Overweight Clinical Trial
Official title:
Native Women's Wellness: Contingency Management for Tobacco Cessation and Weight Loss
A randomized controlled trial for the efficacy of contingency management to encourage smoking cessation and weight loss.
American Indians and Alaska Native (AI/AN) people experience striking disparities in
mortality from cardiovascular disease compared to the general U.S. population. Among women of
childbearing age, early detection of chronic diseases can be missed because the type of
medical care they seek is typically focused on their reproductive health care needs. Yet,
chronic disease risk factors, such as smoking and obesity, are common in this age group and
can be treated with evidence-based interventions.
The investigators of this study propose to implement a contingency management (CM)
intervention that uses gift cards, and prizes to reinforce smoking cessation and weight loss.
CM has been used successfully for a range of addictive behaviors, including cigarette smoking
and heroin, cocaine, methamphetamine, and other illicit substance use, as well as for
reducing psychiatric problems and HIV risk. CM is understudied in the treatment of obesity,
and in AI/AN populations but has great potential for treating smoking and overweight/obesity,
as it reinforces both short- and long-term behaviors. This is important because both smoking
cessation and weight loss are highly prone to short-term relapse, whereas a longer duration
of the desired behaviors is associated with greater success in adopting permanent lifestyle
change. The investigators will perform a randomized, controlled trial using a 2x2 factorial
design to evaluate a 16-week culturally-tailored CM intervention that promotes cigarette
cessation and weight loss among overweight/obese AI/AN women who are current smokers.
Participants will be randomized to receive either: 1) CM for smoking abstinence, 2) CM for
weight loss, 3) CM for both, or 4) a non-contingent control group that will not receive CM
for either behavior. The specific aims are to:
1. Quantify the prevalence of overweight/obesity, smoking, high blood pressure, high
cholesterol, Type 2 diabetes and/or elevated fasting blood glucose, and depression and
anxiety among women of reproductive age (18-44 years) who are patients at a clinic that
primarily serves AI/AN people;
2. Determine if women randomized to CM conditions more often quit or reduce smoking and
lose weight compared to those in the control group;
3. Determine if the intervention is disproportionately effective for women receiving CM for
both smoking abstinence and weight loss, compared to the single-behavior CM groups or
the control group;
4. Quantify group differences in secondary cardiovascular disease risk factors after
completing the various CM interventions.
STUDY DESIGN OVERVIEW The CM intervention is 16 weeks long and consists of four groups: 1) CM
for smoking abstinence, 2) CM for weight loss, 3) CM for both, or 4) a control group that
will not receive CM for either behavior. Participants will be asked to go into the clinic
twice a week for 16 weeks during the intervention period, and will be asked to complete a
baseline visit at the beginning of the study and three follow-up visits one month apart after
the intervention is completed (weeks 20, 24, and 28). In each intervention session the women
participants will complete a urine test to determine if they have smoked a cigarette within
the past 3-4 days, and will be weighed on a dedicated, standardized scale. Other clinical
measurements and self -reported outcomes will be collected as well.
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