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OBJECTIVES: This study aimed to assess the impact of pay-for-performance (P4P) programmes on healthcare in Taiwan. STUDY DESIGN: This was a systematic review and meta-analysis. METHODS: A systematic literature search was performed using the PubMed, Medline, Embase, Cochrane review, Scopus, Web of Science and PsycINFO databases up to July 2023. Meta-analysis of the available outcomes was conducted using a random-effects model. RESULTS: The search yielded 85 studies, of which 58 investigated the programme for diabetes mellitus (DM), eight looked at the programme for chronic kidney disease (CKD), and the remaining studies examined programmes for breast cancer, tuberculosis, schizophrenia and chronic obstructive pulmonary disease. The DM P4P programme was a cost-effective strategy associated with reduced hospitalisation and subsequent complications. The CKD P4P was associated with a lower risk of dialysis initiation. The P4P programme also improved outcomes in breast cancer, cure rates in tuberculosis, reduced admissions for schizophrenia and reduced acute exacerbation in chronic obstructive pulmonary disease. The meta-analysis revealed that the P4P programme for DM (odds ratio [OR] = 0.59; 95% confidence interval [CI] = 0.48-0.73) and CKD (OR = 0.73; 95% CI = 0.67-0.81) significantly reduced mortality risk. However, participation rate in the DM P4P programme was only 19% in 2014. CONCLUSIONS: P4P programmes in Taiwan improve quality of care. However, participation was voluntary and the participation rate was very low, raising the concern of selective enrolment of participants (i.e. 'cherry-picking' behaviour) by physicians. Future programme reforms should focus on well-designed features with the aim of reducing healthcare disparities.

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Future viability depends on ensuring a sustainable society because green energy methods may efficiently reduce greenhouse gas emissions. Nevertheless, stakeholders, consumers, and developers continue to be notably ignorant of the financial incentives connected to green technology. Moreover, there is still a dearth of studies on the range of financial incentives offered by different authorities in India. Monetary incentives, such as tax breaks, indirect tax exemptions, and refunds, are crucial in encouraging the use of green technology in the modern world. This study explores the importance of financial incentives for green building technologies in India, which also looks at the wide range of incentives provided by federal, state, and local governments. Furthermore, the study highlights various state government programs such as goods subsidies, exemptions from local taxes, and fee waivers. Notably, several incentives aimed at consumers, developers, and other stakeholders have been implemented by the Indian Green Building Council (IGBC). This review study emphasizes the effectiveness of financial incentives in green construction projects and draws attention to a clear knowledge gap regarding the adoption of green technology. This study also provides insights into potential future directions. Studies and research results emphasize the importance of spreading the word about financial incentives as a key factor in determining the adoption of green technologies. Many parties, including governmental organizations, municipal governments, developers, and clients engaged in green building technology projects, stand to gain increased awareness.

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Background: The video game industry has introduced a new form of monetization through microtransactions. A controversial example has been the so-called "loot boxes" (LBs) as virtual objects, which are randomized and bought with legal money. In recent years, LBs have come to connect 2 distinct problem behaviors, namely internet gaming disorder (IGD) and online gambling disorder (OGD). Many association studies have been conducted on the 3 constructs, but few have delved into the relationship of problematic use of LBs (PU-LB) with IGD and OGD. Objective: This study aims to explore the mediating role of the PU-LB between IGD and OGD. Methods: This cross-sectional and analytical study used incidental sampling in 24 Spanish schools. The final sample consisted of 542 participants (male: n=523, 96.5%; age: range 11-30 y) who played video games, bought LBs, and had gambled online in the last 12 months. Participants then completed the Spanish versions of the Internet Gaming Disorder Scale-Short Form, Online Gambling Disorder Questionnaire, and PU-LB scale. Results: IGD scores were found to be significantly associated with both PU-LB (r=0.473, P<.001) and OGD (r=0.209, P<.001). Moreover, PU-LB was significantly associated with OGD (r=0.351, P<.001). The structural equation model results indicated that IGD had no significant direct effect on OGD (P=.903). However, the indirect effect of IGD on OGD through PU-LB was significant (P<.001). Therefore, PU-LB fully mediated the relationship between IGD and OGD. Furthermore, these results were found in the subsamples of both minors (<18 y) and young adults (≥18 y). Conclusions: It is suggested that there is a mediation effect of problematic LB use between internet gambling and online gambling problems in both minors and young adults. This has potential practical implications by providing more evidence on how LBs have become a hinge feature between 2 clinically relevant and independent issues. In this regard, adequate industry self-regulation is needed, and effective legislation for the protection of minors is necessary.

