Acceptability of Financial Incentives for Health Behaviours: A Discrete Choice Experiment.

BACKGROUND: Healthy behaviours are important determinants of health and disease, but many people find it difficult to perform these behaviours. Systematic reviews support the use of personal financial incentives to encourage healthy behaviours. There is concern that financial incentives may be unacceptable to the public, those delivering services and policymakers, but this has been poorly studied. Without widespread acceptability, financial incentives are unlikely to be widely implemented. We sought to answer two questions: what are the relative preferences of UK adults for attributes of financial incentives for healthy behaviours? Do preferences vary according to the respondents' socio-demographic characteristics? METHODS: We conducted an online discrete choice experiment. Participants were adult members of a market research panel living in the UK selected using quota sampling. Preferences were examined for financial incentives for: smoking cessation, regular physical activity, attendance for vaccination, and attendance for screening. Attributes of interest (and their levels) were: type of incentive (none, cash, shopping vouchers or lottery tickets); value of incentive (a continuous variable); schedule of incentive (same value each week, or value increases as behaviour change is sustained); other information provided (none, written information, face-to-face discussion, or both); and recipients (all eligible individuals, people living in low-income households, or pregnant women). RESULTS: Cash or shopping voucher incentives were preferred as much as, or more than, no incentive in all cases. Lower value incentives and those offered to all eligible individuals were preferred. Preferences for additional information provided alongside incentives varied between behaviours. Younger participants and men were more likely to prefer incentives. There were no clear differences in preference according to educational attainment. CONCLUSIONS: Cash or shopping voucher-type financial incentives for healthy behaviours are not necessarily less acceptable than no incentives to UK adults.This work is produced under the terms of a Career Development Fellowship research training fellowship issued by the National Institute of Health Research to JA (grant number NIHR-CDF-2011-04-17; http://www.nihr.ac.uk/funding/fellowship-programme.htm). The views expressed are those of the authors and not necessarily those of the NHS, The National Institute for Health Research or the Department of Health. JA is currently funded in full by the Centre for Diet & Activity Research (CEDAR), and the FFS is funded in full by Fuse: the Centre for Translational Research in Public Health. CEDAR and Fuse are UKCRC Public Health Research Centres of Excellence (http://www.ukcrc.org/research-coordination/joint-funding-initiatives/public-health-research/). Funding for CEDAR (grant number MR/K023187/1) and Fuse (grant number MR/K02325X/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.This is the final version of the article. It first appeared from PLOS via http://dx.doi.org/10.1371/journal.pone.015740

Emotional Eating Interventions for Adults Living with Overweight or Obesity: A Systematic Review and Meta-Analysis

Background: Emotional eating (EE) may be defined as a tendency to eat in response to negative emotions and energy-dense and palatable foods, and is common amongst adults with overweight or obesity. There is limited evidence regarding the effectiveness of interventions that address EE. Objectives: To synthesize evidence on the effectiveness of EE interventions for weight loss and EE in adults living with overweight or obesity. Methods: This is a systematic review and meta-analysis. Adhering to the PRISMA guidance, a comprehensive electronic search was completed up to February 2022. Random effects meta-analysis was carried out to determine the percentage change in weight and EE scores. Results: Thirty-four studies were included. The combined effect size for percentage weight change was −1.08% (95% CI: −1.66 to −0.49, I2 = 64.65%, n = 37), once adjusted for publication bias. Similarly, the combined effect size for percentage change in EE was −2.37%, (95% CI: −3.76 to −0.99, I2 = 87.77%, n = 46). Cognitive Behavioural Therapy showed the most promise for reducing weight and improving EE. Conclusions: Interventions to address EE showed promise in reducing EE and promoted a small amount of weight loss in adults living with overweight or obesity

A qualitative exploration of school-based staff's experiences of delivering an alcohol screening and brief intervention in the high school setting: findings from the SIPS JR-HIGH trial.

Background: Whilst underage drinking in the UK has been declining in recent years, prevalence is still higher than in most other Western European countries. Therefore, it is important to deliver effective interventions to reduce risk of harm. Methods: Semi-structured interviews with staff delivering an alcohol screening and brief intervention in the high-school setting. The analysis was informed by normalization process theory (NPT), interviews were open coded and then a framework applied based on the four components of NPT. Results: Five major themes emerged from the analysis. The majority of participants felt that the intervention could be useful, and that learning mentors were ideally suited to deliver it. However, there was a feeling that the intervention should have been targeted at young people who drink the most. Conclusions: The intervention was generally well received in schools and seen as an effective tool for engaging young people in a discussion around alcohol. However, in the future schools need to consider the level of staffing in place to deliver the intervention. Furthermore, the intervention could focus more on the long-term risks of initiating alcohol consumption at a young age

Food insecurity in adults with severe mental illness living in Northern England: Peer research interview findings

