1
|
Ussher M, Best C, Lewis S, McKell J, Coleman T, Cooper S, Orton S, Bauld L. Effect of 3 months and 12 months of financial incentives on 12-month postpartum smoking cessation maintenance: A randomized controlled trial. Addiction 2024. [PMID: 38623627 DOI: 10.1111/add.16487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/22/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND AND AIMS Offering financial incentives is effective for smoking cessation during pregnancy. We tested the effectiveness of financial incentives for maintaining postpartum cessation, comparing 12-month and 3-month incentives with each other and with usual care (UC). DESIGN, SETTING AND PARTICIPANTS This study was a pragmatic, multi-centre, three-arm randomized controlled trial involving four English, National Health Service, stop smoking services. A total of 462 postpartum women (aged ≥ 16 years) took part, who stopped smoking during pregnancy with financial incentives, validated as abstinent from smoking at end of pregnancy or early postpartum. INTERVENTIONS Interventions comprised (i) UC; (ii) UC plus up to £60 of financial voucher incentives offered to participants and £60 offered to an optional significant-other supporter, over 3 months postpartum, contingent upon validated abstinence ('3-month incentives'); or (iii) UC plus '3-month incentives' plus £180 of vouchers offered to participants over 9 months postpartum, contingent upon abstinence ('12-month incentives'). MEASUREMENTS Primary outcome: biochemically validated abstinence at 1 year postpartum. To adjust for testing all comparisons between groups with equal precision, P < 0.017 was necessary for significance. SECONDARY OUTCOMES self-reported and validated abstinence at 3 months postpartum; self-reported abstinence at 1 year postpartum. FINDINGS Primary outcome ascertainment: abstinence was 39.6% (63/159) 12 months incentives, 21.4% (33/154) 3 months incentives and 28.2% (42/149) UC. Adjusted odds ratios [95% confidence interval (CI)] = 12-month versus 3-month incentives OR = 2.41 (95% CI = 1.46-3.96), P = 0.001; 12 months versus UC 1.67 (1.04-2.70), P = 0.035; 3 months versus UC 0.69 (0.41-1.17), P = 0.174. Bayes factors indicated that for 12-month versus 3-month incentives and 12 months versus UC there was good evidence for the alternative hypothesis, and for 3 months versus UC there was good evidence for the null hypothesis. CONCLUSIONS This randomized controlled trial provides weak evidence that up to £300 of voucher incentives over 12 months is effective for maintaining smoking abstinence postpartum compared with usual care. There was good evidence that 12-month incentives are superior to those over only 3 months, for which there was no evidence of effectiveness relative to usual care.
Collapse
Affiliation(s)
- Michael Ussher
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
- Population Health Research Institute, St George's, University of London, London, UK
| | - Catherine Best
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Sarah Lewis
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Jennifer McKell
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Tim Coleman
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Sue Cooper
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Sophie Orton
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Linda Bauld
- Bruce and John Usher Professor of Public Health, Usher Institute and SPECTRUM Consortium, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
2
|
Liu XM, Li J, Chen D, Li H, Qin XY, Wang YX, Gu YZ, Li N, Zhou LG, Feng M. Ano1 regulates embryo transport by modulating intracellular calcium levels in oviduct smooth muscle. Biochim Biophys Acta Mol Basis Dis 2024; 1870:167059. [PMID: 38336104 DOI: 10.1016/j.bbadis.2024.167059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/26/2024] [Accepted: 02/03/2024] [Indexed: 02/12/2024]
Abstract
Oviductal smooth muscle exhibits spontaneous rhythmic contraction (SRC) and controls the passage of the ova at the exact time, but its mechanistic regulation remains to be determined. In this study, female mice with Ano1SMKO (smooth muscle-specific deletion of Ano1) had reduced fertility. Deficiency of Ano1 in mice resulted in impaired oviductal SRC function and reduced calcium signaling in individual smooth muscle cells in the oviduct. The Ano1 antagonist T16Ainh-A01 dose-dependently inhibited SRCs and [Ca2+]i in the oviducts of humans and mice. A similar inhibitory effect of SRCs and [Ca2+]i was observed after treatment with nifedipine. In our study, ANO1 acted primarily as an activator or amplifier in [Ca2+]i and contraction of tubal smooth muscle cells. We found that tubal SRC was markedly attenuated in patients with ectopic pregnancy. Then, our study was designed to determine whether chloride channel Ano1-mediated smooth muscle motility is associated with tubal SRC. Our findings reveal a new mechanism for the regulation of tubal motility that may be associated with abnormal pregnancies such as ectopic pregnancies.
