Protocol for study of financial incentives for smoking cessation in pregnancy (FISCP): randomised, multicentre study

INTRODUCTION:Maternal smoking during pregnancy is associated with adverse perinatal and postnatal health outcomes. The efficacy of nicotine replacement therapies in helping pregnant smokers to quit is not clearly demonstrated; therefore new interventions should be proposed and assessed. Financial incentives rewarding abstinence from tobacco smoking is one of the promising options.OBJECTIVE:To assess the efficacy of financial incentives on smoking abstinence among French pregnant smokers.METHODS AND ANALYSIS:PARTICIPANTS:pregnant smokers aged ≥18 years, smoking at least five manufactured or three roll-your-own cigarettes per day, and pregnant for <18 weeks of amenorrhoea (WA).SETTING:participants will be recruited, included and followed-up at monthly face-to-face visits in 16 maternity wards in France.INTERVENTIONS:participants will be randomised to a control or an intervention group. After a predefined quit date, participants in the control group will receive €20 vouchers at the completion of each visit but no financial incentive for smoking abstinence. Participants in the intervention group will be rewarded for their abstinence by vouchers on top of the €20 show-up fee. The amount of reward for abstinence will increase as a function of duration of abstinence to stimulate longer periods of abstinence.MAIN OUTCOME MEASURE:complete abstinence from quit date to the last predelivery visit.SECONDARY OUTCOME MEASURES:point prevalence abstinence, time to relapse to smoking, birth weight, fetal growth restriction, preterm birth. Main data analysis: outcomes will be analysed on an intention-to-treat (ITT) basis. The ITT population is defined as all randomised smoking pregnant women

Public acceptability of financial incentives to reward pregnant smokers who quit smoking: a United Kingdom-France comparison

A substantial amount of research has been conducted on financial incentives to increase abstinence from smoking among pregnant smokers. If demonstrated to be effective, financial incentives could be proposed as part of health care interventions to help pregnant smokers quit. Public acceptability is important; as such interventions could be publicly funded. Concerns remain about the acceptability of these interventions in the general population. We aimed to assess the acceptability of financial incentives to reward pregnant smokers who stop smoking using a survey conducted in the UK and then subsequently in France, two developed countries with different cultural and social backgrounds. More French than British respondents agreed with financial incentives for rewarding quitting smoking during pregnancy, not smoking after delivery, keeping a smoke-free household, health service payment for meeting target and the maximum amount of the reward. However, fully adjusted models showed significant differences only for the two latter items. More British than French respondents were neutral toward financial incentives. Differences between the representative samples of French and British individuals demonstrate that implementation of financial incentive policies may not be transferable from one country to another

Observation of the Charge Symmetry Breaking d + d -> 4He + pi0 Reaction Near Threshold

We report the first observation of the charge symmetry breaking d + d -> 4He + pi0 reaction near threshold at the Indiana University Cyclotron Facility. Kinematic reconstruction permitted the separation of 4He + pi0 events from double radiative capture 4He + gamma + gamma events. We measured total cross sections for neutron pion production of 12.7 +- 2.2 pb at 228.5 MeV and 15.1 +- 3.1 pb at 231.8 MeV. The uncertainty is dominated by statistical errors.Comment: 7 pages, 2 figures, plain Te

Has charge symmetry breaking been observed in the d d -> alpha pi0 reaction?

Estimates are made of the d d -> alpha gamma gamma production cross sections in a model where each neutron-proton pair in the beam and target initiates an n p -> d gamma reaction. This approach, which successfully reproduces observables in two-pion production at intermediate energies, suggests that direct two-photon production could provide a very significant background to the measurement of the charge-symmetry-breaking (CSB) reaction d d -> alpha pi0. A non-vanishing CSB cross section has been reported which might be confused with such two-photon production under the given experimental conditions.Comment: 9 pages, ReVTEX, 2 figures, submitted to Phys. Rev. Let

Are perceptions and preferences channels of transmission for social inequalities in breast cancer screening attendance?

