Contingency Management for Smoking Cessation in the Homeless

说明(申请人提供)：戒烟服务在无家可归者中是一种未得到满足的需求，他们的吸烟率是国家估计的3倍以上；在这一服务不足的人群中成功的干预措施有可能改善个人和公共健康。应急管理(CM)是一种在包括吸烟者在内的许多物质使用障碍人群中有效的行为干预。然而，还没有已知的研究评估CM对无家可归的吸烟者的影响。我们计划检查寻求治疗的无家可归吸烟者(N=70)的吸烟相关结果，随机分为标准护理戒烟(经皮尼古丁替代疗法[NRT]+标准咨询+一氧化碳[CO]监测)或标准护理+CM(NRT+标准咨询+CO监测+CM)条件。标准咨询和一氧化碳监测将在前4周进行，NRT的使用将持续到第8周。在这两种情况下的参与者将在工作日每天与研究人员会面最多两次，以进行吸烟状况的生化验证。在CM条件下的参与者将有机会在工作日每天获得最多两次负呼气样本(COd 4ppm)的奖励，平均预期强化约408美元。在标准护理条件下，参与者将收到价值2美元的礼品卡，用于在工作日每天提交两次一氧化碳样本，与吸烟状况无关。后续评估将安排在戒烟后5、9、12和24周进行。我们将使用尿可替宁样本来验证研究摄入时以及12周和24周随访时的吸烟状况。每次探视都会采集一氧化碳呼气样本。主要治疗结果将包括提交的阴性样本百分比、治疗期间实现的最长禁欲持续时间和禁欲的点流行率。我们预计，与标准护理中的参与者相比，随机分配到CM的参与者在这些指标上都会有更好的结果。缩写：CM=应急管理CO=一氧化碳CPD=每天吸烟LDA=持续验证戒烟持续时间最长NRT=尼古丁替代疗法PPM=百万分之SC=标准护理

DESCRIPTION (provided by applicant): Smoking cessation services are an unmet need among the homeless, who smoke at rates more than 3 times the national estimate; successful interventions in this underserved population have the potential for improving individual and public health. Contingency management (CM) is a behavioral intervention with efficacy in a number of substance use disorder populations, including smokers. However, no known studies have evaluated the effect of CM in homeless smokers. We plan to examine smoking-related outcomes in homeless treatment-seeking smokers (N = 70) randomized to standard care smoking cessation (transdermal nicotine replacement therapy [NRT] + standard counseling + carbon monoxide [CO] monitoring) or standard care plus CM (NRT + standard counseling + CO monitoring + CM) conditions. Standard counseling and CO monitoring will occur for the first 4 weeks, with NRT use continuing through week 8. Participants in both conditions will meet with study staff up to twice daily on weekdays for biochemical verification of smoking status. Participants in the CM condition will have the opportunity to earn prizes for negative breath samples (CO d 4 ppm) up to twice daily on weekdays, with average expected reinforcement of about $408. Participants in the standard care condition will receive $2 gift cards for CO sample submissions up to twice daily on weekdays, noncontingent on smoking status. Follow-up assessments will be scheduled at 5, 9, 12, and 24 weeks post-quit date. We will use urine cotinine samples to verify smoking status at study intake and the 12- and 24-week follow-ups. CO breath samples will be collected at all visits. Primary treatment outcomes will include percent negative samples submitted, longest duration of abstinence achieved during treatment, and point prevalence rates of abstinence. We expect that participants randomized to CM will have better outcomes across these indices compared to those in standard care. Abbreviations: CM = Contingency management CO = Carbon monoxide CPD = Cigarettes per day LDA = Longest duration of continuous verified abstinence NRT = Nicotine replacement therapy PPM = Parts per million SC = Standard care