Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), PATIENT/CONSUMER, Patient Reminder/Invitation, Educational Material, Telephone Support, Parent Engagement, Incentives

Intervention Description: The study aimed to demonstrate the feasibility and acceptability of Quit4baby for women currently enrolled in Text4baby, a perinatal health text messaging program.

Intervention Results: Most participants responded to the program favorably. Highly rated aspects included the content of the program, skills taught within the program, and encouragement and social support provided by the program. Participants reported that the program was helpful in quitting, that the program gave good ideas on quitting, and that they would recommend the program to a friend. Suggestions for improvement included increasing the message dose and making the quitpal more interactive.

Conclusion: This pilot test provides support for the feasibility and acceptability of Quit4baby. Future studies are needed to assess whether Quit4baby is effective for smoking cessation during pregnancy.

Study Design: Single group pre-post test evaluation pilot

Setting: Electronic phone application

Population of Focus: Women over 18 years of age who are currently pregnant, English proficient, that are currently smoking or smoked in the past 2 weeks

Data Source: Telephone surveys, retrospective computer records review of engagement with the technology

Sample Size: 20

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Incentives

Intervention Description: The Centers for Medicare and Medicaid Services' Meaningful Use (MU) of Electronic Health Record (EHR) Incentive Program could increase rates of smoking assessment and cessation assistance among vulnerable populations. This study examined whether smoking status assessment, cessation assistance, and odds of being a current smoker changed after Stage 1 MU implementation.

Intervention Results: Non-pregnant patients had decreased odds of current smoking over time; odds for all other outcomes increased except for medication orders from 2010 to 2012. Among pregnant patients, odds of assessment and counseling increased across all years. Odds of discussing or ordering of cessation medications increased from 2010 compared with the other 2 study years; however, medication orders alone did not change over time, and current smoking only decreased from 2010 to 2012. Compared with non-pregnant patients, a lower percentage of pregnant patients were provided counseling.

Conclusion: Findings suggest that incentives for MU of EHRs increase the odds of smoking assessment and cessation assistance, which could lead to decreased smoking rates among vulnerable populations. Continued efforts for provision of cessation assistance among pregnant patients is warranted.

Study Design: Quasi experimental cross-sectional (Non- randomized evaluation of a policy change)

Setting: Community health centers (CHC)

Population of Focus: All smokers over 18 years of age with at least one primary care visit to one of the study CHCs in 2010, 2012, or 2014 as well as a subset of pregnant women

Data Source: Electronic health records

Sample Size: Review of health records for 16,802 participants in 2010, 17,631 in 2012 and 18,110 in 2014

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Participation Incentives, Quality Improvement/Practice-Wide Intervention, Expert Support (Provider), Modified Billing Practices, Data Collection Training for Staff, Screening Tool Implementation Training, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Engagement with Payers, STATE, POPULATION-BASED SYSTEMS, Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: The Vermont Child Health Improvement Program (VCHIP) at the University of Vermont collaborated with state agencies and professional societies to conduct a survey of Vermont pediatric and family medicine practices regarding their developmental screening and autism screening processes, referral patterns, and barriers. The survey was administered in 2009 to 103 primary care practices, with a 65% response rate (89% for pediatric practices, 53% for family medicine practices).

Intervention Results: The survey results revealed that while 88% of practices have a specific approach to developmental surveillance and 87% perform developmental screening, only 1 in 4 use structured tools with good psychometric properties. Autism screening was performed by 59% of practices, with most using the M-CHAT or CHAT tool and screening most commonly at the 18-month visit. When concerns were identified, 72% referred to a developmental pediatrician and over 50% to early intervention. Key barriers to both developmental and autism screening were lack of time, staff, and training. Over 80% of practices used a note in the patient chart to track at-risk children, and most commonly referred to child development clinics, audiology, early intervention, and pediatric specialists.

Conclusion: The survey conducted by VCHIP revealed wide variation in developmental and autism screening practices among Vermont pediatric and family medicine practices. While most practices conduct some form of screening, there is room for improvement in the use of validated tools, adherence to recommended screening ages, and implementation of office systems for tracking at-risk children. The survey identified knowledge gaps and barriers that can be addressed through quality improvement initiatives, which most respondents expressed interest in participating in.

Study Design: QE: pretest-posttest

Setting: Pediatric and family medicine practices in Vermont

Population of Focus: Children up to age 3

Data Source: Child medical record; ProPHDS Survey

Sample Size: Chart audits at 37 baseline and 35 follow-up sites (n=30 per site) Baseline charts (n=1381) - Children 19-23 months (n=697) - Children 31-35 months (n=684) Follow-up charts (n=1301) - Children 19-23 months (n=646) - Children 31-35 months (n=655)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Incentives, Farmers Markets

Intervention Description: Data were collected in 2015, using a before-and-after study design. At the farmers' market, a convenience sample of SNAP recipients was recruited for a survey and a 4-week telephone follow-up survey. Differences between the 2 surveys in food security and F&V intake were tested using the Wilcoxon signed-rank test.

Intervention Results: Follow-up surveys were completed with 138 (40%) of the 339 baseline participants. Median F&V consumption increased from 2.82 times per day to 3.29 times per day (median, interquartile range 1.48-3.99 and 3.28-5.02, respectively, P = .002). The percentage of DUFB participants who were food secure increased by 15% (P = .001).

Conclusion: The present results add to the growing literature indicating farmers' market incentives are associated with increased F&V consumption and decreased food insecurity.

Study Design: Before and after study design

Setting: Farmers Market

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Participation Incentives, Modified Billing Practices, Data Collection Training for Staff, Screening Tool Implementation Training, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Engagement with Payers, STATE, POPULATION-BASED SYSTEMS, Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: Early identification of children with developmental and behavioral delays is important in primary care practice, and well-child visits provide an ideal opportunity to engage parents and perform periodic screening. Integration of this activity into office process and flow is necessary for making screening a routine and consistent part of primary care practice.

Intervention Results: In the North Carolina Assuring Better Child Health and Development Project, careful attention to and training for office process has resulted in a significant increase in screening rates to >70% of the designated well-child visits. The data from the project prompted a change in Medicaid policy, and screening is now statewide in primary practices that perform Early Periodic Screening, Diagnosis, and Treatment examinations.

Conclusion: Although there are features of the project that are unique to North Carolina, there are also elements that are transferable to any practice or state interested in integrating child development services into the medical home.

Study Design: QE: pretest-posttest

Setting: Partnership for Health Management, a network within Community Care of North Carolina

Population of Focus: Children ages 6 to 60 months receiving Early Periodic Screening, Diagnosis, and Treatment services

Data Source: Child medical record

Sample Size: Unknown number of charts – screening rates tracked in 2 counties (>20,000 screens by 2004)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Lactation Consultant, Provision of Breastfeeding Item, Group Education, Incentives, Professional Support, COMMUNITY, Individual Supports,

Intervention Description: The Canada Prenatal Nutrition Program (CPNP) aims to improve birth outcomes and promote and support breastfeeding among vulnerable women. Using charitable donations, the Parkdale Parents' Primary Prevention Project (5Ps) CPNP provides postnatal lactation support to its clients in addition to standard prenatal services (group education workshops, individualized support from public health nurses and dieticians, community referrals, snacks, two public transit tokens, grocery store gift card, self-serve food bank, and childcare). This lactation support program was designed and implemented by 5Ps CPNP staff and includes three components: 1) gift package of breastfeeding and infant care supplies; 2) IBCLC visits within 48 h of referral; and 3) double electric breast pump.

