Financial incentives for abstinence among socioeconomically disadvantaged individuals in smoking cessation treatment.

OBJECTIVES: We evaluated the effectiveness of offering adjunctive financial incentives for abstinence (contingency management [CM]) within a safety net hospital smoking cessation program. METHODS: We randomized participants (n = 146) from a Dallas County, Texas, Tobacco Cessation Clinic from 2011 to 2013 to usual care (UC; cessation program; n = 71) or CM (UC + 4 weeks of financial incentives; n = 75), and followed from 1 week before the quit date through 4 weeks after the quit date. A subset (n = 128) was asked to attend a visit 12 weeks after the scheduled quit date. RESULTS: Participants were primarily Black (62.3%) or White (28.1%) and female (57.5%). Most participants were uninsured (52.1%) and had an annual household income of less than $12 000 (55.5%). Abstinence rates were significantly higher for those assigned to CM than UC at all visits following the quit date (all Ps < .05). Point prevalence abstinence rates in the CM and UC groups were 49.3% versus 25.4% at 4 weeks after the quit date and 32.8% versus 14.1% at 12 weeks after the quit date. CM participants earned an average of $63.40 ($150 possible) for abstinence during the first 4 weeks after the scheduled quit date. CONCLUSIONS: Offering small financial incentives for abstinence might be an effective means to improve abstinence rates among socioeconomically disadvantaged individuals participating in smoking cessation treatment.

Daily nicotine patch wear time predicts smoking abstinence in socioeconomically disadvantaged adults: An analysis of ecological momentary assessment data.

INTRODUCTION: Individuals who use the nicotine patch are more likely to quit smoking than those who receive placebo or no medication. However, studies have not yet examined the association between actual daily nicotine patch wear time during the early phase of a smoking cessation attempt and later smoking abstinence. The purpose of this study was to address this gap in the literature. METHODS: Participants who enrolled in a safety-net hospital smoking cessation program were followed for 13 weeks (i.e., 1 week pre-quit through 12 weeks post-quit). Participants completed in-person assessments and daily ecological momentary assessments on study provided smartphones. Multivariate logistic regressions were used to determine if daily patch wear time during the first week post-quit predicted 7-day biochemically verified point prevalence smoking abstinence 4 and 12 weeks following the scheduled quit date. Demographic characteristics and smoking behaviors were adjusted as covariates. RESULTS: Participants (N=74) were primarily non-White (78.7%) and most (86%) had an annual household income of <$20,000. Greater average hours of daily nicotine patch wear time during the first week post-quit was associated with a greater likelihood of abstinence at the 4 and 12 week post-quit visits (aOR=2.22, 95% CI:1.17-4.23; aOR=2.24, 95% CI:1.00-5.03). Furthermore, more days of wearing the patch for ≥19h was associated with a greater likelihood of abstinence at the 4 and 12 week post-quit visits (aOR=1.81, 95% CI:1.01-3.22; aOR=2.18, 95% CI:1.03-4.63). CONCLUSIONS: Greater adherence to the nicotine patch early in a quit attempt may increase the likelihood of smoking cessation among socioeconomically disadvantaged adults.

The influence of perceived neighborhood disorder on smoking cessation among urban safety net hospital patients.

BACKGROUND: Although research has shown that objective neighborhood characteristics are associated with health behaviors including smoking, little is known about the influence of perceived neighborhood characteristics on a smoking cessation attempt. METHODS: Participants (N=139) enrolled in a Dallas safety-net hospital smoking cessation program were followed from 1 week pre-quit through 4 weeks post-quit. Logistic regression analyses were conducted to evaluate the impact of perceived neighborhood order and disorder on the likelihood of achieving biochemically verified point prevalence and continuous smoking abstinence 4 weeks following a scheduled quit attempt. Analyses were adjusted for demographic characteristics, cigarettes per day, intervention group, and pharmacological treatment. RESULTS: Participants were primarily non-White (72.7%) and female (56.8%) with a mean age of 52.5 (SD=3.7) years. Most reported an annual household income of ≤$25,000 (86.3%). Logistic regression analyses indicated that greater neighborhood physical (p=.048) and social order (p=.039) were associated with a greater likelihood of achieving point prevalence smoking abstinence at 4 weeks post-quit. Greater perceived physical (p=.035) and social disorder (p=.039) and total neighborhood disorder (p=.014), were associated with a reduced likelihood of achieving point prevalence abstinence. Social disorder (p=.040) was associated with a reduced likelihood of achieving continuous abstinence at 4 weeks post-quit, while social order (p=.020) was associated with an increased likelihood of continuous abstinence. CONCLUSIONS: Perceptions of neighborhood order and disorder were associated with the likelihood of smoking cessation among socioeconomically disadvantaged smokers making a quit attempt. Findings highlight the need to address perceptions of the neighborhood environment among disadvantaged smokers seeking treatment.