Contingency management and motivational enhancement: a randomized clinical trial for college student smokers. Public acceptability of financial incentives for smoking cessation in pregnancy and breast feeding: a survey of the British public A human alcohol self-administration paradigm to model individual differences in impaired control over alcohol use. Financial Incentives for Extended Weight Loss: A Randomized, Controlled Trial The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Are two youth-focused interventions sufficient to empower youth with chronic health conditions in their transition to adult healthcare: a mixed-methods longitudinal prospective cohort study Prize reinforcement contingency management for treating cocaine users: how low can we go, and with whom? Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial Contingency management for smoking cessation in adolescent smokers. Exercise as an intervention for sedentary hazardous drinking college students: A pilot study. Engaging young probation-referred marijuana-abusing individuals in treatment: a pilot trial. The RealU online cessation intervention for college smokers: a randomized controlled trial. Contingency management interventions for treating the substance abuse of adolescents: a feasibility study. Bupropion SR and contingency management for adolescent smoking cessation. Reducing excessive alcohol consumption at university fraternity parties: a cost-effective incentive/reward intervention. The use of contingency management and motivational/skills-building therapy to treat young adults with marijuana dependence. Differences in Treatment Outcome among Marijuana-Dependent Young Adults with and without Antisocial Personality Disorder Contingency management in community programs treating adolescent substance abuse: a feasibility study. Moderating effects of race in clinical trial participation and outcomes among marijuana-dependent young adults.
INTRODUCTION The efficacy of contingency-management ( CM ) and motivational enhancement therapy ( MET ) for college student smoking cessation was examined . METHODS Nontreatment-seeking daily smokers ( N = 110 ) were r and omly assigned to 3 weeks of CM versus noncontingent reinforcement ( NR ) and to three individual sessions of MET versus a relaxation control in a 2 x 2 experimental design . Expired carbon monoxide ( CO ) sample s were collected twice daily for 3 weeks . Participants earned 5 US dollars for providing each sample ; additionally , those r and omized to CM earned escalating monetary rewards based on CO reductions ( Week 1 ) and smoking abstinence ( Weeks 2 - 3 ) . RESULTS Compared with NR , CM result ed in significantly lower CO levels and greater total and consecutive abstinence during the intervention . Those in the CM and MET groups reported greater interest in quitting smoking posttreatment , but rates of confirmed abstinence at follow-up were very low ( 4 % at 6-month follow-up ) and did not differ by group . DISCUSSION Findings support the short-term efficacy of CM for reducing smoking among college students . Future research should explore enhancements to CM in this population , including a longer intervention period and the recruitment of smokers who are motivated to quit Objective To survey public attitudes about incentives for smoking cessation in pregnancy and for breast feeding to inform trial design . Design Cross-sectional survey . Setting and participants British general public . Methods Seven promising incentive strategies had been identified from evidence syntheses and qualitative interview data from service users and providers . These were shopping vouchers for : ( 1 ) vali date d smoking cessation in pregnancy and ( 2 ) after birth ; ( 3 ) for a smoke-free home ; ( 4 ) for proven breast feeding ; ( 5 ) a free breast pump ; ( 6 ) payments to health services for reaching smoking cessation in pregnancy targets and ( 7 ) breastfeeding targets . Ipsos MORI used area quota sampling and home-administered computer-assisted question naires , with r and omised question order to assess agreement with different incentives ( measured on a five-point scale ) . Demographic data and target behaviour experience were recorded . Analysis used multivariable ordered logit models . Results Agreement with incentives was mixed ( ranging from 34 % to 46 % ) among a representative sample of 1144 British adults .  