Income Levels and Response to Contingency Management for Smoking Cessation

ABSTRACT

Background: Contingency management (CM) has demonstrated its efficacy in treating many drug addictions, including nicotine. However, one of the most commonly perceived limitations with regard to its dissemination into community settings is whether this protocol could be equally effective for treating patients across different income levels. Objective: This study aimed to examine whether individuals' income levels affect treatment success in a cognitive behavioral treatment (CBT) that included a voucher-based CM protocol for smoking cessation. Methods: A total of 92 treatment-seeking smokers in a community setting were randomly assigned to a CBT group (N = 49) or to a CBT plus CM group (N = 43). The CM procedure included a voucher program through which smoking abstinence was reinforced on a schedule of escalating magnitude of reinforcement with a reset contingency. We analyzed the impact of self-reported monthly income, alone and in combination with treatment condition, on short-term (treatment retention) and long-term (self-reported number of days of continuous smoking abstinence at 6-month follow-up) results. Results: Income had no effect on treatment retention and continuous abstinence outcomes at 6-month follow-up in either treatment condition. Treatment modality emerged as the only significant predictor of treatment success. Conclusions: Our findings suggest that treatment-seeking smokers from the general population respond equally well to CM regardless of their income levels. The results of this randomized controlled trial support the generalizability of this evidenced-based program into community settings.

KEYWORDS:

• Contingency management
• community setting
• income
• smoking cessation
• socio-economic status

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Funding

Work on this manuscript was supported by the Spanish Ministry of Science and Innovation (MICINN) Grant (PSI2011-22804) and the Predoctoral Grant BP12-037, from the Foundation for the Promotion of Applied Scientific Research and Technology in Asturias (FICYT). The Spanish Ministry of Science and Innovation and the Foundation for the Promotion of Applied Scientific Research and Technology in Asturias had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the article for publication.