Incentivizing health care behaviors in emerging adults: a systematic review

Figures & data

Table 1 Types of incentives and their definition

Incentive type	Definition	Example
Cash payment	Direct payments of money in the form of cash	Cash given to participants to attend a smoking-cessation session^Citation14
Voucher	A form or check indicating a credit against future purchases or expenditures	Voucher for HPV-vaccine doses,^Citation15 goods purchased by study staff^Citation16
Lottery	Drawing of lots in which prizes are distributed to the winners among persons buying a chance	Participants receive chits to draw for items in a prize bowl, such as phone cards, iTunes vouchers, skateboards, jewelry, etc^Citation17
Deposit contract	Participants put their own money at risk, which can be recouped if designated contingencies are met, but lost if target outcome is not met	Participant contributes 0–$3 per day of their own funds to a deposit contract each day; if goal met, participant accumulates a reward equal to the daily deposit, plus 1:1 match from the investigator; if goal not met, deposit contract money is forfeited^Citation18
The incentive can be further characterized by
Contingency management	Receipt of the incentive is contingent on achieving an outcome	Payment received if girl attended school 80% of days^Citation19
Escalating schedule	With each consecutive desired outcome, the incentive value is increased	With each negative carbon monoxide breath sample, incentive value is increased^Citation14
Reset of escalating schedule	Escalating schedule of incentive can be reset if desired outcome not met	Incentive value reset to lowest value if positive carbon monoxide breath sample^Citation14

Abbreviation: HPV, human papilloma virus.

Figure 1 PRISMA flow diagram.

Table 2 Study characteristics

Study	Condition	Participants (n)	Age range (years)	Intervention	Primary effective	Secondary effective	Negative outcome	Follow-up duration	Sustained at follow-up
Randomized controlled trials
Baird et al^Citation19	HIV/HSV-2	3,796	13–22	Cash transfer	Yes	Yes	No	0 month	NA
Glindemann et al^Citation32	SA	702	University students	Lottery	Yes	No change	No	0 month	NA
Tevyaw et al^Citation14	Smoking	110	18–24	Cash payment	Yes	Yes	No	6 months	No
Gray et al^Citation24	Smoking	134	12–21	Cash payment	Yes (with bupropion)	NA	No	1.5 months	No
Killeen et al^Citation17	SA	31	12–18	Lottery	No change	No	No	3 months	Yes for group by time interaction for cravings
Campbell et al^Citation25	SA, vaccine uptake	3,181	15–30	Cash payment	Yes	No change	No	0 month	NA
Steele Seel^Citation26	SA	14	16–25	Lottery	Yes	Yes	No	2 months	Yes
Leeman et al^Citation27	SA	39	21–25	Cash payment	Yes	Yes	No	1–3 days	NA*
Weinstock et al^Citation28	SA	31	18–27	Lottery	Yes	Yes	No	0 month	NA
Tevyaw et al^Citation29	Smoking	19	14–18	Cash payment	No change	No change	No	0.5 month	No change
An et al^Citation30	Smoking	517	18–24	Voucher	Yes	Yes	No	6 months	NA
Krishnan-Sarin et al^Citation31	Smoking	28	14–18	Cash payment	Yes	Yes	No	0 month	NA
Carroll et al^Citation16	SA	136	18–24	Voucher	Yes	NA	No	6 months	Yes
Sinha et al^Citation33	SA	65	18–25	Voucher	Yes	Yes	No	1 month	Yes
Controlled clinical trials
Finley et al^Citation34	Cerebral palsy	15	4–22	Cash payment	Yes	NA	No	0 month	NA
Mueller et al^Citation35	CAH	63	15–16	Cash payment	Yes	NA	No	0 month	NA
Crossover clinical trials
Corby et al^Citation36	Smoking	8	15–19	Cash payment	Yes	NA	Yes	0.5 month	No
Cohort studies
Black et al^Citation6	HIV/HSV-2	802	12–22	Voucher	Yes	Yes	No	0 month	NA
Lott and Jencius^Citation37	SA	336	12–18	Lottery	Yes	Yes	No	0 month	NA
Uncontrolled before–after studies
Foster et al^Citation39	HIV	11	16–23	Voucher	Yes	NA	No	12 months	Yes
Casey et al^Citation15	HPV	495	18–26	Voucher	Yes	NA	No	0 month	NA
Esposito-Smythers et al^Citation38	SA, sexual behavior	17	18–24	Lottery	Yes	Yes	No	3 months	Yes
Hanewinkel and Wiborg^Citation40	Smoking	1,265	14–25	Lottery, quit and win	Yes	NA	No	0 month	NA
Rofael^Citation41	SA	14	14–20	Lottery	Yes	NA	No	0 month	NA
Rooney et al^Citation42	Smoking	152	18–24	Lottery, quit and win	Yes	NA	No	6 months	No
Weissman et al^Citation43	Smoking	11	13–18	Cash payment	Yes	NA	No	2–3 months	Yes

Note:

* NA because the follow-up was to administer disincentive and not to see sustained effects of the incentive.

Abbreviations: SA, substance abuse; NA, not applicable; CAH, congenital adrenal hyperplasia; HPV, human papilloma virus; HSV, herpes simplex virus.