Mean agreement score was highest for a free breast pump , and lowest for incentives for smoking abstinence after birth . More women disagreed with shopping vouchers than men . Those with lower levels of education disagreed more with smoking cessation incentives and a breast pump . Those aged 44 or under agreed more with all incentive strategies compared with those aged 65 and over , particularly provider targets for smoking cessation . Non-white ethnic groups agreed particularly with breastfeeding incentives . Current smokers with previous stop attempts and respondents who had breast fed children agreed with providing vouchers for the respective behaviours . Up to £ 40/month vouchers for behaviour change were acceptable ( > 85 % ) . Conclusions Women and the less educated were more likely to disagree , but men and women of childbearing age to agree , with incentives design ed for their benefit . Trials evaluating reach , impact on health inequalities and ethnic groups are required prior to implementing incentive interventions . Trial registration number CRD42012001980 We developed an alcohol self-administration paradigm to model individual differences in impaired control . The paradigm includes moderate drinking guidelines meant to model limits on alcohol consumption , which are typically exceeded by people with impaired control . Possible payment reductions provided a disincentive for excessive drinking . Alcohol use above the guideline , despite possible pay reductions , was considered to be indicative of impaired control . Heavy-drinking 21- to 25-year-olds ( n = 39 ) were r and omized to an experimental condition including the elements of the impaired control paradigm or to a  free-drinking condition  without these elements .  Alcohol self-administration  was compared between these two conditions to establish the internal validity of the experimental paradigm . In both conditions , participants self-administered beer and nonalcoholic beverages for 3 hours in a bar setting with 1 - 3 other participants . Experimental condition participants self-administered significantly fewer  beers  and drank to lower blood-alcohol concentrations ( BACs ) on average than those in the free-drinking condition . Experimental condition participants were more likely than free-drinking condition participants to intersperse nonalcoholic beverages with beer and to drink at a slower pace . Although experimental condition participants drank more moderately than those in the free-drinking condition overall , their range of drinking was considerable ( BAC range = .024-.097 ) , with several participants drinking excessively . A lower initial subjective response to alcohol and earlier age of alcohol use onset were associated with greater alcohol self-administration in the experimental condition . Given the variability in response , the impaired control laboratory paradigm may have utility for preliminary tests of novel interventions in future studies and for identifying individual differences in problem-drinking risk ABSTRACT BACKGROUND Previous efforts to use incentives for weight loss have result ed in substantial weight regain after 16 weeks . OBJECTIVE To evaluate a longer term weight loss intervention using financial incentives . DESIGN A 32-week , three-arm r and omized controlled trial of financial incentives for weight loss consisting of a 24-week weight loss phase during which all participants were given a weight loss goal of 1 pound per week , followed by an 8-week maintenance phase . PARTICIPANTS Veterans who were patients at the Philadelphia Veterans Affairs Medical Center with BMI s of 30–40.INTERVENTION Participants were r and omly assigned to participate in either a weight-monitoring program involving a consultation with a dietician and monthly weigh-ins ( control condition ) , or the same program with one of two financial incentive plans . Both incentive arms used deposit contracts ( DC ) in which participants put their own money at risk ( matched 1:1 ) , which they lost if they failed to lose weight . In one incentive arm participants were told that the period after 24 weeks was for weight-loss maintenance ; in the other , no such distinction was made . MAIN MEASUREWeight loss after 32 weeks . KEY RESULTS Results were analyzed using intention-to-treat . There was no difference in weight loss between the incentive arms ( P = 0.80 ) . Incentive participants lost more weight than control participants [ mean DC = 8.70 pounds , mean control = 1.17 , P = 0.04 , 95 % CI of the difference in means ( 0.56 , 14.50 ) ] . Follow-up data 36 weeks after the 32-week intervention had ended indicated weight regain ; the net weight loss between the incentive and control groups was no longer significant ( mean DC = 1.2 pounds , 95 % CI , -2.58–5.00 ; mean control = 0.27 , 95 % CI , -3.77–4.30 , P = 0.76 ) . CONCLUSIONS Financial incentives produced significant weight loss over an 8-month intervention ; however , participants regained weight post-intervention Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Objectives To assess use , utility and impact of transition interventions design ed to support and empower self-management in youth with chronic health conditions during transition into adult healthcare . Design A 4-year mixed- method prospect i ve cohort study . Setting 2 academic paediatric hospitals ( 13 clinics ) in Canada . Participants 50 adolescents ( 42 % male ; mean age 17.9±0.9 years ; 20 underlying diagnoses ) with transfer to adult care planned within 1 year . Interventions The Youth KIT ( an organisational tool that includes goal setting activities ) ; an online transition mentor . Main outcome measures Frequency of use , utility and impact of the transition interventions ; goal achievement ; post-transfer qualitative interviews with youth . Results 50 participants were enrolled during their last year of paediatric care ; 36 ( 72 % ) were followed into adult care . All participants had access to the transition interventions from enrolment until the end of the study ( exposure time : 12–47 months ) . Most youth ( 85 % ) reported using the medical/health section of the Youth KIT at least once ; 20 ( 40 % ) participants engaged in chats with the mentor . The overall perceived utility of both interventions was modest ; the Youth KIT received the highest ratings for ‘ help with goal setting ’ : ( mean ( SD ) : 4.2 ( 2.3 ) ) on a 7-point Likert scale . 