A systematic review of the use of financial incentives and penalties to encourage uptake of healthy behaviors: protocol The effect of introducing a financial incentive to promote application of fluoride varnish in dental practice in Scotland: a natural experiment You can't pay me to quit: the failure of financial incentives for smoking cessation in head and neck cancer patients. Healthcare providers’ views on the acceptability of financial incentives for breastfeeding: a qualitative study Premium-Based Financial Incentives Did Not Promote Workplace Weight Loss In A 2013-15 Study. Social norms and financial incentives to promote employees' healthy food choices: A randomized controlled trial. Randomised controlled trial using social support and financial incentives for high risk pregnant smokers: Significant Other Supporter (SOS) program A Mixed-Methods Randomized Controlled Trial of Financial Incentives and Peer Networks to Promote Walking Among Older Adults Coupling Financial Incentives With Direct Mail in Population-Based Practice Effects of financial incentives for the purchase of healthy groceries on dietary intake and weight outcomes among older adults: A randomized pilot study Design and baseline characteristics of participants in the TRial of Economic Incentives to Promote Physical Activity (TRIPPA): a randomized controlled trial of a six month pedometer program with financial incentives. Effects of Financial Incentives on Saving Outcomes and Material Well-Being: Evidence From a Randomized Controlled Trial in Uganda. Patients as Mercenaries?: The Ethics of Using Financial Incentives in the War on Unhealthy Behaviors Vouchers versus Lotteries: What works best in promoting Chlamydia screening? A cluster randomised controlled trial. An RCT protocol of varying financial incentive amounts for smoking cessation among pregnant women Public acceptability of financial incentives for smoking cessation in pregnancy and breast feeding: a survey of the British public Patient navigation and financial incentives to promote smoking cessation in an underserved primary care population: A randomized controlled trial protocol. A double-blind placebo controlled experimental study of nicotine: I—effects on incentive motivation Frequency and characteristics of cognitive services provided in response to a financial incentive. The Newcastle exercise project: a randomised controlled trial of methods to promote physical activity in primary care Small financial incentives increase smoking cessation in homeless smokers: a pilot study. Some Recent Developments on Financial Incentives for Smoking Cessation Among Pregnant and Newly Postpartum Women Financial Incentives for Extended Weight Loss: A Randomized, Controlled Trial
Background The use of financial incentives and penalties to encourage uptake of healthy behaviors is increasingly seen as a viable intervention in developed countries . Previous review s of the effectiveness of financial incentives and penalties for encouraging the uptake of healthy behaviors have focused on individual behaviors making it difficult to draw overall conclusions about the effectiveness of such interventions . This systematic review will explore the effectiveness of financial incentives and penalties for encouraging a wide range of behaviors , including : smoking cessation , increased physical activity , healthier dietary intake , sensible patterns of alcohol consumption , safe sun , safe sex , and primary preventive clinical behaviors . Methods Systematic methods will be used to search existing literature and screen studies for inclusion . All studies that meet the following inclusion criteria will be included in the review : participants were 18 years old or older and living in high-income countries ; interventions included cash or cash-like incentives to promote the uptake of healthy behaviors , or cash or cash-like penalties to discourage unhealthy behaviors ; the comparator was usual care or no intervention ; study design was r and omized controlled trial , cluster r and omized controlled trial , controlled before and after study , or interrupted time series analysis . Two review ers will independently screen the publications to ensure they meet the inclusion criteria . Quality will be assessed by two research ers , working independently , using the Cochrane risk of bias tool . Meta- analysis will be conducted , if appropriate . Any studies identified as at ‘ high risk of bias ’ will be excluded from meta- analysis . Discussion This systematic review will provide policy-relevant recommendations for the use of financial incentives and penalties as a method of encouraging uptake of healthy behaviors Background Financial incentives are often used to influence professional practice , yet the factors which influence their effectiveness and their behavioural mechanisms are not fully understood . In keeping with clinical guidelines , Childsmile ( Scotl and ’s oral health improvement programme ) advocates twice yearly fluoride varnish application ( FVA ) for children in dental practice . To support implementation Childsmile offered dental practitioners a fee-per-item payment for varnishing 2–5-year-olds ’ teeth through a pilot . In October 2011 payment was extended to all dental practitioners . This paper compares FVA pre- and post-roll-out and explores the financial incentive ’s behavioural mechanisms . Methods A natural experimental approach using a