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

Jesse Dallery, Bethany R. Raiff, Sunny Jung Kim, Lisa A. Marsch, Maxine L Stitzer, Michael J. Grabinski

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)875-883
Number of pages9
JournalAddiction
Volume112
Issue number5
DOIs
StatePublished - May 1 2017

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Smoking Cessation
Carbon Monoxide
Internet
Randomized Controlled Trials
Confidence Intervals
Odds Ratio
Motivation
Clinical Protocols
Visual Analog Scale
Tobacco Products
Control Groups
Therapeutics
Pharmaceutical Preparations

Keywords

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

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health

Cite this

Nationwide access to an internet-based contingency management intervention to promote smoking cessation : a randomized controlled trial. / Dallery, Jesse; Raiff, Bethany R.; Kim, Sunny Jung; Marsch, Lisa A.; Stitzer, Maxine L; Grabinski, Michael J.

In: Addiction, Vol. 112, No. 5, 01.05.2017, p. 875-883.

Research output: Contribution to journalArticle

Dallery, Jesse ; Raiff, Bethany R. ; Kim, Sunny Jung ; Marsch, Lisa A. ; Stitzer, Maxine L ; Grabinski, Michael J. / Nationwide access to an internet-based contingency management intervention to promote smoking cessation : a randomized controlled trial. In: Addiction. 2017 ; Vol. 112, No. 5. pp. 875-883.
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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.",
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T1 - Nationwide access to an internet-based contingency management intervention to promote smoking cessation

T2 - a randomized controlled trial

AU - Dallery, Jesse

AU - Raiff, Bethany R.

AU - Kim, Sunny Jung

AU - Marsch, Lisa A.

AU - Stitzer, Maxine L

AU - Grabinski, Michael J.

PY - 2017/5/1

Y1 - 2017/5/1

N2 - 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.

AB - 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.

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KW - contingency management

KW - deposit contract

KW - financial incentives

KW - technology

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