Nationwide access to an internet-based contingency management intervention to promote smoking cessation: a randomized controlled trial.
Nationwide access to an internet-based contingency management intervention to promote smoking cessation: a randomized controlled trial.
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DOI：
10.1111/add.13715
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发表时间：
2017-05
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影响因子：
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通讯作者：
Grabinski MJ
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文献类型：
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作者：
Dallery J;Raiff BR;Kim SJ;Marsch LA;Stitzer M;Grabinski MJ
应急管理（CM）是促进戒毒最有效的行为干预措施之一，但这种治疗的可用性有限。我们在全国范围内的吸烟者样本中评估了基于互联网的 CM 相对于基于互联网的监测和目标设定对照组的有效性和可接受性。随机对照试验，随访 3 个月和 6 个月。美国。来自 26 个州的吸烟者 (n=94) 被纳入研究（平均年龄 36 岁，56% 为女性）。参与者被随机分配，根据使用呼吸一氧化碳 (CO) 输出进行视频验证的禁欲（n=48；禁欲小组，AC）或根据提交 CO 样本（n=46，提交小组，SC）获得经济奖励（7 周内最高 480 美元）。两个小组也都获得了相同的基于二氧化碳的目标。两组都需要缴纳 50 美元的押金，押金可以从最初的收入中收回。主要结局是第 4 周的点患病率。次要结局是 3 个月和 6 个月随访时的点患病率、阴性 CO 样本的百分比、对 CO 采样方案的遵守情况以及 0-100mm 视觉模拟量表的治疗可接受性评级。 AC (39.6%) 和 SC (13.0%) 组之间的戒断率在 4 周时存在差异（比值比=4.4，95% CI=1.6–12.3），但在 3-（29.2% AC 和 19.6% SC，比值比=1.7，95% CI=.6–4.4）或 6-（22.9% AC 和13.0% SC，优势比=2.0，95% CI=.7–5.9）月随访。在两个主要治疗阶段，阴性 CO 存在显着差异（53.9% AC 和 24.8% SC，比值比 = 3.5，95% CI=3.1–4.0；43.4% AC 和 24.6% SC，比值比 = 2.3，95% CI=1.6–3.4）。遵守 CO 提交协议是等效的（78% AC 和 85% SC，差异 = 7.0%，95% CI = -10.3%–23.8%，x2=.75，p = .39）。最低的可接受性评级是针对评估存款的项目，而最高的评级则涉及干预的难易程度、CO 结果图表和赚钱。与没有激励措施的互联网计划相比，通过互联网提供的应急管理/财务激励计划提高了短期戒断率。
Contingency management (CM) is one of the most effective behavioral interventions to promote drug abstinence, but availability of this treatment is limited. We evaluated the efficacy and acceptability of Internet-based CM relative to an Internet-based monitoring and goal setting control group in a nationwide sample of cigarette smokers. Randomized controlled trial with 3- and 6-month follow ups. USA. Smokers (n=94) from 26 states were enrolled (mean age 36, 56% female). Participants were randomized to earn financial incentives (up to $480 over 7 weeks) based on video-verified abstinence using breath carbon monoxide (CO) output (n=48; Abstinent Contingent Group, AC), or based on submitting CO samples (n=46, Submission Contingent, SC). Both groups also received the same CO-based goals. A $50 deposit was required in both groups that could be recouped from initial earnings. The primary outcome was point prevalence at week 4. Secondary outcomes were point prevalence at the 3- and 6-month follow-ups, percentages of negative CO samples, adherence to the CO sampling protocol, and treatment acceptability ratings on a 0–100mm visual analog scale. Abstinence rates differed at 4 weeks between the AC (39.6%) and SC (13.0%) groups (odds ratio=4.4, 95% CI=1.6–12.3), but not at the 3- (29.2% AC and 19.6% SC, odds ratio=1.7, 95% CI=.6–4.4), or 6- (22.9% AC and 13.0% SC, odds ratio=2.0, 95% CI=.7–5.9) month follow-ups. During the two main treatment phases, there were significant differences in negative COs (53.9% AC and 24.8% SC, odds ratio = 3.5, 95% CI=3.1–4.0; 43.4% AC and 24.6% SC, odds ratio = 2.3, 95% CI=1.6–3.4). Adherence to the CO submission protocol was equivalent (78% AC and 85% SC, difference = 7.0%, 95% CI = −10.3%–23.8%, x2=.75, p = .39). The lowest acceptability ratings were for the items assessing the deposit, whereas the highest ratings concerned the ease of the intervention, the graph of CO results, and earning money. A contingency management/financial incentive program delivered via the Internet improved short-term abstinence rates compared with an internet program without the incentives.