Background

Financial incentives may improve health behaviors. We tested the impact of offering financial incentives for mailed fecal immunochemical test (FIT) completion annually for 3 years.

Methods

Patients, ages 50 to 64 years, not up-to-date with screening were randomized to receive either a mailed FIT outreach (n = 6,565), outreach plus $5 (n = 1,000), or $10 (n = 1,000) incentive for completion. Patients who completed the test were reinvited using the same incentive the following year, for 3 years. In year 4, patients who returned the kit in all preceding 3 years were reinvited without incentives. Primary outcome was FIT completion among patients offered any incentive versus outreach alone each year. Secondary outcomes were FIT completion for groups offered $5 versus outreach alone, $10 versus outreach alone, and $5 versus $10.

Results

Year 1 FIT completion was 36.9% with incentives versus 36.2% outreach alone (P = 0.59) and was not statistically different for $10 (34.6%; P = 0.31) or $5 (39.2%; P = 0.070) versus outreach alone. Year 2 completion was 61.6% with incentives versus 60.8% outreach alone (P = 0.75) and not statistically different for $10 or $5 versus outreach alone. Year 3 completion was 79.4% with incentives versus 74.8% outreach alone (P = 0.080), and was higher for $10 (82.4%) versus outreach alone (P = 0.033), but not for $5 versus outreach alone. Completion was similar across conditions in year 4 (no incentives).

Conclusions

Offering small incentives did not increase FIT completion relative to standard outreach.

Impact

This was the first longitudinal study testing the impact of repeated financial incentives, and their withdrawal, on FIT completion.

Perceived social support has been reliably related to lower rates of morbidity and mortality. However, studies modeling C-reactive protein (CRP) as an important biological pathway linking social support to health have produced inconsistent results. Given purported ethnic/racial differences in sensitivity to social resources, the present study tested if ethnicity/race moderated the link between perceived support and CRP in a diverse community sample of 300 participants from the North Texas Heart Study. Consistent with prior research, there was no overall link between social support and CRP levels. However, the association between social support and high sensitivity (hs)-CRP levels was moderated by ethnicity/race as perceived support predicted lower hs-CRP levels primarily in African Americans. These results suggest the importance of considering how ethnicity/race may inform models on the complex biological mechanisms linking social support to health.

Background

Although the quality of one's social relationships has been linked to important physical health outcomes, less work has been conducted examining family and friends that differ in their underlying positivity and negativity.

Purpose

The main aim of this study was to examine the association between supportive, aversive, and ambivalent family/friends with levels of C-reactive proteins.

Methods

Three hundred participants from the North Texas Heart Study completed the social relationships index and a blood draw to assess high-sensitivity C-reactive proteins (hs-CRPs).

Results

After standard controls, the number of supportive family members predicted lower hs-CRP levels, whereas the number of ambivalent family members predicted higher hs-CRP levels. These links were independent of depressive symptoms and perceived stress.

Conclusions

These data highlight the importance of considering specific types of relationships and their underlying positive and negative aspects in research on social ties and physical health.

Background

Financial incentives may improve health behaviors. We tested the impact of offering financial incentives for mailed fecal immunochemical test (FIT) completion annually for 3 years.

Methods

Patients, ages 50 to 64 years, not up-to-date with screening were randomized to receive either a mailed FIT outreach (n = 6,565), outreach plus $5 (n = 1,000), or $10 (n = 1,000) incentive for completion. Patients who completed the test were reinvited using the same incentive the following year, for 3 years. In year 4, patients who returned the kit in all preceding 3 years were reinvited without incentives. Primary outcome was FIT completion among patients offered any incentive versus outreach alone each year. Secondary outcomes were FIT completion for groups offered $5 versus outreach alone, $10 versus outreach alone, and $5 versus $10.

Results

Year 1 FIT completion was 36.9% with incentives versus 36.2% outreach alone (P = 0.59) and was not statistically different for $10 (34.6%; P = 0.31) or $5 (39.2%; P = 0.070) versus outreach alone. Year 2 completion was 61.6% with incentives versus 60.8% outreach alone (P = 0.75) and not statistically different for $10 or $5 versus outreach alone. Year 3 completion was 79.4% with incentives versus 74.8% outreach alone (P = 0.080), and was higher for $10 (82.4%) versus outreach alone (P = 0.033), but not for $5 versus outreach alone. Completion was similar across conditions in year 4 (no incentives).

