Mobile Contingency Management for Smoking Cessation among Socioeconomically Disadvantaged Adults

项目摘要 尽管美国成年人的吸烟率已降至13.7%，但吸烟率要高得多 在社会经济上处于不利地位的成年人中。肺癌，主要由吸烟引起， 是美国癌症死亡的主要原因。肺癌死亡率在低收入人群中要高得多 社会经济地位(SES)高于其更高的社会经济地位。应急管理(CM)，有形的 加强戒烟和其他预期效果，是促进吸烟的有效途径 在不同的人群中停止。调查人员的初步工作表明，提供少量的 不断升级的戒烟经济激励措施显著提高了 将激励措施作为以临床为基础的治疗的辅助手段纳入社会经济上处于不利地位的成年人。 然而，对于那些不能或不愿意参加办公室访问的人来说，需要采取创新的方法。 智能手机的拥有量正在迅速增长，甚至在低收入成年人中也是如此，这可能提供了一种接触到 以及增加社会经济上处于不利地位的成年人的治疗机会。该计划的目的是 提议的项目是评估基于移动电话的自动化CM方法，该方法将允许 社会经济上处于不利地位的个人从吸烟的经济激励中远程受益 停止。调查人员此前结合了包括1)便携式一氧化碳在内的技术 与手机连接以远程验证戒烟情况的监视器，2)面部识别软件 在提交呼气样本期间确认参与者身份，以及3)远程提供奖励 由自我报告的禁欲的生化确认自动触发。这种自动化的CM方法 将在一项随机对照试验中进行评估，该试验包括532名处于社会经济不利地位的男性 以及寻求戒烟治疗的女性。参与者将被随机分配到其中一部电话 咨询和尼古丁替代疗法(标准护理[SC])或SC加流动经济奖励 对生化证实的戒酒进行干预(CM)。参与者将被跟踪26周，在 计划的退出尝试。经过生化验证的戒烟后26周的7天点戒断流行率将是 主要结果变量。将对成本效益进行评估，以便为与政策有关的决策提供信息。潜力 流动的中医治疗机制，包括自我效能、动机和治疗参与度，将是 探索优化未来版本的干预措施。自动化移动CM提供了一种低成本的方法 戒烟可与现有的电话咨询和药物治疗结合使用 干预措施。如果有效，这种方法代表着朝着广泛传播CM迈出的关键一步 将吸烟治疗纳入实际环境(例如，州戒烟专线、医疗保健系统)，目标是减少 与烟草有关的疾病和差距。

Project Summary Although smoking prevalence has declined to 13.7% among U.S. adults, smoking rates are much higher among socioeconomically disadvantaged adults. Lung cancer, which is primarily caused by cigarette smoking, is the leading cause of cancer death in the U.S. Lung cancer mortality is far greater among those of lower socioeconomic status (SES) than their higher SES counterparts. Contingency management (CM), the tangible reinforcement of abstinence and other desired outcomes, is an effective approach to promoting smoking cessation in a variety of populations. The preliminary work of the investigators has indicated that offering small escalating financial incentives for smoking abstinence dramatically increases cessation rates among socioeconomically disadvantaged adults when incentives are included as an adjunct to clinic-based treatment. However, innovative approaches are needed for those who are unable or unwilling to attend office visits. Smartphone ownership is rapidly growing, even among low-income adults, and may offer a means of reaching and increasing treatment access among socioeconomically disadvantaged adults. The purpose of the proposed project is to evaluate an automated mobile phone-based CM approach that will allow socioeconomically disadvantaged individuals to remotely benefit from financial incentives for smoking cessation. The investigators have previously combined technologies including 1) portable carbon monoxide monitors that connect with mobile phones to remotely verify smoking abstinence, 2) facial recognition software to confirm participant identity during breath sample submissions, and 3) remote delivery of incentives automatically triggered by biochemical confirmation of self-reported abstinence. This automated CM approach will be evaluated in a randomized controlled trial that includes 532 socioeconomically disadvantaged males and females seeking smoking cessation treatment. Participants will be randomly assigned to either telephone counseling and nicotine replacement therapy (standard care [SC]) or SC plus a mobile financial incentives intervention (CM) for biochemically-confirmed abstinence. Participants will be followed for 26 weeks after a scheduled quit attempt. Biochemically-verified 7-day point prevalence abstinence at 26 weeks post-quit will be the primary outcome variable. Cost-effectiveness will be evaluated to inform policy-related decisions. Potential mobile CM treatment mechanisms, including self-efficacy, motivation, and treatment engagement, will be explored to optimize future versions of the intervention. Automated mobile CM offers a low-cost approach to smoking cessation that may be used in combination with existing telephone counseling and pharmacological interventions. If effective, this approach represents a critical step towards the widespread dissemination of CM treatment for smoking to practical settings (e.g. state quit lines, healthcare systems), with the goal of reducing tobacco-related disease and disparities.