45 ( 90 % ) participants set 294 transition goals . Goal achievement performance and satisfaction increased over time ( p≤0.001 ) . The qualitative evidence revealed reasons behind the variability in use and utility of the interventions , the interconnectedness of life-course and healthcare transitions , and the need for stronger partnerships between paediatric and adult healthcare systems . Conclusions Participants ’ perceptions about the utility of the Youth KIT and the online mentor were modest . Transition supports need to be carefully tailored , timed and integrated into healthcare systems . Individualised goal setting may be an important ‘ active ingredient ’ in optimising transition supports and outcomes . Interventions that focus on youth only are insufficient for empowering self-management AIMS This study evaluated the efficacy of a low-cost , prize reinforcement contingency management ( CM ) intervention for reducing  cocaine use .  SETTING Community-based treatment centers . PARTICIPANTS AND DESIGN Cocaine-abusing out- patients ( n = 120 ) were assigned r and omly to one of three 12-week conditions : st and ard treatment , st and ard treatment plus CM with an expected maximum of $ 80 of reinforcement or st and ard treatment plus CM with an expected maximum of $ 240 of reinforcement . INTERVENTION In the CM conditions , patients earned the opportunity to win prizes for su bmi tting negative urine sample s and completing goal -related activities . MEASUREMENTS Drug use was measured at intake and throughout a 3-month treatment period . FINDINGS Patients in the $ 240 CM condition achieved more abstinence than patients in the st and ard condition . Patients who initiated treatment with positive urinalysis results  were most responsive to the CM intervention , with the $ 240 CM condition engendering the best effects in this subgroup . In contrast , patients who initiated treatment with negative urinalysis results  generally remained abstinent during treatment , regardless of treatment assignment . On average , patients in the two CM conditions earned $ 36 and $ 68 in prizes . CONCLUSIONS This study suggests that prize reinforcement CM may be suitable for community-based setting s , and beneficial effects may be magnitude-dependent in more severe patients BACKGROUND Lack of education and an economic dependence on men are often suggested as important risk factors for HIV infection in women . We assessed the efficacy of a cash transfer programme to reduce the risk of sexually transmitted infections in young women . METHODS In this cluster r and omised trial , never-married women aged 13 - 22 years were recruited from 176 enumeration areas in the Zomba district of Malawi and r and omly assigned with computer-generated r and om numbers by enumeration area ( 1:1 ) to receive cash payments ( intervention group ) or nothing ( control group ) . Intervention enumeration areas were further r and omly assigned with computer-generated r and om numbers to conditional ( school attendance required to receive payment ) and unconditional ( no requirements to receive payment ) groups . Participants in both intervention groups were r and omly assigned by a lottery to receive monthly payments ranging from US$ 1 to $ 5 , while their parents were independently assigned with computer-generated r and om numbers to receive $ 4 - 10 .  Behavioural risk assessment  s were done at baseline and 12 months ; serology was tested at 18 months . Participants were not masked to treatment status but counsellors doing the serologic testing were . The primary outcomes were prevalence of HIV and herpes simplex virus 2 ( HSV-2 ) at 18 months and were assessed by intention-to-treat analyses . The trial is registered , number NCT01333826 . FINDINGS 88 enumeration areas were assigned to receive the intervention and 88 as controls . For the 1289 individuals enrolled in school at baseline with complete interview and biomarker data , weighted HIV prevalence at 18 month follow-up was 1·2 % ( seven of 490 participants ) in the combined intervention group versus 3·0 % ( 17 of 799 participants ) in the control group ( adjusted odds ratio [ OR ] 0·36 , 95 % CI 0·14 - 0·91 ) ; weighted HSV-2 prevalence was 0·7 % ( five of 488 participants ) versus 3·0 % ( 27 of 796 participants ; adjusted OR 0·24 , 0·09 - 0·65 ) . In the intervention group , we noted no