Pilot Guaranteed Income Study, Philadelphia, April 2023 (PGI)

Philly Family Trust Study: A Pilot Randomized Controlled Trial of an Unconditional Cash Transfer to Improve Health Behaviors Among Adults With Chronic Diseases

The goal of this pilot clinical trial is to learn about the effects of a short-term unconditional cash transfer (UCT) in people living with poverty and chronic disease (either prediabetes/diabetes or hypertension). The main questions it aims to answer are:

• How feasible and acceptable is the intervention?
• How are key health behaviors and outcomes affected by the intervention?
• What are reasonable effect sizes to expect in a larger trial?

Participants will complete surveys and health measurements at two timepoints 3 months apart. Half of the participants will be randomly assigned to the treatment where they will receive a UCT of $1000 over 4 months. Researchers will compare the treatment group to the control group to see if there are improvements in health risk factors directly related to insufficient resources (food and utility security, stress-levels, mental bandwidth), financial outcomes, and health behaviors.

Study Overview

• Status: Completed
• Conditions: Cardiovascular Diseases
• Intervention / Treatment: Behavioral: Cash Transfer

Detailed Description

Health behaviors are major, modifiable risk factors for the development and progression of chronic diseases, which account for a large proportion of all deaths in the US and contribute to disparities in premature mortality based on both income and race. There is substantial evidence, for example, that behaviors like smoking, physical inactivity, and unhealthy diet are associated with an increased risk of cardiovascular disease (CVD), as are modifiable factors such as blood pressure, cholesterol, body mass index, and fasting glucose. A growing body of research suggests that poverty may affect health behaviors through financial and psychological pathways. However, few studies have rigorously examined the effects of poverty alleviation interventions on health behaviors, particularly among individuals at high risk for CVD. Even fewer studies have examined potential psychological mechanisms by which anti-poverty interventions might influence health behavior. This pilot project will examine the effect of unconditional cash transfers, an economic intervention that is gaining traction among policymakers, on risk factors for CVD and other chronic diseases. The project will focus on low-income adults in Philadelphia who have at least one health risk factor for CVD (diabetes/pre-diabetes and/or hypertension) and examines whether short-term, unconditional cash transfer payments result in changes in objective and self-reported health outcomes. The second aim examines potential psychological mechanisms through which the cash transfer intervention may affect study participants' behavior, including mental health, psychosocial stress, bandwidth, and future orientation. The third aim uses qualitative methods to understand participants' experiences with this study. The project activities will include developing and testing the cash transfer intervention (Stage 1) as well as basic science analysis of mechanisms of change (Stage 0).

Survey and measurement data will be collected from 100 participants at baseline and 3 month follow-up in a two-arm randomized controlled trial (50 in control, 50 in intervention). 16 participants will receive a blood pressure cuff to take home and send measurements weekly to assess the feasibility of at-home measurement (8 control, 8 intervention; half of each group will transmit wirelessly, the other half will not). 30 participants from the 3-month follow-up who are interested in doing an interview will provide additional qualitative data on their experience.

• Study Type: Interventional
• Enrollment (Actual): 100
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19104
      • University of Pennsylvania

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age 18 years or greater
• Pennsylvania Medicaid enrollee
• At least one recent clinic visit at Penn Family Care (earliest six months before start of recruitment)
• Diagnosis of pre-diabetes/diabetes and/or hypertension
• Actively prescribed a medication for diabetes or hypertension
• Regular resident of the Philadelphia metro area without plans to leave in the next 6 months

Exclusion Criteria:

• Does not meet all of the inclusion criteria
• Unable to provide consent
• Non-English speaker
• Cognitive impairment, per principal investigators' discretion

