Association for Behavior Analysis International

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.

Applied researchers; BCBA-Ds; BCBAs; BCABAs; Graduate students; Other healthcare professionals

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.

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.

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.