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Background There is very limited evidence on the existence of cancer-related perceived stigma and self-blame among patients with advanced cancer in Asia, and how they are associated with psychosocial outcomes. This study aimed to address the gap in the current literature by (1) assessing perceived stigma, behavioural self-blame and characterological self-blame among Vietnamese patients with advanced cancer, and (2) investigating the associations of perceived stigma and self-blame (behavioural and characterological) with depression, emotional well-being and social well-being. Methods This cross-sectional study involved 200 Vietnamese patients with stage IV solid cancer. Depression was measured using the Center for Epidemiologic Studies Depression (CES-D) Scale. Emotional well-being and social well-being were measured with the relevant domains of the Functional Assessment of Cancer Therapy-General (FACT-G) scale. Perceived stigma was assessed using the sense of stigma subscale of Kissane’s Shame and Stigma Scale. Behavioural self-blame and characterological self-blame were measured by the patients’ answers to the questions on whether their cancer was due to patient’s behaviour or character. Multivariable linear regressions were used to investigate the associations while controlling for patient characteristics. Results Approximately three-fourths (79.0%, n = 158) of the participants reported perceived stigma with an average score of 20.5 ± 18.0 (out of 100). More than half of the participants reported behavioural self-blame (56.3%, n = 112) or characterological self-blame (62.3%, n = 124). Higher perceived stigma was associated with lower emotional well-being (ß = -0.0; p = 0.024). Behavioural self-blame was not significantly associated with depressive symptoms, emotional well-being or social well-being. Patients who reported characterological self-blame reported greater depressive symptoms (ß = 3.0; p = 0.020) and lower emotional well-being (ß = -1.6; p = 0.038). Conclusion Perceived stigma and self-blame were common amongst Vietnamese advanced cancer patients. Perceived stigma was associated with lower emotional well-being while characterological self-blame were associated with greater depressive symptoms and lower emotional well-being. Interventions should address perceived stigma and self-blame among this population.
Nguyen Tuong Pham; Jia Jia Lee; Nhu Hiep Pham; Thi Do Quyen Phan; Khoa Tran; Hoai Bao Dang; Irene Teo; Chetna Malhotra; Eric A. Finkelstein; Semra Ozdemir. The prevalence of perceived stigma and self-blame and their associations with depression, emotional well-being and social well-being among advanced cancer patients: evidence from the APPROACH cross-sectional study in Vietnam. BMC Palliative Care 2021, 20, 1 -9.
AMA StyleNguyen Tuong Pham, Jia Jia Lee, Nhu Hiep Pham, Thi Do Quyen Phan, Khoa Tran, Hoai Bao Dang, Irene Teo, Chetna Malhotra, Eric A. Finkelstein, Semra Ozdemir. The prevalence of perceived stigma and self-blame and their associations with depression, emotional well-being and social well-being among advanced cancer patients: evidence from the APPROACH cross-sectional study in Vietnam. BMC Palliative Care. 2021; 20 (1):1-9.
Chicago/Turabian StyleNguyen Tuong Pham; Jia Jia Lee; Nhu Hiep Pham; Thi Do Quyen Phan; Khoa Tran; Hoai Bao Dang; Irene Teo; Chetna Malhotra; Eric A. Finkelstein; Semra Ozdemir. 2021. "The prevalence of perceived stigma and self-blame and their associations with depression, emotional well-being and social well-being among advanced cancer patients: evidence from the APPROACH cross-sectional study in Vietnam." BMC Palliative Care 20, no. 1: 1-9.
Many patients with advanced illness have unrealistic survival expectations, largely due to cognitive biases. Studies suggests that when people are motivated to be accurate, they are less prone to succumb to these biases. Using a randomized survey design, we test whether offering advanced cancer patients ( n = 200) incentives to estimate their prognosis improves accuracy. We also test whether presenting treatment benefits in terms of a loss (mortality) rather than a gain (survival) reduces willingness to take up a hypothetical treatment. Results are not consistent with the proposed hypotheses for either accuracy incentives or framing effects.
Eric A Finkelstein; Yin Bun Cheung; Maurice E Schweitzer; Lai Heng Lee; Ravindran Kanesvaran; Drishti Baid. Accuracy incentives and framing effects to minimize the influence of cognitive bias among advanced cancer patients. Journal of Health Psychology 2021, 1 .
AMA StyleEric A Finkelstein, Yin Bun Cheung, Maurice E Schweitzer, Lai Heng Lee, Ravindran Kanesvaran, Drishti Baid. Accuracy incentives and framing effects to minimize the influence of cognitive bias among advanced cancer patients. Journal of Health Psychology. 2021; ():1.
Chicago/Turabian StyleEric A Finkelstein; Yin Bun Cheung; Maurice E Schweitzer; Lai Heng Lee; Ravindran Kanesvaran; Drishti Baid. 2021. "Accuracy incentives and framing effects to minimize the influence of cognitive bias among advanced cancer patients." Journal of Health Psychology , no. : 1.
