Frauke Becker

Genetic Testing and Common Disorders: How to Assess Relevance and Possibilities

In recent years, the attention of the genomics and genetics research community has shifted toward understanding the basis of common disorders. The spectacular growth of genome-wide association studies has shed new light on the variants influencing risk factors. Understanding pathogenesis and etiology, and finding new ways to prevent and treat those diseases are major challenges. In the era of genomics, a promise of personalized prevention and drug treatment is presented, which many people meet with enthusiasm but which others call into question. The Public and Professional Policy Committee (PPPC) of the European Society of Human Genetics (ESHG), EuroGentest and the Institute for Prospective Technological Studies (IPTS) convened to discuss the relevance and possibilities of genetic testing for common disorders. Currently (in 2010), the genetics research community is skeptical about the possibilities of genetic susceptibility testing and screening contributing significantly to the improvement of the quality of health care. Meanwhile, some applications of very limited clinical utility have become available directly to consumers. Recently, the PPPC published critical recommendations on policy concerning DTC genetic testing (EJHG, 25 August 2010). When considering the potential of new genomic developments for a public health perspective, this Background Document takes the spectrum ranging from monogenic disorders on the one hand to common complex disorders on the other hand into account. It is argued that associations between genetic variants and disease risks of clinical relevance have been established, for instance for hereditary breast and ovarian cancer, colon cancer, diabetes mellitus (MODY subtypes), thrombosis, cardiovascular disorders, celiac disease and Alzheimers disease. Although these examples relate to the monogenic subforms of common disease, they can nevertheless be used to reflect on the possibilities and relevant obstacles in using the new genetics in public health. The deliberations, reflected in the final Background Document, have led to the below recommendations from the PPPC concerning the pitfalls and possibilities of genetic testing in common disorders. A draft of both the Background Document and Recommendations has been distributed and posted on the web during the summer of 2009 to elicit further comments. The PPPC and the Board of the ESHG approved the final version. This final text is considered to reflect the views of the European human genetics scientific and professional community.

Genetic testing and common disorders in a public health framework: how to assess relevance and possibilities

Genetic testing and common disorders in a public health framework: how to assess relevance and possibilities

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.

Discrete Choice Experiment Response Rates: A Meta-analysis

This paper uses meta-regression analysis to test how aspects of discrete choice experiment (DCE) study design influence survey response rates. DCEs are a survey-based method used to elicit preferences for health and health care and are prone to survey errors of coverage, sampling, non-response and measurement. However, research on DCE response rates is lacking. Our analysis is motivated by a social exchange theory of survey response. We find that DCE response rates are related to the surveys cognitive burden and the relevance to the surveyed population. Copyright

Statistical methods for body mass index: a selective review

Obesity rates have been increasing over recent decades, causing significant concern among policy makers. Excess body fat, commonly measured by body mass index, is a major risk factor for several common disorders including diabetes and cardiovascular disease, placing a substantial burden on health care systems. To guide effective public health action, we need to understand the complex system of intercorrelated influences on body mass index. This paper, based on all eligible articles searched from Global health, Medline and Web of Science databases, reviews both classical and modern statistical methods for body mass index analysis. We give a description of each of these methods, exploring the classification, links and differences between them and the reasons for choosing one over the others in different settings. We aim to provide a key resource and statistical library for researchers in public health and medicine to deal with obesity and body mass index data analysis.

Women’s preferences for alternative financial incentive schemes for breastfeeding: A discrete choice experiment

Background Increasing breastfeeding rates have been associated with reductions in disease in babies and mothers as well as in related costs. ‘Nourishing Start for Health (NoSH)’, a financial incentive scheme has been proposed as a potentially effective way to increase both the number of mothers breastfeeding and duration of breastfeeding. Aims To establish women’s relative preferences for different aspects of a financial incentive scheme for breastfeeding and to identify importance of scheme characteristics on probability on participation in an incentive scheme. Methods A discrete choice experiment (DCE) obtained information on alternative specifications of the NoSH scheme designed to promote continued breastfeeding duration until at least 6 weeks after birth. Four attributes framed alternative scheme designs: value of the incentive; minimum breastfeeding duration required to receive incentive; method of verifying breastfeeding; type of incentive. Three versions of the DCE questionnaire, each containing 8 different choice sets, provided 24 choice sets for analysis. The questionnaire was mailed to 2,531 women in the South Yorkshire Cohort (SYC) aged 16–45 years in IMD quintiles 3–5. The analytic approach considered conditional and mixed effects logistic models to account for preference heterogeneity that may be associated with a variation in effects mediated by respondents’ characteristics. Results 564 women completed the questionnaire and a response rate of 22% was achieved. Most of the included attributes were found to affect utility and therefore the probability to participate in the incentive scheme. Higher rewards were preferred, although the type of incentive significantly affected women’s preferences on average. We found evidence for preference heterogeneity based on individual characteristics that mediated preferences for an incentive scheme.Conclusions Although participants’ opinion in our sample was mixed, financial incentives for breastfeeding may be an acceptable and effective instrument to change behaviour. However, individual characteristics could mediate the effect and should therefore be considered when developing and targeting future interventions.

