激励贫困县参与烟草求助热线：一项随机试验
Incentivizing Tobacco Helpline Engagement in Persistent Poverty Counties: A Randomized Trial.
作者信息
Kendzor Darla E, Davie Morgan, Chen Meng, Hart Jonathan, Frank-Pearce Summer G, Doescher Mark P, Alexander Adam C, Businelle Michael S, Ogunsanya Motolani E, Sifat Munjireen S, Boozary Laili Kharazi
机构信息
Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences, Oklahoma City, Oklahoma; TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences, Oklahoma City, Oklahoma.
TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences, Oklahoma City, Oklahoma.
出版信息
Am J Prev Med. 2025 Feb;68(2):336-347. doi: 10.1016/j.amepre.2024.10.014. Epub 2024 Oct 29.
INTRODUCTION
Persistent poverty counties (PPCs) are U.S. counties where ≥20% of residents have lived in poverty for ≥30 years. Cancer mortality rates in PPCs are exceptionally high due, in part, to elevated smoking rates.
STUDY DESIGN
The study used a parallel 2-group randomized controlled trial design.
SETTING/PARTICIPANTS: Participants were Oklahoma Tobacco Helpline (OTH) callers from PPCs who smoked daily (N=165). Data were collected in 2022-2023.
INTERVENTION
Participants were randomized to received OTH treatment (coaching calls plus nicotine replacement therapy [NRT]) or OTH treatment + financial incentives (OTH+FI) for completing coaching calls.
MAIN OUTCOME MEASURES
Outcome measures included the number of coaching calls completed, call-contingent incentives earned, past 7-day self-reported abstinence rates, and study retention at 8- and 12-weeks post-enrollment.
RESULTS
Participants (N=165) were predominantly female (63.6%), 24.2% were racially/ethnically minoritized (18.2% single- or multi-race American Indian), and they smoked an average of 21.01 (SD=11.67) cigarettes per day. Adjusted analyses indicated that participants assigned to OTH+FI were significantly more likely than those assigned to OTH to report past 7-day abstinence at the 8-week (AOR=2.28; 95% CI=1.18, 4.48) and 12-week (AOR=2.00; 95% CI=1.03, 3.96) follow-ups when missing outcomes were considered smoking. Participants assigned to OTH+FI were more likely to complete ≥3 coaching calls (AOR=3.64; 95% CI=1.84, 7.43), and they completed more total calls (aRR=1.53; 95% CI,=1.24, 1.90) than those assigned to OTH. The number of coaching calls completed significantly mediated the relationship between treatment group assignment and abstinence at the 8- and 12-week follow-ups. Overall, study retention was >83% at the 8- and 12-week follow-ups and did not differ between groups. Statistical analyses were conducted in 2024.
CONCLUSIONS
Findings support the feasibility and efficacy of offering small FI for completing OTH coaching calls to increase treatment engagement and smoking cessation in PPCs.
引言
持久贫困县是指美国那些有≥20%的居民处于贫困状态达≥30年的县。持久贫困县的癌症死亡率异常高，部分原因是吸烟率升高。
研究设计
本研究采用平行两组随机对照试验设计。
设置/参与者：参与者是来自持久贫困县的俄克拉荷马戒烟热线（OTH）的每日吸烟者（N = 165）。数据于2022 - 2023年收集。
干预措施
参与者被随机分配接受OTH治疗（辅导电话加尼古丁替代疗法[NRT]）或接受OTH治疗 + 完成辅导电话的经济激励（OTH + FI）。
主要结局指标
结局指标包括完成的辅导电话数量、获得的随叫随到激励、过去7天自我报告的戒烟率以及入组后8周和12周的研究留存率。
结果
参与者（N = 165）主要为女性（63.6%），24.2%为少数种族/族裔（18.2%为单一种族或多种族的美国印第安人），他们平均每天吸烟21.01支（标准差 = 11.67）。校正分析表明，在将缺失结局视为吸烟的情况下，分配到OTH + FI组的参与者在8周（调整后比值比[AOR]=2.28；95%置信区间[CI]=1.18, 4.48）和12周（AOR = 2.00；95% CI = 1.03, 3.96）随访时报告过去7天戒烟的可能性显著高于分配到OTH组的参与者。分配到OTH + FI组的参与者更有可能完成≥3次辅导电话（AOR = 3.64；95% CI = 1.84, 7.43），并且他们完成的总电话数比分配到OTH组的参与者更多（调整后风险比[aRR]=1.53；95% CI = 1.24, 1.90）。在8周和12周随访时，完成的辅导电话数量显著介导了治疗组分配与戒烟之间的关系。总体而言，在8周和12周随访时研究留存率>83%，且两组之间无差异。统计分析于2024年进行。
结论
研究结果支持为完成OTH辅导电话提供小额经济激励以提高持久贫困县的治疗参与度和戒烟效果的可行性和有效性。
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