Collapse
Affiliation(s)
- Xiao-Man Liu
- Central Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, PR China; Central Laboratory, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, PR China; Institute of Clinical Microbiology, Shandong Academy of Clinical Medicine, Jinan, Shandong 250021, PR China
| | - Juan Li
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, PR China
| | - Defang Chen
- Office of Operation Management Committee, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250013, PR China
| | - Hao Li
- Department of Blood Transfusion, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, PR China
| | - Xiao-Yan Qin
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, PR China
| | - Yun-Xia Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, PR China
| | - Yong-Zhong Gu
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, PR China
| | - Na Li
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, PR China
| | - Li-Guang Zhou
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, PR China
| | - Mei Feng
- Central Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, PR China; Central Laboratory, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, PR China; Institute of Clinical Microbiology, Shandong Academy of Clinical Medicine, Jinan, Shandong 250021, PR China.
| |
Collapse
|
3
|
Yon B, Williams R, Wedin J, Underhill L, Kurti A. Incentivizing Pregnant Women to Quit Smoking in the Real World-A Community-Based Pilot Intervention. Health Promot Pract 2024; 25:164-166. [PMID: 36444556 DOI: 10.1177/15248399221139299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Smoking during pregnancy is a leading preventable cause of poor pregnancy outcomes. Financial incentives interventions yield quit rates of approximately 30% during pregnancy, versus approximately 4% in traditional smoking cessation programs. This pilot study assessed the feasibility of translating an efficacious University of Vermont research-based intervention into a rural community setting delivered by the Vermont Department of Health. Pregnant women using tobacco products were recruited from the Women, Infants and Children program and Rutland Women's Healthcare. Women were provided in-person tobacco cessation counseling during regularly scheduled meetings and received gift cards throughout pregnancy and 3 months postpartum contingent upon biochemically verified smoking abstinence. Cessation counseling and abstinence monitoring began with high frequency (three visits per week), tapering through postpartum to biweekly visits. Gift card values began at $15, increasing by $5 for consecutive negative samples, to $40 maximum. Participants completed three surveys (enrollment, 4-6 weeks postpartum, 6-12 months postpartum) assessing smoking habits, and barriers and facilitators of treatment engagement and success. From 2018 to 2020, we enrolled 20 pregnant women, of whom six self-reported quitting tobacco at some point during the intervention. At study completion, three reported sustained abstinence. Results suggest that it is feasible to translate a research-based smoking cessation program into a community setting. This article discusses the challenges faced and the lessons learned when implementing research in a rural community setting, recruiting and retaining participants, and adapting protocols during the Covid-19 pandemic.
