Multicomponent Smoking Cessation Treatment Including Mobile Contingency Management in Homeless Veterans

Abstract

Introduction Smoking rates are 80% among persons who are homeless, and these smokers have decreased odds of quitting smoking. Little is known about relapse rates among homeless smokers, but the dearth of research indicates that more information regarding quit rates in this population is needed. Furthermore, innovative methods are needed to treat smoking cessation among homeless smokers. Web-based contingency management (CM) approaches have been found helpful in reducing smoking among other difficult-to-treat smoker populations but have been generally limited by the need for computers or frequent clinic based carbon monoxide (CO) monitoring. This pilot study builds on a web-based CM approach by evaluating a smart phone based application for CM named mobile CM (mCM). Methods Following a one-week training period, 20 homeless veteran smokers participated in a multi-component smoking cessation intervention including 4 weeks of mCM. All smokers received 4 smoking cessation counseling sessions, nicotine replacement and bupropion (if medically eligible). Participants could earn up to $815 ($480 for mCM, $100 for CO readings showing abstinence at posttreatment and follow up, and $35 for equipment return). Mean compensation for the mCM component was $286 of a possible $480. Results Video transmission compliance was high during the one-week training (97%) and the four-week treatment period (87%). Bioverified 7-day point prevalence abstinence was 50% at four weeks. Follow up bioverified single assessment point prevalence abstinence was 65% at three months and 60% at six months. Conclusions mCM may be a useful adjunctive smoking cessation treatment component for reducing smoking among homeless smokers.

Smoking Cessation in Homeless Veterans

“…Should the relevant studies be conducted only in other populations that may not be as vulnerable and then applied on a clinical basis for homeless individuals? The authors of this study 2 appear to have been reasonable in applying the ethical principles of respect, beneficence, and justice in conducting the research. They expend more than is customary on their local institutional review board review.…”

“…In this issue of the Journal, Carpenter and colleagues 2 report an open trial of a multicomponent smoking cessation program for 20 homeless veterans. A novel feature of the study was the development of a smartphone application to facilitate mobile contingency management (mCM) therapy.…”

A Comprehensive Approach to Tobacco Cessation for the Homeless

“…Highlighting the evidence-based practices employed by the contingency management model proposed by Carpenter et al, 1 including pharmacotherapy and behavioral counseling, is important. In addition to medications, there were a total of 13 contact points where participants' smoking status was assessed or biologically verified.…”

“…All of these are well-documented evidence-based practices that improve outcomes, supporting the value of this contingency management model as an effective approach for homeless smokers. 1,11 …”

“…arpenter et al 1 report a study of contingency management (CM) as a potential modality for delivering tobacco cessation treatment to homeless smokers. Contingency management is an intensive behavioral intervention for difficult-to-treat smokers 2 and may be an effective model for delivery of care to this underserved population for whom little guidance exists for effective treatment approaches.…”