University of Vermont

College of Medicine

Vermont Center on Behavior and Health

 

Publications & Press

VCBH publications reflect latest research on a wide range of topics related to drug abuse and other health behaviors, behavioral economics, and behavioral pharmacology.

Related Publications

Better Population Health Through Behavior Change in Adults - A Call to Action

Circulation, October 7, 2013

 

"It is abundantly clear that cardiovascular health is being lost from childhood through young adulthood and that the major reasons are adverse health behaviors related to diet, physical activity, healthy weight maintenance, and smoking.8 These adverse health behaviors are most prevalent among those with low socioeconomic status, little education, and limited access to health care. The elimination of these health risk behaviors would make it possible to prevent at least 80% of heart disease, stroke, and type 2 diabetes mellitus, and even 40% of cancers."

 

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Examining two different schedules of financial incentives for smoking cessation among pregnant women.

April 2, 2014

 

Higgins, S. T., Washio, Y., Lopez, A. A., Heil, S. H., Solomon, L. J., Lynch, M. E., ... & Bernstein, I. M. (2014). Examining Two Different Schedules of Financial Incentives for Smoking Cessation Among Pregnant Women. Preventive Medicine.
 

Cigarette smoking is the leading preventable cause of poor pregnancy outcomes in the U.S. and other industrialized countries, increasing risk for catastrophic pregnancy complications as well as adverse effects that extend into childhood and beyond. This study examines whether an efficacious voucher-based incentives intervention for decreasing smoking during pregnancy and increasing fetal growth could be improved without increasing costs. The strategy was to redistribute the usual incentives so that higher values were available early in the quit attempt.

 

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Access to Treatment for Opioid Dependence in Rural America: Challenges and Future Directions

February 5, 2014
Sigmon, S. C. (2014). Access to Treatment for Opioid Dependence in Rural America: Challenges and Future Directions. JAMA psychiatry, 71(4), 359-360.
 

Opioid abuse is reaching epidemic proportions in the United States. The consequences of opioid abuse and dependence include emergency department visits, premature death, HIV, hepatitis, criminal activity, lost workdays, and economic costs that in the United States exceed $56 billion annually. Agonist maintenance is the most efficacious treatment for opioid dependence and dramatically reduces morbidity, mortality, and spread of infectious disease. However, demand for opioid maintenance treatment far exceeds available capacity. Due to inadequate public funding, unfavorable zoning regulations, and requirements for comprehensive care in programs that increase their cost, an alarming number of methadone clinics have extensive waitlists. Further, while approval of buprenorphine in 2002 extended agonist maintenance into general medical practices, many areas of the country have an insufficient number of physicians willing to prescribe buprenorphine, in part due to concerns about induction logistics, reimbursement challenges, potential for medication diversion, lack of professional support for the clinicians, and lack of psychosocial services for patients. One result of the current situation is that opioid-dependent patients can remain on waitlists for years, during which they are at substantial risk for illicit drug use, criminal activity, infectious disease, overdose, and mortality.

 

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Examining the effects of initial smoking abstinence on response to smoking-related stimuli and response inhibition in a human laboratory model

November 17, 2013
 
Bradstreet, M. P., Higgins, S. T., McClernon, F. J., Kozink, R. V., Skelly, J. M., Washio, Y., ... & Parry, M. A. (2013). Examining the effects of initial smoking abstinence on response to smoking-related stimuli and response inhibition in a human laboratory model. Psychopharmacology, 1-14.

 

This study aims to investigate the effects of different durations of initial abstinence on sensitivity to smoking-related stimuli and response inhibition in the context of a larger battery of outcome measures.

 

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Maternal Body Mass Index Moderates the Influence of Smoking Cessation on Breast Feeding.

November 7, 2013
 
Vurbic, D., Higgins, S. T., McDonough, S. R., Skelly, J. M., & Bernstein, I. M. (2013). Maternal Body Mass Index Moderates the Influence of Smoking Cessation on Breast Feeding. Nicotine & Tobacco Research, ntt173.

 

Smoking cessation is associated with greater breast feeding in newly postpartum women, while being overweight or obese is associated with lower rates of breast feeding. The purpose of this study is to examine whether the increases in breast feeding associated with smoking cessation are moderated by maternal body mass index (BMI). To our knowledge, the interaction of maternal smoking status and overweight/obesity on breast feeding has not been previously reported. Results suggest that overweight/obesity attenuates the positive relationship between smoking abstinence and greater breast feeding among newly postpartum women.

