title: Incentivizing health care behaviors in emerging adults: a systematic review.
abstract: OBJECTIVE
  For emerging adults with chronic medical diseases, the transition from pediatric to adult health care is often a time of great upheaval, commonly associated with unhealthy self-management choices, loss to follow-up, and adverse outcomes. We conducted a systematic review to examine the use of incentive strategies to promote positive health-related behaviors in young adults with chronic medical diseases.
  
  
  METHODS
  The Medline, CINAHL, Embase, PsycInfo, and Cochrane databases were searched through June 2014. Studies of any design where an incentive was used to achieve a target behavior or outcome in a pediatric or emerging adult population (age <30 years) with chronic medical conditions including addictions, were included.
  
  
  RESULTS
  A total of 26 studies comprising 10,880 patients met our inclusion criteria after screening 10,305 abstracts and 301 full-text articles. Of these studies, 20 examined the effects of behavioral incentives on cigarette smoking or substance abuse, including alcohol; four studies explored behavioral incentives in the setting of HIV or sexual health; and two articles studied individuals with other chronic medical conditions. Seventeen articles reported a statistically significant benefit of the behavioral incentive on one or more outcomes, although only half reported follow-up after the incentive period was terminated.
  
  
  CONCLUSIONS
  While the majority of studies reported positive outcomes, these studies focused on promoting the cessation of adverse behaviors rather than promoting positive behaviors. In addition, conclusions were limited by the high risk of bias present in the majority of studies, as well as lack of follow-up after the incentive period. Whether behavioral incentives facilitate the adoption of positive health choices in this population remains to be determined.
authors.affiliation: Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, ON, Canada; Division of Endocrinology and Metabolism, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Catherine H
authors.initials: CH
authors.lastname: Yu
authors.affiliation: Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Guarna
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Pamela
authors.initials: P
authors.lastname: Tsao
authors.affiliation: Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Jude R
authors.initials: JR
authors.lastname: Jesuthasan
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Endocrinology, Department of Medicine, University Health Network, Toronto, ON, Canada.
authors.forename: Adrian Nc
authors.initials: AN
authors.lastname: Lau
authors.affiliation: Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Ferhan S
authors.initials: FS
authors.lastname: Siddiqi
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Julie Anne
authors.initials: JA
authors.lastname: Gilmour
authors.affiliation: Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Danyal
authors.initials: D
authors.lastname: Ladha
authors.affiliation: Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
authors.forename: Henry
authors.initials: H
authors.lastname: Halapy
authors.affiliation: Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, ON, Canada; Division of Endocrinology and Metabolism, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, ON, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Advani
keywords: incentive; self-management; transition; young adult