Alessi Sheila M, Rash Carla J, Petry Nancy M
School of Medicine and Calhoun Cardiology Center - Behavioral Health, University of Connecticut, Farmington, CT.
Nicotine Tob Res. 2017 Mar 1;19(3):290-298. doi: 10.1093/ntr/ntw155.
Abstinence reinforcement is efficacious for improving smoking treatment outcomes, but practical constraints related to the need for multiple in-person carbon monoxide (CO) breath tests daily to verify smoking abstinence have limited its use. This study tested an mHealth procedure to remotely monitor and reinforce smoking abstinence in individuals' natural environment.
Eligible treatment-seeking smokers (N = 90) were randomized to (1) usual care and ecological monitoring with abstinence reinforcement (mHealth reinforcement) or (2) without reinforcement (mHealth monitoring). Usual care was 8 weeks of transdermal nicotine and twice-weekly telephone counseling. Following training, an interactive voice response system prompted participants to conduct CO tests 1-3 daily at pseudorandom times (7 am to 10 pm) for 4 weeks. When prompted, participants used a study cell phone and CO monitor to complete a CO self-test, video record the process, and submit videos using multimedia messaging. mHealth reinforcement participants could earn prizes for smoking-negative on-time CO tests. The interactive voice response generated preliminary earnings immediately. Earnings were finalized by comparing video records against participants' self-reports.
mHealth reinforcement was associated with a greater proportion of smoking-negative CO tests, longest duration of prolonged abstinence, and point-prevalence abstinence during the monitoring/reinforcement phase compared to mHealth monitoring (p < .01, d = 0.8-1.3). Follow-up (weeks 4-24) analyses indicated main effects of reinforcement on point-prevalence abstinence and proportion of days smoked (p ≤ .05); values were comparable by week 24.
mHealth reinforcement has short-term efficacy. Research on methods to enhance and sustain benefits is needed.
This study suggests that mHealth abstinence reinforcement is efficacious and may present temporal and spatial opportunities to research, engage, and support smokers trying to quit that do not exist with conventional (not technology-based) reinforcement interventions.
戒烟强化措施对于改善吸烟治疗效果是有效的，但由于需要每天进行多次现场一氧化碳（CO）呼气测试以验证戒烟情况，相关实际限制阻碍了其应用。本研究测试了一种移动健康程序，用于在个体自然环境中远程监测和强化戒烟情况。
符合条件的寻求治疗的吸烟者（N = 90）被随机分为两组：（1）接受常规护理和带有戒烟强化措施的生态监测（移动健康强化组）；（2）不接受强化措施（移动健康监测组）。常规护理为期8周，包括经皮尼古丁治疗和每周两次的电话咨询。培训后，一个交互式语音应答系统提示参与者在每天上午7点至晚上10点的伪随机时间进行1至3次CO测试，持续4周。收到提示时，参与者使用研究用手机和CO监测仪完成CO自我测试，对测试过程进行视频记录，并通过多媒体短信提交视频。移动健康强化组的参与者若CO测试结果为阴性且按时完成测试，可赢得奖品。交互式语音应答系统会立即生成初步收益。通过将视频记录与参与者的自我报告进行比较来确定最终收益。
与移动健康监测组相比，移动健康强化组在监测/强化阶段的CO测试结果为阴性的比例更高，戒烟持续时间更长，点患病率戒烟率更高（p <.01，d = 0.8 - 1.3）。随访（第4 - 24周）分析表明，强化措施对点患病率戒烟率和吸烟天数比例有主要影响（p≤.05）；到第24周时，各项数值相当。
移动健康强化措施具有短期疗效。需要对增强和维持其益处的方法进行研究。
本研究表明，移动健康戒烟强化措施是有效的，并且可能为研究、参与和支持试图戒烟的吸烟者提供传统（非基于技术的）强化干预所不存在的时间和空间机会。
