Healthy Behaviors: Research

Adolescent E-Cigarette, Hookah, and Conventional Cigarette Use and Subsequent Marijuana Use

Janet Audrain McGovern, PhD
Sep. 12, 2018

Janet Audrain-McGovern, Matthew D. Stone, Jessica Barrington-Trimis, Jennifer B. Unger, Adam M. Leventhal


Objectives: Noncigarette tobacco products may confer a risk of marijuana use similar to combustible cigarettes. We examined whether adolescent electronic cigarette (e-cigarette), hookah, or combustible cigarette use is associated with initiating and currently using marijuana as well as using both tobacco and marijuana concurrently.

Methods: Adolescents from 10 public schools in Los Angeles, California, completed in-classroom surveys at baseline (fall 2013,


Using Behavioral Economics to Encourage Parent Behavior Change: Opportunities to Improve Clinical Effectiveness

Sep. 10, 2018


Pediatric clinical practice often involves improving child health by changing parents' behavior. Strategies from behavioral economics - a field that leverages predictable patterns in human decision-making to overcome barriers to behavior change - can improve health outcomes in adults. Though more research is needed, the application of these approaches to parent behavior change in pediatric settings has the potential to improve the clinical effectiveness of child healthcare. We review the foundational concepts of behavioral economics and identify the unique...

Situational Use of Child Restraint Systems and Carpooling Behaviors in Parents and Caregivers

Sep. 5, 2018

Catherine C. McDonald, Erin Kennedy, Linda Fleisher, and Mark R. Zonfrillo

Abstract [from journal]

Suboptimal compliance with child restraint system (CRS) recommendations can increase risk for injury or death in a motor vehicle crash. The purpose of this study was to examine scenarios associated with incomplete CRS use and non-use in children ages 4⁻10 years. We used a cross-sectional online survey with a convenience sample of parent/caregivers from the United States, age ≥18 years, with a child age 4⁻10 years in their home, who could read and spoke English, and drove child ≥6 times in previous three months. We used descriptive statistics and Mann-


Patient and Physician Predictors of Hyperlipidemia Screening and Statin Prescription

Aug. 23, 2018

Sneha Kannan, David A. Asch, Gregory W. Kurtzman, Steve Honeywell Jr, Susan C. Day, and Mitesh S. Patel

ABSTRACT [from journal]

Objectives: Appropriate lipid management has been demonstrated to reduce cardiovascular events, but rates of hyperlipidemia screening and statin therapy are suboptimal. We aimed to evaluate patient and physician predictors of guideline-concordant hyperlipidemia screening and statin prescription.

Study Design: Retrospective study of patients with primary care provider (PCP) visits from 2014 to 2016 at the University of Pennsylvania Health System.

Methods: Data on patients, screening orders, and...

Use of Web-Based Parent-Adolescent Health Promotion Program among Puerto Ricans

Aug. 9, 2018

Antonia M. Villarruel, Nelson Varas-Díaz, Alexandra Hanlon, Elba Betancourt, Alicia J. Lozano, Lucia DiNapoli

Abstract [from journal]

Background: Despite positive attitudes of Latinos using the Internet and the increased availability of health information resources, few studies have been conducted that examine actual use and barriers to web-based health information.

Objective: To examine whether select sociodemographic factors and technology factors (e.g., computer and Internet access) predicted use of a web-based, parent–adolescent sexual communication program or a physical activity program, entitled Cuídalos, among Puerto Rican parents.


Novel Smartphone-Based Measures of Cell Phone Use While Driving in a Sample of Newly Licensed Adolescent Drivers

Jul. 26, 2018

Catherine C. McDonald, Kristen Ward, Yanlan Huang, Douglas J. Wiebe...

Abstract [from journal]

Background: Motor vehicle crashes are the leading cause of adolescent death. Cell phone use while driving is a contributor to adolescent motor vehicle crash risk. Objective and directly observable measures of cell phone use while driving are needed to implement interventions aimed at reducing cell phone–related crash risk. 

Aims: To describe novel smartphone-based measures of cell phone use while driving in a sample of newly licensed male and female adolescent drivers. 

Methods: Newly licensed...

Effect of Process- and Outcome-Based Financial Incentives on Weight Loss Among Prediabetic New York Medicaid Patients: A Randomized Clinical Trial

Jul. 25, 2018

Eric M. VanEpps, Andrea B. Troxel, Elizabeth Villamil,  Kathryn A. Saulsgiver, Jingsan Zhu, Jo-Yu Chin, Jacqueline Matson, Joseph Anarella,  Patrick Roohan, Foster Gesten, Kevin G. Volpp


Purpose: To determine whether different financial incentives are effective in promoting weight loss among prediabetic Medicaid recipients.

Design: Four-group, multicenter, randomized clinical trial.

