A Randomized Trial of Incentives for Smoking Treatment in Medicaid Members
A Randomized Trial of Incentives for Smoking Treatment in Medicaid Members
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DOI：
10.1016/j.amepre.2017.08.027
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发表时间：
2017-12-01
影响因子：
5.5
通讯作者：
Baker, Timothy B.
中科院分区：
文献类型：
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作者：
Fraser, David L.;Fiore, Michael C.;Baker, Timothy B.
导语：低收入人群吸烟的可能性特别大，戒烟困难。这项研究评估了一种旨在提高吸烟者对吸烟治疗的参与度和戒烟率的金钱激励。研究设计：吸烟激励(n=948)和对照干预(n=952)的两组随机临床试验。设置/参与者：从初级保健患者(n=920)招募的医疗补助接受者(n=920)和致电威斯康星州烟草戒烟热线(n=980)的人。干预：向参与者提供5个戒烟电话，并鼓励他们获得戒烟药物(由Medicaid覆盖)。所有参与者完成一次基线评估和一次为期6个月的吸烟测试后都会收到报酬。只有激励条件参与者在6个月的访问中接受咨询电话(每次30美元)和生化验证戒烟(40美元)的补偿。主要观察指标：研究开始后6个月的7天时点戒烟率和成本/戒烟比。结果：研究开始后6个月，激励条件参与者的生化决定的7天时点戒烟率显著高于对照组(分别为21.6%和13.8%，P<；0.0001)。激励的积极治疗效果在其他禁欲指数中都存在，但影响的大小和禁欲水平在不同指数之间差别很大。激励条件参与者也比非激励对照组参与者更有可能接受威斯康星州烟草戒烟热线治疗电话，他们对电话的接受促成了他们在6个月的随访中实现了更高的禁酒率。成本/戒烟/参与者平均为4,268.26美元，激励参与者为3,601.37美元。结论：本研究显示，相当适度的治疗参与和戒烟奖励支付水平(总共190美元)增加了极低收入吸烟者在戒烟治疗中的参与度和成功率。(C)《2017美国预防医学杂志》。由《美国预防医学杂志》出版
Introduction: Low-income populations are especially likely to smoke and have difficulty quitting. This study evaluated a monetary incentive intended to increase smoking treatment engagement and abstinence among Medicaid recipients who smoke.Study design: Two-group randomized clinical trial of Incentive (n=948) and Control interventions (n=952) for smoking.Setting/participants: Medicaid recipients recruited from primary care patients (n=920) and callers to the Wisconsin Tobacco Quit Line (n=980).Intervention: Participants were offered five quitline cessation calls and were encouraged to obtain cessation medication (covered by Medicaid). All participants received payment for completing a baseline assessment and a 6-month smoking test. Only Incentive condition participants received compensation for taking counseling calls ($30 per call) and for biochemically verified abstinence at the 6-month visit ($40).Main outcome measures: Seven-day point-prevalence smoking abstinence 6-months post study entry and cost/quit.Results: Incentive condition participants had significantly higher biochemically determined 7-day point-prevalence smoking abstinence rates 6 months after study induction than did Controls (21.6% vs 13.8%, respectively, p < 0.0001). A positive treatment effect of incentives was present across other abstinence indices, but the size of effects and levels of abstinence varied considerably across indices. Incentive condition participants were also significantly more likely than non-incentivized Control participants to accept Wisconsin Tobacco Quit Line treatment calls and their acceptance of calls mediated their attainment of higher abstinence rates at 6-month follow-up. The cost/quit/participant averaged $4,268.26 for the Control participants and $3,601.37 for the Incentive participants.Conclusions: This study shows that fairly moderate levels of incentive payments for treatment engagement and abstinence (a total possible payment of $190) increased very low-income smokers' engagement and success in smoking cessation treatment. (C) 2017 American Journal of Preventive Medicine. Published by American Journal of Preventive Medicine