Remote Patient Monitoring and Incentives to Support Smoking Cessation Among Pregnant and Postpartum Medicaid Members: Three Randomized Controlled Pilot Studies.

Background: Smoking rates among low-income individuals, including those eligible for Medicaid, have not shown the same decrease that is observed among high-income individuals. The rate of smoking among pregnant women enrolled in Medicaid is almost twice that among privately insured women, which leads to significant disparities in birth outcomes and a disproportionate cost burden placed on Medicaid. Several states have identified maternal smoking as a key target for improving birth outcomes and reducing health care expenditures; however, efficacious, cost-effective, and feasible cessation programs have been elusive.

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

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).

A Pragmatic Trial of E-Cigarettes, Incentives, and Drugs for Smoking Cessation.

Background: Whether financial incentives, pharmacologic therapies, and electronic cigarettes (e-cigarettes) promote smoking cessation among unselected smokers is unknown.

Methods: We randomly assigned smokers employed by 54 companies to one of four smoking-cessation interventions or to usual care. Usual care consisted of access to information regarding the benefits of smoking cessation and to a motivational text-messaging service.

Attitudes on technological, social, and behavioral economic strategies to reduce cellphone use among teens while driving.

Objective: The majority of U.S. teens admit to handheld cellphone use while driving, an increasingly common cause of crashes.

Financial Incentives for Chronic Disease Management: Results and Limitations of 2 Randomized Clinical Trials With New York Medicaid Patients.

Purpose: To identify whether financial incentives promote improved disease management in Medicaid recipients diagnosed with hypertension or diabetes, respectively.

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

Setting And Participants: Between 2013 and 2016, New York State Medicaid managed care members diagnosed with hypertension (N = 920) or with diabetes (N = 959).

Time to selected quit date and subsequent rates of sustained smoking abstinence.

In efforts to combat tobacco dependence, most smoking cessation programs offer individuals who smoke the choice of a target quit date. However, it is uncertain whether the time to the selected quit date is associated with participants' chances of achieving sustained abstinence. In a pre-specified secondary analysis of a randomized clinical trial of four financial-incentive programs or usual care to encourage smoking cessation (Halpern et al.

Heterogeneity in the Effects of Reward- and Deposit-based Financial Incentives on Smoking Cessation.

Rationale: Targeting different smoking cessation programs to smokers most likely to quit when using them could reduce the burden of lung disease.

Objectives: To identify smokers most likely to quit using pure reward-based financial incentives or incentive programs requiring refundable deposits to become eligible for rewards.

Methods: We conducted prespecified secondary analyses of a randomized trial in which 2,538 smokers were assigned to an $800 reward contingent on sustained abstinence from smoking, a refundable $150 deposit plus a $650 reward, or usual care.

Financial incentives to promote extended smoking abstinence in opioid-maintained patients: a randomized trial.

Background And Aims: Prior studies by our group demonstrated the efficacy of a brief but intensive behavioral intervention for producing initial smoking abstinence among opioid-dependent patients. In the present study, our aim was to promote longer-duration abstinence in this population. Following an initial 2-week incentive intervention for smoking abstinence, we examined whether a 10-week maintenance arm involving continuation of contingent reinforcement will produce greater smoking abstinence than a similar duration of noncontingent reinforcement.

Randomized trial of four financial-incentive programs for smoking cessation.

Background: Financial incentives promote many health behaviors, but effective ways to deliver health incentives remain uncertain.

Methods: We randomly assigned CVS Caremark employees and their relatives and friends to one of four incentive programs or to usual care for smoking cessation. Two of the incentive programs targeted individuals, and two targeted groups of six participants.

Preference-adaptive randomization in comparative effectiveness studies.

Background: Determination of comparative effectiveness in a randomized controlled trial requires consideration of an intervention's comparative uptake (or acceptance) among randomized participants and the intervention's comparative efficacy among participants who use their assigned intervention. If acceptance differs across interventions, then simple randomization of participants can result in post-randomization losses that introduce bias and limit statistical power.

Methods: We develop a novel preference-adaptive randomization procedure in which the allocation probabilities are updated based on the inverse of the relative acceptance rates among randomized participants in each arm.

Characterizing opioid withdrawal during double-blind buprenorphine detoxification.

Background: Prescription opioid (PO) abuse has become an urgent public health issue in the United States. Detoxification is one important treatment option, yet relatively little is known about the time course and severity of opioid withdrawal during buprenorphine detoxification.

Methods: This is a secondary analysis of data from a randomized, placebo-controlled, double-blind evaluation of 1, 2, and 4-week outpatient buprenorphine tapers among primary prescription opioid (PO) abusers.

A randomized, double-blind evaluation of buprenorphine taper duration in primary prescription opioid abusers.

Importance: Although abuse of prescription opioids (POs) is a significant public health problem, few experimental studies have investigated the treatment needs of this growing population.

