title: Partners in Lowering Cholesterol: Comparison of a Multidisciplinary Educational Program, Monetary Incentives, or Usual Care in the Treatment of Dyslipidemia Identified Among Employees Contingency management and motivational enhancement: a randomized clinical trial for college student smokers. Cigarette smoking and site-specific cancer mortality: testing uncertain associations using extended follow-up of the original Whitehall study. Use of personal trainers and financial incentives to increase exercise in a behavioral weight-loss program. Dietary Patterns and Risk of Mortality From Cardiovascular Disease, Cancer, and All Causes in a Prospective Cohort of Women Financial Incentives for Extended Weight Loss: A Randomized, Controlled Trial Strengthening behavioral interventions for weight loss: a randomized trial of food provision and monetary incentives. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Physical activity and cause-specific mortality in men: Further evidence from the Whitehall study A randomized, controlled trial of financial incentives for smoking cessation. Effects of voucher-based incentives on abstinence from cigarette smoking and fetal growth among pregnant women. The effects of cash and lottery incentives on mailed surveys to physicians: a randomized trial. All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work. Smoking cessation in methadone maintenance. Vouchers versus Lotteries: What works best in promoting Chlamydia screening? A cluster randomised controlled trial. Behavioral anti-smoking trial in chronic obstructive pulmonary disease patients Effects of a personal trainer and financial incentives on exercise adherence in overweight women in a behavioral weight loss program. The effects of contingent payment and frequent workplace monitoring on smoking abstinence. Peer Mentoring and Financial Incentives to Improve Glucose Control in African American Veterans The effectiveness of a worksite self-help smoking cessation program: A randomized trail A pilot study on voucher-based incentives to promote abstinence from cigarette smoking during pregnancy and postpartum. Results of a year-long incentives-based worksite smoking-cessation program. A Comparison of Smoking Cessation Treatments for Persons with Schizophrenia and Other Serious Mental Illnesses Randomised controlled trial using social support and financial incentives for high risk pregnant smokers: Significant Other Supporter (SOS) program The SUCCESS project: the effect of program format and incentives on participation and cessation in worksite smoking cessation programs. Work-site cardiovascular risk reduction: a randomized trial of health risk assessment, education, counseling, and incentives. An experimental evaluation of an incentive program to reduce serum cholesterol levels among health fair participants. Correspondence programs for smoking cessation and weight control: a comparison of two strategies in the Minnesota Heart Health Program.
abstract: 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 material s , subjects were assigned to three groups : group 1 received $ 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 r and omization , 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 INTRODUCTION The efficacy of contingency-management ( CM ) and motivational enhancement therapy ( MET ) for college student smoking cessation was examined . METHODS Nontreatment-seeking daily smokers ( N = 110 ) were r and omly 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 ) sample s were collected twice daily for 3 weeks . Participants earned 5 US dollars for providing each sample ; additionally , those r and omized to CM earned escalating monetary rewards based on CO reductions ( Week 1 ) and smoking abstinence ( Weeks 2 - 3 ) . RESULTS Compared with NR , CM result ed 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 . DISCUSSION 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 BACKGROUND The relation between cigarette smoking and several malignancies is still unclear . We examined the association of cigarette smoking with death attributed to 15 cancer sites , 7 of which are regarded as having an uncertain relation with tobacco . PATIENTS AND METHODS The original Whitehall study is a prospect i ve cohort of 17 363 London-based male government employees ( age 40 - 69 years ) who were examined in the late 1960s and then followed up for a maximum of 38 years . RESULTS Following adjustment for demographic characteristics , risk factors , and prevalent disease , established positive cigarette smoking -- cancer gradients were confirmed for carcinoma of the lung , stomach , pancreas , bladder , upper aero-digestive ( including oesophagus ) , and liver , and for myeloid leukaemia . Among the cancers of uncertain relation with smoking , mortality rates for malignancy of the colon , rectum and prostate and for lymphatic leukaemia were elevated in current and /or former smokers . There was essentially no apparent relation between smoking and mortality from carcinoma of the brain or from lymphoma . CONCLUSION In this study , cigarette smoking appears to be a risk factor for several malignancies of previously unclear association with tobacco use Exercise is the best predictor of long-term weight loss . This study evaluated two strategies for improving exercise adherence and long-term weight loss in obese out patients . Obese men and women ( N = 193 ) were r and omized to 1 of 5 treatment groups for 18 months : st and ard behavior therapy ( SBT ) ; SBT with supervised walks ( SW ) 3 times per week ; SBT + SW with personal trainers ( PT ) , who walked with participants , made phone reminders , and did make-up SW ; SBT + SW with monetary incentives ( I ) for completing SW ; and SBT + SW + PT + I. Both PT and I enhanced attendance at SWs , the combination producing the best adherence . Increased walk attendance did not result in higher overall energy expenditure , however , and long-term weight loss was also not improved . Post hoc analyses suggest that the level of exercise needed for successful long-term weight loss is much higher than that usually recommended in behavioral treatment programs Background — The impact of overall dietary patterns that reflect actual eating behaviors on mortality caused by cardiovascular or other chronic diseases is largely unknown . Methods and Results — We prospect ively evaluated the relation between dietary patterns and risk of cardiovascular , cancer , and all-cause mortality among 72 113 women who were free of myocardial infa rct ion , angina , coronary artery surgery , stroke , diabetes mellitus , or cancer and were followed up from 1984 to 2002 . Dietary patterns were derived by factor analysis based on vali date d food frequency question naires administered every 2 to 4 years . Two major dietary patterns were identified : High prudent pattern scores represented high intakes of vegetables , fruit , legumes , fish , poultry , and whole grains , whereas high Western pattern scores reflected high intakes of red meat , processed meat , refined grains , french fries , and sweets/desserts . During 18 years of follow-up , 6011 deaths occurred , including 1154 cardiovascular deaths and 3139 cancer deaths . After multivariable adjustment , the prudent diet was associated with a 28 % lower risk of cardiovascular mortality ( 95 % confidence interval [ CI ] , 13 to 40 ) and a 17 % lower risk of all-cause mortality ( 95 % CI , 10 to 24 ) when the highest quintile was compared with the lowest quintile . In contrast , the Western pattern was associated with a higher risk of mortality from cardiovascular disease ( 22 % ; 95 % CI , 1 to 48 ) , cancer ( 16 % ; 95 % CI , 3 to 30 ) , and all causes ( 21 % ; 95 % CI , 12 to 32 ) . Conclusion — Greater adherence to the prudent pattern may reduce the risk of cardiovascular and total mortality , whereas greater adherence to the Western pattern may increase the risk among initially healthy 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 Behavioral treatments for obesity seek to modify eating and exercise behaviors by a change in their antecedents and consequences . More direct modification of antecedents and consequences by ( a ) the provision of food to patients and ( b ) the provision of financial rewards for weight loss was hypothesized to improve treatment outcomes . Two hundred two men and women were r and omly assigned to no treatment , st and ard behavioral treatment ( SBT ) , SBT plus food provision , SBT plus incentives , or SBT plus food provision and incentives . The major finding was that food provision significantly enhanced weight loss . Weight losses with  SBT  averaged 7.7 , 4.5 , and 4.1 kg at 6 , 12 , and 18 months , respectively , compared with 10.1 , 9.1 , and 6.4 kg , respectively , at the same intervals with the addition of food . Food provision also enhanced attendance , completion of food records , quality of diet , and nutrition knowledge . We conclude that the provision of food to weight-loss patients is a promising methodology that deserves further exploration Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Reports of studies relating physical activity to stroke and cancer sub-types indicate inconsistent findings . Some are hampered by low statistical power , owing to a low number of events , and a failure to adjust for potential confounding variables . The purpose of this study was to relate physical activity to 12 mortality endpoints in a prospect i ve cohort study of 11,663 men aged 40–64 years who responded to an enquiry about travel activity during a baseline medical examination conducted between 1967 and 1969 . During 25 years of follow-up there were 4672  deaths .  