Yukiko Washio

Incentive-based Intervention to Maintain Breastfeeding Among Low-income Puerto Rican Mothers

The study provides a proof-of-concept that monthly financial incentives contingent on observed breastfeeding increased breastfeeding rates through 6-month postpartum among low-income Puerto Rican mothers. BACKGROUND AND OBJECTIVE: Despite maternal and child health benefits, breastfeeding rates are relatively low among low-income Puerto Rican mothers. This study examined the hypothesis that monthly financial incentives would significantly increase the proportion of breastfeeding mothers at 6 months postpartum compared with Supplemental Nutrition Program for Women, Infants, and Children (WIC) services only among Puerto Rican mothers. METHODS: A randomized, 2-arm parallel-group design, from February 2015 through February 2016. Half of the randomized participants received monthly financial incentives contingent on observed breastfeeding for 6 months (Incentive), and the other half received usual WIC services only (Control). Thirty-six self-identified Puerto Rican women who initiated breastfeeding were enrolled. Monthly cash incentives were contingent on observed breastfeeding increasing the amount given at each month from

Developing Community Reinforcement and Family Training (CRAFT) for Parents of Treatment-Resistant Adolescents

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Young women's views on testing for sexually transmitted infections and HIV as a risk reduction strategy in mutual and choice-restricted relationships

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Usability and Acceptability of Everhealthier Women, a Mobile Application to Enhance Informed Health Choices

270. RESULTS: The intent-to-treat analysis showed significantly higher percentages of breastfeeding mothers in the incentive group at each time point compared with those in the control group (89% vs 44%, P = .01 at 1 month; 89% vs 17%, P < .001 at 3 months; 72% vs 0%, P < .001 at 6 months). No significant differences were detected at any time point between study groups for self-reported exclusive breastfeeding rate and infant outcomes (ie, weight, emergency department visits). CONCLUSIONS: Contingent cash incentives significantly increased breastfeeding through 6-month postpartum among WIC-enrolled Puerto Rican mothers; however, no significant differences between the study groups were observed on exclusive breastfeeding rate and infant outcomes. Larger-scale studies are warranted to examine efficacy, implementation potential, and cost-effectiveness.

Analyzing components of Community Reinforcement and Family Training (CRAFT): Is treatment entry training sufficient?

We describe a project focused on training parents to facilitate their treatment-resistant adolescent’s treatment entry and to manage their child after entry into community-based treatment. Controlled studies show that Community Reinforcement and Family Training (CRAFT) is a unilateral treatment that fosters treatment entry of adults; however, there are no controlled trials for parents with a substance-abusing child. We examined the behavioral parent training literature to guide us in tailoring CRAFT for parents of adolescents. We discuss adaptations to CRAFT, outcomes and experiences gained from a brief pilot of the revised CRAFT program, and the future directions of this work.

Perspectives on HIV Testing Among WIC-Enrolled Postpartum Women: Implications for Intervention Development

AIM The aim of this study was to identify relationship dynamics that influences the use of STI/HIV testing among young, urban African American women. BACKGROUND Increasing STI/HIV testing is a key prevention strategy, but more research is needed to identify barriers to testing for young women such as intimate partner violence (IPV). METHODS Thirty semi-structured interviews were conducted with African American women ages 18-24. Content analysis was used. RESULTS Women in choice-restricted relationships were unable to negotiate safer sex practices and testing was viewed as the best option. Women in relationships where the desire to use condoms was mutual used STI and HIV testing as a sign of trust building that preceded unprotected sex. CONCLUSIONS STI/HIV testing must be viewed as one strategy within a package of possible risk reduction. For those in choice-restricted relationships, clinicians should screen patients for partner abuse and provide additional support and referrals as clinically appropriate.

