Healthy Behaviors: Research

Incentive Design and Quality Improvements: Evidence from State Medicaid Nursing Home Pay-for-Performance Programs

Feb. 1, 2018

R. Tamara Konetzka, Meghan M. Skira and Rachel M. Werner

In the American Journal of Health Economics, Rachel Werner and colleagues analyze how incentive design affects quality improvements in the nursing home setting, where several state Medicaid agencies have implemented pay-for-performance (P4P) programs that vary in incentive structure. Using the Minimum Data Set and the Online Survey, Certification, and Reporting data from 2001 to 2009, the authors examine how the weights put on various performance measures that are tied to P4P bonuses, such as clinical outcomes, inspection deficiencies, and staffing levels, affect improvements in...

Using Wearable Devices and Smartphones to Track Physical Activity: Initial Activation, Sustained Use, and Step Counts Across Sociodemographic Characteristics in a National Sample

Dec. 3, 2017

Mitesh S. Patel, Luca Foschini, Gregory W. Kurtzman, Jingsan Zhu, Wenli Wang, Charles A.L. Rareshide, Susan M. Zbikowski

In Annals of Internal Medicine, Mitesh Patel and colleagues describe rates of initial use of activity trackers, sustained use after 6 months, and step counts across different sociodemographic characteristics from a wellness program offered across the United States. Many large employers are using data collected from wearable devices and smartphones in workplace wellness programs; however, the characteristics of persons who use these devices are poorly understood.

Mean daily step count and sociodemographic characteristics between 2014 and 2015 were obtained from Humana for...

The Short- and Long-Term Effects of Smoking Cessation on Alcohol Consumption

Dec. 1, 2017

In the International Journal of Health Economics and Management, Benjamin Ukert examines short- and long-term effects of quitting smoking on alcohol consumption. Most interventions have focused on reducing either cigarette or alcohol consumption to address the severe health and economic consequences of both risky behaviors, while ignoring how they interact.

To estimate the relationship between smoking and alcohol consumption, the author utilizes data from the Lung Health Study (LHS), a randomized smoking...

Ridesharing and Motor Vehicle Crashes in 4 US Cities: An Interrupted Time-Series Analysis

Oct. 30, 2017

Christopher N. Morrison, Sara F. Jacoby, Beidi Dong, M. Kit Delgado, Douglas J. Wiebe 

In the American Journal of Epidemiology, Christopher Morrison and colleagues, including Sara Jacoby, M. Kit Delgado, and Douglas Wiebe, investigated if ridesharing, specifically if using Uber, reduces the rate of motor vehicle crashes.

The authors conducted an interrupted time series analyses using weekly counts of injury crashes and the proportion that were alcohol-involved in four US cities where Uber had piloted, abruptly ceased operations, and then abruptly resumed (Las Vegas, NV; Portland, OR; Reno, NV; San Antonio, TX). The authors hypothesized that Uber’s resumption...

Community Health Worker Support For Disadvantaged Patients With Multiple Chronic Diseases: A Randomized Clinical Trial

Research Brief
Aug. 21, 2017

Community health worker interventions hold promise for improving outcomes of low-income patients with multiple chronic diseases.

Active Choice and Financial Incentives to Increase Rates of Screening Colonoscopy – a Randomized Controlled Trial

Jul. 26, 2017

Shivan J. Mehta, Jordyn Feingold, Matthew Vandertuyn, Tess Niewood, Catherine Cox, Chyke A. Doubeni, Kevin G. Volpp, David A. Asch

In Gastroenterology, Shivan Mehta and colleagues, including Chyke Doubeni, Kevin Volpp, and David Asch, examine various behavioral economics approaches to increase uptake for colorectal cancer screening. The authors assigned 2,245 individuals, all employees of a large academic health system, to one of three interventions: an e-mail containing a phone number for scheduling (control), an e-mail with the active choice to opt in or opt out (active choice), or the active choice e-mail plus a $100 incentive (financial incentive). Participants were followed to determine whether they got...

Calorie Underestimation When Buying High-Calorie Beverages in Fast-Food Contexts

Jul. 14, 2017

Rebecca L. Franckle, Jason P. Block, Christina A. Roberto

In American Journal of Public Health, Rebecca Franckle and colleagues, including Christina Roberto, assess calorie estimation, particularly in high-calorie beverages, among adolescents and adults visiting fast-food restaurants. Previous research has shown that people eating at fast-food restaurants underestimate the caloric content of their purchases, but little is known about whether purchasing beverages affects calorie estimates. Because beverages are generally not the central focus of a meal and can be consumed quickly and with little effort, it is possible that people fail to...

Video Analysis of Factors Associated With Response Time to Physiologic Monitor Alarms in a Children’s Hospital

Jul. 11, 2017

Christopher P. Bonafide, A. Russell Localio, John H. Holmes, Vinay M. Nadkarni, Shannon Stemler, Matthew MacMurchy, Miriam Zander, Kathryn E. Roberts, Richard Lin, Ron Keren

In JAMA Pediatrics, Christopher Bonafide and colleagues, including John Holmes and Ron Keren, seek to identify factors associated with nurses' response time to physiologic monitor alarms at the bedside. As nurse response time to bed alarms remains slow, the authors examine patient- and nurse-related factors that affect responses to alarms. The authors video recorded 551 hours of care administered by 38 nurses to 100 children. They find several variables that shorten nurses’ response time to alarms. These include if the patient was on complex care service, if family members were...

