Small Financial Incentives to Promote Smoking Cessation in Safety Net Hospital Patients

促进安全网医院患者戒烟的小额经济激励

• 批准号: 9181235
• 负责人: Darla Elizabeth Kendzor
• 金额: $ 28.19万
• 依托单位: UNIVERSITY OF OKLAHOMA HLTH SCIENCES CTR
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-11-16 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9181235
• 关键词: Small; Financial; Incentives; Promote; Smoking

Tobacco use is the leading cause of preventable death in the U.S. Although the prevalence of smoking has declined to 17.8% among U.S. adults, 29.2% of those living in poverty report current smoking. Socioeconomic disadvantage is associated with a reduced likelihood of smoking cessation. There is mounting evidence that offering incentives for abstinence (i.e., Contingency Management [CM]) may be an effective approach for promoting short-term smoking cessation, though few studies have demonstrated longer-term effectiveness. In addition, little attention has been paid to socioeconomically disadvantaged smokers specifically in CM intervention studies. Our preliminary work indicates that offering small escalating financial incentives for smoking abstinence dramatically increases short-term cessation rates among socioeconomically disadvantaged smokers when incentives are included as an adjunct to standard clinic-based smoking cessation treatment. Additional work is needed to evaluate the influence of this CM approach in the longer- term with a rigorous and adequately powered trial. Thus, the aims of the proposed study are to: 1) evaluate the longer-term impact of an adjunctive, low-cost CM intervention (relative to usual care) on smoking abstinence rates among economically disadvantaged individuals participating in a clinic-based smoking cessation program, and 2) identify treatment mechanisms and contextual factors associated with cessation outcomes among intervention participants using both traditional and ecological momentary assessment approaches. Economically disadvantaged individuals participating in a clinic-based smoking cessation treatment (N = 320) will be randomly assigned to 1) usual care (UC; n = 160) or 2) UC plus financial incentives for biochemically- confirmed abstinence (CM; n = 160). Those randomized to the CM intervention will have the opportunity to earn small gift cards for biochemically-verified abstinence through 12 weeks post-quit. Specifically, participants may earn $20 for abstinence on the quit date, and this amount will increase by $5 with each successive abstinent visit through 4 weeks post-quit ($150 total). Participants may additionally earn $50 gift cards for abstinence at 8 and 12 weeks post-quit. Biochemically-verified 7-day point prevalence abstinence at 26 weeks post-quit (longer-term abstinence) will be the primary outcome variable, though smoking status will be assessed at all visits. We also hope to gain a better understanding of CM treatment mechanisms and to identify other factors that directly influence cessation via traditional questionnaire and smartphone-based ecological momentary assessment approaches. Smartphone technology allows for “real-time” data collection to more accurately capture important cessation-related variables, and will be used to deliver gain-framed messages to support and strengthen the CM intervention. Findings will provide insight about new treatment targets for intervention research, and will demonstrate an effective, inexpensive, and easily implementable means by which to improve longer-term smoking cessation rates among economically disadvantaged smokers.

烟草使用是美国可预防死亡的主要原因，尽管吸烟的患病率已经 在美国成年人中降至17.8％，居住在贫困报告当前吸烟的人中有29.2％。社会经济 缺点与戒烟的可能性降低有关。有越来越多的证据表明 提供禁欲的激励措施（即应急管理[CM]）可能是一种有效的方法 促进短期戒烟，尽管很少有研究表明长期有效性。在 此外，很少关注社会经济受到干扰的吸烟者，特别是在CM中 干预研究。我们的初步工作表明，为 在社会经济上，戒烟大大提高了短期停止率 当包括激励措施作为标准诊所吸烟的辅助手段时，弱势吸烟者 停止处理。需要其他工作来评估这种商业方法在较长的 具有严格且充分动力的试验的术语。这是拟议研究的目的是：1）评估 辅助性低成本CM干预（相对于通常的护理）对戒烟的长期影响 参加诊所戒烟的经济困扰的人的比率 计划，以及2）确定与停止结果相关的治疗机制和上下文因素 在使用传统和生态瞬时评估方法的干预参与者中。 参加基于诊所的戒烟治疗的经济上干扰的人（n = 320） 将随机分配给1）通常的护理（uc; n = 160）或2）UC加上生物化学的经济激励措施 - 确认的禁欲（CM; n = 160）。那些随机进行CM干预的人将有机会 在提示后12周之前，赚取生物化学验证的节制的小礼品卡。具体来说，参与者 在退出日期可能会赚取20美元的禁欲，这笔款项将增加5美元 避免访问后4周（总计150美元）。参与者可能还可以赚取50美元的礼品卡 戒酒后8和12周。在26周的生化验证的7天点戒烟率 后（长期禁欲）将是主要结果变量，尽管吸烟状况将是 在所有访问中进行评估。我们也希望能更好地了解CM治疗机制和 确定通过传统问卷和基于智能手机直接影响停止停止的其他因素 生态瞬时评估方法。智能手机技术允许“实时”数据收集到 更准确地捕获重要的戒烟相关变量，并将用于交付增益框架 消息以支持和加强CM干预。调查结果将提供有关新待遇的见解 干预研究的目标，并将展示有效，廉价且易于实施的目标 在经济不利的吸烟者中改善长期戒烟率的方法。