Objective: To evaluate, following brief stabilization with a combination of buprenorphine hydrochloride and naloxone hydrochloride dihydrate, the relative efficacy of 1-, 2-, and 4-week buprenorphine tapering regimens and subsequent naltrexone hydrochloride therapy in PO-dependent outpatients.

Design, Setting, And Participants: A double-blind, 12-week randomized clinical trial was conducted in an outpatient research clinic.

Characterizing and improving HIV and hepatitis knowledge among primary prescription opioid abusers.

Background: The high rates of HIV and Hepatitis C (HCV) infection among opioid abusers is a serious public health problem, and efforts to enhance knowledge regarding risks for HIV/hepatitis infection in this population are important. Abuse of prescription opioids (POs), in particular, has increased substantially in the past decade and is associated with increasing rates of injection drug use and HCV infection.

Methods: This study describes the effects of a brief HIV/HCV educational intervention delivered in the context of a larger randomized, double-blind clinical trial evaluating the relative efficacy of 1-, 2-, and 4-week outpatient buprenorphine tapers and subsequent oral naltrexone maintenance for treating PO dependence.

Medicaid incentive programs to encourage healthy behavior show mixed results to date and should be studied and improved.

In September 2011 the Centers for Medicare and Medicaid Services awarded $85 million in grants to ten states to test financial incentive programs to encourage healthy behavior among Medicaid enrollees with chronic diseases. There is little published evidence about the effectiveness of such incentives within the Medicaid program. We evaluated the available research from three earlier Medicaid incentive programs and found mixed results.

Contingency management for behavior change: applications to promote brief smoking cessation among opioid-maintained patients.

Cigarette smoking is highly prevalent among patients who are being treated for opioid-dependence, yet there have been limited scientific efforts to promote smoking cessation in this population. Contingency management (CM) is a behavioral treatment that provides monetary incentives contingent upon biochemical evidence of drug abstinence. This paper discusses the results of two studies that utilized CM to promote brief smoking cessation among opioid-maintained patients.

D-amphetamine, nicotine, and haloperidol produce similar disruptions in spatial and nonspatial temporal discrimination procedures.

Two different and generally noncomplimentary disruptions of timing by pharmacological agents have been found. One is a lateral shift of the psychophysical curve for time, indicating a subjective shortening or lengthening of time, whereas the other is a flattening of the curve and decrease in temporal accuracy. This study assessed the role of a methodological variation in producing this discrepancy.

Disruptive effects of stimulus intensity on two variations of a temporal discrimination procedure.

Previous reports using stimulus intensity changes to disrupt temporal discrimination have shown shifts in the psychophysical curve for time, while studies using other disruptors have shown a flattening of the curve. The current study investigated the impact of increases and decreases in stimulus intensity on temporal discrimination in pigeons, to determine if a flattening of the curve could be extended to this disruptor. The brightness of the sample to be timed was manipulated under two procedural variations, in which the response alternatives were differentiated by color or location.

ABA chronic dosing of D-amphetamine produces differential drug effects in two variants of a temporal discrimination procedure in pigeons.

The impact of two procedural variants of the matching to sample of duration procedure on the effects of chronically administered D-amphetamine on temporal discrimination was assessed. The task consisted of subjects classifying durations as short or long to produce a psychophysical curve for time. Procedural variations included response alternatives being defined by either the location of the response keys (Location), or by their color (Color).

Effects of acute and chronic d-amphetamine on two variations of a temporal discrimination procedure.

This study assessed temporal discrimination using a procedure in which pigeons classified temporal intervals as short or long based on different responses following visually presented stimulus durations. For the Location group, response alternatives were defined by the location of response keys, whereas for the Color group response alternatives were defined by key color. Temporal parameters were derived from psychophysical curves for time, and the impact of d-amphetamine was determined during acute and chronic dosing.

Manipulating pre-feed, density of reinforcement, and extinction produces disruption in the Location variation of a temporal discrimination task in pigeons.

When pharmacological and non-pharmacological agents are used to disrupt temporal discrimination, two major findings have emerged in the literature. One result reveals lateral shifts of the psychophysical curve for time due to disruptors, while the other is a decrease in accuracy for classifying short and long intervals and a flattening of the psychophysical curve. These results represent a discrepancy within the timing literature that requires clarification.

Within-session patterns in variable-interval schedule performance: Variation with deprivation level.

Previous research has shown that patterns in operant responding may change within the course of individual experimental sessions. The proper interpretation of such changes is controversial. At least one source of this controversy may lie in unstated experimental practices across laboratories, as published reports often have failed to detail important particulars of deprivation operations.

Effects of amphetamine on differential reinforcement of low rates of responding.

A multiple differential reinforcement of low rate 8 s discrete-trial, differential reinforcement of low rate 8 s free-operant procedure was used to investigate the effects of D-amphetamine on interval timing in pigeons. On the discrete trial differential reinforcement of low rate early responses terminated the trial; on the free-operant differential reinforcement of low rate early responses reset the reinforcement timer but had no other effects. Frequency distributions of log interevent times for responses following reinforcement on both the free-operant and discrete-trial components showed a single-peaked distribution.