Project Summary Smoking is the number one cause of preventable death in the United States (U.S.). Approximately 14% of U.S. adults are current cigarette smokers, and about 7 out of 10 smokers report a desire to quit. Unfortunately, even among the best smoking cessation interventions, relapse is the most likely outcome. Internet-based contingency management (CM) is a remotely-delivered, evidence-based intervention that involves the provision of financial incentives contingent on objective evidence of smoking abstinence. Internet-based CM has been shown to be both acceptable and highly efficacious, so research efforts are now focused on making the intervention scalable and sustainable by exploring non-monetary incentives for abstinence. About 81% of U.S. adults own a smartphone and 90% of the time people spend on their phones involves using applications (apps) for sending messages, playing mobile games, social networking, shopping, and reading. Given the widespread use of mobile phone apps, and their variety, they may serve as an ideal personalized, low- cost, non-monetary incentive for smoking abstinence that would be relevant to a broad audience in the context of a mobile CM intervention. App blocking programs prevent users from accessing certain apps and they are already available and in high demand; however, none of the existing app-blocking programs are designed to promote health behavior by requiring objective evidence of the target behavior (in this case smoking abstinence) before unblocking the app. The aims of the current proposal are to (1) develop and (2) evaluate Re-Connect, a personalized, smartphone app-blocking-based CM intervention that would limit participants’ access to high-valued, but non-essential (e.g., social media, shopping, games), phone apps until objective evidence of smoking abstinence has been verified. First, we will develop and test Re-Connect using a dynamic systems development, iterative testing, approach involving treatment-seeking smokers at each stage, conducting usability tests via focus groups and feedback sessions. Second, we will randomly assign treatment- seeking smokers (N=50) to either: (1) abstinent contingent (AC) where tokens for unblocking apps can be earned contingent on objective evidence of smoking abstinence (CO < 6ppm), or (2) submission contingent (SC) where tokens can be earned contingent on submitting CO videos, but independent of quitting during a 6- month observation period. Primary outcomes of feasibility and acceptability of Re-Connect will be assessed via (a) enrollment, (b) duration of use, (c) reasons for discontinuation, and (d) participant-reported acceptability. Primary outcomes of preliminary efficacy will be assessed via (e) percent of negative daily CO samples, and (f) 7-day point prevalence of self-reported smoking status, verified by CO, between the two groups. Our team has extensive experience with mobile CM interventions, technology development, focus groups, single-case designs, biostatistics, human factors testing, and clinical trial testing, making us ideally positioned to carry out the proposed proof-of-concept development and testing.

Project Narrative Incentive-based approaches hold great promise for promoting smoking abstinence, but innovative strategies for making them scalable and sustainable are needed. The current application proposes to develop Re- Connect, which will leverage the existing rewarding value of smartphone applications and make access to them contingent on evidence of smoking abstinence. If the approach is successful it has the potential to make a significant public health impact by not only helping to reduce unnecessary death and disease associated with smoking, but it could also be extended to other health behavior as well.