difference between conditional versus unconditional intervention groups for weighted HIV prevalence ( 3/235 [ 1 % ] vs 4/255 [ 2 % ] ) or weighted HSV-2 prevalence ( 4/233 [ 1 % ] vs 1/255 [ < 1 % ] ) . For individuals who had already dropped out of school at baseline , we detected no significant difference between intervention and control groups for weighted HIV prevalence ( 23/210 [ 10 % ] vs 17/207 [ 8 % ] ) or weighted HSV-2 prevalence ( 17/211 [ 8 % ] vs 17/208 [ 8 % ] ) . INTERPRETATION Cash transfer programmes can reduce HIV and HSV-2 infections in adolescent schoolgirls in low-income setting s. Structural interventions that do not directly target sexual behaviour change can be important components of HIV prevention strategies . FUNDING Global Development Network , Bill & Melinda Gates Foundation , National Bureau of Economic Research Africa Project , World Bank 's Research Support Budget , and several World Bank trust funds ( Gender Action Plan , Knowledge for Change Program , and Spanish Impact Evaluation fund ) This pilot study evaluated the use of contingency management ( CM ) procedures in combination with cognitive-behavioral therapy ( CBT ) for  smoking cessation in adolescents . Twenty-eight treatment-seeking adolescent smokers participated in a 1-month , school-based smoking cessation program and were r and omly assigned to receive either CM with weekly CBT or CBT alone . In the CM+CBT group , biochemical verification of abstinence was obtained twice daily during the first 2 weeks , followed by daily appointments during the 3rd week and once every other day during the 4th week . Participants were monetarily reinforced for abstinence on an escalating magnitude schedule with a reset contingency . At the end of 1 week and 1 month of treatment , abstinence verified using quantitative urine cotinine levels was higher in participants in the CM+CBT group ( 1 week : 76.7 % ; 1 month : 53.0 % ) when compared with the CBT-alone group ( 1 week : 7.2 % ; 4 weeks : 0 % ) . These preliminary results provide a strong initial signal supporting the utility of CM techniques for  smoking cessation in adolescents and demonstrate the feasibility of implementing such a program in a school setting Young adults 18 - 24 years have the highest rates of problems associated with alcohol use among all age groups , and substance use is inversely related to engagement in substance-free activities . This pilot study investigated the promotion of one specific substance-free activity , exercise , on alcohol use in college students . Thirty-one sedentary college students who engaged in hazardous drinking ( Alcohol Use Disorders Identification Test scores ≥ 8) were r and omized to one of two conditions : ( a ) one 50-minute session of motivational enhancement therapy ( MET ) focused on increasing exercise , or ( b ) one 50-minute session of MET focused on increasing exercise plus 8 weeks of contingency management ( CM ) for adhering to specific exercise activities . All participants completed evaluations at baseline and post-treatment ( 2-months later ) assessing exercise participation and alcohol use . Results of the pilot study suggest the interventions were well received by participants , the MET+CM condition showed an increased self-reported frequency of exercise in comparison to the MET alone condition , but other indices of exercise , physical fitness , and alcohol use did not differ between the interventions over time . These results suggest that a larger scale trial could better assess efficacy of this well received combined intervention . Investigation in other clinical ly relevant population s is also warranted Young marijuana abusers rarely seek treatment themselves and are difficult to engage in treatment when referred by social agencies . To evaluate treatment engagement strategies in this population , 65 young probation-referred marijuana abusers were r and omly assigned to either three-session motivational enhancement therapy ( MET alone ) or three-session MET plus contingency management ( MET/CM ) , with vouchers for treatment attendance . A significantly higher number of participants in the MET/CM condition completed the three-session intervention as compared with MET alone . Participants in both conditions reported significant reductions in marijuana use and improvement in legal problems . These findings suggest that young marijuana abusers benefit from scientifically vali date d treatments OBJECTIVES To determine the efficacy of providing online cessation intervention for college smokers . METHODS This is a two-group r and omized controlled trial . The intervention group received $ 10 weekly incentives to visit an online college life magazine that provided personalized smoking cessation messages and peer email support . Evaluation assessment s occurred at baseline and 8 , 20 , and 30 weeks after enrollment . The primary outcome is self-reported 30-day abstinence at week 30 . Carbon monoxide ( CO ) breath testing was performed for participants reporting 30-day abstinence at week 30 . RESULTS