Travel activity  was inversely related to mortality attributable to all-causes , coronary heart disease , respiratory disease and lung cancer , whereas the association with stroke was positive . There was evidence for attenuation of some of these associations on adjustment for potentially confounding variables . Our simplistic measure of physical activity may , in part , explain the weak associations seen BACKGROUND Smoking is the leading preventable cause of premature death in the United States . Previous studies of financial incentives for smoking cessation in work setting s have not shown that such incentives have significant effects on cessation rates , but these studies have had limited power , and the incentives used may have been insufficient . METHODS We r and omly assigned 878 employees of a multinational company based in the United States to receive information about smoking-cessation programs ( 442 employees ) or to receive information about programs plus financial incentives ( 436 employees ) . The financial incentives were $ 100 for completion of a smoking-cessation program , $ 250 for cessation of smoking within 6 months after study enrollment , as confirmed by a biochemical test , and $ 400 for abstinence for an additional 6 months after the initial cessation , as confirmed by a biochemical test . Individual participants were stratified according to work site , heavy or nonheavy smoking , and income . The primary end point was smoking cessation 9 or 12 months after enrollment , depending on whether initial cessation was reported at 3 or 6 months . Secondary end points were smoking cessation within the first 6 months after enrollment and rates of participation in and completion of smoking-cessation programs . RESULTS The incentive group had significantly higher rates of smoking cessation than did the information-only group 9 or 12 months after enrollment ( 14.7 % vs. 5.0 % , P<0.001 ) and 15 or 18 months after enrollment ( 9.4 % vs. 3.6 % , P<0.001 ) . Incentive-group participants also had significantly higher rates of enrollment in a smoking-cessation program ( 15.4 % vs. 5.4 % , P<0.001 ) , completion of a smoking-cessation program ( 10.8 % vs. 2.5 % , P<0.001 ) , and smoking cessation within the first 6 months after enrollment ( 20.9 % vs. 11.8 % , P<0.001 ) . CONCLUSIONS In this study of employees of one large company , financial incentives for smoking cessation significantly increased the rates of smoking cessation . ( Clinical Trials.gov number , NCT00128375 . 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 , r and omized 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 r and omly 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 Low response rates , especially among physicians , are a common problem in mailed survey research . We conducted a r and omized trial to examine the effects of cash and lottery incentives on response rates .  A total of 4,850 subjects were r and omized to one of three interventions accompanying a mailed survey-no incentive ( n = 1,700 ) , cash payment [ three levels of Hong Kong dollars ( HKD ) $ 10 , $ 20 , and $ 40 ; N = 50 in each subgroup ] , or entry into a lottery ( three levels of HKD$1,000 , $ 2,000 , and $ 4,000 ; N = 1,000 in each subgroup ) on receipt of the completed question naire . The response rates were higher among those offered incentives than those without ( 19.8 % vs. 16.8 % , P = .012 ) . Cash was the more effective incentive compared to lottery ( 27.3 % vs. 19.4 % , P = .017 ) . Response also increased substantially between the first and second mailings ( 14.2 % vs. 18.8 % , P > .001 ) . In addition , those with specialist qualifications were more willing to participate in mailed surveys . We found no significant differences in response outcomes among the various incentive arms . Cash reward at the $ 20 level was the most cost-effective intervention , in terms of cost per responder . Further systematic examination of the effects of different incentive strategies in epidemiologic studies should be encouraged BACKGROUND Physical activity is associated with low mortality in men , but little is known about the association in women , different age groups , and everyday activity . OBJECTIVE To evaluate the relationship between levels of physical activity during work , leisure time , cycling to work , and sports participation and all-cause mortality . DESIGN Prospect i ve study to assess different types of physical activity associated with risk of mortality during follow-up after the subsequent examination . Mean follow-up from examination was 14.5 years . SETTING Copenhagen University Hospital , Copenhagen , Denmark . PARTICIPANTS Participants were 13,375 women and 17,265 men , 20 to 93 years of age , who were r and omly selected .  