Mobile Contingency Management for Smoking Cessation among Socioeconomically Disadvantaged Adults

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Project Summary Although smoking prevalence has declined to 13.7% among U.S. adults, smoking rates are much higher among socioeconomically disadvantaged adults. Lung cancer, which is primarily caused by cigarette smoking, is the leading cause of cancer death in the U.S. Lung cancer mortality is far greater among those of lower socioeconomic status (SES) than their higher SES counterparts. Contingency management (CM), the tangible reinforcement of abstinence and other desired outcomes, is an effective approach to promoting smoking cessation in a variety of populations. The preliminary work of the investigators has indicated that offering small escalating financial incentives for smoking abstinence dramatically increases cessation rates among socioeconomically disadvantaged adults when incentives are included as an adjunct to clinic-based treatment. However, innovative approaches are needed for those who are unable or unwilling to attend office visits. Smartphone ownership is rapidly growing, even among low-income adults, and may offer a means of reaching and increasing treatment access among socioeconomically disadvantaged adults. The purpose of the proposed project is to evaluate an automated mobile phone-based CM approach that will allow socioeconomically disadvantaged individuals to remotely benefit from financial incentives for smoking cessation. The investigators have previously combined technologies including 1) portable carbon monoxide monitors that connect with mobile phones to remotely verify smoking abstinence, 2) facial recognition software to confirm participant identity during breath sample submissions, and 3) remote delivery of incentives automatically triggered by biochemical confirmation of self-reported abstinence. This automated CM approach will be evaluated in a randomized controlled trial that includes 532 socioeconomically disadvantaged males and females seeking smoking cessation treatment. Participants will be randomly assigned to either telephone counseling and nicotine replacement therapy (standard care [SC]) or SC plus a mobile financial incentives intervention (CM) for biochemically-confirmed abstinence. Participants will be followed for 26 weeks after a scheduled quit attempt. Biochemically-verified 7-day point prevalence abstinence at 26 weeks post-quit will be the primary outcome variable. Cost-effectiveness will be evaluated to inform policy-related decisions. Potential mobile CM treatment mechanisms, including self-efficacy, motivation, and treatment engagement, will be explored to optimize future versions of the intervention. Automated mobile CM offers a low-cost approach to smoking cessation that may be used in combination with existing telephone counseling and pharmacological interventions. If effective, this approach represents a critical step towards the widespread dissemination of CM treatment for smoking to practical settings (e.g. state quit lines, healthcare systems), with the goal of reducing tobacco-related disease and disparities.