 

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A Randomized, Double-blind Evaluation of Buprenorphine Taper Duration in Primary Prescription Opioid Abusers.

October 23, 2013
Sigmon, S. C., Dunn, K. E., Saulsgiver, K., Patrick, M. E., Badger, G. J., Heil, S. H., ... & Higgins, S. T. (2013). A Randomized, Double-blind Evaluation of Buprenorphine Taper Duration in Primary Prescription Opioid Abusers. JAMA psychiatry, 70(12), 1347-1354.
 

Although abuse of prescription opioids (POs) is a significant public health problem, few experimental studies have investigated the treatment needs of this growing population. This study represents a rigorous experimental evaluation of outpatient buprenorphine stabilization, brief taper, and naltrexone maintenance for treatment of PO dependence. Results suggest that a meaningful subset of PO-dependent outpatients may respond positively to a 4-week taper plus naltrexone maintenance intervention.

 

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Vulnerability to Smokeless Tobacco Use Among Those Dependent on Alcohol or Illicit Drugs.

September 30, 2013

 

Redner, R., White, T. J., Harder, V. S., & Higgins, S. T. (2014). vulnerability to smokeless tobacco Use among those Dependent on alcohol or illicit Drugs. Nicotine & Tobacco Research, 16(2), 216-223..

 

Smoking cessation is associated with greater breast feeding in newly postpartum women, while being overweight or obese is associated with lower rates of breast feeding. The purpose of this study is to examine whether the increases in breast feeding associated with smoking cessation are moderated by maternal body mass index (BMI). To our knowledge, the interaction of maternal smoking status and overweight/obesity on breast feeding has not been previously reported. Results suggest that overweight/obesity attenuates the positive relationship between smoking abstinence and greater breast feeding among newly postpartum women.

 

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Preventive Medicine Supplemental Issue on Incentives and Health

November 1, 2012

 

Volume 55, Supplement, Pages S1-S124 (1 November 2012) Incentives on Health
Edited by Stephen T. Higgins, Kenneth Silverman, Stacey C. Sigmon and Neal A. Naito

 

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Incentives and health: An introduction.

Stephen T. Higgins, Kenneth Silverman, Stacey C. Sigmon, Neal A. Naito
Volume 55, Supplement, 1 November 2012, Pages S2–S6
 

This Supplemental Issue of Preventive Medicine brings together contributions from an interdisciplinary group of nationally and internationally recognized scholars on various topics relevant to the effective use of financial incentives to improve health. These scholars discuss current knowledge across a wide range of topic areas, extending from basic aspects of neurobiology that may influence vulnerability to engaging in health-related risk behaviors and responsiveness to incentives to more philosophical issues of fairness and ethics regarding the use of incentives to improve health, with reviews and original studies on the empirical evidence for the effectiveness of incentives in promoting health-related behavior change taking center stage.

 

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Neural systems underlying motivated behavior in adolescence: Implications for preventive medicine

Jessica M. Richards, Rista C. Plate, Monique Ernst
Volume 55, Supplement, 1 November 2012, Pages S7–S16

Although a time of increased independence and autonomy, adolescence is also a time of vulnerabilities, through increased risk-taking and the emergence of psychopathology. Neurodevelopmental changes during this period may provide a neurobiological basis for this normative rise in deleterious behaviors. Thus, the objective of this review was to identify neurodevelopmental processes underlying the emergence of risk-taking and psychopathology in adolescence, and discuss implications of these findings for prevention.

 

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The neurobiology of reward and cognitive control systems and their role in incentivizing health behavior

Hugh Garavan, Karen Weierstall
Volume 55, Supplement, 1 November 2012, Pages S17–S23

 

This article reviews the neurobiology of cognitive control and reward processes and addresses their role in the treatment of addiction. We propose that the neurobiological mechanisms involved in treatment may differ from those involved in the etiology of addiction and consequently are worthy of increased investigation.

