Unconditional cash transfers to improve health behaviors among primary care patients: a qualitative sub-study of a randomized clinical trial

Social Science & Medicine · 2026-02-10

Unconditional cash transfers are a popular poverty reduction approach and may influence behavioral risk factors for chronic disease outcomes through economic and psychological pathways. Few studies have used qualitative interviews to identify the mechanisms through which cash transfers delivered in a health care context might influence the health of people living with chronic diseases in the United States. We conducted a pilot randomized controlled trial to identify pathways through which unconditional cash transfers may influence health and assess the acceptability and feasibility of such an intervention among low-income patients receiving treatment for hypertension or diabetes. Inclusion criteria were: ≥1 visit at the Penn Family Care clinic within the six months prior to study start, ≥18 years of age, Pennsylvania Medicaid beneficiary, diagnosis of pre-diabetes or diabetes, and/or hypertension, prescribed ≥1 oral medication for diabetes or hypertension, and no plans to leave the Philadelphia metro area. Participants were randomized to either the standard of care or an unconditional cash transfer intervention, and completed an assessment at enrollment and after 12 weeks of study participation. We enrolled 100 participants from 3/2023-8/2023 and 93 attended the follow-up visit. Thirty-four participants (selected randomly) completed qualitative interviews. The interviews and survey data revealed that cash transfers were primarily used to address basic needs. We identified potential pathways through which cash transfers may improve health, including temporary reductions in stress and anxiety, changes in diet and physical activity, improved medication adherence, and increased healthcare seeking behavior. The intervention itself was viewed as highly acceptable. Participants in the control group were disappointed not to receive the intervention, but felt the process was fair because all participants were economically vulnerable. These findings suggest unconditional cash transfers may improve health for patients with chronic diseases through a variety of pathways that should be measured in future trials.

Point-of-sale sugar-sweetened beverage warning posters <i>v</i> . control posters were associated with reductions in school store sugar-sweetened beverage purchases made by Guatemalan adolescents

Public Health Nutrition · 2026-01-01

OBJECTIVE: We examined whether point-of-sale warning posters, compared with control posters, reduced Guatemalan adolescents' purchases of sugar-sweetened beverages (SSB) at school stores. DESIGN: We used a difference-in-differences approach (4-week baseline and 4-week treatment). Our primary analysis compared two schools assigned to an intervention warning poster to one school that displayed a control poster. Based on purchase transaction data, the outcomes were volume of SSB, beverage kcal and sugar purchased per transaction. SETTING: Three private schools in Guatemala City, Guatemala. PARTICIPANTS: Students between 12 and 18 years of age. RESULTS: Our primary analysis found that the warning poster decreased the overall volume of SSB (in ounces) that adolescents purchased in the warning poster intervention schools (-2·27 oz. 95 % CI = (-2·70, -1·85)) compared with the control school. This reduction was driven by a decrease in SSB purchases (OR = 0·64, 95 % CI = (0·49, 0·86)). The warning posters were associated with a significant reduction in likelihood of purchasing a beverage with kilocalories (calories) (OR = 0·68, 95 % CI = (0·49, 0·92)). These changes were associated with a significant overall decrease in sugar purchased (-5·54 g 95 % CI = (-6·69, -4·39)). The posters were associated with a significant increase in non-SSB purchases in the intervention schools compared with the control school (OR = 1·53, 95 % CI = (1·16, 2·02)). CONCLUSION: Our results suggest that messages that warn adolescents about the high-sugar content in SSB may be an effective, low-cost way to modestly reduce purchases of these drinks. These findings provide evidence to support national front-of-package labelling, currently being considered in Guatemala.

If you build it, will they use it? Use of a Digital Assistant for Self-Reporting of COVID-19 Rapid Antigen Test Results during Large Nationwide Community Testing Initiative

UNC Libraries · 2025-02-21

Importance: Wide-spread distribution of rapid-antigen tests is integral to the United States' strategy to address COVID-19; however, it is estimated that few rapid-antigen test results are reported to local departments of health. Objective: To characterize how often individuals in six communities throughout the United States used a digital assistant to log rapid-antigen test results and report them to their local Department of Health. Design: This prospective cohort study is based on anonymously collected data from the beneficiaries of The Say Yes! Covid Test program, which distributed 3,000,000 rapid antigen tests at no cost to residents of six communities between April and October 2021. We provide a descriptive evaluation of beneficiaries' use of digital assistant for logging and reporting their rapid antigen test results. Main outcome and measures: Number and proportion of tests logged and reported to the Department of Health through the digital assistant. Results: A total of 178,785 test kits were ordered by the digital assistant, and 14,398 households used the digital assistant to log 41,465 test results. Overall, a small proportion of beneficiaries used the digital assistant (8%), but over 75% of those who used it reported their rapid antigen test results to their state public health department. The reporting behavior varied between communities and was significantly different for communities that were incentivized for reporting test results (p &lt; 0.001). In all communities, positive tests were less reported than negative tests (60.4% vs 75.5%; p&lt;0.001). Conclusions and relevance: These results indicate that app-based reporting with incentives may be an effective way to increase reporting of rapid tests for COVID-19; however, increasing the adoption of the digital assistant is a critical first step.

