Small Financial Incentives to Promote Smoking Cessation in Safety Net Hospital Patients

促进安全网医院患者戒烟的小额经济激励

基本信息

批准号：
9317447
负责人：
Darla Elizabeth Kendzor
金额：
$ 30.38万
依托单位：
UNIVERSITY OF OKLAHOMA HLTH SCIENCES CTR
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-11-16 至 2020-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9317447
关键词：
Abstinence Adherence Adoption Adult Applications Grants Attention Biochemical Cellular Phone Cessation of life Clinic Data Collection Ecological momentary assessment Economically Deprived Population Effectiveness Exposure to Financial cost Gifts Goals Health Healthcare Systems Hospitals Incentives Individual Intervention Intervention Studies Link Malignant Neoplasms Malignant neoplasm of esophagus Malignant neoplasm of larynx Malignant neoplasm of lung Malignant neoplasm of urinary bladder Methods Motivation Nicotine Dependence Outcome Participant Patients Population Poverty Prevalence Questionnaires Randomized Randomized Controlled Trials Renal carcinoma Reporting Research Research Personnel Resources Sampling Self Efficacy Smoke Smoker Smoking Smoking Status Stress Technology Testing Time Tobacco Tobacco Use Cessation Tobacco smoking Tobacco use United States Visit Withholding Treatment Work base behavioral/social science clinical practice contextual factors contingency management cost disability disadvantaged population financial incentive follow-up health disparity improved insight malignant mouth neoplasm negative affect primary outcome programs psychosocial public health relevance safety net smoking cessation smoking prevalence socioeconomic disadvantage stressor theories treatment adherence treatment as usual

项目摘要

DESCRIPTION (provided by applicant): Tobacco use is the leading cause of preventable death in the U.S. Although the prevalence of smoking has declined to 18.1 percent among U.S. adults, 27.9 percent of those living in poverty report current smoking. Socioeconomic disadvantage is associated with a reduced likelihood of smoking cessation. There is mounting evidence that offering incentives for abstinence (i.e., Contingency Management [CM]) may be an effective approach for promoting short-term smoking cessation, though few studies have demonstrated longer-term effectiveness. In addition, little attention has been paid to socioeconomically disadvantaged smokers specifically (e.g., safety- net hospital populations) in CM intervention studies. Our preliminary work indicates that offering small escalating financial incentives for smoking abstinence dramatically increases short-term cessation rates among socioeconomically disadvantaged smokers when incentives are included as an adjunct to standard clinic- based smoking cessation treatment. However, additional work is needed to evaluate the influence of this CM approach in the longer-term with a rigorous and adequately powered trial. Thus, the aims of the proposed study are to: 1) evaluate the longer-term impact of an adjunctive, low-cost CM intervention (relative to usual care) on smoking abstinence rates among socioeconomically disadvantaged individuals participating in a safety-net hospital smoking cessation program, and 2) identify treatment mechanisms and contextual factors associated with cessation outcomes among intervention participants using both traditional and ecological momentary assessment approaches. Participants seeking smoking cessation treatment at an urban safety net hospital (N = 320) will be randomly assigned to 1) usual care (UC; n = 160) or 2) UC plus financial incentives for biochemically-confirmed abstinence (CM; n = 160). Those randomized to the CM intervention will have the opportunity to earn small gift cards for biochemically-verified abstinence through 12 weeks post-quit. Specifically, participants may earn $20 for abstinence on the quit date, and this amount will increase by $5 with each successive abstinent visit through 4 weeks post-quit ($150 total). Participants may additionally earn $50 gift cards for abstinence at 8 and 12 weeks post-quit. Biochemically-verified 7-day point prevalence abstinence at 26 weeks post-quit (longer-term abstinence) will be the primary outcome variable, though smoking status will be assessed at all visits. We also hope to gain a better understanding of CM treatment mechanisms and to identify other factors that directly influence cessation via traditional questionnaire and smartphone-based ecological momentary assessment approaches. Smartphone technology allows for "real-time" data collection to more accurately capture important cessation-related variables, and will be used to deliver gain-framed messages to support and strengthen the CM intervention. Findings will provide insight about new treatment targets for intervention research, and will demonstrate an effective, inexpensive, and easily implementable means by which to improve longer-term smoking cessation rates among economically disadvantaged smokers.

描述（由申请人提供）：烟草使用是美国可预防死亡的主要原因，尽管美国成年人的吸烟率已下降至 18.1%，但 27.9% 的贫困人口表示，当前吸烟造成的社会经济劣势与吸烟有关。减少戒烟的可能性越来越多的证据表明，提供戒烟激励措施（即应急管理 [CM]）可能是促进短期戒烟的有效方法。戒烟，尽管很少有研究证明长期有效性。此外，在 CM 干预研究中，很少关注社会弱势吸烟者（例如安全网医院人群）。当激励措施作为标准临床戒烟治疗的辅助手段时，戒烟可显着提高社会经济地位不利的吸烟者的短期戒烟率。然而，还需要开展额外的工作来评估这种 CM 方法对戒烟的影响。因此，拟议研究的目的是：1）评估辅助性低成本 CM 干预（相对于常规护理）对戒烟率的长期影响。 2）使用传统和生态瞬时评估方法，确定参与安全网医院戒烟计划的社会经济弱势群体中与戒烟结果相关的治疗机制和背景因素。医院 (N = 320) 将被随机分配到 1) 常规护理 (UC; n = 160) 或 2) UC 加上生化确认的禁欲经济激励 (CM; n = 160)。戒烟后 12 周内，通过生化验证的戒烟，参与者有机会获得小礼品卡。戒烟后 4 周内每次连续戒烟可获 5 美元（总计 150 美元），戒烟后 8 周和 12 周经生化验证的戒烟后 26 周点流行率戒烟者还可获得 50 美元礼品卡。（长期戒烟）将是主要结果变量，尽管在每次就诊时都会评估吸烟状况，我们也希望更好地了解 CM 治疗机制并了解吸烟情况。通过传统问卷和基于智能手机的生态瞬时评估方法确定直接影响戒烟的其他因素智能手机技术允许“实时”数据收集以更准确地捕获与戒烟相关的重要变量，并将用于传递增益框架消息。支持和加强 CM 干预。研究结果将为干预研究提供新的治疗目标的见解，并将展示一种有效、廉价且易于实施的方法，以提高经济弱势吸烟者的长期戒烟率。