URL des Documents de travail : http://centredeconomiesorbonne.univ-paris1.fr/documents-de-travail/Documents de travail du Centre d'Economie de la Sorbonne 2015.22 - ISSN : 1955-611XThree broad types of explanations can be found relative to breast cancer screening attendance: socioeconomic characteristics (education), preferences (e.g. attitude toward risk) and perceptions. These determinants are elicited in the experimental laboratory on 178 women aged between 50 and 75 years old. By performing a mediation analysis, this study aims at identifying the main drivers of screening regularity, as it is a crucial determinant of breast cancer mortality reduction. Results show that socioeconomic determinants (both from parents and the individual) have a strong impact. Women whose mother passed compulsory education are more likely to hold a degree and to be risk tolerant and hence to screen regularly. Even if more educated and richer women tend to screen more regularly, these effects are lowered once perceptions are controlled for. Indeed, almost all respondents overestimate their risk of developing breast cancer, but the less educated respondents do so even more. This study reveals that risk preference is a channel for opportunity inequalities. On the contrary, controlling for risk and benefit perceptions tend to alleviate the role played by current socioeconomic status

Une approche comportementale du dépistage du cancer du sein

Cette thèse étudie les facteurs d’offre et de demande associés au recours au dépistage du cancer du sein. Parmi les facteurs d’offre, j’examine comment la coexistence du dépistage organisé au côté du dépistage individuel influence le contenu de l’examen de dépistage ainsi que le recours régulier au dépistage. En plus des facteurs de demande tels les caractéristiques socioéconomiques, une attention particulière est portée à la possibilité d’expliquer le recours régulier au dépistage par les préférences face au risque et temporelles ainsi que les perceptions. À partir de régularités psychologiques identifiées dans les travaux d’économie comportementale et de psychologie, trois interventions de type nudge sont testées dans le cadre d’une expérience randomisée sur le terrain visant à augmenter le taux de dépistage dans le programme national.This thesis explores supply and demand factors associated with the use of breast cancer screening. Among the supply factors, I examine how the coexistence of organized and opportunistic screenings influences the content of the screening exam and screening regularity. Besides the usual demand factors such as socioeconomic characteristics, a special attention is being given to the possibility of explaining screening regularly by individuals’ risk and time preferences and perceptions. Based on psychological patterns identified in the literature in behavioral economics and psychology, three nudge interventions are tested in a randomized field experiment to increase the national program uptake rate

Les déterminants du recours régulier au dépistage du cancer du sein en France

Breast cancer screening diminishes breast cancer mortality only if it is performed regularly. We study the effects of various socioeconomic and health characteristics as well as how the French screening system itself influence screening regularity. We specifically examine whether the screening modality chosen (organized or opportunistic screenings) influences screening regularity. Our results suggest that organized screening increases the probability to screen regularly. In addition, low-income women or those who lived adverse life events tend to screen less regularly than wealthier ones.Le dépistage du cancer du sein ne diminue sa mortalité que si le dépistage est effectué régulièrement. Nous étudions les effets des caractéristiques socio-économiques et de santé ainsi que la façon dont le système français de dépistage influence la régularité du dépistage. Nous examinons particulièrement si la modalité de dépistage choisie (dépistage organisé ou individuel) influence la régularité du dépistage. Nos résultats suggèrent que le dépistage organisé augmente la probabilité de recourir régulièrement au dépistage. En outre, les femmes ayant un faible revenu ou ayant vécu des épisodes de précarité ont moins régulièrement recours au dépistage que les femmes plus aisées

The effects of multi-disciplinary integrated care on healthcare utilization: Evidence from a natural experiment in the UK

Better integration is a priority for most international health systems. However, multiple interventions are often implemented simultaneously, making evaluation difficult and providing limited evidence for policy makers about specific interventions. We evaluate a common integrated care intervention, multi-disciplinary group (MDG) meetings for discussion of high-risk patients, introduced in one socio-economically deprived area in the UK in spring 2015. Using data from multiple waves of the national GP Patient Survey and Hospital Episode Statistics, we estimate its effects on primary and secondary care utilization and costs, health status and patient experience. We use triple differences, exploiting the targeting at people aged 65 years and over, parsing effects from other population-level interventions implemented simultaneously. The intervention reduced the probability of visiting a primary care nurse by three percentage points and decreased length of stay by 1 day following emergency care admission. However, since planned care use increased, overall costs were unaffected. MDG meetings are presumably fulfilling public health objectives by decreasing length of stay and detecting previously unmet needs. However, the effect of MDGs on health system cost is uncertain and health remains unchanged. Evaluations of specific integrated care interventions may be more useful to public decision makers facing budget constraints