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control; No intervention
Experimental: Cash Transfer; Participants will receive $125 every 2 weeks for 8 payments via ClinCard, for a total of $1000.	Behavioral: Cash Transfer; Participants will receive $125 every 2 weeks for 8 payments via ClinCard, for a total of $1000.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Food Security Category	Change from baseline in food security in the last 30 days as measured by the US Department of Agriculture food security scale. Outcome is 3 ordered categories: high or marginal food security, low food security, very low food security.	Assessed at 1-hour appointment at baseline and 3 months
Change in Utility Security Category	Change from baseline in utility security in the last 3 months as measured by the Home Energy Insecurity scale. Outcome is 5 ordered categories: thriving, capable, stable, vulnerable, in-crisis.	Assessed at 1-hour appointment at baseline and 3 months
Change in Financial Well-being Scale	Change from baseline in current financial well-being as measured by the Consumer Financial Protection Bureau Financial Well-Being 0-100 scale (higher scores are correlated to more well-being).	Assessed at 1-hour appointment at baseline and 3 months
Change in Perceived Stress Scale	Change from baseline in perceived stress in the last 30 days as measured by the Perceived Stress Scale (short form; 0-16, higher scores are correlated to more stress).	Assessed at 1-hour appointment at baseline and 3 months
Change in State Anxiety Scale	Change from baseline in current anxiety as measured by the State Trait Anxiety Inventory subscale. The range is from 20-80 with lower scores meaning less anxiety.	Assessed at 1-hour appointment at baseline and 3 months
Change in Mental Bandwidth	Change from baseline in number of lapses in the Psychomotor Vigilance Task (more lapses indicate less mental bandwidth).	Assessed at 1-hour appointment at baseline and 3 months
Change in Health Care Expenditures on Medications	Change from baseline in number of dollars spent out-of-pocket on medications in the past 30 days.	Assessed at 1-hour appointment at baseline and 3 months
Change in Adherence to Medication Refills Scale	Change from baseline in current adherence to refilling medications as measured by that subscale of the Adherence to Refills and Medications Scale (ARMS; 4-16, higher scores indicate lower adherence).	Assessed at 1-hour appointment at baseline and 3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Number of Emergency Department Visits	We had initially hoped to descriptively summarize these outcomes as part of this pilot study, but the staff member leading our analyses departed during the course of this study and we no longer had someone with the skills and bandwidth to pull, merge, and analyze these data from the electronic health record. For that reason, the data were never collected in this sample and so we have not reported these outcomes	Once all study appointments are completed, ED visit data will be collected through the Data Analytics Center for the 3-month period before baseline, and the 3-month period after baseline.
Change in Number of Health Care Visits (Non-emergency Department)	We had initially hoped to descriptively summarize these outcomes as part of this pilot study, but the staff member leading our analyses departed during the course of this study and we no longer had someone with the skills and bandwidth to pull, merge, and analyze these data from the electronic health record. For that reason, the data were never collected in this sample and so we have not reported these outcomes	Once all study appointments are completed, number of health care visits(non-ED) data will be collected through the Data Analytics Center for the 3-month period before baseline, and the 3-month period after baseline.
Change in Cigarette Dependence Scale	Change from baseline in current cigarette dependence as measured by the Cigarette Dependence Scale (short version; 5-25, higher scores indicate more dependence).	Assessed at 1-hour appointment at baseline and 3 months
Change in Alcohol Use Scale	Change from baseline in current alcohol use as measured by the Alcohol Use Disorders Identification Test (0-12, higher scores indicate more use).	Assessed at 1-hour appointment at baseline and 3 months
Change in All Health Care Expenditures	Change from baseline in sum of dollars spent out-of-pocket on medications, office visits, and emergency room visits in the past 30 days.	Assessed at 1-hour appointment at baseline and 3 months
Change in Time Preference (Patience)	Change from baseline on current patience which is a single item in the Preference Survey Module (0 "completely unwilling" to 10 "completely willing" to give up present benefits for future benefits, higher scores indicate future preference).	Assessed at 1-hour appointment at baseline and 3 months
Change in Time Preference (Behavioral Task)	Change from baseline on current snack choice (binary: chose a more or a less healthy snack, choosing a healthy snack indicates future preference).	Assessed at 1-hour appointment at baseline and 3 months
Change in Psychological Distress Scale	Change from baseline in psychological distress in the past 30 days as measured by the Kessler Psychological Distress Scale (K6+, 6-30, higher scores indicate more distress).	Assessed at 1-hour appointment at baseline and 3 months
Change in Number of Healthy Days	Change from baseline in self-reported number of healthy days in the past 30 as measured by the CDC Health-Related Quality of Life Scale (0-30 days).	Assessed at 1-hour appointment at baseline and 3 months
Change in Adherence to Taking Medications Scale	Change from baseline in current adherence to taking medications as measured by that subscale of the Adherence to Refills and Medications Scale (ARMS; 8-32, higher scores indicate lower adherence).	Assessed at 1-hour appointment at baseline and 3 months

Collaborators and Investigators

• Sponsor: University of Pennsylvania
• Collaborators: National Institute on Aging (NIA)
• Investigators: Principal Investigator: Aaron Richterman, MD, MPH, University of Pennsylvania; Principal Investigator: Christina A Roberto, PhD, University of Pennsylvania; Principal Investigator: Harsha Thirumurthy, PhD, University of Pennsylvania

Study record dates

Study Major Dates

• Study Start (Actual): April 4, 2023
• Primary Completion (Actual): October 20, 2023
• Study Completion (Actual): October 20, 2023

Study Registration Dates

• First Submitted: April 3, 2023
• First Submitted That Met QC Criteria: April 18, 2023
• First Posted (Actual): May 1, 2023

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: February 27, 2025
• Last Verified: February 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Cardiovascular Diseases
• Other Study ID Numbers: 852028; 5P30AG034546-14 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No