# The Use of Mobile Health Technology and Behavioral Economics to Encourage Adherence to Statins in Adolescents with Familial Hypercholesterolemia

> **NIH NIH K23** · BOSTON CHILDREN'S HOSPITAL · 2021 · $169,880

## Abstract

PROJECT SUMMARY
Familial hypercholesterolemia (FH) affects over one million Americans and increases the risk of cardiovascular
disease (CVD) by as much as 20-fold. Although the use of statins can substantially reduce this risk, adherence
to statins in adults and adolescence is poor. In adults, lower rates of adherence are associated with an
increased rate of CVD events and all-cause mortality, as well as an additional $44 billion annually in health
care costs. Novel interventions are needed to improve medication adherence in patients with FH, starting in
adolescents.
 An underused strategy to improve medication adherence incorporates the principles of behavioral
economics. Traditional economic theory suggests that providing an incentive to perform a behavior will
increase the frequency of that behavior. [However, two prominent theories in behavioral economics, Present
Bias and Loss Aversion, suggest that not all types of incentives are effective and that poorly structured
incentives can actually be negative enforcers. With novel mobile health technologies (mHealth), interventions
based on behavioral economics can now be studied on a larger scale. In this proposal, the candidate 1) will
test the efficacy of an mHealth intervention based on Present Bias and Loss Aversion to improve statin
adherence in adolescents with FH in a randomized crossover trial; 2) gain a better understanding of the
barriers to adherence in adolescents with risk factors for CVD using focus groups; and 3) perform a cost-
effectiveness analysis with two-way sensitivity analysis of the interventions in Aim 1.] To achieve these goals
and prepare for independence, a comprehensive career development program has been developed to gain
additional training in: 1) clinical trials, 2) mHealth, 3) qualitative methods, 4) behavioral economics, and 5) cost-
effectiveness analysis. Along with formal coursework, the candidate’s mentoring and advisory committee
includes experts in FH and lifestyle interventions (Sarah de Ferranti), mHealth in CVD (Tiffany Powell-Wiley),
cost-effectiveness analysis (Mihail Samnaliev), biostatistics and clinical trials (Kimberlee Gauvreau),
internationally-known leaders in pediatric cardiology and clinical trials (Jane Newburger), and behavioral
economics (Jason Doctor). Boston Children’s Hospital, Harvard School of Public Health, and the National
Heart, Lung, and Blood Institute provide unparalleled environments to prepare a candidate for independence.
Ultimately, the candidate’s long-term goals are to strengthen the understanding of factors that influence health
behaviors in adolescence and to design cost-effective, personalized interventions to help reduce their risk for
CVD. [The additional training and findings from this trial will be the basis for future R01 proposals that will
expand this proposal to include multiple clinical sites with more diverse cohorts and to adolescents with other
risk factors for CVD.]

## Key facts

- **NIH application ID:** 10247619
- **Project number:** 5K23HL145109-03
- **Recipient organization:** BOSTON CHILDREN'S HOSPITAL
- **Principal Investigator:** Jacob Hartz
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $169,880
- **Award type:** 5
- **Project period:** 2019-08-01 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10247619

## Citation

> US National Institutes of Health, RePORTER application 10247619, The Use of Mobile Health Technology and Behavioral Economics to Encourage Adherence to Statins in Adolescents with Familial Hypercholesterolemia (5K23HL145109-03). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10247619. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*