Safer Food Allergy Management For Adolescents

Among the 15 million people with food allergies in the United States, adolescents experience the highest risk ofadverse events, including death from anaphylaxis. Visits to one pediatric emergency department foranaphylaxis doubled between 2001 and 2006, suggesting a rapidly escalating public health burden. Despitethis critical concern, there are few evidence-based strategies to improve food allergy management inadolescents, who must sustain three core prevention strategies: diligent avoidance of allergenic foods,consistent carrying of potentially life-saving epinephrine auto-injectors, and prompt administration ofepinephrine in the event of anaphylaxis.The objective of this proposal is to develop and test interventions to encourage safer food allergy managementamong adolescents. The primary outcome is consistency of epinephrine-carrying, measured using cell phonephotographs at randomly-timed check-ins. This study will be among the first to longitudinally track normativefood allergy management practices and one of the first to test behavior change strategies. This study is thenecessary next step toward a definitive nationwide longitudinal study of food allergy management inadolescents.In a cohort multiple randomized controlled trial (n=130), the study will include two experiments to test theeffectiveness of text message reminders and financial incentives, using various incentive designs that haveproven effective in prior behavioral economics interventions to encourage weight loss and smoking cessation.Aim 1. Test the impact of a text-message reminder system on consistency of epinephrine carrying. Aim 2. Testthe impact of modest financial incentives on consistency of epinephrine carrying. Based on promisingpreliminary data, the central hypothesis is that, compared to controls, adolescents who receive text messagereminders plus modest financial incentives will more consistently carry their epinephrine.The proposed work is aligned with NICHD's mission to ensure ?that all children have the chance to achievetheir full potential for healthy and productive lives.?