Background Hypertension is prevalent in Singapore and is a major risk factor for cardiovascular morbidity and mortality and increased health care costs. Strategies to lower blood pressure include lifestyle modifications and home blood pressure monitoring. Nonetheless, adherence to home blood pressure monitoring remains low. This protocol details an algorithm for remote management of primary care patients with hypertension. Objective The objective of this study was to determine whether wireless home blood pressure monitoring with or without financial incentives is more effective at reducing systolic blood pressure than nonwireless home blood pressure monitoring (usual care). Methods This study was designed as a randomized controlled open-label superiority study. A sample size of 224 was required to detect differences of 10 mmHg in average systolic blood pressure. Participants were to be randomized, in the ratio of 2:3:3, into 1 of 3 parallel study arms :(1) usual care, (2) wireless home blood pressure monitoring, and (3) wireless home blood pressure monitoring with financial incentives. The primary outcome was the mean change in systolic blood pressure at month 6. The secondary outcomes were the mean reduction in diastolic blood pressure, cost of financial incentives, time taken for the intervention, adherence to home blood pressure monitoring, effectiveness of the framing of financial incentives in decreasing nonadherence to blood pressure self-monitoring and the adherence to antihypertensive medication at month 6. Results This study was approved by SingHealth Centralised Institutional Review Board and registered. Between January 24, 2018 and July 10, 2018, 42 participants (18.75% of the required sample size) were enrolled, and 33 participants completed the month 6 assessment by January 31, 2019. Conclusions Due to unforeseen events, the study was stopped prematurely; therefore, no results are available. Depending on the blood pressure information received from the patients, the algorithm can trigger immediate blood pressure advice (eg, Accident and Emergency department visit advice for extremely high blood pressure), weekly feedback on blood pressure monitoring, medication titration, or skipping of routine follow-ups. The inclusion of financial incentives framed as health capital provides a novel idea on how to promote adherence to remote monitoring, and ultimately, improve chronic disease management. Trial Registration ClinicalTrials.gov NCT 03368417; https://clinicaltrials.gov/ct2/show/NCT03368417 International Registered Report Identifier (IRRID) DERR1-10.2196/27496
Marcel Bilger; Agnes Ying Leng Koong; Ian Kwong Yun Phoon; Ngiap Chuan Tan; Juliana Bahadin; Joann Bairavi; Ada Portia M Batcagan-Abueg; Eric A Finkelstein. Wireless Home Blood Pressure Monitoring System With Automatic Outcome-Based Feedback and Financial Incentives to Improve Blood Pressure in People With Hypertension: Protocol for a Randomized Controlled Trial. JMIR Research Protocols 2021, 10, e27496 .
AMA StyleMarcel Bilger, Agnes Ying Leng Koong, Ian Kwong Yun Phoon, Ngiap Chuan Tan, Juliana Bahadin, Joann Bairavi, Ada Portia M Batcagan-Abueg, Eric A Finkelstein. Wireless Home Blood Pressure Monitoring System With Automatic Outcome-Based Feedback and Financial Incentives to Improve Blood Pressure in People With Hypertension: Protocol for a Randomized Controlled Trial. JMIR Research Protocols. 2021; 10 (6):e27496.
Chicago/Turabian StyleMarcel Bilger; Agnes Ying Leng Koong; Ian Kwong Yun Phoon; Ngiap Chuan Tan; Juliana Bahadin; Joann Bairavi; Ada Portia M Batcagan-Abueg; Eric A Finkelstein. 2021. "Wireless Home Blood Pressure Monitoring System With Automatic Outcome-Based Feedback and Financial Incentives to Improve Blood Pressure in People With Hypertension: Protocol for a Randomized Controlled Trial." JMIR Research Protocols 10, no. 6: e27496.
Profit maximizing firms sometimes engage in voluntary informative advertising, usually to promote their reputation as honest brokers. One example of informative advertising is shelf nutrition labels that some supermarket chains voluntarily provide. Several studies have shown that voluntary shelf nutrition and similar front-of-pack nutrition labels positively influence food purchasing patterns. Yet these studies assumed that suppliers are price takers. Using one shelf nutrition label, NuVal, as an example, we revisit this assumption. We take advantage of the natural experiment that occurred when NuVal substantially changed its underlying scoring algorithm. As the NuVal label represents an independent expert assessment of the health quality of each food product, this natural experiment allows for testing the causal effect of the information on demand and price changes independent of the hype that comes with the rollout of a new information policy. After endogenizing prices, we find that price changes offset nearly 42% of the direct effects of the score changes. This result shows the potential benefits of this form of voluntary information disclosure but also that most previous analyses of nutrition labeling overstated the benefits because they failed to account for supply responses.
Wenying Li; Eric Andrew Finkelstein; Chen Zhen. Intended and Unintended Consequences of Salient Nutrition Labels. American Journal of Agricultural Economics 2021, 1 .
AMA StyleWenying Li, Eric Andrew Finkelstein, Chen Zhen. Intended and Unintended Consequences of Salient Nutrition Labels. American Journal of Agricultural Economics. 2021; ():1.
Chicago/Turabian StyleWenying Li; Eric Andrew Finkelstein; Chen Zhen. 2021. "Intended and Unintended Consequences of Salient Nutrition Labels." American Journal of Agricultural Economics , no. : 1.
Context Individuals with noncommunicable diseases account for a disproportionate share of medical expenditures, absenteeism, and presenteeism. Therefore, employers are increasingly looking to worksite wellness programs as a cost-containment strategy. Previous reviews examining whether worksite wellness programs deliver a positive return on investment have shown mixed results, possibly because the more optimistic findings come from studies with poorer methodologic quality. The purpose of this systematic review is to critically revisit and update this literature to explore that hypothesis. Evidence Acquisition A total of 4 databases were systematically searched for studies published before June 2019. Included studies were economic evaluations of worksite wellness programs that were based in the U.S., that lasted for at least 4 weeks, and that were with at least 1 behavior change component targeting 1 of the 4 primary modifiable behaviors for chronic disease: physical activity, healthy diet, tobacco use, and harmful consumption of alcohol. Methodologic quality was assessed using Consensus for Health Economic Criteria guidelines and the risk for selection bias associated with the study design. Data extraction (September 2019–February 2020) was followed by a narrative synthesis of worksite wellness programs characteristics and return on investment estimates. Evidence Synthesis A total of 25 relevant studies were identified. After conducting a quality and bias assessment, only 2 of the 25 studies were found to have both high methodologic rigor and lower risk for selection bias. These studies found no evidence of a positive return on investment in the short term. Conclusions The highest-quality studies do not support the hypothesis that worksite wellness programs deliver a positive return on investment within the first few years of initiation.
Drishti Baid; Edward Hayles; Eric A. Finkelstein. Return on Investment of Workplace Wellness Programs for Chronic Disease Prevention: A Systematic Review. American Journal of Preventive Medicine 2021, 1 .
AMA StyleDrishti Baid, Edward Hayles, Eric A. Finkelstein. Return on Investment of Workplace Wellness Programs for Chronic Disease Prevention: A Systematic Review. American Journal of Preventive Medicine. 2021; ():1.
