PROJECT SUMMARY/ABSTRACT Each year, nearly 4 million smokers are hospitalized in the US, creating an important opportunity to initiate to- bacco cessation treatment. However, smoking cessation treatment started in the hospital must continue at least 1 month post-discharge to be effective. Many hospitals refer smokers to state-sponsored tobacco quitlines to provide counseling follow up. A recent clinical trial found that varenicline use initiated during the hospital stay in combination with post-discharge quitline support increased smokers’ likelihood of quitting by 78%. Nevertheless, most inpatient smokers rarely actually register with the quitline, and those who do register participate in very few sessions. Furthermore, most smokers never fill their prescriptions for post-discharge cessation medications. Novel approaches are needed to engage hospitalized smokers in medication and counseling to increase their odds of quitting. Contingency management (CM) intervention provides financial incentives contingent upon ob- jective evidence of behavior change and is an effective approach to increase engagement in quitline calls and to increase rates of compliance with nicotine gum. Critical gaps remain in our knowledge about how best to deploy CM. CM has not been tested for increasing treatment engagement post-hospitalization. Remote delivery of CM via mobile health (mHealth) has not been tested for smoking cessation treatment. More broadly, CM approaches for concurrently incentivizing combined interventions (such as pharmacotherapy + behavioral sup- port) are lacking. The purpose of the proposed research is to develop and test the feasibility and preliminary efficacy of an mHealth-delivered CM intervention to increase hospitalized smokers’ post-discharge engagement in counseling and pharmacotherapy. The proposed research study has the following specific aims: 1) develop a text-based intervention (CounsCM+MedCM) to remotely incentivize engagement in quitline calls and varenicline utilization among post-discharged smokers; 2) to use mixed methods to understand strengths, weaknesses, and areas for improvement of CounsCM+MedCM; 3) to evaluate the feasibility, acceptability, and preliminary efficacy of CounsCM+MedCM compared to noncontingent “yoked” control (NCYC), in a pilot randomized controlled trial. Dr. Cruvinel is a postdoctoral associate at the University of Kansas Medical Center with experience and training in interventions to address tobacco, alcohol and other drug use. Dr. Cruvinel’s career goal is to reduce tobacco- related morbidity and mortality of hospitalized smokers through novel systems of evidence-based care delivery, with an emphasis on mHealth interventions for underserved populations. The primary training goals of this pro- posal are to gain skills in pharmaco-and behavioral clinical trials, mHealth intervention development, and to develop expertise in CM interventions. The results of the proposed research and training plans will facilitate Dr. Cruvinel's development as an independent investigator and provide preliminary data for a future large-scale efficacy study.

PROJECT NARRATIVE Smoking cessation treatment for hospitalized patients must continue when they leave the hospital in order to achieve the best results. Most smokers, however, return to smoking soon after leaving the hospital. This research will develop and test interventions to engage smokers in post-discharge smoking cessation treatment which will positively impact the long-term health of more than 4 million smokers that are hospitalized every year in the U.S.