Five-hundred and seventeen college smokers at the University of Minnesota were enrolled via internet health screening ( control=260 , intervention=257 ) in the fall of 2004 . Intervention participants completed an average of 18.9 ( SD 2.5 ) of 20 weekly website visits over the course of the study . The rate of 30-day abstinence at week 30 was higher for the intervention compared to the control group ( 41 % vs. 23 % , p<0.001 ) . CO testing showed low rates of under-reporting . There was no difference in self-reported 6-month prolonged abstinence measured at week 30 . CONCLUSION Providing personalized smoking cessation messages as part of a general interest online college life magazine increased 30-day abstinence by the end of this two semester intervention This article reports on the feasibility of using a contingency management intervention with adolescent smokers that has proven efficacious in adult substance abuse treatment . The study used 8 adolescent participants in an A ( 1 week)-B ( 1 week)-A ( 1 week ) reversal design . During the 2 baseline phases , no contingencies were placed on cigarette smoking , and adolescents received money noncontingently . During the experimental intervention week , adolescents received payment contingent on not smoking . The magnitude of reimbursement available during the baseline and intervention phases was equated . Results indicated that the contingency management intervention was effective in reducing smoking , both in terms of increasing the total number of abstinences and consecutive abstinences . In addition , changes in adolescents ' affective states during smoking cessation were found . Anxiety , depression , anger , and fatigue were reported , and these negative states ceased once smoking resumed There is a significant need for evidence -based treatments for adolescent smoking cessation .  Prior research , although limited , has suggested potential roles for bupropion sustained-release ( SR ) and contingency management ( CM ) , but no previous studies have assessed their combined effect . In a double-blind , placebo-controlled design , 134 adolescent smokers were r and omized to receive a 6-week course of bupropion SR + CM , bupropion SR + non-CM , placebo + CM , or placebo + non-CM , with final follow-up at 12 weeks . The primary outcome was 7-day cotinine-verified point prevalence abstinence , allowing for a 2-week grace period . Combined bupropion SR + CM treatment yielded significantly superior abstinence rates during active treatment when compared with placebo + non-CM treatment . In addition , combined treatment showed greater efficacy at multiple time points than did either bupropion SR + non-CM or placebo + CM treatment . Combined bupropion SR and CM appears efficacious , at least in the short-term , for adolescent smoking cessation and may be superior to either intervention alone The impact of an incentive/reward intervention on college students ' intoxication from alcohol consumption at fraternity parties was explored using a group-r and omized trial . Participants included 702 college students ( 447 men , 225 women ) attending fraternity parties in Blacksburg , VA . Six fraternities were r and omly assigned to a control or experimental group , and each of these fraternities hosted two parties . The three fraternities in the experimental group hosted a baseline party first and then hosted an intervention party at which those having a blood alcohol concentration ( BAC ) level below 0.05 were entered in a $ 100 cash lottery . The three fraternities in the control group hosted two control ( non-intervention ) parties . For the experimental fraternities , mean BAC levels were significantly lower at the intervention parties ( M=0.079 ) than the baseline parties ( M=0.098 ) and the percentage of party-goers with a BAC below 0.08 was significantly higher at intervention parties ( 40.1 % ) than at baseline parties ( 30.6 % ) . This field study supports the efficacy of differential reinforcement in controlling student intoxication at party setting Marijuana-dependent young adults ( N = 136 ) , all referred by the criminal justice system , were r and omized to 1 of 4 treatment conditions : a motivational/skills-building intervention ( motivational enhancement therapy/cognitive-behavioral therapy ; MET/CBT ) plus incentives contingent on session attendance or su bmi ssion of marijuana-free urine specimens ( contingency management ; CM ) , MET/CBT without CM , individual drug counseling ( DC ) plus CM , and DC without CM . There was a significant main effect of  CM on treatment retention and marijuana-free urine specimens . Moreover , the combination of MET/CBT plus CM was significantly more effective than MET/CBT without CM or DC plus CM , which were in turn more effective than DC without CM for treatment attendance and percentage of marijuana-free urine specimens . Participants assigned to MET/CBT continued to reduce the frequency of their marijuana use through a 6-month follow-up Background : Few studies have addressed comorbid antisocial personality