Chicago/Turabian StyleDrishti Baid; Edward Hayles; Eric A. Finkelstein. 2021. "Return on Investment of Workplace Wellness Programs for Chronic Disease Prevention: A Systematic Review." American Journal of Preventive Medicine , no. : 1.
Objective Many patients with advanced illness are unrealistically optimistic about their prognosis. We test for the presence of several cognitive biases, including optimism bias, illusion of superiority, self‐deception, misattribution, and optimistic update bias, that could explain unrealistically optimistic prognostic beliefs among advanced cancer patients and quantifies the extent to which hope exacerbates these biases. Methods A cross‐sectional survey was administered to 200 advanced cancer patients with physician‐estimated prognoses of one year or less. Hope was measured using the Herth Hope Index (HHI). Hypotheses were tested using linear and logistic regressions and a structural‐equation model. Results Results are consistent with the presence of optimism bias, illusion of superiority, self‐deception, and misattribution. All of these biases are amplified by higher levels of hope. Each 1‐point higher HHI is associated with a 6% (OR: 1.06; 95% CI: 1.01‐1.11) greater odds of believing their illness is curable, a 0.33‐year (95% CI: 0.17‐0.49) longer expected survival, a 6% (OR: 1.06; 95% CI: 1.02‐1.11) higher probability of believing that survival outcomes are better than the average patient, a 5% higher odds of believing primary intent of treatment is curative (OR: 1.05; 95% CI: 1.00‐1.10), and a 12% (OR: 1.12; 95% CI: 1.05‐1.17) higher odds of believing they are well‐informed. Mediation analyses revealed that hope significantly mediates the effect of mental‐well‐being and loneliness on expected survival. Conclusions Results suggest advanced cancer patients succumb to several cognitive biases which are exacerbated by greater levels of hope. As a result, they are susceptible to possible over‐treatment and regret.
Eric A. Finkelstein; Drishti Baid; Yin Bun Cheung; Maurice E. Schweitzer; Chetna Malhotra; Kevin Volpp; Ravindran Kanesvaran; Lai Heng Lee; Rebecca Alexandra Dent; Matthew Ng Chau Hsien; Mohamad Farid Bin Harunal Rashid; Nagavali Somasundaram D/o. Hope, bias and survival expectations of advanced cancer patients: A cross‐sectional study. Psycho-Oncology 2021, 30, 780 -788.
AMA StyleEric A. Finkelstein, Drishti Baid, Yin Bun Cheung, Maurice E. Schweitzer, Chetna Malhotra, Kevin Volpp, Ravindran Kanesvaran, Lai Heng Lee, Rebecca Alexandra Dent, Matthew Ng Chau Hsien, Mohamad Farid Bin Harunal Rashid, Nagavali Somasundaram D/o. Hope, bias and survival expectations of advanced cancer patients: A cross‐sectional study. Psycho-Oncology. 2021; 30 (5):780-788.
Chicago/Turabian StyleEric A. Finkelstein; Drishti Baid; Yin Bun Cheung; Maurice E. Schweitzer; Chetna Malhotra; Kevin Volpp; Ravindran Kanesvaran; Lai Heng Lee; Rebecca Alexandra Dent; Matthew Ng Chau Hsien; Mohamad Farid Bin Harunal Rashid; Nagavali Somasundaram D/o. 2021. "Hope, bias and survival expectations of advanced cancer patients: A cross‐sectional study." Psycho-Oncology 30, no. 5: 780-788.
Background and objective Up-to-date economic burden of asthma in Singapore is currently unknown. Methods We quantify the per capita and total annual costs of asthma for adults and children by level of symptom control (uncontrolled, partly controlled, and well controlled) via a cross-sectional online survey administered to a national web panel. Participants were asked about healthcare utilisation, days missed from work, and reduced productivity due to their symptoms. These values were then monetised and multiplied by prevalence estimates of adult and child asthmatics to generate total costs. Results A total of 300 adults and 221 parents of children with asthma were included in analysis. The total annual cost of adult asthma was estimated to be SGD 1.74 billion (US$1.25 billion) with 42% coming from the uncontrolled group, 45% from the partly controlled group, and 13% from the well-controlled group. For children, the total cost is SGD 0.35 billion (US$0.25 billion), with 64%, 26% and 10% coming from each group respectively. Combined, the annual economic burden of asthma in Singapore is SGD 2.09 billion (US$1.50 billion) with 79% due to productivity losses. Conclusion Poorly controlled asthma imposes a significant economic burden. Therefore, better control of disease has the potential to generate not only health improvements, but also medical expenditure savings and productivity gains.
Eric A Finkelstein; Eden Lau; Brett Doble; Bennett Ong; Mariko Siyue Koh. Economic burden of asthma in Singapore. BMJ Open Respiratory Research 2021, 8, e000654 .
AMA StyleEric A Finkelstein, Eden Lau, Brett Doble, Bennett Ong, Mariko Siyue Koh. Economic burden of asthma in Singapore. BMJ Open Respiratory Research. 2021; 8 (1):e000654.
Chicago/Turabian StyleEric A Finkelstein; Eden Lau; Brett Doble; Bennett Ong; Mariko Siyue Koh. 2021. "Economic burden of asthma in Singapore." BMJ Open Respiratory Research 8, no. 1: e000654.
Background: Few studies have assessed how patient preferences influence end-of-life costs. Aim: To estimate mean monthly healthcare costs in 2019 Singapore Dollars (SGD) at five time points within the last year of life and identify how patients’ preferences for the trade-off between treatment cost containment and life-extension and other factors affect these costs. Design: Mean monthly costs were quantified in the last 1, 3, 6, 9, and 12-months before death. Univariate and multivariate analyses were conducted. Setting/participants: Billing records for 286 deceased participants in the Cost and Medical Care of Patients with Advanced Serious Illness (COMPASS) cancer cohort study in Singapore. Results: Mean monthly costs were $5140 (95% CI: $4750; $5520) in the 12-months before death and rose to $8350 (95% CI: $7110; $9590) 1-month before death. Participants preferring higher cost containment/less life-extension defied the trend of increasing costs closer to death (mean monthly costs of $4630 (95% CI: $3690; $ 5580) and $4850 (95% CI: $2850; $6850) (12-months and 1-month before death respectively). Participants preferring lower cost containment/more life-extension had costs that were $1050 (95% CI: $49; $2051) and $5220 (95% CI: $2320; $8130) higher than those preferring lower costs/less life-extension 12-months and 1-month before death respectively. Conclusions: On average, cancer patients in Singapore can expect to spend $61,680 in the last year of life. Of broader relevance is that patient preferences and other observable factors clearly influence these costs, suggesting that policymakers and patients can better predict and budget for end-of-life costs by considering these factors.
