An Incentive-Based Mobile Health Program for Smoking Cessation in Low-Resource Populations with a Pilot Micro-Randomized Trial

Introduction: Cigarette smoking is the leading cause of preventable death in the United States. We evaluate the feasibility and acceptability of a digital incentive-based intervention for tobacco cessation among Medicaid beneficiaries with a pilot micro-randomized trial.Methods: Participants (N=37; 63.9% annual income <$15,000), self-enrolled across community-based health centers, were incentivized monetarily to submit breath samples twice daily for four weeks, with additional incentives for negative samples (≤6 parts per million carbon monoxide). Participants were randomized twice daily with fixed probability (0.48) to be sent motivational messages or not via an app. We evaluate acceptability and feasibility of the program. Using a generalization of regression suitable for a binary outcome, we examine the average effect of delivering a message (vs. no message) on proximal sample submissions and smoking status.Results: Thirty-three participants who completed a post-test assessment (97.1%) reported would recommend the program to others. Participants submitted samples during 69.5% of submission windows and 61.3% of participants were smoke free at post-test. After adjusting for previous sample submission, participants were 7% more likely (risk ratio (RR) 1.073; 95% confidence interval [CI]: [1.010,1.140]) to submit a sample after a motivational message was delivered (vs. not delivered). Participants were 7% less likely (RR 0.931; 95%CI: [0.827,1.048]) to submit a positive sample (vs. negative), although not statistically significant.Conclusions: The results support the incorporation of motivational messages into research involving incentive-based treatments for tobacco cessation.