Physical activity was assessed by self-report , and health status , including  blood pressure , total cholesterol level , triglyceride levels , body mass index , smoking , and educational level  , was evaluated . MAIN OUTCOME MEASURE All-cause mortality . RESULTS A total of 2,881 women and 5,668 men died . Compared with the sedentary , age- and sex-adjusted mortality rates in leisure time physical activity groups 2 to 4 were 0.68 ( 95 % confidence interval , 0.64 - 0.71 ) , 0.61 ( 95 % confidence interval , 0.57 - 0.66 ) , and 0.53 ( 95 % confidence interval , 0.41 - 0.68 ) , respectively , with no difference between sexes and age groups . Within the moderately and highly active persons , sports participants experienced only half the mortality of non participants . Bicycling to work decreased risk of mortality in approximately 40 % after multivariate adjustment , including leisure time physical activity . CONCLUSIONS Leisure time physical activity was inversely associated with  all-cause mortality in both men and women in all age groups . Benefit was found from moderate leisure time physical activity , with further benefit from sports activity and bicycling as transportation AIMS To evaluate relapse prevention ( relapse prevention ) and contingency management ( contingency management ) for optimizing smoking cessation outcomes using nicotine replacement therapy for methadone-maintained tobacco smokers . DESIGN Experimental , 2 ( relapse prevention)x2 ( contingency management ) repeated measures design using a platform of nicotine replacement therapy featuring a 2-week baseline period , followed by r and omization to 12 weeks of treatment , and 6- and 12-month follow-up visits . SETTING Three narcotic treatment centers in Los Angeles . PARTICIPANTS One hundred and seventy-five participants who met all inclusion and no exclusion criteria . INTERVENTION Participants received 12 weeks of nicotine replacement therapy and assignment to one of four conditions : patch-only , relapse prevention + patch , contingency management + patch and relapse prevention + contingency management + patch . MEASUREMENTS Thrice weekly sample s of breath ( analyzed for carbon monoxide ) and urine ( analyzed for metabolites of opiates and cocaine ) and weekly self-reported numbers of cigarettes smoked . FINDINGS Participants ( 73.1 % ) completed 12 weeks of treatment . During treatment , those assigned to receive contingency management showed statistically higher rates of smoking abstinence than those not assigned to receive contingencies ( F3,4680=6.3 , P=0.0003 ) , with no similar effect observed for relapse prevention . At follow-up evaluations , there were no significant differences between conditions . Participants provided more opiate and cocaine-free urines during weeks when they met criteria for smoking abstinence than during weeks when they did not meet these criteria ( F1,2054=14.38 , P=0.0002 ; F1,2419=16.52 , P<0.0001 ) . CONCLUSIONS Contingency management optimized outcomes using nicotine replacement therapy for reducing cigarette smoking during treatment for opiate dependence , although long-term effects are not generally maintained . Findings document strong associations between reductions in cigarette smoking and reductions in illicit substance use during treatment 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 Smoking causes chronic obstructive pulmonary disease ( COPD ) , but few controlled studies have tested anti-smoking treatments in COPD . With procedures likely to attract unmotivated persons we recruited 49 quite-ill , smoking COPD patients . During one or two daily home visits for 85 days , breath carbon monoxide ( CO ) and self-reports of daily smoking were obtained . Patients , given quit date s and nicotine gum ( 2-mg pieces , up to 30 per day ) , were assigned r and omly to three groups : Experimentals were reinforced with lottery tickets for CO < 10 ppm . Cigarette Self Report ( CSR ) patients were reinforced for reporting no smoking that day . Controls received non-contingent payments . Each group 's mean CO level fell at the quit date . Thereafter , reinforced patients maintained significantly lower CO levels than Controls . Although many more 24-h abstentions