USING CONTINGENCY MANAGEMENT TO PROMOTE ADHERENCE TO SMOKING CESSATION TREATMENT AMONG HOSPITALIZED SMOKERS - PROJECT SUMMARY/ABSTRACT
Each year, nearly 4 million smokers are hospitalized in the US, creating an important opportunity to initiate to-
bacco cessation treatment. However, smoking cessation treatment started in the hospital must continue at least
1 month post-discharge to be effective. Many hospitals refer smokers to state-sponsored tobacco quitlines to
provide counseling follow up. A recent clinical trial found that varenicline use initiated during the hospital stay in
combination with post-discharge quitline support increased smokers’ likelihood of quitting by 78%. Nevertheless,
most inpatient smokers rarely actually register with the quitline, and those who do register participate in very few
sessions. Furthermore, most smokers never fill their prescriptions for post-discharge cessation medications.
Novel approaches are needed to engage hospitalized smokers in medication and counseling to increase their
odds of quitting. Contingency management (CM) intervention provides financial incentives contingent upon ob-
jective evidence of behavior change and is an effective approach to increase engagement in quitline calls and
to increase rates of compliance with nicotine gum. Critical gaps remain in our knowledge about how best to
deploy CM. CM has not been tested for increasing treatment engagement post-hospitalization. Remote delivery
of CM via mobile health (mHealth) has not been tested for smoking cessation treatment. More broadly, CM
approaches for concurrently incentivizing combined interventions (such as pharmacotherapy + behavioral sup-
port) are lacking. The purpose of the proposed research is to develop and test the feasibility and preliminary
efficacy of an mHealth-delivered CM intervention to increase hospitalized smokers’ post-discharge engagement
in counseling and pharmacotherapy. The proposed research study has the following specific aims: 1) develop a
text-based intervention (CounsCM+MedCM) to remotely incentivize engagement in quitline calls and varenicline
utilization among post-discharged smokers; 2) to use mixed methods to understand strengths, weaknesses, and
areas for improvement of CounsCM+MedCM; 3) to evaluate the feasibility, acceptability, and preliminary efficacy
of CounsCM+MedCM compared to noncontingent “yoked” control (NCYC), in a pilot randomized controlled trial.
Dr. Cruvinel is a postdoctoral associate at the University of Kansas Medical Center with experience and training
in interventions to address tobacco, alcohol and other drug use. Dr. Cruvinel’s career goal is to reduce tobacco-
related morbidity and mortality of hospitalized smokers through novel systems of evidence-based care delivery,
with an emphasis on mHealth interventions for underserved populations. The primary training goals of this pro-
posal are to gain skills in pharmaco-and behavioral clinical trials, mHealth intervention development, and to
develop expertise in CM interventions. The results of the proposed research and training plans will facilitate Dr.
Cruvinel's development as an independent investigator and provide preliminary data for a future large-scale
efficacy study.