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Herein, we propose a blueprint for action to completely measure and recognize the care provided by acute and critical care nurses to be incorporated into policy that shapes and supports practice. We address the nature of nurses' work by identifying nine practice domains, hospital practice environment assumptions, and expected outcomes. Nurses' work, as a cross-system process, needs to be included in hospital-based core measures to fully reflect nurses' impact on patient care. We call for a balanced measurement portfolio focused on patient/family-, unit-, and systems-level outcomes. We focus on what nurses do and what patients and their families can expect rather than only on the elimination of select adverse events. We provide a way forward to allow measure development and implementation with incentives for their use. This approach to making nurses' contributions and impact on outcomes visible will enhance acute and critical care nursing practice and benefit patients and their families.

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Foodborne disease cases are increasingly occurring in home kitchens because of improper food handling behavior. Human factors are considered major determinants of such behavior, although economic factors, which have attracted little attention, may also be important influencers. Taking the service time of kitchen towels as an example, we construct a theoretical model to analyze food handling behavior under an economic framework and empirically explore its economic determinants. Empirically, we use a randomized controlled trial (RCT) coupled with pre- and postsurveys in rural China. The RCT intervention includes information with tips for proper kitchen towel use and in-kind subsidies of one, two, or three packs of kitchen towels, which is regarded as a price intervention. We find that information alone and information plus one pack of towels are not enough to stimulate behavior improvement, whereas information plus two or three packs is sufficient. This implies that the quantity of kitchen towels used increases only as the towel price drops below a certain threshold. As an early attempt, we indicate that food handling behavior is economically driven, suggesting that a well-designed policy should combine educational campaigns and appropriate economic incentives to improve such behavior to reduce the risk of foodborne disease.

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OBJECTIVES: To assess if participation in a North Carolina produce prescription program for Supplemental Nutrition Assistance Program (SNAP) participants with diet-sensitive health conditions (SuperSNAP) is associated with changes in purchase composition and spending source. METHODS: This study used loyalty-card transaction data (October 2019-April 2022). We applied a linear mixed-effects model with overlap weights to perform a difference-indifferences analysis of purchases by SuperSNAP program enrollees compared to the control group. RESULTS: The sample included 1440 SuperSNAP shoppers and 45,851 control shoppers. Compared to shoppers only on SNAP, SuperSNAP shoppers spent $82.98 (95% CI (75.6, 90.3), p-value <0.001) more per month, $76.09 (95% CI (69.4, 82.8), pvalue <0.001) of which were spent strictly on food and beverage products. Among SuperSNAP shoppers, out of the $40 SuperSNAP benefit each month, an estimated $34.86 (95% CI (33.9, 35.8), p-value <0.001) of it was spent on fruits and vegetables. CONCLUSIONS: This study shows the promise of targeted produce prescription programs for SNAP participants in encouraging shifts in purchase composition.

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Despite significant prevention efforts, the numbers of physically inactive individuals, chronic illnesses, exhaustion syndromes and sick leaves are increasing. A still unresolved problem with exercise promotion is the low participation of sedentary persons. This collective term covers heterogeneous subgroups. Their engagement with movement campaigns and resistance to change are influenced by numerous factors. Our aim was to analyse survey data on health, performance, lifestyle habits and the approachability to physical activity campaigns obtained from the Germany-wide ActIv survey. From 2888 study participants aged 50-60 years, 668 persons were categorised into the subgroups "never-athletes", "sports-dropouts", "always-athletes" and "sports-beginners". Large and significant group differences were found for BMI, assessment of quality of life, health and fitness, risk factors and health problems. In total, 42.5% of "never-athletes" and 32.5% of "sports-dropouts" did not state any barriers to sport. There are substantial disparities between the non-athlete groups in terms of their motivation to exercise. In contrast, there are comparatively minor differences in motivation between "sports-dropouts" and "sports-beginners", whose health and fitness are the primary motivators for sport. Our analyses suggest that (i) negative health and performance trends cannot be compensated for by appeals for voluntary participation in exercise programmes and (ii) powerful incentive systems are required.

