Incentives for Participation versus Outcomes for Population Cessation of Smoking

参与的激励与人口戒烟的结果

• 批准号: 8554914
• 负责人: James O Prochaska
• 金额: $ 67.69万
• 依托单位: UNIVERSITY OF RHODE ISLAND
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8554914
• 关键词: Abstinence; Address; Advocate; Chronic; Clinical Services; Clinical Trials Design; Control Groups; Cost Savings; Effectiveness; Evidence based program; Evidence based treatment; Health; Health Services; Health Services Research; Health behavior change; Incentives; Income; Intervention; Knowledge; Mediator of activation protein; Modeling; Motivation; Nicotine Dependence; Nonprofit Organizations; Outcome; Participant; Policies; Policy Maker; Population; Provider; Public Health; Randomized Clinical Trials; Recommendation; Reporting; Research; Rewards; Sampling; Science; Self Efficacy; Services; Severities; Side; Smoker; Smoking; Staging; Technology; Treatment Efficacy; United States National Institutes of Health; base; behavior change; cost; cost effectiveness; design; disorder prevention; financial incentive; follow-up; innovation; population based; smoking cessation; therapy design; treatment adherence; treatment effect; trial comparing

DESCRIPTION (provided by applicant): This proposal addresses major gaps in health services research for treating nicotine addiction in populations of smokers. One of the most important debates in the field of health services for disease prevention is whether financial incentives should be contingent on participation in evidence-based programs for nicotine addiction, or on actual outcomes, like prolonged abstinence. On one side are growing numbers of employers who advocate for standards based services which reward participants who reach a public health standard like total abstinence. On the other side are long lists of non-profit organizations who support cash incentives for participation but oppose standards based incentives out of concern that significant percentages of populations with and without chronic conditions will not be able to achieve such standards and will suffer as a result. This study is aimed at one of the major gaps in knowledge in this debate, which is the lack of any randomized clinical trial that has compared the impacts of outcomes- and participation-based incentives. This population- based, randomized clinical trial with a sample of 870 smokers will compare long-term abstinence rates in three treatment conditions: 1. Those incentivized for participation in an evidence-based treatment designed for smokers at each stage of change; 2. Those incentivized for biologically validated prolonged abstinence at 6 ($200) and 12 ($250) months who could also choose to participate in the TTM-tailored intervention; and 3. An assessment only control condition incentivized just for research participation. The aims are: 1) To assess whether each treatment group outperforms the controls at 12, 24 and 36 months; 2) To assess whether the treatment group incentivized for participation outperforms the treatment group incentivized for outcomes at 36 months as hypothesized; 3) To compare the cost-effectiveness and cost savings of each treatment in a population of mostly unmotivated smokers; 4) To assess the long-term treatment trajectories of each treatment; and 5) To identify mediators of long-term outcomes in each treatment. Innovation in this project is reflected by how many of the aims and themes of this research parallel the NIH (2009) Report's recommendations for innovative research to advance the science of behavior change. They include: 1) the comparison of financial incentives based on treatment participation versus outcomes; 2) the study of treatment adherence and effects of participation on outcomes; 3) the use of tailoring and technology to enhance clinical services; 5) examining treatment efficacy in different subpopulations (e.g., those in different stages of change); 6) comparing cost-effectiveness and cost savings of alternative health services; 7) preparing evidence-based treatments for immediate dissemination; and 8) designing clinical trials that can have immediate impacts on major health service policies. This project has the potential to help fill major knowledge gaps relevant to one of the most critical controversies in the science and service of health behavior change for nicotine addiction.

描述（由申请人提供）：该提案解决了在吸烟人群中治疗尼古丁成瘾的卫生服务研究中的主要差距。在疾病预防的卫生服务领域，最重要的争论之一是，经济激励是否应该取决于参与尼古丁成瘾的循证计划，还是取决于实际结果，如长期戒烟。一方面，越来越多的雇主倡导基于标准的服务，奖励达到公共卫生标准的参与者，如完全禁欲。另一方面，非营利组织的名单很长，他们支持对参与的现金奖励，但反对基于标准的奖励，因为他们担心相当大比例的患有或不患有慢性病的人口将无法达到这些标准，并因此而受到影响。这项研究的目的是在这场辩论中的知识的主要差距之一，这是缺乏任何随机临床试验，比较了结果和参与为基础的激励措施的影响。这项以人群为基础的随机临床试验将比较三种治疗条件下的长期戒烟率：1。那些被激励参与为每个变化阶段的吸烟者设计的循证治疗的人; 2.那些在6个月（200美元）和12个月（250美元）时被生物学验证的长期禁欲的人也可以选择参加TTM定制的干预;和3。仅为研究参与激励的评估控制条件。其目标是：1）评估每个治疗组在12、24和36个月时的表现是否优于对照组; 2）评估是否如假设的那样，在36个月时，激励参与的治疗组优于激励结果的治疗组; 3）在大多数无动机吸烟者的人群中比较每种治疗的成本效益和成本节约; 4）评估每种治疗的长期治疗轨迹; 5）确定每种治疗的长期结局的介质。该项目的创新体现在该研究的许多目标和主题与NIH（2009）报告中关于创新研究以推进行为改变科学的建议相平行。它们包括：1）基于治疗参与与结果的财政激励的比较; 2）治疗依从性和参与对结果的影响的研究; 3）使用定制和技术来加强临床服务; 5）检查不同亚群（例如，这些研究包括：（1）对处于不同变革阶段的人进行评估;（2）对替代性保健服务的成本效益和成本节约进行比较;（3）为立即推广循证治疗做准备;（4）设计可对主要保健服务政策产生直接影响的临床试验。该项目有可能帮助填补与尼古丁成瘾的健康行为改变的科学和服务中最关键的争议之一相关的主要知识空白。