A behavioral economic intervention for low-income smokers - Resubmission - 1 - Revision - 1

项目摘要 低收入人群面临着独特的戒烟障碍，包括高水平的财务困境，创伤， 未满足的社会需求，导致使用吸烟作为应对机制。行为经济学进一步发现 经历经济困难的人必须以牺牲 延迟的目标（如戒烟的长期健康益处）。减轻财政负担的干预措施 艰苦条件和其他社会需求可能会提高这一人群的戒烟率。我们的R37基金正在评估 有效性，行为经济机制，以及整合干预措施的成本效益 财务辅导和转介到财务授权服务和社会服务戒烟 治疗最近的创伤行为理论表明，干预方法，改变 将重点从烟草使用的个人决定因素转移到烟草使用的社会和结构决定因素 可以通过创建一个更全面的，非判断性的， 以戒烟为导向的戒烟过程。此外，具有多种边缘化社会的参与者 身份可能有独特的经验和戒烟过程，而参与干预措施 承认一个人更广泛的生活经验和烟草使用的社会决定因素。最后，共同发生 健康状况，如睡眠卫生不良，可能与戒烟干预相互作用，但这些 相互作用在文献中研究不足。这一行政补充的总体目标是 使用定性方法来确定原始R37提案中未包含的多层次因素， 增强或限制干预对治疗参与、初始戒烟和长期戒烟的影响。 停产维护。定性结果将进一步用于为选择新的定量 措施，包括在父R37赠款的数据收集和分析方法，以提供见解， 干预为什么有效，对谁有效，在什么情况下有效。拟议补编的具体目的是 目的：1）定性研究可能增强或限制干预的干预相关和背景相关因素， 干预对治疗参与、初始戒烟和戒烟维持的影响， 与子目标1.1）探索社会因素和其他健康状况如何相互作用，以影响参与者的 干预经验，行为改变过程，以及干预的潜在作用机制。 目标2）在目标1中确定的定性主题的指导下，选择新的多层次定量指标， 包括在父R37赠款的数据收集和分析方法，以提高母项目的 了解干预的关键作用机制和背景影响。结果 预计将产生关于干预措施的重要见解，这些干预措施涉及社会背景的决定因素， 低收入吸烟者的烟草使用情况。

PROJECT SUMMARY People with low income face unique barriers to cessation, including high levels of financial distress, trauma, and unmet social needs, resulting in the use of smoking as a coping mechanism. Behavioral economics further finds that people experiencing financial hardship must attend to their immediate needs for survival at the expense of delayed goals (such as the long-term health benefits of quitting smoking). Interventions that alleviate financial hardship and other social needs may improve quit rates in this population. Our parent R37 grant is evaluating the effectiveness, behavioral economic mechanisms, and cost-effectiveness of an intervention that integrates financial coaching and referral to financial empowerment services and social services into smoking cessation treatment. Recent trauma-informed theories of behavior suggest that intervention approaches that that shift the focus away from individual determinants of tobacco use to the social and structural determinants tobacco use may improve intervention engagement and effectiveness by creating a more holistic, non-judgmental and resilience-oriented smoking cessation process. Additionally, participants with multiple marginalized social identities may have unique experiences and smoking cessation processes while participating in interventions that acknowledge one’s broader lived experience and social determinants of tobacco use. Lastly, co-occurring health conditions, such as poor sleep hygiene, may interact with tobacco cessation interventions but these interactions have been under-studied in the literature. The overall objective of this administrative supplement is to use qualitative methods to identify multi-level factors not included in the original R37 proposal that may enhance or limit the intervention’s impacts on treatment engagement, initial smoking cessation, and long-term cessation maintenance. The qualitative results will be further used to inform the selection of new quantitative measures to include in the parent R37 grant’s data collection and analytic approaches to provide insights into why the intervention works, for whom, and in which contexts. The Specific Aims of the proposed supplement are to: Aim 1) Qualitatively examine intervention-related and context-related factors that may enhance or limit the intervention’s impacts on treatment engagement, initial smoking cessation, and smoking cessation maintenance, with Sub-Aim 1.1) Explore how social factors and other health conditions may interact to influence participants’ intervention experiences, behavior change processes, and the intervention’s potential mechanisms of action. Aim 2) Guided by the qualitative themes identified during Aim 1, select new multi-level quantitative measures to include in the parent R37 grant’s data collection and analytic approaches to enhance the parent project’s understanding of the intervention’s key mechanisms of action and contextual influences. The results are expected to generate important insights about interventions that address sociocontextual determinants of tobacco use in people with low income who smoke.