Intervention Results: Ninety-one percent of participants were born outside of Canada; 55% had incomes below the Low-Income Cut-Off; and 55% reported food insecurity. All participants initiated breastfeeding, 84% continued for 6 months and 16% exclusively breastfed for 6 months. Among breastfed infants, ≥76% received vitamin D supplementation. Approximately 50% of infants were introduced to solids before 6 months. Only high school education or less and food insecurity were associated with lower breastfeeding rates. Overall, 75% of participants received at least one visit with a lactation consultant and 95% of these received a breast pump.

Conclusion: This study provides initial evidence that postnatal lactation support can be delivered within a CPNP site, with high uptake by clients. While all participants initiated breastfeeding and 84% continued for 6 months, adherence to the recommended 6 months of exclusive breastfeeding was low. Further research is needed to better understand the barriers to exclusive breastfeeding and how to support this practice among vulnerable women.

Study Design: Evaluation data

Setting: A Canada Prenatal Nutrition Program site in Toronto

Population of Focus: Pregnant women in the catchment area

Sample Size: 199 women

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Financial Incentives

Intervention Description: A retrospective review of administrative data was done to evaluate a natural quasi-experiment in a network of publicly funded primary care clinics. Physicians in 6 of 11 clinics were given a financial incentive twice the size of the current Centers for Medicare and Medicaid Services' incentive for achieving group targets in preventive care that included cervical cancer screening, mammography, and pediatric immunization. They also received productivity incentives. Six years of performance indicators were compared between incentivized and nonincentivized clinics. We also surveyed the incentivized clinicians about their perception of the incentive program.

Intervention Results: Although some performance indicators improved for all measures and all clinics, there were no clinically significant differences between clinics that had incentives and those that did not. A linear trend test approached conventional significance levels for Papanicolaou smears (P = .08) but was of very modest magnitude compared with observed nonlinear variations; there was no suggestion of a linear trend for mammography or pediatric immunizations. The survey revealed that most physicians felt the incentives were not very effective in improving quality of care.

Conclusion: We found no evidence for a clinically significant effect of financial incentives on performance of preventive care in these community health centers. Based on our findings and others, we believe there is great need for more research with strong research designs to determine the effects, both positive and negative, of financial incentives on clinical quality indicators in primary care.

Study Design: QE: concurrent comparison group

Setting: Eleven safety-net community health centers in Houston/Harris County, TX (Community Health Program [CHP])

Population of Focus: Practicing CHP physicians

Data Source: Chart review

Sample Size: Approximate total (N≈110) N=physicians Total (N=12,495) Intervention (n=7,411); Control (n=5,084) N=charts reviewed

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Incentives

Intervention Description: This quasi-experimental study examines the impact of Idaho's wellness incentive program, which rewards children with CHIP (Children's Health Insurance Programs) who are up-to-date with well-child visits with $30 in credits per quarter for use toward their CHIP premiums.

Intervention Results: Between baseline and the second year of implementation, the percentage of CHIP children who were up-to-date with well-child visits increased by 116% (from 23% to 49%), compared with a 13% increase (from 29% to 32%) among children with Medicaid, who were not eligible for the incentive. The incentive program had a greater impact on children who were recommended to have one annual well-child visit compared with those recommended to have two to four annual visits. The program was not, however, more effective for those whose premiums were fully covered by the reward compared with those whose premiums were partially covered.

Conclusion: This study provides encouraging evidence to states about using consumer financial incentives for increasing preventive care use.

Study Design: QE: pretest-posttest

Setting: Idaho

Population of Focus: Children ages 1 to 18 years who received Medicaid or CHIP

Data Source: Claims data

Sample Size: Baseline (n=23,232) Year 1 (n= 24,313) Year 2 (n=23,392) N=adolescents ages 12-18

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Patient Reminder/Invitation, Incentives, HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Residents/Medical Students

Intervention Description: Phase 1 lasted 9 months and implemented CCS patient outreach, patient financial incentives, and clinic staff education. Phase 2 lasted 9 months and involved a workflow change in which MAs identified candidates for CCS during patient check-in. Feedback spanned the entire study period.

Intervention Results: After interventions, the average number of monthly Pap tests increased from 35 to 56 in phase 1 and to 75 in phase 2. Of 385 patients contacted in phase 1, 283 scheduled a Pap test and 115 (41%) completed it. Compared to baseline, both interventions improved cervical cancer screening (phase 1 relative risk, 1.86; 95% CI, 1.64–2.10; P < 0.001; phase 2 relative risk, 2.70; 95% CI, 2.40–3.02; P < 0.001). Our clinic’s CCS rate improved from 70% to 75% after the 18-month intervention.

Conclusion: The rate of CCS increased by 5% after a systematic 2-phase organizational intervention that empowered MAs to remind, identify, and prepare candidates during check-in for CCS.

Setting: Urban academic internal medicine clinic

Population of Focus: Women ages 21-64 eligible for cervical cancer screening

Intervention Components (click on component to see a list of all articles that use that intervention): Incentives, , PATIENT_CONSUMER

Intervention Description: We report results from a single-blinded randomized controlled trial examining financial incentives for smoking cessation among 249 pregnant and newly postpartum women.

Intervention Results: Compared to BP, BP + FI significantly increased abstinence early- (AOR = 9.97; 95%CI, 3.32‐29.93) and late-pregnancy (primary outcome, AOR = 5.61; 95%CI, 2.37‐13.28) and through 12-weeks postpartum (AOR = 2.46; CI,1.05‐5.75) although not 24- (AOR = 1.31; CI,0.54‐3.17) or 48-weeks postpartum (AOR = 1.33; CI,0.55‐3.25). There was a significant effect of trial condition on small-for-gestational-age (SGA) deliveries (χ2 [2] = 9.01, P = .01), with percent SGA deliveries (+SEM) greatest in BP, intermediate in BP + FI, and lowest in NS (17.65 + 4.13, 10.81 + 3.61, and 2.53 + 1.77, respectively). Reliability analyses supported the efficacy of financial incentives for increasing abstinence antepartum and postpartum and decreasing SGA deliveries; external-validity analyses supported relationships between antepartum cessation and SGA risk.

Conclusion: Adding financial incentives to Best Practice increases smoking cessation among antepartum and postpartum women and improves other maternal-infant outcomes.

Intervention Components (click on component to see a list of all articles that use that intervention): Pharmacotherapy (Nicotine), Referrals, Other Person-to-Person Education, PATIENT_CONSUMER, Incentives

Intervention Description: Monthly variability in smoking behaviors in caregivers of pediatric asthmatics yields questions of how much and when does smoking reduction result in improved environmental and clinical outcomes.