longitudinal cohort of dental practitioners ( n = 1090 ) compared FVA pre- ( time 1 ) and post- ( time 2 ) financial incentive . Responses from practitioners who did not work in a Childsmile pilot practice when considering their 2–5-year-old patients ( novel incentive group )  were compared with all other responses ( continuous incentive group ) . The Theoretical Domains Framework ( TDF ) was used to measure change in behavioural mechanisms associated with the incentive . Analysis of covariance was used to investigate FVA rates and associated behavioural mechanisms in the two groups . Results At time 2 , 709 74 % , of eligible responders , were followed up . In general , FVA rates increased over time for both groups ; however , the novel incentive group experienced a greater increase ( β [ 95 % CI ] = 0.82 [ 0.72 to 0.92 ] ) than the continuous incentive group . Despite this , only 33 % of practitioners reported ‘ always ’ varnishing increased risk 2–5-year-olds ’ teeth following introduction of the financial incentive , 19 % for st and ard risk children . Domain scores at time 2 ( adjusting for time 1 ) increased more for the novel incentive group ( compared to the continuous incentive group ) for five domains : knowledge , social/professional role and identity , beliefs about consequences , social influences and emotion . Conclusions In this large , prospect i ve , population -wide study , a financial incentive moderately increased FVA in dental practice . Novel longitudinal use of a vali date d theoretical framework to underst and behavioural mechanisms suggested that financial incentives operate through complex inter-linked belief systems . While financial incentives are useful in narrowing the gap between clinical guidelines and FVA , multiple intervention approaches are required OBJECTIVE A prospect i ve r and omised study was conducted at a tertiary care hospital to evaluate the effects of financial incentives for smoking cessation targeted at a high-risk population . METHODS Patients with a past history of head and neck cancer were voluntarily enrolled over a two-year period . They were r and omised to a cash incentives or no incentive group . Subjects were offered enrolment in smoking cessation courses .  Smoking by-product levels were assessed at 30 days , 3 months and 6 months . Subjects in the incentive group received $ 150 if smoking cessation was confirmed . RESULTS Over 2 years , 114 patients with an established diagnosis of head and neck cancer were offered enrolment . Twenty-four enrolled and 14 attended the smoking cessation classes . Only two successfully quit smoking at six months . Both these patients were in the financially incentivised group and received $ 150 at each test visit . CONCLUSION Providing a financial incentive for smoking cessation to a population already carrying a diagnosis of head and neck cancer in order to promote a positive behaviour change was unsuccessful Background Despite a gradual increase in breastfeeding rates , overall in the UK there are wide variations , with a trend towards breastfeeding rates at 6–8 weeks remaining below 40 % in less affluent areas . While financial incentives have been used with varying success to encourage positive health related behaviour change , there is little research on their use in encouraging breastfeeding . In this paper , we report on healthcare providers ’ views around whether using financial incentives in areas with low breastfeeding rates would be acceptable in principle . This research was part of a larger project looking at the development and feasibility testing of a financial incentive scheme for breastfeeding in preparation for a cluster r and omised controlled trial . Methods Fifty – three healthcare providers were interviewed about their views on financial incentives for breastfeeding . Participants were purposively sample d to include a wide range of experience and roles associated with supporting mothers with infant feeding . Semi-structured individual and group interviews were conducted . Data were analysed thematically drawing on the principles of Framework Analysis . Results The key theme emerging from healthcare providers ’ views on the acceptability of financial incentives for breastfeeding  was their possible impact on ‘ facilitating or impeding relationships ’ . Within this theme several additional aspects were discussed : the mother ’s relationship with her healthcare provider and services , with her baby and her family , and with the wider community . In addition , a key priority for healthcare providers was that an incentive scheme should not impact negatively on their professional integrity and responsibility towards women . Conclusion Healthcare providers believe that financial incentives could have both positive and negative impacts on a  mother ’s relationship with her family , baby and healthcare provider . When design ing a financial incentive scheme we must take care to minimise the potential negative impacts that have been highlighted , while at the same time recognising the potential positive impacts for women in areas where breastfeeding rates are low Employers commonly use adjustments to health insurance premiums as incentives to encourage healthy behavior , but the effectiveness of those adjustments is controversial . We gave 197 obese participants in a workplace wellness program a weight loss goal equivalent to 5 percent of their baseline