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BACKGROUND: Recruitment to residency programs in hospitals located in other than major hubs ("remotely located") is a challenge in many countries. In 2011, the Israeli Ministry of Health launched a 10-year financial incentive to encourage physicians to enroll in residency programs in such hospitals. Nearly 1 billion New Israeli Shekels (260 million US$) were invested in that program which had only limited success. As a new physician association's collective agreement is impending, we aimed to measure the effectiveness of selected incentives in attracting medical school graduates to residencies in remotely located hospitals. METHODS: This study included Israeli medical students in their final year of medical school. We used an online questionnaire with multiple-choice demographic questions and a 5-point Likert scale to gauge the effect of various incentives on their preference for residency location. RESULTS: Between July and November 2022, 522 students responded (405 studied in Israeli medical schools [out of 705 students] and 117 in foreign medical schools [out of 1936 students]). Forty-two percent had at least one clerkship in a remotely located hospital, and 24% had included at least one remotely located hospital among their top five choices for internship. Only 13% reported that they prefer a residency program in those institutions. The incentive selected by students as most persuasive was government assistance in acceptance to and financial support for a fellowship abroad, followed by a financial grant and fewer on-call hours. Only 7% of the students indicated that no incentive would influence them to choose a remotely located hospital for their residency training. Medical education in a remotely located university and the choice of at least one remotely located hospital among the top five choices for internship were significantly associated with positive incentive receptivity, whereas male sex and older age were associated with negative receptivity. CONCLUSION: This study on the attitudes of Israeli medical school graduates toward incentives aimed at attracting them to residencies in remotely located institutions revealed that career development opportunities and assistance in obtaining fellowships might influence their choice.

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A successful clinical trial requires participants, but many factors can impede effective study recruitment. To better recruit for quality veterinary clinical trials in client-owned animals that lead to improved evidence-based patient care and outcomes, there is a collective need to share and implement current best practices for recruitment strategies. These strategies should utilize a holistic view of recruitment, encompassing study design and logistics, representative participation, incentives, personnel resources, advertising, and participant retention. Although human clinical trial data and resources can provide guidance, effort also needs to be put into evaluating current practices and opportunities for process improvement that are specific to the conduct of veterinary clinical trials. Considering the power of pets as naturally occurring models of disease and as sentinels, improved conduct of veterinary clinical research has the potential to inform human health outcomes. Continued development of collaborations surrounding best practices and training opportunities in veterinary clinical research will improve the impact of veterinary clinical trials teams, while also promoting workforce development and alternate career paths for veterinary professionals.

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Nursing homes (NH) although conceptually they should look as much like a home as possible, NH have unquestionable similarities with a nosocomium as they are places where many patients with underlying diseases and comorbidities accumulate and where the transmission of microorganisms between residents and between residents and caregivers is frequent.We have not found any recommendations specifically aimed at the prevention of nosocomial infections in MRI by the major Public Health Agencies and, therefore, the Health Sciences Foundation (Fundación de Ciencias de la Salud) has convened a series of experts and 14 Spanish scientific societies to discuss recommendations that could guide NH personnel in establishing written programs for the control and reduction of these infections. The present document is the result of these deliberations and contains suggestions for establishing such control programs on a voluntary and flexible basis in NH. We also hope that the document can help the health authorities to encourage this control activity in the different territorial areas of Spain. In our opinion, it is necessary to draw up a written plan and establish the figure of a coordinator or person responsible for implementing these projects. The document includes measures to be implemented and ways of quantifying the reality of different problems and of monitoring the impact of the measures established.

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Blood donation, a fundamental act of altruism, has undergone significant evolution over the centuries. Despite medical progress, the persistent challenge lies in securing an adequate supply of blood and its derivatives. This article critically examines the proposal to introduce monetary incentives for blood donation, delving into ethical, legal, and pragmatic dimensions. India's current framework staunchly upholds voluntary, unpaid donations. However, global practices diverge significantly. Notably, India previously permitted monetary compensation for blood donation but later prohibited it due to concerns about infection transmission. Monetary incentives offer a potential solution to address key deterrents faced by potential donors. Health anxieties, time constraints, and fear of infection often discourage voluntary donations. By providing financial motivation, we may enhance donor participation and bolster the reliability of the blood supply. While the benefits are evident, caution is essential. Implementing monetary incentives necessitates robust safeguards. Preventing the exploitation of vulnerable populations and ensuring the safety of blood products remain paramount. Striking this delicate balance requires careful consideration. By analyzing ethical, legal, and practical facets, we navigate the intricate landscape of blood supply management.

