title: A behavioral economics intervention to encourage epinephrine-carrying among food-allergic adults: a randomized controlled trial.
abstract: BACKGROUND
  Adolescents and young adults with food allergies are at increased risk of adverse events, including death from anaphylaxis. Epinephrine is the cornerstone of emergency response, yet few individuals with serious food allergies consistently carry their emergency medication. Behavioral economics offers promising, previously untapped opportunities for behavior change in this arena.
  
  
  OBJECTIVE
  To test the effectiveness of modest financial incentives in promoting the carrying of epinephrine and to evaluate the acceptability of text messaging for delivering reminders and key health messages to young adults with food allergies.
  
  
  METHODS
  A mixed-methods randomized controlled trial in young adults with food allergies investigated the carrying of epinephrine auto-injectors using financial incentives plus text message reminders vs text message reminders alone. Epinephrine carriage was assessed 10 times during the 49-day intervention using rapid-reply cell phone photographs plus daily code words.
  
  
  RESULTS
  The intervention (financial incentive) group had their epinephrine auto-injectors at 54% of check-ins vs 27% of check-ins in the control (text-only) group (P = .023). Participants in the 2 groups consistently reported favorable impressions of text messaging as a desirable, unobtrusive way to receive information and support for food allergy management.
  
  
  CONCLUSIONS
  Although the intervention and control groups reported favorable impressions of text message-based reminder systems, the intervention group performed significantly better than the control group on a photograph-based measurement of epinephrine carriage. There remained ample room for improvement in the 2 groups given the goal of consistent, uninterrupted epinephrine carriage by people with potentially life-threatening food allergies.
  
  
  BACKGROUND
  https://clinicaltrials.gov; NCT02354729.
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: carolyncannu@gmail.com.
authors.forename: Carolyn C
authors.initials: CC
authors.lastname: Cannuscio
authors.affiliation: Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Roxanne
authors.initials: R
authors.lastname: Dupuis
authors.affiliation: Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Amy
authors.initials: A
authors.lastname: Graves
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jane W
authors.initials: JW
authors.lastname: Seymour
authors.affiliation: Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Sarah
authors.initials: S
authors.lastname: Kounaves
authors.affiliation: Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Emily
authors.initials: E
authors.lastname: Strupp
authors.affiliation: Master of Public Health Program, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Damien
authors.initials: D
authors.lastname: Leri
authors.affiliation: Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Frasso
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David
authors.initials: D
authors.lastname: Grande
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Zachary F
authors.initials: ZF
authors.lastname: Meisel
mesh_terms: D000293:Adolescent; D000328:Adult; D000707:Anaphylaxis / Q000188:drug therapy* / Q000517:prevention & control; D060909:Economics, Behavioral; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D005512:Food Hypersensitivity / Q000276:immunology*; D006266:Health Education; D006801:Humans; D008297:Male; D009042:Motivation; D017010:Reminder Systems; D012646:Self Administration / Q000295:instrumentation; D060145:Text Messaging; D055815:Young Adult
chemical_list: D004837:Epinephrine