weight . They were r and omly assigned to a control arm , with no financial incentive for achieving the goal , or to one of three intervention arms offering an incentive valued at $ 550 . Two intervention arms used health insurance premium adjustments , beginning the following year ( delayed ) or in the first pay period after achieving the goal ( immediate ) . A third arm used a daily lottery incentive separate from premiums . At twelve months there were no statistically significant differences in mean weight change either between the control group ( whose members had a mean gain of 0.1 pound ) and any of the incentive groups ( delayed premium adjustment , -1.2 pound ; immediate premium adjustment , -1.4 pound ; daily lottery incentive , -1.0 pound ) or among the intervention groups . The apparent failure of the incentives to promote weight loss suggests that employers that encourage weight reduction through workplace wellness programs should test alternatives to the conventional premium adjustment approach by using alternative incentive design s , larger incentives , or both OBJECTIVE Population -level strategies to improve healthy food choices are needed for obesity prevention . We conducted a r and omized controlled trial of 2672 employees at the Massachusetts General Hospital who were regular customers of the hospital cafeteria with all items labeled green ( healthy ) , yellow ( less healthy ) , or red ( unhealthy ) to determine if social norm ( peer-comparison ) feedback with or without financial incentives increased employees ' healthy food choices . METHODS Participants were r and omized in 2012 to three arms : 1 ) monthly letter with social norm feedback about healthy food purchases , comparing employee to " all " and to " healthiest " customers ( feedback-only ) ; 2 ) monthly letter with social norm feedback plus small financial incentive for increasing green purchases ( feedback-incentive ) ; or 3 ) no contact ( control ) . The main outcome was change in proportion of green-labeled purchases at the end of 3-month intervention . Post-hoc analyses examined linear trends . RESULTS At baseline , the proportion of green-labeled purchases ( 50 % ) did not differ between arms . At the end of the 3-month intervention , the percentage increase in green-labeled purchases was larger in the feedback-incentive arm compared to control ( 2.2 % vs. 0.1 % , P=0.03 ) , but the two intervention arms were not different . The rate of increase in green-labeled purchases was higher in both feedback-only ( P=0.04 ) and feedback-incentive arms ( P=0.004 ) compared to control . At the end of a 3-month wash-out , there were no differences between control and intervention arms . CONCLUSIONS Social norms plus small financial incentives increased employees ' healthy food choices over the short-term . Future research will be needed to assess the impact of this relatively low-cost intervention on employees ' food choices and weight over the long-term . TRIAL REGISTRATION Clinical Trials.gov : NCT01604499 Smoking  cessation interventions have posed significant challenges for health professionals , particularly when directed at high risk , low income , pregnant smokers . Typical quit rates for pregnant women who receive publicly financed obstetrical care have rarely exceeded 12–16%.1 As many as 70 % of women who quit smoking during pregnancy relapse within one year of delivery.2 Two areas that have received particular attention as possible adjuncts to behaviour change are the use of reinforcements and social supports . Reinforcement in the form of incentives/rewards for positive behaviours has been controversial as an intervention strategy . Some argue that the “ overjustification effect ” of external rewards may cause subjects to lose internal motivation to modify behaviour over the long term.3 However , results of several studies , including two meta-analyses on reinforcement , provide compelling evidence that positive reinforcement provides positive behavioural changes.4 - 8 A second area of study that has been explored in the behaviour change research is the role of social support in motivating and sustaining selected behaviour change . Recent studies have empirically linked tobacco quit rates with daily interaction with a supportive “ other , ” preferably one who did not smoke.9 10 The primary objective of our intervention was to determine whether the combination of bolstered social support and financial incentives had an effect in significantly reducing smoking behaviour among low income , high risk , pregnant and postpartum women who participate in Oregon 's Women , Infants , and Children ( WIC ) program .  The Significant Other Supporter ( SOS ) program was a r and omised , experimentally design ed smoking cessation study implemented in four Oregon WIC program sites . Criteria for entry into the study included the following : age 15 years or older ; self reported smoker ( “ even a puff in the last seven days ” ) ; English speaker/reader ; WIC eligible ; and 28 weeks gestation or less . Eligible subjects were r and omised into one of two groups , and were Background . Financial incentives and peer networks could be delivered through eHealth technologies to encourage older adults to walk more . Methods . We conducted a 24-week r and omized trial in which 92 older adults with a computer and Internet access received a pedometer , daily walking goals , and weekly feedback on goal achievement .  