Brett Doble; Wei Han Melvin Wong; Eric Finkelstein; on behalf of the COMPASS study team. End-of-life cost trajectories and the trade-off between treatment costs and life-extension: Findings from the Cost and Medical Care of Patients with Advanced Serious Illness (COMPASS) cohort study. Palliative Medicine 2021, 35, 893 -903.
AMA StyleBrett Doble, Wei Han Melvin Wong, Eric Finkelstein, on behalf of the COMPASS study team. End-of-life cost trajectories and the trade-off between treatment costs and life-extension: Findings from the Cost and Medical Care of Patients with Advanced Serious Illness (COMPASS) cohort study. Palliative Medicine. 2021; 35 (5):893-903.
Chicago/Turabian StyleBrett Doble; Wei Han Melvin Wong; Eric Finkelstein; on behalf of the COMPASS study team. 2021. "End-of-life cost trajectories and the trade-off between treatment costs and life-extension: Findings from the Cost and Medical Care of Patients with Advanced Serious Illness (COMPASS) cohort study." Palliative Medicine 35, no. 5: 893-903.
BACKGROUND Hypertension is prevalent in Singapore and is a major risk factor for cardiovascular morbidity and mortality and increased health care costs. Strategies to lower blood pressure include lifestyle modifications and home blood pressure monitoring. Nonetheless, adherence to home blood pressure monitoring remains low. This protocol details an algorithm for remote management of primary care patients with hypertension. OBJECTIVE The objective of this study was to determine whether wireless home blood pressure monitoring with or without financial incentives is more effective at reducing systolic blood pressure than nonwireless home blood pressure monitoring (usual care). METHODS This study was designed as a randomized controlled open-label superiority study. A sample size of 224 was required to detect differences of 10 mmHg in average systolic blood pressure. Participants were to be randomized, in the ratio of 2:3:3, into 1 of 3 parallel study arms :(1) usual care, (2) wireless home blood pressure monitoring, and (3) wireless home blood pressure monitoring with financial incentives. The primary outcome was the mean change in systolic blood pressure at month 6. The secondary outcomes were the mean reduction in diastolic blood pressure, cost of financial incentives, time taken for the intervention, adherence to home blood pressure monitoring, effectiveness of the framing of financial incentives in decreasing nonadherence to blood pressure self-monitoring and the adherence to antihypertensive medication at month 6. RESULTS This study was approved by SingHealth Centralised Institutional Review Board and registered. Between January 24, 2018 and July 10, 2018, 42 participants (18.75% of the required sample size) were enrolled, and 33 participants completed the month 6 assessment by January 31, 2019. CONCLUSIONS Due to unforeseen events, the study was stopped prematurely; therefore, no results are available. Depending on the blood pressure information received from the patients, the algorithm can trigger immediate blood pressure advice (eg, Accident and Emergency department visit advice for extremely high blood pressure), weekly feedback on blood pressure monitoring, medication titration, or skipping of routine follow-ups. The inclusion of financial incentives framed as health capital provides a novel idea on how to promote adherence to remote monitoring, and ultimately, improve chronic disease management. CLINICALTRIAL ClinicalTrials.gov NCT 03368417; https://clinicaltrials.gov/ct2/show/NCT03368417 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/27496
Marcel Bilger; Agnes Ying Leng Koong; Ian Kwong Yun Phoon; Ngiap Chuan Tan; Juliana Bahadin; Joann Bairavi; Ada Portia M Batcagan-Abueg; Eric A Finkelstein. Wireless Home Blood Pressure Monitoring System With Automatic Outcome-Based Feedback and Financial Incentives to Improve Blood Pressure in People With Hypertension: Protocol for a Randomized Controlled Trial (Preprint). 2021, 1 .
AMA StyleMarcel Bilger, Agnes Ying Leng Koong, Ian Kwong Yun Phoon, Ngiap Chuan Tan, Juliana Bahadin, Joann Bairavi, Ada Portia M Batcagan-Abueg, Eric A Finkelstein. Wireless Home Blood Pressure Monitoring System With Automatic Outcome-Based Feedback and Financial Incentives to Improve Blood Pressure in People With Hypertension: Protocol for a Randomized Controlled Trial (Preprint). . 2021; ():1.
Chicago/Turabian StyleMarcel Bilger; Agnes Ying Leng Koong; Ian Kwong Yun Phoon; Ngiap Chuan Tan; Juliana Bahadin; Joann Bairavi; Ada Portia M Batcagan-Abueg; Eric A Finkelstein. 2021. "Wireless Home Blood Pressure Monitoring System With Automatic Outcome-Based Feedback and Financial Incentives to Improve Blood Pressure in People With Hypertension: Protocol for a Randomized Controlled Trial (Preprint)." , no. : 1.
Purpose To estimate potential annual savings in medical expenditures from a subsidized weight management program from the NYC Government perspective. Design Longitudinal observational study. Setting Employees of New York City (NYC) government and enrolled dependents. Sample 14,946 participants with overweight and obesity. Intervention WW (formerly Weight Watchers®) ‘Workshop’ and ‘Digital’ programs. Measures Participation rate, enrollment duration, weight change, and predicted gross and net total and per capita medical expenditure savings and return on investment (ROI). Analysis Participation rate, enrollment duration, weight change, and program costs are based on direct observation. Predicted savings are simulated based on published data relating weight loss to medical expenditure reductions. Results In total, 47% of participating employees and 50% of participating dependents lost weight during the enrollment period. Mean (median) enrollment duration for employees was 7.1 months (7.0) and for dependents was 6.9 months (6.0). Mean (median) weight losses for the employees in ‘Workshops’ and ‘Digital’ was 6.6 lbs (2.80) and 6.3 lbs (0.0). For dependents, weight losses were 7.4 lbs (3.59) and 11.6 lbs (2.0). Per capita and total predicted net savings to NYC Government from employees was estimated to be $120 and $1,486,102 for an ROI of 143%. Including dependents, predicted net savings increases to $1,963,431 for an ROI of 189%. Over 80% of savings came from participants in the Obese III category. Conclusion An evidence-based weight management program has the potential to generate a positive ROI for employers. Future studies should validate these estimates using actual data and more rigorous designs.
