Alaska Native Family-Based, Financial Incentives Intervention for Smoking Cessation: an RCT

基于阿拉斯加原住民家庭的戒烟经济激励干预措施：随机对照试验

• 批准号: 10400485
• 负责人: Christi A Patten
• 金额: $ 63.76万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10400485
• 关键词: Adopted; Adoption; Adult; Alaska; Alaska Native; American Indians; Biochemical; COVID-19; Car Phone; Cardiovascular system; Climate; Communities; Cost Effectiveness Analysis; Data; Decision Making; Effectiveness; Effectiveness of Interventions; Enrollment; Exposure to; Family; Family member; Future; Geography; Goals; Health; Health Services Accessibility; Health system; Home; Household; Incentives; Individual; Intervention; Interview; Life Style; Literature; Maintenance; Malignant neoplasm of lung; Measures; Mediator of activation protein; Morbidity - disease rate; Native-Born; Odds Ratio; Participant; Patient Recruitments; Persons; Policies; Population; Pregnant Women; Process; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Reach Effectiveness Adoption Implementation and Maintenance; Research; Resources; Rewards; Role; Rural; Smoke; Smoking; Smoking Cessation Intervention; Smoking Status; Social Distance; Social support; System; Telephone; Testing; Time; Tobacco; Work; addiction; base; behavioral economics; cigarette smoking; collaborative approach; comparison intervention; cultural values; design; digital; effectiveness evaluation; evidence base; family support; financial incentive; frontier; group intervention; health disparity; health organization; hybrid type 1 design; incentive-based intervention; indexing; intervention effect; mortality; non-Native; pandemic disease; post intervention; programs; residence; respiratory; sex; smoking abstinence; smoking cessation; smoking prevalence; social media; theories; therapy design; tribal health; urban area; urban residence; virtual intervention

PROJECT SUMMARY In Alaska (AK), smoking prevalence of Alaska Native and American Indian (ANAI) people is more than double that of non-Native adults (37% vs. 17%). Unlike other Indigenous populations, tobacco is not used in traditional ceremony. Current cessation strategies have not reduced smoking prevalence among ANAI people. AK geography (largely frontier and road-less) and climate further limit treatment access and reach. Based on behavioral economic theory, financial incentives to promote cessation is a promising approach in other populations, with smoking abstinence rates more than doubling one year after discontinued rewards compared with no incentives. Community input for this study indicate family members are essential in supporting smoking cessation; consistent with the ANAI cultural value of interdependence, defined as relationship-based, collaborative, and reliance on family systems rather than individuals. Our research and others’ document the influence of naturally occurring social support networks on smoking cessation. Family-based incentive interventions have not been evaluated for smoking or other addictions. To fill this gap, the proposed study will evaluate the effectiveness and implementation of a culturally-adapted, ANAI family-based incentives intervention for smoking cessation with the following Specific Aims: (1) Adapt an effective 6-month financial incentive intervention for ANAI people who smoke and family members; (2) Conduct a randomized controlled trial (RCT) to evaluate reach and effectiveness of the intervention compared with the control condition on confirmed, prolonged smoking abstinence at six and 12 months post-intervention; and (3) Evaluate key process indicators relevant to intervention adoption, implementation, and maintenance, and conduct a cost- effectiveness analysis to support further adaptation and dissemination. RCT-enrolled dyads (adult ANAI person who smokes [index participant] and adult family member) will be stratified by index participant’s sex, rural/urban location, residence with family member, and by family member’s smoking status, then randomized to a no incentives control condition (n=328 dyads) or a 6-month incentive intervention (n=328 dyads). All dyads will receive materials on evidence-based cessation resources, social support strategies, and family wellness. We will measure index participant smoking status in both groups weekly for four weeks, and at three and six months. Intervention index participants will receive rewards for verified smoking abstinence at each time point, up to $750; and the family member will receive rewards (e.g., fuel or other needs) equal to the value earned by the index participant. We will explore potential moderators (e.g., index participant sex) and mediators (e.g., interdependence) of intervention effects. To enhance reach, we will recruit participants statewide, primarily with social media, and deliver the intervention virtually. If successful, our results will inform Tribal policy to adopt the intervention within the AK Tribal Health System; and possibly, for use within ANAI communities beyond AK.

项目摘要 在阿拉斯加州（AK），阿拉斯加原住民和美洲印第安人（ANAI）的吸烟率是美国人的两倍多。 非本地成年人（37%对17%）。与其他土著居民不同，烟草不用于传统的 仪式目前的戒烟策略并没有降低ANAI人群的吸烟率。AK 地理（主要是边境和无路）和气候进一步限制了获得治疗的机会和范围。基于 根据行为经济学理论，以经济激励促进戒烟是一种有前途的方法， 在停止奖励后一年， 没有奖励。这项研究的社区投入表明，家庭成员在支持吸烟方面至关重要 停止;与相互依存的ANAI文化价值相一致，定义为基于关系， 合作，依赖家庭系统而不是个人。我们的研究和其他人的文件， 社会支持网络对戒烟的影响家庭激励 尚未对吸烟或其他成瘾的干预措施进行评估。为了填补这一空白，拟议的研究将 评估适应文化的ANAI家庭激励措施的有效性和实施情况 戒烟干预的具体目标如下：（1）适应有效的6个月的财政 对ANAI吸烟者及家庭成员进行激励干预;（2）进行随机对照 随机对照试验（RCT），以评估干预措施的范围和有效性，与对照条件相比， 在干预后6个月和12个月确认长期戒烟;和（3）评估关键 处理与干预措施的采用、实施和维护相关的指标，并进行成本- 进行有效性分析，以支持进一步调整和传播。RCT入组的二人组（成人ANAI患者 吸烟者[索引参与者]和成年家庭成员）将按索引参与者的性别分层， 农村/城市地区、与家庭成员的居住地以及家庭成员的吸烟状况，然后进行随机化 无激励控制条件（n=328对）或6个月的激励干预（n=328对）。所有二分体 将收到有关循证戒烟资源、社会支持策略和家庭健康的材料。 我们将测量两组的指数参与者吸烟状况，每周一次，持续四周， 个月干预指数参与者将在每个时间点获得经验证的戒烟奖励， 高达$750;并且家庭成员将获得奖励（例如，燃料或其他需要）等于 指数参与者。我们将探索潜在的主持人（例如，指数参与者性别）和中介者（例如， （三）干预效果。为了扩大覆盖范围，我们将在全州范围内招募参与者，主要是 通过社交媒体，并通过虚拟方式进行干预。如果成功，我们的结果将告知部落政策， AK部落卫生系统内的干预;并可能在AK以外的ANAI社区内使用。