摘要：Objectives. We evaluated the effectiveness of offering adjunctive financial incentives for abstinence (contingency management [CM]) within a safety net hospital smoking cessation program. Methods. We randomized participants (n = 146) from a Dallas County, Texas, Tobacco Cessation Clinic from 2011 to 2013 to usual care (UC; cessation program; n = 71) or CM (UC + 4 weeks of financial incentives; n = 75), and followed from 1 week before the quit date through 4 weeks after the quit date. A subset (n = 128) was asked to attend a visit 12 weeks after the scheduled quit date. Results. Participants were primarily Black (62.3%) or White (28.1%) and female (57.5%). Most participants were uninsured (52.1%) and had an annual household income of less than $12 000 (55.5%). Abstinence rates were significantly higher for those assigned to CM than UC at all visits following the quit date (all P s < .05). Point prevalence abstinence rates in the CM and UC groups were 49.3% versus 25.4% at 4 weeks after the quit date and 32.8% versus 14.1% at 12 weeks after the quit date. CM participants earned an average of $63.40 ($150 possible) for abstinence during the first 4 weeks after the scheduled quit date. Conclusions. Offering small financial incentives for abstinence might be an effective means to improve abstinence rates among socioeconomically disadvantaged individuals participating in smoking cessation treatment. Tobacco use is the leading cause of preventable death in the United States. 1 Although the prevalence of smoking has declined to 18.1% among US adults, 27.9% of those living below the poverty threshold continue to smoke. 2 Numerous studies have shown that socioeconomic disadvantage is associated with a reduced likelihood of smoking cessation, 3–9 despite comparable numbers of quit attempts by individuals with higher socioeconomic status. 10 Furthermore, abstinence rates among socioeconomically disadvantaged smokers participating in smoking cessation interventions are alarmingly low (e.g., point prevalence abstinence rates of 7%–13% and continuous abstinence rates of 2%–4% at 6-month follow-up). 8,9,11–13 Factors, including exposure to stress or adversity (e.g., neighborhood problems, income instability), limited psychosocial resources (e.g., social support), greater nicotine dependence, greater negative affect, and poor adherence to smoking cessation treatments, may contribute to dismal smoking cessation outcomes and poor general health in socioeconomically disadvantaged populations. 14–16 Notably, contingency management (CM), or the tangible reinforcement of abstinence and other related outcomes, is one approach that has been effective for the promotion of abstinence among individuals participating in treatment of substance abuse or dependence. 17,18 The CM approach is also effective for promoting smoking abstinence in a variety of populations. 19–31 Notably, Etter 32 is evaluating the use of financial incentives for low-income smokers as part of an ongoing Internet-based smoking cessation program in Switzerland. However, the CM approach for smoking cessation has yet to be evaluated in mainstream clinic settings, such as safety net hospitals that serve economically disadvantaged smokers who are motivated to quit smoking. Recent survey research suggests that financial incentives for smoking cessation may be particularly appealing among individuals of low socioeconomic status. 33 Thus, our purpose in this study was to test the effectiveness of offering small financial incentives to encourage short-term abstinence among economically disadvantaged smokers who enrolled in a tobacco cessation program at a safety net hospital.
