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: 8944131
• 负责人: Darla Elizabeth Kendzor
• 金额: $ 5.46万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-08 至 2015-10-15
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8944131
• 关键词: Abstinence; Adherence; Adoption; Adult; Affect; Applications Grants; Attention; Cellular Phone; Cessation of life; Clinic; Data Collection; Disadvantaged; Ecological momentary assessment; Economically Deprived Population; Effectiveness; Esophagus; Exposure to; Gifts; Goals; Health; Healthcare Systems; Hospitals; Incentives; Individual; Intervention; Intervention Studies; Kidney; Larynx; Life; Link; Malignant Neoplasms; Malignant neoplasm of lung; Malignant neoplasm of urinary bladder; Methods; Motivation; Nicotine Dependence; Oral; Outcome; Participant; Patients; Population; Poverty; Prevalence; Questionnaires; Randomized; Randomized Controlled Trials; Relative (related person); Reporting; Research Personnel; Resources; Sampling; Self Efficacy; Smoker; Smoking; Smoking Status; Stress; Technology; Testing; Time; Tobacco; Tobacco Use Cessation; Tobacco smoking; Tobacco use; United States; Visit; Withholding Treatment; Work; base; behavioral/social science; clinical practice; contextual factors; contingency management; cost; disability; financial incentive; follow-up; health disparity; improved; insight; primary outcome; programs; psychosocial; public health relevance; safety net; smoking cessation; smoking prevalence; social science research; socioeconomic disadvantage; socioeconomics; stressor; theories; treatment adherence; treatment as usual

 DESCRIPTION (provided by applicant): Tobacco use is the leading cause of preventable death in the U.S. Although the prevalence of smoking has declined to 18.1 percent among U.S. adults, 27.9 percent 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 (e.g., safety- net hospital populations) 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. However, 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 socioeconomically disadvantaged individuals participating in a safety-net hospital 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. Participants seeking smoking cessation treatment at an urban safety net hospital (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.

 描述（由适用提供）：烟草使用是美国可预防死亡的主要原因，尽管美国成年人的吸烟率下降到18.1％，其中27.9％的贫困报告当前吸烟。社会经济灾难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]）可能是促进短期戒烟的有效方法，尽管很少有研究表明长期有效性。此外，在CM干预研究中，对社会经济打扰的吸烟者（例如安全净医院人群）的关注很少。我们的初步工作表明，在将激励措施作为基于标准的基于临床临床的戒烟治疗的辅助手段时，为戒烟提供的小额逐渐升级会大大提高社会经济处境不利的吸烟者的短期戒烟率。但是，需要进行额外的工作来长期评估这种商业方法的影响。这是拟议研究的目的是：1）评估辅助性，低成本的商业干预措施（相对于通常的护理）对社会经济受到干扰的个体参与安全性NET医院吸烟戒烟计划的受吸烟率和2）识别治疗机制和与传统量相关的均具有评估术语的方法的长期影响。在城市安全网医院寻求戒烟治疗的参与者（n = 320）将随机分配给1）通常的护理（uc; n = 160）或2）UC加上生物化学确认的戒酒的经济激励措施（cm; n = 160）。那些将随机进行CM干预的人将有机会在QIT后12周内赚取小型礼品卡，以供生化验证的禁欲。具体而言，参与者可能会在退出日期获得20美元的禁欲，而这笔款项将增加5美元，而每次成功的避免访问均可到审议后4周（总计150美元）。参与者可能会在审议后8和12周赚取50美元的节制礼品卡。生化验证的7天点戒酒发生率在QIT后26周（长期禁欲）将是主要结果变量，尽管在所有访问中都会评估吸烟状况。我们还希望能够更好地了解CM治疗机制，并确定通过传统问卷和基于智能手机的生态瞬时评估方法直接影响停止的其他因素。智能手机技术允许“实时”数据收集，以更准确地捕获与戒烟相关的重要变量，并将用于传递增益框架消息以支持和加强CM干预。调查结果将提供有关干预研究的新治疗目标的见解，并将展示一种有效，廉价且易于实施的方法，以改善经济弱势吸烟者中的长期戒烟率。