Understanding the link between contingency management and smoking cessation: The roles of sex and self-efficacy

• Published in: Addictive behaviors 2018-09, Vol.84, p.99-105
• Main Authors: Waters, Aaron F., Businelle, Michael S., Frank, Summer G., Hébert, Emily T., Kendzor, Darla E.
• Format: Article
• Language: English
• Subjects: Adults; And public health; Contingency; Contingency management; Drug addiction; Females; Males; Mediation; Self; Self-efficacy; Sex; Sex differences; Sexual behavior; Smoking; Smoking cessation; Socioeconomically disadvantaged
• ISSN: 0306-4603; 1873-6327
• DOI: 10.1016/j.addbeh.2018.03.018

Little is known about the mechanisms linking contingency management (CM) treatment with smoking cessation, and recent research suggests that the CM approach is associated with better smoking cessation outcomes among females than males. The current study investigated self-efficacy as a potential mechanism through which CM treatment influences smoking cessation, and explored whether these relationships differed by sex. Participants (N = 139) were primarily Black (63.3%) and female (57.6%) adults enrolled in a safety-net hospital smoking cessation program. Participants received usual care (UC), which included pharmacotherapy and counseling sessions (n = 66) or a CM intervention (UC + 4 weeks of small, abstinence contingent financial incentives; n = 73). Self-efficacy for quitting was measured on the day after quitting with the Self-Efficacy Scale/Confidence (SESC) questionnaire. Mediation analyses were conducted to evaluate the indirect effects of treatment group on biochemically-verified abstinence (4-weeks post-quit) via self-efficacy, and moderated mediation analyses were conducted to evaluate the moderating role of sex. Self-efficacy was not found to mediate the relations between CM treatment and smoking cessation in the overall sample. However, analyses indicated a significant moderating effect of sex on the indirect effect of treatment group on smoking cessation through self-efficacy (each of the 3 SESC subscales). Specifically, there was a stronger association between CM and greater self-efficacy among females than males. Findings suggest that CM treatment had a differing impact on self-efficacy among males and females, which in turn influenced the likelihood of smoking cessation. •The underlying mechanisms of contingency management (CM) treatment are unknown.•CM treatment may influence smoking cessation through its influence on self-efficacy.•The indirect effect of CM on smoking cessation through self-efficacy varies by sex.•CM treatment was associated with greater self-efficacy among females than males.