Safer Food Allergy Management for Adolescents
Condition: Food Allergy; Adherence, Medication
MeSH terms: Hypersensitivity; Food Hypersensitivity
Study type: Interventional

Summary: 
      Among the 15 million people with food allergies in the U.S., adolescents experience the
      highest risk of adverse events. Yet, there are few evidence-based strategies to improve food
      allergy management in adolescents. In a cohort multiple randomized controlled trial, this
      study will include two experiments to test the effectiveness of text message reminders and
      incentives to encourage epinephrine-carrying.
    

Detailed description: 
      Among the 15 million people with food allergies in the United States, adolescents experience
      the highest risk of adverse events, including death from anaphylaxis. Visits to one pediatric
      emergency department for anaphylaxis doubled between 2001 and 2006, suggesting a rapidly
      escalating public health burden. Despite this critical concern, there are few evidence-based
      strategies to improve food allergy management in adolescents, who must sustain three core
      prevention strategies: diligent avoidance of allergenic foods, consistent carrying of
      potentially life-saving epinephrine auto-injectors, and prompt administration of epinephrine
      in the event of anaphylaxis.

      The objective of this study is to develop and test interventions to encourage safer food
      allergy management among adolescents. The primary outcome is consistency of
      epinephrine-carrying, measured using cell phone photographs at randomly-timed check-ins. This
      study will be among the first to longitudinally track normative food allergy management
      practices and one of the first to test behavior change strategies.

      In a cohort multiple randomized controlled trial (n=130), the study will include two
      experiments to test the effectiveness of text message reminders and incentives, using various
      incentive designs that have proven effective in prior behavioral economics interventions to
      encourage weight loss and smoking cessation. Aim 1. Test the impact of a text-message
      reminder system on consistency of epinephrine carrying. Aim 2. Test the impact of modest
      incentives on consistency of epinephrine carrying. Based on promising preliminary data, the
      central hypothesis is that, compared to controls, adolescents who receive text message
      reminders plus modest financial incentives will more consistently carry their epinephrine.
    

Intervention name(s): Text Message Only; Text message + Incentive 1
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The intervention group (n=25, randomly selected from the base cohort) will receive informational and socially supportive text messages during a 10-week intervention. Investigators will deploy the intervention using the Way to Health platform, which automates outgoing messages and feedback. Many of the messages will be sent to all Intervention 1 participants, to assure consistency of the intervention. A subset will be tailored to address participants' specific allergies. At 10 unannounced check-ins, we will send text messages asking participants in the intervention and control groups if they are carrying their epinephrine.; Among base cohort members not exposed to the text message only intervention (#1), we will randomly select a new intervention group (n=50) to receive text message reminders plus Incentive 1. At each of 10 unannounced check-ins, if unsuccessful in documenting epinephrine-carrying, participants will lose part of their incentive. The remainder of the Cohort (control) will receive text reminders.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Primary purpose: Prevention