A behavioral economic intervention for low-income smokers - Resubmission - 1 - Revision - 1

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PROJECT SUMMARY People with low income face unique barriers to cessation, including high levels of financial distress, trauma, and unmet social needs, resulting in the use of smoking as a coping mechanism. Behavioral economics further finds that people experiencing financial hardship must attend to their immediate needs for survival at the expense of delayed goals (such as the long-term health benefits of quitting smoking). Interventions that alleviate financial hardship and other social needs may improve quit rates in this population. Our parent R37 grant is evaluating the effectiveness, behavioral economic mechanisms, and cost-effectiveness of an intervention that integrates financial coaching and referral to financial empowerment services and social services into smoking cessation treatment. Recent trauma-informed theories of behavior suggest that intervention approaches that that shift the focus away from individual determinants of tobacco use to the social and structural determinants tobacco use may improve intervention engagement and effectiveness by creating a more holistic, non-judgmental and resilience-oriented smoking cessation process. Additionally, participants with multiple marginalized social identities may have unique experiences and smoking cessation processes while participating in interventions that acknowledge one’s broader lived experience and social determinants of tobacco use. Lastly, co-occurring health conditions, such as poor sleep hygiene, may interact with tobacco cessation interventions but these interactions have been under-studied in the literature. The overall objective of this administrative supplement is to use qualitative methods to identify multi-level factors not included in the original R37 proposal that may enhance or limit the intervention’s impacts on treatment engagement, initial smoking cessation, and long-term cessation maintenance. The qualitative results will be further used to inform the selection of new quantitative measures to include in the parent R37 grant’s data collection and analytic approaches to provide insights into why the intervention works, for whom, and in which contexts. The Specific Aims of the proposed supplement are to: Aim 1) Qualitatively examine intervention-related and context-related factors that may enhance or limit the intervention’s impacts on treatment engagement, initial smoking cessation, and smoking cessation maintenance, with Sub-Aim 1.1) Explore how social factors and other health conditions may interact to influence participants’ intervention experiences, behavior change processes, and the intervention’s potential mechanisms of action. Aim 2) Guided by the qualitative themes identified during Aim 1, select new multi-level quantitative measures to include in the parent R37 grant’s data collection and analytic approaches to enhance the parent project’s understanding of the intervention’s key mechanisms of action and contextual influences. The results are expected to generate important insights about interventions that address sociocontextual determinants of tobacco use in people with low income who smoke.