title: Contingent reinforcement for reduced breath carbon monoxide levels: target-specific effects on cigarette smoking. A randomized, controlled trial of financial incentives for smoking cessation. Monetary versus nonmonetary incentives for TB skin test reading among drug users. Drug users' adherence to a 6-month vaccination protocol: effects of motivational incentives. Results of a year-long incentives-based worksite smoking-cessation program. Randomised controlled trial using social support and financial incentives for high risk pregnant smokers: Significant Other Supporter (SOS) program Tuberculosis screening and compliance with return for skin test reading among active drug users. The Healthy Worker Project: a work-site intervention for weight control and smoking cessation. A worksite smoking intervention: a 2 year assessment of groups, incentives and self-help. A randomized study of financial incentives to increase physical activity among sedentary older adults. Improving influenza vaccination rates in the workplace: a randomized trial. Correspondence programs for smoking cessation and weight control: a comparison of two strategies in the Minnesota Heart Health Program.
abstract: This study determined the effects on smoking behavior of providing contingent reinforcement for  nonsmoking  versus  reduced smoking  afternoon breath carbon monoxide ( CO ) target levels . Twenty-eight hired chronic smoker volunteers were r and omly assigned to one of three experimental conditions during a 10-day intervention : ( a ) 8 ppm target CO , $ 5 per day incentive ( n = 11 ) ; ( b ) 16 ppm target CO , $ 4 per day incentive ( n = 8) ; or ( c ) 8 ppm target CO , no incentive ( n = 9 ) . Both payment groups showed significantly lower CO levels and greater amounts of daytime smoking reduction than the no-pay group . A specific effect of CO target was also seen ; 45 % of subjects in the 8 ppm group compared with 0 % of subjects in the 16 ppm target and no-pay groups produced average afternoon CO levels of 8.5 ppm or lower during the intervention . Average levels of CO and smoking reduction did not differ for the two paid groups , however , because some subjects in the 8 ppm group failed to reduce CO sufficiently to contact the reinforcer . Contingent reinforcement based on expired air CO levels can exercise powerful and precise ( target-specific ) control over smoking behavior , but there may be individual differences in ability to meet reinforcement contingencies if difficult targets are introduced abruptly 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 . BACKGROUND In a prior study , we reported that monetary incentives were effective in increasing return for tuberculosis ( TB ) skin test reading . The purpose of this study was to compare the effects of monetary versus nonmonetary incentives and a theory-based educational intervention on return for TB skin test reading in a sample of newly recruited active injection and crack cocaine users , and to determine the prevalence of TB infection in this sample . METHODS Active injection drug and /or crack cocaine users ( n = 1,078 ) , recruited using street outreach techniques , were skin tested for TB . They were r and omly assigned to 1 of 5 experimental treatment conditions : $ 10 cash , grocery store coupons , bus tokens/fast-food coupons , motivational education , or usual encouragement to return . Nonmonetary incentives had a $ 10 value , and all incentives were provided at return for skin test reading . RESULTS Ninety-five percent of those who received $ 10 returned for skin test reading compared to 86 % of those who received grocery store coupons and 83 % of those who received either bus tokens or fast-food coupons . In contrast , only 47 % of those who received the educational session and only 49 % of those who received usual encouragement returned for skin test reading . The prevalence of a positive tuberculin test was 21 % , and was similar for crack cocaine and injection drug users . CONCLUSIONS Nonmonetary and monetary incentives dramatically increased the return rate for TB skin test reading among drug users who are at high risk of TB infection . Nonmonetary incentives were somewhat less effective than monetary incentives Vaccines represent a new and promising avenue of treatment for drug abuse but pose new medication adherence challenges due to prolonged and widely spaced administration schedules . This study examined effects of prize-based incentives on retention and medication adherence among 26 cocaine users involved in a 6-month hepatitis B vaccination series . Participants could meet with research staff weekly for 24 weeks and receive 7 injections containing either the Hepatitis B vaccine or a placebo . All participants received $ 10 at each weekly visit ( maximum of $ 240 ) . Those r and omly assigned to the incentive program received additional monetary payments on an escalating schedule for attendance at weekly monitoring and vaccination visits with maximum possible earnings of $ 751 . Group attendance diverged after study week 8 with attendance better sustained in the incentive than control group ( group by time interaction , p=.035 ) . Overall percent of weekly sessions attended was 82 % for incentive versus 64 % for control ( p=.139 ) . Receiving all scheduled injections were 77 % of incentive versus 46 % of control participants ( p=.107 ) . A significantly larger percentage ( 74 % versus 51 % ; p=.016 ) of injections were received by incentive versus control participants on the originally scheduled day . Results suggest that monetary incentives can successfully motivate drug users to attend sessions regularly and to receive injected medications in a more reliable and timely manner than may be seen under usual care procedures . Thus , incentives may be useful for addressing adherence and allowing participants to reap the full benefits of newly developed medications 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 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 assessed the independent and combined effects of different levels of monetary incentives and a theory-based educational intervention on return for tuberculosis ( TB ) skin test reading in a sample of active injection drug and crack cocaine users . Prevalence of TB infection in