Intervention Results: Caregivers with 3 months of ≥25% decrease in cotinine levels had a significantly greater mean change in child cotinine levels (p = 0.018). “Low” caregiver cotinine levels did not significantly improve pediatric asthma control (OR 2.12 (95% CI: 0.62–7.25)). Caregiver anxiety and depression outcomes, measured by Patient Health Questionnaire (PHQ)-4 scores, was not significantly different based on cotinine categorization (p = 0.079);

Conclusion: Reduced pediatric cotinine levels were seen in caregivers who reduced their smoking for at least 3 months, but clinical outcome measures remained unchanged.

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, Referrals, PATIENT_CONSUMER, Incentives

Intervention Description: The primary aim was to evaluate the efficacy of financial incentives for reducing paediatric tobacco smoke exposures (TSEs) through motivating cigarette usage reduction among low-income maternal caregivers and members of their social network.

Intervention Results: The mean change in monthly child cotinine values was not significantly different in the intervention cohort over the 6-month follow-up period, compared with the control group (p=0.098, CI −0.16 to 1.89). Trends in child cotinine could not be ascribed to caregivers or social network members. Despite decreasing mean monthly cotinine values, neither the intervention cohort’s caregivers (difference in slope (control–intervention)=3.30 ng/mL/month, CI −7.72 to 1.13, p=0.144) or paired social network members (difference in slope (control–intervention)=−1.59 ng/mL/month, CI −3.57 to 6.74, p=0.546) had significantly different cotinine levels than counterparts in the control group.

Conclusion: Financial incentives directed at adult contributors to paediatric TSE did not decrease child cotinine levels.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation, Educational Material, PROVIDER/PRACTICE, Provider Reminder/Recall Systems, Financial Incentives, Nurse/Nurse Practitioner

Intervention Description: Before-and-after comparisons of the time-appropriate delivery rates of cervical and breast cancer screening using the automated and NP-augmented strategies of the P-PROMPT reminder and recall system.

Intervention Results: Before-and-after comparisons of time-appropriate delivery rates (< 30 months) of cancer screening showed the rates of Pap tests and mammograms for eligible women significantly increased over a 1-year period by 6.3% (P < .001) and 5.3% (P < .001), respectively. The NP-augmented strategy achieved comparable rate increases to the automated strategy alone in the delivery rates of both services.

Conclusion: The use of provider and patient reminders and pay-for-performance incentives resulted in increases in the uptake of Pap tests and mammograms among eligible primary care patients over a 1-year period in family practices in Ontario.

Setting: Eight primary care network practices and 16 family health network practices in southwestern Ontario

Population of Focus: Practicing physicians from the participating primary care network and family health network groups

Data Source: CytoBase (consortium of main laboratories in Ontario), combined with rosters of eligible patients

Sample Size: Total (N=246) Analysis (n=232) N=physicians

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Participation Incentives, Quality Improvement/Practice-Wide Intervention, Data Collection Training for Staff, Screening Tool Implementation Training, Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: To assess the degree to which a national sample of pediatric practices could implement American Academy of Pediatrics (AAP) recommendations for developmental screening and referrals, and to identify factors that contributed to the successes and shortcomings of these efforts.

Intervention Results: At the project's conclusion, practices reported screening more than 85% of patients presenting at recommended screening ages. They achieved this by dividing responsibilities among staff and actively monitoring implementation. Despite these efforts, many practices struggled during busy periods and times of staff turnover. Most practices were unable or unwilling to adhere to 3 specific AAP recommendations: to implement a 30-month visit; to administer a screen after surveillance suggested concern; and to submit simultaneous referrals both to medical subspecialists and local early-intervention programs. Overall, practices reported referring only 61% of children with failed screens. Many practices also struggled to track their referrals. Those that did found that many families did not follow through with recommended referrals.

Conclusion: A diverse sample of practices successfully implemented developmental screening as recommended by the AAP. Practices were less successful in placing referrals and tracking those referrals. More attention needs to be paid to the referral process, and many practices may require separate implementation systems for screening and referrals.

Study Design: QE: interrupted timeseries design

Setting: Sixteen pediatric primary care practices from 15 different states

Population of Focus: Children ages 8 to 36 months at wellchild visits

Data Source: Child medical record

Sample Size: Chart audits: - Baseline and Follow-Up: (n=30) per practice in July 2006 and March 2007; total charts audited (n= 960) - Intervention period: (n=10) per practice per month for 7 months; total charts audited (n=1,120)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Participation Incentives, Data Collection Training for Staff

Intervention Description: To explore rates of screening and identification and treatment for behavioral problems using billing data from Massachusetts Medicaid immediately following the start of the state's new court-ordered screening and intervention program.

Intervention Results: Major increase from 16.6% of all Medicaid well-child visits coded for behavioral screens in the first quarter of 2008 to 53.6% in the first quarter of 2009. Additionally, the children identified as at risk increased substantially from about 1600 in the first quarter of 2008 to nearly 5000 in quarter 1 of 2009. The children with mental health evaluations increased from an average of 4543 to 5715 per month over a 1-year period.

Conclusion: The data suggest payment and a supported mandate for use of a formal screening tool can substantially increase the identification of children at behavioral health risk. Findings suggest that increased screening may have the desired effect of increasing referrals for mental health services.

Study Design: Observational pretestposttest design

Setting: Massachusetts

Population of Focus: Children enrolled in Medicaid

Data Source: Medicaid data prepared for Rosie D. v Romney (Patrick) court case

Sample Size: Well-child visits - Baseline/first quarter 2008 (n=122,494)4 - Follow-up/first quarter 2009 (n=118,573)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Incentives, Telephone Support, PATIENT_CONSUMER

Intervention Description: The present study examined the efficacy of a smartphone-based intervention whereby smoking monitoring and incentive delivery occurred remotely using a mobile app. If efficacious, this remote intervention would allow pregnant women residing in geographically remote areas to benefit from incentives-based cessation interventions.

Intervention Results: Outcomes were analyzed using repeated measures analysis based on generalized estimating equations (GEE). Seven-day point prevalence abstinence rates were greater in the incentives versus best practices arms early- (46.7% vs 20.0%, OR = 3.50, 95%CI = 1.11,11.02) and late-antepartum (36.7% vs 13.3%, OR = 3.76, 95%CI = 1.04,13.65), and four- (36.7% vs 10.0%, OR = 5.21, 95%CI = 1.28,21.24) and eight-weeks postpartum (40.0% vs 6.7%, OR = 9.33, 95%CI = 1.87,46.68), although not at the 12- (23.3% vs 10.0%, OR = 2.74, 95%CI = 0.63,11.82) or 24-week (20.0% vs 6.7%, OR = 3.50, 95%CI = 0.65,18.98) postpartum assessments likely due to this pilot study being underpowered for discerning differences at the later assessments, especially 24-weeks postpartum which was three months after treatment completion.

Conclusion: These results support the efficacy of this remote, incentives-based intervention for pregnant smokers. Further research evaluating its efficacy and cost-effectiveness in a well-powered, randomized controlled trial (https://www.sciencedirect.com/topics/medicine-and-dentistry/randomized-controlled-trial) appears warranted.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Incentives

Intervention Description: We examined whether pregnant and newly postpartum smokers at risk for postpartum depression respond to an incentive-based smoking-cessation treatment and how the intervention impacts depression ratings.

