Prize-Based Incentives for Smoking Cessation Among People With HIV: A Sequential Multiple Assignment Randomized Trial
David M Ledgerwood1, Leslie H Lundahl1, Mark K Greenwald1
1Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA.
Summary
Prize-based contingency management (CM) showed limited success in initial smoking cessation for people with HIV (PWH). However, brief booster CM sessions effectively helped early quitters maintain abstinence long-term.
Area of Science:
- Public Health
- Behavioral Science
- HIV Medicine
Background:
- Contingency management (CM) is an effective incentive-based smoking cessation strategy.
- People with HIV (PWH) have a high prevalence of smoking and need tailored interventions.
- A Sequential Multiple Assignment Randomized Trial (SMART) design was used to personalize intervention intensity.
Purpose of the Study:
- To evaluate the efficacy of prize-based CM for smoking cessation in PWH.
- To tailor intervention intensity based on participants' early treatment response.
Main Methods:
- 129 participants were randomized to high-magnitude CM (HM-CM) or standard of care (SoC).
- Non-responders were further randomized to different CM or monitoring support levels.
- Responders received booster CM or no additional care.
- Outcomes included biochemically verified smoking reduction and abstinence at multiple follow-ups.
Main Results:
- Initial CM exposure did not improve early smoking reduction rates compared to SoC.
- Participants receiving low-magnitude incentives after initial reduction were less likely to relapse.
- High-magnitude incentives for non-responders did not enhance later cessation rates.
Conclusions:
- Weekly CM sessions in the initial 4 weeks were not superior to SoC for smoking cessation in PWH.
- Brief booster CM sessions show promise for maintaining smoking cessation in early responders.
- Further research is warranted to optimize CM for PWH smoking cessation.