Conclusions

Offering small incentives did not increase FIT completion relative to standard outreach.

Impact

This was the first longitudinal study testing the impact of repeated financial incentives, and their withdrawal, on FIT completion.

BACKGROUND AND OBJECTIVES: Although dispositional optimism and pessimism have been prospectively associated with health outcomes, little is known about how these associations manifest in everyday life. This study examined how short-term optimistic and pessimistic expectations were associated with psychological and physiological stress processes. METHODS: A diverse sample of adults (N = 300) completed a 2-day/1-night ecological momentary assessment and ambulatory blood pressure (ABP) protocol at ∼45-minute intervals. RESULTS: Moments that were more optimistic than typical for a person were followed by moments with lower likelihood of reporting a stressor, higher positive affect (PA), lower negative affect (NA), and less subjective stress (SS). Moments that were more pessimistic than typical were not associated with any affective stress outcome at the following moment. Neither optimism nor pessimism were associated with ABP, and did not moderate associations between reporting a stressor and outcomes. DISCUSSION: These findings suggest that intraindividual fluctuations in optimistic and pessimistic expectations are associated with stressor appraisals.

BACKGROUND: The effectiveness of colorectal cancer (CRC) screening is limited by underuse, particularly among underserved populations. Among a racially diverse and socioeconomically disadvantaged cohort of patients, the authors compared the effectiveness of fecal immunochemical test (FIT) outreach and colonoscopy outreach to increase screening participation rates, compared with usual visit-based care. METHODS: Patients aged 50 to 64 years who were not up-to-date with CRC screening but used primary care services in a large safety-net health system were randomly assigned to mailed FIT outreach (2400 patients), mailed colonoscopy outreach (2400 patients), or usual care with opportunistic visit-based screening (1199 patients). Patients who did not respond to outreach invitations within 2 weeks received follow-up telephone reminders. The primary outcome was CRC screening completion within 12 months after randomization. RESULTS: Baseline patient characteristics across the 3 groups were similar. Using intention-to-screen analysis, screening participation rates were higher for FIT outreach (58.8%) and colonoscopy outreach (42.4%) than usual care (29.6%) (P <.001 for both). Screening participation with FIT outreach was higher than that for colonoscopy outreach (P <.001). Among responders, FIT outreach had a higher percentage of patients who responded before reminders (59.0% vs 29.7%; P <.001). Nearly one-half of patients in the colonoscopy outreach group crossed over to complete FIT via usual care, whereas <5% of patients in the FIT outreach group underwent usual-care colonoscopy. CONCLUSIONS: Mailed outreach invitations appear to significantly increase CRC screening rates among underserved populations. In the current study, FIT-based outreach was found to be more effective than colonoscopy-based outreach to increase 1-time screening participation. Studies with longer follow-up are needed to compare the effectiveness of outreach strategies for promoting completion of the entire screening process.

Objective

Short sleep duration has been linked with a wide array of poor mental and physical health outcomes. Such risks, however, may be moderated by demographic factors such as gender and race/ethnicity. In a diverse community sample, the current study examined the relationship between gender, race/ethnicity and objectively measured sleep duration, controlling for select potential confounds.

Methods

Participants were 300 community adults (50% female), aged 21 to 70 years, and included 60% non-Hispanic Whites, 15% non-Hispanic Blacks, 19% Hispanic/Latino, and 6% other. As part of a larger study, participants wore an actigraphy device over two nights to assess sleep duration (averaged across both nights). Gender and race/ethnicity were used as grouping variables in a two-way analysis of covariance (ANCOVA) predicting objectively assessed total sleep time, with age, income, and employment status as covariates.

Results

On average, males slept 34 min less than females (P=.002). After controlling for socioeconomic factors, there was a gender by race/ethnicity interaction (P=.030). Within males, Hispanics slept 45 min less than non-Hispanic Whites (P=.002) and 57 min less than non-Hispanic others (P=.008). Males also slept significantly less than females within the non-Hispanic White (difference=-22.9; P=.016) and the Hispanic (difference=-77.1; P<.001) groups.

Conclusions

Extending previous research, the current study provides additional evidence for differences in objective sleep duration based on gender and race/ethnicity in daily life. These data suggest that risk associated with sleep duration is patterned in important ways across gender and race/ethnicity; such information can be used to tailor prevention efforts.

