Incentivizing healthy lifestyle behaviors to reduce cardiovascular risk in people with serious mental illness: An equipoise randomized controlled trial of the wellness incentives program

Contemp Clin Trials. 2019 Jun:81:1-10. doi: 10.1016/j.cct.2019.04.005. Epub 2019 Apr 13.


Background: Medicaid recipients with serious mental illness die 25-30 years earlier than people in the general population due to health conditions that are modifiable through lifestyle changes. Cardiovascular diseases from excess weight, smoking, and sedentary lifestyle contribute substantially to this life expectancy disparity. The current study evaluated the impact of incentives on participation in weight management programming (for overweight and obese adults) and smoking cessation treatment (for regular smokers).

Methods: Participants were Medicaid recipients with disabling mental illness receiving services at any one of 10 community mental health centers across New Hampshire. Using an equipoise stratified randomized design, n = 1348 were enrolled and assigned to one of four weight management programs (Healthy Choices Healthy Changes: HCHC) and n = 661 were enrolled and assigned to one of three smoking cessation interventions (Breathe Well Live Well: BWLW). Following assignment to an intervention, participants were randomized to receive financial incentives (to attend weight management programs, or to achieve abstinence from smoking) or not. Data were collected at baseline and every 3 months for 12 months.

Discussion: New Hampshire's HCHC and BWLW programs were designed to address serious and preventable health disparities by providing incentivized health promotion programs to overweight/obese and/or tobacco-smoking Medicaid beneficiaries with mental illness. This study was an unprecedented opportunity to evaluate an innovative statewide implementation of incentivized health promotion targeting the most at-risk and costly beneficiaries. If proven effective, this program has the potential to serve as a national model for widespread implementation.

Keywords: Cardiovascular disease; Healthy lifestyle; Incentives; Obesity; Serious mental illness; Smoking.

Publication types

  • Clinical Trial Protocol
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Cardiovascular Diseases* / prevention & control
  • Community Mental Health Centers* / organization & administration
  • Health Education / organization & administration
  • Health Promotion* / organization & administration
  • Healthy Lifestyle*
  • Humans
  • Longitudinal Studies
  • Medicaid
  • Mental Disorders* / epidemiology
  • Motivation
  • Multicenter Studies as Topic
  • New Hampshire
  • Overweight / therapy
  • Randomized Controlled Trials as Topic
  • Research Design
  • Risk Factors
  • Smoking Cessation / methods
  • United States / epidemiology
  • Weight Reduction Programs / organization & administration