Alaska Native Family-Based, Financial Incentives Intervention for Smoking Cessation: an RCT

项目总结 在阿拉斯加(AK)，阿拉斯加土著和美国印第安人(Anai)的吸烟率是阿拉斯加人的两倍多 非原住民(37%比17%)。与其他土著居民不同，烟草不在传统的 仪式。目前的戒烟策略并没有降低Anai人群中的吸烟流行率。AK 地理位置(主要是边境地区和无公路地区)和气候进一步限制了治疗的途径和范围。基于 行为经济学理论，财务激励促进戒烟是一种很有前途的方法在其他 戒烟奖励一年后戒烟率增加一倍以上的人群 没有任何激励措施。这项研究的社区意见表明，家庭成员在支持吸烟方面是必不可少的 停止；与相互依赖的Anai文化价值观一致，定义为基于关系的， 协作性，依赖家庭系统而不是个人。我们的研究和其他人的文件记录了 自然形成的社会支持网络对戒烟的影响。基于家庭的激励 干预措施还没有对吸烟或其他成瘾进行评估。为了填补这一空白，拟议的研究将 评估适应文化的、基于家庭的激励措施的有效性和实施情况 戒烟干预的具体目标如下：(1)调整有效的6个月经济状况 对吸烟者及其家庭成员进行激励干预；(2)进行随机对照研究 试验(RCT)，以评估干预的可及性和有效性，并与对照条件进行比较 在干预后6个月和12个月确认长期戒烟；以及(3)评估关键 处理与干预措施的采用、实施和维护相关的指标，并进行成本- 支持进一步适应和传播的有效性分析。RCT登记的二元组(成人ANAI人 谁吸烟[指数参与者]和成年家庭成员)将按指数参与者的性别分层， 城乡位置、家庭成员居住情况以及家庭成员的吸烟状况，然后随机 至无激励控制条件(n=328对)或为期6个月的激励干预(n=328对)。所有二元体 将收到关于循证戒烟资源、社会支持战略和家庭健康的材料。 我们将在四周的时间里每周测量两组参与者的吸烟状况，并在第三和第六周进行 月份。干预指数参与者将在每个时间点获得证实戒烟的奖励， 最高750美元；家庭成员将获得等于以下人员赚取的价值的奖励(例如，燃料或其他需要) 索引参与者。我们将探索潜在的主持人(例如，索引参与者性别)和调解人(例如， 相互依赖)的干预效果。为了扩大影响范围，我们将在全州范围内招募参与者，主要是通过 社交媒体，并以虚拟方式提供干预。如果成功，我们的结果将通知部落政策采用 在正义与发展党部落卫生系统内进行干预；并可能在正义与发展党以外的阿奈人社区内使用。

PROJECT SUMMARY In Alaska (AK), smoking prevalence of Alaska Native and American Indian (ANAI) people is more than double that of non-Native adults (37% vs. 17%). Unlike other Indigenous populations, tobacco is not used in traditional ceremony. Current cessation strategies have not reduced smoking prevalence among ANAI people. AK geography (largely frontier and road-less) and climate further limit treatment access and reach. Based on behavioral economic theory, financial incentives to promote cessation is a promising approach in other populations, with smoking abstinence rates more than doubling one year after discontinued rewards compared with no incentives. Community input for this study indicate family members are essential in supporting smoking cessation; consistent with the ANAI cultural value of interdependence, defined as relationship-based, collaborative, and reliance on family systems rather than individuals. Our research and others’ document the influence of naturally occurring social support networks on smoking cessation. Family-based incentive interventions have not been evaluated for smoking or other addictions. To fill this gap, the proposed study will evaluate the effectiveness and implementation of a culturally-adapted, ANAI family-based incentives intervention for smoking cessation with the following Specific Aims: (1) Adapt an effective 6-month financial incentive intervention for ANAI people who smoke and family members; (2) Conduct a randomized controlled trial (RCT) to evaluate reach and effectiveness of the intervention compared with the control condition on confirmed, prolonged smoking abstinence at six and 12 months post-intervention; and (3) Evaluate key process indicators relevant to intervention adoption, implementation, and maintenance, and conduct a cost- effectiveness analysis to support further adaptation and dissemination. RCT-enrolled dyads (adult ANAI person who smokes [index participant] and adult family member) will be stratified by index participant’s sex, rural/urban location, residence with family member, and by family member’s smoking status, then randomized to a no incentives control condition (n=328 dyads) or a 6-month incentive intervention (n=328 dyads). All dyads will receive materials on evidence-based cessation resources, social support strategies, and family wellness. We will measure index participant smoking status in both groups weekly for four weeks, and at three and six months. Intervention index participants will receive rewards for verified smoking abstinence at each time point, up to $750; and the family member will receive rewards (e.g., fuel or other needs) equal to the value earned by the index participant. We will explore potential moderators (e.g., index participant sex) and mediators (e.g., interdependence) of intervention effects. To enhance reach, we will recruit participants statewide, primarily with social media, and deliver the intervention virtually. If successful, our results will inform Tribal policy to adopt the intervention within the AK Tribal Health System; and possibly, for use within ANAI communities beyond AK.