Smoking high school students quit for cash

The Department of Psychiatry and National Institutes of Health have given local teenagers a new reason to quit smoking — cold, hard cash.

Yale researchers are offering high school students in the greater New Haven area up to $300 to kick the habit for one month.

The goal of the five-year project, funded by a grant from the NIH, is to determine the effectiveness of a technique called contingency management in adolescents. In order to reinforce positive behavior, researchers are replacing cigarettes and the nicotine they contain with money, said Dr. Suchitra Krishnan-Sarin, assistant professor of psychiatry and the project’s principal investigator.

“Getting through the first week of a quit effort is difficult,” she said. “By providing short-term rewards, contingency management helps teens focus on the now and reinforces the desired behavior, which in this case is abstinence from smoking.”

Over the course of four weeks, participants receive monetary rewards in increments of increasing size, and by the end of a successful month, each student will have earned close to $300. Students are also given vouchers for counseling sessions, bringing the total value of a successful month to around $500 per student.

While similar procedures have proven successful with adults, the approach has never been tested on adolescents, said Krishnan-Sarin.

Contingency management is only half of the plan, however. The other half involves a behavioral intervention and educational component in which researchers meet with participants to monitor and discuss their progress.

During every meeting, the students are required to take a breath test and give a urine sample to ensure abstinence, said Krishnan-Sarin.

“The project involves daily appointments with the students,” she said. “If both of the tests are negative, the student gets paid.”

During the week, students and researchers meet at high schools after classes. Participants also meet on the weekends at locations of mutual convenience, like public libraries or fast food restaurants.

While the prevalence of tobacco use by teenagers has decreased steadily over the past several years, according to the NIH, smoking continues to be a problem in area high schools and middle schools, say local administrators.

In 2000, the Connecticut Department of Health found that one out of every three high school students in the state used some form of tobacco, and about 13 percent admitted to smoking on school property.

Diane Reynolds, a counselor at East Haven High School, said both smoking and addiction are serious concerns at East Haven. The school has facilitated multiple smoking-cessation programs over the past several years in order to help students quit, she said.

“I think the kids do know [the risks], but they don’t know how to quit,” said Reynolds. “They try but they are not successful, so this gives them a direction.”

Branford High School Principal Edmund Higgins said he believes the monetary incentive is more effective than an exclusively educational campaign because the majority of students already know the health risks associated with tobacco use.

“Most adolescent smokers say they know it’s bad for them and that they will quit some day,” he said. “It is getting through that first month that is so hard, and that is probably why the financial incentive will help.”

Krishnan-Sarin said although she knows some students will sign up for the money and return to their previous habits after the study is over, these students are nonetheless more likely to quit in the future than if they never participated.

“Previous research has shown individuals who attain some period of abstinence from cigarettes actually are more likely to succeed in the long run,” she said. “This intervention helps them achieve this immediate period of abstinence.”

In addition, researchers teach teenagers skills to make quitting easier should they decide to do so now or in the future, said Krishnan-Sarin.

Thus far about 60 students have participated in the study, which is nearing the end of its second year. Researchers hope to include another 150 students over the next three years.

Students from five high schools in East Haven, West Haven, Branford and Milford have participated in the program, and Krishnan-Sarin’s group is about to launch their project in two more. Other schools have expressed interest in the project, especially since a recent increase in media attention. Krishnan-Sarin said she could not disclose the names of the prospective schools, which are currently involved in a screening process.

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