Introduction

Psychosocial factors are increasingly recognised as important determinants of cardiovascular disease risk. The North Texas Heart Study aims to understand the mechanisms responsible for this association with a focus on social vigilance (ie, scanning the environment for social threats). There is also growing interest in supplementing traditional methods (eg, survey assessment of psychosocial risk paired with cross-sectional and longitudinal health outcomes) with daily or repeated momentary assessment of psychosocial factors. However, there are relatively few longitudinal studies directly comparing these approaches with hard endpoints.

Methods and analysis

The North Texas Heart Study proposes a longitudinal measurement burst design to examine psychosocial determinants of subclinical atherosclerosis. A sample of 300 healthy community participants, stratified by age and gender, will complete survey measures, as well as 2 days of ecological momentary assessment at baseline and at a 2-year follow-up. A range of psychosocial and behavioural factors, objective biomarkers, as well as carotid intima-media thickness (cIMT) will be assessed at both time points. Unadjusted and adjusted models will evaluate cross-sectional associations and determinants of change in the cIMT.

Ethics and dissemination

The Institutional Review Board at the study coordinating institute (University of North Texas) has approved this study. Positive, negative or inconclusive primary and ancillary findings will be disseminated in scientific journals and conferences.

Purpose

To learn the size, composition, and scholarly output of biostatistics, epidemiology, and research design (BERD) units in U.S. academic health centers (AHCs).

Method

Each year for four years, the authors surveyed all BERD units in U.S. AHCs that were members of the Clinical and Translational Science Award (CTSA) Consortium. In 2010, 46 BERD units were surveyed; in 2011, 55; in 2012, 60; and in 2013, 61.

Results

Response rates to the 2010, 2011, 2012, and 2013 surveys were 93.5%, 98.2%, 98.3%, and 86.9%, respectively. Overall, the size of BERD units ranged from 3 to 86 individuals. The median FTE in BERD units remained similar and ranged from 3.0 to 3.5 FTEs over the years. BERD units reported more availability of doctoral-level biostatisticians than doctoral-level epidemiologists. In 2011, 2012, and 2013, more than a third of BERD units provided consulting support on 101 to 200 projects. A majority of BERD units reported that between 25% and 75% (in 2011) and 31% to 70% (in 2012) of their consulting was to junior investigators. More than two-thirds of BERD units reported their contributions to the submission of 20 or more non-BERD grant or contract applications annually. Nearly half of BERD units reported 1 to 10 manuscripts submitted annually with a BERD practitioner as the first or corresponding author.

Conclusions

The findings regarding BERD units provide a benchmark against which to compare BERD resources and may be particularly useful for institutions planning to develop new units to support programs such as the CTSA.

Background

The reported incidence of peripartum cardiomyopathy (PPCM) in the United States varies widely. Furthermore, limited information is available on the temporal trends in incidence and outcomes of PPCM.

Methods and results

We queried the 2004-2011 Nationwide Inpatient Sample databases to identify all women aged 15 to 54 years with the diagnosis of PPCM. Temporal trends in incidence (per 10 000 live births), maternal major adverse events (MAE; defined as in-hospital mortality, cardiac arrest, heart transplant, mechanical circulatory support, acute pulmonary edema, thromboembolism, or implantable cardioverter defibrillator/permanent pacemaker implantation), cardiogenic shock, and mean length of stay were analyzed. From 2004 to 2011, we identified 34 219 women aged 15 to 54 years with PPCM. The overall PPCM rate was 10.3 per 10 000 (or 1 in 968) live births. PPCM incidence increased from 8.5 to 11.8 per 10 000 live births (Ptrend<0.001) over the past 8 years. MAE occurred in 13.5% of patients. There was no temporal change in MAE rate, except a small increase in in-hospital mortality and mechanical circulatory support (Ptrend<0.05). Cardiogenic shock increased from 1.0% in 2004 to 4.0% in 2011 (Ptrend<0.001). Mean length of stay decreased during the study period.

Conclusion

From 2004 to 2011, the incidence of PPCM has increased in the United States. Maternal MAE rates overall have remained unchanged while cardiogenic shock, utilization of mechanical circulatory support, and in-hospital mortality have increased during the study period. Further study of the mechanisms underlying these adverse trends in the incidence and outcomes of PPCM are warranted.