occurred in the intervention period than in baseline , few patients sustained abstinence ; the groups did not differ in that regard . Outcome was predicted by decisions to throw away cigarettes when intervention began , but not by motivation scales nor Fagerstrom dependence scores . Pay schedules apparently exaggerated self-reports of reduced smoking . Although results are statistically significant , there is still no proven , practical treatment for smoking in advanced COPD Exercise is important for long-term weight loss , but few studies have examined ways to improve exercise adherence in overweight subjects participating in a behavioral weight loss program . This paper presents two studies , one conducted at the University of Pittsburgh and one at the University of Minnesota , that sought to improve exercise adherence by exerting more direct control over the environmental antecedents and consequences controlling exercise . Study 1 investigated the use of a personal trainer who called participants regularly and met them at their home or office at scheduled times for a walk . Study 2 investigated the effect of a lottery incentive for exercise adherence . In both studies , the effect of these manipulations was examined in the context of a 24-week st and ard behavioral weight control program with three supervised exercise sessions per week . Neither intervention achieved statistically significant improvements in exercise adherence compared to control conditions , perhaps due in part to the limited statistical power of the studies . Future studies should focus on better underst and ing the barriers to exercise and design ing behavioral interventions that address these barriers This study examined the relative contribution of contingent payment and worksite CO monitoring to the long-term maintenance of smoking abstinence .  Forty-seven hospital employees who had abstained from smoking for five days ( confirmed by CO analysis ) were r and omly assigned to one of three follow-up groups : ( a ) contingent payment/frequent monitoring ( n = 17 ) ; ( b ) noncontingent payment/frequent monitoring ( n = 16 ) ; or ( c ) non-contingent payment/infrequent monitoring ( n = 14 ) . Contingent payment combined with frequent CO monitoring delayed but did not ultimately prevent subjects relapse to smoking by the end of the six month follow-up . Contingent subjects maintained CO values less than or equal to 11 ppm significantly longer than did either the Non-contingent or the Control subjects ( p = .03 ) . CO monitoring alone had no effect on abstinence outcomes ; both Noncontingent and Control subjects showed high rates of early relapse BACKGROUND 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 r and omized , controlled trial . ( Clinical Trials.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 r and omly 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 A 2 × 2 r and omized , factorial pretest/posttest group design was used to evaluate the effectiveness of  self-help smoking cessation methods  at the worksite . The study investigated the effect of a multicomponent health education and skill intervention versus the effect of a monetary incentive to the employee for quitting . All employees received , in addition , a st and ardized self-help smoking cessation manual and maintenance manual . Following agreement to participate and a baseline smoking history , all participants were followed for 6 weeks , 6 months , and 12 months . Saliva was obtained for thiocyanate ( SCN ) analysis of smoking status . Of the estimated 2000 smokers at the site , 387 smokers were recruited . Employees were r and omly assigned to one of four groups . Results of this r and om trial indicate that those employees receiving a multicomponent program were most successful in quitting and remaining abstinent . The monetary incentive appears to have no effect on quit rate We report results from a pilot study examining the use of vouchers redeemable for retail items as incentives for smoking cessation during pregnancy and postpartum . Of 100 study -eligible women who were still smoking upon entering prenatal care , 58 were recruited from university-based and community obstetric practice s to participate in a smoking cessation study . Participants were assigned to either contingent or noncontingent voucher conditions . Vouchers were available during pregnancy and for 12 weeks postpartum . In the contingent condition , vouchers were earned for biochemically verified smoking abstinence . In the noncontingent condition , vouchers were earned independent of smoking status . Abstinence monitoring and associated voucher delivery was conducted daily