Incentivized Smoking Cessation for Diabetics

Individuals with type 2 diabetes (T2D) are at an increased risk of many cancers, though the
causal link is not well understood. Continuing to smoke after a T2D diagnosis is also
associated with accelerated progression of microvascular and macrovascular complications and
an increased risk of death. Smoking cessation is recommended as a standard treatment for
diabetes. However, both patients and providers are faced with other challenging lifestyle
changes and disease management processes, which lead to greater difficulty in quitting.

Contingency management, or a method of providing financial incentives contingent upon
positive behaviors, has shown promise for improving adherence to medication among diabetics
and for improving smoking cessation in other populations. This approach could offer an
innovative and scalable means of increasing abstinence in this group, ultimately reducing
their risk of cancer. This is a multicenter pilot randomized controlled trial that will
recruit participants in Oklahoma and in Strathclyde, Scotland.

This pilot study aims to test the feasibility of providing incentives to patients with T2D
contingent on remote biochemical verification using a smartphone carbon monoxide (CO)
monitor. The investigators will use an ecological momentary assessment (EMA) smartphone
application and CO sensor to monitor urges to smoke, stressors, smoking behaviors, and to
validate continuous abstinence throughout the intervention. Two different contingency
management structures will be explored to investigate the length of time incentives need to
be offered. Qualitative semi-structured interviews will be used to explore the patient and
provider acceptability of an incentive-based cessation program, any unintended consequences
and possible differences between UK and US health settings.

The results of this research will inform the feasibility of carrying out a randomized
controlled trial of this intervention. The ultimate aim is to develop an effective
intervention that could be scaled to the T2D population at large, which reduces cancer risk
and improves disease outcomes among a high-risk group.

Inclusion Criteria:

- Aged 18 to 75

- Type 2 diabetes diagnosis greater than 1 year prior to enrollment

- Currently smoking at least 5 cigarettes per day

- Self-reported quit attempt in past 12 months

Exclusion Criteria:

- Unwilling to make a quit attempt

- Unable to use smartphone iCO monitor following training session