Brown Emma M, Smith Debbie M, Armitage Christopher J
Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Health Innovation One, Sir John Fisher Drive, Lancaster LA1 4AT, UK.
The University of Manchester, Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester, UK.
J Subst Use Addict Treat. 2025 Mar;170:209610. doi: 10.1016/j.josat.2024.209610. Epub 2024 Dec 20.
Smoking prevalence rates in prison are typically four times higher than the rates found within community-based settings, increasing premature mortality. Encouraging smokers to self-administer incentives contingent on abstinence (i.e., self-incentivize) are effective in community-based settings and have the potential to work in an incarcerated population. The present study aims to: gauge the feasibility of- and assess possible effects associated with- encouraging smokers to self-incentivize to increase smoking abstinence.
The study recruited 25 smokers from a UK prison who were attending the prison-based stop smoking service. Participants were randomized to one of three conditions, either: (a) an active control, asked to form a plan to quit smoking (n=5); or to self-incentivize if they had not smoked at all by the end of (b) the week (n=7); or (c) the month (n=13). The study gave no specific options to participants in choosing a self-incentive for a number of reasons (e.g., to enable choice of a self-incentive of sufficient rewarding value within a restrictive setting). Participant eligibility included: (a) aged 18 years or over, (b) able to understand written English, (c) competent to provide informed consent, and (d) were tobacco smokers, smoking on a daily basis. Acceptance and completion assessed feasibility. Chi-square analysis assessed possible effect of the intervention.
Twenty five out of 27 smokers who were approached, welcomed the opportunity of further support and completed the baseline questionnaire. At 3-month follow-up, no participants (0/5) in the control condition abstained from smoking. In contrast, three (out of seven, d=1.12) participants who self-incentivized on a weekly basis abstained, and five (out of 13, d=0.83) participants who self-incentivized on a monthly basis abstained at the 3-month follow-up time point. Abstaining is defined as no cigarette smoked within at least the last 28-days via self-report and supported by biochemical verification from a sub-sample of participants (68%; 17/25).
Use of self-incentives alongside behavioral support and cessation medication is feasible and can be delivered at low-cost. Furthermore, the promise seen in this trial suggests a fully powered randomized controlled trial has the potential to increase smoking abstinence in an incarcerated population.
监狱中的吸烟流行率通常比社区环境中的吸烟流行率高出四倍，这增加了过早死亡率。鼓励吸烟者自我实施基于戒烟的激励措施（即自我激励）在社区环境中是有效的，并且有可能在被监禁人群中发挥作用。本研究旨在：评估鼓励吸烟者自我激励以增加戒烟率的可行性，并评估与之相关的可能效果。
该研究从英国一所监狱中招募了25名参加监狱戒烟服务的吸烟者。参与者被随机分配到三种情况之一，即：（a）积极对照组，被要求制定戒烟计划（n = 5）；或者（b）如果在一周结束时完全没有吸烟则进行自我激励（n = 7）；或者（c）在一个月结束时进行自我激励（n = 13）。由于多种原因（例如，为了使参与者在受限环境中能够选择具有足够奖励价值的自我激励措施），该研究没有为参与者提供选择自我激励措施的具体选项。参与者的资格包括：（a）年龄在18岁或以上，（b）能够理解书面英语，（c）有能力提供知情同意书，以及（d）是吸烟者，每天吸烟。接受率和完成率评估了可行性。卡方分析评估了干预措施的可能效果。
在被邀请的27名吸烟者中，有25名欢迎获得进一步支持的机会并完成了基线调查问卷。在3个月的随访中，对照组中没有参与者（0/5）戒烟。相比之下，在3个月的随访时间点，每周进行自我激励的7名参与者中有3名（d = 1.12）戒烟，每月进行自我激励的13名参与者中有5名（d = 0.83）戒烟。戒烟的定义是通过自我报告，并且在至少过去28天内没有吸烟，并且有参与者子样本（68%；17/25）的生化验证支持。
将自我激励与行为支持和戒烟药物一起使用是可行的，并且可以低成本实施。此外，该试验中看到的前景表明，一项充分有力的随机对照试验有可能提高被监禁人群的戒烟率。
