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

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 USA. 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 0–100mm visual analog scale. Findings Abstinence rates differed at 4 weeks between the AC (39.6%) and SC (13.0%) groups (odds ratio=4.4, 95% CI=1.6–12.3), but not at the 3- (29.2% AC and 19.6% SC, odds ratio=1.7, 95% CI=.6–4.4), or 6- (22.9% AC and 13.0% SC, odds ratio=2.0, 95% CI=.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, odds ratio = 3.5, 95% CI=3.1–4.0; 43.4% AC and 24.6% SC, odds ratio = 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%–23.8%, x2=.75, p = .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.

Technology‐based contingency management and e‐cigarettes during the initial weeks of a smoking quit attempt

“…Participants also rated several aspects of the CM intervention favorably. These results are consistent with several other studies that have examined the social validity of technology‐based CM (e.g., Dallery et al, , ; Raiff, Jarvis, Turturici, & Dallery, ). Participants largely agreed or very strongly agreed that Mōtiv8 was easy, they liked the CO meter, they liked the CO progress graph, and that the program was helpful.…”

“…Second, we did not employ a shaping phase during which gradual reductions in smoking were reinforced. In our previous research, we arranged a 3‐4‐day phase in which reductions from baseline CO were reinforced, and by the end of the phase CO levels needed to indicate abstinence for reinforcement (Dallery et al, , ; Jarvis & Dallery, ). This procedure was included to increase the likelihood that behavior would contact the contingency.…”

A Mobile Game to Support Smoking Cessation: Prototype Assessment (Preprint)

“…One of the most efficacious aids for initiating smoking abstinence is contingency management (CM) [10][11][12]. CM for smoking cessation consists of delivering rewards (typically money) contingent on objective evidence of smoking abstinence (e.g., low levels of the combustion product carbon monoxide (CO) in the exhaled breath).…”

“…Monetary reward payments for smoking cessation can range from $100-500 per person for approximately 2-12 week interventions [11,17,18]. The cost of these payments limits the feasibility of widespread CM adoption.…”

“…Carbon monoxide (CO) is one method to biochemically verify abstinence; however, the half-life of CO is short (~3-6 hours), requiring at least twice daily check-ins to verify abstinence [20]. To address this barrier, Dallery and colleagues developed an efficacious CM intervention that is delivered over the Internet [11,17,21,22], in which participants are provided with a breath CO monitor, and remotely record and submit video clips of themselves providing their breath CO samples twice daily. More recently, mobile CM for smoking cessation (where participants use the camera on their smartphone to record and submit the video clips) has been shown to be feasible, acceptable, and show promise in promoting smoking abstinence [23][24][25].…”