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Automated Mobile Delivery of Financial Incentives for Smoking Cessation among Socioeconomically Disadvantaged Adults: A Feasibility Study (Preprint)


 BACKGROUND
 Socioeconomic disadvantage is associated with a reduced likelihood of smoking cessation. Smartphone ownership is increasing rapidly, including among low-income adults, and smartphone interventions for smoking cessation may increase access to smoking cessation treatment within socioeconomically disadvantaged populations.
 
 
 OBJECTIVE
 The purpose of this project was to develop and test the feasibility of an automated smartphone-based approach to delivering financial incentives for smoking cessation.
 
 
 METHODS
 Socioeconomically disadvantaged adults initiating tobacco cessation treatment were followed from one week before a scheduled quit attempt through 26 weeks after the quit date. All participants received telephone counseling and nicotine replacement therapy. Smoking cessation was verified five times per week via smartphone prompts to complete a smoking status assessment and submit a breath sample with a portable breath carbon monoxide monitor that connects with participants’ smartphones. Identity was verified during smoking status assessments using smartphone-based facial recognition software. When smoking abstinence and identity were verified, an automated credit card payment was triggered. Participants were incentivized for abstinence on the quit date and up to five days per week during the first four weeks after the scheduled quit date, with additional incentives offered at post-quit weeks eight and 12.
 
 
 RESULTS
 Participants (N = 16) were predominantly female (75.00%) and non-Hispanic White (68.75%) or Black (25.00%), or Hispanic of any race (6.25%). Most participants (56.25%) reported an annual household income of < $11,000. During the first four weeks after the scheduled quit date, participants were abstinent on 29.46% of days, they completed an average of 68.45% of mobile smoking status assessments. Participants earned an average of $37.56 during the first four weeks post-quit, with an additional $5.00 and $3.00 earned on average during post-quit weeks eight and 12 respectively (M = $45.56 total). Over the 12-week incentive period, 48.58% of facial recognition assessments worked as expected. At the in-person follow-up visits, CO-confirmed 7-day point prevalence abstinence rates were 18.75% and 12.50% at 12 and 26 weeks post-quit-date, respectively. Notably, all feasibility metrics improved between the first half of participants enrolled and the latter half, which suggests improved intervention delivery over time. Overall, most participants reported that the system was easy to use and that they would recommend this treatment to their friends and family.
 
 
 CONCLUSIONS
 Preliminary data suggest that this smartphone-based approach to verifying identity and smoking status, and automating the delivery of abstinence-contingent incentives to a credit card may be feasible for use among socioeconomically disadvantaged adults.
 
 
 CLINICALTRIAL
 This study is registered at www.clinicaltrials.gov (NCT03517397).
