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| Contingency Management for Smoking in Vulnerable Populations |
| Sunday, May 24, 2015 |
| 9:00 AM–9:50 AM |
| 008A (CC) |
| Area: BPH/CBM; Domain: Applied Research |
| Chair: Rachel Cassidy (Brown University) |
| Abstract: Extending the reach of contingency management (CM) for smoking to vulnerable populations and increasing the effectiveness of CM were among the goals of the current studies. The first study examined predictors of smoking abstinence in college students, and found that heavy drinking days were negatively associated with abstinence. A second study found that extended exposure to CM maintained initial gains in smoking abstinence among opioid-maintained smokers. Results from a third study indicated that increasing the reinforcer magnitude increased the effectiveness of CM for pregnant smokers. In sum, CM continues to show promise for reducing smoking in vulnerable populations. |
| Keyword(s): Contingency Management, Health Behavior, Smoking, Vulnerable Populations |
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| Contingency Management for College Student Smokers: Predictors of Abstinence During Treatment |
| RACHEL CASSIDY (Brown University), Suzanne Colby (Brown University), Damaris Rohsenow (Brown University), Jennifer Tidey (Brown University), Peter Monti (Brown University), Nancy Barnett (Brown University), Mollie Patrick (Brown University) |
| Abstract: College student (N=110) daily smokers were randomized to a three-week smoking contingency management intervention or a noncontingent control. Breath carbon monoxide samples were taken twice daily. Participants earned $5 per sample. Participants in the noncontingent group received these payments just for providing a sample. During the first week, participants in the contingent group were paid for smoking reductions, with only abstinence (CO ≤ 5 ppm) receiving incentives thereafter. Participants in the contingent group had significantly more abstinent days (β= .48, t = 5.9, p <.0001). Greater baseline motivation to quit and lower baseline nicotine dependence were associated with more abstinent days (controlling for condition; β= 1.83, t = 2.3, p <.03; β = -.443, t = -2.3, p < .03). In the contingent group, more heavy drinking days predicted fewer abstinent days (controlling for dependence and motivation; β= -.228, t = -1.07, p <.03). Future contingency management interventions for smoking in this population may benefit from addressing heavy drinking. |
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| Using Financial Incentives to Sustain Smoking Abstinence in Opioid-Maintained Patients |
| ANDREW MEYER (University of Vermont), Stacey C. Sigmon (University of Vermont) |
| Abstract: Prevalence of cigarette smoking among opioid-maintained patients is more than 3-fold that of the general population and associated with significant morbidity and mortality. Our group has developed a behavioral-economic intervention to promote smoking cessation in this challenging population. The current study evaluated whether ongoing maintenance with contingent reinforcement was necessary for sustaining initial smoking abstinence. During Weeks 1-2 (Phase 1), participants provided daily breath CO and urinary cotinine specimens and earned voucher-based incentives contingent on biochemically-verified smoking abstinence. On Day 14, participants were randomized to Extended Contingent (EC) or Extended Noncontingent (EN) groups for Weeks 3-12 (Phase 2). EC participants continued receiving vouchers contingent on abstinence; EN participants received vouchers independent of smoking status and yoked to the EC group. Sixty-three participants were enrolled and randomized (34.4 yrs old, 41% male, 18.2±9.5 cigs/day). At the end of Phase 1, 61.9% of participants were smoking-negative. In Phase 2, EC participants achieved significantly greater levels of smoking abstinence than EN (46.7% vs. 23.5% negative samples, respectively; p=0.023). These results replicate the favorable initial abstinence outcomes seen in our prior studies with opioid-dependent smokers. They also suggest the need for ongoing, intermittent reinforcement of abstinence to sustain the abstinence achieved early on. |
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| Contingency Management for Pregnant Smokers: Tailoring the Incentive Value to Smoking Rate |
| RYAN REDNER (University of Vermont), Stephen T. Higgins (University of Vermont) |
| Abstract: Cigarette smoking is the leading cause of preventable adverse outcomes in pregnancy. While prior trials of financial incentives during pregnancy were promising there is ample room for improvement. The primary predictor of poor treatment outcomes is number of cigarettes smoked per day during pregnancy. The objective of this study was to test whether an efficacious incentives intervention could be improved by providing increased incentive amounts for women smoking at higher rates. Thirty-seven pregnant smokers from local obstetrics practices in the Burlington, VT area were recruited and randomized to the incentive or best-practice condition. Women assigned to the incentive condition received incentives if they were biochemically verified as abstinent. Women with a baseline smoking rate of 10 or more were eligible to earn twice the standard incentive value. Currently, 7 of 13 (54%) of women in the voucher condition and 2 of 19 (11%) in the best-practice condition were biochemically verified as abstinent at the early pregnancy assessment (p = 007). At the same time point 2 of 4 women receiving the higher magnitude vouchers were abstinent. Preliminary results indicate that the increase in incentive value increases the effectiveness of an already effective treatment for smoking cessation among pregnant women. |
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