Unconventional Financial Incentives for Smoking Cessation

Study Overview
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Brief Summary
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The proposed study is a randomized study of actively smoking veterans cared for at the Miami VA Medical Center. Subjects are randomized into 2 groups and will all receive a regimen of nicotine replacement therapy (NRT) standardized to their smoking habit. Subjects are followed biweekly for smoking cessation by using biochemical tests (exCO and COHb) to determine smoking abstinence. The first group called the Banked-Money Group will have $50 placed in a 'bank account' for every clinic visit where their tests reveal abstinence from smoking. As a modified commitment contract, the Banked-Money Group can only withdraw the accrued money at the end of the trial if they complete the trial by quitting smoking for the entire 6 months. The second group called the Reward Group will directly receive $50 for every clinic visit where their tests reveal abstinence from smoking.

Official Title
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Bad is Stronger Than Good: Unconventional Financial Incentives for Smoking Cessation

Conditions
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Smoking Cessation

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Enrollment criteria include subjects 18 years of age or older, currently smoking at least a half a pack of cigarettes a day, who have at least a ten-pack year smoking history, are interested in quitting smoking, agree to submit to exhaled breath and ABG analysis and have reliable means of visiting the clinic every two weeks. Subjects must be able to tolerate NRT including patches and lozenges and meet with the VA smoking cessation counselor. Exclusion Criteria: Subjects will not be enrolled if they are currently taking varenicline as the VA disallows concurrent use of varenicline and NRT.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Banked-money group<br>This group will have $50 placed in a 'bank account' for every clinic visit where their tests reveal abstinence from smoking. As a modified commitment contract, the Banked-Money Group can only withdraw the accrued money at the end of the trial if they complete the trial by quitting smoking for the entire 6 months. | |
| Reward group<br>This group will directly receive $50 for every clinic visit where their tests reveal abstinence from smoking. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Smoking cessation rate | The primary outcome for this study is to compare smoking cessation rates between smokers who received one of two financial incentive strategies in addition to standard of care NRT and counseling. | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Household income | We will determine whether household income affect quit rates. | 1 year | 
| Smoking habits | We will determine whether smoking habits affect quit rates. | 1 year | 
| Nicotine dependence | We will determine whether nicotine dependence affect quit rates. | 1 year | 
| Nicotine withdrawal symptoms | We will determine whether nicotine withdrawal symptoms affect quit rates. | 1 year | 
| Anxiety / Depression | We will determine whether anxiety and / or depression affect quit rates. | 1 year |