Financial incentives for homeless smokers: A community-based RCT

项目总结/摘要 无家可归者吸烟率是非无家可归者的3.5倍 吸烟导致的肺癌发病率增加2倍，吸烟导致的肺癌发病率增加3至5倍。 死亡无家可归的吸烟者想要戒烟，但研究尚未发现帮助他们的最佳方法 帐号吧.在最近发表的一项为期8周的随机对照试验（RCT）中， 无家可归者计划（BHCHP），我们发现，戒烟的经济激励与 7-与非激励对照条件相比，短暂戒烟的几率高出一倍。这些 研究结果表明，经济激励是减少吸烟的一种有前途的方法， 人群，尽管需要在更大样本中进行进一步研究以改善治疗持续时间 禁欲，评估治疗后的效果，更好地了解作用机制和背景因素 这可能会影响治疗效果。为了解决这些差距，我们将开展一项以社区为基础的随机对照试验， BHCHP对成年吸烟者戒烟的经济激励。我们将招募400名参与者 来自3个BHCHP研究中心，并将其随机分配接受指南一致的标准治疗（N=200）或 没有（N=200）戒烟的经济激励。标准护理包括8周的 联合尼古丁替代疗法（NRT）和5次与烟草教练的会议， 行为咨询，分发NRT，并协调现有烟草治疗资源的转介。 奖励机构参与者将额外获得24周的20笔借记卡付款计划， 基于呼出的一氧化碳水平的短期禁欲，增加了16次穿插付款 取决于长期的禁欲基于尿毒藜碱水平。我们将使用嵌入式实验 混合方法设计，其中定性（“qual”）数据收集嵌入更大的定量 （“QUAN”）RCT，目标如下：目标1.（QUAN）确定财务激励措施的效果 在A）治疗结束时（24周）和B）24周时对经毒藜碱验证的7天戒烟进行干预 治疗结束后（48周）。我们假设，激励组的参与者将有更大的禁欲 在两个时间点。目标二。（qual）评估无家可归的吸烟者为什么、如何以及在什么情况下吸烟A） 在经济激励下实现禁欲，以及B）在激励停止后保持禁欲。 为了实现这一目标，我们将在24周和48周时对选定的参与者进行访谈，探讨认知， 他们对经济激励的反应的程序和背景维度，以产生关于 本报告的目的是提供关于治疗期间和治疗后效应的机制的信息，并为这一领域今后的工作提供信息。我们的研究结果 可能对每年在美国医疗保健服务的934，000人产生重要的烟草治疗影响 为无家可归者计划，推进NCI减少弱势群体吸烟的目标。

PROJECT SUMMARY / ABSTRACT Homeless people have a 3.5-fold higher prevalence of cigarette smoking in comparison to non-homeless people, contributing to 2-fold higher rates of lung cancer and 3- to 5-fold higher rates of tobacco-attributable death. Homeless smokers want to quit, but studies have not yet uncovered the optimal approach to help them do so. In a recently published 8-week pilot randomized controlled trial (RCT) at Boston Health Care for the Homeless Program (BHCHP), we found that financial incentives for smoking abstinence were associated with 7-fold higher odds of brief smoking abstinence in comparison to a non-incentivized control condition. These results suggest that financial incentives are a promising approach for reducing smoking in this vulnerable population, although further investigation in a larger sample is needed to improve the duration of on-treatment abstinence, assess post-treatment effects, and better understand mechanisms of action and contextual factors that may influence treatment response. To address these gaps, we will conduct a community-based RCT of financial incentives for smoking abstinence among adult smokers at BHCHP. We will recruit 400 participants from 3 BHCHP sites and randomize them to receive guideline-concordant standard care with (N=200) or without (N=200) financial incentives for smoking abstinence. Standard care will consist of 8 weeks of combination nicotine replacement therapy (NRT) and 5 sessions with a tobacco coach who will provide behavioral counseling, distribute NRT, and coordinate referrals to existing tobacco treatment resources. Incentive arm participants will additionally receive a 24-week schedule of 20 debit card payments contingent on short-term abstinence based on exhaled carbon monoxide levels, augmented with 16 interspersed payments contingent on longer-term abstinence based on urine anabasine levels. We will use an embedded-experiment mixed methods design, where qualitative (‘qual’) data collection is embedded within a larger quantitative (‘QUAN’) RCT with the following aims: Aim 1. (QUAN) To determine the effect of the financial incentives intervention on anabasine-verified 7-day smoking abstinence at A) the end of treatment (24 weeks) and B) 24 weeks after treatment (48 weeks). We hypothesize that incentive arm participants will have greater abstinence at both timepoints. Aim 2. (qual) To assess why, how, and under what circumstances homeless smokers A) achieve abstinence in response to financial incentives and B) maintain abstinence after incentives are stopped. To accomplish this aim, we will interview selected participants at 24 and 48 weeks, probing cognitive, procedural, and contextual dimensions of their response to financial incentives to generate hypotheses about mechanisms for on-treatment and post-treatment effects and to inform future work in this area. Our findings could have important tobacco treatment implications for the 934,000 people served annually in US Health Care for the Homeless programs, advancing NCI’s objective of reducing smoking in vulnerable populations.