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。 在美国成年人中，吸烟率下降到17.8%，29.2%的贫困人口报告目前吸烟。社会经济 缺点是与戒烟的可能性降低有关。有越来越多的证据表明 为禁欲提供激励（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。在 此外，很少关注社会经济上处于不利地位的吸烟者，特别是在CM中 干预研究。我们的初步工作表明，提供小规模的逐步升级的财政激励， 戒烟大大增加了社会经济中的短期戒烟率 当激励措施作为标准诊所吸烟的辅助措施时， 停止治疗。需要开展更多的工作，以评估这种变革管理方法在较长时期内的影响。 一个严格的和充分的试验。因此，拟议研究的目的是：1）评估 连续、低成本CM干预（相对于常规护理）对戒烟的长期影响 参加门诊戒烟的经济困难者的比率 计划，以及2）确定与戒烟结果相关的治疗机制和背景因素 在干预参与者中使用传统和生态瞬时评估方法。 参与基于诊所的戒烟治疗的经济弱势个体（N = 320） 将被随机分配到1）常规治疗（UC; n = 160）或2）UC加生化- 确认禁欲（CM; n = 160）。随机分配至CM干预组的患者将有机会 通过戒烟后12周内的生物化学验证戒烟，获得小礼品卡。具体而言，参与者 在戒烟日，戒烟者可以获得20美元的收入，并且每连续一次戒烟，这个数额就会增加5美元。 戒烟后4周内的戒烟访视（总计150美元）。参与者还可以获得50美元的礼品卡， 戒烟后8周和12周的禁欲率。26周时经生化验证的7天点戒烟率 戒烟后（长期戒烟）将是主要的结果变量，尽管吸烟状况将是 在所有访视中进行评估。我们还希望更好地了解CM治疗机制， 通过传统的问卷调查和基于智能手机的调查，确定直接影响戒烟的其他因素 生态瞬时评估方法。智能手机技术允许“实时”数据收集， 更准确地捕捉重要的终止相关变量，并将用于提供增益框架 支持和加强CM干预的信息。研究结果将提供有关新治疗的见解 干预研究的目标，并将展示一个有效的，廉价的，易于实施的 提高经济上处于不利地位的吸烟者的长期戒烟率的方法。