Intervention Results: The intervention increased smoking abstinence independent of depression status (p < .001), and it decreased mean postpartum BDI ratings as well as the proportion of women scoring in the clinical range (≥17 and >21) compared with the control treatment (ps ≤ .05). Treatment effects on depression ratings were attributable to changes in Dep+ women.

Conclusion: These results demonstrate that depression-prone pregnant and newly postpartum women respond well to this incentive-based smoking-cessation intervention in terms of achieving abstinence, and the intervention also reduces the severity of postpartum depression ratings in this at-risk population.

Study Design: Quasi experimental cross sectional- repeated measures secondary data analysis

Setting: Obstetric practices and Women, Infants, and Children (WIC) program

Population of Focus: English speaking Women, Infants, and Children (WIC) program recipients who were pregnant and newly postpartum smokers at risk for postpartum depression

Data Source: Depression scale scores, breath CO, urine cotinine

Sample Size: 289

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Incentives

Intervention Description: We examined whether impulsiveness moderates response to financial incentives for cessation among pregnant smokers.

Intervention Results: Neither delay discounting (DD) nor Barratt Impulsiveness Scale (BIS) predicted smoking status in the single or combined trials. Receiving abstinence-contingent incentives, lower baseline smoking rate, and a history of quit attempts prepregnancy predicted greater odds of antepartum abstinence across the single and combined trials. No variable predicted postpartum abstinence across the single and combined trials, although a history of antepartum quit attempts and receiving abstinence-contingent incentives predicted in the single and combined trials, respectively.

Conclusion: Overall, this study provides no evidence that impulsiveness as assessed by DD or BIS moderates response to this treatment approach while underscoring a substantial association of smoking rate and prior quit attempts with abstinence across the contingent incentives and control treatment conditions.

Study Design: Cohort- prospective single trial data combined with random group assignment cohorts

Setting: University outpatient research clinic

Population of Focus: English speaking Women, Infants, and Children (WIC) program recipients who were pregnant smokers who resided in the county and did not move for 6 months, no other substance use reported

Data Source: Questionnaires, breath CO & urine cotinine, delay discounting task scores (DD), Barratt Impulsiveness Scale (BIS)

Sample Size: 236

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Participation Incentives, Quality Improvement/Practice-Wide Intervention, Data Collection Training for Staff, Expert Feedback Using the Plan-Do-Study-Act-Tool, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), STATE, POPULATION-BASED SYSTEMS, Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: Seven pediatric primary care practices participated in New Mexico's Developmental Screening Initiative in a year-long quality improvement project with the goal of implementing standardized developmental screening tools.

Intervention Results: At baseline, there were dramatic differences among the practices, with some not engaged in screening at all.

Conclusion: Overall, the use of standardized developmental screening increased from 27% at baseline to 92% at the end of the project.

Study Design: QE: pretest-posttest

Setting: Seven primary care practices in a large urban area and small regional community in New Mexico

Population of Focus: Children ages 1 through 60 months

Data Source: Child medical record

Sample Size: Total medical records reviewed at baseline and follow-up (n=1139)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Navigation (Assistance), Patient Reminder/Invitation, Participation Incentives, Shortened Appointment Interval

Intervention Description: Women were randomized to receive 3–4 and 6–8 weeks postpartum appointments and were followed for 18 months. Study participants were recruited from the VCUMC in-patient postpartum unit by using Electronic Health Records (EHR) to monitor deliveries. Eligible women were contacted within 48 h of delivery and informed about the study. Women who agreed to participate were asked to sign the informed consent form, which authorized research staff to access participants' EHR to enhance tracking of postpartum visit attendance. Study participants were interviewed in person at baseline (within 48 h of delivery) and at the postpartum visit. Participants were compensated $25 for completing the baseline interviews and $30 for completing the postpartum interviews. Follow-up assessments were administered via telephone at 3, 6, 9, 12, and 18-months post-delivery to evaluate secondary outcomes including contraceptive use, infant feeding practices, pregnancy status, stress and social support, and socio-demographic and medical information. Each of the follow-up assessments lasted approximately 10–15 min, and participants were compensated $10 per follow-up assessment. To reduce loss to follow-up, participants' contact information, as well as contact information for at least three persons who would know the participants' whereabouts and could get messages to them, were collected from the patients. To compensate study subjects for their participation and encourage follow-up assessment compliance, thank you letters along with appointment reminders and additional $10 checks were mailed to each participant monthly. This was especially important for hard-to-track women who did not have working phone numbers and did not return for postpartum visits. Additionally, per study protocol, participants received appointment reminder SMS text messages and/or emails 1 day before their scheduled follow-up phone interviews. If participants could not be reached, up to four attempts were made to contact the participant on different days and times of the day, in an effort to schedule the interviews.

Intervention Results: The overall postpartum visit adherence rate was generally high in the study. However, the adherence rate was observed to be relatively lower in the 3–4 weeks group (71%) compared to the 6–8 weeks group (90%). One reason that may explain this finding is that participants may have been more familiar with the traditional 6–8 weeks postpartum visit and thus, may have had some inertia or difficulty in attending a 3–4 week postpartum visit. A large proportion of women were retained in the study as demonstrated by the high completion rates at the 18-month follow-up interview (Total sample: 87.6%; 3–4 weeks group: 88.0%; 6–8 weeks group: 87.3%). Similarly, high adherence to the protocol-directed postpartum visit schedule was reported in the overall study sample (79.7%), as well as in the 3–4 (70.5%) and 6–8 (90.0%) week postpartum groups.

Conclusion: In this trial, we successfully maintained high completion rates throughout the course of the study. This is important given that the study population included hard-to-track women who typically do not return for postpartum visits [12]. Due to economic challenges, underserved women may not have permanent addresses or phone numbers. By utilizing a participant tracking form, we obtained contact information from at least three persons who generally knew the participants' whereabouts and could contact them. This provided multiple avenues for reaching participants and enhanced retention. Additionally, monthly communication and incentives provided the opportunity to maintain participant engagement.

Study Design: Prospective, open-label randomized control trial

Setting: Virginia Commonwealth University Medical Center

Sample Size: 364 women

Age Range: 18-43

Intervention Components (click on component to see a list of all articles that use that intervention): Family-Based Interventions, Incentives,

Intervention Description: The intervention in the study involved a same-day supermarket double-dollar incentive on the purchase of fresh, frozen, or canned fruit and vegetables, combined with nutrition education in the store.

Intervention Results: Compared to the controls, incentivized shoppers-who were given an immediate 50 percent discount on qualifying fruit and vegetables-increased weekly spending on those items by 27 percent; this change was for fresh produce. There was no change in purchases of frozen and canned produce or unhealthful foods. Estimated annual average daily consumption of fruit and vegetables by the incentivized shoppers and by one designated child per incentivized household did not change. Attendance at Cooking Matters events was low.

Conclusion: These findings support financial incentive programs to increase fruit and vegetable purchasing but suggest that effective complementary approaches are needed to improve diet quality.

Study Design: randomized control trial

Setting: Supermarket

Population of Focus: Households with children

Sample Size: 605

Age Range: n/a

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visits, Telephone Support, Adult-led Support/Counseling/Remediation, YOUTH, PATIENT_CONSUMER, Incentives

Intervention Description: The First Breath Wisconsin study examined the cost-effectiveness of providing incentives to pregnant women who smoked to engage in stop smoking treatment.