Sagun Agrawal; Alexis C. Wojtanowski; Laura Tringali; Gary D. Foster; Eric A. Finkelstein. Financial implications of New York City’s weight management initiative. PLOS ONE 2021, 16, e0246621 .
AMA StyleSagun Agrawal, Alexis C. Wojtanowski, Laura Tringali, Gary D. Foster, Eric A. Finkelstein. Financial implications of New York City’s weight management initiative. PLOS ONE. 2021; 16 (2):e0246621.
Chicago/Turabian StyleSagun Agrawal; Alexis C. Wojtanowski; Laura Tringali; Gary D. Foster; Eric A. Finkelstein. 2021. "Financial implications of New York City’s weight management initiative." PLOS ONE 16, no. 2: e0246621.
BACKGROUND Use of a mobile health tool as a waitlist intervention combined with in-person weight management clinic visits may increase participant engagement and be an effective treatment strategy for adolescent obesity. OBJECTIVE The aim of this study was to assess the effectiveness of and adolescent engagement with a mobile application-based lifestyle intervention program as a waitlist intervention prior to their engagement with a multidisciplinary weight management clinic METHODS This single-arm feasibility study recruited adolescents with obesity, aged 10-16 year old, to a waitlist intervention using a mobile app-based lifestyle intervention program with routine clinical care. Primary outcomes were adolescents’ engagement with the mobile application and BMI z-score at 6 months. Secondary outcomes included health behaviours, physical activity levels , quality of life and disordered eating behaviours. RESULTS We enrolled 40 adolescents with mean age of 13.8 ± 1.7 years and BMI z-score of 2.07 ± 0.30. Participants were ethnically diverse with 45% Chinese, 33% Malay, 15% Indians and 10% of other ethnicity. 83% of the participants had a household income level that was below the national median levels. 83% of the participants engaged with the mobile app-based lifestyle intervention program. There was no significant differences in the BMI z-score and disordered eating behaviours of the participants at 6 months. Participants had significant improvement in quality of life (P=0.044) and physical activity level (P=0.026) with reduction of total caloric intake (P=0.018) and fat percentage (P=0.018) at 6 months. CONCLUSIONS Use of a mobile app-based lifestyle intervention program combined with multidisciplinary clinical care is feasible strategy to provide obesity management services to a low-income and racially diverse Asian population and improves quality of life, physical activity levels and reduces fat percentage and total caloric intake. CLINICALTRIAL ClinicalTrials.gov NCT03561597
Chu Shan Elaine Chew; Eric Andrew Finkelstein; Courtney Davis. Use of a mobile lifestyle intervention application as a waitlist intervention for adolescents with obesity: single arm feasibility study (Preprint). 2020, 1 .
AMA StyleChu Shan Elaine Chew, Eric Andrew Finkelstein, Courtney Davis. Use of a mobile lifestyle intervention application as a waitlist intervention for adolescents with obesity: single arm feasibility study (Preprint). . 2020; ():1.
Chicago/Turabian StyleChu Shan Elaine Chew; Eric Andrew Finkelstein; Courtney Davis. 2020. "Use of a mobile lifestyle intervention application as a waitlist intervention for adolescents with obesity: single arm feasibility study (Preprint)." , no. : 1.
Background: The unprecedented severity of coronavirus disease 2019 (COVID-19) constitutes a serious public health concern. However, adoption of COVID-19-related preventive behaviours remain relatively unknown. This study investigated predictors of preventive behaviours. Methods: An analytical sample of 897 Singaporean adults who were quota sampled based on age, gender, and ethnicity were recruited through a web-enabled survey. Outcomes were adoption of, or increased frequency of preventive behaviours (avoiding social events; avoiding public transport; reducing time spent shopping and eating out; wearing a mask in public; avoiding hospitals/clinics; keeping children out of school, washing hands/using sanitisers; keeping surroundings clean; avoiding touching public surfaces; working from/studying at home). Public perceptions regarding COVID-19 (chances of getting COVID-19; perceived likelihood of COVID-19-related intensive care unit (ICU) admission; government trust; self-efficacy; perceived appropriateness of COVID-19 behaviours; response efficacy), anxiety, and demographic characteristics (age; ethnicity; marital status; education; chronic conditions; current living arrangements) were investigated as predictors of preventive behaviours adopted during COVID-19 in binomial and ordered logistic regressions. Results: Though adoption of preventive behaviours among Singaporeans varied, it was, overall, high, and consistent with government recommendations. Nearly a quarter reported moderate to severe anxiety (General Anxiety Disorder 7-item – GAD-7 scores). Respondents who perceived higher COVID-19 risks, had higher government trust, higher self-efficacy, and perceived that others acted appropriately reported increased adoption/frequency of preventive measures. The strongest indicator of behavioural change was response efficacy. Respondents who were older, highly educated, anxious and married reported higher adoption/frequency of preventive measures. Conclusion: To successfully influence appropriate preventive behaviours, public health messages should highlight response efficacy, increase self-efficacy, and promote trust in governmental response. Focus should be on demographic segments with low adoptions, such as younger individuals and those with low education.
Semra Ozdemir; Sean Ng; Isha Chaudhry; Eric Andrew Finkelstein. Adoption of Preventive Behaviour Strategies and Public Perceptions About COVID-19 in Singapore. International Journal of Health Policy and Management 2020, 1 .