Collapse
Affiliation(s)
- Bethany Yon
- Vermont Department of Health, Burlington, VT, USA
| | | | | | | | | |
Collapse
|
4
|
David AT, Sharma V, Bittencourt L, Gurka KK, Perez-Carreño JG, Lopez-Quintero C. Exploring the associations between serious psychological distress and the quantity or frequency of tobacco, alcohol, and cannabis use among pregnant women in the United States. Prev Med 2023; 177:107770. [PMID: 37951544 PMCID: PMC11099898 DOI: 10.1016/j.ypmed.2023.107770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 11/04/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
Serious Psychological Distress (SPD) and prenatal exposure to substances are associated with adverse outcomes for pregnant individuals and their developing offspring. This study aims to examine the relationship between SPD and quantity, or frequency of substance use among pregnant women in the United States (US). Descriptive and negative binomial regression analyses of the 2015-2019 National Survey on Drug Use and Health (NSDUH) were conducted among 3373 pregnant women (18 to 44 years old) to examine the association between SPD and (1) average number of cigarettes smoked in the past 30 days, (2) number of days of binge drinking in the past 30 days, and (3) number of days of cannabis use in the past 30 days. About 6% of the study population experienced SPD in the past 30 days. Compared to pregnant women who did not report SPD, pregnant women experiencing SPD showed greater rates in the number of cigarettes smoked during the past 30 days (IRR = 2.1, 95%CI = 1.1, 4.5), the number of days of binge drinking in the past 30 days (IRR = 5.1, 95%CI = 1.7, 15.4), and the number of days of cannabis use in the past 30 days (IRR = 2.9, 95%CI = 1.3, 6.5). Our results extend findings from prior research by documenting an association between SPD and the quantity and frequency of substance use among pregnant women in the US. Individual and structural interventions addressing SPD and/or substance might help reduce the impact of these comorbid conditions on expectant parents and their offspring.
Collapse
Affiliation(s)
- Ayomide T David
- University of Florida, Department of Epidemiology, 2004 Mowry Road, Gainesville, FL 32610, United States of America.
| | - Vinita Sharma
- Boise State University, School of Public and Population Health, Boise, ID 83725-1835, United States of America.
| | - Lorna Bittencourt
- University of Minnesota, Division of Environmental Health Sciences, Minneapolis, MN 55455, United States of America
| | - Kelly K Gurka
- University of Florida, Department of Epidemiology, 2004 Mowry Road, Gainesville, FL 32610, United States of America.
| | - Juan Guillermo Perez-Carreño
- University of Florida, Department of Epidemiology, 2004 Mowry Road, Gainesville, FL 32610, United States of America.
| | - Catalina Lopez-Quintero
- University of Florida, Department of Epidemiology, 2004 Mowry Road, Gainesville, FL 32610, United States of America.
| |
Collapse
|
5
|
Dallery J, Ives L, Knerr A. Toward an era of impact of digital contingency management in the treatment of substance use disorders. Prev Med 2023; 176:107518. [PMID: 37080501 DOI: 10.1016/j.ypmed.2023.107518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/03/2023] [Accepted: 04/15/2023] [Indexed: 04/22/2023]
Abstract
Digital contingency management entails remote methods to obtain biochemical confirmation of drug status and provide desirable, tangible consequences contingent on abstinence. Advances in digital CM suggest that it may be on the cusp of making a public health impact. Specific advances include technological capabilities and affordability, companies that specialize in digital CM, policies and reimbursement models, and the increasing availability of resources related to CM. Digital CM has expanded from cigarette smoking to alcohol and illicit substance misuse, and to include a diverse range of underserved and high-risk groups (e.g., pregnant and postpartum women, socioeconomically disadvantaged individuals, adolescents, and rural populations). Although the digital divide continues to narrow, culturally responsive methods may increase uptake and engagement with digital CM. The promise of digital CM is widescale access to an evidence-based treatment with low staff burden, no side effects, high fidelity engagement, acceptability, and effectiveness, and greater equity. We may be close to realizing this promise.