Participants were r and omized to  weekly feedback only ( Comparison ) , entry into a lottery with potential to earn up to $ 200 each week walking goals were met ( Financial Incentive ) , linkage to four other participants through an online message board ( Peer Network ) , or both interventions ( Combined ) . Main outcomes were the proportion of days walking goals were met during the 16-week intervention and 8-week follow-up . We conducted a content analysis of messages posted by Peer Network and Combined arm participants . Results . During the 16-week intervention , there were no differences in the proportion of days walking goals were met in the Financial Incentive ( 39.7 % ; p = .78 ) , Peer Network ( 24.9 % ; p = .08 ) , and Combined ( 36.0 % ; p = .77 ) arms compared with the Comparison arm ( 36.0 % ) . During 8 weeks of follow-up , the proportion of days walking goals were met was lower in the Peer Network arm ( 18.7 % ; p = .025 ) but not in the Financial Incentive ( 29.3 % ; p = .50 ) or Combined ( 24.8 % ; p = .37 ) arms , relative to the Comparison arm ( 34.5 % ) . Messages posted by participants focused on barriers to walking and provision of social support . Conclusions . Financial incentives and peer networks delivered through eHealth technologies did not result in older adults  walking more Financial incentives are being used increasingly to encourage a wide array of health behaviors because of their well-established efficacy . However , little is known about how to translate incentive-based strategies to public health practice geared toward improving population -level health , and a dearth of research exists on how individuals respond to incentives through public health communication strategies such as direct mail . This study reports results of a population -based r and omized controlled trial testing a direct mail , incentive-based intervention for promoting mammography uptake . The study population was composed of a r and om sample of Minnesota women enrolled in Medicare fee-for-service and overdue for breast cancer screening . Participants ( N = 18,939 ) were r and omized into three groups : ( 1 ) Direct Mail only , ( 2 ) Direct Mail plus Incentive , and ( 3 ) Control . Both direct mail groups received two mailers with a message about the importance of mammography ; however , Mail plus Incentive mailers also offered a $ 25 incentive for getting a mammogram . Logistic regression analyses measured intervention effects . Results showed the odds for receiving mammography were significantly higher for the Direct Mail plus Incentive group compared with both Direct Mail only and Control groups . The use of incentives also proved to be cost-effective . Additionally , the Direct Mail only group was more likely to receive mammography than the Control group . Findings offer experimental evidence on how the population -based strategy of direct mail coupled with a financial incentive can encourage healthy behavior , as well as how incentive-based programs can be translated into health promotion practice aim ed at achieving population -level impact Providing financial incentives can be a useful behavioral economics strategy for increasing fruit and vegetable intake among consumers . It remains to be determined whether financial incentives can promote intake of other low energy-dense foods and if consumers who are already using promotional tools for their grocery purchases may be especially responsive to receiving incentives . This r and omized controlled trial tested the effects of offering financial incentives for the purchase of healthy groceries on 3-month changes in dietary intake , weight outcomes , and the home food environment among older adults . A secondary aim was to compare frequent coupon users ( FCU ) and non-coupon users ( NCU ) on weight status , home food environment , and grocery shopping behavior .  FCU ( n = 28 ) and NCU ( n = 26 ) were r and omly assigned to either an incentive or a control group . Participants in the incentive group received $ 1 for every healthy food or beverage they purchased . All participants completed 3-day food records and a home food inventory and had their height , weight , and waist circumference measured at baseline and after 3 months . Participants who were responsive to the intervention and received financial incentives significantly increased their daily vegetable intake ( P = 0.04 ) . Participants in both groups showed significant improvements in their home food environment ( P = 0.0003 ) . No significant changes were observed in daily energy intake or weight-related outcomes across groups ( P < 0.12 ) . FCU and NCU did not differ significantly in any anthropometric variables or the level at which their home food environment may be considered ' obesogenic ' ( P > 0.73 ) . Increased consumption of vegetables did not replace intake of more energy-dense foods . Incentivizing consumers to make healthy food choices while simultaneously reducing less healthy food choices may be important Non-communicable diseases ( NCDs ) are emerging as the predominant global health challenge of this century . Physical inactivity is one of the primary risk factors for NCDs . Therefore , increasing physical activity levels is a public health imperative . The arrival of affordable wearable technologies , such as wireless pedometers , provides one strategy for encouraging walking . However , the effectiveness of these technologies in promoting sustained behavior change has not been established . Insights from economics suggest that incentives may be a useful strategy for increasing maintenance and effectiveness of behavior change interventions , including physical activity interventions that rely on wearable technologies . The aim of this trial is to test the effectiveness of a common wireless pedometer with or without one of two types of incentives ( cash or donations to charity ) for reaching weekly physical activity goals . We present here the design and baseline characteristics of participants of this four arm r and omized controlled trial . 