Coercion or Caring: The Fundamental Paradox for Adherence Interventions for HIV+ People With Mental Illness

Jul. 3, 2017

Marlene M. Eisenberg, Michael Hennessy, Donna Coviello, Nancy Hanrahan, Michael B. Blank

In AIDS and Behavior, Marlene Eisenberg and colleagues, including Nancy Hanrahan and Michael Blank, examine if a high-intensity HIV-treatment intervention would be perceived as coercive by HIV-positive individuals with serious mental illness. Previous research has shown that potentially coercive mandates during the earliest stages of mental health treatment are associated with later treatment benefits. Furthermore, the prevalence of HIV is significantly higher among populations with mental illness. The authors developed an HIV management regimen that utilized advance practice...

Economic evaluation of a behavioral intervention versus brief advice for substance use treatment in pregnant women: results from a randomized controlled trial

Jun. 22, 2017

Xiao Xu, Kimberly A. Yonkers, and Jennifer Prah Ruger

In BMC Pregnancy and Childbirth, Xiao Xu and colleagues, including Jennifer Ruger, assess the economic impact of motivational enhancement therapy and cognitive behavioral therapy (MET-CBT) among substance-using pregnant women. The study was performed alongside a clinical trial that compared the intervention to brief advice about the risks of substance use and found no significant differences in the outcomes such as drug and alcohol use. As such, the authors conducted a cost minimization analysis, from the perspective of the health system. They found that, while the intervention...

Promising Themes for Antismoking Campaigns Targeting Youth and Young Adults

Jun. 20, 2017

Emily Brennan, Laura A. Gibson, Ani Kybert-Momjian, Jiaying Liu, Robert C. Hornik

In Tobacco Regulatory Science, Emily Brennan and colleagues, including Robert Hornik, assess the impact of various anti-smoking themes in campaigns targeting youth and young adults. The authors surveyed 13- to 17-year-olds and 18- to 25-year-olds for their responses to 20 different potential campaign themes. The themes were aimed at four behavioral targets: preventing smoking initiation among youth (defined as 13-17 year olds), preventing initiation among young adults (defined as 18-25 year olds), stopping progression to daily smoking among young adults, and encouraging cessation...

A comparative effectiveness education trial for lifestyle health behavior change in African-Americans

Jun. 20, 2017

Chanita Hughes Halbert, Scarlett Bellamy, Vanessa Briggs, Ernestine Delmoor, Joseph Purnell, Rodney Rogers, Benita Weathers, Jerry C. Johnson

In Health Education Research, Chanita Hughes Halbert and colleagues, including Jerry Johnson, compared the effects of an education trial about risk factors for cancer and cardiovascular disease (CVD) within an African-American community. Participants were randomized to receive either integrated education about shared risk factors between cancer and CVD, or disease-specific education about CVD risk factors only. The authors assessed whether the type of education received affected fruit and vegetable intake or physical activity level. They find that when participants with less than...

Effect of message congruency on attention and recall in pictorial health warning labels

Jun. 19, 2017

Kristen Lochbuehler, Melissa Mercincavage, Kathy Z. Tang, C Dana Tomlin, Joseph N. Cappella, Andrew A. Strasser

In Tobacco Control, Kristen Lochbuehler and colleagues, including Joseph Cappella, investigate the effect of pictorial health warning label congruency on smokers’ attention and recall of label content. Daily smokers were randomly assigned to view pictorial warning labels (PWLs) where the label’s image and text were either congruent or incongruent in their theme. Participants had their eye movements tracked, and were asked to recall the label content both immediately after exposure and five days later. The authors find that those who viewed PWLs of a congruent theme spent less time...

Association between features of patient-provider discussions and routine prostate-specific antigen testing

Jun. 11, 2017

Joshua Liao, Mark J. Ommerborn, Cheryl R. Clark

In PLoS One, Joshua Liao and colleagues examine the impact of provider recommendations and presence of a personal doctor on routine prostate cancer screening with PSA testing. Although the US Preventive Services Task Force recommends against routine prostate cancer screening, specialty organizations support screening via shared decision making between providers and selected patients. The investigators used the 2013 Behavioral Risk Factor Surveillance System to identify 1,737 men surveyed about their PSA testing decisions. More than 70% of respondents reported some form of...

When Primary Care Providers (PCPs) Help Patients Choose Prostate Cancer Treatment

Jun. 11, 2017

Archana Radhakrishnan, David Grande, Michelle Ross, Nandita Mitra, Justin Bekelman, Christian Stillson, MPH and Craig Evan Pollack

In the Journal of the American Board of Family Medicine, Archana Radhakrishnan, David Grande, Nandita Mitra, Justin Bekelman, and colleagues evaluate how frequently men with localized prostate cancer report receiving help from their primary care provider (PCP) about their treatment, and whether men who do are less likely to receive definitive treatment (either radical prostatectomy or radiotherapy). The investigators mailed surveys to men newly diagnosed with localized prostate cancer between 2012 and 2014 in the greater Philadelphia region. A total of 2,386 men responded. Among...

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