Incentives for Participation versus Outcomes for Population Cessation of Smoking

描述(由申请人提供)：这项建议解决了治疗吸烟者尼古丁成瘾的卫生服务研究中的主要空白。在疾病预防的卫生服务领域，最重要的争论之一是，经济激励是应该取决于参与尼古丁成瘾的循证项目，还是应该取决于实际结果，比如长期戒烟。一方是越来越多的雇主，他们倡导基于标准的服务，奖励达到完全禁欲等公共卫生标准的参与者。另一边是一长串非营利组织，他们支持现金奖励参与，但反对基于标准的奖励，因为他们担心患有和不患有慢性病的人口中有相当大比例将无法达到这种标准，并将因此受到影响。这项研究的目的是针对这场辩论中知识的主要缺口之一，即缺乏任何随机临床试验来比较基于结果的激励和基于参与的激励的影响。这项以人群为基础的随机临床试验以870名吸烟者为样本，将比较三种治疗条件下的长期戒烟率：1.那些在改变的每个阶段参与为吸烟者设计的循证治疗的人；2.那些在6个月(200美元)和12个月(250美元)时受到生物验证的长期戒烟的人，他们也可以选择参加TTM量身定制的干预；以及3.只鼓励参与研究的对照条件。其目的是：1)评估每一治疗组在12、24和36个月时是否优于对照组；2)评估在36个月时激励参与的治疗组是否优于假设的36个月结果激励治疗组；3)在主要没有动机的吸烟者群体中比较每种治疗的成本效益和成本节约；4)评估每种治疗的长期治疗轨迹；以及5)找出每种治疗的长期结果的中介因素。这个项目的创新体现在这项研究的目标和主题与NIH(2009)报告中关于创新研究的建议有多少相似之处，以推动行为变化科学的发展。它们包括：1)基于治疗参与的财政奖励与结果的比较；2)治疗坚持和参与对结果的影响的研究；3)使用量身定制和技术来加强临床服务；5)检查不同亚群的治疗效果(例如，处于不同变化阶段的人群)；6)比较替代医疗服务的成本效益和成本节约；7)准备立即传播的循证治疗；以及8)设计能够对主要的医疗服务政策产生直接影响的临床试验。该项目有可能帮助填补与尼古丁成瘾的健康行为改变的科学和服务中最关键的争议之一相关的主要知识空白。

DESCRIPTION (provided by applicant): This proposal addresses major gaps in health services research for treating nicotine addiction in populations of smokers. One of the most important debates in the field of health services for disease prevention is whether financial incentives should be contingent on participation in evidence-based programs for nicotine addiction, or on actual outcomes, like prolonged abstinence. On one side are growing numbers of employers who advocate for standards based services which reward participants who reach a public health standard like total abstinence. On the other side are long lists of non-profit organizations who support cash incentives for participation but oppose standards based incentives out of concern that significant percentages of populations with and without chronic conditions will not be able to achieve such standards and will suffer as a result. This study is aimed at one of the major gaps in knowledge in this debate, which is the lack of any randomized clinical trial that has compared the impacts of outcomes- and participation-based incentives. This population- based, randomized clinical trial with a sample of 870 smokers will compare long-term abstinence rates in three treatment conditions: 1. Those incentivized for participation in an evidence-based treatment designed for smokers at each stage of change; 2. Those incentivized for biologically validated prolonged abstinence at 6 ($200) and 12 ($250) months who could also choose to participate in the TTM-tailored intervention; and 3. An assessment only control condition incentivized just for research participation. The aims are: 1) To assess whether each treatment group outperforms the controls at 12, 24 and 36 months; 2) To assess whether the treatment group incentivized for participation outperforms the treatment group incentivized for outcomes at 36 months as hypothesized; 3) To compare the cost-effectiveness and cost savings of each treatment in a population of mostly unmotivated smokers; 4) To assess the long-term treatment trajectories of each treatment; and 5) To identify mediators of long-term outcomes in each treatment. Innovation in this project is reflected by how many of the aims and themes of this research parallel the NIH (2009) Report's recommendations for innovative research to advance the science of behavior change. They include: 1) the comparison of financial incentives based on treatment participation versus outcomes; 2) the study of treatment adherence and effects of participation on outcomes; 3) the use of tailoring and technology to enhance clinical services; 5) examining treatment efficacy in different subpopulations (e.g., those in different stages of change); 6) comparing cost-effectiveness and cost savings of alternative health services; 7) preparing evidence-based treatments for immediate dissemination; and 8) designing clinical trials that can have immediate impacts on major health service policies. This project has the potential to help fill major knowledge gaps relevant to one of the most critical controversies in the science and service of health behavior change for nicotine addiction.