Incentive Use for Improving Maternal Health: Perspective From Behavioral Science

Objective: To explore womens use and acceptance of Everhealthier Women, a mobile health (mHealth) application (app) designed to provide women with easy access to preventive health information and to promote adherence to life‐saving clinical screenings and disease prevention behaviors. Design: Qualitative descriptive study. Setting: A Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) office in a large Northeastern U.S. city. Participants: Fifteen low‐income women ages 18 to 30 years who used WIC services. Methods: Participants completed a baseline survey regarding their use of technology to obtain health information. Next, they received an introductory session to Everhealthier Women on a mobile device by a study staff member and individually explored the app. Afterward, they completed a questionnaire in the waiting room to assess their initial views on the acceptability and usefulness of the app. Participants were then contacted over a period of 3 weeks to elicit feedback about their app use through a series of open‐ended questions. Descriptive statistics were calculated, and content analysis was performed. Results: Fourteen of the 15 participants reported using the Internet to search for health information in the past. Seven participants had used mHealth apps, and 14 believed that Everhealthier Women was easy to navigate and beneficial for women of all ages. They reported being more likely to use the app if it was recommended by a friend or health care provider. The app was mainly used to search for health information and set appointment reminders. Conclusion: mHealth apps can be powerful public health tools; however, evidence should inform their development. Research about specific apps, such as Everhealthier Women, advances our knowledge about the benefits of mHealth and implementation challenges and could inform stakeholders of the optimal level of investment in new technologies. Consideration of financial, time, and personal constraints is needed to evaluate the use of mHealth apps by economically disadvantaged populations.

An epidemiological, developmental and clinical overview of cannabis use during pregnancy

Community Reinforcement and Family Training (CRAFT) assists family members with a treatment-resistant loved one. The most consistent outcome of CRAFT is increased treatment entry of the identified treatment-resistant person (IP). This led us to question whether all 6 components of CRAFT are necessary. In a randomized clinical trial, 115 concerned significant others (CSOs) of an IP received 12–14 sessions of the full CRAFT intervention, 4–6 sessions focused on Treatment Entry Training (TEnT), or 12–14 sessions of Al-Anon/Nar-Anon Facilitation (ANF). We monitored treatment entry, attendance, and substance use of the IP and the CSO’s mood and functioning. Data were collected at baseline and 4, 6, and 9 months after the baseline. We found significant reductions in time to treatment entry (&khgr;(2)2 = 8.89, p = .01) and greater treatment entry rates for CRAFT (62%; odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.1–6.9) and TEnT (63%; OR = 2.9, 95% CI = 1.2–7.5) compared with ANF (37%), but CRAFT and TEnT did not differ significantly from each other (OR = 1.1, 95% CI = 0.4–2.7). No between-group differences in IP drug use were reported by CSOs, but days of drug use decreased over time for all groups (F(3, 277) = 13.47, p < .0001). Similarly, CSO mood and functioning did not differ between the 3 conditions but improved over time (p < .0001 for all significant measures). We replicated the results of previous trials demonstrating that CRAFT produces greater treatment entry rates than ANF and found similar treatment entry rates for CRAFT and TEnT. This suggests that treatment entry training is sufficient for producing the best established outcome of CRAFT.

Prior Exposure to Intimate Partner Violence Associated With Less HIV Testing Among Young Women

Low-income minority women are disproportionately represented among those living with HIV in the U.S and also at-risk for substance abuse and intimate partner violence-collectively called the SAVA syndemic-which may impede HIV testing uptake. Views about HIV testing were assessed among women (ages 18-29) enrolled in a federally funded nutrition program for women, infants, and children (WIC) in a large Mid-Atlantic city. A survey (n = 80) and three focus groups were conducted in WIC offices located in neighborhoods with high HIV prevalence. Among this primarily minority sample, most would be interested in getting an HIV test if offered at WIC. Benefits included knowing ones HIV status, convenience, and accessible location, while transportation and peer/partner encouragement were enabling factors. Barriers included privacy concerns and intimate partner violence. Findings will be used to design an intervention to promote HIV testing among women who attend WIC and that proactively addresses reported barriers.

Self-report measure as a useful tool to identify prenatal substance use and predict adverse birth outcomes:

Incentive use to improve maternal health behavior has been controversial, and guidelines to effectively design and implement such an intervention have been published. This commentary briefly describes a perspective from behavioral science for the existing guideline on the development of an incentive-based intervention to change maternal health behaviors. It is recommended to emphasize the saliency of incentives as an important variable to maintain the intervention effect while addressing barriers to feasibility and sustainability.