800 full-time employees ( desk-bound office workers ) belonging to 15 different worksites ( on average , 53 ( sd : 37 ) employees at each worksite ) were successfully r and omized to one of four study arms . If shown to be effective , wearable technologies in concert with financial incentives may provide a scalable and affordable health promotion strategy for governments and employers seeking to increase the physical activity levels of their constituents The use of savings products to promote financial inclusion has increasingly become a policy priority across sub-Saharan Africa , yet little is known about how families respond to varying levels of savings incentives and whether the promotion of incentivized savings in low-re source setting s may encourage households to restrict expenditures on basic needs . Using data from a r and omized controlled trial in Ug and a , we examine : 1 ) whether low-income households enrolled in an economic-empowerment intervention consisting of matched savings , workshops , and mentorship  reduced spending on basic needs and 2 ) how varied levels of matching contributions affected household savings and consumption behavior . We compared primary school-attending AIDS-affected children ( N = 1,383 ) r and omized to a control condition with two intervention arms with differing savings-match incentives : 1:1 ( Bridges ) and 1:2 ( Bridges PLUS ) . We found that : 1 ) 24 months post-intervention initiation , children in Bridges and Bridges PLUS were more likely to have accumulated savings than children in the control condition ; 2 ) higher match incentives ( Bridges PLUS ) led to higher deposit frequency but not higher savings in the bank ; 3 ) intervention participation did not result in material hardship ; and 4 ) in both intervention arms , participating families were more likely to start a family business and diversify their assets Consider the following paradox : few people would balk if research ers offered smokers $ 1,000 to participate in a year-long r and omized trial of a smoking cessation intervention , yet many would find it distasteful for a large employer to pay its smoking employees an extra $ 1,000 if they remained smoke-free for one year . Such discrepant judgments are underst and able from the perspective of classical economics . Research participants merit compensation for the risks and opportunity costs they endure in the service of public health , whereas individuals should need no reward for promoting their own well being . However , contrary to traditional theories of rationality , people frequently fail to make health-promoting choices , particularly when such choices require short-term sacrifices to foster long-term goals .1,2 Thus , corporate and government health plan leaders are increasingly applying extrinsic motivations such as financial incentives and other programs to augment health – particularly cardiovascular health – while hopefully increasing productivity and restraining costs.3 , 4 Early evidence suggests that financial incentives can effectively promote the cardioprotective behaviors of smoking cessation,5 , 6 weight loss,7 , 8 and cholesterol reduction.9  Incentives are also currently being studied as a means of promoting warfarin adherence.10 Although the results of these early studies are promising , further research is needed to determine which incentive structures and amounts are optimal , assess the ability of incentives to produce sustained behavior changes , and evaluate the cost-effectiveness of implementing incentive programs  . Ethical dimensions of the incentives themselves are also in need of further analysis . For example , some have charged that financial incentive programs are coercive , inequitable , and inconsistent with shared social values.11 Others have even suggested that implementing incentive programs serves to punish patients for their illnesses.12 In this essay , we outline the rationale for incentive programs to promote cardiovascular health , identify the ethical arguments that have been used to challenge such programs , and assess the merits of these arguments In this cluster r and omised trial ( N=1060 ) , we tested the impact of financial incentives ( £ 5 voucher vs. £ 200 lottery ) framed as a gain or loss to promote  Chlamydia screening in students aged 18 - 24 years , mimicking the st and ard outreach approach to student in halls of residence . Compared to the control group ( 1.5 % ) , the lottery increased screening  to 2.8 % and the voucher increased screening  to 22.8 % . Incentives framed as gains were marginally more effective ( 10.5 % ) that loss-framed incentives ( 7.1 % ) . This work fundamentally contributes to the literature by testing the predictive validity of Prospect Theory to change health behaviour in the field