during the initial 5 days of the cessation effort , gradually decreased to every other week antepartum , increased to once weekly during the initial 4 weeks postpartum , and then decreased again to every other week for the remaining 8 weeks of the postpartum intervention period . Contingent vouchers increased 7-day point-prevalence abstinence at the end-of-pregnancy ( 37 % vs. 9 % ) and 12-week postpartum ( 33 % vs. 0 % ) assessment s. That effect was sustained through the 24-week postpartum assessment ( 27 % vs. 0 % ) , which was 12 weeks after discontinuation of the voucher program . Total mean voucher earnings across antepartum and postpartum were 397 US dollars ( SD=414 US dollars ) and 313 US dollars ( SD=142 dollars ) in the contingent and noncontingent conditions , respectively . The magnitude of these treatment effects exceed levels typically observed with pregnant and recently postpartum smokers , and the maintenance of effects through 24 weeks postpartum extends the duration beyond those reported previously This study evaluated the impact of a year-long incentives-based worksite smoking-cessation program .  Nineteen moderate-sized worksites , employing a total of approximately 1100 smokers , were r and omized to Incentive or No Incentive conditions .  All identified smokers in the worksite were considered as subjects , whether or not they participated in the intervention . Analyses were conducted at both the worksite and individual level , and using both self-reported and biochemically vali date d cessation as endpoints . The incentive program did not significantly improve cessation rates at either the 1-year or 2-year follow-up assessment s. We conclude that more broadly focused interventions that also address worksite smoking policies , skills training , and cessation re sources , or programs that target additional risk factors are needed to substantially enhance quit rates Abstract Adults with any DSM-IV diagnosed mental illness smoke nearly half of the cigarettes consumed in the U.S. ( Lasser et al. 2000 ) . This study compared two smoking cessation interventions for persons with schizophrenia or other serious mental illness because national data suggests that : ( 1 ) they smoke at two to three times the rate of the general population ; ( 2 ) cessation interventions for this population are understudied ; ( 3 ) most cessation studies exclude persons with serious mental illness ; and ( 4 ) cessation results in public health care savings and disposable income savings for clients . This study included a large number of persons with serious mental illness ( N = 181 ) who were r and omly assigned to one of three groups : contingent reinforcement ( CR ) , CR plus nicotine patch ( 21 mg , CR+NRT ) for 16 weeks , and a minimal intervention , self-quit control group . These participants were followed for 36 weeks . CR was accomplished with escalating financial compensation for achieving and maintaining abstinence as verified by expired carbon monoxide ( CO ) . Quit rates , as measured by expired CO , were higher and discordant with saliva cotinine quit rates . Cotinine showed lower quit rates and small differences between intervention and control partici pants at weeks 20 and 36 . There was , however , evidence of reduced smoking and importantly , no evidence of psychiatric exacerbation 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 OBJECTIVES This study examined the effect of program format and incentives on participation and cessation in worksite smoking cessation programs . METHODS Twenty-four worksites were r and omized to 6 conditions that differed in cessation program format and the use of incentives . Programs were offered for 18 months in each worksite . A total of 2402 cigarette smokers identified at baseline were surveyed 12 and 24 months later to assess participation in programs and cessation . RESULTS A total of 407 ( 16.9 % ) of the smoker cohort registered for programs ; on the 12- and 24-month surveys , 15.4 % and 19.4 % of the cohort , respectively , reported that they had not smoked in the previous 7 days . Registration for programs in incentive sites was almost double that of no-incentive sites ( 22.4 % vs 11.9 % ) , but increased registration did not translate into significantly greater cessation rates . Program type did not affect registration or cessation rates . CONCLUSIONS Although incentives increase rates of registration in worksite smoking cessation programs , they do not appear to increase cessation rates .  