A behavioral economic intervention for low-income smokers

项目总结 低收入人群吸烟的可能性是高收入人群的三倍。收入差距 在过去的50年里，烟草的使用一直存在--部分原因是人们对设计的努力有限 针对低收入成年人吸烟的社会背景决定因素的戒烟干预。 烟草使用不仅对低收入者造成极端的健康后果，而且还可能加剧 他们在烟草上的资金可能会用于必需品，从而给他们带来财政压力。低收入吸烟者也面临着 戒烟的独特障碍，包括严重的财政困难和其他社会需要，这导致 使用吸烟作为一种应对机制。行为经济学进一步发现，人们经历了 财政压力加大了对眼前需求的关注，牺牲了延迟的目标(如长期目标) 戒烟的健康益处)--导致关注戒烟的认知“带宽”有限。 缓解经济压力和帮助低收入吸烟者注意戒烟好处的干预措施可能会 提高这一弱势群体的戒烟率。 我们之前进行了一项随机研究，测试一种新型干预措施，该干预措施将金融指导整合到 针对低收入吸烟者的戒烟计划。在后续行动中，干预参与者更有可能 戒烟，报告的经济压力水平较低，报告的经济满意度高于 一个最低限度的日常护理对照组。我们建议的R01的目标是利用以前的成功 研究并进行一项大型随机对照试验(RCT)，比较其有效性、机制和 针对标准强化戒烟治疗的综合干预成本。我们有以下几个方面 具体目标：(1)比较综合干预和标准戒烟咨询的效果 (2)确定综合干预的重要作用机制；以及 (3)与标准咨询相比，评估综合干预的成本和成本效果。 为了实现这些目标，我们将进行一项双臂、平行小组RCT。我们将招募并随机挑选900人 吸烟者(每臂450人)：(1)对照组：标准戒烟咨询或(2)干预： 综合财务-戒烟咨询。这两组人都将接受为期8周的尼古丁替代 心理治疗。我们将在基线、6个月和12个月对参与者进行调查，以评估结果和 机制，并在12个月时(我们的主要结果)对自我报告的戒酒进行生化验证。我们会 评估并比较两个治疗组的每次戒烟成本。

PROJECT SUMMARY People with low income are three times more likely to smoke than people with high income. The income disparity in tobacco use has persisted over the past 50 years—in part because there have been limited efforts to design cessation interventions that address the sociocontextual determinants of smoking among low-income adults. Tobacco use not only causes extreme health consequences for low-income people, but it can also exacerbate their financial strain by using funds on tobacco that could go towards essentials. Low-income smokers also face unique barriers to cessation, including high levels of financial distress and other social needs, which results in the use of smoking as a coping mechanism. Behavioral economics further finds that people experiencing financial strain have an increased focus on immediate needs at the expense of delayed goals (such as the long- term health benefits of cessation)—resulting in limited cognitive “bandwidth” to attend to smoking cessation. Interventions that alleviate financial stress and help low-income smokers attend to the benefits of quitting may improve quit rates in this vulnerable population. We previously conducted a randomized study testing a novel intervention that integrates financial coaching into a smoking cessation program for low-income smokers. At follow-up, intervention participants were more likely to have quit smoking, report lower levels of financial stress, and report higher levels of financial satisfaction than a minimal usual care control group. Our goal with the proposed R01 is to leverage the successes of the prior study and conduct a large randomized controlled trial (RCT) comparing the effectiveness, mechanisms, and costs of the integrated intervention against standard intensive cessation treatment. We have the following Specific Aims: (1) Compare the effectiveness of the integrated intervention to standard cessation counseling on long-term abstinence; (2) Identify the significant mechanisms of action of the integrated intervention; and (3) Estimate the cost and cost-effectiveness of the integrated intervention compared to standard counseling. To accomplish these aims, we will conduct a two-arm, parallel-group, RCT. We will recruit and randomize 900 smokers (n=450 per arm) to either: (1) Control: Standard Smoking Cessation Counseling or (2) Intervention: Integrated Financial-Smoking Cessation Counseling. Both groups will receive 8 weeks of nicotine replacement therapy. We will survey participants at baseline, 6 months, and 12 months to assess outcomes and mechanisms, and biochemically verify self-reported abstinence at 12 months (our primary outcome). We will assess and compare the cost-per-quit in the two treatment arms.