Setting and Participants: Medicaid managed care enrollees residing in New York, aged 18 to 64 years, and diagnosed as prediabetic or high risk for diabetes (N = 703).

Intervention: In a 16-week program, participants were randomly


Factors Associated With Pediatrician Responses to Alternative Immunization Schedule Requests

Jul. 24, 2018

Abstract [from journal]

We conducted a cross-sectional online survey among 4 chapters of the American Academy of Pediatrics from July through October 2014 to describe characteristics of pediatricians and practices associated with practice-level responses to alternative immunization schedule requests. Among 374 pediatricians, 58% reported frequent alternative immunization schedule requests and 24% reported feeling comfortable using them. Pediatricians who work in practices that accommodate alternative immunization schedule requests have increased odds of having a


Vaccine Hesitancy in Pediatric Primary Care Practices

Jul. 16, 2018

Salini Mohanty, Amy Carroll-Scott, Marissa Wheeler, Cecilia Davis-Hayes, Renee Turchi, Kristen Feemster, Michael Yudell, ...


Understanding how pediatric practices handle parental vaccine hesitancy is important as it impacts the efficiency and effectiveness of pediatric practices. In total, 21 semi-structured interviews with pediatric practice staff within a primary care network were conducted between May 2012 and March 2013. Thematic analysis focused on the barriers and challenges of vaccine hesitancy and strategies to reduce the burden at the practice level. Barriers and challenges of vaccine hesitancy included time constraints, administrative challenges, financial challenges...

Why Effective Interventions Do Not Work for All Patients: Exploring Variation in Response to a Chronic Disease Management Intervention

Jul. 16, 2018

Merritt Edlind, Nandita Mitra, David Grande, Frances K. Barg, Tamala Carter, Lindsey Turr,...


Background: Half of all Americans have a chronic disease. Promoting healthy behaviors to decrease this burden is a national priority. A number of behavioral interventions have proven efficacy; yet even the most effective of these has high levels of nonresponse.

Objectives: In this study, we explore variation in response to an evidence-based community health worker (CHW) intervention for chronic disease management.

Research Design: We used a convergent parallel design that combined a...

Social Incentives and Gamification to Promote Weight Loss: The LOSE IT Randomized, Controlled Trial

Jul. 16, 2018

Gregory W. Kurtzman, Susan C. Day, Dylan S. Small, Marta Lynch, Jingsan Zhu, Wenli Wang, Charles A. L. Rareshide, Mitesh S. Patel


Background: Social networks influence obesity patterns, but interventions to leverage social incentives to promote weight loss have not been well evaluated.

Objective: To test the effectiveness of gamification interventions designed using insights from behavioral economics to enhance social incentives to promote weight loss.

Design: The Leveraging Our Social Experiences and Incentives Trial (LOSE IT


A Randomized Controlled Trial of Opt-in Versus Opt-Out Colorectal Cancer Screening Outreach

Jul. 9, 2018

Shivan J. Mehta, Tanya Khan, Carmen Guerra, Catherine Reitz, Timothy McAuliffe, ...


Objectives: Colorectal cancer (CRC) screening uptake is suboptimal, despite national efforts to increase screening rates. Behavioral economic approaches such as changing defaults may increase participation. We compare response rates to opt-in or opt-out messaging in mailed fecal immunochemical test (FIT) outreach.

Methods: This is a two-arm randomized controlled trial among 314 patients aged 50–74 years who had at least two primary care visits in the 2...

Health Warning Labels Correct Parents' Misperceptions About Sugary Drink Options

Jun. 27, 2018

Alyssa J. Moran, Christina A. Roberto


Introduction: Noncarbonated sugar-sweetened beverages, such as fruit drinks, sports drinks, and sweetened teas are increasingly promoted to and consumed by youth. These beverages may be perceived as healthier options than soda. To educate consumers about beverages high in added sugar, several cities and states have proposed policies mandating health warning labels on sugar-sweetened beverages.

Methods: In 2015, a total of 2,381 parents were randomized to a no label, calorie label, or warning label condition. An...

Loss-Framed Financial Incentives and Personalized Goal-Setting to Increase Physical Activity among Ischemic Heart Disease Patients Using Wearable Devices: The ACTIVE REWARD Trial

Jun. 13, 2018

Neel P. Chokshi, Srinath AdusumalliDylan S. Small, Alexander Morris, Jordyn Feingold, ...


Background: Regular physical activity reduces the risk of cardiovascular events, but most ischemic heart disease (IHD) patients do not obtain enough.

Methods and Results: ACTIVE REWARD (A Clinical Trial Investigating Effects of a Randomized Evaluation of Wearable Activity Trackers with Financial Rewards) was a 24‐week home‐based, remotely monitored, randomized trial with a 16‐week intervention (8‐week ramp‐up incentive phase and 8