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Addiction. 2017 May;112(5):875-883. doi: 10.1111/add.13715. Epub 2017 Jan 25.

Nationwide access to an internet-based contingency management intervention to promote smoking cessation: a randomized controlled trial.

Author information

1
University of Florida, Gainesville, FL, USA.
2
National Development and Research Institutes, New York, NY, USA.
3
Rowan University, Glassboro, NJ, USA.
4
The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
5
The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
6
Red5hift LLC, Hanover, NH, USA.

Abstract

BACKGROUND AND AIMS:

Contingency management (CM) is one of the most effective behavioral interventions to promote drug abstinence, but availability of this treatment is limited. We evaluated the efficacy and acceptability of internet-based CM relative to an internet-based monitoring and goal-setting control group in a nationwide sample of cigarette smokers.

DESIGN:

Randomized controlled trial with 3- and 6-month follow-ups.

SETTING:

United States.

PARTICIPANTS:

Smokers (n = 94) from 26 states were enrolled (mean age 36, 56% female).

INTERVENTION AND COMPARATOR:

Participants were randomized to earn financial incentives (up to $480 over 7 weeks) based on video-verified abstinence using breath carbon monoxide (CO) output (n = 48; abstinent contingent group, AC), or based on submitting CO samples (n = 46, submission contingent, SC). Both groups also received the same CO-based goals. A $50 deposit was required in both groups that could be recouped from initial earnings.

MEASURES:

The primary outcome was point prevalence at week 4. Secondary outcomes were point prevalence at the 3- and 6-month follow-ups, percentages of negative CO samples, adherence to the CO sampling protocol, and treatment acceptability ratings on a 0-100-mm visual analog scale.

FINDINGS:

Abstinence rates differed at 4 weeks between the AC (39.6%) and SC (13.0%) groups [odds ratio (OR) = 4.4, 95% confidence interval (CI) = 1.6-12.3], but not at the 3- (29.2% AC and 19.6% SC, OR = 1.7, 95% CI = 0.6-4.4) or 6- (22.9% AC and 13.0% SC, OR = 2.0, 95% CI = 0.7-5.9) month follow-ups. During the two main treatment phases, there were significant differences in negative COs (53.9% AC and 24.8% SC, OR = 3.5, 95% CI = 3.1-4.0; 43.4% AC and 24.6% SC, OR = 2.3, 95% CI = 1.6-3.4). Adherence to the CO submission protocol was equivalent (78% AC and 85% SC, difference = 7.0%, 95% CI = -10.3 to 23.8 %, F < 1, P = 0.39). The lowest acceptability ratings were for the items assessing the deposit, whereas the highest ratings concerned the ease of the intervention, the graph of CO results, and earning money.

CONCLUSIONS:

A contingency management/financial incentive program delivered via the internet improved short-term abstinence rates compared with an internet program without the incentives.

KEYWORDS:

Cigarette smoking; contingency management; deposit contract; financial incentives; technology; treatment

PMID:
27923264
PMCID:
PMC5382065
DOI:
10.1111/add.13715
[Indexed for MEDLINE]
Free PMC Article

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