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

基于阿拉斯加原住民家庭的戒烟经济激励干预措施：随机对照试验

• 批准号: 10400485
• 负责人: Christi A Patten
• 金额: $ 63.76万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10400485
• 关键词: Adopted; Adoption; Adult; Alaska; Alaska Native; American Indians; Biochemical; COVID-19; Car Phone; Cardiovascular system; Climate; Communities; Cost Effectiveness Analysis; Data; Decision Making; Effectiveness; Effectiveness of Interventions; Enrollment; Exposure to; Family; Family member; Future; Geography; Goals; Health; Health Services Accessibility; Health system; Home; Household; Incentives; Individual; Intervention; Interview; Life Style; Literature; Maintenance; Malignant neoplasm of lung; Measures; Mediator of activation protein; Morbidity - disease rate; Native-Born; Odds Ratio; Participant; Patient Recruitments; Persons; Policies; Population; Pregnant Women; Process; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Reach Effectiveness Adoption Implementation and Maintenance; Research; Resources; Rewards; Role; Rural; Smoke; Smoking; Smoking Cessation Intervention; Smoking Status; Social Distance; Social support; System; Telephone; Testing; Time; Tobacco; Work; addiction; base; behavioral economics; cigarette smoking; collaborative approach; comparison intervention; cultural values; design; digital; effectiveness evaluation; evidence base; family support; financial incentive; frontier; group intervention; health disparity; health organization; hybrid type 1 design; incentive-based intervention; indexing; intervention effect; mortality; non-Native; pandemic disease; post intervention; programs; residence; respiratory; sex; smoking abstinence; smoking cessation; smoking prevalence; social media; theories; therapy design; tribal health; urban area; urban residence; virtual intervention

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.

项目摘要 在阿拉斯加（AK），阿拉斯加原住民和美洲印第安人（Anai）人民的吸烟率是两倍多 非本地成年人（37％比17％）。与其他土著人群不同，烟草不用于传统 仪式。当前的停止策略并没有降低Anai人群的吸烟率。 AK 地理（很大程度上是边境和无路）和气候进一步限制了治疗的访问和覆盖范围。基于 行为经济理论，促进戒烟的经济激励措施是其他有前途的方法 种群中停止奖励后一年的戒烟率增加了一倍以上 没有激励措施。这项研究的社区意见表明，家庭成员对于支持吸烟至关重要 停止；与相互依赖的Anai文化价值一致，被定义为基于关系的， 协作，并依赖家庭系统而不是个人。我们的研究和其他人的文件 自然发生的社会支持网络对戒烟的影响。基于家庭的激励措施 尚未评估抽烟或其他添加的干预措施。为了填补这一空白，拟议的研究将 评估由文化适应的，基于ANAI家庭的激励措施的有效性和实施 以下特定目的进行戒烟的干预措施：（1）调整有效的6个月财务 对吸烟和家人的Anai人的激励干预； （2）进行随机控制 与对照条件相比 证实，干预后六个月和12个月的戒烟长期戒酒； （3）评估密钥 与干预，实施和维护相关的过程指标，并进行成本 - 有效分析以支持进一步的适应和传播。 RCT注册二元组（成人Anai人 谁抽烟[指数参与者]和成年家庭成员）将由指数参与者的性别分层 粗糙/城市地点，与家人的住所以及家人的吸烟状况，然后随机 没有激励措施控制条件（n = 328个二元组）或6个月的激励干预措施（n = 328个二元组）。所有二元 将获得基于证据的戒烟资源，社会支持策略和家庭健康的材料。 我们将每周在两组中衡量索引参与吸烟状态，持续四个星期，在三个和六个星期中 月份。干预指数参与者将在每个时间点获得验证的戒烟奖励， 最高$ 750;家庭成员将获得等于所获得的价值的奖励（例如燃料或其他需求） 指数参与者。我们将探索潜在的主持人（例如，指数参与者性别）和调解人（例如， 干预效应的相互依存关系。为了提高覆盖范围，我们将在全州招募参与者，主要是 社交媒体，并实际上进行干预。如果成功，我们的结果将为部落政策提供信息，以通过 在AK部落卫生系统内进行干预；并且可能在AK以外的Anai社区中使用。