 

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The use of financial incentives in promoting smoking cessation

Stacey C. Sigmon, Mollie E. Patrick
Volume 55, Supplement, 1 November 2012, Pages S24–S32

 

Cigarette smoking is the leading cause of preventable death in the United States and world. Despite the availability of numerous therapies for smoking cessation, additional efficacious interventions are greatly needed. We provide a narrative review of published studies evaluating financial incentives for smoking cessation and discuss the parameters important for ensuring the efficacy of incentive interventions for smoking cessation.

 

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Financial incentives for smoking cessation among pregnant and newly postpartum women

Stephen T. Higgins, Yukiko Washio, Sarah H. Heil, Laura J. Solomon, Diann E. Gaalema, Tara M. Higgins, Ira M. Bernstein
Volume 55, Supplement, 1 November 2012, Pages S33–S40

 

Smoking during pregnancy is the leading preventable cause of poor pregnancy outcomes in the U.S., causing serious immediate and longer-term adverse effects for mothers and offspring. In this report we provide a narrative review of research on the use of financial incentives to promote abstinence from cigarette smoking during pregnancy, an intervention wherein women earn vouchers exchangeable for retail items contingent on biochemically-verified abstinence from recent smoking.

 

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Public opinion about financial incentives for smoking cessation

James D. Park, Nandita Mitra, David A. Asch
Volume 55, Supplement, 1 November 2012, Pages S41–S45

 

The aim of this study is to assess public support for a smoking cessation policy involving financial incentives.

 

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Maintenance of reinforcement to address the chronic nature of drug addiction

Kenneth Silverman, Anthony DeFulio, Sigurdur O. Sigurdsson
Volume 55, Supplement, 1 November 2012, Pages S46–S53
 

Drug addiction can be a chronic problem. Abstinence reinforcement can initiate drug abstinence, but as with other treatments many patients relapse after the intervention ends. Abstinence reinforcement can be maintained to promote long-term drug abstinence, but practical means of implementing long-term abstinence reinforcement are needed.

 

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Using incentives to reduce substance use and other health risk behaviors among people with serious mental illness

Jennifer W. Tidey
Volume 55, Supplement, 1 November 2012, Pages S54-S60
 

Serious mental illness (SMI) is associated with high rates of tobacco and other drug dependence, poor treatment compliance, obesity and low levels of physical activity, which have severe medical and psychosocial consequences. Interventions that effectively reduce these health risk behaviors among people with SMI are urgently needed.

 

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Financial incentives and weight control

Robert W. Jeffery
Volume 55, Supplement, 1 November 2012, Pages S61–S67
 

This paper reviews research studies evaluating the use of financial incentives to promote weight control conducted between 1972 and 2010. It provides an overview of behavioral theories pertaining to incentives and describes empirical studies evaluating specific aspects of incentives. Research on financial incentives and weight control has a history spanning more than 30 years. Early studies were guided by operant learning concepts from Psychology, while more recent studies have relied on economic theory. Both theoretical orientations argue that providing financial rewards for losing weight should motivate people to engage in behaviors that produce weight loss. Empirical research has strongly supported this idea. However, results vary widely due to differences in incentive size and schedule, as well as contextual factors. Thus, many important questions about the use of in- centives have not yet been clearly answered. Weight-maintenance studies using financial incentives are particularly sparse, so that their long-term efficacy and thus, value in addressing the public health problem of obesity is unclear. Major obstacles to sustained applications of incentive in weight control are funding sources and acceptance by those who might benefit.

 

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Empirical observations on longer-term use of incentives for weight loss

Leslie K. John, George Loewenstein, Kevin G. Volpp
Volume 55, Supplement, 1 November 2012, Pages S68–S74
 

Behavioral economic-based interventions are emerging as powerful tools to help individuals accomplish their own goals, including weight loss. Deposit contract incentive systems give participants the opportunity to put their money down toward losing weight, which they forfeit if they fail to lose weight; lottery incentive systems enable participants to win money if they attain weight loss goals. In this paper, we pool data from two prior studies to examine a variety of issues that unpublished data from those studies allow us to address. First, examining data from the deposit contract treatments in greater depth, we investigate factors affecting deposit frequency and size, and discuss possible ways of increasing deposits. Next, we compare the effectiveness of both deposit contract and lottery interventions as a function of participant demographic characteristics. These observations may help to guide the design of future, longer-term, behavioral economic-based interventions.