Intervention Results: Cost-effectiveness analysis calculated the incremental cost-effectiveness ratio (ICER) per one additional smoker who quit. The incentive group had higher 6-month post-birth biochemically-confirmed tobacco abstinence than the control group (14.7% vs. 9.2%). Incremental costs averaged $184 per participant for the incentive group compared to controls ($317 vs $133). The ICER of financial incentives was $3399 (95% CI $2228 to $8509) per additional woman who was tobacco abstinent at 6 months post-birth. The ICER was lower ($2518 vs $4760) for women who did not live with another smoker.

Conclusion: This study shows use of financial incentives for stop smoking treatment is a cost-effective option for low-income pregnant women who smoke.

Intervention Components (click on component to see a list of all articles that use that intervention): Incentives, , PATIENT_CONSUMER

Intervention Description: The First Breath Wisconsin study examined the cost-effectiveness of providing incentives to pregnant women who smoked to engage in stop smoking treatment.

Intervention Results: The incentive group had higher 6-month post-birth biochemically-confirmed tobacco abstinence than the control group (14.7% vs. 9.2%). Incremental costs averaged $184 per participant for the incentive group compared to controls ($317 vs $133). The ICER of financial incentives was $3399 (95% CI $2228 to $8509) per additional woman who was tobacco abstinent at 6 months post-birth. The ICER was lower ($2518 vs $4760) for women who did not live with another smoker.

Conclusion: This study shows use of financial incentives for stop smoking treatment is a cost-effective option for low-income pregnant women who smoke.

Intervention Components (click on component to see a list of all articles that use that intervention): Financial Incentives, Incentives

Intervention Description: This study evaluates a Target gift card incentive employed by a Minnesota health plan serving Medicaid beneficiaries over the period 2002-2003.

Intervention Results: The dichotomous intervention variable suggested that those living within about 2.5 miles of a Target store were about 3% more likely to have a visit than those living farther than 2.5 miles. The dichotomous variable, however, indicated that this represents a smaller decline in well-child visits, rather than an increase. This was due to the fact that for those living near a Target store, the percentage receiving the incentive declined from 37.06% to 35.82% in transitioning from the pre- to post-implementation period, respectively, and for those living far from a Target store, the percentages declined from 32.03% to 28.42%. Thus, the unadjusted difference-in-differences calculation was 2.024, indicating that the decline in wellchild visits would have been greater were it not for the incentive.

Conclusion: Using alternative specifications for the intervention variable, results of the difference-in-differences equations suggest that the incentive program significantly increased the likelihood that a Medicaid beneficiary would have a well-child visit.

Study Design: N/A

Setting: N/A

Data Source: N/A

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Incentives, Motivational Interviewing

Intervention Description: The purpose of this study is to test in a clinical prenatal care setting the effectiveness of the Smoke-Free Moms intervention, which provides pregnant women a series of financial incentives for smoking cessation.

Intervention Results: Of 175 eligible pregnant women enrolled, 134 women were followed to the postpartum visit (Intervention n=66, Control n=68). The quit rates during pregnancy did not differ between groups (Intervention 36.4%, Control 29.4%, p=0.46). However, significantly more intervention mothers quit and continued as nonsmokers postpartum (Intervention 31.8%, Control 16.2%, p=0.04). In a logistic regression model including baseline sociodemographic, depressed mood, stress, and readiness to quit items, confidence in being able to quit predicted both cessation outcomes. The financial incentive intervention was an independent predictor of cessation in pregnancy through postpartum.

Conclusion: Financial incentives with existing smoking-cessation counseling by staff in low-income clinical prenatal programs led to cessation that continued during the postpartum period. Further study in larger populations is indicated.

Study Design: Cohort- control trial with non-random assignment

Setting: Prenatal clinics in federally qualified health centers

Population of Focus: Low income pregnant smokers served in clinic settings who had not spontaneously quit on learning of their pregnancy and were still smoking at the time of their first prenatal visit

Data Source: Surveys, urine cotinine

Sample Size: 175 started program, 134 followed through to postpartum visit

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Incentives, , PATIENT_CONSUMER

Intervention Description: The purpose of this study is to test in a clinical prenatal care setting the effectiveness of the Smoke-Free Moms intervention, which provides pregnant women a series of financial incentives for smoking cessation.

Intervention Results: Of 175 eligible pregnant women enrolled, 134 women were followed to the postpartum visit (Intervention n=66, Control n=68). The quit rates during pregnancy did not differ between groups (Intervention 36.4%, Control 29.4%, p=0.46). However, significantly more intervention mothers quit and continued as nonsmokers postpartum (Intervention 31.8%, Control 16.2%, p=0.04). In a logistic regression model including baseline sociodemographic, depressed mood, stress, and readiness to quit items, confidence in being able to quit predicted both cessation outcomes. The financial incentive intervention was an independent predictor of cessation in pregnancy through postpartum.

Conclusion: Financial incentives with existing smoking-cessation counseling by staff in low-income clinical prenatal programs led to cessation that continued during the postpartum period. Further study in larger populations is indicated.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Incentives, Educational Material, Peer Counselor, Motivational Interviewing, Pharmacotherapy (Nicotine), Other Person-to-Person Education, Group Education, Community-Based Group Education

Intervention Description: To assess the feasibility and acceptability of implementing a culturally tailored, intensive smoking cessation program, including contingency-based financial rewards (CBFR), for pregnant Aboriginal women.

Intervention Results: Twenty-two of 38 eligible women (58%) enrolled in the program, with 19 (86% remaining at the end of their pregnancy. The program was highly acceptable to both women and providers. Feasibility issues included challenges providing twice-weekly visits for 3 weeks and running fortnightly support groups. Of the 19 women who completed the program, 15 (79%) reported a quit attempt lasting >=24 hours, and 8 (42%) were CO-confirmed as not smoking in late pregnancy. The rewards were perceived to help motivate women, but the key to successful quitting was considered to be the intensive support provided.

Conclusion: 'Stop Smoking in its Tracks' was acceptable and is likely to be feasible to implement with some modifications. The program should be tested in a larger study.

Study Design: Single group pre-post test

Setting: Aboriginal Maternal and Infant Health Services clinics

Population of Focus: Pregnant aboriginal women seeking prenatal care at health services sites who were smoking and older than 16 years and less than 20 weeks gestation who were local residents

Data Source: Self-reported smoking levels, breath CO

Sample Size: 38, 19 completed the program

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Education, Quality Improvement/Practice-Wide Intervention, Provider Incentives (Maintenance of Certification)

Intervention Description: A provider-focused intervention that included repeated contacts, education, individualized feedback, and strong quality improvement incentives to raise HPV vaccination rates at two federally qualified community health centers.

Intervention Results: Girls and boys in intervention practices significantly increased HPV vaccine initiation during the active intervention period relative to control practices (girls OR 1.6, boys OR 11; p<0.001 for both). Boys at intervention practices were also more likely to continue to initiate vaccination during the post-intervention/maintenance period (OR 8.5; p<0.01). Girls and boys at intervention practices were more also likely to complete their next needed HPV vaccination (dose 1, 2 or 3) than those at control practices (girls OR 1.4, boys OR 23; p<0.05 for both). These improvements were sustained for both boys and girls in the post-intervention/maintenance period (girls OR 1.6, boys OR 25; p<0.05 for both).