AMA StyleSemra Ozdemir, Sean Ng, Isha Chaudhry, Eric Andrew Finkelstein. Adoption of Preventive Behaviour Strategies and Public Perceptions About COVID-19 in Singapore. International Journal of Health Policy and Management. 2020; ():1.
Chicago/Turabian StyleSemra Ozdemir; Sean Ng; Isha Chaudhry; Eric Andrew Finkelstein. 2020. "Adoption of Preventive Behaviour Strategies and Public Perceptions About COVID-19 in Singapore." International Journal of Health Policy and Management , no. : 1.
Positive front-of-pack (FOP) labels, including Singapore’s Healthier Choice Symbol (HCS), target a subset of healthier products whose consumption is to be encouraged. However, this may inadvertently lead to excess caloric intake, which could be addressed by including an additional label identifying calories per serving. We test this hypothesis by adding a Physical Activity Equivalent (PAE) label, an indicator of calorie content, to all products available in an on-line grocery store. We conducted a randomized controlled trial using a 3 arm within-subject crossover design in adult Singapore residents recruited online. Participants shopped once in each condition in an experimental online grocery store in random order: 1) no FOP label (Control); 2) Select products displaying HCS labels (HCS-only); 3) Condition 2 with additional information displaying PAEs per serving on every product (HCS+PAE). 117 participants were recruited and data from 317 shops were analyzed. We used first-differenced regressions to assess the impact of the conditions on calories per serving (primary) and on other measures of diet quality. The HCS-only condition led to a statistically significant five-percentage point increase in the proportion of HCS products purchased (95% CI, 1%: 9%). However, neither the HCS-only (3.45; 95% CI, −12.52: 19.43) nor HCS + PAE (8.14; 95% CI, −5.25: 21.54) condition led to a change in the number of calories per serving purchased or changes in other measures of diet quality. Positive labels, like the HCS, are likely to increase purchases of labelled products. However, these changes may not lead to improvements in diet quality or calorie intake. Combining positive labels with additional PAE information does not appear to address this concern.
Eric A. Finkelstein; Brett Doble; Felicia Jia Ler Ang; Wei Han Melvin Wong; Rob M. van Dam. A randomized controlled trial testing the effects of a positive front-of-pack label with or without a physical activity equivalent label on food purchases. Appetite 2020, 158, 104997 .
AMA StyleEric A. Finkelstein, Brett Doble, Felicia Jia Ler Ang, Wei Han Melvin Wong, Rob M. van Dam. A randomized controlled trial testing the effects of a positive front-of-pack label with or without a physical activity equivalent label on food purchases. Appetite. 2020; 158 ():104997.
Chicago/Turabian StyleEric A. Finkelstein; Brett Doble; Felicia Jia Ler Ang; Wei Han Melvin Wong; Rob M. van Dam. 2020. "A randomized controlled trial testing the effects of a positive front-of-pack label with or without a physical activity equivalent label on food purchases." Appetite 158, no. : 104997.
Background Insufficient physical activity is a global public health concern. Research indicates incentives can increase physical activity levels of children but has not tested whether incentives targeted at children can be leveraged to increase physical activity levels of their parents. This study evaluates whether a novel incentive design linking children’s incentives to both their and their parent’s physical activity levels can increase parent’s physical activity. Methods We conducted a two-arm, parallel, open-labelled randomized controlled trial in Singapore where parent-child dyads were randomly assigned to either (1) rewards to child contingent on child’s physical activity (child-based) or (2) rewards to child contingent on both child’s and parent’s physical activity (family-based). Parents had to be English-speaking, computer-literate, non-pregnant, full-time employees, aged 25–65 years, and with a participating child aged 7–11 years. Parent-child dyads were randomized within strata (self-reported low vs high weekly physical activity) into study arms in a 1:1 ratio. Participants were given activity trackers to assess daily steps. The outcome of interest was the between-arm difference in the change from baseline in parent’s mean steps/day measured by accelerometry at months 6 and 12 (primary endpoint). Results Overall, 159 and 157 parent-child dyads were randomized to the child-based or family-based arms, respectively. Outcomes were evaluated on an intent-to-treat basis. At month 6, there was a 613 steps/day (95% CI: 54–1171) differential in favour of family-based parents. At month 12, our primary endpoint, the differential was reduced to 369 steps/day (95% CI: − 88–1114) and was no longer statistically significant. Conclusions Our findings suggest that novel incentive designs that take advantage of group dynamics may be effective. However, in this design, the effectiveness of the family-based incentive to increase parent’s physical activity was not sustained through one year. Trial registration NCT02516345 (ClinicalTrials.gov) registered on August 5, 2015.
Eric Andrew Finkelstein; Robyn Su May Lim; Dianne Stanton Ward; Kelly R. Evenson. Leveraging family dynamics to increase the effectiveness of incentives for physical activity: the FIT-FAM randomized controlled trial. International Journal of Behavioral Nutrition and Physical Activity 2020, 17, 1 -11.
AMA StyleEric Andrew Finkelstein, Robyn Su May Lim, Dianne Stanton Ward, Kelly R. Evenson. Leveraging family dynamics to increase the effectiveness of incentives for physical activity: the FIT-FAM randomized controlled trial. International Journal of Behavioral Nutrition and Physical Activity. 2020; 17 (1):1-11.
Chicago/Turabian StyleEric Andrew Finkelstein; Robyn Su May Lim; Dianne Stanton Ward; Kelly R. Evenson. 2020. "Leveraging family dynamics to increase the effectiveness of incentives for physical activity: the FIT-FAM randomized controlled trial." International Journal of Behavioral Nutrition and Physical Activity 17, no. 1: 1-11.
