|There’s More than One Way to Arrange a Contingency: Strategies for Supporting Healthy Behaviors
|Sunday, May 28, 2017
|8:00 AM–9:50 AM
|Hyatt Regency, Capitol Ballroom 5-7
|Area: CBM; Domain: Applied Research
|Chair: Kimberly C. Kirby (Rowan University)
|Discussant: Derek D. Reed (The University of Kansas)
|CE Instructor: Kimberly C. Kirby, Ph.D.
|Abstract: The United States has faced steadily rising rates of chronic health problems that develop from long-standing patterns of unhealthy behavior. Developing and maintaining new healthy behaviors can be challenging, especially when reinforcement for an unhealthy alternative is reliable and immediate while the healthy choices are reinforced on a delayed and uncertain schedule. The effectiveness of using incentives to promote healthy behavior and counteract unhealthy choices is becoming increasingly well-known, and in recent years a variety of innovative strategies have emerged for delivering them. In the current symposium, a series of talks will address different strategies for delivering positive reinforcement for a variety of healthy behaviors in populations of children, adolescents, and adults. The healthy behaviors addressed include medication compliance, drug abstinence, smoking cessation, and consumption of fruits and vegetables. Strategies vary from applying established methods (e.g., token reinforcement and parent training) in new contexts to developing innovative methods of delivery (internet-based and gaming formats). All strategies show positive changes in behaviors and demonstrate methods for preventing or addressing serious health concerns by applying established principles of behavior analysis.
|Instruction Level: Intermediate
Incentives for Suppression of Viral Load in People Living With HIV: Interim Results
|KENNETH SILVERMAN (Johns Hopkins University), Andrew Rodewald (Johns Hopkins University School of Medicine), Carol-Ann Getty (Johns Hopkins University School of Medicine), Brian R. Katz (Johns Hopkins University School of Medicine), August F. Holtyn (Johns Hopkins University School of Medicine), Brantley Jarvis (Johns Hopkins University School of Medicine), Shrinidhi Subramaniam (Johns Hopkins University)
Consistent use of antiretroviral medications by adults living with HIV can suppress plasma HIV-1 RNA (viral load) to undetectable levels. This ongoing study is evaluating the effectiveness of an incentive intervention in promoting suppression of viral load. Adults living with HIV who have detectable viral loads are being randomly assigned to an Incentive or a Usual Care Control group. Incentive participants receive high magnitude incentives for maintaining reduced or undetectable viral loads, the testing frequency is gradually reduced as participants achieve longer periods of viral load suppression, incentives are arranged on a schedule of escalating reinforcement for sustained suppression of viral load, and the intervention is maintained for two years. Assessments are conducted every 3 months throughout the two years of treatment and every 6 months throughout the year following treatment. Interim results for 30 participants who completed the 3-month assessment show that Incentive participants have significantly lower viral loads than the Usual Care Control participants at the 3-month assessment. If the incentive intervention maintains suppressed viral load, it could be used to improve the health of adults living with HIV.
Community Reinforcement and Family Training With Parents of Substance-Using Treatment-Resistant Youth
|KIMBERLY C. KIRBY (Rowan University), Kathleen Meyers (Treatment Research Institute), Elena Bresani (Treatment Research Institute), Lois A. Benishek (Treatment Research Institute), Mary Louise E. Kerwin (Rowan University), Yukiko Washio (Treatment Research Institute), Robert J. Meyers (Robert J. Meyers, Ph.D. & Associates)
Little research has examined methods for helping a parent with a treatment-resistant child who is using alcohol or drugs. We adapted Community Reinforcement and Family Training (CRAFT) designed for spouses of substance-using adults for use by parents of treatment resistant youth and evaluated the revised program on efficacy in facilitating treatment entry and reducing substance use and behavior problems of the youth. Parents were randomly assigned to receive either CRAFT or 12-Step Facilitation Training (TFT). Parents reported on their youths treatment entry during CRAFT sessions and at 3-, 6-, and 12-month follow-up assessments. At baseline and follow-ups, parents also reported on youth substance use and behavior problems (using Achenbach Child and Adult Behavior Checklists). Large differences were seen with 77% of the youth of CRAFT parents receiving a brief intervention and treatment referral compared to 42% of the youth in the TNF group. There were significant reductions in substance use and behavior problems as a main effect of time; but no differences as a function of the type of training.
|Nationwide Access to an Internet-Based Contingency Management Intervention to Promote Smoking Cessation: A Randomized Controlled Trial
|JESSE DALLERY (University of Florida), Bethany R. Raiff (Rowan University), SunnyJung Kim (The Geisel School of Medicine at Darmouth), Lisa A. Marsch (Dartmouth College), Maxine Stitzer (Johns Hopkins University School of Medicine), Mike Grabinski (Red5hift LLC)
|Abstract: Contingency management (CM) is one of the most effective behavioral interventions to promote drug abstinence, but availability of this treatment is limited. We evaluated the efficacy and acceptability of internet-based CM relative to an Internet-based monitoring and goal setting control group in a nationwide sample of cigarette smokers. Participants were randomized to earn financial incentives based on video-verified abstinence using breath carbon monoxide (CO) output (Abstinent Contingent Group, AC), or based on submitting CO samples (Submission Contingent, SC). Both groups also received the same CO-based goals. A deposit was required in both groups that could be recouped from initial earnings. Smokers from 26 states were enrolled. Abstinence rates differed at 4 weeks between the AC and SC groups, but not at the 3-, or 6-month follow-ups. The lowest acceptability ratings were for the items assessing the deposit, whereas the highest ratings concerned the ease of the intervention, the graph of CO results, and earning money. It is efficacious and acceptable to extend the reach of CM interventions for smoking cessation using technology.
|Gamifying the School Cafeteria to Increase Healthy Eating
|GREGORY J. MADDEN (Utah State University), Frank Sosa (Utah State University), Damon Joyner (Utah State University), Hali King (Utah State University), Heidi Wengreen (Utah State University), Sheryl Aguilar (Utah State University)
|Abstract: Children in 1st through 5th grades participated in a school-wide healthy eating program known as the FIT Game. Following a stable baseline period in which fruit and vegetable consumption was measured daily, the FIT Game intervention was introduced in two schools in what would be an A-B-A-B design. In the game phases, the school worked cooperatively to aid a group of heroes (the FITs) in their quest to find and capture a band of villains (the VAT). The game narrative was presented in comic-book formatted episodes presented in the school cafeteria. Each day that the school collectively met a vegetable-consumption goal, the game continued the next day with a new episode. Game elements included competitions against fictional schools, voting to determine the direction of the narrative, solving riddles, earning and spending virtual currency, and helping the heroes to complete their quests. Bootstrapping statistical analyses appropriate to time-series data were used to evaluate differences across the A and B phases (alpha less than .05). In both schools, vegetable consumption significantly increased during both FIT Game phases. Fruit consumption did not decrease in response to the contingency placed on vegetable consumption; to the contrary, there was a modest (but non-significant) increase.