Behavioral incentives have been used to encourage smoking cessation in older adolescents, but the acceptability of incentives to promote a smoke-free lifestyle in younger adolescents is unknown. To inform the development of novel, effective, school-based interventions for youth, we assessed middle school students’ interest in participating in an incentive-based tobacco abstinence program. We surveyed 988 students (grades 6–8) attending three Connecticut middle schools to determine whether interest in program participation varied as a function of (1) intrapersonal factors (i.e., demographic characteristics (sex, age, race), smoking history, and trait impulsivity) and/or (2) aspects of program design (i.e., prize type, value, and reward frequency). Primary analyses were conducted using multiple regression. A majority of students (61.8%) reported interest in program participation. Interest did not vary by gender, smoking risk status, or offering cash prizes. However, younger students, non-Caucasian students, behaviorally impulsive students, and students with higher levels of self-regulation were more likely to report interest. Inexpensive awards (e.g., video games) offered monthly motivated program interest. In sum, middle school students reported high levels of interest in an incentive-based program to encourage a tobacco-free lifestyle. These formative data can inform the design of effective, incentive-based smoking cessation and prevention programs in middle schools. 1. Introduction Tobacco use is the leading cause of preventable morbidity and mortality in the United States [1, 2]. According to the National Youth Tobacco Survey [3], 5% of middle school students (grades 6–8) currently smoke cigarettes and 20% of nonsmokers report willingness to experiment with cigarettes. A growing body of research indicates that trait impulsivity, or “a predisposition toward rapid, unplanned action…with diminished regard to negative consequences” [4] may further increase risk for smoking initiation [5–7]. High levels of intent to smoke among young adolescents may be driven in part by intrapersonal factors like impulsivity and contribute to sharp increases in smoking uptake among high school students. Unfortunately, early initiation of smoking predicts future regular smoking and increases the likelihood of developing lifetime respiratory conditions, cardiovascular disease, and cancers [8]. Thus, effective tobacco prevention/intervention programs in middle schools are needed. Unfortunately, few well-designed prevention or intervention trials have shown promise in middle
References
[1]
B. Rostron, “Smoking-attributable mortality by cause in the United States: revising the CDC's data and estimates,” Nicotine and Tobacco Research, vol. 15, no. 1, pp. 238–246, 2013.
[2]
A. H. Mokdad, J. S. Marks, D. F. Stroup, and J. L. Gerberding, “Actual causes of death in the United States, 2000,” Journal of the American Medical Association, vol. 291, no. 10, pp. 1238–1245, 2004.
[3]
Centers for Disease Control and Prevention, “Tobacco use among middle and high school students United States, 2000–2009,” Morbidity and Mortality Weekly Report, vol. 59, no. 33, pp. 1063–1068, 2010.
[4]
F. G. Moeller, D. M. Dougherty, E. S. Barratt, J. M. Schmitz, A. C. Swann, and J. Grabowski, “The impact of impulsivity on cocaine use and retention in treatment,” Journal of Substance Abuse Treatment, vol. 21, no. 4, pp. 193–198, 2001.
[5]
J. Audrain-McGovern, D. Rodriguez, K. P. Tercyak, G. Neuner, and H. B. Moss, “The impact of self-control indices on peer smoking and adolescent smoking progression,” Journal of Pediatric Psychology, vol. 31, no. 2, pp. 139–151, 2006.
[6]
J. L. O'Loughlin, E. N. Dugas, E. K. O'Loughlin, I. Karp, and M. P. Sylvestre, “Incidence and determinants of cigarette smoking initiation in young adults,” Journal of Adolescent Health, vol. 54, no. 1, pp. 26–32.e4, 2014.
[7]
K. P. Tercyak and J. Audrain-McGovern, “Personality differences associated with smoking experimentation among adolescents with and without comorbid symptoms of ADHD,” Substance Use and Misuse, vol. 38, no. 14, pp. 1953–1970, 2003.
[8]
K. S. Kendler, J. Myers, M. I. Damaj, and X. Chen, “Early smoking onset and risk for subsequent nicotine dependence: a monozygotic co-twin control study,” The American Journal of Psychiatry, vol. 170, no. 4, pp. 408–413, 2013.
[9]
S. E. Wiehe, M. M. Garrison, D. A. Christakis, B. E. Ebel, and F. P. Rivara, “A systematic review of school-based smoking prevention trials with long-term follow-up,” Journal of Adolescent Health, vol. 36, no. 3, pp. 162–169, 2005.
[10]
S. Sussman, C. W. Dent, A. W. Stacy et al., “Project towards no tobacco use: 1-year behavior outcomes,” The American Journal of Public Health, vol. 83, no. 9, pp. 1245–1250, 1993.
[11]
G. Dino, K. Horn, J. Goldcamp, A. Fernandes, I. Kalsekar, and C. Massey, “A 2-year efficacy study of Not On Tobacco in Florida: an overview of program successes in changing teen smoking behavior,” Preventive Medicine, vol. 33, no. 6, pp. 600–605, 2001.
[12]
S. Sussman, C. W. Dent, and K. L. Lichtman, “Project EX. Outcomes of a teen smoking cessation program,” Addictive Behaviors, vol. 26, no. 3, pp. 425–438, 2001.
[13]
C. L. Backinger, C. N. Michaels, A. M. Jefferson, P. Fagan, A. L. Hurd, and R. Grana, “Factors associated with recruitment and retention of youth into smoking cessation intervention studies—a review of the literature,” Health Education Research, vol. 23, no. 2, pp. 359–368, 2008.
[14]
L. W. Hawk, C. Higbee, A. Hyland, T. Alford, R. O'Connor, and K. M. Cummings, “Concurrent quit & win and nicotine replacement therapy voucher giveaway programs: participant characteristics and predictors of smoking abstinence,” Journal of Public Health Management and Practice, vol. 12, no. 1, pp. 52–59, 2006.