Changing Entrée Portion Size Labels to Encourage Selection of Smaller Portions When Dining Out: A Randomized Controlled Field Experiment

Current Developments in Nutrition · 2025-05-01

Using a mental model approach to undercut the effects of exposure to mRNA vaccination misconceptions: Two randomized trials

Proceedings of the National Academy of Sciences · 2025-11-24 · 1 citations

Although messenger RNA (mRNA) technology revolutionized vaccine creation, its use is threatened by unwarranted fear that DNA left over from the vaccine manufacturing process could integrate into recipients' DNA, increasing cancer and heritable risks. Drawing on the mental model theory of reasoning, our two preregistered interventions undercut these problematic conclusions. They do so by testing the effectiveness of two mental model-based interventions juxtaposing problematic claims with visualized or verbally explained models of basic biological and vaccination systems. Study 1: a) graphically modeled how mRNA COVID-19 vaccination works (Model 1); b) verbally modeled ways in which cells protect themselves from foreign DNA (Model 2); and c) provided ancillary material designed to bolster perceptions of mRNA vaccination safety. Study 2 deployed an animation of the cell-protection model (Model 2), alone, and in combination with Study 1's messaging. Neither the mRNA vaccine nor the DNA protection model explicitly acknowledged the problematic DNA-integration claim. Both preemptive (before) and rebuttal (after) positioning of the models were effective. Within-person analyses suggested that preemptive positioning may be somewhat more effective than rebuttal positioning. Some positive effects of exposure to the modeled knowledge messaging condition in Study 1 persisted 2 mo after exposure.

Preconception and Prenatal Medicaid Coverage for Medicaid-Insured Births

Journal of Women s Health · 2025-07-22

Background: Medicaid provides insurance for 40% of U.S. births. Patterns of preconception Medicaid enrollment are not well-described. Methods: Using Medicaid Analytic Extract files, this retrospective cohort study of individuals with a 2014 Medicaid-insured birth examined months of Medicaid enrollment and changes in enrollment status during 84 months prior to birth. We used linear regression to assess the association between enrollment months and 2014 age, race and ethnicity, rural residence, any Medicaid eligibility due to disability, foster care involvement, or pregnancy, chronic health conditions, and state of residence. We examined variation across states in the relationship between enrollment months and changes in enrollment status. Results: We identified 944,068 individuals in 30 states. Individuals had a median of 40.6 (SD 27.3) enrollment months of Medicaid and 3.2 (SD 2.3) changes in enrollment status. Twenty-eight percent were enrolled in Medicaid for ≥63 months. In regression analysis, age, race and ethnicity, and chronic health conditions were associated with enrollment months. Each year of age was associated with −0.93 enrollment months (95% CI −1.27, −0.60). For chronic conditions, hypertension was associated with an additional 3.12 enrollment months (95% CI 2.53, 3.71), diabetes with 3.28 (95% CI 2.24, 4.32), and mental health with 6.27 (95% CI 5.55, 6.98). The relationship between enrollment months and changes in enrollment status varied across states. Conclusions: Medicaid plays a substantial role in preconception health insurance for individuals with Medicaid-insured births. This is particularly true for younger individuals and those with comorbidities associated with adverse birth outcomes.

A Normative Assessment of Parental Political Socialization: The Case of the 2024 U.S. Presidential Debates

American Behavioral Scientist · 2025-07-29

Adopting a normative democratic theory framework, this project assesses the degree to which parents and guardians maximized the political socialization opportunities afforded by the 2024 U.S. presidential debates. A three-step communication process involving debate exposure, intergenerational co-consumption, and intergenerational discussion is offered as a socialization ideal. Data collected during two waves of a national probability-based panel survey of U.S. adults (first wave fielded July 11–18, 2024, N = 1,496; second wave fielded September 13–30, 2024, N = 1,744) are used to assess parents and guardians relative to the proposed three-step process. Less than 20% of parents or guardians maximized the parental political socialization opportunities created by either debate. A third data collection involving a national probability-based survey of parent/guardian-teen/young adult dyads ( N = 236, fielded October 22–November 4, 2024) is used to assess a pair of actor-partner interdependence models that indicate how a failure to maximize the political socialization potential of presidential debates negatively impacts intergenerational exchanges about the election within households.