Collapse
|
6
|
Kock LS, Erath TG, Coleman SRM, Higgins ST, Heil SH. Contingency management interventions for abstinence from cigarette smoking in pregnancy and postpartum: A systematic review and meta-analysis. Prev Med 2023; 176:107654. [PMID: 37532032 PMCID: PMC10828115 DOI: 10.1016/j.ypmed.2023.107654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/24/2023] [Accepted: 07/29/2023] [Indexed: 08/04/2023]
Abstract
Contingency management is one of the most effective treatments for substance use disorders in not-pregnant people. The most recent quantitative review of its efficacy among pregnant and postpartum women who smoke cigarettes concluded with moderate certainty that those receiving contingent financial incentives were twice as likely to be abstinent compared with controls. We aimed to update and extend previous reviews. Five databases were systematically searched for randomized controlled trials (RCTs) published before December 2022 that assessed the effectiveness of incentives for abstinence from substance use. Data from trials of smoking abstinence were pooled using a random-effects meta-analysis model (restricted maximum likelihood). Results are reported as risk-ratios (RRs) with 95% confidence intervals (CIs). This study is registered with PROSPERO, CRD42022372291. Twelve RCTs (3136) pregnant women) were included. There was high certainty evidence that women receiving incentives were more likely to be abstinent than controls at the last antepartum assessment (12 RCTs; RR = 2.43, 95% CI 2.04-2.91, n = 2941, I2 = 0.0%) and moderate certainty evidence at the longest postpartum assessment while incentives were still available (five RCTs; RR = 2.72, 1.47-5.02, n = 659, I2 = 44.5%), and at the longest postpartum follow-up after incentives were discontinued (six RCTs; RR = 1.93, 1.08-3.46, n = 1753, I2 = 51.8%). Pregnant women receiving incentives are twice as likely to achieve smoking abstinence during pregnancy suggesting this intervention should be standard care for pregnant women who smoke. The results also demonstrate that abstinence continues into the postpartum period, including after incentives are discontinued, but more trials measuring outcomes in the postpartum period are needed to strengthen this conclusion.
Collapse
Affiliation(s)
- Loren S Kock
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St, Burlington, VT 05401, United States.
| | - Tyler G Erath
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St, Burlington, VT 05401, United States
| | - Sulamunn R M Coleman
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St, Burlington, VT 05401, United States
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St, Burlington, VT 05401, United States
| | - Sarah H Heil
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St, Burlington, VT 05401, United States
| |
Collapse
|
7
|
Higgins ST. Behavior change, health, and health disparities 2023: Contingency management for treating substance use disorders and promoting health in vulnerable populations. Prev Med 2023; 176:107746. [PMID: 37898183 DOI: 10.1016/j.ypmed.2023.107746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2023]
Abstract
This Special Issue (SI) of Preventive Medicine is the 10th in a series on behavior change, health, and health disparities. This issue focuses on Contingency Management (CM), a highly efficacious behavior-change intervention for substance use disorders (SUDs) and other behavioral health conditions wherein patients receive material incentives (e.g., vouchers exchangeable for retail items) contingent on objectively verified behavior change. Despite substantial support for its efficacy, CM remains largely unavailable in U.S. community SUD treatment facilities and other healthcare settings. This is especially concerning regarding stimulant use disorder for which CM is the only reliably efficacious intervention in controlled studies and yet is unavailable to the vast majority of those in need. This SI details recent promising developments in efforts to surmount longstanding implementation obstacles while also detailing other promising advances from meta-analyses and controlled trials examining CM's efficacy in treating other difficult-to-treat problems including smoking among pregnant women and mothers of young children as well among those as those experiencing homelessness and alcohol use disorder, the promise of digital CM, and a potential new application in promoting adherence with SUD medications.
Collapse
Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, Departments of Psychiatry and Psychological Science, University of Vermont, 1 South Prospect St., UHC, MS482 Burlington, VT 05401, USA.