this sample was also determined . METHODS Active or recent drug users ( n = 1004 ) , recruited via street outreach techniques , were skin tested for TB . They were r and omly assigned to 1 of 2 levels of monetary incentive ( $ 5 and $ 10 ) provided at return for skin test reading , alone or in combination with a brief motivational education session . RESULTS More than 90 % of those who received $ 10 returned for skin test reading , in comparison with 85 % of those who received $ 5 and 33 % of those who received no monetary incentive . The education session had no impact on return for skin test reading . The prevalence of a positive tuberculin test was 18.3 % . CONCLUSIONS Monetary incentives dramatically increase the return rate for TB skin test reading among drug users who are at high risk of TB infection OBJECTIVES A r and omized trial was conducted to evaluate the effectiveness of a work-site health promotion program in reducing obesity and the prevalence of cigarette smoking . METHODS Thirty-two work sites were r and omized to treatment or no treatment for 2 years . Treatment consisted of health education classes combined with a payroll-based incentive system . Evaluation was based on cohort and cross-sectional surveys . RESULTS Of 10,000 total employees in treatment work sites , 2041 and 270 participated in weight control and smoking cessation programs , respectively .  Weight losses averaged 4.8 lbs , and 43 % of smoking participants quit . Net 2-year reductions in smoking prevalence in treatment vs control work sites were 4.0 % and 2.1 % in cross-sectional and cohort surveys , respectively . No treatment effect was found for weight . Treatment effects for smoking prevalence and weight were both positively correlated with participation rates in the intervention programs ( r = .45 for smoking and r = .55 for weight ) . CONCLUSIONS This work-site health promotion program was effective in reducing smoking prevalence at a cost that is believed to make the investment worthwhile Sixty-three companies in the Chicago area were recruited to participate in a worksite smoking cessation program . Participants in each worksite received a television program and newspaper supplement ( part of a community-wide media campaign ) , and one of three conditions : ( 1 ) self-help manuals alone ( M ) , ( 2 ) self-help manuals and incentives for 6 months ( IM ) or ( 3 ) maintenance manuals , incentives and cognitive-behavioral support groups for 6 months ( GIM ) . Results at the 2 year assessment are examined using a r and om-effects regression model . In addition , various definitions of quit-rate commonly used in smoking cessation research are explored and the advantages of using a public health approach in the worksite are examined OBJECTIVE Less than half of all U.S. adults meet public health recommendations for physical activity , and even fewer older adults ( aged 50 years and over ) are sufficiently active . Because inactivity increases the risk of costly medical complications , successful efforts to increase physical activity among older adults may potentially be cost-effective . We sought to test if financial incentives for walking could increase physical activity among sedentary older adults . METHODS We conducted a 4-week r and omized controlled study using pedometers .  A total of 51 adults age 50 + from the Raleigh-Durham area of North Carolina participated in the study in April-May 2007 . Individuals were r and omized into one of two arms . The control group received a fixed payment of $ 75 ; the intervention group received a fixed payment of $ 50 plus up to $ 25 more per week depending on the number of weekly aerobic minutes  , defined as 10 + minutes of continuous walking or jogging . RESULTS The control group logged 2.3 h per week , on average . The intervention group logged 4.1 h per week and received an additional weekly payment of $ 17.50 , on average . CONCLUSION Modest financial incentives tied to aerobic minutes are an effective , and potentially cost-effective , approach for increasing physical activity among sedentary older adults BACKGROUND To minimize absenteeism result ing from influenza , employers frequently offer on-site  influenza vaccination to employees . Yet the level of uptake of vaccine is low among working adults . This study was design ed to increase workplace influenza vaccination rates by offering both a choice of intranasal ( LAIV ) and injectable ( TIV ) influenza vaccines to eligible employees , and an incentive for being vaccinated , and by increasing awareness of the vaccine clinic . DESIGN This study used a stratified r and omized cluster trial . SETTING / PARTICIPANTS A total of 12,222 employees in 53 U.S. companies with previous influenza vaccine clinics were examined . INTERVENTIONS Control sites advertised and offered vaccine clinics as previously done . Choice sites offered LAIV or TIV and maintained their previous advertising level but promoted the choice of vaccines . Choice Plus sites increased advertising and promoted and offered a choice of vaccines and a nominal incentive . MAIN OUTCOME MEASURES These included vaccination rates among eligible employees . Hierarchic linear modeling ( HLM ) was used to determine factors associated with vaccination . RESULTS The overall vaccination rate increased from 39 % in 2007 - 2008 to 46 % in 2008 - 2009 ( p<0.001 ) . The difference in vaccination rates for LAIV was 6.5 % for Choice versus Control and 9.9 % for Choice Plus versus Control ( both p<0.001 ) . Rates of TIV increased by 15.9 percentage points in the Choice Plus arm versus Control for workers aged > or = 50 years ( p=0.024 ) . Rates of TIV did not change in workers aged 18 - 49 years in either intervention arm or in workers aged > or = 50 years in the Choice arm . In HLM analyses , factors significantly associated with increased vaccination were older age , female gender , previous company vaccination rate , and the Choice Plus intervention . CONCLUSIONS An incentive for vaccination , an intensified advertising campaign , and offering a choice of influenza vaccines improved vaccination rates in the workplace 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: 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: 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 .