A behavioral economic intervention for low-income smokers

针对低收入吸烟者的行为经济干预

基本信息

批准号：
10540748
负责人：
Erin Rogers
金额：
$ 69.33万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-12-14 至 2026-11-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10540748
关键词：
Abstinence Address Adult Attention Biochemical Budgets Cognitive Counseling Data Eligibility Determination Enrollment Face Financial Hardship Funding Goals Health Health Benefit Income Intervention Investigation Knowledge Link Low Income Population Low income Motivation Outcome Outcome Assessment Participant Patient Self-Report Persons Randomized Randomized, Controlled Trials Reporting Services Smoke Smoker Smoking Surveys Testing Tobacco Tobacco Use Cessation Tobacco use Treatment Efficacy Vulnerable Populations acceptability and feasibility arm behavioral economics compare effectiveness comparison intervention coping mechanism cost cost comparison cost effectiveness cost estimate design discounting economic determinant effectiveness testing empowerment experience follow-up group intervention health care settings improved income disparities innovation intervention participants long term abstinence nicotine replacement novel primary outcome programs recruit reduce tobacco use safety net satisfaction smoking cessation social success theories treatment arm treatment as usual usual care arm

项目摘要

PROJECT SUMMARY People with low income are three times more likely to smoke than people with high income. The income disparity in tobacco use has persisted over the past 50 years—in part because there have been limited efforts to design cessation interventions that address the sociocontextual determinants of smoking among low-income adults. Tobacco use not only causes extreme health consequences for low-income people, but it can also exacerbate their financial strain by using funds on tobacco that could go towards essentials. Low-income smokers also face unique barriers to cessation, including high levels of financial distress and other social needs, which results in the use of smoking as a coping mechanism. Behavioral economics further finds that people experiencing financial strain have an increased focus on immediate needs at the expense of delayed goals (such as the long- term health benefits of cessation)—resulting in limited cognitive “bandwidth” to attend to smoking cessation. Interventions that alleviate financial stress and help low-income smokers attend to the benefits of quitting may improve quit rates in this vulnerable population. We previously conducted a randomized study testing a novel intervention that integrates financial coaching into a smoking cessation program for low-income smokers. At follow-up, intervention participants were more likely to have quit smoking, report lower levels of financial stress, and report higher levels of financial satisfaction than a minimal usual care control group. Our goal with the proposed R01 is to leverage the successes of the prior study and conduct a large randomized controlled trial (RCT) comparing the effectiveness, mechanisms, and costs of the integrated intervention against standard intensive cessation treatment. We have the following Specific Aims: (1) Compare the effectiveness of the integrated intervention to standard cessation counseling on long-term abstinence; (2) Identify the significant mechanisms of action of the integrated intervention; and (3) Estimate the cost and cost-effectiveness of the integrated intervention compared to standard counseling. To accomplish these aims, we will conduct a two-arm, parallel-group, RCT. We will recruit and randomize 900 smokers (n=450 per arm) to either: (1) Control: Standard Smoking Cessation Counseling or (2) Intervention: Integrated Financial-Smoking Cessation Counseling. Both groups will receive 8 weeks of nicotine replacement therapy. We will survey participants at baseline, 6 months, and 12 months to assess outcomes and mechanisms, and biochemically verify self-reported abstinence at 12 months (our primary outcome). We will assess and compare the cost-per-quit in the two treatment arms.

项目概要低收入人群吸烟的可能性是高收入人群的三倍。过去 50 年来，烟草使用的影响一直持续存在——部分原因是设计方面的努力有限。解决低收入成年人吸烟的社会背景决定因素的戒烟干预措施。烟草使用不仅对低收入人群造成极端的健康后果，而且还会加剧低收入吸烟者也面临着将资金用于购买必需品的烟草的财务压力。戒烟所特有的情况，包括严重的财务困境和其他社会障碍，从而导致使用吸烟作为应对机制的行为经济学进一步发现，人们经历的。财务压力使人们更加关注眼前的需求，而牺牲了延迟的目标（例如长期目标）戒烟对健康的好处）——导致戒烟的认知“带宽”有限。减轻经济压力并帮助低收入吸烟者享受戒烟好处的干预措施可能会提高这一弱势群体的戒烟率。我们之前进行了一项随机研究，测试了一种新颖的干预措施，该干预措施将财务辅导融入针对低收入吸烟者的戒烟计划在随访中，干预参与者更有可能。与其他人相比，已戒烟、财务压力较低、财务满意度较高我们提出的 R01 的目标是利用先前的成功。研究并进行大型随机对照试验（RCT），比较有效性、机制和针对标准强化戒烟治疗的综合干预的成本如下。具体目标： (1) 比较综合干预与标准戒烟咨询的有效性 (2) 确定综合干预的重要作用机制； (3) 与标准咨询相比，估计综合干预的成本和成本效益。为了实现这些目标，我们将进行一项双臂平行组随机对照试验，我们将招募 900 名受试者并进行随机分组。吸烟者（每组 n = 450 名）：(1) 控制：标准戒烟咨询或 (2) 干预：两组都将接受为期 8 周的尼古丁替代疗法。我们将在基线、6 个月和 12 个月时对参与者进行调查，以评估结果和结果。机制，并在 12 个月时通过生化方法验证自我报告的戒断情况（我们的主要结果）。评估并比较两个治疗组的每次戒烟成本。