| |
Collapse
|
8
|
Hallgren KA, Duncan MH, Iles-Shih MD, Cohn EB, McCabe CJ, Chang YM, Saxon AJ. Feasibility, Engagement, and Usability of a Remote, Smartphone-Based Contingency Management Program as a Treatment Add-On for Patients Who Use Methamphetamine: Single-Arm Pilot Study. JMIR Form Res 2023; 7:e47516. [PMID: 37410529 PMCID: PMC10360016 DOI: 10.2196/47516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/11/2023] [Accepted: 05/29/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND In the United States, methamphetamine-related overdoses have tripled from 2015 to 2020 and continue to rise. However, efficacious treatments such as contingency management (CM) are often unavailable in health systems. OBJECTIVE We conducted a single-arm pilot study to evaluate the feasibility, engagement, and usability of a fully remotely delivered mobile health CM program offered to adult outpatients who used methamphetamine and were receiving health care within a large university health system. METHODS Participants were referred by primary care or behavioral health clinicians between September 2021 and July 2022. Eligibility criteria screening was conducted by telephone and included self-reported methamphetamine use on ≥5 out of the past 30 days and a goal of reducing or abstaining from methamphetamine use. Eligible participants who agreed to take part then completed an initial welcome phase that included 2 videoconference calls to register for and learn about the CM program and 2 "practice" saliva-based substance tests prompted by a smartphone app. Participants who completed these welcome phase activities could then receive the remotely delivered CM intervention for 12 consecutive weeks. The intervention included approximately 24 randomly scheduled smartphone alerts requesting a video recording of themselves taking a saliva-based substance test to verify recent methamphetamine abstinence, 12 weekly calls with a CM guide, 35 self-paced cognitive behavioral therapy modules, and multiple surveys. Financial incentives were disbursed via reloadable debit cards. An intervention usability questionnaire was completed at the midpoint. RESULTS Overall, 37 patients completed telephone screenings, with 28 (76%) meeting the eligibility criteria and consenting to participate. Most participants who completed a baseline questionnaire (21/24, 88%) self-reported symptoms consistent with severe methamphetamine use disorder, and most had other co-occurring non-methamphetamine substance use disorders (22/28, 79%) and co-occurring mental health disorders (25/28, 89%) according to existing electronic health records. Overall, 54% (15/28) of participants successfully completed the welcome phase and were able to receive the CM intervention. Among these participants, engagement with substance testing, calls with CM guides, and cognitive behavioral therapy modules varied. Rates of verified methamphetamine abstinence in substance testing were generally low but varied considerably across participants. Participants reported positive opinions about the intervention's ease of use and satisfaction with the intervention. CONCLUSIONS Fully remote CM can be feasibly delivered within health care settings lacking existing CM programs. Although remote delivery may help reduce barriers to treatment access, many patients who use methamphetamine may struggle to engage with initial onboarding. High rates of co-occurring psychiatric conditions in the patient population may also contribute to uptake and engagement challenges. Future efforts could leverage greater human-to-human connection, more streamlined onboarding procedures, larger incentives, longer durations, and the incentivization of non-abstinence-based recovery goals to increase uptake and engagement with fully remote mobile health-based CM.
Collapse
Affiliation(s)
- Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Mark H Duncan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Matthew D Iles-Shih
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Eliza B Cohn
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Connor J McCabe
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Yanni M Chang
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Andrew J Saxon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
- Center of Excellence in Substance Addiction Treatment and Education, Veterans Health Administration Puget Sound Health Care System, Seattle, WA, United States
| |
Collapse
|
9
|
Patten CA, Koller KR, King DK, Prochaska JJ, Sinicrope PS, McDonell MG, Decker PA, Lee FR, Fosi JK, Young AM, Sabaque CV, Brown AR, Borah BJ, Thomas TK. Aniqsaaq (To Breathe): Study protocol to develop and evaluate an Alaska Native family-based financial incentive intervention for smoking cessation. Contemp Clin Trials Commun 2023; 33:101129. [PMID: 37091507 PMCID: PMC10120296 DOI: 10.1016/j.conctc.2023.101129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/27/2023] [Accepted: 04/01/2023] [Indexed: 04/05/2023] Open
Abstract
Background Alaska Native and American Indian (ANAI) communities in Alaska are disproportionately affected by commercial tobacco use. Financial incentive interventions promote cigarette smoking cessation, but family-level incentives have not been evaluated. We describe the study protocol to adapt and evaluate the effectiveness and implementation of a remotely delivered, family-based financial incentive intervention for cigarette smoking among Alaskan ANAI people. Methods The study has 3 phases: 1) qualitative interviews with ANAI adults who smoke, family members, and stakeholders to inform the intervention, 2) beta-test of the intervention, and 3) randomized controlled trial (RCT) evaluating intervention reach and effectiveness on verified, prolonged smoking abstinence at 6- and 12-months post-treatment. In the RCT, adult dyads (ANAI person who smokes [index participant] and family member) recruited throughout Alaska will be randomized to a no-incentives control condition (n = 328 dyads) or a 6-month incentive intervention (n = 328 dyads). All dyads will receive cessation support and family wellness materials. Smoking status will be assessed weekly for four weeks and at three and six months. Intervention index participants will receive escalating incentives for verified smoking abstinence at each time point (maximum $750 total); the family member will receive rewards of equal value. Results A community advisory committee contributed input on the study design and methods for relevance to ANAI people, particularly emphasizing the involvement of families. Conclusion Our study aligns with the strength and value AIAN people place on family. Findings, processes, and resources will inform how Indigenous family members can support smoking cessation within incentive interventions. Clinical Trials Registry NCT05209451.