Conclusion: Provider-focused interventions including repeated contacts, education, individualized feedback, and strong quality improvement incentives have the potential to produce sustained improvements in HPV vaccination rates.

Study Design: Cluster RCT

Setting: 1 outpatient pediatric/adolescent department at a major urban academic medical center and 7 affiliate federally qualified community health centers

Population of Focus: Females who received primary care (>1 well visit) in the pediatric/adolescent department at a participating practice during the 2-year study period, excluding females who were pregnant during the study period and patients who received care in both an intervention and control practice5

Data Source: Electronic medical records

Sample Size: Total (n=3,961)6

Age Range: 11/21/2022

Intervention Components (click on component to see a list of all articles that use that intervention): Family-Based Interventions, Incentives,

Intervention Description: Randomized controlled design. Purchases were tracked using a loyalty card that provided participants with a 5% discount on all purchases during a 3-month baseline period followed by the 4-month intervention.

Intervention Results: Coupons were redeemed among 53% of eligible baskets. Total weekly F&V spending increased in the intervention arm compared to control ($1.83, 95% CI=$0.29, 3.88). The largest increase was for fresh F&V ($1.97, 95% CI=$0.49, 3.44). Secondary analyses revealed greater increases in F&V spending among SNAP-eligible participants who redeemed coupons ($5.14, 95% CI =$1.93, 8.34) than among non-SNAP-eligible participants who redeemed coupons ($3.88, 95% CI =$1.67, 6.08).

Conclusion: A double-dollar pricing incentive increased F&V spending in a low-income community despite the moderate uptake of the coupon redemption. SNAP-eligible customers saw the greatest F&V spending increases. Financial incentives for F&V are an effective strategy for food assistance programs to increase healthy purchases and improve dietary intake in low income families.

Study Design: randomized control design

Setting: A supermarket in a low-income rural Maine community

Population of Focus: Low-income and SNAP supermarket customers

Sample Size: 401

Age Range: n/a

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Incentives,

Intervention Description: The effect of financial incentives to improve breastfeeding prevalence is unknown. The Nourishing Start for Health (NOSH) trial, a cluster randomized trial with 6 to 8 weeks follow-up, was conducted between April 1, 2015 and March 31, 2016, in 92 electoral ward areas in England with baseline breastfeeding prevalence at 6 to 8 weeks post partum less than 40%. Usual care was delivered by clinicians (mainly midwives, health visitors) in a variety of maternity, neonatal, and infant feeding services, all of which were implementing the UNICEF UK Baby Friendly Initiative standards. Shopping vouchers worth £40 (US$50) were offered to mothers 5 times based on infant age (2 days, 10 days, 6-8 weeks, 3 months, 6 months), conditional on the infant receiving any breast milk.

Intervention Results: In the intervention (5398 mother-infant dyads) and control (4612 mother-infant dyads) group, the median (interquartile range) percentage of women aged 16 to 44 years was 36.2% (3.0%) and 37.4% (3.6%) years, respectively. After adjusting for baseline breastfeeding prevalence and local government area and weighting to reflect unequal cluster-level breastfeeding prevalence variances, a difference in mean 6- to 8-week breastfeeding prevalence of 5.7 percentage points (37.9% vs 31.7%; 95% CI for adjusted difference, 2.7% to 8.6%; P < .001) in favor of the intervention vs usual care was observed. No significant differences were observed for the mean prevalence of breastfeeding initiation (61.9% vs 57.5%; adjusted mean difference, 2.9 percentage points; 95%, CI, −0.4 to 6.2; P = .08) or the mean prevalence of exclusive breastfeeding at 6 to 8 weeks (27.0% vs 24.1%; adjusted mean difference, 2.3 percentage points; 95% CI, −0.2 to 4.8; P = .07).

Conclusion: Financial incentives may improve breastfeeding rates in areas with low baseline prevalence. Offering a financial incentive to women in areas of England with breastfeeding rates below 40% compared with usual care resulted in a modest but statistically significant increase in breastfeeding prevalence at 6 to 8 weeks. This was measured using routinely collected data.

Study Design: Cluster randomized trial

Setting: Electoral wards in England

Population of Focus: Mother-infant dyads residing in the 92 study electoral ward areas

Sample Size: 10,010 mother-infant dyads

Age Range: Mothers aged 16 to 44 years

Intervention Components (click on component to see a list of all articles that use that intervention): Family-Based Interventions, Financial Incentives, Food Prescriptions

Intervention Description: The intervention involves providing additional fruit and vegetable vouchers to pregnant Women, Infants, and Children (WIC) clients as a strategy to improve food security and diet quality. The study aimed to assess the impact of this intervention on food insecurity and fruit and vegetable intake among pregnant WIC clients.

Intervention Results: Participants in intervention and comparison counties completed surveys at enrollment and approximately three months later (n = 609). Mean ± SD food insecurity at baseline was 3.67 ± 2.79 and 3.47 ± 2.73 in the intervention and comparison groups, respectively, and the adjusted between-group change from baseline to follow-up in food insecurity was 0.05 [95% CI: −0.35, 0.44] (p > 0.05). F&V intake (in cup equivalents) was 2.56 ± 0.95 and 2.51 ± 0.89 at baseline in the two groups, and the adjusted mean between-group difference in changes from baseline was −0.06 [−0.23, 0.11] (p > 0.05). Recruitment and data collection for this study coincided with the most intensive of America’s COVID relief efforts. Our results may indicate that small increases in highly targeted food resources make less of a difference in the context of larger, more general resources being provided to individuals and households in need.

Conclusion: Our results may indicate that small increases in highly targeted food resources make less of a difference in the context of larger, more general resources being provided to individuals and households in need.

Study Design: comparion group

Setting: San Francisco, California

Population of Focus: Pregnant individuals with low income enrolled in the Women, Infants, and Children (WIC) program.

Sample Size: 770

Age Range: 26-35

Intervention Components (click on component to see a list of all articles that use that intervention): Incentives, Farmers Markets

Intervention Description: Data were collected from 1,223 Double Up Food Bucks participants at 42 Oregon farmers' markets. Chi-square tests of independence and logistic regressions were used to examine associations among key variables.

Intervention Results: Most participants reported buying more fruits and vegetables (FVs) (91.0%), trying new FV types (82.2%), eating less processed food (69.8%), having more food available at home (81.1%), and perceiving improvements in health (87.9%). Perceptions of affordability were higher among younger adults (P < 0.001) and households with 3-5 people (P = 0.02), with children (P < 0.001), and without chronic disease (P = 0.003). Perceptions of increased FV purchases were higher in households with children (P = 0.009) and reported overall health improvements were higher among non-White participants (P = 0.04). Perceptions of increased FV purchases and affordability were associated with other positive program outcomes.

Conclusion: Participants may perceive barriers to purchasing FVs from farmers' markets, which are not fully addressed by the increased purchasing power from a FV incentive. Targeted redesign, outreach, and education may improve program experiences among groups with less positive perceptions. Further research to identify explanations for variation in program experience is needed.

