French Katherine M, Gonzalez Sasha Z, Sherman Scott E, Link Alissa R, Malik Sadozai Zoe, Tseng Chi-Hong, Jumkhawala Saahil A, Tejada Briesny, White Andrew, Ladapo Joseph A
Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY, 10016, USA.
Department of Medicine, VA New York Harbor Healthcare System, 423 East 23rd Street, New York, NY, 10010, USA.
Trials. 2018 Nov 21;19(1):646. doi: 10.1186/s13063-018-3003-y.
Smoking is the leading preventable cause of death in the United States, but evidence-based smoking cessation therapy is underutilized. Financial incentive strategies represent an innovative approach for increasing the use of counseling and pharmacotherapy. If effective, they could supplement or supplant resource-intensive policy options, particularly in populations for whom smoking has substantial societal costs. FIESTA (Financial IncEntives for Smoking TreAtment) will randomize hospitalized smokers to receive usual smoking cessation care alone or usual smoking care augmented with financial incentives. We aim to compare the impact of these two strategies on 1) smoking abstinence, 2) use of counseling and nicotine replacement therapy, and 3) quality of life of participants. We also will evaluate the short-term and long-term return on the investment of incentives. The FIESTA Oral Microbiome Substudy will compare the oral microbiome of smokers and nonsmokers to longitudinally assess whether smoking cessation changes oral microbiome composition.
We will enroll 182 inpatient participants from the Manhattan campus of the Veterans Affairs New York Harbor Healthcare System. All participants receive enhanced usual care, including screening for tobacco use, counseling while hospitalized, access to nicotine replacement therapy, and referral to a state Quitline. Patients in the financial incentive arm receive enhanced usual care and up to $550 for participating in the New York Smoker's Quitline, using nicotine replacement therapy (NRT), and achieving biochemically confirmed smoking cessation at 2 months and 6 months. In the microbiome substudy, we enroll nonsmoking control participants matched to each recruited smoker's hospital ward, sex, age, diabetes status, and antibiotic use. After discharge, participants are asked to complete periodic phone interviews at 2 weeks, 2 months, 6 months, and 12 months and provide expired carbon monoxide and saliva samples at 2 months, 6 months, and 12 months for cotinine testing and oral microbiome analysis.
The incentive interventions of FIESTA may benefit hospitalized smokers, an objective made all the more critical because smoking rates among hospitalized patients are higher than those in the general population. Moreover, the focus of FIESTA on evidence-based therapy and bioconfirmed smoking cessation can help guide policy efforts to reduce smoking-related healthcare costs in populations with high rates of tobacco use and costly illnesses.
ClinicalTrials.gov, NCT02506829 . Registered on 1 July 2014.
吸烟是美国可预防的首要死因，但基于证据的戒烟疗法未得到充分利用。经济激励策略是增加咨询和药物治疗使用的一种创新方法。如果有效，它们可以补充或取代资源密集型政策选择，特别是在吸烟会带来巨大社会成本的人群中。FIESTA（吸烟治疗的经济激励）将把住院吸烟者随机分为两组，一组仅接受常规戒烟护理，另一组接受常规护理并增加经济激励。我们旨在比较这两种策略对以下方面的影响：1）戒烟情况；2）咨询和尼古丁替代疗法的使用；3）参与者的生活质量。我们还将评估激励措施投资的短期和长期回报。FIESTA口腔微生物组子研究将比较吸烟者和非吸烟者的口腔微生物组，以纵向评估戒烟是否会改变口腔微生物组组成。
我们将从纽约港退伍军人事务医疗系统曼哈顿校区招募182名住院参与者。所有参与者都将接受强化常规护理，包括烟草使用筛查、住院期间的咨询、尼古丁替代疗法的获取以及转介到州戒烟热线。经济激励组的患者在参与纽约吸烟者戒烟热线、使用尼古丁替代疗法（NRT）并在2个月和6个月时实现经生化确认的戒烟后，除接受强化常规护理外，还将获得高达550美元。在微生物组子研究中，我们招募与每位招募的吸烟者在医院病房、性别、年龄、糖尿病状况和抗生素使用方面相匹配的非吸烟对照参与者。出院后，要求参与者在2周、2个月、6个月和12个月时完成定期电话访谈，并在2个月、6个月和12个月时提供呼出一氧化碳和唾液样本，用于可替宁检测和口腔微生物组分析。
FIESTA的激励干预措施可能会使住院吸烟者受益，这一目标尤为关键，因为住院患者的吸烟率高于普通人群。此外，FIESTA对基于证据的疗法和经生化确认的戒烟的关注有助于指导政策努力，以降低烟草使用率高且疾病成本高的人群中与吸烟相关的医疗保健成本。
ClinicalTrials.gov，NCT02506829。于2014年7月1日注册。
