PROJECT SUMMARY
In Alaska (AK), smoking prevalence of Alaska Native and American Indian (ANAI) people is more than double
that of non-Native adults (37% vs. 17%). Unlike other Indigenous populations, tobacco is not used in traditional
ceremony. Current cessation strategies have not reduced smoking prevalence among ANAI people. AK
geography (largely frontier and road-less) and climate further limit treatment access and reach. Based on
behavioral economic theory, financial incentives to promote cessation is a promising approach in other
populations, with smoking abstinence rates more than doubling one year after discontinued rewards compared
with no incentives. Community input for this study indicate family members are essential in supporting smoking
cessation; consistent with the ANAI cultural value of interdependence, defined as relationship-based,
collaborative, and reliance on family systems rather than individuals. Our research and others’ document the
influence of naturally occurring social support networks on smoking cessation. Family-based incentive
interventions have not been evaluated for smoking or other addictions. To fill this gap, the proposed study will
evaluate the effectiveness and implementation of a culturally-adapted, ANAI family-based incentives
intervention for smoking cessation with the following Specific Aims: (1) Adapt an effective 6-month financial
incentive intervention for ANAI people who smoke and family members; (2) Conduct a randomized controlled
trial (RCT) to evaluate reach and effectiveness of the intervention compared with the control condition on
confirmed, prolonged smoking abstinence at six and 12 months post-intervention; and (3) Evaluate key
process indicators relevant to intervention adoption, implementation, and maintenance, and conduct a cost-
effectiveness analysis to support further adaptation and dissemination. RCT-enrolled dyads (adult ANAI person
who smokes [index participant] and adult family member) will be stratified by index participant’s sex,
rural/urban location, residence with family member, and by family member’s smoking status, then randomized
to a no incentives control condition (n=328 dyads) or a 6-month incentive intervention (n=328 dyads). All dyads
will receive materials on evidence-based cessation resources, social support strategies, and family wellness.
We will measure index participant smoking status in both groups weekly for four weeks, and at three and six
months. Intervention index participants will receive rewards for verified smoking abstinence at each time point,
up to $750; and the family member will receive rewards (e.g., fuel or other needs) equal to the value earned by
the index participant. We will explore potential moderators (e.g., index participant sex) and mediators (e.g.,
interdependence) of intervention effects. To enhance reach, we will recruit participants statewide, primarily with
social media, and deliver the intervention virtually. If successful, our results will inform Tribal policy to adopt the
intervention within the AK Tribal Health System; and possibly, for use within ANAI communities beyond AK.