Financial incentives for homeless smokers: A community-based RCT

对无家可归吸烟者的经济激励：基于社区的随机对照试验

基本信息

批准号：
9898329
负责人：
TRAVIS P. BAGGETT
金额：
$ 63.14万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-04-01 至 2024-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9898329
关键词：
Abstinence Address Adult Aftercare Alkaloids Anabasine Area Behavior Therapy Behavioral Behavioral Sciences Boston Carbon Monoxide Cessation of life Clinic Clinical Trials Cognitive Collaborations Communities Control Groups Counseling Data Collection Dimensions Distant Enrollment Exhalation Future Goals Guidelines Healthcare High Prevalence Homelessness Incentives Incidence Income Intervention Interview Investigation Malignant neoplasm of lung Medical center Methods Modification Participant Patients Persons Pharmacological Treatment Population Public Health Publishing Randomized Randomized Controlled Trials Resistance Resources Rewards Sampling Schedule Shelter facility Site Smoke Smoker Smoking Testing Time Tobacco Tobacco use Urine Vulnerable Populations Work arm attributable mortality base behavioral economics cigarette smoke cigarette smoking comorbidity contextual factors design disadvantaged population disparities in morbidity experience experimental study financial incentive improved innovation malignant oropharynx neoplasm mortality multidisciplinary nicotine patch nicotine replacement payment programs recruit reduce tobacco use response retention rate smoking abstinence smoking cessation socioeconomic disadvantage standard care theories treatment effect treatment response

项目摘要

PROJECT SUMMARY / ABSTRACT Homeless people have a 3.5-fold higher prevalence of cigarette smoking in comparison to non-homeless people, contributing to 2-fold higher rates of lung cancer and 3- to 5-fold higher rates of tobacco-attributable death. Homeless smokers want to quit, but studies have not yet uncovered the optimal approach to help them do so. In a recently published 8-week pilot randomized controlled trial (RCT) at Boston Health Care for the Homeless Program (BHCHP), we found that financial incentives for smoking abstinence were associated with 7-fold higher odds of brief smoking abstinence in comparison to a non-incentivized control condition. These results suggest that financial incentives are a promising approach for reducing smoking in this vulnerable population, although further investigation in a larger sample is needed to improve the duration of on-treatment abstinence, assess post-treatment effects, and better understand mechanisms of action and contextual factors that may influence treatment response. To address these gaps, we will conduct a community-based RCT of financial incentives for smoking abstinence among adult smokers at BHCHP. We will recruit 400 participants from 3 BHCHP sites and randomize them to receive guideline-concordant standard care with (N=200) or without (N=200) financial incentives for smoking abstinence. Standard care will consist of 8 weeks of combination nicotine replacement therapy (NRT) and 5 sessions with a tobacco coach who will provide behavioral counseling, distribute NRT, and coordinate referrals to existing tobacco treatment resources. Incentive arm participants will additionally receive a 24-week schedule of 20 debit card payments contingent on short-term abstinence based on exhaled carbon monoxide levels, augmented with 16 interspersed payments contingent on longer-term abstinence based on urine anabasine levels. We will use an embedded-experiment mixed methods design, where qualitative (‘qual’) data collection is embedded within a larger quantitative (‘QUAN’) RCT with the following aims: Aim 1. (QUAN) To determine the effect of the financial incentives intervention on anabasine-verified 7-day smoking abstinence at A) the end of treatment (24 weeks) and B) 24 weeks after treatment (48 weeks). We hypothesize that incentive arm participants will have greater abstinence at both timepoints. Aim 2. (qual) To assess why, how, and under what circumstances homeless smokers A) achieve abstinence in response to financial incentives and B) maintain abstinence after incentives are stopped. To accomplish this aim, we will interview selected participants at 24 and 48 weeks, probing cognitive, procedural, and contextual dimensions of their response to financial incentives to generate hypotheses about mechanisms for on-treatment and post-treatment effects and to inform future work in this area. Our findings could have important tobacco treatment implications for the 934,000 people served annually in US Health Care for the Homeless programs, advancing NCI’s objective of reducing smoking in vulnerable populations.

项目概要/摘要无家可归者的吸烟率是非无家可归者的 3.5 倍人，导致肺癌发病率增加 2 倍，烟草相关发病率增加 3 至 5 倍无家可归的吸烟者想要戒烟，但研究尚未发现帮助他们的最佳方法。波士顿医疗保健中心最近发表了一项为期 8 周的随机对照试验 (RCT)。无家可归者计划 (BHCHP)，我们发现戒烟的经济激励与与非激励对照条件相比，短暂戒烟的几率高出 7 倍。结果表明，经济激励措施是减少这一弱势群体吸烟的一种有前途的方法人群，尽管需要对更大的样本进行进一步研究以延长治疗持续时间禁欲，评估治疗后效果，更好地了解作用机制和背景因素为了解决这些差距，我们将进行一项基于社区的随机对照试验。 BHCHP 的成年吸烟者戒烟的经济激励措施我们将招募 400 名参与者。来自 3 个 BHCHP 站点，并将它们随机分配以接受符合指南的标准护理 (N=200) 或没有 (N=200) 戒烟经济激励的标准护理将包括 8 周。联合尼古丁替代疗法 (NRT) 和 5 次由烟草教练提供的课程行为咨询、分发 NRT 并协调转介现有的烟草治疗资源。激励臂参与者还将额外收到一份为期 24 周的 20 笔借记卡付款计划，具体取决于根据呼出的一氧化碳水平进行短期戒断，并通过 16 次分散付款进行增强取决于尿液新木碱水平的长期戒断，我们将使用嵌入式实验。混合方法设计，其中定性（“定性”）数据收集嵌入到更大的定量数据中（“QUAN”）RCT 具有以下目标：目标 1.（QUAN）确定财务激励措施的效果在 A) 治疗结束时（24 周）和 B) 24 对经阿巴斯辛验证的 7 天戒烟进行干预治疗后几周（48 周），我们激励组将有更大的禁欲。目标 2.（定性）评估无家可归者吸烟的原因、方式以及在什么情况下 A) B) 在激励措施停止后保持禁欲。为了实现这一目标，我们将在 24 周和 48 周时采访选定的参与者，探讨认知、他们对经济激励的反应的程序和背景维度，以产生关于治疗中和治疗后效果的机制，并为该领域的未来工作提供信息。可能对美国医疗保健机构每年服务的 934,000 人产生重要的烟草治疗影响针对无家可归者计划，推进 NCI 减少弱势群体吸烟的目标。