Incentivized Smoking Cessation for Diabetics
Condition: Smoking Cessation; Diabetes Mellitus, Type 2
MeSH terms: Diabetes Mellitus, Type 2
Study type: Interventional

Summary: 
      This pilot study aims to test the feasibility of providing incentives to patients with T2D
      contingent on remote biochemical verification using a smartphone carbon monoxide (CO)
      monitor. The investigators will use an ecological momentary assessment (EMA) smartphone
      application and CO sensor to monitor urges to smoke, stressors, smoking behaviors, and to
      validate continuous abstinence throughout the intervention. Two different contingency
      management structures will be explored to investigate the length of time incentives need to
      be offered.
    

Detailed description: 
      Individuals with type 2 diabetes (T2D) are at an increased risk of many cancers, though the
      causal link is not well understood. Continuing to smoke after a T2D diagnosis is also
      associated with accelerated progression of microvascular and macrovascular complications and
      an increased risk of death. Smoking cessation is recommended as a standard treatment for
      diabetes. However, both patients and providers are faced with other challenging lifestyle
      changes and disease management processes, which lead to greater difficulty in quitting.

      Contingency management, or a method of providing financial incentives contingent upon
      positive behaviors, has shown promise for improving adherence to medication among diabetics
      and for improving smoking cessation in other populations. This approach could offer an
      innovative and scalable means of increasing abstinence in this group, ultimately reducing
      their risk of cancer. This is a multicenter pilot randomized controlled trial that will
      recruit participants in Oklahoma and in Strathclyde, Scotland.

      This pilot study aims to test the feasibility of providing incentives to patients with T2D
      contingent on remote biochemical verification using a smartphone carbon monoxide (CO)
      monitor. The investigators will use an ecological momentary assessment (EMA) smartphone
      application and CO sensor to monitor urges to smoke, stressors, smoking behaviors, and to
      validate continuous abstinence throughout the intervention. Two different contingency
      management structures will be explored to investigate the length of time incentives need to
      be offered. Qualitative semi-structured interviews will be used to explore the patient and
      provider acceptability of an incentive-based cessation program, any unintended consequences
      and possible differences between UK and US health settings.

      The results of this research will inform the feasibility of carrying out a randomized
      controlled trial of this intervention. The ultimate aim is to develop an effective
      intervention that could be scaled to the T2D population at large, which reduces cancer risk
      and improves disease outcomes among a high-risk group.
    

Intervention name(s): Financial incentives
Intervention type(s): Behavioral
Intervention description(s): Treatment arm participants will receive financial incentives ($20 per week) contingent on biochemically verified smoking abstinence submitted once daily for the time period allocated.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: 3-arm randomized controlled trial
Masking: None (Open Label)
Primary purpose: Treatment