Using Group Commitment for Smoking Cessation

Study Overview
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Brief Summary
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This study proposes a novel behavioral intervention to help smokers in Thailand to achieve their goals of quitting. Smoking treatment programs are rare throughout most of Asia and unlikely to meet the impending demand for quitting that tobacco control regulations is stimulating. New approaches are needed. The present study is a randomized controlled trial to test the effectiveness of a novel, scalable approach to smoking cessation that is targeted toward rural Southeast Asian communities. Thailand is used as a test case to explore if pairs of smokers quit successfully after making financially-backed commitments and receiving cash incentives to quit. The control group receives education and counseling about quitting. In addition to education and counseling about quitting, the intervention includes two key components: Each participant is encouraged to deposit his cigarette money on a weekly basis, to be returned only if the smoker quits successfully within three months. Such commitment contracts, based on theory from behavioral economics, are designed to help a person to maintain self-control and motivation in the face of temptation. Each participant is paired with another study participant. If both quit, each receives a cash bonus. The joint incentives are designed to lead partners to support each other throughout the quit attempt. Thus, group commitment contracts marshal a robust blend of elements: financial commitment, social support, peer pressure, and monetary rewards. A larger, follow-up evaluation will clarify the relative importance of each of these elements.

Official Title
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Using Group Commitment for Smoking Cessation

Conditions
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Smoking

Intervention / Treatment
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* Behavioral: Group commitment contract
* Behavioral: Smoking cessation education and counseling


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Current smoker of at least 10 cigarettes per week and at least 100 cigarettes over the course of a lifetime Residents of the study area in Nakhon Nayok province, which includes the six subdistricts of Klong Yai, Chumpon, Bueng San, Pak Phli, Khao Phoem, or Ongkharak Exclusion Criteria: Pregnant Plans to leave the study area within the next 12 months

Ages Eligible for Study
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Minimum Age: 20 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group commitment contracts<br>In addition to education and counseling, the intervention includes the following components: Each participant is encouraged to deposit his cigarette money on a weekly basis, to be returned only if the smoker quits successfully within three months. The project gives a series of two matching contributions of 150 baht each to participants who meet certain deposit requirements. Each participant is paired with another study participant. If both quit, each receives a cash bonus of 1,200 baht. At enrollment, pairs receive brief counseling on ways to support each other during the quit attempt. | Behavioral: Group commitment contract<br>* Each participant is required to deposit at least 50 baht at enrollment. A deposit collector visits each participant on a weekly basis and collects additional deposits on a voluntary basis. All deposits are returned only if the smoker quits successfully within three months. The project gives a matching contribution of 150 baht for the initial deposit of at least 50 baht. All participants in the treatment group are further randomized to a one-month group and a three-month group. The one-month group receives an additional 150 baht of project funds if they deposit 100 baht of their money within one month of enrollment. The three-month group receives 150 baht for depositing 100 baht within three months of enrollment. Each participant is paired with another study participant. If both quit, each receives a cash bonus of 1,200 baht. At enrollment, pairs receive brief counseling on ways to support each other during the quit attempt.<br>* Other names: Partner intervention;Behavioral: Smoking cessation education and counseling<br>* Participants receive educational pamphlets on reasons to quit smoking and strategies for quitting smoking. They also receive one-time, group counseling on quitting smoking from a nurse trained in smoking cessation counseling.<br>* Other names: Smoking cessation counseling;|
| Active Comparator: Education and counseling<br>Participants in this group receive educational pamphlets about quitting smoking and one-time, group counseling from a nurse trained in smoking cessation counseling. | Behavioral: Smoking cessation education and counseling<br>* Participants receive educational pamphlets on reasons to quit smoking and strategies for quitting smoking. They also receive one-time, group counseling on quitting smoking from a nurse trained in smoking cessation counseling.<br>* Other names: Smoking cessation counseling;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Smoking Status at 6 Months | 7-day point prevalence of smoking abstinence measured 6 months after enrollment, using a NicCheck urine cotinine test. Participants who self-report having smoked in the last 7 days, as part of the follow-up survey, are considered to be continuing smokers. | 6 months after enrollment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Concordance of Smoking Status Between Partners at 6 Months | The concordance of smoking status among randomly assigned pairs: both abstain, both smoke, or one abstains and one smokes, measured using 7-day point-prevalence abstinence at 6 months after enrollment, measured using self-reported abstinence and urine cotinine testing. Participants in the control condition are assigned to a pair, but their partner's identity is never revealed during the study. | 6 months after enrollment | 
| Smoking Status at 3 Months | 7-day point prevalence of smoking abstinence measured 3 months after enrollment, using a NicCheck urine cotinine test. Participants who self-report having smoked in the last 7 days, as part of the follow-up survey, are considered to be continuing smokers. | 3 months after enrollment | 
| Concordance of Smoking Status Between Partners at 3 Months | The concordance of smoking status among randomly assigned pairs: both abstain, both smoke, or one abstains and one smokes, measured using 7-day point-prevalence abstinence at 3 months after enrollment, measured using self-reported abstinence and urine cotinine testing. Participants in the control condition are assigned to a pair, but their partner's identity is never revealed during the study. | 3 months after enrollment | 
| Smoking Status at 14 Months | 7-day point prevalence of smoking abstinence measured 6 months after enrollment, using a NicCheck urine cotinine test. Participants who self-report having smoked in the last 7 days, as part of the follow-up survey, are considered to be continuing smokers. | 14 months after enrollment |