Association for Behavior Analysis International

Contingency management is efficacious in promoting desirable behavior change across a variety of behavior. The treatment strategy has also been used as a tool to help isolate the effects of a number of variables on behavior change. This symposium highlights3 unique studies in which contingency management is used to incentivize healthy choices and dissociate the effects of several independent and predictor variables on treatment outcomes. The first paper examines the effects of incentive type and treatment fidelity on outcome measures in a contingency management program designed to increase children's fruit and vegetable consumption. The second paper examines whether patterns of voucher reimbursement predict treatment success in a contingency management program to promote abstinence among pregnant smokers. The third paper investigates the effects of percentile schedules on the number of steps taken per day in a prize-based contingency management program designed to increase physical activity among healthy adults. These studies demonstrate that contingency management is a promising treatment model for applications designed to promote a diverse group of healthy behaviors and for laboratory investigations of the effects of various independent variables on treatment outcomes.

In contingency management (CM) objectively verified target behaviors are reinforced with vouchers that can be redeemed for goods or services. One use of this treatment approach has been to encourage pregnant smokers to abstain during their pregnancy. The voucher redemption records of 174 pregnant women enrolled in a voucher-based smoking cessation treatment were examined to see if patterns of voucher redemption or other measures of impulsivity (e.g. delay discounting, Barratt Impulsiveness Scale) could predict treatment success. Women were classified as high (n=71) or low (n=103) abstinence based on whether greater than or fewer than 50% of their urine samples during the course of their treatment were cotinine negative. Frequency of redemption between high and low abstinence groups did not differ significantly. However, significant differences were found between the groups when examining the percentage of earnings that had been spent at different time points in treatment. Voucher redemption patterns may serve as a naturalistic measure of impulsivity in this population.

The CDC (2010) recommends that adults engage in a minimum two hours of intense activity per week. Research shows a positive relationship between physical activity and overall health, but most Americans are not physically active. Hindrances to working out include unrealistic expectations and physical discomfort or pain. The current study incentivizes increases in physical activity. Healthy adults were recruited to wear a Fitbit computerized pedometer for up to six weeks. During a baseline period, steps per day were measured, prize draws were earned for wearing the Fitbit. Prizes varied in value from $2 to $150, with a 50% probability of winning each draw. During an intervention phase, daily criterion for draws was set at a percentile of recent steps. Criterion required current steps exceed 4, 5 or 6 of the previous 7 days steps. Finally, a return to baseline required only wearing the Fitbit to earn draws. Preliminary results show significant increases in steps in half of the participants, with those individuals with the lowest baseline rates of stepping showing the greatest increases during intervention.