Background Smoking during pregnancy is harmful to the unborn child . Few smoking cessation interventions have been successfully incorporated into st and ard antenatal care . The main aim of this study is to determine the feasibility of a personal financial incentive scheme for encouraging smoking cessation among pregnant women . Design A pilot r and omised control trial will be conducted to assess the feasibility and potential effectiveness of two varying financial incentives that increase incrementally in magnitude ( $ 20 vs. $ 40AUD ) , compared to no incentive in reducing smoking in pregnant women attending an Australian public hospital antenatal clinic . Method Ninety ( 90 ) pregnant women who self-report smoking in the last 7 days and whose smoking status is biochemically verified , will be block r and omised into one of three groups : a. No incentive control group ( n=30 ) , b. $ 20 incremental incentive group ( n=30 ) , and c. $ 40 incremental incentive group ( n=30 ) . Smoking status will be assessed via a self-report computer based survey in nine study sessions with saliva cotinine analysis used as biochemical validation . Women in the two incentive groups will be eligible to receive a cash reward at each of eight measurement points during pregnancy if 7-day smoking cessation is achieved . Cash rewards will increase incrementally for each period of smoking abstinence . Discussion Identifying strategies that are effective in reducing the number of women smoking during pregnancy and are easily adopted into st and ard antenatal practice is of utmost importance . A personal financial incentive scheme is a potential antenatal smoking cessation strategy that warrants further investigation . Trial registration Australian New Zeal and Clinical Trials Registry ( ANZCTR ) number : Objective To survey public attitudes about incentives for smoking cessation in pregnancy and for breast feeding to inform trial design . Design Cross-sectional survey . Setting and participants British general public . Methods Seven promising incentive strategies had been identified from evidence syntheses and qualitative interview data from service users and providers . These were shopping vouchers for : ( 1 ) vali date d smoking cessation in pregnancy and ( 2 ) after birth ; ( 3 ) for a smoke-free home ; ( 4 ) for proven breast feeding ; ( 5 ) a free breast pump ; ( 6 ) payments to health services for reaching smoking cessation in pregnancy targets and ( 7 ) breastfeeding targets . Ipsos MORI used area quota sampling and home-administered computer-assisted question naires , with r and omised question order to assess agreement with different incentives ( measured on a five-point scale ) . Demographic data and target behaviour experience were recorded . Analysis used multivariable ordered logit models . Results Agreement with incentives was mixed ( ranging from 34 % to 46 % ) among a representative sample of 1144 British adults .  Mean agreement score was highest for a free breast pump , and lowest for incentives for smoking abstinence after birth . More women disagreed with shopping vouchers than men . Those with lower levels of education disagreed more with smoking cessation incentives and a breast pump . Those aged 44 or under agreed more with all incentive strategies compared with those aged 65 and over , particularly provider targets for smoking cessation . Non-white ethnic groups agreed particularly with breastfeeding incentives . Current smokers with previous stop attempts and respondents who had breast fed children agreed with providing vouchers for the respective behaviours . Up to £ 40/month vouchers for behaviour change were acceptable ( > 85 % ) . Conclusions Women and the less educated were more likely to disagree , but men and women of childbearing age to agree , with incentives design ed for their benefit . Trials evaluating reach , impact on health inequalities and ethnic groups are required prior to implementing incentive interventions . Trial registration number CRD42012001980 Despite the high risk of tobacco-related morbidity and mortality among low-income persons , few studies have connected low-income smokers to evidence -based treatments . We will examine a smoking cessation intervention integrated into primary care . To begin , we completed qualitative formative research to refine an intervention utilizing the services of a patient navigator trained to promote smoking cessation . Next , we will conduct a r and omized controlled trial combining two interventions : patient navigation and financial incentives . The goal of the intervention is to promote smoking cessation among patients who receive primary care in a large urban safety-net hospital . Our intervention will encourage patients to utilize existing smoking cessation re sources ( e.g. , quit lines , smoking cessation groups , discussing smoking cessation with their primary care providers ) . To test our intervention , we will conduct a r and omized controlled trial , r and omizing 352 patients to the intervention condition ( patient navigation and financial incentives ) or an enhanced traditional care control condition .  