Cigarette smoking remains the most common source of preventable morbidity and mortality in the United States, with in excess of $167 billion in economic costs per year. Contingency management (CM), in which tangible incentives are provided contingent on a target behavior like abstinence, is highly efficacious in improving substance abuse treatment outcomes and is receiving increased attention for smoking cessation. Expired carbon monoxide (CO) is the most common objective smoking status test used in smoking research and treatment. Unfortunately, multiple CO tests/day are typically required to detect all smoking and reinforce sustained abstinence. The resulting logistical and resource limitations greatly limit the application of this potentially powerful quit smoking toolset. This study addresses these limitations by examining the effectiveness of using interactive voice response technology (IVR) to implement CM. Smokers who want to quit (N = 90 randomized) will receive 2 quit preparation sessions based on public health guidelines for smoking cessation and set a target quit date (TQD). Participants will be randomly assigned to 1 of 2 treatment conditions: (a) IVR- S consisting of objective smoking status monitoring using IVR, telephone counseling and transdermal nicotine and (b) IVR-CM, consisting of the same monitoring, telephone counseling and transdermal nicotine plus IVR- based CM for smoking abstinence (CO d 6ppm). All participants will (1) objectively monitor and report smoking status 1-3x/day via cell phone and IVR (weeks 1-4), (2) receive biweekly telephone counseling (weeks 1-4), and (3) receive transdermal nicotine (weeks 1-8), starting on the TQD. All participants will receive CO testing equipment and a study cell phone and training on how to self-test CO and use the IVR system. CO self-tests will be 1-3 times/day at pseudo-random times prompted by the IVR system. CO self-tests will be video-taped using the cell phone video capture function, results reported to the IVR system, and video records e-mailed to research staff via the study cell phone daily. In the IVR-CM condition, participants will also have the opportunity to win prizes ($1, $20, and $100 in value) for negative tests. The IVR system will generate preliminary values of incentives earned for negative tests and report the values to IVR-CM participants daily. Incentive values will be finalized after comparison of IVR reports and video records and delivered to participants at least once weekly. Nicotine withdrawal, motivation to change, urges to smoke, and substance/medication use will be assessed at Intake, Week 4 (end of counseling and daily monitoring), Week 8, Week 12 and Week 24 (follow- up). Primary outcomes will be 7-day objectively verified point-prevalence smoking abstinence rates at Week 4 (short-term) and Weeks 8, 12, and 24 (longer-term), and longest duration of sustained smoking abstinence (during treatment). Counseling and CO testing compliance will also be examined. It is hypothesized that abstinence rates will be higher in the IVR-CM condition compared to the IVR-S, supporting a combined IVR CM approach, and thereby greatly increasing the applicability of these powerful smoking cessation tools.

Public Health Relevance

Cigarette smoking is the leading cause of preventable morbidity and mortality in the U.S., with economic costs exceeding $167 billion annually. Contingency management procedures that reinforce smoking abstinence based on the most common objective test of smoking status - expired carbon monoxide (CO) levels - have the potential to improve smoking abstinence rates when applied alone or in conjunction with pharmacotherapy, but technological limitations severely limit the application of these procedures. If results of this study suggest that using interactive voice technology (IVR) to remotely conduct CM and CO testing procedures is effective, the public health impact could be the more widespread applicability of this potentially powerful intervention to promote smoking cessation.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZRG1-RPIA-K (09))
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Grossman, Debra
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University of Connecticut
Internal Medicine/Medicine
Schools of Medicine
United States
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