Systematic review on use of health incentives in U.S. to change maternal health behavior
Open accessAbstract
Use of financial incentives contingent on health outcomes has shown effective in health behavior change. Evidence-based information on the effect of incentive use for maternal health behavior change can inform whether and how to proceed with future research as well as incorporate incentive-based interventions in the existing healthcare system. This systematic literature review was conducted among prospective studies on incentive use for maternal health behavior change in a U.S. cohort according to the PRISMA methodology. Databases subject to the search included PubMed, Web of Science, PsycINFO, and EBSCOhost. Studies published in peer-reviewed journals on or before January 7, 2019, written in English, conducted in U.S., using incentives contingent on maternal health behavior change, and prospectively designed were included. Two authors independently searched titles and abstracts. An abstraction table was constructed, and the risk of bias was assessed using the GRADE approach. The review showed that incentives such as vouchers and other financial incentives were effective in improving outcomes especially related to substance use, tobacco use, and breastfeeding. Mixed evidence was found in improving treatment adherence outcomes; however the studies with randomized trials on the outcome of treatment adherence also showed low certainty. Continued improvements need to be made in implementing an incentive-based approach in the context of comprehensive treatment and routine healthcare, exploring electronic- or mobile-based implementation of the approach, and implementing the approach for a wider variety of outcomes during both prenatal and postpartum periods.
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Limited data indicate that alpha-2 adrenergic agonists (e.g., dexmedetomidine for severe symptoms, clonidine for mild to moderate symptoms) are beneficial for stimulant-induced agitation and can help with hypertension and tachycardia.
“Limited data indicate that alpha-2 adrenergic agonists (eg, dexmedetomidine for more severe symptoms, clonidine for mild to moderate symptoms) are beneficial in treating stimulantinduced agitation and can also be useful in the treatment of hypertension and tachycardia and, thus, should be considered in the management of the hyperadrenergic state of stimulant intoxication.152,153”
From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [152]
The Results section on pregnant and postpartum women with substance use disorders discusses vouchers for abstinence and treatment attendance, not medications for stimulant intoxication. Searches for alpha-2 adrenergic agonists, dexmedetomidine, clonidine, hypertension, tachycardia, and stimulant-induced agitation found no passage addressing the claim. (LLM, conf=0.75)
Experimental — accuracy not yet measuredA 2015 review by Richards and colleagues identified six high-quality studies that support antipsychotics and benzodiazepines for agitation and psychosis.
“Richards et al (2015) reviewed six high-quality studies supporting the use of antipsychotics and benzodiazepines to manage agitation and psychosis.152”
From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [152]
Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredDexmedetomidine was reported to successfully treat cocaine-associated hypertensive emergencies, while propranolol, sodium nitroprusside, nifedipine, labetalol, and phentolamine were reported to successfully treat ATS-associated hypertensive emergencies.
“All evidence came from case reports and case series; cocaine-associated hypertensive emergencies were successfully treated with dexmedetomidine, and ATS-associated hypertensive emergencies were successfully treated with propranolol, sodium nitroprusside, nifedipine, labetalol, and phentolamine.”
From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [152]
Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThe evidence base for treating stimulant-associated hypertensive emergency consisted entirely of case reports and case series.
“All evidence came from case reports and case series; cocaine-associated hypertensive emergencies were successfully treated with dexmedetomidine, and ATS-associated hypertensive emergencies were successfully treated with propranolol, sodium nitroprusside, nifedipine, labetalol, and phentolamine.”
From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [152]
The Results (Synthesis of Results; no page provided) discuss incentives for maternal substance abstinence, not treatment of stimulant-associated hypertensive emergencies. Searches for case reports, case series, hypertensive emergencies, and the named drugs found no passage addressing the claim. (LLM, conf=0.78)
Experimental — accuracy not yet measuredTwo systematic reviews examined treatment for stimulant-associated hypertensive emergency.
“Two systematic reviews were identified that examined treatment for stimulant-associated hypertensive emergency.152,153”
From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [152]
The Study Selection and Results sections describe a systematic review of incentives for maternal health behaviors, including cocaine abstinence among pregnant and postpartum women. Neither those passages nor searches for stimulant-associated hypertensive emergency and its treatment address treatment of hypertensive emergencies. (LLM, conf=0.77)
Experimental — accuracy not yet measured
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- Authors
- Washio, Y., Atreyapurapu, S., Hayashi, Y., Taylor, S., Chang, K., Ma, T., & Isaacs, K.
- Affiliations
- RTI International (US)
- Benten Technologies (United States) (US)
- Pennsylvania State University (US)
- Corresponding author
- Washio, Yukiko
- Venue
- Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 2021-04
- Volume
- 145
- Pages
- 106442
- ISSN
- 0091-7435 (ISSN-L)
- PMC
- PMC7956068
- OpenAlex
- W3124352809
- Cited by
- 13
- References
- 48
- Citations by year
- 2025: 3 · 2024: 1 · 2023: 5 · 2022: 4
- FWCI
- 0.40
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Preventive Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
- Topics
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Keywords
- financial incentives, maternal health behavior, health behavior change, vouchers, substance use, tobacco use, breastfeeding, medication adherence, prenatal care, postpartum care, incentive-based interventions
- MeSH terms
- Breast Feeding, Delivery of Health Care, Female, Humans, Motivation, Pregnancy, Prospective Studies, Health Behavior
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