title: Abstinence Reinforcement Therapy (ART) for rural veterans: Methodology for an mHealth smoking cessation intervention.
abstract: Smoking is the most preventable cause of morbidity and mortality in U.S. veterans. Rural veterans in particular have elevated risk for smoking and smoking-related illness. However, these veterans underutilize smoking cessation treatment, which suggests that interventions for rural veterans should optimize efficacy and reach.
  
  
  
  The primary goal of the current study is to evaluate the effectiveness of an intervention that combines evidenced based treatment for smoking cessation with smart-phone based, portable contingency management on smoking rates compared to a contact control intervention in a randomized controlled trial among rural Veteran smokers. Specifically, Veterans will be randomized to receive Abstinence Reinforcement Therapy (ART) which combines evidenced based cognitive-behavioral telephone counseling (TC), a tele-medicine clinic for access to nicotine replacement (NRT), and mobile contingency management (mCM) or a control condition (i.e., TC and NRT alone) that will provide controls for therapist, medication, time and attention effects.
  
  
  
  Smokers were identified using VHA electronic medical records and recruited proactively via telephone. Participants (N=310) are randomized to either ART or a best practice control consisting of telephone counseling and telemedicine. Participating patients will be surveyed at 3-months, 6-months and 12-months post-randomization. The primary outcome measure is self-reported and biochemically validated prolonged abstinence at 6-month follow-up.
  
  
  
  This trial is designed to test the relative effectiveness of ART compared to a telehealth-only comparison group. Dissemination of this mHealth intervention for veterans in a variety of settings would be warranted if ART improves smoking outcomes for rural veterans and is cost-effective.
authors: VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC 27705, United States; Durham VA Medical Center, Durham, NC 27705, United States. Electronic address: sarah.wilson@duke.edu.
authors: Sarah M
authors: SM
authors: Wilson
authors: Durham VA Medical Center, Durham, NC 27705, United States.
authors: Lauren P
authors: LP
authors: Hair
authors: Durham VA Medical Center, Durham, NC 27705, United States.
authors: Jeffrey S
authors: JS
authors: Hertzberg
authors: VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC 27705, United States; Durham VA Medical Center, Durham, NC 27705, United States.
authors: Angela C
authors: AC
authors: Kirby
authors: Center for Health Services Research in Primary Care, 508 Fulton Street, Durham, NC 27705, United States.
authors: Maren K
authors: MK
authors: Olsen
authors: Center for Health Services Research in Primary Care, 508 Fulton Street, Durham, NC 27705, United States.
authors: Jennifer H
authors: JH
authors: Lindquist
authors: Center for Health Services Research in Primary Care, 508 Fulton Street, Durham, NC 27705, United States.
authors: Matthew L
authors: ML
authors: Maciejewski
authors: VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC 27705, United States; Durham VA Medical Center, Durham, NC 27705, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, United States.
authors: Jean C
authors: JC
authors: Beckham
authors: VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC 27705, United States; Durham VA Medical Center, Durham, NC 27705, United States; Center for Health Services Research in Primary Care, 508 Fulton Street, Durham, NC 27705, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, United States.
authors: Patrick S
authors: PS
authors: Calhoun
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000379:methods*; D006801:Humans; D012107:Research Design; D012424:Rural Population; D016540:Smoking Cessation / Q000191:economics / Q000379:methods*; D017216:Telemedicine / Q000379:methods*; D061485:Tobacco Use Cessation Devices; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
keywords: Clinical trial; Financial incentives; Mobile health=mHealth; Smoking cessation; Telehealth; eHealth