Page 17 - Delaware Medical Journal - February 2017
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patient. The collected data (blood alcohol concentration [BAC] in breath samples) is then, transmitted over the cellular network along with the photo.
The cell phones and their CWCSS
social workers, friends, or families were registered on the monitoring website for sending alerts to request breath samples and share monitoring results. Participants were required to send two to three breath samples a day, at least one in the morning and one in the evening.
Incentive Implementation
Financial incentives were provided for alcohol-negative breath samples on a weekly basis. The amount participants received in Week 1 if all submitted breath samples were alcohol-negative was $10, escalating by $5 for every two to four weeks, until the amount reached $50. (See Table 1) Financial incentives in form
of community gift cards were delivered monthly by HBC staff in person along
with feedback of how well participants
are doing. Upon missed sampling, HBC staff contacted a participant to examine what contributed to missing the scheduled sampling, and the incentive schedule was reset after the second missed sample. Additionally, CWCSS social workers provided placement in residential treatment upon alcohol-positive breath samples.
Four participants were referred to CWCSS.
(Table 2) was approved by the university IRB of the last author. Participants 1 and 3 completed the program throughout their pregnancy. Participant 1 was a minor under the age of 18 and had a history of alcohol abuse. She sent breath samples for 96 percent of the
scheduled opportunities, and all submitted samples showed alcohol-negative.  opportunities consecutively, but responded to the call by HBC staff explaining that she was visiting her sister in another town and did not bring the breathalyzer with her. She missed seven scheduled sampling opportunities sporadically, because she often slept late and missed morning sampling alerts.
The legal consequences of providing alcohol-positive samples are severe, which creates a concern for the participant purposely choosing not to submit breath samples at the expense of the incentive amount reset when she engaged in drinking. Unless biochemical alcohol use 
on missed samples might be too costly

process, especially when participants
have a legitimate reason of missing  hospitalization). Incentives contingent on weekly performance are not sensitive to each sampling opportunity, and providing incentives on a monthly basis may be too delayed to maintain motivation to comply. HBC staff considered using a reloadable debit card that allows them to provide  short interval. If HBC staff still observe frequent missed samples, they will increase the number of requests for sampling a day or switch to completely random monitoring to address this concern.
Participant 3 had used alcohol during two prior pregnancies and was arrested for driving while intoxicated. Because of her history of chronic prenatal drinking, she was required to provide three samples a day. Participant 3 sent breath samples for 99 percent of the scheduled opportunities
and all submitted samples showed alcohol- negative. She missed two scheduled sampling opportunities, but showed alcohol abstinence when a CWCSS case manager visited her at home. The second missed sampling was due to her labor.
At the end of the program, Participants 1 and 3 mentioned that they found the program to be very helpful and would have recommended the program to other pregnant mothers at risk for drinking.
Participants 2 and 4 moved to a different county during their pregnancy and were lost to follow up after their move. HBC staff were not able to collect survey results before Participants 2 and 4 moved. Participant 2 was referred by an obstetric doctor for reporting drinking during pregnancy. During program participation, Participant 2 sent breath samples for 86 percent of the scheduled opportunities. She missed nine scheduled sampling opportunities sporadically, because of cell phone coverage issues by going to another county to visit relatives.
Participant 4 was screened positive for alcohol dependence at the substance abuse treatment program. Participant
4 sent breath samples for 94 percent of the scheduled sampling opportunities. She missed seven scheduled sampling opportunities consecutively, because she was admitted to a hospital for sickness  moved out of her mother’s house, and lost her cell phone service for a while.
The program services discontinued
when the participants moved out of the Crow Wing County, because the CWCSS case manager could not provide case management in other counties, and the cellular service was poor, causing a loss of contact with the participants. HBC staff
Del Med J | February 2017 | Vol. 89 | No. 2

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