Alcohol Screening and Brief Intervention in Police Custody Suites: Pilot Cluster Randomised Controlled Trial (AcCePT)

We achieved target recruitment and high brief intervention delivery if this occurred immediately after screening. Low rates of return for counselling and retention at follow-up were challenges for a definitive trial. Conversely, high consent rates for access to police data suggested at least some outcomes could be measured remotely.

Health Economics of Obesity

Obesity rates have been increasing over decades, and obesity is now considered one of the most important medical and public health problems. Excess body fat is defined as a major risk factor for several common disorders contributing to increased morbidity and mortality and placing a substantial burden on healthcare systems and economies. Defining weight gain as a consequence of individual behaviors associated with specific food patterns, dietary compositions, and calorie expenditure allows to describe obesity as a preventable condition. A better understanding of the obesogenic environment and how it affects individual behaviors may help to guide effective public health policies and to identify effective interventions and treatments in a clinical context. Although the pathways leading to obesity are not entirely clear, the associated costs can be more easily quantified on individual, societal, and healthcare system level. In the context of scarce health resources, economic evaluations can be used to model the long-term costs and health-related outcomes as well as the relative cost-effectiveness of interventions and treatments compared with alternative measures. These models allow for consideration of varying environmental factors as well as individual characteristics and can help in predicting outcomes on individual and societal levels. Results can be used to guide health policies and identify the best-targeted approaches and the most effective and cost-effective interventions when tackling the obesity problem.

Parental Preferences for the Organization of Preschool Vaccination Programs Including Financial Incentives: A Discrete Choice Experiment

Objective: To establish preferences of parents and guardians of preschool children for the organization of preschool vaccination services, including financial incentives. Design: An online discrete choice experiment. Participants: Parents and guardians of preschool children (up to age 5 years) who were (n = 259) and were not (n = 262) classified as at high risk of incompletely vaccinating their children. High risk of incomplete vaccination was defined as any of the following: aged less than 20 years, single parents, living in one of the 20% most deprived areas in England, had a preschool child with a disability, or had more than three children. Main Outcome Measures: Participant preferences expressed as positive (utility) or negative (disutility) on eight attributes and levels describing the organization of preschool vaccination programs. Results: There was no difference in preference for parental financial incentives compared to no incentive in parents “not at high risk” of incomplete vaccination. Parents who were “at high risk” expressed utility for cash incentives. Parents “at high risk” of incomplete vaccination expressed utility for information on the risks and benefits of vaccinations to be provided as numbers rather than charts or pictures. Both groups preferred universally available, rather than targeted, incentives. Utility was identified for shorter waiting times, and there were variable preferences for who delivered vaccinations. Conclusions: Cash incentives for preschool vaccinations in England would be welcomed by parents who are “at high risk” of incompletely vaccinating their children. Further work is required on the optimal mode and form of presenting probabilistic information on vaccination to parents/guardians, including preferences on mandatory vaccination schemes.

P65 Acceptability of financial incentives for health behaviours in UK adults: a discrete choice experiment

Background Systematic reviews conclude personal financial incentives (PFI) are effective at changing health-related behaviours. However, PFI may be publically unacceptable, meaning they are unlikely to be widely implemented. We answered two questions using a discrete choice experiment (DCE): what are the relative preferences of UK adults for attributes of PFI for four health-related behaviours? Do preferences vary with age, gender or educational attainment? Methods DCEs describe interventions according to their ‘attributes’ (e.g. PFI type), and ‘levels’ of these (e.g. cash, shopping voucher). Participants are asked which of 2–3 ‘scenarios’, combining different levels of each attribute, they prefer. Relative preferences for attribute levels can then be determined. Participants were adult members of a market research panel, living in the UK, selected using quota sampling (based on age, gender, educational attainment, current smoking and physical activity). Preferences were examined for PFI for: smoking cessation, regular physical activity, and attendance for vaccination and screening. Attributes (and levels) were: PFI type (none, cash, shopping vouchers, lottery tickets); value (continuous variable); schedule (same value each week, value increases as behaviour change is sustained); other information provided (none, written information, face-to-face discussion, both); and recipients (all eligible individuals, people living in low-income households, pregnant women). Data were collected anonymously online (n = 356) and analysed in Stata v13.0 using conditional logistic regression. Results will be presented as marginal utility values compared to reference for each behaviour, with p-values (confidence intervals are difficult to calculate). Results Cash or voucher-based PFI were as (ps > 0.05), or more (ps < 0.05), acceptable to participants than no PFI for all behaviours. PFI offering lottery-type rewards and those targeted at particular groups were less acceptable than no reward and untargeted rewards for all behaviours (ps < 0.05). Preferences were inversely related to PFI value. Preferences for additional information provided alongside PFI varied between behaviours. Preferences for no PFI, additional information alongside PFI, and PFI not targeted at particular groups increased with age (ps < 0.05). Men were more likely than women to prefer any PFI over none, and PFI targeted at those living in low-income households (ps < 0.05). There were no consistent differences in preferences by educational attainment. Conclusion We used a convenience sample, but increased representativeness with quota sampling. PFI for four healthy behaviours were as or more acceptable than no incentives to UK adults. To maximise acceptability, PFI should be in the form of cash or shopping vouchers, and not lotteries; be of low value; and available to all.