We will perform follow-up at 6 , 12 , and 18 months following the start of the intervention . Evaluation of the intervention will target several implementation variables : reach ( participation rate and representativeness ) , effectiveness ( smoking cessation at 12 months [ primary outcome ] ) , unintended consequences ( e.g. , purchase of illicit substances with incentive money ) , adoption ( use of intervention across primary care suites ) , implementation ( delivery of intervention ) , and maintenance ( smoking cessation after conclusion of intervention ) . Improving the implementation of smoking cessation interventions in primary care setting s serving large underserved population s could have substantial public health impact , reducing cancer-related morbidity/mortality and associated health disparities Rationale Brain reward pathways implicated in addiction appear to be less reactive in regular drug users ; behavioural manifestations may include decreased sensitivity to natural reinforcers . Objectives This study aim ed to replicate earlier findings of abstinence-associated incentive motivation deficits in smokers and to determine whether these can be reversed with nicotine in the form of lozenge . Methods One hundred forty-five smokers were each tested twice , once after receiving nicotine , and once after receiving placebo lozenge in counterbalanced order . Participants completed various tests of incentive motivational functioning : a measure of subjective enjoyment , the Snaith – Hamilton pleasure scale ( SHAPS ) ; a simple card sorting task , the card arranging reward responsivity objective test ( CARROT ) with and without financial incentive ; the modified emotional Stroop test ; a cue-reactivity task ; and a novel reaction time task to explore effects of signals of reward , the incentive motivational enhancement of response speed task . Results Compared with performance during abstinence ( placebo condition ) , nicotine was associated with : higher self-reported pleasure expectations on the SHAPS ; enhanced responsiveness to financial reward on the CARROT in smokers who smoked 15 or more cigarettes a day ; and greater interference from appetitive words on the Stroop task . Conclusions These results are generally consistent with contemporary neurobiological theories of addiction and suggest that short-term smoking abstinence is associated with impaired reward motivation which can be reversed with nicotine OBJECTIVE To determine the effects of a financial incentive on the number and types of  cognitive services ( CS )  provided by community pharmacies to Medicaid recipients in the State of Washington . DESIGN Prospect i ve r and omized trial . CS were reported using a problem-intervention- result coding system over a 20-month period . SETTING AND SUBJECTS Pharmacists practicing in 110 study ( financial incentive ) and 90 control community pharmacies . RESULTS Study pharmacists documented an average of 1.59 CS interventions per 100 prescriptions over a 20-month period , significantly more than controls , who documented an average of 0.67 interventions ( P < .05 ) per 100 prescriptions . One-half ( 48.4 % ) of all CS were for patient-related problems , 32.6 % were for drug-related problems , 17.6 % were for prescription-related problems , and 1.4 % were for other problems that did not involve drug therapy . A change in drug therapy occurred as a result of 28 % of all CS documented in this demonstration . Changes were rarely ( 2.4 % ) due to generic or therapeutic substitution and almost always ( 90 % ) followed communication with the prescriber . The average self-reported time to perform CS was 7.5 minutes ; 75 % of interventions were < or = 6 minutes . Considerable differences existed between study and control groups in the types of problems identified , intervention activities performed , and results of interventions . CONCLUSION A financial incentive was associated with significantly more , and different types of , CS performed by pharmacists Abstract Objective : To evaluate the effectiveness of combinations of three methods to promote physical activity . Design : R and omised controlled trial . Baseline assessment with post-intervention follow up at 12 weeks and 1 year . Setting : One urban general practice , 1995 - 7 . Participants : 523 adults aged 40 to 64 years , r and omised to four intervention groups and a control group . Interventions : Brief ( one interview ) or intensive ( six interviews over 12 weeks ) motivational interviewing based on the stages of change model of behaviour change , with or without financial incentive ( 30 vouchers entitling free access to leisure facilities ) . Main outcome measures : Physical activity score ; sessions of moderate and vigorous activity in the preceding four weeks . Results : Response rate was 81 % at 12 weeks and 85 % at one year . More participants in the intervention group reported increased physical activity scores at 12 weeks than controls ( 38 % v 16 % , difference 22 % , 95 % confidence interval for difference 13 % to 32 % ) , with a 55 % increase observed in those offered six interviews plus vouchers . Vigorous activity increased in 29 % of intervention participants and 11 % of controls ( difference 18 % , 10 % to 26 % ) , but differences between the intervention groups were not significant . Short term increases in activity were not sustained , regardless of intensity of intervention . Conclusions : The most effective intervention for promoting adoption of exercise was the most intensive . Even this did not promote long term adherence to exercise . Brief interventions promoting physical activity that are used by many schemes in the United Kingdom are of question able