The overall goal is to prevent future tobacco-related morbidity, mortality and medical care expenses in all smokers, but especially low-income smokers by adoption of novel, effective prevention measures delivered in non-medical venues.
We aim to accomplish this by building the empirical basis and beginning to develop a more effective motivation to quit smoking based on a financial message to quit. Developing such a low-cost, population-based, intervention would expand the number of delivery settings. Such non-medical settings could include grocery stores, banks, check-cashing locations, tax preparation offices, etc., each of which may offer its own teachable moments related to costs of smoking. The financial motivation can be tailored to special populations, e.g., double your tax refund by quitting smoking or save money for your new baby. New venues and use of an effective, low-cost intervention will aid in reducing the smoking rates of low-income smokers and will address disparities in smoking, health and income. Using online web-based experiments and surveys, we will test whether the financial incentive to quit smoking is more effective than the health incentive. We will optimize the financial message by testing the impact of both priming the recipients to think about their financial situation and by tailoring to their specific smoking pattern. Based on the findings and our expertise in addiction treatment and behavioral economics, we will begin to develop a low-cost, intervention for low-income smokers. Effective, population-based approaches reduce the strain on the overburdened health care system, consistent with the emphasis on health care reform and providing prevention programs for low-income communities.
Aim 1 : Determine whether the financial motivation to stop smoking is more effective than the health motivation. 1.a. Analyze which factors account for differences in the relative effectiveness of the financial or health message to quit smoking. Income of both the individual and the local community is a key factor, but age, gender, education, smoking status, other community measures, and state tobacco policies will be examined.
Aim 2 : Determine whether priming smokers to consider financial or health issues makes the message to quit more effective. 2.a. Analyze which factors make different priming types more effective, e.g., examine differences by income, age, gender, education, smoking status, and state tobacco policies. Exploratory Aim 3: Explore whether a tailored or general message is more effective. 3.a. Explore which factors account for differences in the effectiveness of message type with the goal of understanding for who each priming type is more effective;again income is a key factor but we will also examine other factors. Exploratory Aim 4: Begin developing a scalable, population-based smoking cessation intervention based on recognizing the opportunity cost of smoking based on findings from above and by using our expertise in economic incentives for smokers.

Public Health Relevance

Our overriding goal is the prevention of future tobacco-related morbidity, mortality and medical care expenses in all smokers, and especially low-income smokers. We will examine the extent to which financial motivation to quit smoking is more powerful than the health motivation, especially for low-income individuals, and use our findings to begin developing interventions. This will pave the way for additional research that we believe will eventually help low-income smokers to quit smoking, and thus help combat disparities in smoking, health and income.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZRG1-HDM-C (50))
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Duffy, Sarah Q
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Yale University
Public Health & Prev Medicine
Schools of Medicine
New Haven
United States
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Marti, Joachim; Sindelar, Jody (2015) Smaller Cigarette Pack as a Commitment to Smoke Less? Insights from Behavioral Economics. PLoS One 10:e0137520
Sindelar, Jody L; O'Malley, Stephanie S (2014) Financial versus health motivation to quit smoking: a randomized field study. Prev Med 59:1-4