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Introduction: Construction worker safety remains a major concern even as task automation increases. Although safety incentives have been introduced to encourage safety compliance, it is still difficult to accurately measure the effectiveness of these measures. A simple count of accident rates and lower numbers do not necessarily mean that workers are properly complying with safety regulations. To address this problem, this study proposes an image-based approach to monitor moment-by-moment worker safety behavior and evaluate the effects of different safety incentive scenarios. Methods: By capturing workers' safety behaviors using a model integrated with OpenPose and spatiotemporal graph convolutional network, this study evaluated the effects of safety-incentive scenarios on workers' compliance with rules while on the job. The safety incentive scenarios in this study were designed as 1) varying the type (i.e., providing rewards and penalties) of incentives and 2) varying the frequency of feedback about ones' own compliance status during tasks. The effects of the scenarios were compared to the average compliance rates of three safety regulations (i.e., personal protective equipment self-monitoring hazard avoidance, and arranging the safety hook) for each scenario. Results: The results show that 1) rewarding a good-compliance is more effective when there is no feedback on compliance status, and 2) penalizing non-compliance is more effective when there are three feedbacks during the tasks. Discussion: This study provides a more accurate assessment of safety incentives and their effectiveness by focusing on safe behaviors to promote safety compliance among construction workers.

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In recent years, enterprises have increasingly recognized the pivotal role of external users in driving product innovation. Open innovation platforms (OIPs), which facilitate interactions between companies and external innovators, have emerged as critical conduits in this regard. However, OIP managers face the challenge of motivating innovators to sustain their contributions. While some OIPs have implemented material incentives, the impact of such rewards on users' ongoing innovation efforts remains uncertain. This study utilized a large-scale dataset from an OIP to examine how performance-contingent material rewards influence the subsequent behaviors of online innovators. Employing a quasi-experimental design involving propensity score matching (PSM) and difference-in-differences (DID) analysis, we found that receiving performance-contingent material rewards led to a decrease in the quantity of subsequent ideas generated by innovators. However, these rewarded innovators produced ideas of higher quality. Interestingly, the novelty of ideas submitted by innovators declined following their receiving of rewards. Moreover, newly enlisted innovators exhibited a more positive response to these incentives. Our findings provide valuable insights for platform managers seeking to optimize incentive mechanisms. We suggest adopting diversified incentive approaches and refining incentive strategies to effectively motivate continuous innovation among users on OIPs.

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Background: Substance use disorders (SUDs) are heterogeneous across multiple functional domains. Various frameworks posit that domains (e.g., executive function) contribute to the persistence of SUDs; however, the domains identified in different studies vary.Objectives: We used factor analysis to identify the underlying latent domains present in a large sample (N = 5,244, 55.8% male) with a variety of SUDs to yield findings more generalizable than studies with a narrower focus.Method: Participants (1,384 controls and 3,860 participants with one or more SUDs including alcohol, cocaine, cannabis, and/or opioid use disorders) completed the Semi-Structured Assessment for Drug Dependence and Alcoholism, the NEO Personality Inventory, and the Wisconsin Card Sorting Test. Exploratory factor analysis (EFA) and fit indices (root mean-squared error of approximation (RMSEA), Comparative Fit Index (CFI), and Tucker-Lewis Index (TLI)) were used to examine different latent variable models. A multiple indicators, multiple causes (MIMIC) approach-tested associations of the latent variables with sociodemographics, substance use, and a history of abuse/neglect.Results: A six-factor model (predominant alcohol, predominant cocaine, predominant opioid, externalizing, personality, and executive function) provided the best fit [RMSEA = 0.063 (90% CI 0.060, 0.066), CFI = 0.98, TLI = 0.96]. All factors were moderately correlated (coefficient = 0.25-0.55, p < .05) with the exception of executive function. MIMIC analysis revealed different patterns of associations (all p < .0001) with sociodemographics, substance use, and a history of abuse/neglect among the factors.Conclusions: The domains identified, particularly executive function, were parallel to those observed previously. These factors underscore the heterogeneous nature of SUDs and may be useful in developing more targeted clinical interventions.

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Cooperation is essential for the survival of human society. Understanding the nature of cooperation and its underlying mechanisms is crucial for studying human behavior. This paper investigates the impact of leadership on public cooperation by employing repeated sequential public goods games, as well as by examining whether leading by example (through rewards and punishments) can promote cooperation and organizational success. The leaders were assigned randomly and were given the authority to reward or punish. As a result, (1) the leaders showed a strong tendency toward reciprocity by punishing free riders and rewarding cooperators at their own expense, which enhanced the intrinsic motivation for others to follow their example; and (2) both rewards and punishments were effective in promoting cooperation, but punishment was more effective in sustaining a high level of collaboration. Additionally, leaders preferred using rewards and were more reluctant to use punishments. These findings are crucial for creating organizational structures that foster cooperation.