effectiveness . Key messages Schemes promoting physical activity are currently popular in general practice in Britain , but few have been rigorously evaluated and their effectiveness is unknown . In this study , the most effective intervention for promoting adoption of physical activity was the most intensive , involving six motivational interviews and a financial incentive A comparatively brief intervention ( one interview ) was only effective in the short term in around a third of participants Short term increases in physical activity were not maintained at one year follow up and even the most intensive intervention was ineffective in promoting long term adherence to increased physical activity . National and local government , health authorities , and primary healthcare teams should be cautious about current and future expenditure on , and implementation of , exercise prescription or referral Although over 70 % of homeless individuals smoke , few studies have examined the effectiveness of smoking cessation interventions in this vulnerable population . The purpose of this pilot study was to compare the effectiveness of shelter-based smoking cessation clinic usual care ( UC ) to an adjunctive contingency management ( CM ) treatment that offered UC plus small financial incentives for smoking abstinence .  Sixty-eight homeless individuals in Dallas , Texas ( recruited in 2012 ) were assigned to UC ( n=58 ) or UC plus financial incentives ( CM ; n=10 ) groups and were followed for 5 consecutive weeks ( 1 week pre-quit through 4 weeks post-quit ) . A generalized linear mixed model regression analysis was conducted to compare biochemically-verified abstinence rates between groups . An additional model examined the interaction between time and treatment group . The participants were primarily male ( 61.8 % ) and African American ( 58.8 % ) , and were 49 years of age on average . There was a significant effect of treatment group on abstinence overall , and effects varied over time . Follow-up logistic regression analyses indicated that CM participants were significantly more likely than UC participants to be abstinent on the quit date ( 50 % vs. 19 % abstinent ) and at 4 weeks post-quit ( 30 % vs. 1.7 % abstinent ) . Offering small financial incentives for smoking abstinence may be an effective way to facilitate smoking cessation in homeless individuals Smoking during pregnancy is a leading preventable cause of poor pregnancy outcomes and immediate and longer-term adverse health outcomes among exposed offspring . Developing more effective smoking cessation interventions for pregnant women has been a public health priority for more than 30 years . We review developments over the past 3 years ( 2012–2015 ) on the use of financial incentives to promote smoking cessation among pregnant women . We search ed the literature for reports on primary and secondary analyses and review s of controlled trials on this topic published in peer- review ed journals using the search engine PubMed , review ed bibliographies of published articles , and consulted expert colleagues . The search revealed several important developments , with the following three being especially noteworthy . First , the review identified four new r and omized controlled trials , three of which further supported the efficacy of this treatment approach . One of the three trials supporting efficacy also included the first econometric analysis of this treatment approach showing financial incentives with pregnant smokers to be highly cost-effective . Second , two Cochrane review s were published during this 3-year period covering the more recent and earlier efficacy trials . Meta-analyses in both review s supported the efficacy of the approach . Lastly , the first effectiveness trial was reported demonstrating that  financial incentives increased abstinence rates above control levels when implemented by obstetrical clinic staff in a large urban hospital working with community tobacco interventionists . Overall , there is a growing and compelling body of evidence supporting the efficacy and cost-effectiveness of  financial incentives for smoking cessation among pregnant women ABSTRACT BACKGROUND Previous efforts to use incentives for weight loss have result ed 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 r and omized 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 BMI s of 30–40.INTERVENTION Participants were r and omly 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 MEASUREWeight 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
There was not convincing evidence that effects were different between different groups of behaviours .
Meta-regression found some , limited , evidence that effect sizes decreased as post-intervention follow-up period and incentive value increased .
However , the latter effect may be confounded by the former .
The available evidence suggests that financial incentive interventions are more effective than usual care or no intervention for encouraging healthy behaviour change .
BACKGROUND Financial incentive interventions have been suggested as one method of promoting healthy behaviour change .
OBJECTIVES To conduct a systematic review of the effectiveness of financial incentive interventions for encouraging healthy behaviour change ; to explore whether effects vary according to the type of behaviour incentivised , post-intervention follow-up time , or incentive value .