Contingency Management for Smoking Cessation in the Homeless

描述（由申请人提供）：戒烟服务是无家可归者未满足的需求，他们的吸烟率是国家估计的3倍以上；在这些得不到充分服务的人群中，成功的干预措施有可能改善个人和公共健康。应急管理（CM）是一种对包括吸烟者在内的许多物质使用障碍人群有效的行为干预。然而，没有已知的研究评估CM对无家可归的吸烟者的影响。我们计划检查无家可归寻求治疗的吸烟者（N = 70）的吸烟相关结果，随机分为标准治疗戒烟（经皮尼古丁替代疗法[NRT] +标准咨询+一氧化碳[CO]监测）或标准治疗加CM （NRT +标准咨询+一氧化碳监测+ CM）。标准咨询和CO监测将在前4周进行，NRT使用持续到第8周。这两种情况下的参与者将在工作日与研究人员会面最多两次，以进行吸烟状况的生化验证。参加CM测试的人将有机会赢取呼气样本（二氧化碳浓度为4ppm）阴性样本的奖励，奖励在工作日每天最多两次，平均奖金约为408元。标准护理条件下的参与者将收到价值2美元的礼品卡，用于在工作日每天两次提交CO样品，与吸烟状况无关。随访评估将安排在戒烟后5、9、12和24周。我们将使用尿液可替宁样本来验证研究摄入时的吸烟状况以及12周和24周的随访。所有访视将采集一氧化碳呼气样本。主要治疗结果将包括提交的阴性样本百分比，治疗期间达到的最长戒断时间，以及戒断的点流行率。我们期望随机分配到CM的参与者在这些指标上比标准治疗的参与者有更好的结果。缩写：CM =应急管理CO =一氧化碳CPD =每天香烟LDA =最长持续时间连续证实戒断NRT =尼古丁替代疗法PPM =百万分之一SC =标准护理

DESCRIPTION (provided by applicant): Smoking cessation services are an unmet need among the homeless, who smoke at rates more than 3 times the national estimate; successful interventions in this underserved population have the potential for improving individual and public health. Contingency management (CM) is a behavioral intervention with efficacy in a number of substance use disorder populations, including smokers. However, no known studies have evaluated the effect of CM in homeless smokers. We plan to examine smoking-related outcomes in homeless treatment-seeking smokers (N = 70) randomized to standard care smoking cessation (transdermal nicotine replacement therapy [NRT] + standard counseling + carbon monoxide [CO] monitoring) or standard care plus CM (NRT + standard counseling + CO monitoring + CM) conditions. Standard counseling and CO monitoring will occur for the first 4 weeks, with NRT use continuing through week 8. Participants in both conditions will meet with study staff up to twice daily on weekdays for biochemical verification of smoking status. Participants in the CM condition will have the opportunity to earn prizes for negative breath samples (CO d 4 ppm) up to twice daily on weekdays, with average expected reinforcement of about $408. Participants in the standard care condition will receive $2 gift cards for CO sample submissions up to twice daily on weekdays, noncontingent on smoking status. Follow-up assessments will be scheduled at 5, 9, 12, and 24 weeks post-quit date. We will use urine cotinine samples to verify smoking status at study intake and the 12- and 24-week follow-ups. CO breath samples will be collected at all visits. Primary treatment outcomes will include percent negative samples submitted, longest duration of abstinence achieved during treatment, and point prevalence rates of abstinence. We expect that participants randomized to CM will have better outcomes across these indices compared to those in standard care. Abbreviations: CM = Contingency management CO = Carbon monoxide CPD = Cigarettes per day LDA = Longest duration of continuous verified abstinence NRT = Nicotine replacement therapy PPM = Parts per million SC = Standard care