Incentives for Participation versus Outcomes for Population Cessation of Smoking

描述（由申请人提供）：本提案解决了卫生服务研究中治疗吸烟者尼古丁成瘾的主要差距。在疾病预防的卫生服务领域，最重要的争论之一是，财政激励是否应该取决于参与尼古丁成瘾的循证项目，还是取决于实际结果，比如长期戒断。一方面，越来越多的雇主提倡以标准为基础的服务，奖励那些达到公共健康标准的参与者，比如完全禁欲。另一边是一长串非营利组织的名单，他们支持现金激励参与，但反对基于标准的激励，因为他们担心很大一部分有或没有慢性疾病的人口将无法达到这些标准，并因此而受苦。这项研究针对的是这场辩论中一个主要的知识空白，即缺乏任何随机临床试验来比较基于结果的激励和基于参与的激励的影响。这项以人群为基础的随机临床试验将比较三种治疗条件下吸烟者的长期戒断率：那些被激励参与在每个改变阶段为吸烟者设计的循证治疗的人；2. 那些在6个月（200美元）和12个月（250美元）时获得生物学验证的延长禁欲奖励的人也可以选择参加ttm量身定制的干预；和3。仅为研究参与而激励的评估控制条件。目的是：1)评估每个治疗组在12、24和36个月时是否优于对照组；2)评估在36个月时，奖励参与的治疗组是否如假设的那样优于奖励结果的治疗组；3)比较在大多数无动机吸烟者群体中每种治疗的成本效益和成本节约；4)评估各治疗方案的长期治疗轨迹；5)确定每种治疗的长期结局的中介因素。该项目的创新体现在该研究的许多目标和主题与NIH（2009）报告中关于推动行为改变科学的创新研究的建议相一致。它们包括：1)基于治疗参与与结果的财政激励的比较；2)治疗依从性及参与对结果的影响研究；3)利用量身定制和技术提升临床服务；5)检查不同亚群（如处于不同变化阶段的亚群）的治疗效果；6)比较替代保健服务的成本效益和成本节约；7)准备以证据为基础的治疗方法，以便立即传播；8)设计能够对主要卫生服务政策产生直接影响的临床试验。这个项目有可能帮助填补与尼古丁成瘾的健康行为改变的科学和服务中最关键的争议之一相关的主要知识空白。

DESCRIPTION (provided by applicant): This proposal addresses major gaps in health services research for treating nicotine addiction in populations of smokers. One of the most important debates in the field of health services for disease prevention is whether financial incentives should be contingent on participation in evidence-based programs for nicotine addiction, or on actual outcomes, like prolonged abstinence. On one side are growing numbers of employers who advocate for standards based services which reward participants who reach a public health standard like total abstinence. On the other side are long lists of non-profit organizations who support cash incentives for participation but oppose standards based incentives out of concern that significant percentages of populations with and without chronic conditions will not be able to achieve such standards and will suffer as a result. This study is aimed at one of the major gaps in knowledge in this debate, which is the lack of any randomized clinical trial that has compared the impacts of outcomes- and participation-based incentives. This population- based, randomized clinical trial with a sample of 870 smokers will compare long-term abstinence rates in three treatment conditions: 1. Those incentivized for participation in an evidence-based treatment designed for smokers at each stage of change; 2. Those incentivized for biologically validated prolonged abstinence at 6 ($200) and 12 ($250) months who could also choose to participate in the TTM-tailored intervention; and 3. An assessment only control condition incentivized just for research participation. The aims are: 1) To assess whether each treatment group outperforms the controls at 12, 24 and 36 months; 2) To assess whether the treatment group incentivized for participation outperforms the treatment group incentivized for outcomes at 36 months as hypothesized; 3) To compare the cost-effectiveness and cost savings of each treatment in a population of mostly unmotivated smokers; 4) To assess the long-term treatment trajectories of each treatment; and 5) To identify mediators of long-term outcomes in each treatment. Innovation in this project is reflected by how many of the aims and themes of this research parallel the NIH (2009) Report's recommendations for innovative research to advance the science of behavior change. They include: 1) the comparison of financial incentives based on treatment participation versus outcomes; 2) the study of treatment adherence and effects of participation on outcomes; 3) the use of tailoring and technology to enhance clinical services; 5) examining treatment efficacy in different subpopulations (e.g., those in different stages of change); 6) comparing cost-effectiveness and cost savings of alternative health services; 7) preparing evidence-based treatments for immediate dissemination; and 8) designing clinical trials that can have immediate impacts on major health service policies. This project has the potential to help fill major knowledge gaps relevant to one of the most critical controversies in the science and service of health behavior change for nicotine addiction.