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Among individuals living with psychotic disorders, social impairment is common, debilitating, and challenging to treat. While the roots of this impairment are undoubtedly complex, converging lines of evidence suggest that social motivation and pleasure (MAP) deficits play a key role. Yet most neuroimaging studies have focused on monetary rewards, precluding decisive inferences. Here we leveraged parallel social and monetary incentive delay fMRI paradigms to test whether blunted reactivity to social incentives in the ventral striatum-a key component of the distributed neural circuit mediating appetitive motivation and hedonic pleasure-is associated with more severe MAP symptoms in a transdiagnostic sample enriched for psychosis. To maximize ecological validity and translational relevance, we capitalized on naturalistic audiovisual clips of an established social partner expressing positive feedback. Although both paradigms robustly engaged the ventral striatum, only reactivity to social incentives was associated with clinician-rated MAP deficits. This association remained significant when controlling for other symptoms, binary diagnostic status, or ventral striatum reactivity to monetary incentives. Follow-up analyses suggested that this association predominantly reflects diminished striatal activation during the receipt of social reward. These observations provide a neurobiologically grounded framework for conceptualizing the social-anhedonia symptoms and social impairments that characterize many individuals living with psychotic disorders and underscore the need to establish targeted intervention strategies.

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The introduction of the Quality Payment Program (QPP) by the Centers for Medicare & Medicaid Services (CMS) played a critical role in the process of transitioning U.S. healthcare from a pay-for-service to a pay-for-performance system. Physicians can participate in the QPP through one of three reporting methods: the traditional merit-based incentive payment system (MIPS), MIPS Value Pathways (MVPs), or Advanced Alternative Payment Models (APMs). These reporting methods require physicians to submit data on quality measures, which are averaged to determine a total quality performance score, which is weighted along with other QPP measures related to self-performance to provide an aggregate final performance score. This final score is used to determine either a negative, neutral, or positive percentage modifier for the physician's Medicare reimbursement payments, which applies to the fiscal year two years following the year of reporting. Quality measures are either specialty-specific or cross-specialty, meaning that they are reportable by any physician specialty. No studies have compared performance across physician specialty categories on these measures. Critics argue that CMS has not ensured equitable reporting of cross-specialty quality measures due to the difference in emphasis on aspects of care of different physician specialties, potentially advantaging some. For example, family medicine physicians may score higher on the blood pressure control quality measure due to its relevance in their practice. Significant performance differences could highlight areas of improvement for certain physicians in certain specialties and guide balanced measure development. The QPP currently uses non-specialty-specific historical quality performance scores as benchmarks to determine current-year quality measure scores, likely leading to unfair comparisons. Establishing specialty-specific benchmarks for cross-specialty measures would promote equitable evaluation and fair competition among all participating physicians.

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BACKGROUND: The use of targeted advertisements on social media platforms (eg, Facebook and Instagram) has become increasingly popular for recruiting participants for online survey research. Many of these surveys offer monetary incentives for survey completion in the form of gift cards; however, little is known about whether the incentive amount impacts the cost, speed, and quality of data collection. OBJECTIVE: This experiment addresses this gap in the literature by examining how different incentives in paid advertising campaigns on Instagram for completing a 10-minute online survey influence the response rate, recruitment advertising cost, data quality, and length of data collection. METHODS: This experiment tested three incentive conditions using three Instagram campaigns that were each allocated a US $1400 budget to spend over a maximum of 4 days; ads targeted users aged 15-24 years in three nonadjacent designated market areas of similar size to avoid overlapping audiences. Four ad creatives were designed for each campaign; all ads featured the same images and text, but the incentive amount varied: no incentive, US $5 gift card, and US $15 gift card. All ads had a clickable link that directed users to an eligibility screener and a 10-minute online survey, if eligible. Each campaign ran for either the full allotted time (4 days) or until there were 150 total survey completes, prior to data quality checks for fraud. RESULTS: The US $15 incentive condition resulted in the quickest and cheapest data collection, requiring 17 hours and ad spending of US $338.64 to achieve 142 survey completes. The US $5 condition took more than twice as long (39 hours) and cost US $864.33 in ad spending to achieve 148 survey completes. The no-incentive condition ran for 60 hours, spending nearly the full budget (US $1398.23), and achieved only 24 survey completes. The US $15 and US $5 incentive conditions had similar levels of fraudulent respondents, whereas the no-incentive condition had no fraudulent respondents. The completion rate for the US $15 and US $5 incentive conditions were 93.4% (155/166) and 89.8% (149/166), respectively, while the completion rate for the no-incentive condition was 43.6% (24/55). CONCLUSIONS: Overall, we found that a higher incentive resulted in quicker data collection, less money spent on ads, and higher response rates, despite some fraudulent cases that had to be dropped from the sample. However, when considering the total incentive amounts in addition to the ad spending, a US $5 incentive appeared to be the most cost-effective data collection option. Other costs associated with running a campaign for a longer period should also be considered. A longer experiment is warranted to determine whether fraud varies over time across conditions.