Impact of the Philadelphia Beverage Tax on Perceived Beverage Healthfulness, Tax Awareness, and Tax Opinions

Journal of Nutrition Education and Behavior · 2024-03-11 · 2 citations

The Philadelphia Beverage Tax and Pediatric Weight Outcomes

JAMA Pediatrics · 2024-11-25 · 6 citations

Importance: Taxation of sweetened beverages is a proposed strategy to reduce excess sugar consumption. The association of such taxes with health outcomes is not well studied. Philadelphia, Pennsylvania, is the largest US city with a beverage tax. Objective: To assess whether the 2017 Philadelphia beverage tax was associated with changes in pediatric weight outcomes. Design, Setting, and Participants: This study used difference-in-differences models weighted by inverse probability of treatment weights to adjust for differences between youth in Philadelphia (tax exposed) and in the surrounding counties (control) on age, sex, race, ethnicity, Medicaid insurance status, health care use, and census-tract socioeconomic index. Mixed-effects linear and logistic regression models estimated differences in posttax changes in standardized body mass index (zBMI) and prevalence of obesity (a BMI 95th percentile or higher for age and sex) between Philadelphia and control. Stratified analyses assessed differences by age, sex, race, Medicaid insurance status, and baseline weight. Data came from electronic health records of a primary care network operating in the Philadelphia region. A panel analysis included youth 2 to 18 years old with 1 or more BMI measurement pretax (2014 to 2016) and 1 or more BMI measurement posttax (2018 to 2019). A cross-sectional analysis included youth 2 to 18 years old with 1 or more BMI measurement at any time from 2014 to 2019. These data were analyzed from December 2020 through July 2024. Exposure: Living in Philadelphia after implementation of the beverage tax. Main outcomes and measures: zBMI and obesity prevalence. Results: In panel analysis of 136 078 youth, the tax was associated with a difference in zBMI change of -0.004 (95% CI, -0.009 to 0.001) between Philadelphia and the control and a 1.02 odds ratio (95% CI, 0.97-1.08) of BMIs in the 95th percentile or higher. In cross-sectional analysis of 258 584 youth, the difference in zBMI change was -0.004 (95% CI, -0.009 to 0.001) and the odds ratio of a BMI in the 95th percentile or higher was 1.01 (95% CI, 0.95-1.07). In subgroup analyses, some differences in zBMI change were evident by race, age, Medicaid insurance status, and baseline weight but these differences were small and inconsistent across samples. Conclusions and Relevance: These results show that 2 years after implementation, the Philadelphia beverage tax was not associated with changes in youth zBMI or obesity prevalence. Though certain subgroups demonstrated small statistically significant changes in zBMI, they are of low clinical significance.

Associations of the Philadelphia sweetened beverage tax with changes in adult body weight: an interrupted time series analysis

The Lancet Regional Health - Americas · 2024-10-12 · 7 citations

Background Sweetened beverage taxes are associated with large decreases in sugar-sweetened beverage sales, but their effects on weight outcomes are unclear.We examined associations of the 2017 Philadelphia beverage tax with changes in adult weight outcomes. MethodsWe obtained electronic health record data on adults 18-65 years old in Philadelphia (intervention) and other areas of Pennsylvania and New Jersey (control) from 2014 to 2019.Controlled interrupted time series models compared post-tax changes in trends of body mass index (BMI, primary outcome) and obesity prevalence (secondary outcome).A panel sample comprised 175,675 adults with at least one BMI measure in both the pre-tax (2014-2016) and post-tax (2017-2019) periods.A cross-sectional sample comprised 587,121 adults with at least one BMI measure from 2014 to 2019.Findings Before tax implementation, Philadelphia panel patients had a mean BMI of 30.4 kg/m 2 and an obesity prevalence of 44.5%.After implementation, in the panel sample, there was a -0.03 kg/m 2 (95% CI: -0.07, 0.02) per quarter decrease in BMI vs. control, implying a -0.32 kg/m 2 (-0.85, 0.20) change at the end of the 3-year study period.In the cross-sectional sample, there was a -0.05 kg/m 2 (95% CI: -0.09, -0.01) per quarter decrease in BMI vs. control, implying a -0.60 kg/m 2 (-1.04, -0.16) change at the end of the study period.Results for obesity prevalence were consistent with the BMI results.Interpretation There was some limited evidence of a decrease in BMI and obesity prevalence in Philadelphia 3 years after beverage tax implementation.Replication of these results is needed.