONCLUSION: </b>Peer mentorship improved glucose control in a cohort of African American veterans with diabetes.<b>Primary Funding Source: </b>National Institute on Aging Roybal Center.
BACKGROUND: Previous efforts to use incentives for weight loss have resulted in substantial weight regain after 16 weeks.
OBJECTIVE: To evaluate a longer term weight loss intervention using financial incentives.
DESIGN: A 32-week, three-arm randomized controlled trial of financial incentives for weight loss consisting of a 24-week weight loss phase during which all participants were given a weight loss goal of 1 pound per week, followed by an 8-week maintenance phase.
PARTICIPANTS: Veterans who were patients at the Philadelphia Veterans Affairs Medical Center with BMIs of 30-40.
INTERVENTION: Participants were randomly assigned to participate in either a weight-monitoring program involving a consultation with a dietician and monthly weigh-ins (control condition), or the same program with one of two financial incentive plans. Both incentive arms used deposit contracts (DC) in which participants put their own money at risk (matched 1:1), which they lost if they failed to lose weight. In one incentive arm participants were told that the period after 24 weeks was for weight-loss maintenance; in the other, no such distinction was made.
MAIN MEASURE: Weight loss after 32 weeks.
KEY RESULTS: Results were analyzed using intention-to-treat. There was no difference in weight loss between the incentive arms (P = 0.80). Incentive participants lost more weight than control participants [mean DC = 8.70 pounds, mean control = 1.17, P = 0.04, 95% CI of the difference in means (0.56, 14.50)]. Follow-up data 36 weeks after the 32-week intervention had ended indicated weight regain; the net weight loss between the incentive and control groups was no longer significant (mean DC = 1.2 pounds, 95% CI, -2.58-5.00; mean control = 0.27, 95% CI, -3.77-4.30, P = 0.76).
CONCLUSIONS: Financial incentives produced significant weight loss over an 8-month intervention; however, participants regained weight post-intervention.
AIMS: This study examined whether smoking cessation using voucher-based contingency management (CM) improves birth outcomes.
DESIGN: Data were combined from three controlled trials.
SETTING: Each of the trials was conducted in the same research clinic devoted to smoking and pregnancy.
PARTICIPANTS: Participants (n=166) were pregnant women who participated in trials examining the efficacy of voucher-based CM for smoking cessation. Women were assigned to either a contingent condition, wherein they earned vouchers exchangeable for retail items by abstaining from smoking, or to a non-contingent condition where they received vouchers independent of smoking status.
MEASUREMENT: Birth outcomes were determined by review of hospital delivery records.
FINDINGS: Antepartum abstinence was greater in the contingent than non-contingent condition, with late-pregnancy abstinence being 34.1% versus 7.4% (P<0.001). Mean birth weight of infants born to mothers treated in the contingent condition was greater than infants born to mothers treated in the non-contingent condition (3295.6 ± 63.8 g versus 3093.6 ± 67.0 g, P = 0.03) and the percentage of low birth weight (<2500 g) deliveries was less (5.9% versus 18.5%, P = 0.02). No significant treatment effects were observed across three other outcomes investigated, although each was in the direction of improved outcomes in the contingent versus the non-contingent condition: mean gestational age (39.1 ± 0.2 weeks versus 38.5 ± 0.3 weeks, P = 0.06), percentage of preterm deliveries (5.9 versus 13.6, P = 0.09), and percentage of admissions to the neonatal intensive care unit (4.7% versus 13.8%, P = 0.06).
CONCLUSIONS: These results provide evidence that smoking-cessation treatment with voucher-based CM may improve important birth outcomes.
<b>INTRODUCTION: </b>The efficacy of contingency-management (CM) and motivational enhancement therapy (MET) for college student smoking cessation was examined.<b>METHODS: </b>Nontreatment-seeking daily smokers (N = 110) were randomly assigned to 3 weeks of CM versus noncontingent reinforcement (NR) and to three individual sessions of MET versus a relaxation control in a 2 x 2 experimental design. Expired carbon monoxide (CO) samples were collected twice daily for 3 weeks. Participants earned 5 US dollars for providing each sample; additionally, those randomized to CM earned escalating monetary rewards based on CO reductions (Week 1) and smoking abstinence (Weeks 2-3).<b>RESULTS: </b>Compared with NR, CM resulted in significantly lower CO levels and greater total and consecutive abstinence during the intervention. Those in the CM and MET groups reported greater interest in quitting smoking posttreatment, but rates of confirmed abstinence at follow-up were very low (4% at 6-month follow-up) and did not differ by group.<b>DISCUSSION: </b>Findings support the short-term efficacy of CM for reducing smoking among college students. Future research should explore enhancements to CM in this population, including a longer intervention period and the recruitment of smokers who are motivated to quit.
AIMS: This study examined whether voucher-based reinforcement therapy (VBRT) contingent upon smoking abstinence during pregnancy is an effective method for decreasing maternal smoking during pregnancy and improving fetal growth.
DESIGN, SETTING AND PARTICIPANTS: A two-condition, parallel-groups, randomized controlled trial was conducted in a university-based research clinic. A total of 82 smokers entering prenatal care participated in the trial.
