Testing Financial Incentive Interventions in Dyadic-Smoker Couples - Project Summary/Abstract
Smokers partnered with other smokers (i.e., dual-smoker couples) represent ~2/3 of all smokers. Dual-
smoker couples (DSCs) are less likely to try to quit smoking and more likely to relapse during a quit attempt,
reducing overall smoking cessation rates and representing a high-risk clinical population. Despite their high
prevalence and risk for persistent smoking, however, there are limited data on the smoking cessation
interventions among DSCs. Building on previous research that suggests financial incentive treatments (FITs)
are effective at increasing motivation to quit and quit rates in general, the proposed pilot study will
systematically explore using two variants of FIT with DSCs. Specifically, we will test a traditional FIT (i.e.,
targeting one individual of a couple) as well as a dyadic variant of FIT—targeting both members of a couple
with simultaneous financial incentives. Determining the efficacy of FIT (single or dyadic) for DSCs would
require a randomized controlled trial (RCT) and the proposed pilot study will generate critical preliminary data
in three domains. First, we will examine the feasibility of a novel modified dyadic version of FIT for DSCs that
targets both members of the dyad (dyadic FIT), comparing it to standard FIT and a no-FIT active control group.
Second, we will use the pilot study to generate a range of effect size estimates to inform a future RCT of FIT in
DSCs. Finally, we will examine individual and dyadic factors that may serve as mechanisms of behavior
change for FIT interventions in DSCs.
We address these questions in a three-group pilot RCT. In all conditions, both individuals in the couple will
have access to standardized active treatment (i.e., Nicotine Replacement Therapy, a 4-week manualized
educational program). In each couple, the person who first contacts the cessation program will be designated
the target. In the control condition, no individual will receive financial incentives. In the single-target FIT
condition, the target will additionally receive financial incentives for program attendance and abstinence at
follow-up. In the dyadic FIT condition, both members of each couple (target + partner) will receive financial
incentives for program attendance and smoking abstinence. The primary feasibility outcome is % of
participants who complete all sessions of the study; the primary tolerability outcomes are the % of participants
opting to discontinue study participation due to study procedures. Primary outcomes are program completion
and point-prevalence abstinence at 3 months. Potential mechanisms of behavior change include both
individual factors (e.g., change in self-efficacy and motivation) and dyadic factors (e.g., joint quitting, partner
support). Preliminary data on feasibility, efficacy, and mechanisms of behavior change will allow us to
determine whether the dyadic format for FIT is viable for smoking cessation in DSCs. The findings will be
directly used to inform future RCTs testing FIT to promote quitting in this treatment refractory population.