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Prosocial behaviour is a bedrock of humane societies. Although previous studies have shown that parental style is an important contributing factor for children's prosocial behaviour, the psychological mechanism underlying this association in specific cultural background remains unclear. Based on the ecological systems theory, this study sought to explore the influence of parental warmth on children's prosocial behaviour, and the mediating effect of self-efficacy, as well as the moderating role of teachers' incentive evaluation in the link between self-efficacy and children's prosocial behaviour. This cross-sectional, survey-based study collected data from parents and teachers of 414 Chinese preschoolers (5-6 years old). Parents of these children finished questionnaires on the Chinese version of the short-form Egna minnen av. Barndoms uppfostran (s-EMBU-C), Child Behaviour Scale (CBS), and the revised General Self-efficacy Scale (GSES), while Incentive evaluation questionnaire was finished by their teachers. Results indicated that children who experience high parental warmth were more likely to act prosocially (b = 0.61, p < 0.001) and the association between parental warmth and prosocial behaviour was partially mediated by self-efficacy (indirect effect = 0.25, 95 % CI = [0.19, 0.32]). Besides, teachers' incentive evaluation moderated the link between self-efficacy and children's prosocial behaviour (b = 0.24, p < 0.001). Specifically, the effect of self-efficacy on prosocial behaviour was stronger for high teachers' incentive evaluation children than those with low teachers' incentive evaluation. These findings extend the existing understanding of the mechanism concerning the influence of parental warmth on prosocial behaviour in Chinese settings. The results revealed that interventions that could improve children's self-efficacy would be effective in accelerating their prosocial behaviour and schools played a crucial role in working with families to increase their self-efficacy at a young age. It should be noted that this study focused only on Chinese children of 5-6 years old, and the cross-sectional design means that the possibility of bidirectional effects could not be ruled out.

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BACKGROUND: South Africa has the highest rate of fetal alcohol spectrum disorders (FASD) globally. As with alcohol use during pregnancy, alcohol consumption while breastfeeding adversely impacts infant development. We pilot tested an incentive-based text-messaging intervention to reduce alcohol use during pregnancy and lactation in South Africa. METHODS: A single-arm pilot trial was conducted over 3 months in healthcare facilities in Cape Town, South Africa. Pregnant and breastfeeding participants tested positive for recent alcohol use by urinalysis. The three-month intervention had two components, contingency management of alcohol abstinence confirmed by urinalysis twice weekly and weekly health-related text messaging from an evidence-based brief intervention. We collected twice weekly urine samples for measurement of ethyl glucuronide (EtG), an alcohol biomarker, and measures of self-reported alcohol and drug use, violence exposure, and mental health at six weeks and three months post-enrollment. RESULTS: Sixty participants were enrolled, of whom 31 were pregnant and 29 lactating. The number of days with four or more drinks in the past month decreased from 9 days at baseline, on average, to 1-3 days (p-value range: 0.144-0.010) at follow-up timepoints. There were statistically significant increases in the proportions of participants with alcohol-negative urine tests (p < 0.001). The percentages of participants breastfeeding while using alcohol decreased from baseline to the end of 3 months in the overall sample and among those enrolled postpartum, though these were not significant (p-value range: 0.255-0.147). Maternal depression scores also decreased among participants enrolled postpartum (p = 0.054). Emotional abuse by the main partner, but neither physical nor sexual abuse, significantly decreased at both follow-ups in the overall sample (p = 0.032) and among participants enrolled while pregnant (p = 0.015). CONCLUSIONS: This study is among the first to pilot test an incentive-based text-messaging intervention for maternal alcohol use and other outcomes such as depression and violence exposure. Further testing is warranted in a well-powered, randomized controlled trial.