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， 肺癌是美国癌症死亡的主要原因。 社会经济地位（SES）高于他们的SES同行。应急管理（CM），有形 加强戒烟和其他期望的结果，是促进吸烟的有效方法 在各种人群中停止。调查人员的初步工作表明，提供小 不断升级的戒烟经济激励措施大大提高了戒烟率， 当激励措施作为诊所治疗的辅助措施时，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，需要采取创新办法。 智能手机的拥有量正在迅速增长，即使在低收入的成年人中也是如此，这可能会提供一种联系方式。 以及增加社会经济弱势成年人获得治疗的机会。的目的 拟议的项目是评估一个自动化的移动的手机为基础的CM方法，将允许 社会经济上处于不利地位的个人远程受益于吸烟的经济奖励 停止调查人员先前已经结合了包括1）便携式一氧化碳 与移动的电话连接的监视器，以远程验证戒烟，2）面部识别软件 在呼吸样本提交期间确认参与者身份，以及3）远程递送激励 自动触发的生化确认自我报告禁欲。这种自动化的CM方法 将在包括532名社会经济弱势男性的随机对照试验中进行评估 以及寻求戒烟治疗的女性。参与者将被随机分配到 咨询和尼古丁替代疗法（标准护理[SC]）或SC加移动的经济激励 干预（CM）的生物化学证实的禁欲。参与者将被跟踪26周后， 预定的退出尝试。将在戒烟后26周时进行生物化学验证的7天点戒烟率 主要结果变量。将对成本效益进行评价，以便为政策相关决定提供信息。潜在 移动的CM治疗机制，包括自我效能，动机和治疗参与，将 探索以优化干预的未来版本。自动化的移动的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理学结合使用 干预措施。如果有效的话，这种方法将是向广泛传播CM迈出的关键一步 将吸烟治疗应用于实际环境（例如，州戒烟热线，医疗保健系统），目的是减少 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.