Technology-based contingency management and e-cigarettes during the initial weeks of a smoking quit attempt

Abstract

Contingency management (CM) interventions are among the most effective behavioral interventions for smoking. This study assessed the effects of CM and electronic cigarettes (ECs) on smoking reductions and abstinence for durations of 30-36 days. Twelve participants were exposed to Baseline, EC alone, and EC + CM conditions. An internet-based platform was used to monitor smoking via breath carbon monoxide (CO) and deliver CM for smoking abstinence (CO ≤4 ppm). A Bluetooth-enabled EC monitored daily EC puffs. Abstinence rates were equivalent between EC (34.4%) and EC + CM (30.4%) conditions. Both conditions promoted smoking reductions. We observed an inverse correlation between smoking and EC puffs (r = -.62, p < .05). Results suggest the use of electronic cigarettes can promote smoking reductions and abstinence, and CM did not improve these outcomes. Larger magnitude consequences or tailoring EC characteristics (e.g., flavor) may have improved outcomes. Technology-based methods to collect intensive, longitudinal measures of smoking and electronic cigarette use may be useful to characterize their environmental determinants.

Keywords: cigarette smoking; contingency management; e-cigarette; smoking cessation; technology.

Figure 1.

Carbon monoxide (CO) levels in parts per million (filled circles, primary axis) and number of EC puffs per day (open circles, secondary axis) across phases. BL = baseline. Horizontal dashed lines represent abstaining goals (CO ≤4 ppm). Arrows indicate that a participant reported using e-liquid not provided by researchers. The first day in EC phase corresponded with the quit date. Note that two CO samples are plotted consecutively along the x-axis per day.

Figure 2.

Individual carbon monoxide (CO) levels in parts per million (filled circles, primary axis) and number of EC puffs per day (open circles, secondary axis) across phases. BL = baseline. Horizontal dashed lines represent abstaining goals (CO ≤4 ppm). Arrows indicate that a participant reported using e-liquid not provided by researchers. The first day in EC + CM phase corresponded with the quit date. Note that two CO samples are plotted consecutively along the x-axis per day.

Figure 3.

Percentage of breath carbon monoxide (CO) samples that were less than or equal to abstinence criteria of 4 parts per million (ppm) across each phase. Dots represent data for each participant. Open circles represent data for participants who met abstinence criteria in EC phase and did not receive EC + CM. Horizontal lines represent means.

Figure 4.

Mean percentage change in breath carbon monoxide (CO) samples from baseline plotted as a function of mean EC puffs per day for each phase. Each dot represents data for a participant. Filled circles represent participants in the EC phase and open circles represent participants in the EC + CM phase.

Figure 5.

Acceptability ratings for the electronic cigarette. Each dot represents a score for a participant. Horizontal lines represent means. Responses were provided on a visual analog scale from 0-100 (0 = Very Strongly Disagree, 100 = Very Strongly Agree).

Figure 6.

Acceptability ratings for intervention procedures. Each dot represents a score for a participant. Horizontal lines represent means. Responses were provided on a visual analog scale from 0-100 (0 = Very Strongly Disagree, 100 = Very Strongly Agree). CTA = Clearing the Air.