TevyawTOColbySMTideyJWContingency management and motivational enhancement: a randomized clinical trial for college student smokersNicotine Tob Res200911673974919443788

 PubMed Web of Science ®Google Scholar

CaseyBRCrosbyRAVanderpoolRCDignanMBatesWPredictors of initial uptake of human papillomavirus vaccine uptake among rural Appalachian young womenJ Prim Prev2013341–2718023325057

 PubMed Web of Science ®Google Scholar

CarrollKMEastonCJNichCThe use of contingency management and motivational/skills-building therapy to treat young adults with marijuana dependenceJ Consult Clin Psychol200674595596617032099

 PubMed Web of Science ®Google Scholar

KilleenTKMcRae-ClarkALWaldropAEUpadhyayaHBradyKTContingency management in community programs treating adolescent substance abuse: a feasibility studyJ Child Adolesc Psychiatr Nurs2012251334122299805

 PubMedGoogle Scholar

JohnLKLoewensteinGTroxelABNortonLFassbenderJEVolppKGFinancial incentives for extended weight loss: a randomized, controlled trialJ Gen Intern Med201126662162621249462

 PubMed Web of Science ®Google Scholar

BairdSJGarfeinRSMcIntoshCTOzlerBEffect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trialLancet201237998231320132922341825

 PubMed Web of Science ®Google Scholar

GlindemannKEEhrhartIJDrakeEAGellerESReducing excessive alcohol consumption at university fraternity parties: a cost-effective incentive/reward interventionAddict Behav2007321394816650622

 PubMed Web of Science ®Google Scholar

GrayKMCarpenterMJBakerNLBupropion SR and contingency management for adolescent smoking cessationJ Subst Abuse Treat2011401778620934835

 PubMed Web of Science ®Google Scholar

CampbellJVGarfeinRSThiedeHConvenience is the key to hepatitis A and B vaccination uptake among young adult injection drug usersDrug Alcohol Depend200791Suppl 1S64S7217276018

 PubMed Web of Science ®Google Scholar

Steele SeelJMEliciting abstinence and improving retention in a vocational and educational training program for young people: a pilot study [dissertation]AlbuquerqueUniversity of New Mexico2011

 Google Scholar

LeemanRFCorbinWRNogueiraCKrishnan-SarinSPotenzaMNO’MalleySSA human alcohol self-administration paradigm to model individual differences in impaired control over alcohol useExp Clin Psychopharmacol201321430331423937598

 PubMed Web of Science ®Google Scholar

WeinstockJCapizziJWeberSMPescatelloLSPetryNMExercise as an intervention for sedentary hazardous drinking college students: a pilot studyMent Health Phys Act201471556224949085

 PubMed Web of Science ®Google Scholar

TevyawTOGwaltneyCTideyJContingency management for adolescent smokers: an exploratory studyJ Child Adolesc Subst Abuse20071642344

 Web of Science ®Google Scholar

AnLCKlattCPerryCLThe RealU online cessation intervention for college smokers: a randomized controlled trialPrevent Med2008472194199

 Web of Science ®Google Scholar

Krishnan-SarinSDuhigAMMcKeeSAContingency management for smoking cessation in adolescent smokersExp Clin Psychopharmacol200614330631016893273

 PubMed Web of Science ®Google Scholar

SinhaREastonCRenee-AubinLCarrollKMEngaging young probation-referred marijuana-abusing individuals in treatment: a pilot trialAm J Addict200312431432314504024

 PubMed Web of Science ®Google Scholar

FinleyWWEthertonMDDickmanDKarimianDSimpsonRWA simple EMG-reward system for biofeedback training of childrenBiofeedback Self Regul1981621691807260186

 PubMedGoogle Scholar

MuellerSCDanieleTMacIntyreJIncentive processing in congenital adrenal hyperplasia (CAH): a reward-based antisaccade studyPsychoneuroendocrinology201338571672122917623

 PubMed Web of Science ®Google Scholar

CorbyEARollJMLedgerwoodDMSchusterCRContingency management interventions for treating the substance abuse of adolescents: a feasibility studyExp Clin Psychopharmacol20008337137610975628

 PubMed Web of Science ®Google Scholar

BlackSWallaceMMiddelkoopKImproving HIV testing amongst adolescents through and integrated Youth Centre rewards program: insights from South AfricaChild Youth Ser Rev20144598105

 Web of Science ®Google Scholar

LottDCJenciusSEffectiveness of very low-cost contingency management in a community adolescent treatment programDrug Alcohol Depend20091021–316216519250774

 PubMed Web of Science ®Google Scholar

FosterCMcDonaldSFrizeGAyersSFidlerS“Payment by results” – financial incentives and motivational interviewing, adherence interventions in young adults with perinatally acquired HIV-1 infection: a pilot programAIDS Patient Care STDS2014281283224428797

 PubMed Web of Science ®Google Scholar

Esposito-SmythersCBrownLKWolffJSubstance abuse treatment for HIV infected young people: an open pilot trialJ Subst Abuse Treat201446224425023988190

 PubMed Web of Science ®Google Scholar

HanewinkelRWiborgGInitial evaluation of a real-world self-help smoking cessation programme for adolescents and young adultsAddict Behav200631101939194516457963

 PubMed Web of Science ®Google Scholar

RofaelMSplat – when alcohol and cars collide: increasing awareness of high school athletes about the dangers of drinking and drivingJ Investig Med2013611158

 Web of Science ®Google Scholar

RooneyBLSilhaPGloydJKreutzRQuit and Win smoking cessation contest for Wisconsin college studentsWMJ20051044454916117234

 PubMedGoogle Scholar

WeissmanWGlasgowRBiglanALichtensteinEDevelopment and preliminary evaluation of a cessation program for adolescent smokersPsychol Addict Behav1987128491

 Google Scholar