Objectives To assess the extent to which public support for outbreak containment policies varies with respect to the severity of an infectious disease outbreak. Methods A web-enabled survey was administered to 1,017 residents of Singapore during the COVID-19 pandemic, and was quota-sampled based on age, gender and ethnicity. A fractional-factorial design was used to create hypothetical outbreak vignettes characterised by morbidity and fatality rates, and local and global spread of an infectious disease. Each respondent was asked to indicate which response policies (among 5 policies restricting local movement and 4 border control policies) they would support in 5 randomly-assigned vignettes. Binomial logistic regressions were used to predict the probabilities of support as a function of outbreak attributes, personal characteristics and perceived policy effectiveness. Results Likelihood of support varied across government response policies; however, was generally higher for border control policies compared to internal policies. The fatality rate was the most important factor for internal policies while the degree of global spread was the most important for border control policies. In general, individuals who were less healthy, had higher income and were older were more likely to support these policies. Perceived effectiveness of a policy was a consistent and positive predictor of public support. Conclusions Our findings suggest that campaigns to promote public support should be designed specifically to each policy and tailored to different segments of the population. They should also be adapted based on the evolving conditions of the outbreak in order to receive continued public support.
Semra Ozdemir; Si Ning Germaine Tan; Isha Chaudhry; Chetna Maholtra; Eric Andrew Finkelstein. Public Preferences for Government Response Policies on Outbreak Control. 2020, 1 .
AMA StyleSemra Ozdemir, Si Ning Germaine Tan, Isha Chaudhry, Chetna Maholtra, Eric Andrew Finkelstein. Public Preferences for Government Response Policies on Outbreak Control. . 2020; ():1.
Chicago/Turabian StyleSemra Ozdemir; Si Ning Germaine Tan; Isha Chaudhry; Chetna Maholtra; Eric Andrew Finkelstein. 2020. "Public Preferences for Government Response Policies on Outbreak Control." , no. : 1.
We investigated the predictors of patient-experienced and preferred roles for decision making, and the association between patient-experienced role in decision making and patient outcomes among congestive heart failure (HF) patients in a multi-ethnic Asian population. We surveyed 246 H F patients classified as New York Heart Association class 3/4. Multivariable regressions were used to analyse the associations between patient-experienced roles and patient outcomes. Patients who were male, employed, attained higher education, and had a higher cognitive score were more likely to experience and prefer active roles in decision making. Younger patients and patients with lower symptom burden were more likely, while married patients were less likely to prefer leading decision making. Patients with collaborative (family and/or physician) decision making reported higher emotional well-being and sense of meaning/peace. Collaborative and patient-led decision making were associated with higher perceived control over illness. Those who were led by others or made decisions alone reported lower quality of physician communication. Collaborative decision making was associated with higher emotional well-being, sense of meaning/peace, and higher perceived control over illness among HF patients. Physicians should explain the benefits of shared decision making and encourage patients to participate in treatment decisions.
Semra Ozdemir; Irene Teo; Filipinas Gines Bundoc; Chetna Malhotra; Khung Keong Yeo; Kheng Leng David Sim; Eric Andrew Finkelstein. Role in decision making among congestive heart failure patients and its association with patient outcomes: a baseline analysis of the SCOPAH study. Patient Education and Counseling 2020, 104, 496 -504.
AMA StyleSemra Ozdemir, Irene Teo, Filipinas Gines Bundoc, Chetna Malhotra, Khung Keong Yeo, Kheng Leng David Sim, Eric Andrew Finkelstein. Role in decision making among congestive heart failure patients and its association with patient outcomes: a baseline analysis of the SCOPAH study. Patient Education and Counseling. 2020; 104 (3):496-504.
Chicago/Turabian StyleSemra Ozdemir; Irene Teo; Filipinas Gines Bundoc; Chetna Malhotra; Khung Keong Yeo; Kheng Leng David Sim; Eric Andrew Finkelstein. 2020. "Role in decision making among congestive heart failure patients and its association with patient outcomes: a baseline analysis of the SCOPAH study." Patient Education and Counseling 104, no. 3: 496-504.
Background: Insufficient physical activity is a global public health concern. Research indicates incentives can increase physical activity levels of children but has not tested whether incentives targeted at children can be leveraged to increase physical activity levels of their parents. This study evaluates whether a novel incentive design linking children’s incentives to both their and their parent’s physical activity levels can increase parent’s physical activity.Methods: We conducted a two-arm, parallel, open-labelled randomized controlled trial in Singapore where parent-child dyads were randomly assigned to either (1) rewards to child contingent on child’s physical activity (child-based) or (2) rewards to child contingent on both child’s and parent’s physical activity (family-based). Parents had to be English-speaking, computer-literate, non-pregnant, full-time employees, aged 25–65 years, and with a participating child aged 7–11 years. Parent-child dyads were randomized within strata (self-reported low vs high weekly physical activity) into study arms in a 1:1 ratio. Participants were given activity trackers to assess daily steps. The outcome of interest was the between-arm difference in the change from baseline in parent’s mean steps/day measured by accelerometry at months 6 and 12 (primary endpoint).Results: Overall, 159 and 157 parent-child dyads were randomized to the child-based or family-based arms, respectively. Outcomes were evaluated on an intent-to-treat basis. At month 6, there was a 613 steps/day (95% CI: 54–1171) differential in favour of family-based parents. At month 12, our primary endpoint, the differential was reduced to 369 steps/day (95% CI: -88–1114) and was no longer statistically significant.Conclusions: Our findings suggest that novel incentive designs that take advantage of group dynamics may be effective. However, in this design, the effectiveness of the family-based incentive to increase parent’s physical activity was not sustained through one year.Trial registration: NCT02516345 (ClinicalTrials.gov) registered on August 5, 2015
Eric Finkelstein; Robyn Su May Lim; Dianne Stanton Ward; Kelly R. Evenson. Leveraging Family Dynamics to Increase the Effectiveness of Incentives for Physical Activity: The FIT-FAM Randomized Controlled Trial. 2020, 1 .
AMA StyleEric Finkelstein, Robyn Su May Lim, Dianne Stanton Ward, Kelly R. Evenson. Leveraging Family Dynamics to Increase the Effectiveness of Incentives for Physical Activity: The FIT-FAM Randomized Controlled Trial. . 2020; ():1.
Chicago/Turabian StyleEric Finkelstein; Robyn Su May Lim; Dianne Stanton Ward; Kelly R. Evenson. 2020. "Leveraging Family Dynamics to Increase the Effectiveness of Incentives for Physical Activity: The FIT-FAM Randomized Controlled Trial." , no. : 1.