 

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Coronary heart disease as a case study in prevention: Potential role of incentives

Philip. A. Ades, Diann E. Gaalema
Volume 55, Supplement, 1 November 2012, Pages S75–S79
 

Coronary atherosclerosis is a complex entity with behavioral, genetic and environmental antecedents. Most risk factors for coronary heart disease have a behavioral component. These include tobacco use, hyperlipidemia, hypertension, obesity, insulin resistance, diabetes and physical inactivity. The role of monetary incentives to encourage healthful behaviors related to the prevention and treatment of coronary heart disease has received little attention. In this review, the potential role of monetary incentives to prevent or treat coronary heart disease is discussed. In particular, the potential role of providing incentives for patients to participate in cardiac rehabilitation (CR), a multi-risk intervention, is highlighted.

 

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Impact of a pay for performance program to improve diabetes care in the safety net

Alyna T. Chien, Diana Eastman, Zhonghe Li, Meredith B. Rosenthal
Volume 55, Supplement, 1 November 2012, Pages S80–S85
 

The objective of this study is to evaluate the impact of a “piece-rate” pay for performance (P4P) program aimed at improving diabetes care processes, outcomes and related healthcare utilization for patients enrolled in a not-for-profit Medicaid-focused managed care plan.

 

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The use of incentives to reinforce medication adherence

Anthony DeFulio, Kenneth Silverman
Volume 55, Supplement, 1 November 2012, Pages S86–S94
 

Poor medication adherence is a longstanding problem, and is especially pertinent for individuals with chronic conditions or diseases. Adherence to medications can improve patient outcomes and greatly reduce the cost of care. The purpose of the present review is to describe the literature on the use of incentives as applied to the problem of medication adherence.

 

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Promoting healthy behaviours and improving health outcomes in low and middle income countries: A review of the impact of conditional cash transfer programmes

Meghna Ranganathan, Mylene Lagarde
Volume 55, Supplement, 1 November 2012, Pages S95–S105
 

To provide an overview of Conditional Cash Transfer (CCT) programmes in low and middle income countries and present the evidence to date on their contribution to improvements in health and the encouragement of healthy behaviours.

 

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Incentives to promote family planning

Sarah H. Heil, Diann E. Gaalema, Evan S. Herrmann
Volume 55, Supplement, 1 November 2012, Pages S106–S112
 

Over the past 60 years, population control has become an increasingly urgent issue worldwide as a growing population strains already limited resources. The use of financial incentives to promote family planning is an innovative approach that has potential to make a contribution to efforts to better manage population growth. This report reviews eight studies that examined the effect of incentives on family planning.

 

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Controlling health care costs in the military: The case for using financial incentives to improve beneficiary personal health indicators

Neal A. Naito, Stephen T. Higgins
Volume 55, Supplement, 1 November 2012, Pages S113–S115
 

The objective of this study is to provide insight on the feasibility and utility of implementing a broad based incentive program for health within the Military Health System (MHS).

 

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Optimizing financial incentives to improve health among military personnel: Differences by pay grade and across branches

Jody L. Sindelar, Nicholas Torsiello
Volume 55, Supplement, 1 November 2012, Pages S116–S117
 

The focus of this volume is to provide information on financial incentives to develop and sustain habits that can improve the health of military personnel. There are several reasons to use financial incentives in the military, including that the military already successfully relies on incentives to recruit and retain personnel. Furthermore, substantial evidence already indicates that financial incentives can improve health habits in the civilian population. They have been shown to reduce the use of illicit drugs (e.g., Higgins et al., 2008; Higgins et al., 2004; Lussier et al., 2006), help smokers to quit smoking (Heil et al., 2008; Volpp et al., 2006, 2009a; Sindelar, 2008), encourage others to lose weight (John et al., 2011; Volpp et al., 2008a) and address other health habits (Volpp et al., 2008b). However, research is needed in military populations to assess the effectiveness and cost-benefit of incentive systems as well as to adapt them to specifics of the military.

 

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Fairness and wellness incentives: What is the relevance of the process-outcome distinction?

Jody L. Sindelar, Nicholas Torsiello
Volume 55, Supplement, 1 November 2012, Pages S118–S123

 

To determine whether the commonly drawn distinction between the fairness of incentives targeting behavioral processes (or effort) and those targeting outcomes (or achievement) provide suitable grounds for favoring either approach in healthcare research, policy and practice.

 

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Last modified April 10 2014 10:07 PM