disorder ( ASPD ) and marijuana dependence in young adults , and results from previous studies are inconsistent . Objectives : This study evaluated differences in pretreatment characteristics and treatment outcomes between marijuana-dependent young adults with and without ASPD . Methods : Data for this study were derived from a r and omized trial , in which marijuana-dependent young adults ( n = 136 ) between 18 and 25 years of age were r and omized to four behavioral conditions : ( 1 ) MET/CBT with CM , ( 2 ) MET/CBT without CM , ( 3 ) DC with CM , and ( 4 ) DC without CM . Results : Forty-four percent of the participants met DSM-IV-TR criteria for ASPD . ASPD clients had significantly more lifetime alcohol dependence disorders , marijuana use in the 28 days pretreatment , arrests , and assault and weapon charges compared to those without ASPD . ASPD clients did not differ in retention or substance use outcomes at 8 weeks posttreatment or the 6-month follow-up . In general , both groups had more attendance in the voucher condition , but there were no significant ASPD by treatment interactions . Conclusions : These data suggest that marijuana-dependent young adults with comorbid ASPD do not necessarily have poorer retention or substance use outcomes compared with marijuana-dependent young adults who do not have ASPD when treated in a well-defined behavioral therapy protocol . Scientific significance : Previous research has shown increased risks for clients with comorbid ASPD and marijuana dependence ; however , our findings suggest that specialized programs for clients with ASPD may not be necessary if they are provided with empirically supported , structured treatments PROBLEM Adolescent substance abuse remains a public health problem , and more effective treatment approaches are needed . PURPOSE The study aims to determine the feasibility and preliminary effectiveness of implementing a  cost-effective contingency management ( CM ) intervention in community substance abuse treatment for adolescents with marijuana use disorders . METHODS Thirty-one adolescents with primary marijuana use disorder enrolled in a community treatment were r and omized into either a prize-based CM intervention contingent when su bmi tting negative urine drug screens ( UDS ) or a noncontingent control group . FINDINGS There were no significant group differences in percent negative UDS , sustained negative UDS , or retention in treatment . CONCLUSIONS CM was difficult to integrate into community treatment programs and did not seem to be an effective adjunct to st and ard community substance abuse treatment for adolescents with marijuana use disorders . Modifying the CM procedure for adolescents , changing staff attitudes toward CM , and /or combining CM with other evidence -based psychosocial treatment may improve outcomes BACKGROUND Few studies have examined clinical trial participation rates and treatment outcomes among underserved young adults who are dependent on marijuana , the most commonly abused illicit drug . METHOD The present study was a secondary analysis of a trial of court-referred marijuana-dependent young adults ( ages 18 - 25 ) r and omized to one of four treatment conditions : Motivational Enhancement Therapy/Cognitive Behavioral Therapy ( MET/CBT ) , MET/CBT+Contingency Management ( CM ) , Drug Counseling ( DC ) or DC+CM .  African American ( N=81 ) participants were compared to White ( N=31 ) participants with respect to rates of participation in phases of treatment and substance use outcomes . In addition , the interaction of race and treatment condition was examined to ascertain if the interventions yielded different effects based on race . RESULTS Among those who started treatment , African American young adults were significantly less likely to complete the treatment and posttreatment phases of the clinical trial than their White counterparts . Irrespective of treatment type , substance use outcomes ( i.e. , percentage of marijuana-negative specimens and longest duration of continuous abstinence ) did not vary by race . However , there was a significant interaction effect between treatment type and race ; African American young adults did not benefit differentially from any specific type of treatment , but CM was effective in reducing proportion of marijuana positive sample s among White young adults . CONCLUSIONS Findings suggest that clinical trial treatment and posttreatment completion rates vary by race in this population , as does response to specific treatment types . More treatment research focusing specifically on African American marijuana-dependent young adults is warranted
PURPOSE For emerging adults with chronic medical diseases , the transition from pediatric to adult health care is often a time of great upheaval , commonly associated with unhealthy self-management choices , loss to follow-up , and adverse outcomes .
We conducted a systematic review to examine the use of incentive strategies to promote positive health-related behaviors in young adults with chronic medical diseases .