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Financial Incentives

Intervention Description: The study evaluated a natural experiment with pay-for-performance using administrative reports of physician group quality from a large health plan for an intervention group (California physician groups) and a contemporaneous comparison group (Pacific Northwest physician groups). Quality improvement reports were included from October 2001 through April 2004 issued to approximately 300 large physician organizations. Main outcome measures: Three process measures of clinical quality: cervical cancer screening, mammography, and hemoglobin A1c testing.

Intervention Results: Improvements in clinical quality scores were as follows: for cervical cancer screening, 5.3% for California vs 1.7% for Pacific Northwest; for mammography, 1.9% vs 0.2%; and for hemoglobin A1c, 2.1% vs 2.1%. Compared with physician groups in the Pacific Northwest, the California network demonstrated greater quality improvement after the pay-for-performance intervention only in cervical cancer screening (a 3.6% difference in improvement [P = .02]). In total, the plan awarded 3.4 million dollars (27% of the amount set aside) in bonus payments between July 2003 and April 2004, the first year of the program. For all 3 measures, physician groups with baseline performance at or above the performance threshold for receipt of a bonus improved the least but garnered the largest share of the bonus payments.

Conclusion: Paying clinicians to reach a common, fixed performance target may produce little gain in quality for the money spent and will largely reward those with higher performance at baseline.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: PacifiCare medical groups in California and the Pacific Northwest

Population of Focus: Physician groups

Data Source: PacifiCare physician group performance reports

Sample Size: Intervention (n=163); Control (n=42) N=physician groups

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): Consultation (Parent/Family), Financial Incentives, Referrals,

Intervention Description: Poverty is a common root cause of poor health and disrupts medical care. Clinically embedded antipoverty programs that address financial stressors may prevent missed visits and improve show rates. This pilot study evaluated the impact of clinic-based financial coaching on adherence to recommended preventive care pediatric visits and vaccinations in the first 6 months of life. In this community-partnered randomized controlled trial comparing clinic-based financial coaching to usual care among low-income parent-infant dyads attending pediatric preventive care visits, we examined the impact of the longitudinal financial intervention delivered by trained coaches addressing parent-identified, strengths-based financial goals (employment, savings, public benefits enrollment, etc.). We also examined social needs screening and resource referral on rates of missed preventive care pediatric visits and vaccinations through the 6-month well-child visit.

Intervention Results: Eighty-one parent-infant dyads were randomized (35 intervention, 46 control); nearly all parents were mothers and more than one-half were Latina. The rate of missed visits among those randomized to clinic-based financial coaching was half that of controls (0.46 vs 1.07 missed of 4 recommended visits; mean difference, 0.61 visits missed; P = .01). Intervention participants were more likely to have up-to-date immunizations each visit (relative risk, 1.26; P = .01) with fewer missed vaccinations by the end of the 6-month preventive care visit period (2.52 vs 3.8 missed vaccinations; P = .002).

Conclusion: In this pilot randomized trial, a medical-financial partnership embedding financial coaching within pediatric primary care improved low-income families' adherence to recommended visits and vaccinations. Clinic-based financial coaching may improve care continuity and quality in the medical home.

Study Design: Randomized controlled trial

Setting: Pediatric primary care clinic at Harbor-UCLA, an academically affiliated safety net medical center and second largest in Los Angeles County’s Department of Health Services

Population of Focus: Low-income parent-infant dyads presenting to pediatric primary care clinics for scheduled, non-acute primary care visits

Sample Size: 81 parent-infant dyads, with 35 dyads assigned to the intervention group receiving clinic-based financial coaching and 46 dyads assigned to the control group receiving usual care

Age Range: The participants included English- and Spanish-speaking adult parents and their infants younger than 4 months of age

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Incentives, Group Education

Intervention Description: To determine the effects of a partner-supported, incentive-based educational program on rates and duration of breast-feeding among low-income women.

Intervention Results: Women in the intervention group reported a higher percentage of breast-feeding at all measurement times.

Conclusion: These findings suggest that incentives, such as donated prizes, can be used to attract primiparous women from lower socioeconomic groups, along with their partners, to participate in educational interventions designed to promote breast-feeding. Participation by couples in breast-feeding promotion activities can dramatically increase the rate and duration of breast-feeding.

Study Design: QE: non-equivalent control group

Setting: 2 WIC clinics in Flagstaff, AZ

Population of Focus: Primiparous women with an expected due date between May and Dec 1992

Data Source: Mother self-report

Sample Size: Intervention (n=26) Control (n=26)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Motivational Interviewing, Adult-led Support/Counseling/Remediation, PATIENT_CONSUMER, YOUTH, Incentives

Intervention Description: To evaluate a hospital-initiated intervention to reduce tobacco smoke exposure in infants in the neonatal intensive care unit.

Intervention Results: The intervention effect on infant cotinine was not significant, except among mothers who reported high baseline readiness/ability to protect their infant (P ≤ .01) and mothers who completed the study within 6 months postdischarge (per protocol; P ≤ .05). Fewer mothers in the motivational interviewing plus financial incentives condition were smoking postdischarge (P ≤ .01). More mothers in the motivational interviewing plus financial incentives group reported a total home and car smoking ban at follow-up (P ≤ .05).

Conclusion: Motivational interviewing combined with financial incentives reduced infant tobacco smoke exposure in a subset of women who were ready/able to protect their infant. The intervention also resulted in less maternal smoking postpartum. More robust interventions that include maternal and partner/household smoking cessation are likely needed to reduce the costly effects of tobacco smoke exposure on children and their families.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Incentives, Telephone Support, Pharmacotherapy (Nicotine), Peer Counselor

Intervention Description: To assess the efficacy of a financial incentive added to routine specialist pregnancy stop smoking services versus routine care to help pregnant smokers quit.

Intervention Results: Recruitment was extended from 12 to 15 months to achieve the target sample size. Follow-up continued until September 2013. Of the 306 women randomised, three controls opted out soon after enrolment; these women did not want their data to be used, leaving 306 intervention and 303 control group participants in the intention to treat analysis. No harms of financial incentives were documented. Significantly more smokers in the incentives group than control group stopped smoking: 69 (22.5%) versus 26 (8.6%). The relative risk of not smoking at the end of pregnancy was 2.63 (95% confidence interval 1.73 to 4.01) P<0.001. The absolute risk difference was 14.0% (95% confidence interval 8.2% to 19.7%). The number needed to treat (where financial incentives need to be offered to achieve one extra quitter in late pregnancy) was 7.2 (95% confidence interval 5.1 to 12.2). The mean birth weight was 3140 g (SD 600 g) in the incentives group and 3120 (SD 590) g in the control group (P=0.67).

Conclusion: This phase II randomised controlled trial provides substantial evidence for the efficacy of incentives for smoking cessation in pregnancy; as this was only a single centre trial, incentives should now be tested in different types of pregnancy cessation services and in different parts of the United Kingdom.