The uncertainty around coronavirus disease-19 (COVID-19) has triggered anxiety among public. We aimed to assess the variation in anxiety and risk perceptions of COVID-19 among adults in Singapore. We administered a web-survey to a panel of residents between 31 March and 14 April 2020. We assessed anxiety using general anxiety disorder (GAD) scale and assessed participants’ risk perceptions regarding severity of the outbreak. Of the 1,017 participants, 23% reported moderate to severe anxiety [GAD score≥10]. A high proportion reported perceived likelihood of ICU admission (46%) and death (30%) upon getting COVID-19. Results from path analysis showed that younger participants, those with chronic conditions, those living with children and low perceived trust in government response to COVID-19 had a significantly higher anxiety mediated by their perceived risk of dying upon getting COVID-19. These results highlight the need for management of anxiety through adequate and effective risk communication for the general public.
Chetna Malhotra; Isha Chaudhry; Semra Ozdemir; Irene Teo; Eric Andrew Finkelstein. Anxiety and perceived risk during COVID-19 outbreak. 2020, 1 .
AMA StyleChetna Malhotra, Isha Chaudhry, Semra Ozdemir, Irene Teo, Eric Andrew Finkelstein. Anxiety and perceived risk during COVID-19 outbreak. . 2020; ():1.
Chicago/Turabian StyleChetna Malhotra; Isha Chaudhry; Semra Ozdemir; Irene Teo; Eric Andrew Finkelstein. 2020. "Anxiety and perceived risk during COVID-19 outbreak." , no. : 1.
The rising prevalence of non-communicable diseases has brought attention to the importance of consuming a healthy diet. One strategy to improve diet quality is through front-of-pack (FOP) nutrition labels. Taking advantage of an online grocery store, we allowed consumers to choose the FOP labels they preferred, and combined this information with real-time feedback on the overall nutritional quality of the shopping basket. We hypothesized that these dynamic food labels with real-time feedback (DFLF) would improve nutritional quality of food purchases. This trial followed a two-arm (no-label control and DFLF) crossover design with 125 participants exposed to each condition once in random order via an online grocery store. A first difference regression model allowed for estimating the unbiased effect of the DFLF on diet quality, measured by the weighted average Nutri-Score (ranging 1 to 5) per serving (primary) and changes in select nutrients and calories. The mean weighted Nutri-Score was 0.4 (12.6%) higher in the DFLF arm (CI: [0.2, 0.6]) relative to the control. The DFLF also decreased the amount of sugar per serving by 0.9 g (CI: [−1.7, −0.0]) and total sugar per shop by 169.5 g (CI: [−284.5, −54.5]). The DFLF features significantly improved nutrition quality relative to no labelling, as measured by average Nutri-Score values. These results shed light on the considerable potential of the online shopping environment to improve diet quality through customization and real time feedback.
Soye Shin; Rob M. Van Dam; Eric A. Finkelstein. The Effect of Dynamic Food Labels with Real-Time Feedback on Diet Quality: Results from a Randomized Controlled Trial. Nutrients 2020, 12, 2158 .
AMA StyleSoye Shin, Rob M. Van Dam, Eric A. Finkelstein. The Effect of Dynamic Food Labels with Real-Time Feedback on Diet Quality: Results from a Randomized Controlled Trial. Nutrients. 2020; 12 (7):2158.
Chicago/Turabian StyleSoye Shin; Rob M. Van Dam; Eric A. Finkelstein. 2020. "The Effect of Dynamic Food Labels with Real-Time Feedback on Diet Quality: Results from a Randomized Controlled Trial." Nutrients 12, no. 7: 2158.
Objectives Patient preference for place of death is an important component of advance care planning (ACP). If patients' preference for place of death changes over time, this questions the value of their documented preference. We aimed to assess the extent and correlates of change in preference for place of death over time among patients with symptoms of advanced heart failure. Design We conducted a secondary analysis of data from a randomized controlled trial of a formal ACP program vs usual care. Setting and Participants We interviewed 282 patients aged 21 years old and above with heart failure and New York Heart Association Classification III and IV symptoms in Singapore. Analytic sample included 200 patients interviewed at least twice. Methods We assessed factors associated with patients' preference for place of death (home/institution/no preference) and change in their preference for place of death from previous time point (change toward home death/toward an institutional death/toward no preference/no change). These included patient demographics, quality of life (Kansas City Cardiomyopathy Questionnaire), and prognostic understanding. Results In our study, 66% of patients with heart failure changed their preference for place of death at least once during the study period with no consistent pattern of change. Correct prognostic understanding at the time of survey reduced the relative risk of change in preference for place of death to home (relative risk ratio 0.49, 95% confidence interval 0.32, 0.76), whereas a higher quality of life score was associated with a lower relative risk of patients changing their preferred place of death to an institution (relative risk ratio 0.99, 95% confidence interval 0.97, 1.00) relative to no change in preference. Conclusions and Implications We provide evidence of instability in patients with heart failure preference for place of death, which suggests that ACP documents should be regularly re-evaluated.
Chetna Malhotra; Filipinas G. Bundoc; David Sim; Fazlur Rehman Jaufeerally; Eric A. Finkelstein. Instability in Preference for Place of Death Among Patients With Symptoms of Advanced Heart Failure. Journal of the American Medical Directors Association 2020, 22, 349.e29 -349.e34.
AMA StyleChetna Malhotra, Filipinas G. Bundoc, David Sim, Fazlur Rehman Jaufeerally, Eric A. Finkelstein. Instability in Preference for Place of Death Among Patients With Symptoms of Advanced Heart Failure. Journal of the American Medical Directors Association. 2020; 22 (2):349.e29-349.e34.
Chicago/Turabian StyleChetna Malhotra; Filipinas G. Bundoc; David Sim; Fazlur Rehman Jaufeerally; Eric A. Finkelstein. 2020. "Instability in Preference for Place of Death Among Patients With Symptoms of Advanced Heart Failure." Journal of the American Medical Directors Association 22, no. 2: 349.e29-349.e34.