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

在美国，吸烟是可预防的死亡的主要原因。 在美国成年人中降至17.8%，29.2%的贫困人口报告目前吸烟。社会经济学 劣势与戒烟的可能性降低有关。越来越多的证据表明 为禁欲提供激励(即应急管理[CM])可能是一种有效的方法 促进短期戒烟，尽管很少有研究证明长期效果。在……里面 此外，对社会经济上处于不利地位的吸烟者，特别是在CM中的吸烟者，很少受到关注 干预研究。我们的初步工作表明，为 在社会经济学中，戒烟显著增加短期戒烟率 将激励措施作为标准诊所吸烟的辅助措施纳入的弱势吸烟者 戒烟治疗。还需要额外的工作来评估这种CM方法在更长时间内的影响- 以严格和有足够动力的试验为条件。因此，拟议研究的目的是：1)评估 辅助性、低成本CM干预(相对于常规护理)对戒烟的长期影响 参加以诊所为基础的戒烟服务的经济困难个人的比率 计划，以及2)确定与戒烟结果相关的治疗机制和背景因素 在使用传统和生态瞬时评估方法的干预参与者中。 参加以诊所为基础的戒烟治疗的经济困难个人(N=320) 将随机分配到1)常规护理(UC；n=160)或2)UC加上生化经济奖励- 确认戒酒(CM；n=160)。那些随机接受CM干预的人将有机会 戒烟12周后，为经过生化验证的戒烟行为赢取小礼品卡。具体来说，参与者 可以在戒烟日获得20美元的戒酒收入，并且这一金额将每连续增加5美元 戒烟后4周内禁欲(总计150美元)。参赛者还可以额外获得50美元的礼品卡 戒烟后8周和12周禁欲。经过生化验证的26周的7天节制时点 戒烟后(长期戒烟)将是主要的结果变量，尽管吸烟状况将是 在所有访问中进行评估。我们也希望更好地了解CM的治疗机制，并 通过传统问卷和基于智能手机的方式确定直接影响戒烟的其他因素 生态瞬时评估方法。智能手机技术可实现实时数据收集，以 更准确地捕获与戒烟相关的重要变量，并将用于提供收益框架 支持和加强CM干预的信息越来越多。这些发现将为新的治疗方法提供见解 干预研究的目标，并将展示一种有效、廉价和易于实施的 提高经济困难吸烟者长期戒烟率的方法。

Tobacco use is the leading cause of preventable death in the U.S. Although the prevalence of smoking has declined to 17.8% among U.S. adults, 29.2% 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 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. 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 economically disadvantaged individuals participating in a clinic-based 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. Economically disadvantaged individuals participating in a clinic-based smoking cessation treatment (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.