Collapse
|
10
|
Liu L, Zhao Y, Li J, Zhang N, Lan Z, Liu X. Efficacy of digital therapeutics in smoking cessation: A systematic review and meta-analysis. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2023. [DOI: 10.1016/j.medntd.2023.100209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
|
11
|
Higgins ST. Behavior change, health, and health disparities 2022: Innovations in tobacco control and regulatory science to decrease cigarette smoking. Prev Med 2022; 165:107309. [PMID: 36252828 DOI: 10.1016/j.ypmed.2022.107309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This Special Issue of Preventive Medicine (PM) is the 9th in a series on behavior change, health, and health disparities. This topic is critically important to improving population health. Unhealthy lifestyles including substance misuse, unhealthy food choices, physical inactivity, and non-adherence with medical regimens are important preventable causes of chronic disease and premature death. This year we focus on cigarette smoking, which continues to have devastating health impacts including more than 8 million annual premature deaths globally and 480,000 in the U.S. where most of the research reported in this Special Issue was conducted. While the introduction of new tobacco products into the marketplace like electronic nicotine delivery systems (ENDS) demands attention, it is essential that we remain focused on the enormous challenges involved in eliminating cigarette smoking. This Special Issue examines innovations in tobacco control and regulatory science aimed towards reducing cigarette smoking. Discussion of new tobacco products is largely limited to their role in this overarching aim of reducing combusted cigarette use. We discuss important innovations in tobacco control (e.g., digital text-based interventions, ENDS-assisted cessation, financial incentives) and regulatory science (e.g., nicotine reduction in cigarettes, flavor bans). Throughout, attention is given to the important topic of disparities in terms of understanding the uneven adverse impacts of cigarette smoking and efforts to eliminate it, and the critical importance of researching vulnerable populations. Across these topics we have recruited contributions from accomplished investigators, clinicians, and policymakers to acquaint readers with recent advances while also noting knowledge gaps and unresolved challenges.
Collapse
Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, Departments of Psychiatry and Psychological Science, University of Vermont, United States.