\ua9 2023 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.Food insecurity means that a person does not have access to sufficient nutritious food for normal growth and health. Food insecurity can lead to many health problems such as obesity, heart disease, diabetes, and other long term health conditions. People living with a severe mental illness are more likely to experience food insecurity than people without mental illness. Peer-led in-depth interviews were conducted with adults with severe mental illness from Northern England, during which their experiences of food insecurity and strategies to tackle food insecurity were discussed. Interviews took place between March and December 2022, with interviews being transcribed and analysed using deductive and inductive thematic analysis. Thirteen interviews were conducted, finding that food insecurity in adults with severe mental illness was often a long-standing issue. Unemployment, the cost-of-living crisis and fuel poverty impacted on experiences of food insecurity. Difficulties accessing food banks such as transport, stigma, and the limited selection of available food was also discussed. Strategies to tackle food insecurity centred on making food banks more accessible and improving the quality of available food. Future research should aim to eradicate food insecurity for adults with severe mental illness, as limited research and action focuses on this population group over and above ‘mental illness’ or ‘poor mental health’. Removing barriers to accessing food such as lack of transport, and providing food which is of adequate nutritional quality, should be prioritised, as well as tackling the stigma and accessibility issues surrounding food banks use

La oportunidad de una cláusula ambiental de elementos esenciales en acuerdos comerciales de la Unión Europea con Estados terceros : a propósito del Acuerdo Unión Europea-Mercosur

Números monográficos con título distintivo catalogados individualmente.‎Bajo la denominación "Documentos de trabajo" se publican resultados de los proyectos de investigación realizados y promovidos por el CEALCI. Además pueden ser incluidos en esta serie aquellos trabajos que, previa aceptación por el Consejo Editorial, reunan los requisitos de calidad establecidos y coincidan con los objetivos de la Fundación Carolina y su Centro de Estudios.‎Bibliografía: p. 20-22Resumen: En el presente documento se reflexiona sobre la conveniencia de introducir, en los acuerdos comerciales de la Unión Europea con Estados terceros, una cláusula que expresamente califique como elemento esencial del tratado aspectos de protección ambiental. En este ámbito, la práctica relativa a la cláusula democrática —que presenta ya un largo recorrido en la adopción de tratados comerciales— supone un antecedente que ayuda a valorar las posibles ventajas y límites de la utilización de este tipo de disposiciones. A lo largo del trabajo, se utiliza como caso de estudio el acuerdo sobre comercio e inversiones concluido en 2019 entre la Unión Europea y el Mercosur, el cual supone un caso particular, a la vez que paradigmático, en el que la pregunta sobre la oportunidad de una cláusula sobre elementos esenciales con contenido ambiental resulta de interés, e incide sobre las posibilidades de que el acuerdo pueda ser definitivamente adoptado. El análisis en torno a este acuerdo permite enunciar algunas conclusiones sobre la oportunidad de introducir este tipo de cláusula en el tratado, las cuales pueden extenderse, de forma general, a los acuerdos comerciales de la Unión Europea con Estados terceros

A qualitative account of young people's experiences of alcohol screening and brief interventions in schools: SIPS Jr-HIGH trial findings.

BACKGROUND: The United Kingdom (UK) has seen a decrease in the number of young people drinking alcohol. However, the UK prevalence of underage drinking still ranks amongst the highest in Western Europe. Whilst there is a wealth of evidence reporting on the effectiveness of both primary, and secondary interventions, there are few reports of the experiences of young people who receive them. METHODS: The present study reports findings from interviews with 33 young people who were involved in an alcohol screening and brief intervention randomized controlled trial in schools in England. All interviews were analysed using inductive applied thematic analysis. RESULTS: Three major themes were identified following the analysis process: 1) drinking identities and awareness of risk; 2) access to support and advice in relation to alcohol use; and 3) appraisal of the intervention and potential impact on alcohol use. CONCLUSIONS: There appeared to be a reluctance from participants to describe themselves as someone who drinks alcohol. Furthermore, those who did drink alcohol often did so with parental permission. There was variation amongst participants as to how comfortable they felt talking about alcohol issues with school staff. Overall participants felt the intervention was useful, but would be better suited to 'heavier' drinkers

Cost-effectiveness of financial incentives to promote adherence to depot antipsychotic medication: economic evaluation of a cluster-randomised controlled trial

Background: Offering a modest financial incentive to people with psychosis can promote adherence to depot antipsychotic medication, but the cost-effectiveness of this approach has not been examined. Methods: Economic evaluation within a pragmatic cluster-randomised controlled trial. 141 patients under the care of 73 teams (clusters) were randomised to intervention or control; 138 patients with diagnoses of schizophrenia, schizo-affective disorder or bipolar disorder participated. Intervention participants received £15 per depot injection over 12 months, additional to usual acute, mental and community primary health services. The control group received usual health services. Main outcome measures: incremental cost per 20% increase in adherence to depot antipsychotic medication; incremental cost of ‘good’ adherence (defined as taking at least 95% of the prescribed number of depot medications over the intervention period). Findings: Economic and outcome data for baseline and 12-month follow-up were available for 117 participants. The adjusted difference in adherence between groups was 12.2% (73.4% control vs. 85.6% intervention); the adjusted costs difference was £598 (95% CI -£4 533, £5 730). The extra cost per patient to increase adherence to depot medications by 20% was £982 (95% CI -£8 020, £14 000). The extra cost per patient of achieving 'good' adherence was £2 950 (CI -£19 400, £27 800). Probability of cost-effectiveness exceeded 97.5%at willingness-to-pay values of £14 000 for a 20% increase in adherence and £27 800 for good adherence. Interpretation: Offering a modest financial incentive to people with psychosis is cost-effective in promoting adherence to depot antipsychotic medication. Direct healthcare costs (including costs of the financial incentive) are unlikely to be increased by this intervention. Trial Registration: ISRCTN.com 7776928