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Randomized Controlled Trial
. 2023 Feb 1;151(2):e2022058876.
doi: 10.1542/peds.2022-058876.

Food Allergy Management for Adolescents Using Behavioral Incentives: A Randomized Trial

Roxanne Dupuis  1 , Rachel Feuerstein-Simon  2 , Terri F Brown-Whitehorn  3 , Jonathan M Spergel  3 , Kevin G Volpp  2 , Xochitl Luna Marti  2 , Andrea B Troxel  4 , Zachary F Meisel  3 , Cynthia J Mollen  3 , Erica L Kenney  1 , Jason Block  5 , Steven L Gortmaker  1 , Carolyn C Cannuscio  2
Affiliations
Randomized Controlled Trial

Food Allergy Management for Adolescents Using Behavioral Incentives: A Randomized Trial

Roxanne Dupuis et al. Pediatrics. .

Abstract

Objective: We sought to evaluate the use of behavioral economics approaches to promote the carrying of epinephrine auto-injectors (EAIs) among adolescents with food allergies. We hypothesized that adolescents who receive frequent text message nudges (Intervention 1) or frequent text message nudges plus modest financial incentives (Intervention 2) would be more likely to carry their epinephrine than members of the usual care control group.

Methods: We recruited 131 adolescents ages 15 to 19 with a food allergy and a current prescription for epinephrine to participate in a cohort multiple randomized controlled trial. Participants were randomly assigned to participate in Intervention 1, Intervention 2, or to receive usual care. The primary outcome was consistency of epinephrine-carrying, measured as the proportion of checkpoints at which a participant could successfully demonstrate they were carrying their EAI, with photo-documentation of the device.

Results: During Intervention 1, participants who received the intervention carried their EAI 28% of the time versus 38% for control group participants (P = .06). During Intervention 2, participations who received the intervention carried their EAI 45% of the time versus 23% for control group participants (P = .002).

Conclusions: Text message nudges alone were unsuccessful at promoting EAI-carrying but text message nudges combined with modest financial incentives almost doubled EAI-carriage rates among those who received the intervention compared with the control group. However, even with the intervention, adolescents with food allergies carried their EAI <50% of the time. Alternative strategies for making EAIs accessible to adolescents at all times should be implemented.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest related to this article to disclose.

Figures

FIGURE 1
FIGURE 1
Study intervention flow.
FIGURE 2
FIGURE 2
Example of a successful checkpoint photograph.
FIGURE 3
FIGURE 3
Proportion of participants who carried their epinephrine auto-injector at each individual checkpoint.
See this image and copyright information in PMC

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