This proposal addresses major gaps in health services research for treating nicotine addiction in populations of smokers. One of the most important debates in the field of health services for disease prevention is whether financial incentives should be contingent on participation in evidence-based programs for nicotine addiction, or on actual outcomes, like prolonged abstinence. On one side are growing numbers of employers who advocate for standards based services which reward participants who reach a public health standard like total abstinence. On the other side are long lists of non-profit organizations who support cash incentives for participation but oppose standards based incentives out of concern that significant percentages of populations with and without chronic conditions will not be able to achieve such standards and will suffer as a result. This study is aimed at one of the major gaps in knowledge in this debate, which is the lack of any randomized clinical trial that has compared the impacts of outcomes- and participation-based incentives. This population- based, randomized clinical trial with a sample of 870 smokers will compare long-term abstinence rates in three treatment conditions: 1. Those incentivized for participation in an evidence-based treatment designed for smokers at each stage of change; 2. Those incentivized for biologically validated prolonged abstinence at 6 ($200) and 12 ($250) months who could also choose to participate in the TTM-tailored intervention; and 3. An assessment only control condition incentivized just for research participation.
The aims are: 1) To assess whether each treatment group outperforms the controls at 12, 24 and 36 months; 2) To assess whether the treatment group incentivized for participation outperforms the treatment group incentivized for outcomes at 36 months as hypothesized; 3) To compare the cost-effectiveness and cost savings of each treatment in a population of mostly unmotivated smokers; 4) To assess the long-term treatment trajectories of each treatment; and 5) To identify mediators of long-term outcomes in each treatment. Innovation in this project is reflected by how many of the aims and themes of this research parallel the NIH (2009) Report's recommendations for innovative research to advance the science of behavior change. They include: 1) the comparison of financial incentives based on treatment participation versus outcomes; 2) the study of treatment adherence and effects of participation on outcomes; 3) the use of tailoring and technology to enhance clinical services; 5) examining treatment efficacy in different subpopulations (e.g., those in different stages of change); 6) comparing cost-effectiveness and cost savings of alternative health services; 7) preparing evidence-based treatments for immediate dissemination; and 8) designing clinical trials that can have immediate impacts on major health service policies. This project has the potential to help fill major knowledge gaps relevant to one of the most critical controversies in the science and service of health behavior change for nicotine addiction.
One of the most important debates in the field of disease prevention is whether financial incentives should be contingent on participation in evidence-based programs for smoking cessation or on actual outcomes, like prolonged abstinence. This study can fill a major knowledge gap in this debate, which is the lack of any population trial that compared the impacts of outcomes- and participation-based incentives in a population of smokers. This research can help policy makers and health service providers choose the incentives approach that provides the most effectiveness, cost-effectiveness and cost-savings for entire populations of smokers.
