Mary F Brunette1, Sarah I Pratt1, Stephen J Bartels1, Emily A Scherer1, Stacey C Sigmon1, Joelle C Ferron1, Meghan Santos1, Gail E Williams1, Samuel Kosydar1, Rosemarie S Wolfe1, Doris Lotz1, Kelley Capuchino1. 1. Dr. Brunette, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry, and Dr. Scherer is with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Brunette, Dr. Pratt, and Dr. Bartels are also with the Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, where Dr. Ferron, Ms. Santos, Ms. Williams, Mr. Kosydar, and Ms. Wolfe are affiliated. Dr. Sigmon is with the Department of Psychiatry, University of Vermont College of Medicine, Burlington. Dr. Lotz and Ms. Capuchino are with the New Hampshire Department of Health and Human Services, Concord.
Abstract
OBJECTIVE:Medicaid beneficiaries with severe mental illnesses are a financially disadvantaged group with high rates of smoking and poor cessation outcomes. This study examined whether abstinence-contingent monetary incentives improved outcomes when added to cessation treatments at community mental health centers: prescriber visit for pharmacotherapy only (PV only), prescriber visit and facilitated quitline (PV+Q), and prescriber visit and telephone cognitive-behavioral therapy (PV+CBT). METHODS:During 2012-2015, a total of 1,468 adult, daily smoking Medicaid beneficiaries with mental illnesses receivedWeb-based motivational tobacco education. Eligible participants who wanted cessation treatment (N=661) were randomly assigned to treatment with or without abstinence-contingent incentives for four weeks after a quit attempt and assessed for biologically verified abstinence at three, six, nine, and 12 months. To examine intervention effect on abstinence over time, logistic generalized linear models estimated with generalized estimating equations were used, with missing observations imputed as smoking. RESULTS:Participants included smokers with schizophrenia disorders (N=148), bipolar disorder (N=150), major depressive disorder (N=158), and anxiety and other disorders (N=205). There was no significant effect of intervention (PV only, PV+Q, and PV+CBT). However, participants who received monetary incentives were more likely to be abstinent from smoking over time (adjusted odds ratio [AOR]=1.77, p=.009). Post hoc comparisons indicated greater abstinence at 12 months in PV+Q with incentives than in PV+Q without incentives (14% versus 4% abstinent, AOR=3.94, p=.014). Treatment participation and cessation outcomes did not differ significantly between diagnostic groups. CONCLUSIONS:Abstinence-contingent incentives improved cessation outcomes among financially disadvantaged smokers with mental illness receiving tobacco treatment at community mental health centers.
RCT Entities:
OBJECTIVE: Medicaid beneficiaries with severe mental illnesses are a financially disadvantaged group with high rates of smoking and poor cessation outcomes. This study examined whether abstinence-contingent monetary incentives improved outcomes when added to cessation treatments at community mental health centers: prescriber visit for pharmacotherapy only (PV only), prescriber visit and facilitated quitline (PV+Q), and prescriber visit and telephone cognitive-behavioral therapy (PV+CBT). METHODS: During 2012-2015, a total of 1,468 adult, daily smoking Medicaid beneficiaries with mental illnesses received Web-based motivational tobacco education. Eligible participants who wanted cessation treatment (N=661) were randomly assigned to treatment with or without abstinence-contingent incentives for four weeks after a quit attempt and assessed for biologically verified abstinence at three, six, nine, and 12 months. To examine intervention effect on abstinence over time, logistic generalized linear models estimated with generalized estimating equations were used, with missing observations imputed as smoking. RESULTS:Participants included smokers with schizophrenia disorders (N=148), bipolar disorder (N=150), major depressive disorder (N=158), and anxiety and other disorders (N=205). There was no significant effect of intervention (PV only, PV+Q, and PV+CBT). However, participants who received monetary incentives were more likely to be abstinent from smoking over time (adjusted odds ratio [AOR]=1.77, p=.009). Post hoc comparisons indicated greater abstinence at 12 months in PV+Q with incentives than in PV+Q without incentives (14% versus 4% abstinent, AOR=3.94, p=.014). Treatment participation and cessation outcomes did not differ significantly between diagnostic groups. CONCLUSIONS: Abstinence-contingent incentives improved cessation outcomes among financially disadvantaged smokers with mental illness receiving tobacco treatment at community mental health centers.
Entities:
Keywords:
Bipolar disorder; Community mental health centers; Computer technology Incentives; Major Depression; Mental illness; Post-traumatic stress disorder; Schizophrenia; Smoking; Smoking Cessation treatment
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