|Habits That Hinder Health and Wealth: Using Behavior Analysis to Reduce Risky Behaviors|
|Sunday, May 27, 2018|
|3:00 PM–4:50 PM |
|Manchester Grand Hyatt, Coronado Ballroom AB|
|Area: CBM/CSS; Domain: Applied Research|
|Chair: Bethany R. Raiff (Rowan University)|
|Discussant: Kimberly C. Kirby (Rowan University; University of Pennsylvania)|
|CE Instructor: Kimberly C. Kirby, Ph.D.|
According to a recent national report (United Health Foundation, 2016), 72% of American adults report that they engage in least one unhealthy behavior. Although having multiple unhealthy habits is less common (24%), about 70% of our increasing healthcare costs are related to care for Americans with multiple chronic medical conditions. The efficacy of using positive reinforcement to counteract risky or poor health-related choices is becoming increasingly well-known. However, despite decades of research focused on a variety of health-related behaviors, very little attention has been paid to using a fuller range of behavior analytic principles and procedures and there are still risky health behaviors that have not yet been addressed. This symposium will include four presentations that together present a more comprehensive picture of the potential contribution that behavior analysis can make in addressing public health and safety issues. Presentations will address the use of functional assessments for smoking, behavioral economic strategies to address the relatively new public health risk of cellphone use while driving, a long-term behavior maintenance strategy using wage supplement incentives to promote employment and abstinence with adults who have opiate use disorders, and the social validity of behavior analysis strategies among medical professionals, substance abuse treatment providers, and the general public.
|Instruction Level: Basic|
|Keyword(s): Behavioral Economics, Behavioral Health, Contingency Management, Incentives|
|Target Audience: |
Applied researchers; BCBA-Ds; BCBAs; BCABAs; Graduate students; Other healthcare professionals
|Learning Objectives: At the conclusion of the presentation, participants will: (1) become familiar with the use of functional assessment for smoking reduction, (2) have learned about novel application of behavioral economics to reduce teen cellphone use while driving, (3) understand how incentive programs can be utilized to promote both substance use abstinence and steady employment, (4) be informed of the social validity of contingency management programs in healthcare settings, and (5) better apply behavior analytic theory to promote health behavior change.|
|A Functional Assessment Questionnaire for Smoking Treatment Recommendations|
|CONNOR ANDREW BURROWS (Rowan University), Jesse Dallery (University of Florida), SunnyJung Kim (Dartmouth), Bethany R. Raiff (Rowan University)|
|Abstract: Smoking is the leading cause of preventable death in the United States. In addition, smoking imposes a substantial economic cost, accounting for a total of more than $300 billion dollars of direct healthcare expenditure and lost productivity (CDC, 2017). Despite the well-established potential harm, relapse rates remain high during quit attempts. According to García-Rodríguez et al. (2013), relapse rates exceed 50% within the first 12 months of abstinence. In the realm of applied behavior analyses, functional assessment has long been recognized as a reliable method to increase the targeted effectiveness of treatments for a variety of problem behaviors (Hanley, Iwata, & McCord, 2003). It has been suggested that the use of functional assessment may aid in designating targeted treatment for smokers based on the maintaining function of the behavior (Axelrod, 1991). The current study (N = 102) sought to assess the reliability and validity of the Functional Assessment of Smoking for Treatment Recommendations (FASTR). The full FASTR included five subscales: 1) Conditioned Reinforcement, 2) Social Reinforcement, 3) Negative Reinforcement, 4) Antecedent Stimuli, and 5) Positive Reinforcement. The full battery of subscales was found to be adequately reliable and valid, with a reliability coefficient of α = 0.81, with the subtests ranging between α = 0.67 and α = 0.84.|
Behavioral Economic Strategies to Reduce Cell Phone Use While Driving Among Teens: Attitudes and Intervention Effectiveness
|KATHRYN SAULSGIVER (University of Pennsylvania), Catherine McDonald (University of Pennsylvania), Jessie Hemmons (University of Pennsylvania), Mucio Kit Delgado (University of Pennsylvania)|
The majority of U.S. teens admit to handheld cellphone use while driving, an increasingly common cause of crashes. We examined teens' willingness to reduce cellphone use while driving, perceptions of potential strategies to limit this behavior, and effectiveness of several interventions across 2 experiments. Teen drivers (n=153), aged 16-17, completed an online survey and a subset (n=32) were enrolled into a randomized trial that examined the effectiveness of opt-out, opt-in, or opt-out blocking plus parental notifications for reducing distracted driving. Teens were willing or somewhat willing to give up reading texts (90%), sending texts (95%), and social media (99%). They were not willing to give up navigation (59%) and music applications (43%). Strategies perceived as being "very effective" included financial rewards (75%), loss-framed financial incentives (63%), insurance discounts (53%), and automatic phone locking while driving (54%). The predominant reason for not wanting to use this technology was not wanting parents to monitor their behavior (60%). Results from the randomized trial will be available at the time of this presentation. Promising strategies for increasing acceptance of cellphone blocking technology among teens includes automated locking and text responses and permitting hands-free navigation and music combined with behavioral economic incentives to sustain engagement.