Study Design: RCT

Setting: Hospital and community-based health care clinics

Population of Focus: English speaking pregnant women who smoked receiving obstetrical care through UK National Health Services (NHS)

Data Source: Breath CO, Nicotine dependence scale, self-report, cotinine levels (blood, urine and saliva)

Sample Size: 609 -306 intervention, 303 control

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Incentives, , PATIENT_CONSUMER

Intervention Description: To examine effectiveness, cost effectiveness, generalisability, and acceptability of financial incentives for smoking cessation during pregnancy in addition to variously organised UK stop smoking services.

Intervention Results: From 9 January 2018 to 4 April 2020, of 4032 women screened by stop smoking services, 944 people were randomly assigned to the intervention group (n=471) or the control group (n=470). Three people asked for their data to be removed. 126 (27%) of 471 participants stopped smoking from the intervention group and 58 (12%) of 470 from the control group (adjusted odds ratio 2.78 (1.94 to 3.97) P<0.001). Serious adverse events were miscarriages and other expected pregnancy events requiring hospital admission; all serious adverse events were unrelated to the intervention. Most people who stopped smoking from both groups relapsed after their baby was born.

Conclusion: The offer of up to £400 of financial voucher incentives to stop smoking during pregnancy as an addition to current UK stop smoking services is highly effective. This bolt-on intervention supports new guidance from the UK National Institute for Health and Care Excellence, which includes the addition of financial incentives to support pregnant women to stop smoking. Continuing incentives to 12 months after birth is being examined to prevent relapse.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Peer Counselor, Educational Material, Group Education, Incentives,

Intervention Description: The AMEN (originally "Avondale Moms Empowered to Nurse;" remaned to "All Moms Empowered to Nurse") project was the first Peer-to-Peer (Mom-to-Mom) breastfeeding education and support project in Avondale, a neighborhood in Hamilton County, Ohio. AMEN was designed to provide Peer-to-Peer (Mom-to-Mom) breastfeeding education and support, specifically for African American mothers living in neighborhoods of poverty, to increase breastfeeding initiation and duration. The peer support group typically met one to two times per month with the provision of childcare, transportation, refreshments, and grocery gift card incentives. Group activities included sharing of a breastfeeding topic of interest by Champion moms, various interactive activities (e.g., breastfeeding Jeopardy), and faciliated sharing by attendees, in addition to special guest presentations. With the COVID-19 pandemic, the group pivoted to the virtual world (Zoom) allowing even more mothers to join.

Intervention Results: Since May 2017, 67 AMEN support meetings have included 158 participants, with average attendance of 10 (range 5–19) per meeting. In addition to 8 Champions, 110 moms have attended, including 24% expecting mothers. Additional attendees include 13 family support persons, 23 guest speakers, and 12 from community outreach programs. Qualitative feedback from participants has been uniformly positive. Breastfeeding initiation rates have increased 12% in the initial neighborhood.

Conclusion: Harnessing strength within the local community, Champion Breastfeeding Moms have successfully launched AMEN breastfeeding support groups in under-resourced African American urban neighborhoods, helping more mothers reach their breastfeeding goals.

Study Design: Mixed methods

Setting: Home visitation program, Every Child Succeeds, at Carmel Presbyterian Church in partnership with the Cincinnati Children's Hospital Medical Center in the Avondale neighborhood

Population of Focus: Participants in the AMEN peer support program

Sample Size: 67 support meetings with a total of 158 participants (8 champions, 110 mothers, 13 family support persons, 23 guest speakers, and 12 from community outreach programs)

Age Range: Not reported

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Incentives,

Intervention Description: Incentives that are immediately delivered contingent on verified occurence of a specific observable behavior have been effective in encouraging healthy behavior change. This study examined the hypothesis that monthly financial incentives would significantly increase the proportion of breastfeeding mothers at 6 months postpartum compared with WIC services only among low-income, urban Puerto Rican mothers.

Intervention Results: The intent-to-treat analysis showed significantly higher percentages of breastfeeding mothers in the incentive group at each time point compared with those in the control group (89% vs 44%, P = .01 at 1 month; 89% vs 17%, P < .001 at 3 months; 72% vs 0%, P < .001 at 6 months). No significant differences were detected at any time point between study groups for self-reported exclusive breastfeeding rate and infant outcomes (ie, weight, emergency department visits).

Conclusion: Contingent cash incentives significantly increased breastfeeding through 6-month postpartum among WIC-enrolled Puerto Rican mothers; however, no significant differences between the study groups were observed on exclusive breastfeeding rate and infant outcomes. Larger-scale studies are warranted to examine efficacy, implementation potential, and cost-effectiveness.

Study Design: Randomized, 2-arm parallel-group design

Setting: WIC program

Population of Focus: WIC-enrolled Puerto Rican mothers

Sample Size: 36 women

Age Range: Mothers 18-29 years of age

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Peer Counselor, Motivational Interviewing, Educational Material, Other Person-to-Person Education, Community-Based Group Education, Group Education, Incentives

Intervention Description: Given serious consequences of maternal smoking, we aimed to develop and test a multicomponent behavioral intervention to enhance smoking cessation during pregnancy.

Intervention Results: The estimated smoking cessation rate was 70.0% (21/30) at the second week of the intervention, and 63.3% (19/30) at the conclusion of the 8-week intervention assuming the dropouts as smoking. In interrupted time series analysis, the mean daily number of cigarettes smoked among quitters decreased by 6.52, 5.34, and 4.67 among early, delayed, and late intervention groups, respectively. Quitters' mean urine cotinine level maintained stably high before the intervention but decreased rapidly to the nonsmoking range once the intervention was initiated. Most participants (85.7%) reported meeting or exceeding expectations, and 100% would recommend the program to others.

Conclusion: This pilot multicomponent intervention was feasible and acceptable to most participants, resulting in a high smoking cessation rate among pregnant smokers who were unlikely to quit spontaneously.

Study Design: Cohort-Multiple-baseline intervention pilot studymultiple interrupted time series approach

Setting: Community-based prenatal clinics

Population of Focus: English speaking pregnant women who are current smokers without alcohol or drug dependency or mental health disorders

Data Source: Urine cotinine, self-report calendar of cigarette use

Sample Size: 30

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Incentives

Intervention Description: Analysis of four controlled clinical trials on the efficacy of financial incentives for smoking cessation to determine whether pregnant and newly postpartum smokers at risk for postpartum depression respond to an incentive-based smoking-cessation treatment and how the intervention impacts depression ratings. Women were assigned either to an intervention wherein they earned vouchers exchangeable for retail products contingent on abstaining from smoking or to a control condition wherein they received vouchers of comparable value independent of smoking status. Depression ratings were applied antepartum and postpartum, across 7 assessments.

Intervention Results: Financial incentives that were contingent on smoking cessation significantly increased 7-day, point-prevalence abstinence rates compared to the non-contingent control condition at each assessment through 24 weeks postpartum.

Conclusion: The study concludes that depression-prone pregnant and newly postpartum women respond well to this incentive-based smoking-cessation intervention in terms of achieving abstinence, and the intervention also reduces the severity of postpartum depression ratings in this at-risk population.

Study Design: Quasi experimental cross sectional

Setting: Women, Infants and Children clinic obstetrical practices

Population of Focus: Economically-disadvantaged pregnant and newly postpartum smokers at risk for depression.

Data Source: Depression scales, survey, cotinine levels

Sample Size: 289

Age Range: Not specified