| |
Collapse
|
12
|
Tappin D, Sinclair L, Kee F, McFadden M, Robinson-Smith L, Mitchell A, Keding A, Watson J, Watson S, Dick A, Torgerson D, Hewitt C, McKell J, Hoddinott P, Harris FM, Boyd KA, McMeekin N, Ussher M, Bauld L. Effect of financial voucher incentives provided with UK stop smoking services on the cessation of smoking in pregnant women (CPIT III): pragmatic, multicentre, single blinded, phase 3, randomised controlled trial. BMJ 2022; 379:e071522. [PMID: 36261162 PMCID: PMC9580214 DOI: 10.1136/bmj-2022-071522] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To examine effectiveness, cost effectiveness, generalisability, and acceptability of financial incentives for smoking cessation during pregnancy in addition to variously organised UK stop smoking services. DESIGN Pragmatic, multicentre, single blinded, phase 3, randomised controlled trial (Cessation in Pregnancy Incentives Trial phase 3 (CPIT III)). SETTING Seven UK stop smoking services provided in primary and secondary care facilities in Scotland, Northern Ireland, and England. PARTICIPANTS 944 pregnant women (age ≥16 years) who self-reported as being smokers (at least one cigarette in the past week) when asked at first maternity visit, less than 24 weeks' gestation, and notified to the trial team by routine stop smoking services. INTERVENTIONS Participants in the control group were offered the standard stop smoking services, which includes the offer of counselling by specially trained workers using withdrawal orientated therapy and the offer of free nicotine replacement therapy. The intervention was the offer of usual support from the stop smoking services and the addition of up to £400 ($440; €455) of LoveToShop financial voucher incentives for engaging with current stop smoking services or to stop smoking, or both, during pregnancy. MAIN OUTCOME MEASURES Self-reported smoking cessation in late pregnancy (between 34 and 38 weeks' gestation) corroborated by saliva cotinine (and anabasine if using nicotine replacement products). Results were adjusted for age, smoking years, index of multiple deprivation, Fagerström score, before or after covid, and recruitment site. Secondary outcomes included point and continuous abstinence six months after expected date of delivery, engagement with stop smoking services, biochemically validated abstinence from smoking at four weeks after stop smoking date, birth weight of baby, cost effectiveness, generalisability documenting formats of stop smoking services, and acceptability to pregnant women and their carers. RESULTS From 9 January 2018 to 4 April 2020, of 4032 women screened by stop smoking services, 944 people were randomly assigned to the intervention group (n=471) or the control group (n=470). Three people asked for their data to be removed. 126 (27%) of 471 participants stopped smoking from the intervention group and 58 (12%) of 470 from the control group (adjusted odds ratio 2.78 (1.94 to 3.97) P<0.001). Serious adverse events were miscarriages and other expected pregnancy events requiring hospital admission; all serious adverse events were unrelated to the intervention. Most people who stopped smoking from both groups relapsed after their baby was born. CONCLUSIONS The offer of up to £400 of financial voucher incentives to stop smoking during pregnancy as an addition to current UK stop smoking services is highly effective. This bolt-on intervention supports new guidance from the UK National Institute for Health and Care Excellence, which includes the addition of financial incentives to support pregnant women to stop smoking. Continuing incentives to 12 months after birth is being examined to prevent relapse. TRIAL REGISTRATION ISRCTN Registry ISRCTN15236311.
Collapse
Affiliation(s)
- David Tappin
- Child Health, School of Medicine, Honorary Senior Research Fellow, University of Glasgow, UK
| | | | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Margaret McFadden
- National Health Service Lanarkshire Clinical Trials Unit, Airdrie, UK
| | | | | | - Ada Keding
- York Trials Unit, University of York, York, UK
| | | | - Sinead Watson
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Alison Dick
- York Trials Unit, University of York, York, UK
| | | | | | - Jennifer McKell
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Fiona M Harris
- School of Health and Life Sciences, University of the West of Scotland, Paisley, UK
| | - Kathleen A Boyd
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicola McMeekin
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Michael Ussher
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
- Population Health Research Institute, St George's, University of London, London, UK
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
13
|
Affiliation(s)
- Daniel Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Jasper V Been
- Division of Neonatology, Department of Paediatrics, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
| |
Collapse
|
14
|
Pisinger C, Toxværd CG, Rasmussen M. Smoking Cessation Programs Are Less Effective in Smokers with Low Socioeconomic Status Even When Financial Incentives for Quitting Smoking Are Offered-A Community-Randomized Smoking Cessation Trial in Denmark. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10879. [PMID: 36078595 PMCID: PMC9518409 DOI: 10.3390/ijerph191710879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 06/15/2023]
Abstract
Financial incentives offered to those who quit smoking have been found effective, also in persons with low socioeconomic status (SES), but no previous study has investigated who benefits most: smokers with low or high SES. In this community-randomized trial ("Richer without smoking"), three Danish municipalities were randomized to reward persons who were abstinent when attending the municipal smoking cessation program (FIMs) and three municipalities were randomized to spend the same amount on smoking cessation campaigns recruiting smokers to the smoking cessation program (CAMs). The municipalities each received approximately USD 16,000. An intention-to-treat approach was used in analyses. In regression analyses adjusted for individual- and municipal-level differences, we found that smokers with high SES living in FIMs had significantly higher proportion of validated long-term successful quitters (OR (95% CI): 2.59 (1.6-4.2)) than high-SES smokers living in CAM. Smokers with low SES, however, did not experience the same benefit of financial incentives as smokers with high SES. Neither the FIMs nor the CAMs succeeded in attracting more smokers with low SES during the intervention year 2018 than the year before. Our study showed that smokers with low SES did not experience the same benefit of financial incentives as smokers with high SES.