[15]
S. E. Meredith, M. J. Grabinski, and J. Dallery, “Internet-based group contingency management to promote abstinence from cigarette smoking: a feasibility study,” Drug and Alcohol Dependence, vol. 118, no. 1, pp. 23–30, 2011.
[16]
K. G. Volpp, A. B. Troxel, M. V. Pauly et al., “A randomized, controlled trial of financial incentives for smoking cessation,” The New England Journal of Medicine, vol. 360, no. 7, pp. 699–709, 2009.
[17]
D. A. Cavallo, J. L. Cooney, A. M. Duhig et al., “Combining cognitive behavioral therapy with contingency management for smoking cessation in adolescent smokers: a preliminary comparison of two different CBT formats,” The American Journal on Addictions, vol. 16, no. 6, pp. 468–474, 2007.
[18]
S. Krishnan-Sarin, A. M. Duhig, S. A. McKee et al., “Contingency management for smoking cessation in adolescent smokers,” Experimental and Clinical Psychopharmacology, vol. 14, no. 3, pp. 306–310, 2006.
[19]
K. Cahill and R. Perera, “Quit and Win contests for smoking cessation,” Cochrane Database of Systematic Reviews, no. 4, Article ID CD004986, 2008.
[20]
M. E. Morean, G. Kong, D. R. Camenga et al., “Contingency management improves smoking cessation treatment outcomes among highly impulsive adolescent smokers relative to cognitive behavioral therapy,” Under review.
[21]
S. Krishnan-Sarin, B. Reynolds, A. M. Duhig et al., “Behavioral impulsivity predicts treatment outcome in a smoking cessation program for adolescent smokers,” Drug and Alcohol Dependence, vol. 88, no. 1, pp. 79–82, 2007.
[22]
L. Steinberg, S. Graham, L. O'Brien, J. Woolard, E. Cauffman, and M. Banich, “Age differences in future orientation and delay discounting,” Child Development, vol. 80, no. 1, pp. 28–44, 2009.
[23]
B. Reynolds and S. Fields, “Delay discounting by adolescents experimenting with cigarette smoking,” Addiction, vol. 107, no. 2, pp. 417–424, 2012.
[24]
E. L. Deci, “Effects of externally mediated rewards on intrinsic motivation,” Journal of Personality and Social Psychology, vol. 18, no. 1, pp. 105–115, 1971.
[25]
E. L. Deci, R. M. Ryan, and R. Koestner, “A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation,” Psychological Bulletin, vol. 125, no. 6, pp. 627–668, 1999.
[26]
M. Promberger and T. M. Marteau, “When do financial incentives reduce intrinsic motivation? Comparing behaviors studied in psychological and economic literatures,” Health Psychology, vol. 32, no. 9, pp. 950–957, 2013.
[27]
B. Isensee and R. Hanewinkel, “Meta-analysis on the effects of the smoke-free class competition on smoking prevention in adolescents,” European Addiction Research, vol. 18, no. 3, pp. 110–115, 2012.
[28]
Charles-Schwab, “Teens & Money Survey: insights into money attitudes, behaviors, and expectations of 16- to 18-year-olds,” 2011, http://www.schwabmoneywise.com/public/file/P-4192268/110526-SCHWAB-TEENSMONEY.pdf.
[29]
T. S. Schepis, R. A. Desai, A. E. Smith et al., “Impulsive sensation seeking, parental history of alcohol problems, and current alcohol and tobacco use in adolescents,” Journal of Addiction Medicine, vol. 2, no. 4, pp. 185–193, 2008.
[30]
M. J. S. Hanson, “Cross-cultural study of beliefs about smoking among teenaged females,” Western Journal of Nursing Research, vol. 21, no. 5, pp. 635–651, 1999.
[31]
J. H. Patton, M. S. Stanford, and E. S. Barratt, “Factor structure of the Barratt Impulsiveness Scale,” Journal of Clinical Psychology, vol. 51, no. 6, pp. 768–774, 1995.
[32]
L. Steinberg, C. Sharp, M. S. Stanford, and A. T. Tharp, “New tricks for an old measure: the development of the Barratt Impulsiveness Scale-Brief (BIS-Brief),” Psychological Assessment, vol. 25, no. 1, pp. 216–226, 2013.
[33]
M. E. Morean, K. S. Demartini, R. F. Leeman et al., “Psychometrically improved, abbreviated versions of three classic measures of impulsivity and self-control,” Psychological Assessment. In press.
[34]
L. D. Johnston, P. M. O'malley, J. G. Bachman, and J. E. Schulenberg, Monitoring the Future National Survey Results on Drug Use, 1975–2011, Institute for Social Research, The University of Michigan, Ann Arbor, Mich, USA, 2012.
[35]
L. D. Rosen, Rewired: Understanding the iGeneration and the Way They Learn, Palgrave MacMillan, New York, NY, USA, 2010.
[36]
J. Concato, A. R. Feinstein, and T. R. Holford, “The risk of determining risk with multivariable models,” Annals of Internal Medicine, vol. 118, no. 3, pp. 201–210, 1993.
[37]
L. T. Hu and P. M. Bentler, “Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives,” Structural Equation Modeling, vol. 6, no. 1, pp. 1–55, 1999.
[38]
J. H. Steiger, “Understanding the limitations of global fit assessment in structural equation modeling,” Personality and Individual Differences, vol. 42, no. 5, pp. 893–898, 2007.
[39]
B. M. Byrne and D. Watkins, “The issue of measurement invariance revisited,” Journal of Cross-Cultural Psychology, vol. 34, no. 2, pp. 155–175, 2003.
