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

 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已下降至18.1%，但生活在贫困中的人中有27.9%报告目前吸烟。社会经济劣势与戒烟的可能性降低有关。越来越多的证据表明，提供禁欲激励（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。此外，很少关注社会经济上处于不利地位的吸烟者（例如，安全网医院人群）。我们的初步工作表明，当激励措施作为标准的基于诊所的戒烟治疗的辅助措施时，为戒烟提供小规模的逐步升级的经济激励措施可以显著提高社会经济弱势吸烟者的短期戒烟率。然而，还需要进行更多的工作，以评估这种CM方法在长期内的影响，并进行严格和充分的试验。因此，拟议研究的目的是：1）评估连续性、低成本CM干预的长期影响（相对于常规护理）对参加安全网医院戒烟计划的社会经济弱势个体的戒烟率的影响，和2）使用传统和生态学方法，在干预参与者中确定与戒烟结果相关的治疗机制和背景因素暂时的评估方法。在城市安全网医院寻求戒烟治疗的受试者（N = 320）将被随机分配到1）常规治疗（UC; n = 160）或2）UC加生化证实戒烟的经济激励（CM; n = 160）。那些被随机分配到CM干预的人将有机会获得小礼品卡，用于戒烟后12周内经过生化验证的禁欲。具体而言，参与者可以在戒烟日获得20美元的禁欲，并且在戒烟后4周内，每次连续禁欲访问都会增加5美元（总计150美元）。参与者还可以在戒烟后8周和12周获得50美元的戒烟礼品卡。戒烟后26周时经生化验证的7天时点戒烟率（长期戒烟）将是主要结局变量，但将在所有访视时评估吸烟状态。我们还希望通过传统的问卷调查和基于智能手机的生态瞬时评估方法更好地了解CM治疗机制，并确定直接影响戒烟的其他因素。智能手机技术允许“实时”数据收集，以更准确地捕捉与停产有关的重要变量，并将用于提供增益框架信息，以支持和加强变革管理干预。研究结果将为干预研究提供新的治疗目标，并将证明一种有效，廉价，易于实施的方法，以提高经济上处于不利地位的吸烟者的长期戒烟率。

 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.