Collapse
Affiliation(s)
- Charlotta Pisinger
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark
- Department of Public Health, Faculty of Health Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Danish Heart Foundation, 1120 Copenhagen, Denmark
| | - Cecilie Goltermann Toxværd
- Department of Public Health, Faculty of Health Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Mette Rasmussen
- Clinical Health Promotion Centre, WHO-CC, The Parker Institute, Bispebjerg & Frederiksberg Hospital, 2000 Frederiksberg, Denmark
- Clinical Health Promotion Centre, WHO-CC, Department of Health Sciences, Lund University, 223 62 Lund, Sweden
| |
Collapse
|
15
|
Peltier MR, Roberts W, Verplaetse TL, Burke C, Zakiniaeiz Y, Moore K, McKee SA. Licit and illicit drug use across trimesters in pregnant women endorsing past-year substance use: Results from National Survey on Drug Use and Health (2009-2019). Arch Womens Ment Health 2022; 25:819-827. [PMID: 35737132 PMCID: PMC9359119 DOI: 10.1007/s00737-022-01244-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/08/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Given the health consequences, perinatal substance use is a significant public health concern, especially as substance use rates increase among women; ongoing data regarding the rates of substance use across trimesters of pregnancy is needed. METHODS The present study utilized cross-sectional population-based data from the National Survey of Drug Use and Health (NSDUH) between 2009 and 2019. We aimed to explore both licit and illicit substance use assessed within each trimester among women endorsing past-year substance use. The NSDUH sample included 8,530 pregnant women. RESULTS Perinatal substance use was less prevalent among women in later trimesters; however, past-month substance use was observed for all substances across trimesters. The prevalence of past-month licit substance use among pregnant women ranged from 5.77 to 22.50% and past-month illicit substance use ranged from 4.67 to 14.81%. In the second trimester, lower odds of past-month substance use were observed across tobacco, alcohol, and marijuana (odds ratios [ORs] ranging from 0.29 to 0.47), when compared to the first trimester. A similar lower rate of past-month substance use was observed in the third trimester compared to the first trimester, across tobacco, alcohol, and marijuana use, as well as cocaine, prescription pain medication, and tranquilizer use (ORs ranging from 0.02 to 0.42). The likelihood of polysubstance use was lower among women in the second and third trimesters compared to the first trimester (ORs ranging from 0.09 to 0.46). CONCLUSION Findings indicate that a minority of women continue to use substances across all trimesters. This is especially true among women using licit substances and marijuana. These results highlight the need for improved interventions and improved access to treatment for these women.
Collapse
Affiliation(s)
- MacKenzie R Peltier
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA.
- Psychology Section, VA Connecticut Healthcare System, West Haven, CT, USA.
| | - Walter Roberts
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
| | - Terril L Verplaetse
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
| | - Catherine Burke
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
| | - Yasmin Zakiniaeiz
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
| | - Kelly Moore
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
- Department of Psychology, East Tennessee State University, Johnson City, TN, USA
| | - Sherry A McKee
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
| |
Collapse
|