A behavioral economic intervention for low-income smokers

针对低收入吸烟者的行为经济干预

• 批准号: 10366558
• 负责人: Erin Rogers
• 金额: $ 68.84万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-12-14 至 2026-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10366558
• 关键词: Abstinence; Address; Adult; Attention; Biochemical; Budgets; Cognitive; Counseling; Data; Enrollment; Face; Financial Hardship; Funding; Goals; Health; Health Benefit; Income; Intervention; Investigation; Knowledge; Link; Low income; Motivation; Outcome; Participant; Patient Self-Report; Persons; Randomized; Randomized Controlled Trials; Reporting; Services; Smoke; Smoker; Smoking; Surveys; Testing; Time; Tobacco; Tobacco Use Cessation; Tobacco use; Treatment Efficacy; Vulnerable Populations; acceptability and feasibility; arm; behavioral economics; compare effectiveness; comparison intervention; coping mechanism; cost; cost effectiveness; cost estimate; design; discounting; economic determinant; effectiveness testing; empowerment; experience; follow-up; group intervention; health care settings; improved; income disparities; innovation; intervention participants; nicotine replacement; novel; primary outcome; programs; recruit; reduce tobacco use; safety net; satisfaction; smoking cessation; social; success; theories; treatment arm; treatment as usual; usual care arm

PROJECT SUMMARY People with low income are three times more likely to smoke than people with high income. The income disparity in tobacco use has persisted over the past 50 years—in part because there have been limited efforts to design cessation interventions that address the sociocontextual determinants of smoking among low-income adults. Tobacco use not only causes extreme health consequences for low-income people, but it can also exacerbate their financial strain by using funds on tobacco that could go towards essentials. Low-income smokers also face unique barriers to cessation, including high levels of financial distress and other social needs, which results in the use of smoking as a coping mechanism. Behavioral economics further finds that people experiencing financial strain have an increased focus on immediate needs at the expense of delayed goals (such as the long- term health benefits of cessation)—resulting in limited cognitive “bandwidth” to attend to smoking cessation. Interventions that alleviate financial stress and help low-income smokers attend to the benefits of quitting may improve quit rates in this vulnerable population. We previously conducted a randomized study testing a novel intervention that integrates financial coaching into a smoking cessation program for low-income smokers. At follow-up, intervention participants were more likely to have quit smoking, report lower levels of financial stress, and report higher levels of financial satisfaction than a minimal usual care control group. Our goal with the proposed R01 is to leverage the successes of the prior study and conduct a large randomized controlled trial (RCT) comparing the effectiveness, mechanisms, and costs of the integrated intervention against standard intensive cessation treatment. We have the following Specific Aims: (1) Compare the effectiveness of the integrated intervention to standard cessation counseling on long-term abstinence; (2) Identify the significant mechanisms of action of the integrated intervention; and (3) Estimate the cost and cost-effectiveness of the integrated intervention compared to standard counseling. To accomplish these aims, we will conduct a two-arm, parallel-group, RCT. We will recruit and randomize 900 smokers (n=450 per arm) to either: (1) Control: Standard Smoking Cessation Counseling or (2) Intervention: Integrated Financial-Smoking Cessation Counseling. Both groups will receive 8 weeks of nicotine replacement therapy. We will survey participants at baseline, 6 months, and 12 months to assess outcomes and mechanisms, and biochemically verify self-reported abstinence at 12 months (our primary outcome). We will assess and compare the cost-per-quit in the two treatment arms.

项目摘要 收入低的人吸烟的可能性是高收入的人的三倍。收入差异 在过去的50年中，在烟草中使用一直存在 - 部分是因为设计的努力有限 戒烟干预措施解决了低收入成年人吸烟的社会上下文决定者。 烟草不仅会对低收入人士造成极端的健康后果，而且还会加剧 他们的财务压力是通过在烟草上使用的资金来涉及必需品。低收入吸烟者也面对 戒烟的独特障碍，包括高水平的财务困扰和其他社会需求，这导致了 使用吸烟作为应对机制。行为经济学进一步发现，人们经历了 财务压力以牺牲延迟目标为代价（例如长期 戒烟的术语健康益处） - 以有限的认知“带宽”的方式来戒烟。 减轻财务压力并帮助低收入吸烟者戒烟的益处的干预措施可能 提高这个脆弱人群的戒烟率。 我们之前进行了一项随机研究，对新的干预进行了研究，将财务教练整合到 一项针对低收入吸烟者的戒烟计划。随访时，干预参与者更有可能 戒烟，报告财务压力水平较低，并报告比 最小的通常护理对照组。我们提出的R01的目标是利用先前的成功 研究并进行了大型随机对照试验（RCT），以比较有效性，机制和 反对标准强化戒烟处理的综合干预成本。我们有以下 具体目的：（1）将综合干预措施与标准停止咨询的有效性进行比较 长期禁欲； （2）确定综合干预措施的重要作用机制；和 （3）与标准咨询相比，估算综合干预的成本和成本效益。 为了实现这些目标，我们将进行两臂平行组，RCT。我们将招募和随机分组900 吸烟者（n = 450臂）至：（1）控制：标准的戒烟咨询或（2）干预： 综合的财务戒烟咨询。两组将获得8周的尼古丁替代品 治疗。我们将在基线，6个月和12个月的基线调查参与者，以评估结果和 机制以及生化在12个月时验证自我报告的禁欲（我们的主要结果）。我们将 评估和比较两个治疗组中的每次费用。