Incentives to Promote Employment and Abstinence in Unemployed Adults With Opioid-Use Disorder
|SHRINIDHI SUBRAMANIAM (Johns Hopkins University), August F. Holtyn (Johns Hopkins University School of Medicine), Kenneth Silverman (Johns Hopkins University)|
Poverty is a pervasive risk factor for poor health, often amplifying destructive effects of substance-use disorder. We describe an ongoing study evaluating abstinence-contingent wage supplements (ACWS) to promote abstinence and employment in chronically unemployed adults with opioid-use disorder. In Phase 1 (3 months), participants can work on job-skills training for 20 hr/week and earn ~$10/hr. Abstinence contingencies are introduced sequentially: Participants must provide opiate-negative and then opiate- and cocaine-negative urine samples to continue earning maximum pay. In Phase 2 (1 year), participants are randomly assigned to receive Individualized Placement and Support (IPS) supported employment (IPS ONLY) or IPS with ACWS. IPS+ACWS participants can earn hourly stipends for participating in pre-employment IPS and up to $320/week in wage supplements for maintaining opiate- and cocaine-abstinence and full-time employment. Assessments are conducted every 30 days, at which participants provide urine samples and self-reports of employment. Preliminary data indicate that IPS+ACWS promotes participation in IPS and employment. Of the first 34 participants in the program, 11/17 IPS+ACWS participants reported employment in the first 6 months of Phase 2 versus 4/17 IPS ONLY participants. ACWS, if informed by principles of stimulus control and reinforcement, may be a powerful intervention to reduce socioeconomic health disparities.
Social Validity of Contingency Management Interventions: Comparison of Acceptability as a Function of Treatment Provider and Disease
|MATTHEW J. DWYER (Rowan University), Mary Tabit (Treatment Research Institute at Public Health Management Corporation), Elena Bresani (Rowan University; Treatment Research Institute at Public Health Management Corporation), Dustin Fife (Rowan University), Kimberly C. Kirby (Rowan University)|
Contingency management (CM) interventions have strong empirical support for treating a wide range of risky health behaviors, but are seldom adopted by treatment programs. The purpose of this investigation was to survey substance abuse treatment providers, medical providers, and the general public about their beliefs regarding CM. We surveyed 600 participants that included a sample of medical treatment providers (MP, n= 200), substance use treatment providers (SUP, n= 200), and the general public (GP, n= 200). Data were compared across groups and across different health conditions in which CM interventions have been demonstrated to improve health outcomes. Results indicate that incentive-based CM programs are not widely used in physical healthcare settings (8% reported using incentive programs) compared to specialty substance use treatment settings (37.5%), and were rated more favorably among the GP (4.0 on an 1 to 5 Likert scale with 1= strongly disagree and 5=strongly agree) and SUP (3.7) over MP (3.4; F = 3.01, p < .001, R2= .07). Although the effect size was small, the average scores made the difference between supporting and not supporting an incentive program. Also, the greatest difference was observed for those strongly favoring incentive programs. For example, the number of participants that indicated they strongly agreed that overall they were in favor of incentive programs was 56 and 37 for the GP and SUP groups respectively, while only 11 MP strongly agreed. Preliminary results also suggest differences in favorability as a function of disease treated. For example, over 70 % of the MP said they would favor CM to treat obesity and smoking, but less than 40% would endorse use for marijuana, opiates, or other drugs. These findings indicate the need for improving the social validity of CM interventions, particularly among healthcare professionals.