Phone counseling seems to be at least as effective as group programs for promoting smoking cessation in worksites OBJECTIVES This study reports an efficacy trial of four work-site health promotion programs . It was predicted that strategies making use of behavioral counseling would produce a greater reduction in cardiovascular disease risk factors than screening and educational strategies . METHODS Twenty-eight work sites were r and omly allocated to a health risk assessment , risk factor education , behavioral counseling , or behavioral counseling plus incentives intervention . Participants were assessed before the intervention and at 3 , 6 , and 12 months . RESULTS Compared with the average of the health risk assessment and risk factor education conditions , there were significantly higher vali date d continuous smoking cessation rates and smaller increases in body mass index and estimated percentage of body fat in the two behavioral counseling conditions . The behavioral counseling condition was associated with a greater reduction in mean blood pressure than was the behavioral counseling plus incentives condition . On average among all groups , there was a short-term increase in aerobic capacity followed by a return to baseline levels . CONCLUSIONS Work-site interventions that use behavioral approaches can produce lasting changes in some cardiovascular risk factors and , if implemented routinely , can have a significant public health impact OBJECTIVE To evaluate the impact of a health fair and incentive program on the reduction of  serum cholesterol levels among participants . DESIGN Pretest-posttest control group design , with a 6-month delay between pretest and posttest screenings . SETTING Health fair program for employees of a large midwestern school district . PARTICIPANTS Volunteer sample among persons with serum cholesterol levels above 5.17 mmol/L ( 200 mg/dL ) . Participants were r and omly assigned to experimental ( N = 29 ) and comparison groups ( N = 34 ) . INTERVENTION The intervention consisted of four components : a health fair , health risk information , announcement of follow-up screening , and an incentive program . The incentive program consisted of five $ 100 cash prizes for reducing serum cholesterol levels by 20 % or below 5.17 mmol/L ( 200 mg/dL ) . The comparison group received only the first three components . MAIN OUTCOME MEASURE Serum cholesterol levels were measured by a venipuncture , nonfasting , chemical analysis process . RESULTS The experimental group showed a 13.2 % reduction in serum cholesterol levels , and the comparison group exhibited an 11.3 % reduction ( P < .05 ) . CONCLUSIONS A health fair , consisting of information on the level of risk and how to reduce risk , and announcement of follow-up screening and incentives can reduce the risk for cardiovascular disease Mailed invitations to participate in weight loss and /or smoking cessation correspondence programs to 31,400 households in a suburban community . Two programs were offered to r and omized subsets of households , a 6-month correspondence program costing + 5 and the same program for free but requiring a + 60 deposit to be refunded based on success in weight loss or smoking cessation . Overall , sign-up included 1,304 people for weight loss and 142 for smoking cessation . The + 5 program was about 5 times as popular as the incentive program .  Vali date d weight change after 6 months averaged about 4 lb for the + 5 program and 8 lb for the incentive program . Corresponding rates of smoking cessation were about 9 % and 20 % , respectively . We conclude that correspondence programs for the promotion of weight control and smoking cessation are potentially cost-effective methods for reaching individuals in the community at large , many of whom would not be interested in clinic-based programs . Issues meriting further research include recruitment , especially of smokers , and evaluation of the relative trade-offs in recruitment success versus efficacy of differing treatment approaches
target: Personal financial incentives can change habitual health-related behaviors and help reduce health inequalities .
  However , their role in reducing disease burden is potentially limited given current evidence that effects dissipate beyond three months post-incentive removal
background: OBJECTIVES Uncertainty remains about whether personal financial incentives could achieve sustained changes in health-related behaviors that would reduce the fast-growing global non-communicable disease burden .
  This review aims to estimate whether : i. financial incentives achieve sustained changes in smoking , eating , alcohol consumption and physical activity ; ii .
  effectiveness is modified by ( a ) the target behavior , ( b ) incentive value and attainment certainty , ( c ) recipients ' deprivation level .