Re-Connect: Personalized, Non-Monetary Smartphone-based Rewards for Smoking Cessation

Smoking is the number one cause of preventable death in the United States (U.S.). Approximately 14% of U.S. adults are current cigarette smokers, and about 7 out of 10 smokers report a desire to quit. Unfortunately, even among the best smoking cessation interventions, relapse is the most likely outcome. We developed and tested internet-based contingency management (CM), which is a remotely-delivered evidence-based intervention that involves the provision of financial incentives contingent on objective evidence of smoking abstinence. Internet-based CM has been shown to be both acceptable and highly efficacious, so research efforts are now focused on making the intervention scalable and sustainable by exploring non-monetary incentives for abstinence. About 81% of U.S. adults own a smartphone and 90% of the time people spend on their phones involves using applications (apps) for sending messages, playing mobile games, social networking, shopping, and reading. Given the widespread use of mobile phone apps, and their variety, they may serve as an ideal low-cost, non-monetary incentive for smoking abstinence that would be relevant to a broad audience in the context of a mobile CM intervention. App blocking programs prevent users from accessing certain apps and they are already available and in high demand; however, none of the existing app-blocking programs are designed to promote health behavior by requiring objective evidence of the target behavior (in this case smoking abstinence) before unblocking the app. The aims of the current proposal are to (1) develop and (2) evaluate Re-Connect, a smartphone app-blocking-based CM intervention that would limit participants’ access to high-valued, but non-essential, phone apps until objective evidence of smoking abstinence has been verified. First, we will develop and test Re-Connect using a dynamic iterative testing approach with treatment-seeking smokers, conducting usability tests via focus groups and feedback sessions. Second, we will randomly assign treatment-seeking smokers (N=50) to either: (1) abstinent contingent (AC) where tokens for unblocking apps can be earned contingent on objective evidence of smoking abstinence (CO < 4ppm), or (2) submission contingent (SC) where tokens can be earned contingent on submitting CO videos, but independent of quitting during a 12-week clinical trial. Feasibility, acceptability, and preliminary efficacy of Re-Connect will be assessed via the primary outcome measures of (a) usage and retention, (b) patient-reported acceptability, and (c) percent of negative daily CO samples and self-reports of smoking status between the two groups. Our team has extensive experience with mobile CM interventions, technology development, focus groups, single-case designs, human factors UI/UX testing, and clinical trial testing, making us ideally positioned to carry out the proposed proof-of-concept development and testing.