Halpern Scott D, French Benjamin, Small Dylan S, Saulsgiver Kathryn, Harhay Michael O, Audrain-McGovern Janet, Loewenstein George, Asch David A, Volpp Kevin G
1 Department of Medicine.
2 Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute of Health Economics.
Am J Respir Crit Care Med. 2016 Oct 15;194(8):981-988. doi: 10.1164/rccm.201601-0108OC.
Targeting different smoking cessation programs to smokers most likely to quit when using them could reduce the burden of lung disease.
To identify smokers most likely to quit using pure reward-based financial incentives or incentive programs requiring refundable deposits to become eligible for rewards.
We conducted prespecified secondary analyses of a randomized trial in which 2,538 smokers were assigned to an $800 reward contingent on sustained abstinence from smoking, a refundable $150 deposit plus a $650 reward, or usual care.
Using logistic regression, we identified characteristics of smokers that were most strongly associated with accepting their assigned intervention and ceasing smoking for 6 months. We assessed modification of the acceptance, efficacy, and effectiveness of reward and deposit programs by 11 prospectively selected demographic, smoking-related, and psychological factors. Predictors of sustained smoking abstinence differed among participants assigned to reward- versus deposit-based incentives. However, greater readiness to quit and less steep discounting of future rewards were consistently among the most important predictors. Deposit-based programs were uniquely effective relative to usual care among men, higher-income participants, and participants who more commonly failed to pay their bills (all interaction P values < 0.10). Relative to rewards, deposits were more effective among black persons (P = 0.022) and those who more commonly failed to pay their bills (P = 0.082). Relative to rewards, deposits were more commonly accepted by higher-income participants, men, white persons, and those who less commonly failed to pay their bills (all P < 0.05).
Heterogeneity among smokers in their acceptance and response to different forms of incentives suggests potential benefits of targeting behavior-change interventions based on patient characteristics. Clinical trial registered with www.clinicaltrials.gov (NCT 01526265).
针对使用戒烟计划时最有可能戒烟的吸烟者制定不同的戒烟计划，可减轻肺部疾病负担。
确定使用基于纯奖励的经济激励措施或需要退还押金才能获得奖励资格的激励计划时，最有可能戒烟的吸烟者。
我们对一项随机试验进行了预先指定的二次分析，该试验将2538名吸烟者分配到以下组：持续戒烟可获得800美元奖励、150美元可退还押金加650美元奖励或常规护理。
我们使用逻辑回归确定了与接受指定干预并戒烟6个月最密切相关的吸烟者特征。我们评估了11个预先选定的人口统计学、吸烟相关和心理因素对奖励和押金计划的接受度、疗效和效果的影响。在分配到基于奖励和基于押金的激励措施的参与者中，持续戒烟的预测因素有所不同。然而，更大的戒烟意愿和对未来奖励更低的折扣率一直是最重要的预测因素。相对于常规护理，基于押金的计划在男性、高收入参与者以及更常拖欠账单的参与者中具有独特的效果（所有交互P值<0.10）。相对于奖励，押金在黑人（P = 0.022）和更常拖欠账单的人中更有效（P = 0.082）。相对于奖励，押金更常被高收入参与者、男性、白人以及较少拖欠账单的人接受（所有P < 0.05）。
吸烟者对不同形式激励措施的接受度和反应存在异质性，这表明根据患者特征进行行为改变干预可能具有潜在益处。临床试验已在www.clinicaltrials.gov注册（NCT 01526265）。