INTERVENTION: Participants were assigned randomly to either contingent or non-contingent voucher conditions. Vouchers exchangeable for retail items were available during pregnancy and for 12 weeks postpartum. In the contingent condition, vouchers were earned for biochemically verified smoking abstinence; in the non-contingent condition, vouchers were earned independent of smoking status.
MEASUREMENTS: Smoking outcomes were evaluated using urine-toxicology testing and self-report. Fetal growth outcomes were evaluated using serial ultrasound examinations performed during the third trimester.
FINDINGS: Contingent vouchers significantly increased point-prevalence abstinence at the end-of-pregnancy (41% versus 10%) and at the 12-week postpartum assessment (24% versus 3%). Serial ultrasound examinations indicated significantly greater growth in terms of estimated fetal weight, femur length and abdominal circumference in the contingent compared to the non-contingent conditions.
CONCLUSIONS: These results provide further evidence that VBRT has a substantive contribution to make to efforts to decrease maternal smoking during pregnancy and provide new evidence of positive effects on fetal health.
OBJECTIVE: We sought to assess whether either a low-cost educational intervention or small monetary incentive is more effective than usual care in lowering low-density lipoprotein (LDL) cholesterol among employees.
METHODS: Employees with an LDL-C >130 mg/dL were eligible. After receiving on-line educational materials, subjects were assigned to three groups: group 1 received dollar 100 if they reduced their LDL-C by 15% within 6 months, group 2 participated in a multi-disciplinary educational program, and group 3 received no further intervention.
RESULTS: In total, 171 employees participated. Baseline mean LDL-C was 156 mg/dL. Approximately 6 months after randomization, mean LDL-C was reduced 17.9 mg/dL (11.3%) in group 1, 17.9 mg/dL (11.5%) in group 2, and 5.5 mg/dL (3.5%) in group 3. Reductions in groups 1 and 2 were statistically superior to group 3 (P = 0.02).
CONCLUSIONS: Both an employer directed low-cost educational program and small monetary incentives similarly lowered LDL-C compared with usual care.
OBJECTIVE: Any smoking during the initial 2 weeks of attempting to quit predicts poor short- and longer-term outcomes in the general population of cigarette smokers. The present study examined whether that rule applies to pregnant women.
METHODS: Data were obtained from 129 women participating in clinical trials on smoking-cessation examining the efficacy of voucher-based incentives delivered contingent on biochemically-verified abstinence or a control condition wherein incentives were given independent of smoking status. Smoking status was assessed in weeks 1 and 2 of the cessation effort and again at an end-of-pregnancy assessment scheduled at weeks 28-32 gestation using self-report and biochemical verification.
RESULTS: Smoking in weeks 1 or 2 predicted smoking at the end-of pregnancy assessment independent of treatment condition. There was a 79% and 92% chance that those who smoked in weeks 1 or 2 would be classified as smokers at end-of-pregnancy in the contingent-incentive and control conditions, respectively.
CONCLUSIONS: Clinicians assisting pregnant women trying to quit smoking may want to monitor progress in the initial weeks of the cessation effort and consider enhancing/changing the intervention when smoking is detected.
Compared with white persons, African Americans have a greater incidence of diabetes, decreased control, and higher rates of microvascular complications. A peer mentorship model could be a scalable approach to improving control in this population and reducing disparities in diabetic outcomes.
OBJECTIVE:
To determine whether peer mentors or financial incentives are superior to usual care in helping African American veterans decrease their hemoglobin A(1c) (HbA(1c)) levels.
DESIGN:
A 6-month randomized, controlled trial. (ClinicalTrials.gov registration number: NCT01125956)
SETTING:
Philadelphia Veterans Affairs Medical Center.
PATIENTS:
African American veterans aged 50 to 70 years with persistently poor diabetes control.Intervention: 118 patients were randomly assigned to 1 of 3 groups: usual care, a peer mentoring group, and a financial incentives group. Usual care patients were notified of their starting HbA(1c) level and recommended goals for HbA(1c). Those in the peer mentoring group were assigned a mentor who formerly had poor glycemic control but now had good control (HbA(1c) level ≤7.5%). The mentor was asked to talk with the patient at least once per week. Peer mentors were matched by race, sex, and age. Patients in the financial incentive group could earn $100 by decreasing their HbA(1c) level by 1% and $200 by decreasing it by 2% or to an HbA(1c) level of 6.5%.Measurements: Change in HbA(1c) level at 6 months.
RESULTS:
Mentors and mentees talked the most in the first month (mean calls, 4; range, 0 to 30), but calls decreased to a mean of 2 calls (range, 0 to 10) by the sixth month. Levels of HbA(1c) decreased from 9.9% to 9.8% in the control group, from 9.8% to 8.7% in the peer mentor group, and from 9.5% to 9.1% in the financial incentive group. Mean change in HbA(1c) level from baseline to 6 months relative to control was -1.07% (95% CI, -1.84% to -0.31%) in the peer mentor group and -0.45% (CI, -1.23% to 0.32%) in the financial incentive group.Limitation: The study included only veterans and lasted only 6 months.
CONCLUSION:
Peer mentorship improved glucose control in a cohort of African American veterans with diabetes.Primary Funding Source: National Institute on Aging Roybal Center.
